09-21-2002

POLITICS: Doc Politic

Sen. Bill Frist is on plenty of short lists these days to assume some of
the country's biggest jobs. Maybe he'll get the nod to head the new
Homeland Security Department. Perhaps he'll succeed Dick Cheney on the GOP
ticket in 2004 if the vice president's health falters. Then again, Senate
Republicans might make Frist their leader next year, especially if, as
chairman of the National Republican Senatorial Committee, he leads them
back to the majority in this fall's elections.


Of course, the Tennessee Republican might not change jobs at all. Instead,
he might simply stay put for now, and then leave the Senate in 2006
because of his promise to limit himself to two terms. After that, he could
launch a presidential campaign in 2008. Or he might just return home to
resume his pioneering work as a heart-lung transplant surgeon.


Given all of those possibilities, these are heady days for Frist.
Attractive, articulate, and bright, the 50-year-old lawmaker who is the
only physician in the Senate has become a rising GOP star since his
improbable election in 1994. Back then, as a political novice who hadn't
even bothered to vote until his 30s, he knocked off three-term Sen. James
R. Sasser just as he was poised to become Democratic leader in the
Senate.


"Frist is `Most Likely to Succeed,' if you look at the
yearbook," said Marshall Wittmann, a senior fellow at the Hudson
Institute. "He is the Republican ideal of someone who should advance:
He has a life outside of politics, he's telegenic, and he has actually
saved lives. Politicians always like to say that, but he can say that and
be truthful."


Unlike the stereotypical surgeon who exudes a brash


I-walk-on-water attitude, Frist has retained his Southern manners along
with a certain reserve. During a recent interview with National Journal,
he pointed out that he does not share the mercurial moods of so many of
his medical colleagues who "throw instruments and get upset, and
throw people out of the operating room if things aren't going right."
Frist added, "I've never thrown anyone out of an operating room; I've
never thrown instruments." Observing the senator's low-key ways for
even a short time makes it obvious that such must be the case.


Frist has probably attracted more national attention for coming to the
rescue of a tourist in cardiac distress in 1995, helping to resuscitate
the gunman who killed two Capitol Police officers in 1998, and aiding
elderly Sen. Strom Thurmond, R-S.C., when he collapsed on the Senate floor
last fall, than he has for his health policy initiatives on Capitol Hill.
Still, it would be a mistake to completely buy into the aw-shucks,
I'm-a-doctor-here-to-help persona that Frist likes to project.


Frist has a quiet intensity about him that comes more into focus the more
you see him in action. Heck, the guy has written four books, and in the
last three years he's run six marathons-feats that betray his drive and
self-discipline. He's also an avid pilot who finds flying
relaxing.


As Election Day approaches, Frist is bringing that same intense,
methodical approach to his high-profile job as chairman of the NRSC, the
Senate Republicans' campaign committee. But given the ferocity of the
fight for Senate control at a time when just one seat separates the
parties, Frist must now prove that those traits that have made him a
successful surgeon and lawmaker can also make the difference on the
campaign battlefield.


Frist, after all, has devoted a relatively small portion of his working
life to politics, and he seems more inclined to be analytical than
pugnacious in his approach. By contrast, the position of campaign
committee chairman has generally been awarded to senators who are veterans
of the take-no-prisoners school of elections. Frist's three immediate
predecessors at the NRSC-Sen. Mitch McConnell, R-Ky., former Sen. Alfonse
M. D'Amato, R-N.Y., and Sen. Phil Gramm, R-Texas-are all tenacious
political brawlers.


"If you would take the 50 or 49 Republican senators and say which one
would be the least likely to fill that job, you probably would pick
Frist," Sen. Chuck Hagel, R-Neb., said in an interview.


Election Day will show whether Frist's efforts in recruiting candidates,
raising money, and honing campaign messages and strategies are enough to
enable his party to retake Senate control. Political operatives agree that
for Frist, the stakes are sky-high.


"Probably more than anyone in America, Bill Frist's whole political
future depends on delivering a Republican Senate," said Stephen Moore
of the Club for Growth, a political action committee that backs
conservative candidates. "If he does, he will be the Republican Tiger
Woods. If he doesn't, his star will have faded somewhat. So from a
personal standpoint, he has so much riding on this, because he has got
national aspirations of being either vice president or
president."


Frist is well aware that his performance in November could have a huge
influence on his own future political fortunes. "I have a vision. I
have an agenda for that committee. I have a strategy. It's up to me to
make it work with my colleagues," he said in the interview with NJ.
"It's measurable. I'll be held accountable."


In his political debut in 1994, Frist certainly showed a willingness to
throw a punch. He spent $3.7 million of his own fortune on his campaign,
in which he attacked Sasser as a career politician, out of touch with
Tennessee. Frist promised to be a citizen-legislator who would limit
himself to two terms, and he rode the 1994 Republican revolution to a
surprisingly easy victory, 56 percent to 42 percent.


Given his term-limits vow, and his understated but strong drive to make
the most of his time in the Senate, Frist has immersed himself in
high-profile health care issues-including the global AIDS crisis,
bioterrorism, cloning, Medicare reform, and patients' rights. Although his
voting record tilts to the right, he has shown a willingness to work
across the aisle.


After last fall's anthrax attacks, for instance, Frist and Sen. Edward
Kennedy, D-Mass., teamed up to produce sweeping bioterrorism-preparedness
legislation that President Bush signed in June. Frist even pulled some
near-all-nighters to write a book, When Every Moment Counts: What You Need
to Know About Bioterrorism From the Senate's Only Doctor.


"I am very committed to big issues, big ideas; that's why I am
here," Frist said. "I am not going to be here forever. I've got
things I want to do. And at the end of the day, I am going to look back
and say, `I made a difference.' "


Some critics suggest, however, that Frist's political ambitions are
trumping his principled positions on important health policy issues. They
charge that Frist has tempered his stances on AIDS funding and cloning in
a bid to earn chits as a team player among Republicans and to move up the
political ladder.


In fact, even with his determination to focus on big policy issues, Frist
has undertaken time-consuming and sometimes tedious political tasks that
suggest he has higher ambitions. At the 2000 Republican National
Convention, he served as co-chairman of the Platform Committee, a
thankless job but one that acquainted him with GOP constituencies that are
important in the presidential nominating process. And of course, after
easily winning re-election in 2000, he ran unopposed to be NRSC
chairman.


Frist's emergence on the national political stage was also confirmed
shortly before the 2000 convention, when Bush included him among the
handful of possible running mates he was considering. Bush later appointed
Frist as his presidential campaign's liaison to the Senate.


Though he's still not a household name, Frist has attracted lots of
attention in Washington. At the same time, his low-key affability plays
well against the Senate's big egos. "I have a very high opinion of
Frist," said Gramm, who, as a former NRSC chairman, helped him make
the leap into politics. "If I could buy stock in him, I would. What
matters [in politics] is energy and intellectual firepower. He's got a
high quotient on both."


Frist even wins praise from liberals like Sen. Russ Feingold, D-Wis., who
has been impressed with his work on the Senate Foreign Relations African
Affairs Subcommittee. "It's been a real blessing to have Senator
Frist, first as chairman of the Africa subcommittee, and secondly, for me
to be the chairman with him as the ranking member," Feingold said.
"The courtesy and camaraderie is such that it doesn't really matter
who is the chairman and who is the ranking member, because we are both so
committed to these issues."


Added McConnell, "He's an extremely well-respected guy. He could run
for anything he wants to.... He is certainly presidential
timber."


Pulling Punches?


An old axiom of Washington politics says that the higher one flies, the
harder one falls. As Frist has assumed a more prominent role, he has
increasingly become a target for criticism.


Frist's high profile during the anthrax attacks on Capitol Hill provoked
some quiet grumbling that he was grandstanding, a Democratic source said.
Frist provided information about anthrax during frequent briefings and
through his office Web site. But some congressional insiders, rather than
being reassured by his presence, thought Frist was being a camera hound
and had insinuated himself into a medical area in which he had little
expertise.


The Democratic source charged that Frist's statements downplaying the need
for staffers to be vaccinated were not well-founded and were
"irresponsible." And Frist's assertion at a bipartisan caucus of
senators in mid-October that no one else would die from anthrax exposure
was flat wrong, the source added. In fact, several more people did die
when anthrax turned up at postal facilities. Frist later acknowledged that
he had underestimated the dangers to postal workers from sealed
envelopes.


Others have charged that Frist's political ambition has led him to pull
punches on important health care issues. They point to his recent
acceptance of a White House compromise on funding for international AIDS
prevention. Frist had pushed for $500 million in fiscal 2002 to fight AIDS
transmission from mothers to their newborn children. But critics say that
he acquiesced to White House pressure to accept $200 million in fiscal
2002 and $300 million in fiscal 2004.


Dr. Paul Zeitz, executive director of the Global AIDS Alliance, said that
many activists were "really devastated with this last-minute
withdrawal that Frist did." In a recent interview, Zeitz said,
"It is a real setback. A lot of Republicans who were willing to seek
higher levels of funding now have all retreated and are toeing the line
with the president."


Such rebukes from activists have clearly stung Frist. "I don't think
you'll find anybody else in the United States Senate that has personally
spent as much time on HIV/AIDS," he said. Since he's been in the
Senate, Frist has made five trips to Africa, where he has performed
surgery on AIDS patients.


Frist explained that rather than drawing a line in the sand and getting
nothing, he decided to pursue AIDS funding through a pragmatic course that
would produce results. After recognizing that the $500 million would not
be forthcoming this year, he said, he got a pledge from the White House
for the money over time. "If we had blindly tried to pass a $500
million bill in committee, it would have been stripped out," he said.
"That's not going to save any lives."


Sen. Richard J. Durbin, D-Ill., was not appeased by Frist's assurances
that the additional money would be forthcoming. "I was just stunned
and disappointed by his decision," Durbin said. "If we don't
step in soon, this is going to be a devastating epidemic. No one has seen
it firsthand more than Senator Frist. No one has spoken out on it more
than Senator Frist. And now I hope that he will come back to his original
$500 million commitment for one year."


Meanwhile, Frist has also been pilloried by some in the medical and
scientific communities for his opposition to "therapeutic
cloning," a stance that they charge was driven by the senator's
desire to cultivate conservative interest groups. The advocates are
furious that Frist won't accept their view that creating human embryos for
research is the best hope for treating diabetes, Parkinson's disease, and
other illnesses.


"Bill Frist is the biggest disappointment to me since New Coke,"
said Dr. Charles Barnett, who recently left his medical practice in
Knoxville, Tenn., after 21 years to start a biotech company. "He is
smart as a whip. He has charisma. He could make a wonderful leader. But
you don't become a leader by making popular decisions." Barnett
added, "You ask any other doctor who is a transplant surgeon if they
are against all [human embryo] cell research-I'll give you $100 if you can
find one. He took this political stand not to help people, but to pay off
the Far Right so nobody would get mad at him."


Dr. David Gerkin, a former president of the Tennessee Medical Association,
agreed. Frist "is not stepping outside the line and taking a single
issue that is contrary to the [GOP] leadership," Gerkin said.
"If you take a poll of physicians in Tennessee, ... there is some
skepticism that he really remembers where he came from."


Frist disputes the notion that he has strayed from his roots.
"Obviously, working with the president and the administration for the
last two years, I am very supportive" of them, he said. But "if
you look at my conservative-liberal record, it hasn't shifted at
all."


In an op-ed in April, Frist wrote that so-called therapeutic cloning
raises "serious ethical concerns," and that he could not
"justify the purposeful creation and destruction of human embryos in
order to experiment on them." Instead, he advocated embryonic
stem-cell research, a procedure that could use embryos left over after in
vitro fertilization.


Frist's position showed that he's no longer a doctor first who just
happens to be in politics. He acknowledged that if he were still purely a
scientist, he would "come out very differently," because he
would argue that "the good of science will trump ... philosophical or
spiritual" beliefs. But Frist said that in his role as a senator,
"being responsible to 6 million Tennesseeans and a few hundred
million Americans and globally," he must weigh broader
concerns.


To critics such as Barnett, Frist's approach reeks of too much political
calculation. And in fact, the senator's nuanced stance has fueled still
more talk that he may have his eye on higher office.


If Frist does undertake a national race, he will surely be asked about his
and his family's holdings in Hospital Corporation of America, the nation's
leading owner of hospitals, a company his brother co-founded. Public
watchdog groups argue that because Frist knowingly had millions of dollars
invested in a blind trust in the company until this year, he should have
recused himself from votes that might have affected HCA's bottom line.
Frist now has what is called a "qualified blind trust" and
doesn't know whether he continues to have HCA holdings.


The Political Grindstone


Frist says he largely ignores all the chatter that he may run for
president or ascend to some other high political role. While the senator
suggests that he is not aiming for such positions, he also leaves plenty
of wiggle room. "That is not a goal of mine," he said when asked
if he would run for president in 2008. Frist also dismisses speculation
about his heading the Homeland Security Department. "That is just
people talking," he said. "I am not playing coy. My goal really
is to do a good job here in the Senate, and if the president asked, I
would consider" his request.


Frist certainly does not exude the transparent ambition that colors almost
every move of possible Democratic presidential hopefuls, such as Sens.
John Edwards, D-N.C., and John F. Kerry, D-Mass. Still, Frist cannot end
the chatter with an aw-shucks wave of his hand.


Uwe Reinhardt, Frist's economics professor at Princeton University, is a
huge fan who sees his former student's chairmanship of the NRSC as a
launching pad to a possible future presidential bid. "You'd sleep
very well with him in the White House. He wouldn't have to have 20 people
tell him what to think," Reinhardt said in an interview. "But
you have to [have a strategy] to get there. One great way to get there is
to work with all these senators [on their campaigns], and have a Rolodex,
and everyone owes you. So that could very well be part of the
strategy."


Whatever his reasons for seeking the position, Frist clearly has his work
cut out for him as NRSC chairman. It is perhaps no surprise that Frist was
unopposed when he ran for the job. Senate Republicans suffered a highly
disappointing 2000 election cycle, in which five of their incumbents were
swept out of office, and this year they face the daunting task of having
to defend 20 Senate seats while Democrats must protect just 14.


"It's a grueling, grueling job," Hagel noted. "I can see
why a lot of my colleagues were not all that interested. When you get a
bright guy like Frist who handles himself very well, and is very
articulate and attractive, who is interested, everybody said, `Absolutely,
Bill, go do it. We are right behind you.' "


Frist dismisses the notion that he is at a disadvantage in his political
role because of his reserved style. "Come to the operating room, see
what it takes to do a heart transplant on a 6-day-old premature baby, and
you'll see whether one has the right stuff to run the National Republican
Senatorial Committee or be a United States senator," he said.


From the start of this election year, Frist has shown that he is capable
of throwing sharp elbows. In February, he authorized a series of ads
capitalizing on Bush's high approval ratings, to be aired in five states
in which Senate Democrats appeared vulnerable. In the spots, which made
the case that the five senators had failed to do their jobs when they
opposed an economic-stimulus plan, Bush appears and declares,
"There's something more important than politics, and that is to do
our jobs."


Democrats cried foul. They were furious that the president was repeatedly
emphasizing the need for unity and bipartisanship, while at the same time
appearing in such a political ad. Although the Democratic response was
predictable, the reaction at the White House was more revealing. The
political operatives there were said to have been less than thrilled at
Frist's tactic-and at not having been given a clear heads-up.


Frist has said in interviews with National Journal since then that he did
not get White House approval for the ads, but he has no regrets. "In
retrospect, it was the right thing," he insisted. "I don't send
any ads over for them to check out. I'm scared I'd be told what to do all
the time, if I shared."


The episode reflects Frist's willingness to be aggressive at the NRSC.
Shortly after Labor Day, when he briefed reporters on his take on the key
Senate races, it was obvious that he had thrown himself into the job at
full throttle. "I work very closely with him on the senatorial
committee," Sen. Christopher S. Bond, R-Mo., said in an interview.
"I have never seen anybody put the time and effort into it that he
does. Then he stays up until the middle of the night writing a book on
bioterrorism."


Even as he wins praise for his performance so far, Frist knows that such
accolades will be irrelevant if the GOP fails to recapture Senate control.
To that end, he told reporters at the September 5 briefing to expect the
unexpected in coming weeks. "You'll see that we are pretty
aggressive," Frist said. "You'll see that we are willing to take
risks, risks that [may make] my colleagues [ask], `What in the world are
you doing?' "


Part of the risk-taking has already occurred, as the NRSC was out front in
endorsing a number of candidates in GOP Senate primaries this year,
including Rep. Saxby Chambliss in Georgia and Elizabeth Dole in North
Carolina. Conservative rivals for the Republican nomination in those
contests grumbled that the committee shouldn't try to dictate outcomes
within the party process. But both Chambliss and Dole easily prevailed,
and in November they will face, respectively, Sen. Max Cleland, D-Ga., and
former Clinton White House Chief of Staff Erskine Bowles.


Frist's decision to back state Elections Commissioner Suzanne Haik Terrell
in Louisiana is more surprising, because she is running against two other
Republicans, Rep. John Cooksey and state Rep. Tony Perkins, who are better
established in the state's politics. Under Louisiana's peculiar election
laws, the three Republicans and Democratic Sen. Mary L. Landrieu will face
off on November 5, and if no one wins more than 50 percent of the vote,
the two top vote-getters will meet in a subsequent runoff.


Frist said he attempted to have a hand in selecting strong GOP nominees in
primaries because he wanted to increase the number of competitive Senate
races. He has repeatedly emphasized that he and Bush have worked together
to recruit very strong Senate Republican challengers, many of whom have
previously run in statewide races. "I don't want this to boil down to
three races, or four races, or five races," Frist said. "You'll
see again how we ... take certain risks to put that in play."


Frist clearly relishes his role as an underdog trying to win back Senate
control for the GOP. "It's great. I have loved it," he said.
"It's going to be tough.... When I first started doing the heart-lung
transplants, never before had they been done in history-never before-and I
was in the operating room. It was fun to do those, too."


Transplanting Careers


The story of Bill Frist cannot be understood without a look back at the
circuitous path he took to Washington. His journey shows that throughout
his life, not just at the NRSC, he has been a risk taker. His willingness
to leave an enormously fulfilling career in medicine and enter an entirely
different, complicated, and unfamiliar arena is stunning. Frist's
self-confidence-even audacity-in making that jump is also telling. It may
well foreshadow other bold political leaps for him in the future.


Not all that long ago, Frist was regularly performing one of the most
demanding high-wire acts in medicine: heart-lung transplant surgery. With
a simple picnic cooler in hand, he would race from his base at Vanderbilt
University Medical Center in Nashville to points around the country, often
in the middle of the night, flying on small aircraft.


As described in his 1989 book, Transplant, the doctor and his small team
undertook these urgent missions when they were informed that a registered
organ donor was brain-dead. They would examine the prospective donor's
heart and if it was in good shape, remove it from the body, put it in the
cooler to keep it at the proper temperature, and hurry back to Nashville.
In the meantime, a patient in dire need of a new heart would have been
prepared to undergo the intricate procedure that would often keep Frist in
the operating room for many hours. Assuming there were no serious
complications, the heart recipient could go on to live a long, healthy
life.


Frist built the heart and lung transplant program at Vanderbilt, where he
performed more than 200 heart and lung transplants, the first pediatric
heart transplant in Tennessee, and the first combined heart-lung
transplant in the South. The sheer boldness and success of Frist's
practice provoked admiration, and in some cases envy, from other
physicians.


In leaving that field, despite the accolades and obvious satisfaction it
provided him, Frist was also breaking from his family's deep attachment to
medicine. His father was an internist and cardiologist in Nashville for
more than 55 years. One of his brothers is a cardiac surgeon, and the
other co-founded Hospital Corporation of America and is chairman of
Columbia/HCA Healthcare. Frist himself went to Harvard Medical School and
later trained under Dr. Norman Shumway, a pioneer in heart
transplantation, at Stanford University Medical Center.


Whit Ayres, the pollster in Frist's 1994 Senate campaign, said he was
stunned when he learned that the doctor wanted to enter politics. "My
first thought when he said, `I'm thinking about running for the Senate,'
was, Why in the world would you want to do that? You are a god in your own
world right now," Ayres recalled. "He felt a real commitment to
public service, and felt like he could make a real
difference."


Time and again, Frist has said that politics and medicine offer the
similar challenges of protecting people from harm and helping make their
lives more fulfilling. In a 1999 book, Tennessee Senators, which Frist
co-authored, he wrote that from as far back as college and medical school,
he had "quietly hoped" to "serve others at a broad policy
level" someday. It is easy to dismiss such declarations as political
palaver, but in spending time with Frist and talking with those who know
him, one finds no other obvious explanation for his move into the
rough-and-tumble world of politics. But what about his future?


Frist refuses to say much about his immediate goals beyond Election Day.
Should the GOP retake the Senate, he will clearly be someone to watch. Not
only will he be hailed as a great political strategist, he will be
positioned to advocate a shake-up of the Senate Republican leadership, if
that is his ambition. Wittmann of the Hudson Institute said Frist could
make the case that he, and not current Minority Leader Trent Lott,
R-Miss., or Minority Whip Don Nickles, R-Okla., is best suited to
lead.


"He would have a strong argument to say to his colleagues, `Lott or
Nickles doesn't cut it. I'm the outsider who can be the fresh face,'
" Wittmann said. "Moreover, he is someone from a border state
who's perceived as a moderate, unlike Nickles or Lott." Wittmann
added, "The rap will be that he doesn't know enough about the
institution and


hasn't earned his spurs. But ... there is a lot of dissatisfaction with
Lott, and Nickles certainly doesn't necessarily have an overwhelming
majority."


Frist has often emphasized in interviews that as a rule, he favors
bringing new blood and fresh ideas to institutions. That notion is
reflected in his term-limits promise. In Tennessee Senators, co-author J.
Lee Annis Jr. wrote that Frist's support for Lott after the 1994 election
to be majority whip, a race Lott won by one vote, was based on the view
that the "conservative revolution demanded that the GOP include new
leadership to present a fresher, more vibrant vision for the
future."


When asked to comment on the current Senate Republican leadership team,
Frist ducks. "We will have a narrow window ... where the Republicans
have the House, the Senate, and the presidency," he said. "It's
not time for learning curves, so that would argue that there shouldn't be
too much change.... We are going to need somebody, or a group of people,
who can legislatively be sharp and efficient, and work the legislative
process like a well-oiled machine."


"I am not going to say anything for or against the group we have in
there now," Frist added, "but I think there will be an
assessment after the election." He also said he's not sure whether he
would want to be NRSC chairman for another two years.


Given his career trajectory so far, it is difficult to imagine that Frist
does not harbor higher political ambitions. Then again, he might stun
everybody, and once again choose an unexpected path. Stay tuned.


Kirk Victor

National Journal