The Lancet
As a former heart surgeon, Senate Majority Leader Bill Frist‘s election prompted high hopes that he would bring a much-needed reality check to an ideologically divided US Congress. But, says Samuel Loewenberg, Frist now seems more at home with conservative ideologues than health advocates.
Bill Frist is the US Senate’s only doctor. He is also one of America’s wealthiest elected officials. As the Republican majority leader, he is the conservative party’s point man on health care. Now, he is being talked about as one of the top candidates to replace George W Bush as President.
Throughout his 12-year political career, being a physician has been integral to the political persona of Senator Frist. He never misses an opportunity to put his medical credentials at the forefront (the initials “MD” follow his signature on all campaign documents), and he is known to keep a medical bag in his lavish Senate-leader’s office.
Frist, a graduate of Harvard Medical School, made a name for himself by establishing a heart-lung transplant centre at Vanderbilt University. Visiting the state of New Hampshire last year, which is the first state in America to vote on the presidential elections, Frist told constituents, “first and foremost, I am a doctor”. But for both medical professionals and political observers, Frist’s legislative record suggests that he is often more of a conservative warrior than he is a physician with lawmaking powers.
Many medical professionals had high hopes when Frist was elected, imagining that the former heart surgeon’s knowledge of medical issues would bring a much-needed reality check to the ideologically divided US Congress. But the methodical approach with which Frist began his tenure evaporated as his political star rose. During the past few years, he has become the leading advocate on health-care issues for the Grand Old Party, as the Republicans are known. More often than not, he has taken positions that would seem to put him more in the camp of conservative ideologue than medical practitioner.
“He is using the charisma of medicine as a way to give himself credibility”, says William Winslade, a bioethicist and law professor at the Institute for the Medical Humanities at the University of Texas Medical Branch at Galveston. Winslade says he is very disappointed in Frist, in whom he initially had high hopes. “There were many people like me who initially thought that because he’s a doctor, maybe he’ll be different than the nit-picking lawyers who normally populate Washington. But in fact, he is a loose cannon and has became an acolyte of Bush”, says Winslade.
The most glaring episode of Frist’s attempt to use his medical credentials for political gain was his intervention in the case of Terri Schiavo, a severely brain-damaged woman in Florida whose husband fought with her family to allow her to die. This personal tragedy became a national shouting match once the politicians in Washington got a hold of it. At the forefront of the debate was Frist, who went so far as to make a speech on the floor of the Senate, saying that “speaking more as a physician than as a US senator”, he believed there was “insufficient information to conclude that Terri Schiavo is in a persistent vegetative state”.
The uproar from the public, and especially from the medical community, was huge. Many felt that Frist, a heart-transplant surgeon who had never spent time with the brain-damaged woman, had no business making what amounted to a public diagnosis on a case in which he had no first-hand knowledge.
“He crossed a couple of boundaries there. He is not a neurologist. He made the statement after looking at a video tape, and that’s not an appropriate context to make a diagnosis or to make a statement to the public”, says Michael Williams, a neurologist at Johns Hopkins Medical School in Baltimore, and who is chair of the ethics committee of the American Academy of Neurology.
Most recently, Frist sought to pass a law severely limiting the damage physicians and medical institutions would have had to pay out if sued for malpractice. While this has long been on the wish list of the American Medical Association, it also would have helped the Frist family company, Columbia/HCA, which owns one of America’s largest medical malpractice insurance companies.
The measure did not survive long in Congress, which is overwhelmingly averse to putting such curbs on the legal system. The right to sue for damages is generally viewed in America as a basic right, the opportunity for “the little guy” to seek redress against powerful individuals and corporations. Senator Harry Reid, the Democratic leader, called the proposal “a waste of the Senate’s time”.
Frist has also sought to gain legal protections for vaccine makers, in some cases giving them near total immunity from lawsuits. A citizen advocacy group opposed to the measure, the Foundation for Taxpayer and Consumer Rights, argued that Frist and 41 other senators have a conflict of interest in this case, because they own US16 million in pharmaceutical stock.
Frist’s aim of protecting companies from lawsuits does not just extend to the medical arena; he likes to cite as one of his greatest legislative successes the legislation he pushed through that protects gun-makers from lawsuits by victims’ families.
While Frist likes to present himself as a doctor, it is the business of medicine where he has made his fortune. Much of that came from his holdings in Columbia/HCA, America’s largest private hospital chain, which was founded by his brother and father. Columbia/HCA’s profit-driven brand of medical care nearly imploded several years ago, after federal regulators fined the company 17 billion, the largest such fine in history, after finding the company had committed massive fraud against Medicare.
Frist’s connection to the chain got him in hot water again recently, after he divested himself of as much as 10 million in HCA stock right before the price dropped, prompting an insider trading investigation by the Securities and Exchange Commission. Frist has claimed he was not informed about his HCA holdings, which are listed between 7 million and 35 million, because they are held in a blind trust. But many experts say it seems clear Frist was aware of the sale.
Despite his extensive ties to corporate medicine and pharmaceuticals, Frist has often taken the lead on health-care legislation. Most recently, he ushered through a major overhaul of the Medicare programme. While the stated aim of the project is to provide drugs to senior citizens, many advocacy groups argue that it is, in fact, a big government giveaway to the drug industry.
He also recently voted to cut 10 billion out of the Medicaid budget, which is the programme that serves the very poorest Americans. Ron Pollack, the executive director of the non-partisan health-care advocacy group Families USA, says that Frist has been a disappointment. “Here is a Senator who has far greater medical background than anybody else in the Senate, who also was on the key committee of Congress that has jurisdiction over health care, and almost without exception you could count on Senator Frist to support the most politically opportunistic position that would help his political career rather than those that would provide leadership to solve America’s pressing health-care problems”, says Pollack.
In the past few months, Frist seems to have been courting conservative Christian voters. He has come out in favour of banning gay marriage and of the teaching of intelligent design in schools. Moderate Republicans have noted hopefully that Frist broke with the Bush Administration by supporting stem-cell research. He has also been a strong advocate for funding for global AIDS initiatives. However, he also favours “abstinence-only” education.
But while Frist’s health-policy positions may sometimes seem confused, he has had a far clearer success at mastering the favourite dark art of Washington insiders: political fund-raising. Here, too, he has used his medical background to his advantage. One of the most brazen was the “charity fundraiser” he organised during the 2004 Republican presidential nominating convention in New York, for which he solicited donations of 250000.
Frist’s charity was medically themed, promising to donate funds to HIV/AIDS; the invitation noted that while the charities had yet to be determined, “a legal framework is being drafted so that all contributions will be charitable and therefore, tax deductible”.
But the charity, called World of Hope, seems to operate as an extension of the Frist political machine. According to recently disclosed tax returns obtained by the Associated Press, the charity raised 44 million, most of which came from major corporate donors, including pharmaceutical giant Eli Lilly and health insurer Blue Cross/Blue Shield.
The charity distributed 3 million to groups working on AIDS in Africa, including charities run by evangelical Christian groups with close links to the Republican party. The rest of the money went to overheads, including nearly half a million dollars in consulting fees to members of Frist’s inner circle of campaign operatives.
“Why does a corporation give 250000 to Frist’s charity? They want influence and access”, says the head of one of Washington’s largest lobbying firms.
