On a bright fall day in a Princeton office with scant decoration, former Senate Majority Leader Bill Frist remained vague about his plans for the future. “I wouldn’t rule out going back to the practice of medicine,” he said. “I wouldn’t rule out going to the laboratory. I wouldn’t rule out running for governor, or running for president.”
Frist, who is currently teaching health care policy at the Woodrow Wilson School, has since announced that he will not return to the practice of medicine, nor will he return to government. Rather, he will enter the private sector, where he has recently been hired as a partner by the Chicago-based private equity firm Cressey & Company LP.
Frist’s turn to private equity is not entirely unusual, especially considering the many politicians who have taken a break from public life to work in the private sector – former Presidents George H.W. Bush was an adviser to the Carlyle Group, and Bill Clinton is currently on the board of the private equity firm Yucaipa, to give just two prominent examples. Nor is Frist’s current digression into the academic world a sign that he has abandoned politics – before becoming president of the United States, Dwight Eisenhower and Woodrow Wilson both served as presidents of Ivy League universities, at Columbia and Princeton, respectively. Nonetheless, Princeton remains a peculiar home for the Republican from Tennessee, and the former Senate Majority Leader does not seem like the natural choice to teach health care policy at a predominantly liberal campus in the Northeast. After speaking with Frist, however, this contradiction did not stand out so starkly, as it fit within what could be described succinctly as the surgeon-turned-senator-turned academic-turned-soon-to-be-consultant’s contradiction-fueled persona. Indeed, from his take on the presidential hopefuls, to his stance on health care and AIDS prevention, Bill Frist expressed an openness not expected from the conservative Republican Majority Leader of just two years ago.
One way to examine the contradictions of Bill Frist is to look at the man’s relationship with Princeton University, his alma matter and employer.
Frist first arrived at the New Jersey Ivy in late 1970 as young undergraduate from Nashville looking to study health care policy. With time, he would find likeminded undergraduates as a member of (the largely conservative) Cottage Club. Nonetheless, the Senator recalls initially arriving on the campus as a complete outsider. “I came to Princeton not knowing anybody here and not having any connections at all,” Frist said. “I didn’t have brothers here, parents here, nobody from my high school came that year, nobody came from the two years before. So I really didn’t know anybody.”
Since the Senator’s graduation from Princeton, many Frists, including two of his three sons, have attended the school, and in 1997, the Frist family cemented its Princetonian link with a $25 million donation financing the Frist campus center. This year, Bill Frist has returned to Princeton’s campus, to teach undergraduate and graduate courses on health care policy with Uwe Reinhardt, one of his former professors.
Despite this long history, Frist’s relation to Princeton remains an awkward and unlikely one. It is, after all, for his career as a Republican Majority Leader whose beliefs stand in line with the conservative Christian base that Frist is remembered. His thick Tennessee drawl unmistakably identifies him as a traditional Southerner, and his politics have reflected this trait. Even looking back at the Princeton student body’s interaction with the Senator, it has been far from rosy. The May 2005 “student filibuster” held against Frist in front of the campus center was in fact a rare moment of Princeton activism, as students picketed in protest of the Majority Leader’s threat to disallow democratic filibusters in the Senate.
How exactly did Frist go from being an outsider in a foreign setting to an alumnus, donor, and professor? There is no simple answer to this question, said Frist, though he described his “continuous involvement with Princeton over the years” as fully natural. Speaking about his family’s $25 million donation, he traced the story back to his days as a student, when he lamented that there was “no place for people informally to congregate, to talk, to capture informal interactions.”
As one of the first elected young alumni trustees, Frist recalls pushing for the construction of a campus center. “When I was there as a trustee,” he said, “I didn’t really contribute much directly, but it was clear to me that what was missing here was some kind of effective student center.” During his four years as a trustee, Frist helped implement the residential college system, but watched with disappointment as the idea of a student center remained on the back burner.
“People would talk about it,” said Frist, “but they would say that faculty investment was more important, or new dorms were more important, and the students would be OK because it had been that way for one hundred years.” Even after the a commission headed by prominent Princeton sociologist Marvin Bressler pushed for the construction of a campus center, Frist recalls, the project never came to fruition. “So what I did,” said Frist, “is I said in the back of my mind if I’m ever in a position at all to contribute to or instigate or pull people in for student center, I was going to do it.”
In the twenty years after Frist’s promise to himself, his family’s fortune grew significantly – his brother, the head of Hospital Corporation of America, has a net worth in the billions – and an enthusiastic Bill Frist set about gathering money to fund the campus center Princetonians succinctly refer to as “Frist.” “The important part of the story,” said the former Senator, clearly proud of his perfect philanthropic narrative, “is that I probably wouldn’t have done it if I hadn’t begun to dream back then that someday we could put it to the top of the list.”
Just as Frist’s substantial gift to a liberal school in the Northeast stands out as odd, so does the source of that donation money. The Frist family fortune stems largely from money made through Hospital Corporation of America, the company started by a group including two members of the Frist family in 1968. Bill Frist himself earned an estimated $35 million off of to his share in HCA, which he controversially sold in June of 2005, only two weeks before the stock dropped 9%. This led the U.S. attorney for the Southern District of New York to issue subpoenas involving the trade, and triggered an insider trader investigation by the U.S. Securities and Exchange Commission. Frist was eventually cleared of any wrongdoing after an eighteen-month investigation, but the accusation did raise questions about the senator’s finances.
Beyond Frist’s active role on Princeton’s predominantly liberal campus, the contradiction of his presence can also be felt in the politician’s views, as Frist seems to have drifted from the conservative right to something of a center. Discussing the presidential candidates in the 2008 election – back when McCain was still a long shot and Hillary was the inevitable Democrat – Frist predictably lavished praise on the crop of Republican candidates, while also speaking highly of the Democratic hopefuls.
He stressed his strong support for the now no longer running Fred Thompson, a fellow Tennessean, as “plain spoken, direct,” and praised Giuliani as a hero in the fight against terrorism. He spoke of the recently vanquished Mitt Romney as the smartest and most thoughtful of the candidates. Accurately, he complimented John McCain as a “tenacious, independent, comeback kid, who will probably end up as one of the top two on our side.” (Mike Huckabee, the other Republican survivor, was not even mentioned).
Frist’s description of the candidates on the other side of the aisle was equally positive. “If I was gonna vote in a Democrat primary,” Frist explained, enjoying the hypothetical question, “I would vote for Barack.” For Frist, Obama is “very young, very inexperienced, but he’s got the best rhetoric and the best call for hope and dreams and opportunity.” He paused. “Of all the candidates I think he’s got the message the best in terms of forward looking youth, energy, hope, capturing dreams, all of which are so important.”
As for Hillary Clinton, Frist proudly described her as “a good friend” for whom he has “tremendous respect,” before proceeding to focus on what he saw as her positives. On the issue of health care, the topic on which Frist is now teaching, he found room to praise her with surprisingly positive words: “Health care emerges as the number one issue if you move Iraq to the side,” he explained, “and she’s addressed it in the most complete and substantive way of any of the candidates.” He predicted, with absolute assurance: “She will be the nominee.” After Obama’s recent winning streak, impressive fund-raising, and ever-growing momentum, Frist’s confidence may prove to have been misplaced.
Looking back on Frist’s predictions, his comments are striking not for their accuracy, but for their unequivocally positive tinge, whether regarding Democrats or Republicans. This optimistic, bipartisan tone extended beyond his presidential predictions, as Frist sought to distance himself from partisan politics throughout our conversation, perhaps foreshadowing the recent Super Bowl commercial in which he giddily travels around D.C with Democratic consultant James Carville, while the two reconciled pals sip on a nice cold Coke.
Regarding his own future, Frist expressed a desire to cross party lines, citing a Nobel-Prize-winning Tennessean that he just might want to emulate. “Al Gore got out of politics,” explained Frist, “yet he’s made a huge contribution to an understanding of environment and an understanding of health type issues.” Frist added: “I will probably doing very similar things over the next years.”
The contrast between Frist’s public persona and the more centrist views he expressed in his Princeton office can perhaps best be understood through the lens of yet another, less flattering contradiction: Frist has become known both as a doctor, and as a spokesman for ideas that go against the overwhelming medical consensus. Critics will forever regard Frist as a voice not of reason but of absurdity, recalling his persistent refusal to deny that AIDS cannot be transmitted through sweat and tears on “This Week with George Stephanopoulos” in 2004. At the time, many organizations, such as the Center for Gender and Health Equality, vociferously demanded an apology from the Senator.
When I asked Frist whether he stood by his comments, he vaguely dismissed them, without clearly denying the unquestionably bogus claim. “The virus itself is not very communicable, but ‘are there viral particles in other secretions of the body?’ and the answer is yes.” Frist said his comments from 2004 were “spun by the media,” to make him look bad, yet for one reason or another, he continued to beat around the bush, failing to clearly disclaim the objectively false and potentially dangerous myth.
The moment for which Frist will be most remembered is, in the eyes of many critics, no less absurd. In early 2005, the then majority leader gave a highly publicized speech to Congress in which he challenged the diagnosis of Terri Schiavo as being in a persistent vegetative state. He based this claim “on a review of the video footage, which I spent an hour or so looking at last night in my office here in the Capitol.” Many in the political and medical communities saw it as irresponsible for Frist to diagnose a patient from the other end of the country. Laurie Zoloth, director of bioethics for the Center for Genetic Medicine at Northwestern University, contested the legitimacy of Frist’s diagnosis in the pages of The Washington Post. “It is extremely unusual — and by a non-neurologist, I might add,” she wrote.
When recalling the Schiavo case, Frist fully stood by the stance he took in early 2005. “Is it morally right for someone who has taken two oaths to preserve life – one as a physician and one to support the constitution,” he said, “not to ignore the fact that a woman who was alive, who was not brain dead, who did not have a terminal illness, was being killed. From a moral stance it makes absolute sense.” Frist also played down the incident as a footnote in his term. “The total time I spent on the floor was about four minutes,” he said, “and yet people will look at that and say ‘should you be getting involved?’” The instance, says Frist, was “blown up by the media for partisan reasons to try to take down somebody.”
As for the ethics of diagnosing based on videotape, Frist was defensive. “I’ve taken care of more brain dead people than 99.9 percent of people in the world,” he said “and so politically what people will try to do is take where they think you’re most powerful and right and then try to belittle that and bring it down.” He added: “was it ever reported – you can talk about that – that the video I saw was the court appointed medical video, and not that handheld video that you were watching on TV?” (It was, in fact, reported, in both Washington Post and New York Times articles from 2005, that Frist had seen the official court appointed medical video.)
Even in the classroom, Bill Frist’s contradictions are quick to come to the surface. Shortly after beginning his PowerPoint presentation for a class of graduate students at the Woodrow Wilson School, Frist lingered on a slide of himself operating on a gorilla in the National Zoo before opening Congress one morning. He boasted that he lost no opportunity to learn about the human heart, even if it meant operating on primates before meeting with an Israeli Prime Minister. Both out of the ordinary and unnecessary, Frist’s operation on gorillas was widely seen as a publicity stunt with little medical value when it was first reported in a Washington Post article.
As Frist changed slides, however, and the conversation moved on to the topic of a failed health care plan in Tennessee, he let the centrist within him rise to the surface. “We can learn a lot from Europe,” he said, referring to health care. Like many Democrats (and few Republicans), Frist regards health care reform as an issue of the utmost importance. “I have a vision of a patient-centered, consumer driven, provider friendly, health care plan that is driven by three things,” he said: “twenty-first century information, maximized choice for patients, and an element of control whereby the underinsured and the uninsured are addressed with refundable tax credits to allow them to participate.” Though Frist’s proposal is far from the socialized health care of most European nations, or even the universal health care proposed by the Democratic candidates, his calls to “move towards a more egalitarian system” that doesn’t leave “16 percent of the American people outside of some sort of security for health care,” have a ring to them that’s more Barack and Hillary than John and Mike.
Of all health-related issues, Frist spoke on the topic of HIV/AIDS with the greatest conviction. The former Senator serves on the board of various organizations to fight against disease in Africa, and he is currently co-chairing rock star Bono’s “One in 08” campaign with former Democratic minority leader Tom Daschle. Frist, who has worked with AIDS patients since the 1980’s, qualifies himself as an early champion of the fight against the disease, and cited the Bush administration’s $34 billion commitment to HIV/AIDS research as that administration’s greatest success. “That investment is the largest in the history of the world on a single virus,” he said, with great enthusiasm. Frist has also worked on the ground in Africa, performing medical missions for a month or two every year. During a December 3rd talk entitled “Medicine as a Currency for Peace” given at Princeton, Frist recalled going to countries like Uganda, Sudan, Mozambique, and Rwanda “not as a senator, not as a Majority Leader – I take no security – but as a doctor.” He went on to describe the MacGyver-esque nature of his surgery: “Usually it’s fishing line, a knife, and a little bit of anesthesia. And that’s it.” Beyond examining patients and doing humanitarian work, Frist has also been a vocal proponent of abstinence-first education. When I asked about the effectiveness of this restrictive method in AIDS-ridden nations, Frist leaned forward, and held his face less than a foot from mine for emphasis: “We’ve distributed more condoms than anybody else,” he explained. “And that’s not part of abstinence!” He added: “Again, write it down there, a billion condoms, more than anybody!”
In fact, as Frist proudly points out, it is largely thanks to his convincing that Bush dedicated such unprecedented amounts to the fight against AIDS. Despite this enthusiasm, the Senator remains realistic and pessimistic, acknowledging that the money is only the beginning of a long, losing battle: “For every gotten person there will be six new infections,” he said. “We’re only able to treat so many people. So now people are realizing that we do have come back and stress prevention and not treatment.”
Looking at Senator Bill Frist, M.D., it is hard to miss the many contradictions that make up the man. Moreover, one hesitates to qualify these contradictions as either proof of political evolution or evidence of blatant hypocrisy. Regardless, it seems the disappointing end to Frist’s tenure as Senate Majority Leader – he handed over Congress to a Democratic majority after a historical midterm election loss – helped him drift towards a political center.
I asked Frist whether he would accept a cabinet position working for a Republican president. “Or a Democrat president,” he enthusiastically added, with something of a grin.