Bill Frist

Health care reform should begin with a more efficient and market-driven system rather than a broad expansion of insurance coverage, former U.S. Senate Majority Leader Bill Frist said Thursday.

“Let’s get costs under control using a transparent, competitive marketplace system and then expand coverage as we can,” he said.

Dr. Frist, a heart and lung transplant surgeon and the first practicing doctor elected to the U.S. Senate since 1928, spoke Thursday at a Rotary Club of Chattanooga luncheon.

After leaving the Senate in 2006, Dr. Frist now divides his time between his home in Nashville and Princeton, N.J., where he is a professor at Princeton University.

In a media briefing before the luncheon, Dr. Frist described health care costs and access as “the single most important domestic issue facing the United States,” and he underlined the urgent need for reform.

“Right now the costs of health care are going up for a typical family about three times faster than wages, and that simply can’t be sustained,” he said.

In his luncheon speech, Dr. Frist said the political left tends to focus more on expanding insurance coverage but pays less attention to the costs of providing that coverage.

He pointed to the collapse of TennCare, the state’s managed Medicaid program, about 10 years after it was implemented in 1994. At the outset, the program was seen as a national model for broadly expanding health care coverage, but TennCare’s expenditures grew out of control, leading to its dismantling and massive reform of the program.

“We have to be very careful. We have to learn from things like TennCare,” Dr. Frist said.

Commenting on the presidential race, Dr. Frist said he believes Republican nominee U.S. Sen. John McCain, R-Ariz., has the strongest stance on security but said Democratic candidates Sens. Hillary Clinton and Barack Obama have been much more specific on domestic issues such as health care.

“A large part of that is because the Democrat base ranks it as a higher priority than the Republican base,” he said.

Before his speech, Dr. Frist told the media he is thinking about a run for Tennessee governor when Gov. Phil Bredesen’s term expires in 2010.

“I have served the state of Tennessee, represented 6 million Tennesseans the last 12 years of my life, and the question is, ‘Are you going to consider that again in the future?’ And I am going to consider it,” he said. “We’ll look at it, and a decision will be made sometime after the first of the year.”

Jim Brexler, president and CEO of Erlanger hospital, who attended the luncheon, said Dr. Frist’s comments about considering both expanding coverage and controlling costs were right on target.

“You can’t do one without the other, and what’s happening in the country now is a consensus is forming that there needs to be coverage, and the only way we’re going be able to do it is to control and be more efficient about the quality and costs that we have, and so it’s just two different perspectives about which way to get to it,” he said.

Dr. B.W. Ruffner, the former dean at the University of Tennessee at Chattanooga’s College of Medicine who also attended the luncheon, said that, in addition to a focus on consumer education and ways to manage medical information, health care reform must include efforts to evaluate the effectiveness of new — and often expensive — medical technology, which he said is a significant driver of health care spending.

“I think he’s got a very practical perspective on things,” Dr. Ruffner said of Dr. Frist. “I think the real dilemma is whether those things will really bring the costs down enough. ... Certainly the things he described all need to be done.”

FAST FRIST FACTS

* Nashville native Bill Frist is a heart and lung transplant surgeon and the first practicing doctor elected to the U.S. Senate since 1928.

* After two terms as a senator, Dr. Frist left in 2006. He said he is considering a bid for Tennessee governor in 2010.

* As a senator, Dr. Frist authored the Medicare Prescription Drug Improvement and Modernization Act of 2003, which created the Medicare prescription drug benefit. It also created health savings accounts, tax-free accounts that can be combined with a high-deductible health plan. The contributions made to the accounts can be used to pay for out-of-pocket medical expenses.

* Dr. Frist has run seven marathons in the past 10 years.