VOICES OF REFORM: Frist's View From Nashville

Former Senate Majority Leader Bill Frist was in town the other day, and we had a chance to talk for a bit after he took part in a distinctly nonpartisan discussion about social determinants of  health (and how much of it comes down to education). While he isn't closely involved in the health reform efforts in Washington, he is watching from afar - and he sounded a lot more encouraged as an outside-the-Beltway Republican than some of his colleagues sound here inside.

Frist divides his between teaching at Vanderbilt, work in global and public health, and his affiliation with a private investment firm focused on the healthcare industry.

He said he thinks it's highly likely we'll see legislation enacted this year that gets us "much much closer" to the goal of covering 100 percent of Americans. He didn't think we would necessarily cover absolutely everybody but he said he anticipated getting close on the coverage front, while also moving toward a delivery and payment system oriented toward "value-based' health care,  instead of the current system based on volume and the quantity of procedures rather than the quality of care.

"We need to shift from unit- based (payments) to value- based," he said. He was also supportive of payment reforms such as bundling (which pays doctors and hospitals for an episode of care and provides incentives for keeping patients out of the hospital). Frist also lauded aspects of this year's stimulus bill (which almost all Republicans opposed) for investments in health and healthy communities.

Frist was in town for an Alliance for Health Reform event on The Robert Wood Johnson Foundation's Commission to Build a Healthier America (on which he served). He spoke a lot about public-private partnerships in wellness promotion, about investing federal resources in childcare, nutrition and early education. He also spoke about the need to take the long view— a very long view. Some of these investments won't pay off for a generation, and therefore don't "count" in Washington's five and ten year budget windows.   But they need to be made.

Some of the measures he proposed might have raised eyebrows of some fellow conservatives still in Washington. For instance, it's common for conservatives to talk about how "consumers" should have "skin in the game," and pay out of pocket for the first dollar of their health care. Frist wanted to take some more skin out of the game, at least in terms of  ending copayments for prevention, wellness and screening (although I should clarify that we didn't talk about this in detail and I'm not sure whether he meant across the board for all health plans or for specific populations, or whether this should be a voluntary policy or a regulation etc).

We suspect that some of our readers will wonder why Frist wasn't calling for more of these policies and investments when he was a position to do something about it. Fair enough. But given the partisan cacophony in Washington these days, it was still good to hear a conservative Republican doctor calling for major reforms and significant long-term federal investments in keeping Americans healthy (and educated) and getting them the care they need. Nothing Frist said, at the panel discussion or in our subsequent conversation, sounded like it marched off a page of Frank Luntz's memo.

One topic that didn't come up - either in our conversation or at the Alliance event itself.  How much of a public health  "two-fer" is there in how we finance health reform, ie. how much bang for our buck (and how many bucks!) could we get by taxing sugary drinks or junk food? But the alliance helpfully included in a packet of articles distributed at the event (and available online) a New England Journal of Medicine perspective calling a sugary beverage tax "a key took in efforts to improve health." The co-author: Thomas Frieden, whom President Obama just tapped to head the CDC.

 (PS. An update -- Just after we posted this, the Senate Finance Committee put out a paper on financing options for heatlh reform -- and the sugary drink tax is in the mix.)