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medicare
Dr. Oz Nomination Seen as Potential Boon for Medicare Privatization
"Dr. Oz wants to fully privatize Medicare," warned one advocacy group. "That’s why Donald Trump put him in charge of Medicare."
Nov 20, 2024
Dr. Mehmet Oz, whose unsuccessful 2022 Pennsylvania Senate bid included pitching voters on a plan to expand the privatized Medicare Advantage program, is now in a position to potentially actualize that plan.
President-elect Donald Trump announced Tuesday that Oz, also known by his TV personality name Dr. Oz, is his pick to lead the Centers for Medicare and Medicaid Services (CMS).
"Dr. Oz—a massive investor in Pharma—told the voters of Pennsylvania his plans to privatize Medicare… and they rejected him. Now Trump is giving him the authority to see his industry-approved plan carried through," wrote the progressive-leaning outlet The Lever, which covered Oz's support for Medicare Advantage back in 2022.
Through Medicare Advantage, which has been promoted by Trump and other congressional Republicans, seniors can opt out of traditional government-run Medicare health plans and instead choose plans administered by private insurers, such as UnitedHealthcare and Cigna.
According to The Lever's 2022 reporting, Oz pushed Medicare Advantage plans on his show The Dr. Oz Show and co-wrote a 2020 column for Forbes with a former healthcare executive in which they argued that a "Medicare Advantage For All" plan can "save" our healthcare system. In the column, Oz and his co-author articulated a plan to expand Medicare Advantage by imposing a 20% payroll tax.
Oz "is not a good pick for a very powerful position in charge of a trillion dollars of healthcare spending," wrote Matt Stoller of the American Economic Liberties Project on X, in reference to The Lever's investigation.
The Lever also reported that Oz's plan to expand private plans under Medicare Advantage could "boost companies in which he invests." For example, Oz and his wife owned up to $550,000 worth of stock in UnitedHealth Group, at the time of reporting. UnitedHealthcare and Humana account for nearly half, or 47%, of Medicare Advantage enrollees nationwide, according to the health policy organization KFF.
Additionally, a 2022 investigation by The New York Timesfound that major health insurers have exploited Medicare Advantage to boost their profits by billions of dollars.
Project 2025, a list of right-wing policy proposals led by the Heritage Foundation that Trump has tried to distance himself from, calls for making Medicare Advantage the default option for Medicare beneficiaries, which, if enacted, "would be a multibillion-dollar annual giveaway to corporations at the expense of Medicare enrollees and taxpayers," according to the liberal research and advocacy organization the Center for American Progress.
Robert Weissman, co-president of Public Citizen, offered a related critique of Oz: Americans "need someone who will crack down on insurers who want to deny care to the sick, providers who skimp on quality healthcare, corporations that want to privatize Medicare, and Big Pharma profiteers and ideologues who want to slash Medicaid and refuse care to low-income people. What they do not need is a healthcare huckster, which unfortunately Dr. Mehmet Oz appears to have become, having spent much of his recent career hawking products of dubious medical value."
In addition to the potential boon for private insurers, some researchers, news outlets, and members of Congress have also raised concerns about the quality of care administered under Medicare Advantage.
A 2022 government report found that "[Medicare Advantage Organizations] sometimes delayed or denied Medicare Advantage beneficiaries' access to services, even though the requests met Medicare coverage rules" and also "denied payments to providers for some services that met both Medicare coverage rules and [Medicare Advantage Organization] billing rules."
In October, a group of three Democratic lawmakers wrote to the current CMS administrator about increasingly widespread abuses and care denials by for-profit Medicare Advantage insurers.
"We are concerned that in many instances MA plans are failing to deliver, compromising timely access to care, and undermining the ability of seniors and Americans with disabilities to purchase the coverage that’s right for them," Sen. Ron Wyden (D-Ore.), Rep. Frank Pallone Jr. (D-N.J.), and Rep. Richard Neal (D-Mass.) wrote in a letter.
"We continue to hear alarming reports from seniors and their families, beneficiary advocates, and healthcare providers that MA plans are falling short, and finding a good plan is too difficult," they wrote.
In particular, they pointed to Medicare Advantage plans' growing reliance on prior authorization, a complex, barrier-ridden process whereby doctors must demonstrate a proposed treatment is medically necessary before the insurer will cover it.
"Overuse of prior authorization is not only harmful to patients, it hinders healthcare providers' ability to offer best-in-class service," they added.
Social Security Works, a progressive advocacy group, warned in a social media post Tuesday that "Dr. Oz wants to fully privatize Medicare."
"That's why Donald Trump put him in charge of Medicare," the group added. "We will fight to stop this charlatan from getting anywhere near our Medicare system."
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'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."
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Medicare Advantage: A By-the-Numbers Look at This Profit-Seeking Healthcare Scam
Proponents claimed it would lower costs and improve health care for seniors. It has achieved neither of those goals; instead, it has become a wildly profitable scheme for private insurance giants.
Nov 15, 2024
The quasi-privatized system called “Medicare Advantage,” otherwise known as Part C, was created in 2003 as a means of expanding the role of private sector corporations in the publicly-funded Medicare system. Proponents claimed it would lower costs and improve health care for seniors. It has achieved neither of those goals; instead, MA has become a wildly profitable scheme for private insurance giants, who have become adept at taking advantage of Medicare’s billing model to claim exorbitant profits. At this point, MA is more profitable for many companies than their conventional insurance businesses.
And the program continues to grow. Medicare Advantage now has more enrollees than traditional Medicare, thanks in no small part to aggressive public relations campaigns that sell seniors on the idea that the plans cut costs and increase choice. Congress has simultaneously failed to plug the holes in traditional Medicare, pushing seniors towards MA to avoid high out-of-pocket costs. Policymakers can fill these gaps and guarantee true comprehensive coverage simply by redirecting the overpayments to MA insurers into Medicare.
Numerous studies and media investigations have documented the problems with Medicare Advantage. What follows is a collection of some of the most notable figures documenting the high costs of this failed experiment in privatizing Medicare.
$88-$140 billion
The amount that the federal government overpaid private insurers under Medicare Advantage in 2022, according to the Physicians for a National Health Program (PNHP).
$612 billion
The amount that Medicare Advantage plans overcharged the federal government due to upcoding and favorable selection between 2007 and 2023, according to the Medicare Payment Advisory Commission (MedPAC), an independent congressional agency established to advise Congress on issues affecting the Medicare program.
$600 billion
According to one study, this is the projected excess spending between 2023 to 2031 due to the ways that Medicare Advantage plans use ‘upcoding,’ the process of classifying beneficiaries as being sicker than they really are in order to increase payments.
$35 billion
The amount that MedPAC estimates taxpayers will overpay MA insurers this year through ‘favorable selection,’ the practice of targeting healthy seniors for their plans.
$4.2 billion
The amount that MA insurers received for questionable home visit health risk assessments (and related chart reviews) in 2023, according to an October 2024 report from the Department of Health and Human Services.
80 percent
The percentage of mental health providers in a sample of MA plans that were determined to be “ghosts” (meaning they were unreachable, not accepting new patients, or not in-network), according to a recent Senate investigation.
1.8 million
Estimated number of Medicare Advantage customers whose health plans will be canceled in 2025.
167 percent
The amount that drug deductibles will increase for roughly two-thirds of all Medicare Advantage enrollees next year.
55.7 percent
The increase in MA care denials from 2022 to 2023, according to research from the American Hospital Association.
54 percent
The increase in the denial rate for long-term acute care hospitals in Humana’s Medicare Advantage plans from 2020 to 2022 (Senate Majority Staff Report, 10/17/24).
$660 million
The amount of taxpayer money that CVS/Aetna stashed away in 2018 by denying Medicare Advantage patients’ claims for treatment at inpatient facilities (Senate Majority Staff Report).
78 percent
The percentage of physicians in a 2023 American Medical Association survey who said that Medicare Advantage’s prior authorization processes caused a recommended treatment for a patient to be abandoned.
$6 billion
One estimate of the amount spent in 2022 on the marketing companies that work to attract new subscribers in Medicare Advantage plans.
556,068
The number of English-language TV commercials touting Medicare Advantage that aired during the seven-week open enrollment period in 2022.
$50 billion
The amount that the Wall Street Journal estimates private insurers received between 2018 and 2021 for “hundreds of thousands of questionable diagnoses that triggered extra taxpayer-funded payments.”
$2,329
The amount that MA insurers receive per beneficiary above the estimated costs of Medicare.
$1,730
The gross profit margin posted by MA companies in 2021 – more than double their profit margin on the individual market.
$172 million
The amount that Cigna agreed to pay in 2023 to “resolve allegations that it knowingly submitted and failed to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees to increase its payments from Medicare.” The Justice Department continues to investigate similar allegations involving other MA providers.
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