Will Frist Deliver on Prescription Drugs?
By: Source: AARP Bulletin Today Date Posted: 2003-06-23 13:37:16
After toppling Saddam Hussein's regime in Iraq, President Bush now hopes for equal success in advancing his domestic agenda, with Medicare as a high priority. And to pull that off, the man he will rely on above all is the most powerful lawmaker in the Senate—its new majority leader, Bill Frist of Tennessee.
It is a formidable task, given the Republicans' tiny majority in the Senate and the controversial nature of Bush's proposals for deep tax cuts and fundamental changes to Medicare.
That reality hit home for Frist in mid-April, after just 100 days in his job. It took only two moderate Republican senators, joining with Democrats out of concern for rising deficits, to scuttle the president's full budget request for tax cuts of $726 billion. The Senate, instead, voted for less than half that amount.
So what are the chances for Frist—a long-time advocate for transforming Medicare—to steer difficult legislation that arouses equally strong feelings?
On the very day of his setback on the tax vote, Frist seemed cautiously confident on that point as he talked to the AARP Bulletin in the historic and elegant majority leader's office suite in the Capitol.
He hopes to bring a Medicare bill to a vote in the Senate before July 4, he says—and with enough bipartisan support to pass.
Javascript for the Contact Congress sticker End Contact Congress sticker"That's an ambitious goal," he admits. But "[even] in a closely divided Senate, with civility and trust and appropriate leadership … you can accomplish great and bold things. And I would state up front that strengthening and improving Medicare and at the same time adding a [prescription drug] benefit is a bold initiative, and one I believe this Congress can accomplish."
Boldness—a word he uses frequently—is a Frist trademark. It isn't evident in his manner, which in conversation is amiable but controlled, with none of the gesticulations favored by many politicians, even in private, to drive their points.
But at age 49, his trajectory to majority leader has been near vertical. He didn't even vote in an election until 1988; and before 1994, when he won a Senate seat in his first race, he'd never held elective office.
Before then, all his professional experience was in medicine. Frist is patently proud of being a physician. He never fails to mention it in speeches and interviews, a habit his critics interpret as veiling keen political ambition with an aura of "compassionate conservatism." It is an image that Bush, a close friend, is anxious to project in making health care a Republican rather than a Democratic vote-catcher.
By all accounts Frist is a warm, caring doctor whose concern for AIDS patients still takes him on annual missions to Africa. But he is foremost a surgeon, a job that requires ego-strength and unsentimental detachment. He specialized in cancer surgery and heart transplants, the ultimate in medical boldness.
So it's no surprise that Frist appears to view Medicare as an ailing patient—and his diagnosis is that it needs not just prescription drugs but radical surgery.
"Medicare today, because of its antiquated structure, is unable to deliver the quality of care that is state of the art in 2003," he says. "No prescription drugs, no preventive medicine, no chronic disease management."
His solution, shared by Bush and other Republican leaders, is to change the system by adding a range of competitive private insurance options which, they argue, would offer beneficiaries more choice and better care.
Ten or 20 years from now, he says, he hopes Medicare will be "a joint public-private system that captures the private sector's responsiveness to individual patient needs with the government assurance of health care security."
Frist can make that vision sound attractive, but herein lies the political quagmire.
Most Democrats argue that such sweeping changes over time would privatize Medicare, making beneficiaries vulnerable to the vagaries of a for-profit industry. Medicare is a basically sound and popular system, they say, to which drug coverage could be added now without changing its structure.
Frist disagrees. With the Medicare population due to double over the next 30 years, he believes the present program is fiscally unsustainable. "If we just added prescription drugs," he says, "the system won't function, can't function."
Frist's faith in the "efficiencies" of the private sector to bring down costs is in his blood. His father founded one of the nation's largest private health care companies. But many Democrats dispute that private plans would save money.
"My sense is that with higher administrative costs, profits and risk load … [private plans] would actually be more expensive than traditional fee-for-service Medicare," Sen. Max Baucus, D-Mont., remarked at a recent Senate Finance Committee hearing.
Others argue that it is Bush's hefty tax cuts that will most undermine Medicare's future solvency by pushing the deficit to record highs.
These divisions—and many other arguments back and forth—preview just how highly charged the partisan debate will be in coming weeks as lawmakers struggle to find common ground.
Frist, as chief scheduler for Senate business, says he wants to allow "ample time for debate and amendments" in the Senate Finance Committee, where a bill will be thrashed out, and also on the Senate floor.
"The reality in the Senate today," he says, "is that we do have to achieve 60 [out of 100] votes" for any bill to pass. Apparently optimistic in the face of very long odds, he adds: "So by definition it has to be bipartisan."
Share
preview