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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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Sick and Tired of Industry Greed, Activists Across US Target For-Profit Health Insurers
"I'm tired of insurance companies putting profit over people," said one activist at a Chicago rally.
Oct 12, 2023
Pushing back against insurers' annual denial of nearly a quarter-billion healthcare claims or pre-authorization requests, activists rallied in more than a dozen U.S. cities on Wednesday to demand "an end to private health insurance industry greed so people can get the care they need when they need it."
The Care Over Cost Campaign—a national grassroots initiative launched by the advocacy group People's Action—held rallies in cities including Baltimore, Maryland; Chicago, Illinois; Denver, Colorado; Detroit Michigan; Portland, Maine; and Hartford, Connecticut, known as the "insurance capital of the world." The campaign called on the industry lobby group America's Health Insurance Plans (AHIP) to "direct its members to put people over profit."
Activists implored AHIP and private health insurance corporations including Blue Cross Blue Shield (BCBS), UnitedHealthcare, Cigna, Humana, and Aetna "focus on ending the epidemic of care denials."
"CEOs at private health insurance companies profit off our pain and deny our healthcare. That's why people are rising up across the country to expose the lie that private health insurers are there for us when we need them," People's Action Healthcare for All campaign director Aija Nemer-Aanerud said in a statement.
"We all deserve the care we need when we need it, and it's time for greedy corporations like BCBS, Aetna, Cigna, and UnitedHealthcare to pay up and stop denying care," Nemer-Aanerud added.
According to Care Over Cost, private insurers deny more than 248 million claims and pre-authorization requests each year.
The campaign's demands include "sharing claims denial data, holding public meetings, ceasing lobbying, and working with policymakers and public authorities to transform the system to people over profit."
In Chicago, activists from groups including the People's Lobby, ONE Northside, and Jane Addams Senior Caucus held a "die-in" demonstration outside the downtown office of BlueCross BlueShield in support of what the organizers said are "the 700,000 Americans whose lives are impacted or lost due to lack of access to medical care from denied medical claims each day."
Activist Michael Grice, who lives with a disability, told rally attendees that "it took me over four years to get the wheelchair I'm sitting in now."
"I'm tired of insurance companies putting profit over people," Grice said. "They always do it for people with disabilities and senior citizens. I'm fed up with this garbage."
Illinois state Sen. Mike Simmons (D-7) addressed the Chicago rally, asserting that "it's not too much to ask in a developed democracy that people live long, healthy, prosperous lives."
"Those 700,00 denied claims—that's someone who needs insulin, someone who has an untreated liver condition," Simmons said. "That's somebody's aunt, somebody's mom."
Hartford rally attendee Kristen Whitney Daniels toldCT Insider: "This is an untenable situation. And it's only getting worse and worse every year, getting less and less covered."
"The frustrations are gonna boil over eventually," she added. "And [insurers] can either be part of the solution and working with patients to find ways to help patients have health, or they can be a part of the problem."
Responding to the protests, Alex Kepnes, executive director of communications for Aetna, toldCT Insider that the company wants to be "part of the solution."
"We believe that every American should have access to affordable, high-quality health coverage," Kepnes said. "The basic premise of making healthcare more affordable and simpler is at the core of CVS Health's transformation."
CVH Health, which owns Aetna, reported revenue of over $300 billion last year, with profits topping $4 billion—even as the company plans to lay off 500 Connecticut employees.
Daniels, who has Type 1 diabetes and other healthcare needs, said her insurance company, UnitedHealth, is part of the problem, making it extremely difficult to get the insulin she needs. She also said the company stopped covering one medication she needs a year after it was approved for coverage.
"I am tired of insurance companies getting rich off treating patients and disabled folks, like myself, as if we are expendable."
"The problem is this medication has worked so well for the last two years," Daniels said. "So I know how well it works. And then I want it and then I've been off of it for the last few months. And it's been horrible. It's like relearning to be diabetic again."
"I am tired of insurance companies getting rich off treating patients and disabled folks, like myself, as if we are expendable. I am not alone," she added. "That's why I am fighting and I will keep on fighting these claims and for affordable insurance that everyone has access to."
Phil Brewer, an emergency physician representing the single-payer healthcare advocacy group Physicians for a National Health Program (PNHP) at the Hartford rally, told CT Insider that "requiring pre-authorization used to be rare."
"Now it's routine," he added. "It also used to be that a human being actually reviewed the request, but now most requests are 'reviewed' by algorithm-driven AI programs."
At the Portland rally, Ronan Aubrey—whose family has a history of cancer—said they were surprised to receive a bill for a diagnostic ultrasound they thought would be covered by their insurance.
"Because my procedure was recommended by a doctor, I had assumed it would be fully covered. I was wrong," Aubrey told the Maine Beacon. "My insurer only covered a small part of the scan and procedure because I hadn't yet met my $3,500 deductible for the year."
"When an insurer tells us that medical care we need isn't covered, what are we going to do?" Aubrey asked. "My insurer shouldn't be deciding whether I should be getting a medical procedure—my doctor should."
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