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Ann Thorac Surg 1995;60:8-11
© 1995 The Society of Thoracic Surgeons
United States Senator, Tennessee
Last year, I spoke at the Annual Meeting of the Society of Thoracic Surgeons addressing specifically how a physician can, and should, become an active player in politics and public service. At that time, I stood before you as a candidate for the United States Senate. Today, I return as the 29th United States Senator from the State of Tennessee.
In our discussion last year, I painted a spectrum of five ways that physicians can become involved: First, using myself as an illustration, I said one could run for elective office. Although that is not possible for many, I hope that my candidacy and ultimate election to the United States Senate will serve as an inspiration to many others in our profession.
Second, I encouraged physicians and others in the medical arena to support candidates at all levels of government, from city and county officials all the way through national office. This means moral support and financial support.
Third, I feel that each physician should select an issue and actively voice his or her concern. Last year, an issue that many of you chose was that of the Clinton health care plan and we, along with the help of the American people and small business, reversed the trend to more centralized and bureaucratic control of our health care system.
Fourth, I suggested that each of you get to know your own legislators. Get to know your legislators on a first-name basis so that they feel free to call you and you to call them. Your input is vital.
Fifth, participate at a grassroots level. That may mean writing letters to your local newspaper or participating on community panels. Your presence in the community goes much further than you can possibly imagine in shaping public policy.
That was last year, and I now stand before you as one of 100 United States Senators. At that time neither I, as your speaker, nor the electorate at large could have predicted the political earthquake that occurred on November 8, 1994.
My presence here today—the fact that I, who just a little over a year ago was performing heart and lung surgery, stand before you as a United States Senator—is a testament not to me, but to the power of the individual voter—the individual wage earner, the individual taxpayer—and proof that our American system still works.
Thirteen months ago with no political experience I left the operating room at Vanderbilt University to do my best to help change the direction of the country.
Was my success in the election just the antiincumbency mood? No; in fact, 24 of the 26 incumbent Senators running last year won their races. The only full-term incumbent Senator who was defeated was my opponent. Incumbents are tough to beat.
Was it the year of the newcomer to politics? No. In fact, of my class of 11 freshman Senators (all Republican, the largest freshman class since 1980), I am the only true outsider, the only real newcomer to Washington. Of my class seven have served as Congressmen, one was a Governor, and two others were aides to high-level Washington officials.
``Why did I run?'' I had a great income as a surgeon, a job of respect in my community. I would have to uproot my wife Karyn and our three sons from a community we love, and put on hold a medical practice I had spent 15 years building. I ran for the United States Senate because in my heart I truly believe that our country has been moving in the wrong direction. Congress had lost touch with our basic values. And I honestly felt that if elected to the United States Senate, I could make a difference.
First, I have three young sons, and they are the reason I ran. Looking ahead, I saw Harrison, Jonathan, and Bryan growing up in a world of decreasing opportunity— a world of faltering family and moral values. Second, as a physician in the private sector, I have watched big and bigger government and increasing regulations bleed the spirit of our country—bleed the spirit of hard work and creativity in our practices. Third, as a taxpayer, I have witnessed the diminishing value of government for every tax dollar spent, with more tax dollars being wasted than ever before.
Last week, in testimony before the Budget Committee of the United States Senate, Martin Gross, government critic and author, outlined a litany of absurdities and waste in government today. He cited 82 different state and federal programs spending more than $360 billion on welfare. He calculated that if you simply gave that money directly to the people in the welfare system, they would each get $14,500 a year—$58,000 for a family of four. As he pointed out, no one today sees near that much money in benefits. It is eaten up by duplication and waste.
I blame the US Congress for this because Congress has not only allowed this to happen, but has actually passed laws to make all this happen.
Before making the final decision to run, I wanted hard data to determine whether or not my opponent, 18-year incumbent Senator Jim Sasser, future leader of the Democratic party, could be defeated. All press accounts at that time depicted Jim Sasser as unbeatable. Therefore, in July 1993, sixteen months before the general election, I conducted a survey of 800 voters in Tennessee. Hidden in the data was the answer to the question, ``Can the man everyone says is invincible really be beat?''
The findings of the survey that argued against challenging Jim Sasser were:
Sasser's reasonable approval rating and his position as Budget Committee Chairman would ensure that he would have all the campaign financing he could possibly want.
But in the survey findings was one important and telling finding that led me to run. In response to the question, ``In general, do you think that Jim Sasser deserves to be reelected as US Senator, or do you think it's time to give someone else a chance?'' only 34% of the respondents said he deserved reelection and 48% said it was time for someone else. That one piece of data told me I could win.
Yes, at the outset my brothers and sisters, and all of my friends, questioned my sanity; even just days before the general election people would still ask me, ``How in the world can you, a heart transplant surgeon with absolutely no political experience, really expect to make a difference in Washington? You will be the last in seniority. The Republicans will probably be in the minority. You don't know the congressional system at all, and in fact you don't even have any close friends who are politicians.''
I took a leave of absence on December 15, eight months before the August primary. On January 1, I had a few pieces of furniture, a few pieces of office equipment, a fax machine, three staff members, and a database consisting of the 270 names on my Christmas card list. I did not have a political godfather. I did not have the backing of the Republican leadership. But I had a core of dedicated friends and family who believed in me. Candidly, although my friends and family believed in me, deep in their hearts, they really did not think I could win, but they were going to support me anyway.
I was told by the political pros that I could not win. I did not fit the acceptable political profile. I was told not to run.
First, according to tradition, you cannot win a statewide race in Tennessee as a Republican unless you are from East Tennessee, or unless you have developed a broad political base with high name identification. I am from Nashville, which is in Middle Tennessee. Strike One.
Second, I had never held public office, I had never run for public office, and I had never been involved in elective politics. I am a doctor and there has not been a practicing doctor elected to the Senate since 1928. Doctors, I was told, were perceived as elitists, not in touch with reality; doctors, according to public polls, drove fancy cars and lived in big houses. They were not in touch with the common man. Strike Two.
Third—as my staff loves to remind me, and as was plastered on TV screens across the state daily—I had not even voted during the years of my medical training. Republicans said this would be fatal. Strike Three.
Indeed, like so many of you, I had been one of those people who was caught up in focusing on my personal life, raising a family, and building a medical practice. I had always trusted elected officials to do what was right—to do what they said they were going to do. I paid my taxes, but never paid attention to how my tax dollars were spent. In effect, I was one of those people—one of the majority, I might add—who had allowed this country to get in the miserable shape it is in today.
Not unlike some of you in this room, I woke up one day, looked around, and was struck by the fact that I was a part of the problem. But I also felt that I could be a part of the solution. No longer could I sit in the doctor's lounge between open heart cases, complaining about the future of this country. It was time to act, to participate, to become a part of the solution.
As a candidate, I studied the political traditions in Tennessee, and I respected those political traditions, but I knew I would have to chart a totally new course to win. A traditional approach could not defeat the incumbent Senator who was slated to be the next majority leader in the Senate. I ran a contrarian, unconventional campaign.
First, conventional wisdom said, ``Run the primary principally in East Tennessee—the heart of Republican territory.'' I ran statewide.
Second, conventional wisdom said, ``Run against your Republican opponents in the Republican primary, not the incumbent Senator.'' From day one, because I knew to beat Sasser my primary challenge would be to educate the voter as to his liberal voting record, I ran my campaign against Sasser, almost never mentioning my five primary opponents.
Third, conventional wisdom said, ``Focus entirely on the Republican voter during the primary.'' I made a broad public appeal to Independents and conservative Democrats to join my effort.
I set and announced my goals early. I announced a goal to have a volunteer campaign organization in each of Tennessee's 95 counties. The traditional Republicans told me this would be impossible.
I told Tennesseans that I was going to run the most focused, most disciplined and broadest-based campaign in Tennessee history. And that I was going to do everything I could to earn their respect. I said that after I had earned their respect as a candidate, I was going to come back and ask them to contribute financially to my campaign.
I announced that I was going to have thousands of contributors to my campaign and they would be from all 95 counties. Many old pros in the state laughed. The pundits said it would be impossible to do in the primary against five other candidates with two other statewide races going on at the same time. Too much competition for the few dollars.
The political pundits continued to write that no one was going to give to my campaign. They would say, ``You're a doctor, you have money. You can finance the campaign yourself. No one will give to you.'' My response was that I would not use any of my own personal resources in the campaign until Tennesseans demonstrated that they believed in me and would support me broadly.
I relied heavily on direct mail—politically as well as financially. I campaigned in every single county. My campaign headquarters had an ``Open 24 Hours'' sign flashing—and someone was always there monitoring an 800-number around the clock.
By the end of the primary in August, my campaign had developed a volunteer organization in all 95 Tennessee counties. We had raised more than $1.2 million, and we had contributors from every single county in Tennessee. We soundly defeated all five primary opponents (one of whom was an East Tennessean who had the blessing and the backing of the traditional Republican establishment).
During the three months between the primary and general elections, I stayed with the very simple message that we had used in the primary (``18 years is long enough''). I religiously focused on Jim Sasser and his liberal voting record throughout both the primary and general elections.
Three million pieces of direct mail, two million phone calls, more than 9,000 volunteers, and a statewide organization in all 95 counties—we accomplished a lot with our grassroots network. By the end of the general election, more than 10,000 Tennesseans had given money to our effort. No challenger race in Tennessee history had seen this many contributors.
Ultimately, a heart transplant surgeon with no political experience defeated a popular 18-year incumbent United States Senator—a Democratic leader and Chairman of the US Senate Budget Committee—by an astounding 14 percentage points, 56% to 42%.
The Tennessee media and the hardcore Democrat and Republican political traditionalists were surprised—no, they were absolutely flabbergasted. But the people of Tennessee—the wage earners, the taxpayers, the voters—were not surprised. They knew all along what was happening. We reached out to each of them and they—as individuals—made it happen.
On November 8, the beginning of change occurred. I want to emphasize this—the beginning of change occurred.
But we have done the surgery. We have done the transplant. Like in a transplant patient, the old, worn-out heart has been removed and the new heart has been transplanted, and we are at the point where it is about ready to start to beat. We have yet to begin the recovery stage.
On November 8, not a single incumbent Republican Senator, Republican Representative, or Republican Governor was defeated. The Republican Party emerged in state after state as the Party of Change—The Party of the Future.
We want lower taxes, less spending, and fewer regulations. We favor small government because we believe that individual freedom and individual responsibility are far preferable to government power and government responsibility. Individual responsibility results in the most opportunity for the greatest number of people to achieve. Freedom and opportunity lead to success, happiness, and self-esteem.
Now what does all this mean for America? Well, it has taken more than 40 years for the country to get in the shape it is in now.
This one election cycle is not going to completely change everything. If you do not believe it, go to your library and review the newspaper articles from the election in 1952—the year General Dwight D. Eisenhower was elected President of the United States. His coattails provided the GOP with a majority in both Houses of Congress. The newspaper articles in 1952 read almost exactly like they did after the election of this November. But just two years later, Democrats turned everything upside down and regained control of both Houses of Congress.
And remember recent history as well. It was just two years ago in 1992 that the Democrats had a large freshman class of 62 members in the House who were celebrating their triumphs after the elections. They had just recaptured the White House for the first time in 12 years, and they felt they had a mandate to govern. They were wrong!
How active have physicians been in the Congress? I am the first practicing physician elected to the United States Senate in 66 years. I am the first practicing physician ever to be elected to the United States Senate without having previously sought or held another public office.
Since 1879, there have been 46 United States Senators who have received some medical training. Thirty-four have practiced medicine. I am only the fifth practicing physician to have served in the Senate during this century. The medical institutions attended by previous Senators include the University of Pennsylvania (10), Edinburgh (Scotland) Medical College (3), Harvard (2), and Jefferson (2).
Of the total of five physicians in the 104th Congress, I am the only physician in the United States Senate. Jim McDermott, MD (Washington), a psychiatrist who is the only Democrat physician in the Congress, was reelected to the House of Representatives. Newcomers to the House of Representatives include Dave Weldon, MD (Florida), Greg Ganske, MD (Iowa), and Thomas Coburn, MD (Oklahoma). There are two Governors who are physicians: John Kitzhaber, MD (Oregon), and Howard Dean, MD (Vermont).
Thus far, two major pieces of legislation have passed both Houses of Congress, one on Congressional accountability and the other on elimination of unfunded mandates. The pace in Congress today is faster than at any time in recent history. The next major issue to be addressed is that of the Balanced Budget Amendment. The Balanced Budget Amendment has broad public support across this country, but it is doubtful that enough votes will be gathered in the Senate for passage. If not, it is likely to be the number one issue in the Presidential election two years from now.
As to the future of health care, there will not be one major, comprehensive health care plan passed in the near future. The approach will be incremental and will focus on the marketplace. Issues that will be addressed this year include preexisting illness, portability of insurance, tort reform, and deductibility for the self-employed.
Clearly the debate on health care issues has been redefined. Last year it was the role of the federal government to control health care. This year the role of the federal government will be to establish an environment so that the marketplace can function.
The most important challenge facing the United States Senate is to balance the federal budget. Earlier this week, the Director of the Congressional Budget Office testified before the Senate Budget Committee. He projected that the annual federal deficit will reach $284 billion by the year 2000 and that by the year 2005, the budget deficit will climb to $421 billion. The deficit clearly destroys the future of our children; it destroys the American Dream for the next generation.
The driving force behind this deficit is the entitlement programs. The largest of the entitlement programs, other than Social Security, are Medicare and Medicaid. These, therefore, will be the focus of budget scrutiny over the next several years. Whereas all other government spending has been projected to grow at 5% a year, the projected growth in both of these programs is 10% a year. The challenge for both you and me is to maintain high quality of care and reduce the growth in spending in these two programs.
The most important thing I can say to you is to stress that nothing, absolutely nothing, will change in America if you, as an individual, walk away from November's election and believe you have done your duty.
Friends, your duty—just like my duty in the Senate—has just begun. We have not yet made true change. We have only made possible true change in this country's direction. What can you do as a citizen?
Your elected officials cannot do their jobs alone. We have seen what happens when Americans take their government for granted: destruction of the American Dream, a debt that mortgages the future of our children.
My pledge to Tennesseans is that I will be a true citizen legislator: that I will go to Washington, for a period of time, with a mission to accomplish and not a career to protect, and then I will return to Tennessee to live under the laws that I helped pass. For the next six years I hope that you will consider me the third Senator from your state. I will make the same commitment to you that I have made to Tennesseans, and I ask of you the same that I have asked of them. Help me be the very best United States Senator I am capable of being, and work with me to change the direction of this country.
And finally, we need to all join in as participants in the evolution of public policy. Let me close with the words of Theodore Roosevelt:
Let's all be in the arena.
Footnotes
Presented at the Twenty-eighth Postgraduate Program of The Society of Thoracic Surgeons, Palm Springs, CA, Jan 29, 1995.
Address reprint requests to Senator Frist, 4205 Hillsboro Rd, Suite 306, Nashville, TN 37215.
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