A physician leads the Senate; can Dr. Frist deliver?

Doctors and policy experts alike are eager to see how his background as a heart surgeon affects the legislative agenda.

By Joel B. Finkelstein, AMNews staff. Jan. 20, 2003. Additional information

Washington -- The medical community is optimistic that the selection of Sen. Bill Frist, MD (R, Tenn.), as Senate majority leader will boost the chances that legislation addressing problems facing physicians will make it to the president's desk this year.

"He has a realistic grasp of what can be done," said Keith Horvath, MD, a heart surgeon at Northwestern Memorial Hospital in Chicago.

Dr. Horvath said Dr. Frist is in a good position to understand that doctors are between a rock and hard place, with rising premiums for liability insurance on one side and falling Medicare and Medicaid payments on the other.

The American Medical Association is encouraged that Dr. Frist has been a vocal advocate of medical liability reform, said President-elect Donald J. Palmisano, MD. "The AMA remains optimistic that a [tort reform] bill will be heard in timely fashion."

While physicians hope Dr. Frist will also be an ally on reversing the Medicare payment cuts, some policy experts predict that broad Medicare reform will be his overarching goal. Both he and President Bush are said to favor making comprehensive changes to the Medicare system, which they consider outdated.

Policy experts speculate that Dr. Frist would include physician payment corrections in this broader effort. This could hurt chances of a quick resolution to the reimbursement problem and lump the payment issue in with more contentious reform measures.

Having Dr. Frist at the Senate's helm will focus the Bush administration more on revamping Medicare and less on revising the physician pay formula, said John C. Goodman, PhD, president of the National Center for Policy Analysis, a think tank.

In an effort to shift more patients out of fee-for-service Medicare, Dr. Frist has proposed creation of a new agency to oversee Medicare+Choice separately from regular Medicare. The White House has let it be known it would push for similar reforms.

Democrats charge that Republicans would like to see Medicare changed from an entitlement program to one relying on the private sector to provide benefits.

One of Dr. Frist's biggest Medicare reform objectives is to create an outpatient prescription drug program. Democrats have argued that GOP proposals are inadequately funded to bring help to the neediest seniors.

Besides his advocacy for Medicare reform, Dr. Frist has focused on other health care issues. He has been a strong advocate for AIDS awareness and research funding.

"As a physician who has both visited and performed medical relief work in Africa, Sen. Frist brings important experience, having seen firsthand the devastating face of the worldwide HIV/AIDS pandemic," according to a statement from the AIDS Healthcare Foundation. "He also co-sponsored the first legislation to appropriate U.S. funds to battle AIDS globally, and we are hopeful that he will shepherd AIDS funding legislation that has stalled in Congress."

After the 2001 anthrax attacks, Dr. Frist became a Senate leader and White House point man on bioterrorism prevention and preparedness. In June 2002, Bush signed bioterrorism legislation that Dr. Frist co-sponsored.

Dr. Frist recently spoke out about human cloning in response to the unsubstantiated claim by Clonaid, a company sponsored by a religious group called the Raelians, that a baby had been born as a genetic duplicate of its mother.

Their "announcement reinforces the need for Congress to continue its efforts to enact a ban on human cloning," Dr. Frist said.

His leadership on health care issues has won him popularity. "He has a lot of credibility in the Senate and with the public," said Dr. Goodman.

Not everyone is a fan

Consumer groups are likely to continue taking aim at Dr. Frist for his ties to the embattled HCA hospital chain, which was started by his family and which has spent hundreds of millions of dollars settling Medicare fraud charges.

"Frist's ownership of and entanglement with one of America's biggest corporate criminals, hospital chain Columbia/HCA, shows his loyalty and should have prevented him from leading the U.S. Senate," said Jamie Court, executive director of the Foundation for Taxpayer and Consumer Rights.

Dr. Frist has been criticized by consumer groups as supporting legislation to help hospitals and pharmaceutical companies to the detriment of patients. He voted against a version of managed care reform that would have given patients more flexibility to sue plans. In addition, he penned language slipped into the homeland security bill that shields makers of thimerosal-containing vaccines from pending class action lawsuits.

Getting the job done

Regardless of whether surgeons and other physicians will be happy with Dr. Frist's agenda this year, it seems likely he will be better able to push health legislation than his predecessor, Sen. Trent Lott (R, Miss.). Dr. Frist "has a way of putting opponents at ease," said Dr. Goodman.

Many experts agree Dr. Frist has a knack for working across party lines. He also has a history of working closely with Democrats on health legislation, including Medicare reform.

However, it was his work raising money for last year's senatorial campaigns that is likely to win him the most friends in the Senate. He helped raise more than $100 million in campaign funds and was given the lion's share of credit for helping the Republicans take back the Senate majority.

For physicians like Dr. Horvath, the Chicago heart surgeon, what's important is that Dr. Frist puts health care squarely on the agenda in the Senate this year. However, he added, "I don't expect him to be pro-physician on every issue."

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Copyright 2003 American Medical Association. All rights reserved.