Gregg proved himself a strong advocate for the pharmaceutical industry in the 104th Congress. A case in point is the FDA Export Reform and Enhancement Act of 1995. The failed legislation would have enabled pharmaceutical firms -- including Bristol-Myers -- to sell drugs lacking FDA approval in other countries. (Incidentally, at least two of the bill's co-sponsors in the House also owned significant stock in pharmaceutical companies.)

The fate of the bill in the Senate, however, rested largely on Gregg, the chairman of the Labor and Human Resources Subcommittee on Aging, which had jurisdiction over the measure. What's more, Gregg was the Senate's chief deputy whip, the No. 3 man in control of Republican votes. But although he held hearings on the bill, Gregg could not drive the measure to the Senate floor for a vote.

Undaunted, he used his seat on an appropriations subcommittee to attach an amendment onto last year's appropriations bill that served the same purpose as the failed bill, enabling drugmakers to export products that have yet to pass FDA muster. The amendment carried without debate and became law in April 1996.

Over the next 10 months, Bristol-Myers stock soared 65 percent, from $82 a share to $136 a share. Although Gregg has not yet disclosed his 1996 stock holdings, his staff has given no indication that he sold any of his Bristol-Myers stock. If he has kept it, his stock increased in value by between $60,000 and $150,000 during those 10 months.

Gregg's aides take offense at even the suggestion that there might be a conflict of interest. Arguing that this was a "jobs" measure to keep the firms from moving their manufacturing offshore, they point out that Sen. Ted Kennedy (D-Mass.) co-sponsored the amendment and that the earlier bill had passed from committee on a 16-0 vote. Although Gregg's staffers claim the senator undertook his legislative effort on behalf of his constituents, they cite only one small New Hampshire drug firm that expressed interest in the legislation.

But the Frists' ace in the hole is Bill, whose finances depend directly on Columbia/HCA's success. In 1994 Sen. Frist disclosed that his personal fortune of $20 million included more than $13 million in Columbia/HCA stock.

Frist is an outspoken advocate for giving Medicare recipients more "options" -- options that could direct billions of Medicare dollars to Columbia/HCA. In January, Frist, along with Sen. Jay Rockefeller (D-W. Va.), introduced a bill that would for the first time allow hospitals and doctors to join together as private entities that could contract with Medicare. That would enable these so-called provider-sponsored organizations (PSOs) to compete directly with HMOs for Medicare patients. Not surprisingly, Columbia/HCA stands to make a tidy profit from the new business.

Frist also opposes a White House plan that would save Medicare $6 billion by reducing payments to HMOs and, if approved, PSOs as well. According to various recent studies, the government is overpaying HMOs for Medicare patients by at least 5 to 7 percent. But even though he acknowledges that HMOs are being overpaid, Frist argues, "That might be a good thing. It will attract more managed care companies into the market and drive prices down."

Frist is not troubled by his apparent conflict of interest. "Everybody knows my background, where I come from, and the hats that I wear," he says. "Sure it could become an issue. Some may want to make it an issue." But Frist adds, "There is a stone wall that comes between any [PAC] money that I get or interests that I have, and what I do here."

Over the past several years, Columbia/ HCA has swooped in and purchased scores of hospitals in states from Florida to California. According to a 1996 New England Journal of Medicine article, what follows when Columbia/HCA takes over is less charity care, the replacement of senior health professionals with less experienced (and less expensive) workers, and the risk of lower quality service as profit supersedes care. In late March, federal investigators from the FBI, IRS, and Department of Health and Human Services seized files from several Columbia/HCA facilities in El Paso, Texas. As Mother Jones went to press, the government had not yet announced the scope and purpose of the investigation. According to the Houston Chronicle, investigators were looking for evidence that doctors were being paid to refer patients to Columbia/HCA facilities.

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