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http://www.nytimes.com/2003/01/11/politics/11MEMO.html

Weapon in Health Wars: Frist's Role as a Doctor

By ROBIN TONER

ASHINGTON, Jan. 10 — Critics of the Republican health care agenda say they are getting a little tired of hearing about the heroic-healer image of the new Senate majority leader, Bill Frist, a former transplant surgeon. They say that he may be a wonderful heart surgeon but that he is peddling the same old Republican free-market ideology on Medicare.

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Seven years ago the leading defender of Republican proposals to overhaul Medicare, the vast government health insurance program for the elderly, was the speaker of the House, Newt Gingrich, who was not known for his bedside manner. This year the Bush administration and the Republican Party have a smooth, empathetic, Harvard-trained physician to make the case.

Critics fear that Dr. Frist, as he has asked to be called, will be able to use his trustworthy doctor's persona to sell a far-reaching and contentious proposal to open up Medicare to more private health plans. With Dr. Frist supporting it, "how could it be wrong?" Representative Jim McDermott, a liberal Seattle Democrat, said with more than a little sarcasm. The majority leader's M.D. is the Bush administration's "finesse card on health care," said Mr. McDermott, himself a psychiatrist.

It may, in fact, be the Republicans' not-so-secret weapon on an issue that has bedeviled them in the past, when they were often accused of simply trying to save money rather than "reform" a popular program. Glen Bolger, a Republican pollster who worked for Dr. Frist's senatorial re-election campaign, says that "without question" the Tennessee Republican "has a certain gravitas and expertise on the issue that few other politicians can bring to the table."

Doctors still rank among the most honest and ethical professionals in the voters' minds, according to a Gallup poll in November (although nurses rank even higher). And Dr. Frist's image has been burnished by his medical missions overseas and his occasional reviving of ailing visitors to the Capitol. Just last week he drew heavy news coverage for helping tend to accident victims on a Florida highway.

"It sure doesn't hurt when you're stopping along the highway to help people," said one health industry lobbyist.

A less amused Democratic strategist in the Senate, grumbling about the "bizarre media fascination" with Dr. Frist's surgical side, said: "It's a wonderful profession. He's done wonderful things for people. But he's changed professions now."

Still, inside the relatively small world of health policy, Dr. Frist gets high marks for understanding the issues and speaking the language. The Princeton health economist Uwe Reinhardt, who taught him when he was an undergraduate and stayed in touch with him over the years, recalls being invited along one night when he was still practicing heart surgery, to watch him harvest a heart and later transplant it.

Throughout the night, Dr. Frist gave a running narrative of what he was doing and how much it cost, Professor Reinhardt recalled.

"We have this strange notion in the United States that spending on health care is a bad thing, a burden," the economist said. "When you stand there, in the operating room, and watch him literally revive a dead man and enable him to live a pretty good life, you have to ask, Is this just another burden on the economy?"

These appealing images leave critics of the administration's health proposals in a quandary. For all the strengths Dr. Frist brings to the table because of his background, they say, he and the administration have embraced an approach to Medicare that many Democrats and others say simply will not work. But separating a popular messenger from what they consider a deeply flawed message is not easy.

"I've been really impressed by his doctoring ability, his compassion and his charitable actions," said Gail Shearer, director of health policy analysis at Consumers Union. "But in the past he's aligned himself with market-oriented solutions. His perspective is one of trust in the marketplace, and in this particular place we don't think the market works too well."

In fact, the divisions over health care — specifically, how much to trust the private market, how much to rely on government — are among the most profound in politics today. Republicans and their allies say turning Medicare into more of a private health care marketplace, in which numerous health plans compete for the elderly's business, will give the program's beneficiaries more choices and modernize its bureaucratic structure before the baby boom generation hits.

Democrats and their allies say Medicare was created because the private health insurance market failed to meet the needs of the elderly. They charge that what some Republicans are ultimately aiming for is replacing the guaranteed benefits of Medicare with a voucher.

Dr. Frist will stand on the fault line of this debate in more ways than one, some strategists and health analysts say: he has very direct experience with the private health care marketplace. His father and brother helped found what became the largest hospital company in the country, the Hospital Corporation of America, later renamed HCA. That chain became the focus of a long-running government inquiry into accusations of health care fraud, which HCA ultimately settled for a cumulative $1.7 billion in fines and penalties.

Dr. Frist has played no role in managing HCA. But he invested in it when it was founded, and it proved lucrative. He is now one of the wealthiest members of Congress, with most of his holdings in blind trusts.

"While Republicans obviously have an interest in promoting him as a doctor, I think Democrats will have a similar interest in reminding voters that he is the senator from the Hospital Corporation of America," said Geoffrey Garin, a Democratic pollster.

Even the "M.D." may have its flaws among some voters: Gallup found that older women, an important block on health issues, were less trusting of doctors than were other groups.

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