Bill Frist

The Doctor’s Orders

Air Date: February 14, 2015

Bill Frist discusses how American health care policy can fuel innovation.

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I’m Alexander Heffner, your host on The Open Mind.

Amid the hysteria surrounding the 2014 Ebola outbreak, our guest today was a calm, thoughtful voice of reason.

The acclaimed medical surgeon-turned-U.S. Senate Majority leader, Tennessee Republican Bill Frist has particular insight into the intersection of our medical and political processes and thus speaks with great authority on issues of public health.

In the Senate, Dr. Frist led efforts to modernize Medicare for improved access to prescription drugs for seniors as well as to expand funding to combat the AIDS epidemic.

In the Roll Call newspaper, Senator Frist rejected the “Us vs. Them” mentality of politicians critical of the American response to disease-ravaged Africa.

As adjunct professor of Cardiac Surgery at Vanderbilt University, chairman of health service private equity firm Cressey & Company and founder of the global health nonprofit Hope Through Healing Hands, Senator Frist is keenly aware that a global planet demands global solutions.

“Infectious disease outbreaks we will have to address in the future,” he wrote in Forbes magazine “are outbreaks that won’t respect national borders and will demand international responses.”

In this sprit today, let’s hear the doctor’s orders for the new Congress, how can our health policy from crisis management to end-of-life care overcome the partisan gridlock. And it’s a pleasure to have you here Senator …

FRIST: Alexander, great to be with you.

HEFFNER: … doctor …

FRIST: … thank you very much, appreciate it.

HEFFNER: How can we overcome what has … what, what is this toxic polarized environment in the way we address health care? And you’re doing it from the private sector and the non-profit world masterly. How do you apply that to the political discourse?

FRIST: Yeah, you know, it’s fascinating and, and I spend most of my time out of Washington today having spent 12 years there every day, every night and, and really loved the place because it is where the power of ideas come together and clash. We have a challenge today because of the partisanship that really has sort of gridlocked the place.

But they’re great little areas and … education is one, but healthcare to me is, is the greatest of all, because healthcare is so intimate … what happens to you or your spouse or your family or your kids. That becomes a central organizing thing, principal, entity around which it doesn’t matter whether you’re Republican or Democrat or Left or Right or Conservative or Liberal. It is sort of an American approach. And the American approach is one of, of a patient centered, knowledge driven 21st century current type program that focuses on the patient that as providers that are friendly to in an engaging way.

The real opportunity we have is technology. Technology today with super computers and parallel computers and mobile devices and, and wrist monitoring, opens up a whole new world around which we can coalesce to move forward, centering on better care for the, for the patient. And that’s the opportunity we have today that we didn’t have before and I do think it will play out in Washington, DC as it will in the private sector … broadly.

HEFFNER: So the politics will ultimately follow the pace of this technological revolution?

FRIST: Yeah, and it’s the technological revolution as a tool for the intimacy and the personal caring that everybody has about their loved one. Or themselves. Or their health. So if you build out from there instead of starting with just the policy of Obamacare, or Nixon care or Clinton care … don’t start there. Start with that we care about the patient, build out and people do come together.

HEFFNER: That patient centered approach sounds like one we can build a lot of consensus around.

FRIST: It, it, it is … hmmm … but you have to remind people because in Washington, people have lobbyists running around and you have Left and Right and Republican and Democrat and it’s built into this sort of clashing 24/7 …ah, ahmm, not circus, but almost a circus. So you have to remind them. People like me who are on the outside … I’m not in politics now, I’m not going back into politics, but I was in Washington yesterday and my voice and my narrative very much is “Let’s approach this, centering on the patient”. And if everybody stayed centered on the patient, all of the politics and the, the sort of gridlock just falls away. I’ve seen it.

I saw it with PEFAR, which is the President’s Emergency Funding … under President Bush, where President Bush came with an idea, recognizing that 3 million people were dying globally around the year and in the State of the Union message in 2003, at the end of it, threw out that we were going to have the single largest contribution by any country in the history of the world to fight a single virus.

And all of a sudden Democrats came out and said, “President Bush, way to go and Republicans and Americans and people from Ethiopia and Africa, the continent of Africa … and China … everybody cheered. And it’s been successful. That Bill, we passed in the Senate, three paragraphs long, has saved over 10 million lives. One Bill …three paragraphs. It shows the power of the central organizing principal or idea centered on health rallying.

Ebola recently … just, just in the last few months … all of a sudden the world attention, as you … in the opening … you mentioned that for the first time, when I go back to Tennessee and talk to all my, my people that are in Appalachia, over in Nashville, Music City, USA … it used to be they’d say, “Why does supporting global health in Ethiopia or in the Sudan .. why does it matter?”

And then all of a sudden, the same virus that’s in Liberia, you know, 14 hours later is in Dallas … a hospital in Dallas, Texas. All of a sudden people say, “Hmmm, I understand and why don’t we invest not just in America, but indirectly in America by investing in a global health infrastructure around the world to protect our children, to protect the next generation.” That sort of understanding is out there today and we’re building support for that.

HEFFNER: Well, the oneness of humanity is, is such a powerful idea that we can interrogate a bit further here, but it, it appears to me that the innovative organs of health policy that you work with, for-profit, non-profit … the Gates Foundation, Facebook, which both stepped up to fight Ebola. They’re leading, they’re the pioneers … where, where do they team up with the government … at this point, are they on their own track. And as it often seems, that they see the dysfunction and, and realize the oneness of humanity is something that they’re, they’re convinced of, but not so much the political process.

FRIST: I think the opportunity that we have … I … and was sitting again at a conference yesterday with the Bi-Partisan Policy Center in Washington, DC … Bi-Partisan Policy Center, you don’t hear that word very much there, but it’s a center that we worked at, and Karen DeSalvo, who right now is in charge of public health for the whole country and in Liberia and the Commissioned Health Corps, all public health, she’s also in charge of all technology of IT in healthcare. She’s wearing these dual hats.

But her whole thematic was public/private partnerships. It’s not the government, it’s not us versus they, but it is the great corporations in America and obviously in Washington this one percent … all these people are angry at the rich people in New York. But in truth the great corporations of, of America and there I think most of their CEO’s have very strong ethics and do want to partner with the, the public will, the public … the government itself. And the true advances I think, with the big ideas is going to be in a true public/private partnership.

And I think again … Ebola … we don’t want to overplay Ebola, but right now to take this little virus and contain it, we use traditional public health … but also the great scientists out there who are inventing a diagnostic test today to detect that virus, not when you’re symptomatic, but very early on, is working hand in hand … these great corporations … the great scientists that are out there … the great academies, the great universities … are working hand-in-hand with our CDC … our Centers for Disease Control … in, in Atlanta now, where you’ve got these public/private partnerships and that’s where the magic’s going to happen.

HEFFNER: And historically that’s been the case.

FRIST: It’s been the case, but what we have today is technology is moving so fast … that it used to be the government could put out guidelines and regulations on technology and they would last for 30 years. You know, go back to the telephone itself. Those lasted 30 or 40 years.

Now when you have the half life of science getting so short, you know where you’re doubling computer power every 18 months … every 18 months … the policymaker hat, forget my private sector hat, has to design a regulation that is not so rigid, that gives sort of the general track, protects the public from a safety standpoint, promotes the efficacy, but does not stifle the innovation and, and the creativity and the dynamism of the private sector.

And that’s where science is today. It’s where technology is today. And we see it, we feel it. You know the iPad, the iPad is only … what ten years old and, you know, it’s just … time is flying. And, and with that that’s the challenge.

The public sector is going to have to loosen up enough not, not over regulate because it will stifle the innovation for the great cures … whether … we still don’t have a cure for HIV/AIDS today. It’s still killing millions of people.

But we don’t have that cure and as we look for new diseases like Alzheimer’s, we look at technological solutions that allow the use of the 3.2 billion bits that’s in your genetic code, in every cell, 3.2 billion bits of information that can be used to your benefit … you can’t over-regulate that today because it stifles innovation, it stifles creativity and it holds back … so that’s the challenge today that we didn’t have even five years ago.

HEFFNER: Well, it strikes me that if you set … if the private sector set benchmarks for progress on HIV/AIDS … on cancer, then the for-profit model with which some of our population has grievances …

FRIST: MmmHmm.

HEFFNER: … would be more tolerable, because the money is serving the public interest in a, in a clear way. And, you know …

FRIST: Mmmm.

HEFFNER: … obviously the government has failed here in setting those same benchmarks, they’ve been incapable of, of achieving those feats …

FRIST: Yeah.

HEFFNER: …the private sector, with some of the technology advances you’re mentioning, has come closest to it.

FRIST: Well, it’s good … I think it’s a great, it’s a great big idea. Because government … see I’m a private sector guy … I did 12 years in government and I loved it. And it’s the most … it is the most … I do heart transplants and I do … you know, treat people … all over the world … and they’re equal in their nobility … in nobleness … you know, the humility … it would be the one noble, but they’re, they’re equal. These politicians that every body hates in Washington, they’re doing a, a noble job.

Government doesn’t have to fail. You look at the human genome project, the Human Genome Project set out with a ten year project with about a $10 billion price tag when you projected ahead. It’s what defines this genetic code. This phone book …

HEFFNER: Right.

FRIST: … of what’s in every little cell in your body … is a phone book, a 3.2 billion bits of information that we didn’t know 15 years ago. So government set out the goals with benchmarks … this is where we’re going to be in three years, nine, six years and ten years.

The good story is that it came in half of what we thought it was going to cost and it came in … the result was eight years and not ten years. And that’s government laying it out there. How did it do it? It didn’t do it through big buildings, government buildings with government scientists, it opened it up to the private sector and said, “Listen, these are the benchmarks, you go do it, use your creativity and your smart brains and the great universities and computers and parallel computers and we’ll work hand-in-hand.”

And that model is a celebration, I think of what government can be which basically sets the benchmarks, sets the regulations, protects the American people. Makes sure there’s a certain amount of distributive justice and then allow the private sector to do all the, the flow of money coming in and markets and risk taking … government doesn’t take risk … risk taking … that’s what innovation requires today.

So the partnership model is a very, very important one that I use in my mind as I look at other really challenging issues. Ebola is a health care one, but you can apply it to immigration, you can apply it to energy supply. You can apply it … I think broadly to sort of the role of manufacturing in the United States today and tomorrow.

HEFFNER: Elizabeth Holmes … I don’t know if you’ve heard that name, but she’s creating this application on your iPhone where you can literally sample one drop of blood and you’ll be able to determine …

FRIST: Yeah …

HEFFNER: … whether you have any number of diseases …

FRIST: Yeah.

HEFFNER: … and also just track your general health …

FRIST: Yeah.

HEFFNER: … and welfare. That’s the future. You were telling me off camera a bit about some of the innovative organizations and approaches in the medical field.

FRIST: Well … sort of full disclosure … because we hadn’t talked about it …

HEFFNER: Right.

FRIST: … I’m on the Board of Theranos, which is Elizabeth Holmes company. And I … it’s a … so I’m on the Board of it … and why am I on the Board of it? I’m in the private sector and so I basically want to be where the most disruptive change there is in healthcare … we still have 35 million people who are uninsured, that’s a challenge.

We have the cost of healthcare which is just still … continues to sky rocket … everybody says healthcare’s spending … it’s flat. That’s what you hear from Washington, DC and therefore don’t worry about it.

I guarantee your premiums went up this year and they went up last year and they’re going up next by 10 … five to fifteen percent. And so tell individuals the cost of healthcare is flat … and it’s not. Those are the sort of issues that are out there.

So I look for disruptive change on the quality aspects and on the access aspects and on the cost aspects. And a company like Theranos … is a company that said, “Maybe the answer does not come from within the field of healthcare.” And so what she did as a 17 year-old Stanford drop out …

HEFFNER: Stanford drop out … right …

FRIST: … and then worked hard … she works 24 hours a day, she’s a workaholic, she’s focused. She’s smart and all that …but she basically had a vision and kills herself to make it work and she’s working with 400 engineers … not medical doctors, not medical scientists, not people from Harvard Medical School or you know, Stanford, the places I’ve been, but basically she said, “No, we got a problem there, let’s go, let’s draw from the systems approach of engineers, bring them, parachute them in … and address the issue.

So what she’s come up with is that … and I, I … when I do the surgery, all that stuff … I’m okay. But if I had blood drawn from me, I get queasy and I faint. I mean it’s really …

HEFFNER: (Laugh)

FRIST: … hilarious … isn’t it. The basis is instead of having four big tubes of blood drawn, why don’t you just have a little prick …

HEFFNER: Finger prick.

FRIST: And those little two or three drops of blood, you put into a machine that’s sort of setting right there and you can do all 1,200 lab tests that Medicare reimburses for. You don’t have to send it off to New Jersey, or a big lab or put it in little boxes outside the doctor’s offices. You don’t have to have a Fed Ex truck, or Fed Ex, you know, flying the blood around. It’s just all done right there.

So, it’s disruptive healthcare and it, it came from somebody very young in age … it didn’t come from a great medical scientist and it captures the power of the markets. People taking risk, people investing …

HEFFNER: MmmHmm.

FRIST: … that sort of disruptive change is how we end up addressing cost, quality and access in healthcare today.

HEFFNER: Have you found any current regulations poised to stifle her? I mean along the lines that you’re describing …

FRIST: Yeah …

HEFFNER: … I’m wondering …

FRIST: … it’s, it’s a great question and without speaking directly to that because obviously that’s very successful, then how do you make it … and she’s partnering with other companies to make it accessible to you … but right now, if you wanted access to what I just told you …which you can go on her and do it all … but you, right now, would probably have to go to the local doctor, get four tubes done …

HEFFNER: Quest Diagnostics …

FRIST: … wait forever and you know, have your results back to back and maybe never hear the results.

HEFFNER: (laughter)

FRIST: … where with her basically you just get it right back in 20 minutes. So, how do you make that really take it to scale is, is, is the challenge. There are … the fact that the food and drug … this has nothing to do with Theranos … but the Food and Drug Administration which is high value … I love it … it affects probably 50% of all consumer goods.

All the consumer goods you use over the course of the day, about 50% are regulated in some shape or form by the Food and Drug Administration. It’s a great organization that started back in the 1920’s with the company actually … or some patients who died in Tennessee.

But the FDA right now, it takes abut $1.3 billion dollars for a single drug to come through. It takes about 11 years for that drug to work its way through the process. So you have a drug that is life saving, or potentially life saving and you have to wait until 2025 for that drug to be there. And in the meantime that drug could have been curing millions and millions of people.

Why is that the case? Because the FDA has not been modernized. It does … right now you still take it and put it in a thousand patients somewhere and you watch those patients over time … it doesn’t take advantage of the super computing, the parallel computing and the analytics and the mathematics and the modeling we have today, coming back to our earlier conversation. We have this technology today. So it is time for the Food and Drug Administration and I love it and they do a great job in devices, making sure they’re safe … and efficacious and drugs … great. But it needs to be modernized today. And if it’s modernized, this innovation and creativity and flow of capital to cures of disease, what’s even more important … prevention of, of disease and lowing the burden of disease can happen now in an iterative way instead of waiting 11 years and $1.3 billion dollars for each drug.

HEFFNER: Is the tension misplaced? And what I mean by that is … are we regulating where we shouldn’t be? And not regulating where we ought to be preventing carcinogens from entering the food chain? That …

FRIST: You know it’s interesting … and it’s a good question. It’s such a big question. I’ll say what I have found …so when I came … it’s interesting … when I became United States Senator in 1994 … I’m a doctor, scientist … treat patients … my whole life is spent individual patients … my whole adult life …

HEFFNER: Amazing.

FRIST: … but there had not … the last doctor elected to the United States Senate at that time, was in 1928. And we spent a lot of our conversation talking about healthcare. Healthcare is 18% of our global economy …it’s 18% of it and the fact that there was not a doctor …

HEFFNER: Mmm …

FRIST: … a scientist in the United States Senate. So I think we can do better in terms of our sort of representative government. Now the good news is that there are now five doctors in the United States Senate and once that barrier was broken and there are probably 30 in the House of Representatives …

HEFFNER: MmmHmm.

FRIST: … I don’t know the exact number. But we need to do the same thing and, and encourage people to run from regular jobs and regular lives. And I lived it. You get through it, I did 12 years … I loved it. I started at the bottom, I got to the top and I left. And I basically came in saying “That’s all I’m going to do.” And I, I hope that I can be a model for other people … cause it is a noble profession.

HEFFNER: It’s the Madisonian vision …

FRIST: Well …

HEFFNER: … you bring someone who had professional expertise in, in a certain realm of society and especially with the advancement of technology in medicine today and the imperativeness and the intimacy of that … we need more doctors.

FRIST: Or, yup, doctors or scientists, or engineers or just like regular people …

HEFFNER: Right.

FRIST: … and it is …and people laugh and say, “Well that was in the old days.” It’s not in the old days … and I’m a living example … I’m out of the business since … I still work in Washington … I still go to Washington to help my friends, but I, I hope that I can be an example.

You take somebody who is a doctor, had never run for political office, never served in political office, had nobody in his family in the political office, said “I want to serve. I’m only going to serve for 12 years”, and that’s what I said in 1994. I went up and served and, and served, that’s what it’s all about. It’s not that much different I’ll say … then me coming in and you needing a heart transplant, me putting a heart into you or, or having heart disease when I’m treating you one on one.

Public service, in Washington, in Washington today as bad as it may seem to most people is exactly that. They have the opportunity to lift not just one person up, but lift up a, a

HEFFNER: … a mass.

FRIST: … in Congress a district or a state. And that’s the way my mind thinks and that’s, that’s the reality. I’ve, I’ve lived it and now I’m on to that next phase of trying to marry the public sector, or government with the private sector in addressing these seemingly, seemingly insurmountable problems that are out there. And they’re not insurmountable.

HEFFNER: They would be less insurmountable if we divorced ourselves from this Left/Right paradigm of a certain party being pro-regulation and anti-regulation. Is there a blueprint …

FRIST: Yeah … oh yeah, well, I think the, the structural reform thing … is driven by 24/7 media … by a primary system … the way we elect people …

HEFFNER: But even if we just looked at this Congress in 2015 and, and saw the potential for areas of compromise in, in …

FRIST: Oh, yeah …

HEFFNER: … healthcare policy.

FRIST: I think, I think you can do it … I think you can do it … in, in a whole range of policy. I will say it takes leadership … you say “this Congress” … the next President will have the opportunity … if they … it’s not that hard to do … if the next President comes in and we have no idea who it’s going to be … it doesn’t matter … it doesn’t … obviously I’m a Republican, so it matters … but it doesn’t really matter … if it’s a Democrat or Republican … if they come in, to a table, and have the leadership of the Senate there and of the House of Representatives, and say “Listen, I’m President of the United States, you’re a co-equal branch of, of government, so I don’t rule you and you don’t rule me. But I pledge to work with you and you in civil discourse. And we’re not going to agree, I mean you don’t want to necessarily agree … but we’re going to compromise on the issues that are in the best interests of America, and I pledge that to you.” And then lives it. That’s all it takes. And get together with them on a regular basis, I mean every two weeks, to get those seven people together every two weeks, sitting around a table … no press, no flurry of cameras coming in at the end. That’s all it takes.

The American people are so hungry for it. The American … and, and I’m in the real world. I’m out there. I’m not in Washington. The American people are so hungry … it’s not … they don’t even want to be a centrist overall … they don’t mind the clash of the ideas, ’cause that’s what fun … that’s where great ideas come from. But what they want is a civil discourse and a dialog that focuses on the issues that are most important to them and their children.

And the President of the United States is the only person who can set that. The Majority leader can’t set it. I’ve been there, I’ve seen it … you say “We can blame the Majority Leader or the, the Speaker of the House”. They can’t do it. They don’t have it. And so the next President can do it.

In the meantime, I would do exactly what you suggested, I would take three issues, I would pull people together and I’m … don’t know what those issues are right now … I thought immigration would be one, but I think with the Executive Order that’s not going to be fully addressed now.

But take three issues, focus on that over the next 24 months and try to pull people together around those.

HEFFNER: Was that strategy not employed or ultimately I think Republicans perceived Obamacare as being forced down the throat of the American population.

FRIST: Yeah.

HEFFNER: From, from it’s … from the outset I remember caucus meetings … this is when you had retired already …

FRIST: Yeah.

HEFFNER: … but they had set up small groups, “think” groups …

FRIST: Mmm.

HEFFNER: … with industry leaders at the time your former colleague Senator Baucus was, was the Chair of the Committee …

FRIST: Right.

HEFFNER: … that was decisive … they tried, but their strategy failed or maybe the goods they were selling is not what … in sync with the oneness of humanity or the vision that we can, we can form as a consensus …

FRIST: Well …

HEFFNER: … because they did some due diligence around that community building.

FRIST: Yeah. First of all, the President … Obama showed strong leadership in getting a healthcare bill done that purportedly addressed a very serious issue, access to healthcare in this country. And as President of the United States he did jam it through. He used procedures … as Majority Leader for social causes … has never been done before. Wasn’t done with Medicare, wasn’t done with Medicaid, it wasn’t done with Social Security, it wasn’t done with Civil Rights.

Pushing it through using a procedure that is set up to be able to jam stuff through. What that may … I’ve given him credit for the leadership and trying to address a very important issue. The American people were more focused on cost … but he took an issue of … which is a real issue … putting it through the way he did simply meant the tough part is the implementation of laws … it’s not passing them. And the implementation, when you’re implementing something that’s very tough and you push something through … you’re just not going to have the support. Not just about Republicans, but centrist Democrats as, as well.

So that’s the, the challenge that we had today. So once that was done, it sort of pre-empted any of the work forces that were already being done. It became sort of this potpourri of everybody threw their Bill in and they pushed that Bill through and all of a sudden we have all these conflicting Bills today that are in court today, as we speak, as you know.

And there will be a series of court cases instead of having a central organizing Bill that was done with Democrats and Republicans and Left and Right and Conservative …

HEFFNER: And the camaraderie suffered, as a result.

FRIST: Well, in the implementation … the whole point is that there’s nobody there supporting Obamacare today … very few … but there’s good stuff in it … I mean there’s really good stuff in it … but the sort of bad stuff … needs to be fixed … there’s nobody in there saying “I’m going to fix it”, because it’s gotten to be so unpopular. But, but let me just say …

HEFFNER: Sure.

FRIST: … because Republicans have basically just said, “Let’s just kill Obamacare”. And that’s okay from the rhetoric standpoint. But Republicans have to offer solutions that are better …

HEFFNER: Rectify.

FRIST: …that, that are better. And, and you can just say, “Let’s start jettisoning things” … you can jettison the bad things, but you need to offer pro-active solutions. And whether or not Republicans can show that they can govern … over the next 24 months … maybe the next 48 months … is going very much depend on the positive solutions that are put forward. And I would argue with a President in there that pulls everybody together … they don’t have to be just Republican solutions, they can be American solutions.

HEFFNER: To be continued … Senator, doctor … Bill Frist … a pleasure to have you on.

FRIST: Thank you, Alexander, a real pleasure.

HEFFNER: And thanks to you in the audience. I hope you join us again next time…for a thoughtful excursion into the world of ideas. Until then, keep an open mind.

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