In 1994, Bill Frist campaigned to bring his "surgical personality" to the Senate. The genial heart transplant specialist promised to take a physician's approach to America's problems: to listen, diagnose, develop treatment plans and, when necessary, to operate. His ads showed him hard at work in hospital scrubs, with grateful transplant recipients offering emotional tributes to his dedication and compassion.
"Bill's a surgeon, but he's more than that," declared the father of a boy to whom Frist gave a new heart. "He's an honest, caring, hard-working man, and he'll make a great senator."
Five years later, as that senator prepares to run for reelection, his probable opponent is trying to give him a new image: the heartless face of Big Medicine. Rep. Harold E. Ford Jr. (D) has been barnstorming around Tennessee to tell voters that Frist wrote the Senate GOP's managed-care bill -- which the American Medical Association calls a "Patients' Bill of Wrongs." Ford also blasts Frist for owning nearly $25 million in stock in his family's for-profit hospital chain, calling it a "blatant conflict of interest" for a senator involved in health care issues.
With the House preparing to take up the managed-care issue tomorrow, the emerging Tennessee campaign could provide the first glimpse of the issue's power as a campaign issue among voters irate at health maintenance organizations. Frist, infuriated by the attacks, is fighting back hard, reminding Tennesseans of his long-standing commitment to patients. Ford, confident that he's on to something, predicts that much of the electorate will soon see Frist as yet another medical sellout.
"This one issue has given me the traction to run," said Ford, 29, who has been the youngest House member on Capitol Hill ever since he succeeded his long-serving father, Harold Ford Sr., in 1996. "It's so easy to understand. . . . I couldn't make up a better issue."
Frist remains a strong favorite over his would-be challenger; he has a $3 million fund-raising advantage, a new GOP poll gives him an early 30-point lead, and Ford would be Tennessee's first black senator. And it is probably too early to predict how the thorny HMO issue will play with ordinary voters. But it was clear as Ford touted his support for the Democrats' more sweeping Patients' Bill of Rights last week in a meeting with doctors at a Memphis breast care clinic that at the very least, Frist's opposition has alienated his old medical colleagues.
"I like Dr. Frist, but the people in this room are very concerned that he's forgotten about his patients," said family practitioner Robert Kirkpatrick, a Republican who is the incoming president of the local medical society. "We've got a lot of questions right now."
In the House, several GOP doctors are working with Democrats to push broad protections for all 161 million Americans with health insurance, including guaranteed access to specialists, an assurance of care at the nearest emergency room, and the right to sue health plans. Frist has been the most prominent advocate of a middle-ground approach, pushing some new guarantees but for far fewer patients, and resisting a more aggressive legal crackdown on HMOs that Frist fears would raise insurance costs for everyone.
Doctors used to be a reliable GOP constituency, and Tennessee physicians overwhelmingly supported Frist in 1994. But the managed-care revolution has clearly changed that. In their meeting with Ford, the two dozen doctors swapped horror stories about profit-minded HMOs that denied payments because wrists weren't broken or hearts weren't stopped; they complained that one plan is using prison inmates to answer its members' calls on nights and weekends. Ford didn't even vote on HMO reform when it reached the House floor last year -- he was busy studying for his bar exam -- but as pediatrician John Hill told him: "You're preaching to the choir now."
"Dr. Frist has been a huge disappointment," complained Charles Handorf, a pathologist who supported Frist five years ago. "We thought we knew what he was about. But it looks like he's stepped out of the tradition of patient advocacy and become a pure politician."
That has been Ford's message as he has toured the state, spreading the word about Frist's ties to for-profit hospital giant Columbia-HCA. Frist's brother Thomas took over as the firm's chief executive officer shortly after federal officials launched a massive investigation of alleged billing fraud; with more than $375 million in stock, Thomas Frist is also its largest shareholder. The senator owns a much smaller stake in the conglomerate, but while the Senate Ethics Committee has not required him to recuse himself from voting on health care issues, Ford has accused him of protecting his family's company at the expense of his constituents.
In an interview, Frist said he's confident the attacks on his ethics will fall flat. He said he has put his Columbia stock in a blind trust, and does not discuss legislation with his brother. He argued that Columbia would not be directly affected by managed-care reform anyway because it is not an HMO, although more than a third of its patients are covered by HMOs.
But mostly, Frist thinks it's ludicrous to accuse a doctor who has sweated through 10,000 procedures and does medical missionary work in Africa of not caring about patients. He said he agrees that money-minded HMOs are destroying the medical system, shifting control to accountants instead of doctors and patients. He says he's proud that he brought the first managed-care bill to the Senate floor. He just thinks the tougher bills go too far.
"It's a potent issue, because people feel so strongly about health care. But throwing me in bed with the HMOs, that just won't wash," said Frist, 47, the former director of the transplant program at Vanderbilt University Medical Center. "People know I've dedicated my entire life to taking care of others."
Frist said his position on HMOs stems from the Hippocratic oath he took as a doctor: "First, do no harm." He thinks giving disgruntled managed-care patients the right to sue HMOs would just boost their premiums, swelling the ranks of the 44 million uninsured Americans. He did say that if the House passes a stronger bill, he might be willing to compromise. But if fighting trial lawyers makes him a traitor to his own profession, he said, so be it.
"I understand why the doctors are so angry; their autonomy is getting stripped away, and they want to crack down on HMOs any way they can," said Frist, who made headlines last year when he saved the life of Russell Weston Jr., the gunman who had killed two Capitol Police officers. "But my world is bigger than doctors now. I'm taking the larger view."
Ford has not even declared his Senate candidacy; he won't make a final decision before his uncle Joe's mayoral race ends this week in Memphis. But most Democrats believe he is their best chance to unseat Frist. He is handsome, energetic, bright. He is a charismatic campaigner, greeting Memphis voters with easy hugs and hey-babys, but he is also a child of the Beltway, smooth with the money men in dark suits. And while his indicted-but-never-convicted father, now a lobbyist, may be a handicap in a statewide race, he still has a loyal following in Memphis.
Then again, Ford has never held a nonpolitical job; he went straight from law school to Congress. He won't be old enough to serve in the Senate until May; even some Democrats think he needs more seasoning. And the GOP poll gave Frist a 56 percent favorable rating, versus only 16 percent unfavorable. Ford admits that if it weren't for the HMO issue, he probably wouldn't think of giving up a safe House seat.
For now, Ford is playing hardball, whipping off letters accusing Frist of "reckless behavior," repeatedly citing a Center for Public Integrity study that concluded "Columbia-HCA's staunchest ally in Congress is undoubtedly its CEO's brother."
Frist says the company does not lobby him, but Columbia did spend $360,000 last year lobbying Congress on issues that included managed-care reform; sources say the firm supported the effort to guarantee emergency-room care, which Frist opposed, but came down on the same side as Frist against a Democratic measure to protect hospital whistleblowers.
By 2000, though, the details of this dispute are likely to be obscured. The real questions will be whether Ford can make Frist a symbol of a new medical establishment ruled by money instead of compassion, and whether voters can even distinguish among the various HMO reform plans floating around Congress. In interviews in Memphis -- where Ford also has uncles running for state senator and city councilor; his younger brother may try to replace him in the House -- few voters outside the medical world said HMO reform was their top issue. But even fewer voters had anything good to say about HMOs.
Sharon Brown, a Federal Express customer service agent, said her niece's HMO won't cover some of her leukemia treatments because she's not terminal: "That Frist guy doesn't care. He doesn't have to worry about medical bills." Jesse Sherfield, a phlebotomist, agreed that HMO cost-cutting has gone way too far: "I see too many people half-taken care of. . . . Frist is just lining his own pocket." Otto Lashley Jr., a union meat-cutter, said he thinks health care will be "huge" in 2000: "I don't like that doctor guy looking out for number one, you know?"
But Frist doesn't seem worried. Five years ago, he attacked Sen. James R. Sasser (D-Tenn.) as a professional politician who had never held a job outside Washington; he is sure to do the same to Ford. His experience in the medical world, he says, makes him a better legislator.
"Everyone knows who I am, and why I'm here," Frist said. "People tell me: `You're the only one there who's worked in a hospital, and they want you to walk away? That's crazy!' Look, I'll support the doctors when they're right, and I'll fight them when they go too far."