Last time I ran into Bill Frist, he was sounding distinctly nonpartisan on a panel discussion about preventive care and social determinants of health. We then talked about comparative effectiveness research at Vanderbilt, where he is affiliated, and he was so enthusiastic that he took my notebook out of my hands and began sketching diagrams of DNA molecules (at least I think that's what they were.) I asked him why he didn't write on op-ed about this, given that the research has been so controversial among his fellow Republicans. As far as I know, he hasn't written that an op-ed -- but he just penned an endorsement of an individual mandate to purchase health insurance.

The mandate is a lynch pin of effective insurance market reform and it's coming under increasing Republican attack. Some state legislators are even talking about amending their constitutions -- a largely symbolic conversation among conservatives -- to ban such a requirement.

In his guest column for U.S. News and World Report, Frist called for an individual mandate. He wants to begin smaller than the bills currently being considered in Congress, recommending a mandate for catastrophic coverage as "an appropriate place to start." But he defined catastrophic coverage as good enough to protect people from bankruptcy from medical bills, and made clear that he favors expanding coverage as the economy improves.

Of course, a number of Frist's former colleagues were for a mandate before they were against a mandate, and the idea was injected into the national debate (at least when I first became aware of it) in 1993–94 with by a Republican, albeit a moderate one, the late Sen. John Chafee. That was before Frist won his first Senate term in the 1994 Republican tidal wave.

 Frist writes (emphasis ours) :

In our reimbursement-driven, public-private health sector (which delivers the most robust health services on the globe), the only way affordable access can be achieved is for every citizen to have some type of insurance... No industrialized country in the world leaves such a large proportion of its citizens without coverage. And insurance matters. Those without health insurance on average receive poorer care and die sooner.

 He added,

No family in America should fear bankruptcy because of an accident, a child's cancer, or a heart attack. That is the purpose of insurance. An individual mandate is the only way to achieve affordable insurance coverage for every American in a pluralistic, public-private sector.

The former Senate majority leader made some effort to cast the mandate in a conservative light. He said it would eliminate wasteful cost-shifting, enhance transparency, reduce adverse selection, and make the insurance market function better. But his basic pitch was a moral one. People need to be covered. A mandate is the best and fairest way to achieve that.

Judging from what we're seeing in the Senate, conservatives are not going to rush to his side. But his comments might add a bit of ammunition and fortitude to those in the center who may play an outsized role in determining the contours of reform.

We're looking forward to reading Frist next on comparative effectiveness. We can even suggest an opening paragraph. Something along the lines of :"Conservatives should embrace research designed to improve the quality of American health care, and make sure that our hard-earned dollars don't get wasted on care that doesn't work or isn't needed."