The Senator from HCA

The spectacle of public officials mortgaging themselves to corporate special interests is a phenomenon not without precedent in American political life. A generation ago, Sen. Henry M. Jackson of Washington carried the well-earned moniker "the senator from Boeing" for his devotion to military spending that benefitted his home state's resident aircraft manufacturer. A Jackson contemporary, Sen. Robert S. Kerr of Oklahoma, was widely perceived as the oil-and-gas industry's man in Congress because of his major holdings in locally owned Phillips Petroleum and his peculiar fondness for a federal tax break called the oil depletion allowance.

Senatorial advocacy on behalf of specific industries at the expense of the public interest has continued unimpeded into our own time. Never before until now, however, has someone tied closely to a particular corporate interest ascended to the rarified position of Senate majority leader. Yet, that is the situation the country finds itself in with the selection of Sen. William H. Frist of Tennessee to replace the discredited Trent Lott as leader of the upper chamber's ruling Republicans.

The White House, which wanted Frist badly -- he is politically a George W. Bush clone -- has been at pains to ensure that their man is presented in the best possible light. He is, the public has been told, a compassionate conservative, a moderate and non-ideological legislator, someone who reaches across party lines -- in short, the anti-Lott.

Above all, the resumé emphasizes, he is a doctor, the Senate's only practicing physician; more than that, he is a heart surgeon, a member of the most glamorous and respected branch of the profession. And if that weren't enough, he donates time to charitable medical causes here and abroad, and has written two books detailing his experiences in the fight against death and disease. Not to put too fine a point on it, Bill Frist appears at first glance to be the perfect Senate conduit for the Bush legislative agenda, especially as it applies to health issues.

In fact, there is some superficial truth surrounding the GOP's publicity blitz on behalf of its new Senate leader. By all accounts, Frist is an engaging individual who possesses decent personal impulses and cares seriously about serious issues. So far, so good, but the two-term Tennessee senator is no Dr. Marcus Welby; neither is he another Mike Mansfield when it comes to selfless senatorial service and pure political motives.

Bill Frist is the man, remember, who engineered last fall's successful Republican Senate takeover as the party's senatorial campaign chairman. That campaign featured a questioning of the patriotism of selected Democratic senators, and the raising and spending of record millions in corporate election contributions. Make no mistake, beneath the smooth Frist veneer lurks a hardboiled political partisan.

The Tennessee senator also sports a voting record that emphasizes the "conservative" in compassionate conservative. According to political analysts, he is one of the 10 least liberal senators now serving. In that respect, he is a worthy successor to Trent Lott: a dedicated right-winger emblematic of the Republican party in the South, albeit without the rough edges and the provocative, inflammatory rhetoric.

Then, there is Frist's close connection to the for-profit health industry. This is expressed in a number of ways. To begin with, two of the top three sources of campaign funds for Frist's Senate runs were the pharmaceutical companies (whose vested interest in medical legislation is well known) and the health professionals (especially doctors, a traditionally conservative interest group).

The drug companies did more than send in campaign checks. Journalist Mark Shields reports that Eli Lilly & Co., the Indianapolis-based pharmaceutical giant, purchased one-third of the 2002 publishing run for Frist's melodramatically titled tract on bioterrorism, When Every Moment Counts. Lilly has already received a payoff of sorts, through a Frist-written provision in the recent Homeland Security Act exempting one of the company's vaccine drugs from any user lawsuits. They may get another; Frist is known to prefer a non-governmental, voucher-centered prescription-drug benefit for seniors within the framework of a privatized Medicare system.

The most important thing to know about Bill Frist when it comes to health policy, however, is his personal relationship with the for-profit hospital chain Hospital Corporation of America (HCA), recently renamed HCA -- The Healthcare Company. HCA was founded in 1968 by Frist's late father Thomas F. Frist, Sr. and the senator's brother Thomas F. Frist Jr., both medical doctors who preferred entrepreneurship. The Nashville-based multinational, which has gone through several permutations in its brief history, is currently the fourth-largest private healthcare company in America with 2001 revenues of $18 billion, as well as the nation's leading operator of for-profit hospitals.

The Frists have done exceedingly well in the field of marketplace medicine. Thomas Frist Jr., who was HCA's CEO in the late 1990s, when it was known as Columbia/HCA Healthcare, was then worth $1 billion and listed among Forbes magazine's 400 richest Americans. His brother the senator chose to practice at a rival hospital, but nonetheless kept on intimate terms with the family firm by maintaining what CNBC, the business network, calls "tens of millions of dollars in HCA stock." The money has been placed in a blind trust, which purports to establish the new majority leader's disinterestedness on health legislation, but he doubtless remembers the source of the Frist fortune.

Sadly, the family has not done well by doing good. Quite the reverse. Following its 1994 merger with Columbia Hospital Corporation, another aggressive for-profit, HCA reached its expansionary zenith (over 350 hospitals and 285,000 employees), but also its peak in notoriety. Columbia/HCA did not build new hospitals; it bought existing ones, mostly struggling nonprofit institutions acquired at rock-bottom prices and often over community objections. The firm's yearly profit goal was set at a staggering 20% of revenues, and hospital CEOs (formerly called administrators) were pressured to achieve it -- at the sacrifice of proper staffing, patient care, and charity work, if necessary.

In the process, Columbia/HCA, which modelled its corporate style after that of Wal-Mart, descended first into morally questionable behavior and then into outright criminality. During the late 1990s, a series of exposés on for-profit hospitals, in general, and on the predatory Frist chain, in particular, appeared in such prestigious publications as The New England Journal of Medicine; this was followed by federal investigations involving the Justice Department, the SEC, and the IRS. Accusations against Columbia/HCA included overcharging, improper billing, denying emergency care, bribing physicians, defrauding the Medicare program, avoiding taxes, and (shades of Enron!) disseminating inaccurate financial data to investors. The company eventually acknowledged guilt, paid $1.7 billion in fines, and reorganized under another, less infamous, name.

All is now said to be fine with the new, reformed HCA, but making money from sickness and misery, and undermining the nonprofit community-hospital sector remain its prime objectives. That should be kept in mind when Bill Frist leads the Republican charge for a privatized, market-friendly Medicare program. The senator from HCA needs to be firmly reminded of the medical maxim his family firm ignored: "First, do no harm."

Wayne O'Leary is a writer in Orono, Maine.

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