SUBSCRIBE TO OUR FREE NEWSLETTER
Daily news & progressive opinion—funded by the people, not the corporations—delivered straight to your inbox.
5
#000000
#FFFFFF
5
#000000
#FFFFFF
centers for medicare and medicaid services
'Unfit': Trump Nominates Dr. Oz to Run Medicare
"By nominating RFK Jr. and Mehmet Oz," said one public health expert, "Trump is giving his middle finger to science."
Nov 19, 2024
If confirmed to be the next U.S. secretary of health and human services, anti-vaccine activist Robert F. Kennedy Jr. could be working "closely" with another official who's infamous for his questionable health guidance: Dr. Mehmet Oz, who President-elect Donald Trump on Tuesday nominated to run the Centers for Medicare and Medicaid Services.
Trump said in a statement that if confirmed, Oz would "cut waste and fraud within our Country's most expensive Government Agency"—a plan that advocates for Medicare said would be carried out by privatizing the healthcare program that serves more than 66 million senior citizens.
As The Lever reported in 2022, Oz aggressively pushed Medicare Advantage plans on his show, The Dr. Oz Show, airing one segment about the insurance agency MedicareAdvantage.com and urging viewers to sign up for the program via a hotline. Insurance companies that offer Medicare Advantage plans are notorious for requiring "prior authorization" for doctors to provide certain medical procedures, subjecting patients to deceptive marketing, and harming senior citizens.
Considering his opposition to traditional Medicare, Matt Stoller of the American Economic Liberties Project said Oz "is not a good pick for a very powerful position in charge of a trillion dollars of healthcare spending."
The advocacy group Social Security Works noted that plans to "completely privatize Medicare" are also in Project 2025, the far-right policy agenda that Trump repeatedly tried to distance himself from while campaigning.
"Hands off our earned benefits!" said the group.
With Trump's support, Oz unsuccessfully ran to represent Pennsylvania in the U.S. Senate in 2022. The president-elect said Tuesday that if confirmed, Oz would work closely with Kennedy "to take on the illness industrial complex."
Kennedy's proposals for doing so include halting research on drug development, removing teeth-strengthening fluoride from drinking water, and firing Food and Drug Administration employees who have waged a "war on public health" through the "suppression" of the veterinary drug ivermectin and raw milk, which has been associated with disease outbreaks.
Oz has spent years peddling health advice, half of which University of Alberta researchers found to be "baseless or wrong" in a 2014 study published in the British Medical Journal. He promoted a study claiming coffee bean weight loss pills would "burn fat fast for anyone," but the research was later retracted. Oz also claimed that eating certain foods like red onion and endive could reduce a person's cancer risk by up to 75%, leading one paper published in the journal Nutrition and Cancer to assert, "Reality Check: There is no such thing as a miracle food."
Oz has also maintained close ties to multi-level marketing companies that promote products like vitamins with false claims about their ability to treat, cure, or prevent diseases.
"Dr. Oz is unfit to run CMS," said Lawrence Gostin, director of the O'Neill Institute at Georgetown University. "He peddles conspiracy theories on vaccines and fake cures. He profits from fringe medical ideas."
"By nominating RFK Jr. and Mehmet Oz," he added, "Trump is giving his middle finger to science. Having worked for 40 years in public health, it's utterly disheartening."
Keep ReadingShow Less
Alarms Raised Over For-Profit Medicare Advantage Using AI to Deny Care to Seniors
"Insurers using AI to deny needed care to seniors and people with disabilities means sacrificing patient needs on the altar of corporate greed," said one campaigner.
Jun 25, 2024
Dozens of Democratic U.S. lawmakers joined consumer and patient advocates on Tuesday in sounding the alarm over the use of artificial intelligence by companies providing Medicare Advantage plans to deny healthcare to their senior customers.
Fifty-one Democratic members of Congress and Independent Sen. Bernie Sanders of Vermont wrote to Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Books LaSure on Tuesday expressing their concern over Medicare Advantage (MA) providers' increasing use of algorithmic systems to deny patient care.
"Plans continue to use AI tool to erroneously deny care and contradict provider assessment findings," the letter notes. "Last year, a class action lawsuit was filed alleging that UnitedHealth Group unlawfully used an AI algorithm, nH Predict, to deny rehabilitative care to sick Medicare Advantage patients."
"The lawsuit cites an investigation suggesting that UnitedHealth Group pressured employees to use the algorithm to issue payment denials to Medicare Advantage beneficiaries and set a goal for employees to keep patient rehabilitation stays within 1% of the length of stay predicted by nH Predict," the lawmakers continued.
MA plans are not part of Medicare. They are a private health insurance "scam" created by a Republican-controlled Congress and signed into law by then-President George W. Bush "as a way of routing hundreds of billions of taxpayer dollars into the pockets of for-profit insurance companies," according to frequent Common Dreams opinion contributor Thom Hartmann.
Advocates have warned about the use of AI in MA denials since at least last year, while imploring congressional and regulator action to protect seniors and people with disabilities from being preyed upon by what critics have called "Medicare disadvantage" companies.
In February, CMS "clarified that Medicare Advantage organizations may use algorithms, artificial intelligence, and related technologies to assist in making coverage determinations, but these technologies may not override standards related to medical necessity and other applicable rules for how coverage determinations by Medicare Advantage organizations are made."
Rights groups echoed the lawmakers' concerns about the use of AI for MA denials.
"Medicare Advantage insurers using AI to deny needed care to seniors and people with disabilities means sacrificing patient needs on the altar of corporate greed," Public Citizen executive vice president Lisa Gilbert said. "CMS must expand upon the steps it has already taken to improve oversight of companies using AI to deny care that would be covered by traditional Medicare."
"It is time to protect enrollees by cracking down on Medicare Advantage insurers using AI to deny needed care through additional reporting requirements and increased enforcement actions against bad actors," Gilbert added.
David Lipschutz, associate director of the Center for Medicare Advocacy, said in a statement that "in our experience, MA plans' use of AI or algorithmic software has led to more inappropriate denials and premature terminations of care—this must end."
A report published earlier this month revealed that MA plans have overcharged the federal government by $612 billion since 2007—and $82 billion last year alone. Another report published last year by Physicians for a National Health Program found that MA plans are also overcharging U.S. taxpayers by up to $140 billion per year, enough to erase all Medicare Part B premiums or fully fund Medicare's prescription drug program.
A 2022 U.S. Senate Finance Committee investigation found that insurance companies and other brokers are "running amok" with "fraudsters and scam artists" making false or misleading claims to dupe seniors into buying MA plans. In February 2023, Reps. Mark Pocan (D-Wis.), Ro Khanna (D-Calif.), and Jan Schakowsky (D-Ill.) reintroduced legislation to change the official name of MA to "alternative private health plan" to make clear that such coverage is offered by for-profit companies.
Keep ReadingShow Less
'We Need Medicare for All Yesterday': US Healthcare Spending to Hit $7.7 Trillion
"The jaw-dropping figures," said one advocate, "highlight the need to move to Medicare for All immediately."
Jun 14, 2024
A federal analysis released this week projects that U.S. healthcare spending is set to rise to $7.7 trillion by 2032 and account for nearly 20% of the nation's economy, findings that single-payer advocates described as yet another indictment of the country's for-profit system and further evidence of the need for Medicare for All.
The Centers for Medicare and Medicaid Services' (CMS) Office of the Actuary said Wednesday that it expects national healthcare expenditures to outpace U.S. economic growth over roughly the next decade, "resulting in an increase in the health spending share of GDP from 17.3% in 2022 to 19.7% in 2032."
The CMS analysis showed that U.S. healthcare spending grew at a rate of 7.5% last year, with overall expenditures reaching $4.8 trillion. CMS said it projects health spending will rise by 5.6% annually over the coming years, with overall spending reaching $7.7 trillion by 2032.
Robert Weissman, president of the consumer advocacy group Public Citizen, said in a statement Thursday that the coming surge in healthcare spending "has nothing to do with improving care and everything to do with price-gouging, monopolization, and wealth extraction by insurance corporations, Big Pharma, and for-profit hospitals."
Despite spending more on healthcare per capita than any other rich nation, the U.S. consistently ranks last among its peers in health outcomes.
Weissman on Thursday pointed to an academic analysis published earlier this week in JAMA Internal Medicine detailing the massive costs of Medicare Advantage, a federally funded program run by private insurance companies. The paper notes that private Medicare Advantage plans have overcharged the federal government to the tune of $612 billion since 2007—much of which insurers pocket as profit.
"We have known for decades that healthcare costs in the U.S. are out of control," said Weissman. "The jaw-dropping figures from CMS highlight the need to move to Medicare for All immediately so that we can finally start to make healthcare more affordable for taxpayers, while ensuring everyone in America can access the care and medicines they need."
Studies have repeatedly shown that transitioning to a Medicare for All system—as proposed by Sen. Bernie Sanders (I-Vt.) and more than 120 other members of Congress—would save the U.S. hundreds of billions of dollars a year and countless lives compared to the status quo, which leaves tens of millions of people uninsured, underinsured, and unable to afford lifesaving treatments and medications.
Peer-reviewed research published in 2022 estimated that more than 338,000 coronavirus-related deaths could have been prevented in the U.S. if the country had a single-payer system that guaranteed coverage to all people as a right.
"Other countries spend far less per capita on healthcare while guaranteeing coverage and providing higher quality care," Weissman said Thursday. "It is time that we do the same."
Keep ReadingShow Less
Most Popular