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Newsmaker Interview With Bill Frist

By RealClearPolitics

William H. Frist, MD is a heart surgeon and the former Majority Leader of the United States Senate.

RCP: Republican candidates are pledging to repeal the health care bill, and with your background in medicine and also as a leader in the Senate acutely aware of policy-making, what's the best way for Republicans to proceed?

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Frist: Republicans will not repeal the fundamentals of the new law. Because of the law's unpopularity with so many hard-working, centrist voters, who see their health cost and taxes continuing to rise, the mantra of "repeal and replace" resonates at election time. Republicans will pick up 500 state legislative seats, the majority of governorships, and will regain control of the House. In two weeks, they then become the leaders of the legislative branch. The electorate wants results and their responsibility will be to constructively shape implementation of the new law.

RCP: If they try to repeal parts of the bill, what parts will they start with, and what is realistic?

Frist: Passing a law is 20% of the work (the easy part). Implementing it successfully requires 80% of the effort. As with Medicare and Medicaid in the 1960's and 1970's, implementation will ultimately be defined by regulatory language, interpretation of Congressional intent, and the outcome of elections (in this case, a series of elections in 2010, 2012, 2014, and 2016).

Repeal of discrete sections of the law are a possibility but will require solid bi-partisan support. For example, consideration will be given to repeal (or modification of) the Independent Payment Advisory Board. Is it too much power to allow 15 unelected individuals the absolute authority to unilaterally dictate with the force of law how to cut Medicare for as much as 2% a year every year?

RCP: What parts of this bill are solid and should stay in place if changes begin?

Frist: The "individual mandate," the redefinition of the Medicaid coverage threshold to be 133% of poverty, the demonstration projects of accountable care organizations and medical homes, payment reform, and prevention are solid.

RCP: Do you think Republicans have been entirely correct in how they've portrayed the bill; do you think there misperceptions remain about the law as Democrats suggest?

Frist: Those who call the law a federal government takeover are wrong. Yes, there are more government mandates, bureaucracies, and hefty government spending, but our health care sector will maintain its rugged pluralism and its strong employer-based foundation (150 billion people). Care will continue to be delivered by non-government physicians and nurses working in non-government hospitals and facilities.

RCP: What new legislation would you like to see crop up regarding health care delivery in this country?

Frist: The health sector needs breathing room from new legislation. For innovation to prosper, new cost-effective treatments to emerge, accountable care organizations to be established, state exchanges to be operationalized, more laws are not needed. The sector needs some certainty and time to adapt.

RCP: How big of a role do you think health care and the new law will factor into the Republican presidential primary over the next year, and how do you think it will shake up the field?

Frist: The next presidential election will be determined by 2 things: the economy/jobs and Afghanistan. Health care will not be a defining issue in the presidential election in 2 years, but will be cited by voters as supporting evidence of one's own views on taxes, the role of government, and entitlement spending (the debt).

RCP: If a Republican unseats President Obama in 2012, what's the first step that president should take regarding health care policy?

Frist: The President must focus "like a laser beam" on health care costs. This will likely begin with provider payment reform which will transform fee-for-service, volume-based payments to value-based constructs. Incentives and markets will work. Government fiat will not.

RCP: What is being ignored currently in the implementation of the health care bill/what do you think will crop up in the debate in the next few years that we're missing now?

Frist: The law is state-driven, not federally driven. Both the 16 million new entrants to Medicaid and the 24 million in the new health exchanges will be state-administered. Today, the federal government is inadequately serving the states in view of the huge (and I'd argue appropriate) responsibility it has thrust on the states.

RCP: What is the best way to curb health care costs in your view?

Frist: Markets and incentives. When fairly framed by government, they work. Just look at the Medicare Modernization Act of 2003. With transparency, competition, incentives, partnership with the private sector, prescription drug costs for seniors with Medicare have year after year have come in 10 - 20% less than predicted. That is bending the cost curve.

RCP: You're still very involved in health care policy in the country from Tennessee; what's topping your agenda on health care policy and what you will be doing over the next few years?

Frist: My life is health. I spend a third of my time on health care policy, a third on global health issues like children's issues and clean water through Hope Through Healing Hands, and a third marrying private capital to dynamic managers who are constructively and innovatively addressing the "value equation" in health care. I loved transplanting hearts and I love transforming health care.

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