USA TODAY

WASHINGTON — Republican Sen. Bill Frist of Tennessee is a man accustomed to excelling, even overachieving, in all he does.

Born to wealth and privilege and educated at the nation’s finest schools, Frist built a career opening chests and saving lives with pioneering heart and lung transplant surgery. Then he simply walked away in 1994 for an audacious political campaign against a popular incumbent senator.

Not only did he win, but eight years later, the surgeon-senator who didn’t vote until Ronald Reagan was leaving the White House is also passing more experienced colleagues to become majority leader. Senate GOP colleagues are expected to make his selection official today. He’ll be the point man for President Bush at what could be his presidency’s peak of power, with his party commanding majorities in the House and Senate and high public-approval ratings.

Few who know Frist question whether he is up to the job. But unanswered is whether his unique combination of surgical and political skills will help him forge compromises that advance Bush’s agenda without alienating his party’s fractious elements.

“He has addressed problems of medical care for all Americans, not just theoretically, in a hands-on way,” Sen. Richard Lugar, R-Ind., said Sunday. “He personifies not just the rhetoric about idealism but as a life that has been lived.”

Democrats have been impressed, too. They have regarded Frist as a tough opponent on two key health-policy measures: giving patients greater ability to sue their HMOs and providing a prescription-drug benefit to seniors. This year, they learned what he could do politically. Frist led the Republicans’ Senate campaigns, which took them from a minority to a majority.

“Maybe his ascendancy will help represent a breakthrough on things like providing through Medicare a prescription-drug benefit,” said Sen. Bob Graham, D-Fla. “I certainly hope so.”

Going for the jugular

Frist didn’t enter politics until 1994. He didn’t even vote until he was 36.

Now 50, he is a Southerner with a conservative record. But he presents a more urbane and sophisticated image than Sen. Trent Lott, the man he is replacing, to the educated suburbanites who are increasingly the Republican Party’s target voters.

“The main thing that Frist represents that Lott does not represent, and what the Bush White House wants the most, is that Frist is a national person and a national political figure, as opposed to being a Southern political figure,” says David Bositis, senior political analyst at the Joint Center for Political and Economic Studies.

Frist, a marathoner, can be tough. When he became head of the Republicans’ 2002 Senate campaigns, he joked about his qualifications: All his training, Frist said, was pointed toward one thing: “Within 45 seconds, to be able to cut out the human heart.” Democrats who lost Senate seats may think he did just that.

Republicans expect Frist and Bush will push health issues to the front of the Senate’s agenda. Tops among the health care issues next year will be helping seniors pay prescription-drug bills, health coverage for the uninsured, and finding agreement on innovations that will shore up Medicare without busting the federal budget.

Frist has proven flexible. He pushed for $500 million in international AIDS spending last year, then acquiesced to Bush’s $200 million offer. He also drew criticism from some for compromising on the issue of stem-cell research. He opposed “therapeutic cloning” of human embryos for research in treating diabetes, Parkinson’s and other diseases, angering advocates of more research and treatment.

Already, he has faced hostility from some hard-liners. “Sen. Bill Frist is not somebody conservatives would be comfortable with,” says Paul Weyrich, president of the Free Congress Foundation and a longtime leader of the GOP’s conservative wing. “He’s a moderate Republican at heart.”

Frist has voted with conservatives to ban certain forms of abortion. But some anti-abortion groups doubt his commitment to their cause of banning abortion.

Frist figured in one of the final controversies of this year’s congressional session. He was the author of a provision that blocks lawsuits by families claiming their children’s autism was caused by vaccines containing mercury. The provision was added secretly to a bill creating the Department of Homeland Security, but Frist denied any involvement.

Denies conflict of interest

Frist has always distinguished himself from colleagues by keeping “M.D.” at the end of his senator’s signature. He is the first doctor in the Senate in 50 years.

Some critics accuse him of a conflict of interest on health issues. Frist’s father and brother founded what has become the nation’s largest for-profit hospital chain, HCA. The company has created vast wealth for the Frist family. It also has been subject to the largest-ever federal fraud case; it agreed to repay the government $1.7 billion for overbilling Medicare.

The company, which has 180 hospitals and $18 billion in annual revenue, is the Microsoft of the health care industry, health policy consultant Robert Laszewski says. “They are an aggressive, acquisition-minded company. They try to come in and dominate markets. They are really tough,” he says.

Jamie Court, executive director of the Foundation for Taxpayer and Consumer Rights, a California-based consumer group, says Frist has helped the company by pushing for limits on damages in lawsuits. “He is going to be the poster boy for how close the Republican Party is with corporate criminals,” Court said Friday.

Frist rejects any conflict of interest. He notes that he never managed or even worked for the company. Most of his assets are in a blind trust. His Senate financial disclosure forms, which report broad ranges of assets, show that Frist and his wife and children have $ 25 million or more in HCA stock.

With Lott’s departure in a furor over race, Frist may face that issue as well. Frist was not in Congress to vote on many civil rights bills that Lott opposed, but he received a failing grade, as did all Republican senators, from the NAACP this year. And during this year’s Senate campaigns, which he led, Republicans were accused of discouraging black turnout in several states.