KHN's Eric Pianin talks with former Senate Majority Leader Bill Frist, R-Tenn., about his new book, "A Heart to Serve, The Passion to Bring Health, Hope, and Healing."
Frist offers his views on the health care debate on Capitol Hill. The former heart transplant surgeon and businessman predicts that Congress will ultimately approve a $1 trillion health care reform plan that will expand insurance coverage to millions but do very little to "bend the cost curve" of the health care industry. Frist, a member of the Kaiser Family Foundation board, also discusses the influence of his father on his career.
ERIC PIANIN: Welcome, Senator Bill Frist.
SENATOR BILL FRIST: Good, thank you. Good to be with you.
ERIC PIANIN: Your book, "A Heart to Serve," is arriving in bookstores just as Congress is reaching a critical point in the debate over health care reform legislation. Why are you bringing out the book now and what do you hope to achieve with it?
SENATOR BILL FRIST: The title of the book, "A Heart to Serve: The Passion To Bring Health, Hope and Healing" are a consistent themes in my own life, in large part because of the family that I grew up with. But it does come out at a time where the focus very much is on how we as a nation can address fundamental issues related to health care, which affect every individual in terms of intimacy of healthcare; the health of their children, the well-being of their spouse, decisions being made. So much of the concentration there is how do we use the private sector - being a provider, being a doctor? The public sector, having been majority leader of the United States Senate, how do we actually combine into a partnership to lift everyone up?
ERIC PIANIN: I’m sure that as a former Senate Majority Leader, you’ve been following the debate in the Senate and the House very closely. Let me ask you to gaze into your crystal ball and offer a forecast. Will Congress approve major health care legislation this year? And what is it likely to look like?
SENATOR BILL FRIST: The answer is "yes." Before I predict, in that crystal ball, what it will look like ... Howard Baker, the Former Majority leader before (I was) said: “Anytime you look into that crystal ball, be ready to eat crushed glass.” So I say this recognizing that in a few weeks, I could be far off, but yes. My colleagues in the Senate, with whom I talk regularly, will pass the bill. The bill will not be as bipartisan as I think I would like or the nation would like. But it will address fundamental issues that center around the uninsured, attempts to make our health care sector more of a health care system.
If I had to predict, crushed glass aside, I would say it will be a plan of about a trillion dollars over 10 years. We spend about $2.3 trillion, 18 percent of our GDP every year, but over a 10-year period, this will be an additional $1 trillion. It will address the issues of the uninsured, but it will not insure 46 million people who are uninsured today. They may not be uninsured six months from now, but today. Why? Because for 10 million people or 11 million people who are non-U.S. citizens; they’re simply not addressed in the bill. There are 12 million people out there who have a health care plan today, it will not fully address them, but it will end up addressing about 20 million of the hardcore uninsured today.
Taxes will go up; premiums will go up for people who are privately insured, the 170 million people who are privately insured today. Fairness and equity will not be fully achieved, but we will move in that direction. There will be very little in the bill to actually bend the cost curve; the fact that health care over the last 40 years has gone up 2 1/2 to 3 percent faster than GDP.
ERIC PIANIN: One of the biggest controversies has been over whether the legislation should include a public insurance entity to compete with private insurers to drive down the cost of premiums and extend health care coverage to millions of Americans. The Finance Committee voted twice this week to reject, proposals to include a public option in the legislation. What do you think about that idea in general? And if not a public option, what about a trigger?
SENATOR BILL FRIST: You know, the American people— and Washington doesn’t really get it very well - the American people don’t know what a public plan is. And in truth, when I talk to large groups of people across America, people say "yes, we’re okay with the public plan, but what we don’t want is a socialized plan." But that’s not what President Obama or even the Congress wants or have promised. But they also said we don’t want a national, federally-controlled, federally-directed plan, we don’t want that. Thus, they want a public plan, and I predict we will have a backup public plan.
It is very likely to be very similar to what we did in 2003 in the Congress. And that was to say that "people deserve and need affordable access to health care; we expect the private sector to implement this proposal and to step up." But at the end of the day, if you don’t have one proposal or two plans out there in the private sector, the public sector will step in. It’s likely to be more like a cooperative, which simply means more local control, not federal control. Local participation. So I predict that we will actually have a backup public plan that is nonthreatening to the public sector or the private sector.
ERIC PIANIN: You came out this week in favor of an individual mandate as part of the health care legislation. Why is that so essential?
SENATOR BILL FRIST: You know, people often times compare health insurance to car insurance or other types of insurance. If you really thought through it: health insurance today for the individual, what do they really want? Basically, they want protection from bankruptcy. They want protection from if they develop cancer, or their child develops a heart disease or if their child develops leukemia, that it doesn’t destroy their livelihood. Therefore, some element of catastrophic coverage can do that, it has to be designed well. The reason I stopped short of promising everybody what President Obama did, everybody gets the care of the United States senator," is that we can’t afford it today in times of recession. In America, for equity issues, where we’re the richest country in the world, I do think that every citizen deserves protection from individual bankruptcy.
ERIC PIANIN: Why not a tough employer mandate to go along with that?
SENATOR BILL FRIST: In an ideal world, an individual mandate would be enough, because everybody’s individual responsibility is either to get it, and if they can’t afford it, to get some assistance to get it. The real challenge will be on the employers’ side, in stopping short of employer mandate, I do believe you can do what Congress is saying now. That if you’re an employer, and you’re of a certain size, you may not be mandated to provide insurance, but you are mandated to pay an excise tax of some sort if you don’t provide that insurance. So it’s a watered-down employer mandate.
ERIC PIANIN: You discuss in your book the need for a 21st century American healthcare system that is patient-centered, consumer-driven, and provider-friendly. What does that mean?
SENATOR BILL FRIST: It really comes from my past, of 20 years in the practice of medicine and having taken care of thousands of patients and thousands of operations. That, at the end of the day, the purpose of all this stuff is not more insurance, it’s not universal health care, it’s not better hospitals, it’s not better community health clinics. But at the end of the day, it is to be able to look somebody in the eye, and say: "your life is going to be healthier, productive, more fulfilling." And that’s where the patient centeredness, that having spent 12 years in the United States Senate, you tend to lose that. I mean, it’s policy, and it’s a bunch of policies in a bucket, you kind of stir them around, and you pick a few out. At the end of the day, you need the nurse, the physician, the social worker concentrated on the patient, what’s in the best interest of the patient, what is the biggest value to the patient.
ERIC PIANIN: Do you see any middle ground between the Dems and the Republicans on medical malpractice issues?
SENATOR BILL FRIST: No, no, unfortunately, as a Majority Leader - and I was the only Majority Leader to do this - I brought a free-standing malpractice bill to the floor five times. It’s always been an amendment on another bill, and every time it was defeated overwhelmingly by the trial lawyer lobby, which has evolved to being in total support of the Democratic party. So, I see no meaningful tort reform.
ERIC PIANIN: Do you think the Republicans are being wise in refusing to support any major Democratic plan this year? Or is there a political downside to what the Republicans are doing?
SENATOR BILL FRIST: Well, you know, first of all, it’s nice for me now to be out of the partisanship, which Washington feeds on. The contrast of ideas expects it to a certain extent, but clearly, over the last 20 years has gotten worse and worse and worse. I think a huge mistake that was made by the Obama administration, and the leadership of the Senate, was to send a message, which really began inside the Beltway about two months ago, that we’re going to get health care reform, like it or not. Not talking just to Republicans, because (Rep.) Jim Cooper and the 52 Blue Dog Democrats are in the same boat as the Republicans. But sending this signal that at the end of the day, we will use a process of called reconciliation. That simply means that we’re going to— through this door in a room of legislation, the threshold of getting though that door is 50 votes instead of 60 votes, which simply means that at the end of the day, "we don’t have to listen to you, Blue Dog Democrat, we don’t have to listen to you centrist Democrat or Republican."
Max Baucus, who’s a Democrat, runs the Finance Committee, is taking just the opposite [tack] and has stressed this bipartisanship. He wore me out on it as Majority Leader for the last 12 years, 14 years. And he is one person who I think is doing his very best working with the Finance Committee to ensure bipartisanship. I counsel my Republicans to stay at the table, we were able to do it in 2003 with the prescription drug bill; we did not use reconciliation of the 50-vote threshold. I think that signal was sent way too early by the administration that it’s going to be a "take it or leave it," and therefore, why should people participate?
ERIC PIANIN: Finally, you devoted considerable space in your book in discussing the life and career of your father, Dr. Thomas Frist. And the impact that he had on your life and your career and your outlook on life, I guess. Why don’t you just describe him a little and sort of sum up the lessons you learned from your dad?
SENATOR BILL FRIST: Yeah, well, I of course appreciate you asking that. This book is not just on health care, but healthcare is— a lot is built around it, because I grew up blessed to grow up with a mentor who happened to be my father, somebody who started with no money whatsoever. Money was never an objective, died at 88 years of age, still cared less about money. But his total being, genuine. Politicians fake it, I mean, not all of them, but you have to sometimes. But his genuine commitment was to make the person who walked into that room or whose home he entered in terms of having a problem and his whole purpose was healing, was making that person’s life better. And it was centered on the person, it was taking the time and the intimacy to do that.
How he did it was interesting, he did it by becoming a doctor. He did it by thinking outside of the box; he did it— and there a lot of stories in the book about never taking "no" for an answer, never, never, never. He did it by not always thinking he was right.
There’s a great story, which I love in the book, about starting an alcohol and drug rehabilitation program in Nashville, Tennessee. And a patient had come to him the early 1960s, and he was very busy and he was building his practice and had no time. But this patient came in with a need. There was no good alcohol rehabilitation program, alcoholism had the stigma in the South at the time. And Dad said "I don’t have the time." And, he went home and talked to Mom, they went to bed, and other woke up in the middle of the night and said, “Tommy, are you sure you shouldn’t do this?” And he told the guy flat out, "no." And the next morning he woke up and said, “I’m going to call him right back.” He did it, and now that served about— that center now over the last 30 years now has served about 250,000 people. So, he was willing to change his mind.
And then the last thing that I’ll mention is: he had this mantra, I even named one of my earlier books about it, with that title: "Good People Beget Good People." And people sometimes misinterpret that as "good people" kind of bragging on yourself. But no, with humility - recognizing that your main responsibility is not what you can do, but taking advantage of the team around you.
And so in medicine, building a heart transplant center at a time that there were none, or doing the first lung transplants in the country and participating there; I’ve always said if I can build teams of people, and around me that are better than me in every way, and not be threatened by that, that things will happen. And same thing in the United States Senate, I think. The staff here, the tremendous staff around people, if you get really good people who are committed. So that "good people beget good people" is probably - when you’re looking at leadership, you’re looking at service, you’re looking at making other people’s lives more fulfilling - it’s probably the underlying theme that I come back to, again and again, in the book.
ERIC PIANIN: Senator Bill Frist, thank you very much.
SENATOR BILL FRIST: Great to be with you, thank you.