On Dec. 19, as Sen. Bill Frist (R-Tenn.) prepared to announce that he would run for Senate majority leader if Sen. Trent Lott (R-Miss.) resigned, another story of importance to Frist graced the financial pages. The day before, the Department of Justice reached an agreement with HCA Inc., the hospital chain founded by Frist's father and brother. HCA, the largest for-profit hospital chain in the country, had agreed to end a decade of federal investigations into alleged fraud by paying the government $631 million. Tack that on to previous settlements, and HCA has now paid an astounding total of $1.7 billion to settle fraud claims.
Then, on Dec. 20, Lott stepped down from his leadership post. Three days later, the Senate Republicans anointed Frist their new leader without opposition. In his first speech as Senate majority leader, Frist spoke about prescription drugs, Medicare and the uninsured. The heart surgeon made sure that everyone who heard the speech knew that he was a doctor, mentioning that he had seen the problems in the nation's health "firsthand."
But the man now in charge of setting the Senate agenda never mentioned that he owes his wealth -- and probably his ability to run for the Senate with no prior political experience -- to a for-profit hospital chain.
The Dec. 19 announcement that HCA had reached a settlement caused a slight jump in the company's stock, which had struggled in the second half of the year. For Sen. Frist, that spelled good news: Though he never worked with his father or brother at HCA, his personal fortune, estimated to be in the area of $20 million, was built mostly on his ownership of stock in the family business. He used a large chunk of that money to launch a political career in 1994, defeating incumbent Sen. Jim Sasser (D-Tenn.). Six years later, after sailing to a second term, Frist took the reins of the National Republican Senatorial Committee. His political stock continued to rise as he helped the GOP take control of the Senate this past November.
When he first ran in 1994, Frist disclosed that of his $20 million, about $13 million was Columbia/HCA stock. (In 1993, a merger with Columbia Hospital Corporation led to the name change; in 2000, the company became known as HCA again.) Since his election to the Senate, he has placed his holdings in a blind trust. Frist no longer manages his own portfolio, and he says he doesn't know how much stock he owns in HCA. But he likely still owns a significant amount of HCA stock, and his brother, Thomas Frist Jr. -- until recently the company's chairman and CEO -- remains a member of HCA's board of directors.
Frist has used his unique position in the Senate -- he is the legislative body's only physician -- to sell himself as a leading policy-maker on health issues from research funding and cloning to managed care and Medicare. On many issues, he has been an important advocate and negotiator. He is credited with working to increase funding for AIDS programs worldwide, joining with colleagues as politically diverse as Sens. Jesse Helms (R-N.C.) and Hillary Rodham Clinton (D-N.Y.) on different pieces of legislation. He proposed a bill to prohibit cloning while allowing stem-cell research to continue, a compromise plan that clearly influenced the president's own decision to allow research to continue on pre-existing stem-cell lines. And his medical background made him a calming presence during the fall 2001 anthrax scare. He followed that up with a book -- When Every Moment Counts: What You Need to Know About Bioterrorism from the Senate's Only Doctor -- becoming one of the federal government's most visible experts on health policy and raising his profile among voters.
But in the health-insurance arena, Frist has been accused by patients' advocates and some physicians -- including former supporters -- of toeing the GOP line, defending HMOs and hospital corporations such as HCA. While one of Frist's fellow physicians in Congress, Rep. Greg Ganske (R-Iowa), was working with Democrats to produce a patients' bill of rights that would protect people from HMOs, Frist supported the president's plan to limit liability faced by managed-care organizations.
Frist's actions have angered some doctors, who hoped he would take on HMOs after they helped elect him to Congress. Frist defends his position by arguing that suits against HMOs would only drive up premiums and thus hurt patients in the long run, creating an even larger pool of uninsured Americans. After telling The Washington Post a few years ago that he understands "why doctors are angry," Frist added: "But my world is bigger than doctors now. I'm taking the larger view." The larger view for Frist, though, apparently means corporate interests, not individual patients' rights. He has consistently supported programs that would enable hospital corporations to increase profits. He opposed plans to cut Medicare payments to HMOs, even though studies showed the government was paying too much. And, most recently, he has been accused of helping his supporters at pharmaceutical giant Eli Lilly by adding a provision to the Homeland Security Act that limits the rights of people to sue the company for complications from Thimerosal, a preservative used in Lilly-made vaccines for children.
Frist's relationship with HCA may or may not be the reason for his consistent support of the hospital and pharmaceutical industries. If Frist sells whatever holdings he has in HCA, as even some conservative columnists have suggested he do, his most glaring conflict of interest will disappear. But his family's long association with the corporation still taints Frist's pro-hospital voting record. The best way for Frist to quiet the accusations that will likely rise along with his stature in Washington would be for him to stop aligning himself with drug companies and HMOs and to start defending patients and physicians. Frist obviously cares deeply about his own patients -- even the most liberal Democrats must give him credit for his work on AIDS issues, improving the nation's public-health system and his personal efforts caring for patients in developing countries. But Frist cannot hide behind those good deeds forever. As the Senate's majority leader, he should stand up to hospitals and insurers to pass legislation that would provide prescription drugs to Medicare recipients and protect the rights of all patients. This is, however, an unlikely proposition for a man who wants to be in the White House in six years -- and will rely heavily on hospitals and drug manufacturers to get there.
Michael S. Gerber is a staff writer at The Hill.
