A Heart to Serve

by Bill Frist

  A young woman was passing by, carrying an armful of papers, and looking as though she might be headed to work somewhere on Capitol Hill. “Excuse me,” I said. “Could you please tell us how to find the Russell Senate Office Building?”

  I could feel my face turning red from embarrassment when the young woman pointed directly behind me. We were standing right in front of Russell, less than a hundred yards away. We were as green as you could get.

  From Russell, we set out to search for our first transition office, really not much more than a cubbyhole in the basement of the adjacent Dirksen Building, with a telephone, a desk, and a few folding chairs. While I attended various orientation meetings, Mark immediately began the interviewing process, attempting to pull together a staff before I took office officially on January 5, 1995. We had little to work with. We didn’t even have a secretary, so I dictated the letters and sent them back to Nashville via FedEx to be typed and mailed by campaign volunteers.

  Throughout December, Mark and I traveled back and forth to Washington for two or three days at a time, interviewing a plethora of applicants for the relatively few staff positions we had available. Since my predecessor had been a Democrat, no existing infrastructure was intact from which we could draw skilled, experienced staff members. Thanks to the “Republican Revolution,” there were so many new Republican senators and congressmen in town, there was a scramble to hire experienced staff. Consequently, the number of available people on our side of the aisle who knew the way things needed to be done was relatively slim.

  In reviewing resumes, Mark noticed that “everybody in Washington was somebody really important,” or at least one would think from reading the job descriptions. Only by personally interviewing applicants could we discern that the job seeker who had “personally attended to numerous high-ranking government officials” was actually a waiter in the Senate dining room. Mark carried the load there. It was a long, tedious process of wading through the pile of job applications, hoping to find qualified personnel who would be able to help us hit the ground running.

  Fortunately, Mark was able to recruit some excellent staff members, including Ramona Lessen, a sixteen-year veteran of Capitol Hill. Ramona was a godsend, since she knew how things worked in Washington and whom to see to get things done. She became my right hand for the next twelve years.

  Several veterans of Capitol Hill told Mark, “You better get yourselves an office manager who knows what’s going on around here,” so we also considered hiring Donna Beck, who had recently been the office manager for retiring Senate majority leader George Mitchell. She was highly qualified, but when word got out that we were interested in hiring her, we received a phone call from one of the Washington conservative “think tanks,” warning us, “You know, of course, that she is a former Democrat staffer.”

  “Yes, we know,” Mark replied, “but she knows what needs to be done.” It was our first brush with how things work in Washington; it doesn’t matter who is the most talented person, or who can do the most to help the country. What matters most in Washington is a person’s political affiliation. But that didn’t matter to us. We hired Donna because she was the best, and she did an excellent job. Donna’s work was exemplary, and she really helped us get up and running quickly.

  In the same way, we hired Ginger Parra to help run our Tennessee state office. Ginger was also a Democrat, and she and I had worked together when she was the executive director of the Tennessee Medicaid Commission. She was a talented woman who helped us immensely in the early days of my new career. Overall, we tried to hire a blend of people, some like Kathy Fine, our first legislative director, a Vanderbilt Law School graduate who had worked for Senator Coverdell, and others who had little to no Washington experience at all, but who could bring fresh ideas from the private sector to our staff. Yes, we were elected as “a breath of fresh air,” but we knew that experience in Washington was critical for survival.

  I was sworn in on January 5. My entire family, including my octogenarian parents, traveled from Tennessee to attend the public ceremonies, and then–vice president Al Gore accompanied Karyn and me to the old Supreme Court chamber within the Capitol, where I laid my hand on Karyn’s dad’s Bible as the vice president conducted the private swearing-in ceremony.

  Dad was excited for me, but he felt less than excited about my putting medicine on the back burner. When he saw my name on the front entry door of my Senate office, he walked down the hall, waited for me to come out of a meeting, and walked me back to the nameplate where he deliberately pointed. “Bill, something important is missing, isn’t it?” asked Dad. I looked at the nameplate and knew immediately what Dad was referring to—there was no “MD” after my name.

  I immediately had Ramona request a new sign, and kept the “MD” on both my door and my official desk on the Senate floor throughout my terms of office as a constant and visible reminder of who I am, where I came from, and who I will always be. To me those letters behind my name reflect my personal and professional values and ethics; beyond that, they place the emphasis where it ought to be in government, on helping individuals, not simply the majority or the loudest voices.

  Walking into the chamber of the U.S. Senate as the new guy was like stepping into a whole new world. I was breathless. Anyone with even a rudimentary appreciation of history and the remarkable leaders who have served our country in that stately room could easily be overwhelmed. The blue-carpeted floor, the one hundred personal, carved wooden Senate chamber desks, forty-eight of which date back to 1819, the two (one Republican, the other Democrat) side-by-side cloakrooms at the back, and the second-floor galleries for visitors, lined with the white marble busts of the American vice presidents (who are the presidents of the Senate), and the inscriptions above the presiding officer’s desk, E Pluribus Unum (One out of many), and above the doors—Annuit Coeptis (God has favored our undertakings), Novus Ordo Seclorum (A new order of the ages), and our national motto, “In God We Trust” over the south-central entrance—all speak of the rich history and traditions of the U.S. Senate.

  As the new kid on the hill, I was literally number one hundred on the Senate seniority list—after all the incumbents, as well as the newly elected officials who had held government office previously. Yes, I started at the absolute bottom. It reminded me of that first day of medical school, as a misplaced southerner humbled even further by the hallowed halls of Harvard, but at least there, I was not junior to the other 125 in my class. In the Senate, even though my freshman class of eleven incoming Republicans was larger than usual, I was the lowest man on the totem pole. (There remains some friendly debate about who was lower in the pecking order, my colleague Spence Abraham, senator from Michigan, or me. We flipped a coin to determine who was number one hundred, and I won! Regardless, both of us were looking up from the bottom.)

  Being last in seniority mattered. It meant that our tiny, tight transitional offices (the second ones) were tucked in the attic of the Hart Building, with no outside windows, while we awaited the completion of our permanent offices in Dirksen. We even had to cut six inches off our hallway flagpole because the ceilings were so low. We didn’t have a conference room, so all of our staff meetings were held out in the narrow attic hall. Some conferences and interviews between female staffers were even conducted in the women’s restroom! When we moved into our permanent location in the expansive Everett Dirksen Building a few months later, we felt as though our modest offices were palatial.

  One of the first committees on which I was assigned to serve was the Senate Banking Committee. I had served on the board of Third National Bank in Nashville, so I was comfortable with my knowledge about the issues with which we were dealing. My first day in office, I attended financial hearings at which Arthur Levitt, chairman of the Securities and Exchange Commission, and Federal Reserve chairman Alan Greenspan were questioned by our committee. Before long, I was also on the Small Business Committee, the Labor and Human Resources Committee, and the Budget Committee.

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nbsp; I was serious about my role as a citizen legislator, as the old bulls of the Senate probably realized when I offered my first piece of legislation to the Senate—a proposal for term limits. I extolled the desirability of term limits, quoting Harry Truman, who said that limiting the amount of time an official could spend in office would “cure both senility and seniority, both terrible legislative diseases.” It was like sticking a hot firebrand in the eyes of the old bulls.

  It got worse. During my first term in office, I supported a constitutional amendment requiring a balanced budget, as well as extending a line-item veto to the president. Convinced that the 1994 Republican revolution at the polls had been a mandate for a fresher, more vibrant vision for the future, I also strongly supported Senator Trent Lott’s ascent as majority whip.

  I was eager to represent my state well, so during the first few months in office, I tried to read, answer, and sign as much of the mail from my Tennessee constituents as possible. Before long, I was signing stacks of mail every day. We had no standard letters, no letters to state my positions on various issues, no staff members who could help shape my responses to the issues—I didn’t even know what the real issues were yet! We were all learning on the job. Fortunately, under the dedicated leadership of Mark and with the help of Ramona and the experienced staff members who had worked for Senator Coverdell and Senator George Mitchell, we started to get our bearings.

  Several senior senators also helped me find my way in the dark. Majority Leader Bob Dole was a strong influence, and a good role model when it came to maintaining civility in the Senate, never hesitant about stepping across the aisle of the Senate floor to engage a Democrat on an issue demanding bipartisan support. Senator Pete Domenici came alongside me early on, not just as a mentor, but as a good friend. And Trent Lott, the heir apparent to Bob Dole’s position when Dole decided to run for president in 1996, helped me better understand the way things worked in Washington.

  Nevertheless, my early days in the Senate were challenging. Similar to med school, an enormous amount of information needed to be assimilated quickly and accurately, so I asked questions constantly and I listened—a lot.

  One of the first controversial issues with which I had to deal was President Clinton’s nomination of Dr. Henry W. Foster Jr., to fill the office formerly held by Joycelyn Elders as surgeon general.

  Many senators don’t like the position of surgeon general in the first place. In 1995, many Republicans especially didn’t like President Clinton’s previous use of the office, particularly Joycelyn Elders’s active lobbying for the distribution of contraceptives in public schools, as well as her suggestions that perhaps drug legalization should be encouraged. So when President Clinton nominated Dr. Foster, the conservative guns came out firing. False accusations swirled about the man, and much of the acrimony was politically driven. It was character assassination and I detested it.

  The abortion issue surged to the forefront of every discussion about the nomination, because Dr. Foster was an obstetrician who had performed thousands of healthy deliveries, but had also performed abortions associated with medical necessity earlier in his career. He was not an “abortionist,” as his critics wrongly claimed. Although strongly pro-life—I opposed abortion—I felt that Dr. Foster’s detractors, mostly my fellow Republicans, purposely and maliciously twisted the facts surrounding the doctor’s medical practice to destroy his reputation.

  Making matters even more delicate for me, Dr. Foster was the chairman of obstetrics and gynecology at Meharry Medical School in Nashville, my hometown, and I knew him personally. He and I had served together on a medical ethics board in Nashville and he had impressed me as a knowledgeable doctor and a good, moral man, with the highest professional ethics. I was aware of his record of being involved with abortions, but I was also aware of his vocal support for sexual abstinence programs, and that he had founded and directed the successful “I Have a Future” program in Nashville, ironically one of President George H. W. Bush’s “Thousand Points of Light.” The program designed by Dr. Foster was an effort to reduce adolescent pregnancies through education, especially in economically depressed areas where teens were considered more at risk for HIV/AIDS and other sexually transmissible diseases.

  I gathered and read assiduously Dr. Foster’s writings, scrutinizing them through the prism of his alleged advocacy for abortion. Though he did not deny that he had performed abortions, or was listed as the doctor of record (a term in academic teaching centers for the senior surgeon in charge of the case, whether or not he or she actually did the procedure) for thirty-nine abortions, he had publicly stated that he abhorred abortion and advocated abstinence as a means of stemming the tide of teen pregnancies. I then met privately with Dr. Foster, and we discussed how he viewed the surgeon general’s position and what he hoped to accomplish if confirmed. Dr. Foster told me that his priorities would be full-scale attacks on teen pregnancy issues, youth smoking, screening for breast and prostate cancer, and AIDS research. Whether or not Dr. Foster was simply telling me what I wanted to hear, I became convinced that I would support him, in spite of the strong conservative opposition. The issue to me became bigger than Dr. Foster’s nomination or my position on it. Before getting involved in politics, I had been appalled by the disrespect, scorn, and derision Democrats had hurled at Supreme Court nominees Robert Bork and Clarence Thomas, castigating good, intelligent men as though they were repugnant criminals. The Democrats’ crass comments and actions filled me with revulsion. It didn’t seem right to me to condone that same sort of politically biased shredding of a doctor (or anyone else) simply because he had been nominated by President Clinton rather than President Bush.

  Beyond that, the simple truth was that the surgeon general did not set the nation’s policy regarding abortion. When the Senate had confirmed as surgeon general Dr. C. Everett Koop, an outspoken opponent of abortion, his service did not outlaw abortion in our country. Neither would we change the laws regarding abortion by nominating Dr. Foster. To me, the bottom-line issue was: Is the person qualified to do the job and serve with integrity?

  Conservative groups came out in strong opposition to Dr. Foster, while organizations such as Planned Parenthood and the National Abortion Rights and Reproduction Action League supported him. When word got out that I was supportive of Dr. Foster, some pro-life groups felt as though I was betraying them. Several prominent Republicans called Mark and told him straightforwardly that if I wanted to end my political career quickly, I should decide in favor of Foster. Suddenly, I was torn between supporting my senior Republican colleagues and standing for what I believed to be right. Welcome to Washington.

  During my first meeting with Bob Dole in his majority leader’s office, I was asked to vote against Foster’s nomination. I told Senator Dole that I could not do so in good conscience and I explained my position. To his credit, Dole told me to vote my heart, and he would respect that. In Bob Dole, I saw a true statesman in action.

  As a member of the Labor and Human Resources Committee, I took part in the hearings in which Dr. Foster was first officially questioned about his qualifications and his positions. The committee had the power to squelch the nomination right there or send it on to the full Senate for a vote. During the hearings, I posed many questions to Dr. Foster, allowing him to make or break his own case. I did, however, come to his direct aid when a hysterectomy Foster had performed was described by my Republican colleagues as an abortion. I felt the questions asked Dr. Foster about that case were misleading, so I cross-examined him almost like a trial lawyer, allowing him to clarify the facts. No doubt my support of Dr. Foster “rehabilitated” him in the eyes of several of my Senate colleagues and helped propel his nomination out of the committee with a nine-to-seven vote in favor, one yea vote being mine.

  Afterward, Ted Kennedy sang my praises, saying what a magnificent job Senator Frist had done in the hearings. Naturally, that didn’t sit well with my more conservative constituents back home.

  When the
nomination reached the Senate floor, it was met with resounding opposition by most members of my party. President Clinton eventually withdrew Dr. Foster’s nomination following a filibuster led by Senator Phil Gramm of Texas, so a full vote of the Senate was never taken. Ironically, although I was on the losing side of the Foster nomination, my positions began to define my place in the Senate. Perhaps I had demonstrated that I had truly come as a citizen legislator, an independent thinker, willing to buck my own party if necessary to do what I felt was right. Consequently, members of both parties began to seek me out privately with queries about various medical and health-care issues. They didn’t always agree with my prescriptions, but at least they were willing to consider my diagnoses of the problems.

  Later in 1995, Senator Dole appointed me as chairman of the Medicare Working Group, a task force charged with developing policies that would strengthen Medicare. It was a natural fit for me, drawing upon my experience chairing the state Medicaid task force back in Tennessee. I soon discovered that both the Medicare and Medicaid programs were growing at more than 10 percent every year, double the rate of the budget as a whole, and fueling the growth of the national deficit. For the first time, Medicare spending was exceeding the funds coming into the Medicare Trust Fund. As a government, we simply were overpromising to the next generation what we could deliver. Although nobody wanted to talk about it for fear of repercussions in the upcoming 1996 elections, if we didn’t impose some limits on the ever-increasing spending, and do it soon, the entire hospital trust fund would be depleted and bankrupt within seven years.

  Naturally, the Democrats, who loved to spend, seized on our proposed limits to future increases in spending and labeled them (using the press) as “cuts” in spending on Medicare, in an attempt to give the impression that those heartless Republicans were taking care away from the elderly who desperately needed it. I realized that we were going to get little accomplished on the issue until after the 1996 elections. My colleagues on the task force suggested that as a doctor, I could help calm the situation by appearing in a series of television ads refuting the Democratic charges that Republicans wanted to cut Medicare coverage. I was glad to do the ads, but I was beginning to understand what some people referred to as Washington’s voodoo economics. Only in Washington political circles could reducing the amount of increased spending be interpreted as a spending cut.