Frist's Modest New Goal: World Health

Bill Frist is a man with a mission or, actually, many missions. Far from working on his golf handicap or perfecting his surf-casting, the supposedly retired former Senate majority leader is trying to cure disease — all over the world — as well as beat back hunger, illiteracy, and the other ills besetting the Third World.

This would appear a backbreaking undertaking to most mortals, but one gets the impression that for Dr. Frist, it is challenging, but also quite a bit of fun. While still involved in trying to overhaul health care in America, the two-term Tennessee senator is also traveling the globe researching the origins of animal-borne viruses, performing heart surgery in Sudan, visiting refugee camps in Chad, and going to Bangladesh to work with Save the Children.

A few minutes of conversation with this thoughtful and intense man is enough to dispel any impression that these initiatives are just an academic exercise (despite his upcoming gig teaching at Princeton's Woodrow Wilson School): Dr. Frist, a heart surgeon, believes he can make a difference. Over breakfast in Nantucket on one of the rare days the Republican former senator is enjoying his family's vacation home here, he speaks out on the domestic issue that he expects will dominate the 2008 elections.

"For the Democrats, health care is the no. 1 domestic issue," he says. "The Republicans are focused on immigration right now, but after the primaries, health care will be the no. 1 topic of debate. Every exit poll since 1994 has shown this to be of rising concern to voters, who trust Democrats more than Republicans to get the system fixed."

The most glaring problem, according to Dr. Frist, is the disastrous state of Medicare.

"Its outlook is worse than that of Social Security," he says. "The system is expected to go bankrupt in 2019, as compared to 2039 for Social Security. The unfunded liabilities for Medicare are six times those of Social Security. The president thought that fixing Social Security would be easier, but it didn't work. We are going to have to address Medicare. Half of health care dollars are spent by the government. There are only 3.5 people paying in to Medicare today to support one recipient, compared to seven people back in the 1960s. In 20 years, it will be only 2.8 people."

Other than addressing Medicare, Dr. Frist also has a framework for shaking up the bloated and complex health care apparatus.

"Costs have been rising 2.5% per year faster than GDP for the past 30 years," he says. "Insurance premiums have increased 3 1/2 times faster than wage growth. To begin to make a difference, we need to make sure our system is patient-centered, consumer-driven, and provider-friendly.

"First, incentives have to be aligned to focus on the patient. Only about 40% of all spending actually gets to the doctor and the patient. The rest goes to insurance, advertisements, and other costs, as well as waste and fraud. We have to be sure that decisions benefit the patient, and not some hospital administrator.

"Second, the process needs to be consumer-driven. When we were working on providing prescription reimbursement through Medicare, the Democrats took the view that ‘old people can't make good decisions. They don't know enough, and they'll be confused.' "It turns out that the people receiving the new program are more than 90% satisfied with it — there's no doubt that it's working. If you give people a choice, they will make the right decisions. But we don't have adequate information today. We need 21st-century information about medical institutions and practices. You can't find out even simple things, like where the most heart surgeries are being done.

"Finally, health care programs have to be made provider-friendly. We can't continue to drive the best M.D.s out of the business. I trained to be a heart surgeon for many, many years; I didn't get my first real job until I was 35 years old. The only thing we offer people going through that training now is a 100% certainty that they'll be sued. There has to be some reward. There are now 70 training programs in this country for cardiac surgeons; 40 of them are empty."

After many conversations, it is clear that Dr. Frist is proud of his role in pushing the Bush administration to take a leading role in the fight against HIV. "I talked to President Bush, who didn't know much about HIV, but who ended up committing $15 billion to fight the disease," he says. "That's more than any leader has ever spent on a single disease. One little bill, and instead of 60 million dying of HIV/AIDS in the future, maybe only 40 million will. It shows what leadership can do."

He also takes some credit for the Medicare reform bill passed in 2003. "We cut a deal with the AARP," he says. "It was the first time an entitlements bill included an element of competition, and the first time Medicare had a drug component. Everyone was worried about the cost, but it's come in 30% below what was anticipated. Competition works. The Dems will try to undo it and get the government more involved in being the sole bidder. We've seen at the Veterans Administration that that approach just doesn't work."

Dr. Frist has teamed up recently with his one-time Democratic counterpart, Tom Daschle, a former senator of South Dakota, to form ONE Vote '08, a nonpartisan grassroots group that will educate presidential candidates of all stripes on health and poverty issues around the world in the months until the next president takes office. The effort is important to Americans, Dr. Frist says, as "poverty and hunger lead to instability, which feeds terrorism. There is a lack of hope in places like Botswana, where the average life expectancy is 39, thanks to AIDS."

Along with his traditional "Nantucket red" pants, Dr. Frist also sports a white bracelet signifying his support for ONE Vote. "Last week, I was on a conference call for ONE Vote '08, and we had 11,000 people on the call," he says. "We have over 2 million on our email list."

The hope is that as candidates stump across the country, seeing the organization's signature bracelets will remind them that voters care about world poverty. Dr. Frist fulfilled his promise to the voters of Tennessee by retiring after 12 years in the Senate. It is clear, though, that he has not abandoned public life. Would he consider running again?

"I don't know. Al Gore is a good model; you can have a big impact even if you're not in office," he says.

In the meantime, he'll continue to pursue more reasonable tasks — like curing the world's ills. Thank heavens.