Quotes of the Day

Senate majority leader Bill Frist likes to tell a story from his days as a pioneering heart surgeon back in Tennessee. A lot of times, Frist recalls, you'd have a critical patient lying there waiting for a new heart, and you'd want to cut, but you couldn't start unless you knew that the replacement heart would make it to the operating room. You didn't want a mistake like opening up the transplant cooler and seeing it filled with Coca-Cola. "A lot can happen at the end," Frist says with a laugh.

A politician, like a surgeon, is tested on deadline, when all the preparation and the pressures come together to be manipulated into success by a cool professional. Frist, the politician, will look back on this time as the moment when his operating skills either saved or failed him. At stake are nothing less than the most sweeping energy bill in 11 years and the biggest overhaul of Medicare since the health program for the nation's seniors was enacted in 1965.

When he succeeded Trent Lott as Republican leader in the Senate in December, Frist seemed the ideal replacement. Jetting to Africa often to perform surgeries, he was a contrast to Lott, whose racially insensitive remarks drove him from the leadership. With his Princeton-Harvard pedigree, youthful looks and daily running schedule, he was a perfect fit for the hyperathletic President, who portrays himself as a compassionate conservative.

But in the 11 months since he took over from Lott, Frist has confounded critics and admirers alike—proving himself both more nimble and less adroit than many expected. Despite his discipline—he sleeps only four hours a night—critics accuse him of making amateurish mistakes in managing the Senate calendar. And despite his gentle bedside manner, he is a ruthless, crafty warrior for George W. Bush, not afraid of doing what it takes to outmaneuver the Democrats.

Medicare could turn out to be his—and the President's—grand domestic prize going into the election. The proposal before Congress would reform the program in myriad ways, most notably by giving seniors their first prescription-drug benefit. Democrats, who also know that a Bush victory on prescription drugs would be politically devastating, are scrambling to stop the $400 billion measure. More important, Democrats oppose the bill's embrace of private-style health care, its failure to rein in pharmaceutical companies and its generous subsidies for hmos. The House narrowly passed the controversial measure early Saturday morning, 220-215, but only after the vote was held open for nearly three hours so both Republican leaders on the floor and Bush on the phone could browbeat G.O.P conservatives, angry that the bill didn't contain enough market reforms, into switching their votes.

If Democrats, for their part, seem apoplectic over Medicare, it's also because the Republicans have stolen the issue from them. And Frist, as much as any other Republican, is the one who helped take it away. He kept top Democrats like minority leader Tom Daschle from the conference that wrote the bill, not an unheard-of maneuver against a Senator of lesser rank but a brassy one to be pulling on the chamber's top Democrat. Instead Frist handpicked the Democratic Senators he would negotiate with: Louisiana's John Breaux, who worked with him on a Medicare-reform panel and who shares his views; and Montana's Max Baucus, who was just as eager to cut a deal.

Shut out of the room, a hapless Daschle tried to play an outside game—rallying seniors against the measure. But Frist outfoxed him. He began huddling privately with top aarp officials last December and held some 15 meetings with them over the next 11 months. Frist was dogged, tracking down aarp executive William Novelli at home or on the road to trade ideas by cell phone on reforming Medicare. "I don't think they were used to that," Frist told Time, noting that Republicans had traditionally seen the group as being too close to Democrats. "But I made it clear I needed them." It worked. aarp—which boasts 35 million members—threw its weight behind the G.O.P overhaul.

At the same time that Frist has been poaching in Democratic territory, he has been careful to protect his flank with the G.O.P's hard-liners, who were worried at the outset that he was a closet moderate. Late last spring conservative and evangelical groups bluntly warned Frist that their activists would sit out next year's elections if they didn't see him cracking down on Democratic filibusters of conservative judges. "He got the message," says Free Congress Foundation chairman Paul Weyrich. Earlier this month Frist staged a 39-hour talkathon on the Senate floor to harangue the Democrats on the judges they blocked. The gabfest infuriated Daschle, who claimed Frist double-crossed him. Daschle had agreed to Frist's request to keep the Senate working through Veterans Day so it would have more time to clear its usual backlog. Only later did he learn that Frist also planned to use the week's extra time for a Republican telethon to promote conservative justices. Daschle dismissed it as a "colossal waste of time"—the judges remained blocked—and Democratic whip Harry Reid accused Frist of "amateur leadership." Many Republican Senators privately admitted that "it was a mindless walk into a cul-de-sac," as one put it, "designed to appeal to the 20% of our base that listens to Rush Limbaugh every day." Still, Frist had done what he set out to do: appease the restless troops on the right.

Frist, who was Bush's favorite candidate to replace Lott, has made rookie mistakes in his first year as majority leader. That may not be too surprising for a man who ascended to the post after being in the Senate for only eight years, having spent his career as a surgeon and then earning millions of dollars from HCA Inc., a hospital chain his father and brother founded. Last April Frist publicly agreed to a tax-cut package that was $200 billion less than what House Republican leaders wanted. House Speaker Dennis Hastert was furious, and Frist spent weeks healing the rift. Republican Senators trying to push the initial energy bill through the Senate last June publicly griped that they couldn't build momentum behind the measure because Frist kept pulling it from the floor to deal with other legislation. Even Senators who are part of Frist's leadership team were irked earlier this month when he slipped up and allowed the $87 billion spending bill for Iraq and Afghanistan to pass without a roll-call vote. It let off the hook Democrats who didn't want to be seen as voting against the troops.

At the same time, Frist's hardball tactics—shutting out Democratic lawmakers, springing important bills just before arraignment and counting on exhausted opponents to give up—may come back to haunt him. For one thing, cooperation from angry Democrats may be even harder to secure now on complex measures like the $31 billion energy bill, which was snarled in the Senate last week because of disputes over ethanol subsidies and liability protection for makers of gasoline additives. "The environment in the Senate is as poisonous as I've ever seen," says a worried Republican Senator.

But farther down Pennsylvania Avenue, at the White House, the President sees Fristy—his nickname for the doctor—as not just an ally in the Senate but also a key player in his 2004 campaign. "It's a lot easier running for re-election after having passed a major Medicare reform," a presidential adviser says. The President, who never warmed to the independent-minded Lott, began his alliance with Frist during the 2000 campaign, when Bush tapped him to be a liaison to the Senate. Since then, Frist has cultivated the President too and hunted with Dick Cheney and top adviser Karl Rove. "He wants the President to like him," says a White House insider. "You can tell."

For his part, Frist says, "my leadership style is pretty simple: define a mission, be able to write it on a single card in a single sentence." The kindly exterior has always masked his aggressive nature. Heart-transplant surgeons are like that. "They are people who are disciplined, are focused, are no-nonsense," Frist says. "The timid people in medicine don't go into the field of cutting hearts out and putting them in." Tom Daschle would surely agree.

• Douglas Waller and Matthew Cooper