PNHP

Hobbling Health & Human Services

Hobbling Health & Human Services

The federal health department, DHHS, just announced major cuts and organizational consolidation, claiming improved efficiency and effectiveness. We see dangerously shifting priorities and a refusal to engage with the real causes of our ailing health system.

HHS Announces Transformation to Make America Healthy Again, U. S. Department of Health and Human Services, March 27, 2025

Today, the U.S. Department of Health and Human Services (HHS) announced a dramatic restructuring in accordance with President Trump’s Executive Order, “Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.”

Fact Sheet:

  1. The plan combines personnel cuts, centralization of functions, and consolidation of HHS divisions, including:
    • The current 82,000 full-time employees will be reduced to 62,000
    • 28 divisions will be consolidated to 15
    • 10 regional offices will become 5
    • Human Resources, Information Technology, Procurement, External Affairs, and Policy will be centralized.
  1. Regarding FDA, CDC, NIH, and CMS:
    • FDA [Food & Drug Administration] will decrease its workforce by approximately 3,500 full-time employees, with a focus on streamlining operations and centralizing administrative functions. This reduction will not affect drug, medical device, or food reviewers, nor will it impact inspectors.
    • The CDC [Centers for Disease Control & Prevention] will decrease its workforce by approximately 2,400 employees, with a focus on returning to its core mission of preparing for and responding to epidemics and outbreaks. …
    • The NIH [National Institutes of Health] will decrease its workforce by approximately 1,200 employees by centralizing procurement, human resources, and communications across its 27 institutes and centers.
    • CMS [Center for Medicare & Medicaid Services] will decrease its workforce by approximately 300 employees, with a focus on reducing minor duplication across the agency. This reorganization will not impact Medicare and Medicaid services.
  1. The consolidation and cuts are designed not only to save money, but to make the organization more efficient and more responsive to Americans’ needs, and to implement the Make America Healthy Again goal of ending the chronic disease epidemic.
  1. No additional cuts are currently planned, but the Department will continue to look for further ways to streamline its operations and agencies.
  1. A new Administration for a Healthy America (AHA) will consolidate the OASH, HRSA, SAMHSA, ATSDR, and NIOSH [in brief: access, workforce, equity; substance use & mental health; environmental toxins; occupational health], so as to more efficiently coordinate chronic care and disease prevention programs and harmonize health resources to low-income Americans. Divisions of AHA include Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce, with support of the U.S. Surgeon General and Policy team.
  1.  HHS will have a new Assistant Secretary for Enforcement to provide oversight of the Departmental Appeals Board (DAB), Office of Medicare Hearings and Appeal (OMHA), and the Office for Civil Rights (OCR) to combat waste, fraud, and abuse.
  1.  HHS will combine the Assistant Secretary for Planning and Evaluation (ASPE) and Agency for Healthcare Research and Quality (AHRQ) into the Office of Strategy to conduct research that informs the Secretary’s policies and evaluates the effectiveness of the Department’s programs for a healthier America.
  1.   The critical programs within the Administration for Community Living (ACL) that support older adults and people of all ages with disabilities will be split across the Administration for Children and Families (ACF), Assistant Secretary for Planning and Evaluation (ASPE), and Centers for Medicare and Medicaid Services (CMS).

HHS Announces Transformation to Make America Healthy Again, YouTube, by HHS Secretary Robert F. Kennedy Jr. (6 minute video)

Comment:

By Don McCanne, M.D. and Jim Kahn, M.D., M.P.H.

Be afraid. Be very afraid.

These changes may appear innocuous, just bureaucratic streamlining. However, name changes matter, reflecting major policy shifts. For example, “Substance Abuse” (in SAMHSA) and “Toxic” (in ATSDR) are gone from the new agency names and thus focus. Also, you can be sure that “equity” (an explicit HRSA mandate) is expunged from the new health agency mix.

It has not been revealed exactly who proposed the structural changes in “Transformation to Make America Healthy Again.” From prior media reports we suspect Elon Musk, senior advisor to the president and de facto head of the Department of Government Efficiency (which still lacks official status as a governmental agency) plus his unqualified employees, all tacking to the preferences of Secretary Robert Kennedy Jr. and President Donald Trump. Remarkably absent are qualified health care professionals and economists who place patients first. Soon on the scene as head of CMS will be Dr. Mehmet Oz who wishes to privatize Medicare with Medicare Advantage. (He has proposed “Medicare Advantage for All” but that won’t happen – and if it did would pale in comparison even to current Medicare Advantage.) We have no idea how the new agencies hope to reduce waste, fraud, and abuse … and the DOGE current track record bodes poorly.

Considerable damage will be inflicted on important existing programs. The planned cuts in personnel (and presumably resources) for the FDA, CDC, and NIH will reduce their essential services and harm us: riskier drugs, weaker public health, and diminished discovery research. RFK Jr states that he will establish a new “Administration for a Healthy America” (“Ah Ha”, he says) … but we have zero confidence that this carefully crafted phrase actually portends improved government organization to strengthen US health care services.

Not to mention our need for a universal, comprehensive, equitably funded, affordable health care system that we can all be proud of. In contrast to what RFK Jr claims, our over-spending and poor longevity have nothing to do with DHHS functioning. As we’ve discussed in HJM, the excess mortality is due to higher risk factors (including obesity, opioids, poverty, guns, and traffic accidents) and … worse health insurance! Recent surges in mortality reflect poor COVID response and lack of insurance. Our higher costs are due to massive administrative waste as well as high prices for drugs and procedures.

The new HHS will shift health care dollars from public health and patient care to tax cuts for billionaires.

As we said, be afraid, be very afraid!

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Medicaid cuts? Work requirements? They’d make health care worse for all.

Medicaid work requirements are rooted in the idea that some people are deserving of health care and others are not. We need to stand firm against this idea.

By Zach Grissom and Arya Zandvakili, M.D., Ph.D.
Des Moines Register, March 25, 2025

As budget negotiations heat up, the U.S. Congress has proposed severe cuts to Medicaid nationally and the Iowa Legislature is considering Medicaid work requirements — both of which could place health care out of reach for thousands of Iowans.

Will Iowa’s top elected officials — U.S. Reps. Mariannette Miller-Meeks, Ashley Hinson, Zach Nunn and Randy Feenstra, U.S. Sens. Chuck Grassley and Joni Ernst, and Gov. Kim Reynolds — stand up for their constituents’ health care, or will they push forward policies that strip health care from Iowans? Are tax cuts for the wealthy more important to our legislators than access to health care and keeping rural hospitals open?

Medicaid enrollment in Iowa is between 600,000 to 850,00 in any given month since 2020. In 2022, the federal government covered 72.6% of Iowa’s $6.9 billion Medicaid costs, ensuring access to doctors, prescriptions and hospital care. Work requirements and cuts to Medicaid threaten coverage for thousands of working families and increase financial strain on rural hospitals.

Rural hospitals are the backbone of Iowa’s communities, providing everything from emergency care to maternity services. Cuts to Medicaid would mean less revenue to these hospitals and could push many to the brink — out of Iowa’s 93 hospitals, 31 hospitals have already lost services, 20 are at risk of closure, and five face immediate shutdown. Regardless of whether you use Medicaid, we all depend on the same hospitals. We need our legislators to protect and strengthen rural hospitals, not cut their revenue through decreased Medicaid funding.

On the issue of Medicaid work-requirements, 75% of Iowa’s Medicaid recipients are already working. The majority of those who are not working are in school, providing care to dependents, or are disabled. When Arkansas tried Medicaid work requirements in 2019, 17,000 lost insurance without a significant increase in employment. Experience shows that Medicaid work requirements just create waste and increased paperwork without achieving meaningful goals.

Medicaid work requirements are rooted in the idea that some people are deserving of health care and others are not. We need to stand firm against this idea. Whether you are rich or poor, working or not, we all deserve health care without being saddled with debt. This stance is not only moral. It is also motivated by the fact that our own well-being depends on the well-being of those in our community. When people lose access to primary care and other basic services, they are forced to delay care and become more reliant on emergency room visits; this places stress on the health care system and makes it more difficult to provide care for everyone.

Iowa’s elected officials must put people over politics by protecting Medicaid and the hospitals that keep our communities alive. Contact Grassley and Ernst and your representative and tell them to stand against Medicaid spending cuts. Contact your Iowa senators and representatives to stand against Medicaid work requirements.

Zach Grissom is a first-year medical student, a Navy veteran of nine years, and a founding member of Iowa Students for a National Health Program (iowasnahp@gmail.com).

Dr. Arya Zandvakili is a physician and chair of Iowa Physicians for a National Health Program (iowa@pnhp.org).

https://desmoinesregister.com…

Dr. Oz and the Plot Against Medicare

Medicare Advantage plans are killing seniors and bankrupting hospitals. Now the Trump administration is preparing to make them mandatory, ending Medicare as we know it.

By Alexander Zaitchik
Drop Site News, March 24, 2025

Presently tied up in Senate confirmation hearings, Mehmet Cengiz Oz, the Oprah-certified wellness advocate known as “Dr. Oz,” might soon become director of the Centers for Medicare and Medicaid Services (CMS). If confirmed, the daytime TV doctor has agreed to sell his roughly $600,000 in UnitedHealthcare stock, along with an array of medical industry holdings in devices, supplements, and pharmaceuticals.

Yet the mortal threat Oz poses to American healthcare goes deeper than his six-figure stake in the country’s biggest and most notorious private insurer. For years, Oz has worked as a pitchman for Medicare Advantage (MA) plans. This managed care alternative allows corporations to bill the federal government for administering Medicare benefits on its behalf, and is a boon for private insurers. As a UnitedHealth shareholder and licensed insurance broker, Oz has long been financially and ideologically committed to the takeover of traditional Medicare by private insurers. Led by UnitedHealth, the insurance industry has made a hugely profitable algorithmic science out of denying and delaying care to maximize profits.

Private insurers already receive more than half of Medicare’s $840 billion budget. With Oz’s confirmation in sight, they are now eyeing the rest. The first step, announced in the conservative policy blueprint Project 2025, is to make Medicare Advantage “the default enrollment” for newly eligible seniors. The long-term plan is the ruination and displacement of traditional Medicare entirely—and ultimately to a system, controlled by big insurers, that Oz calls “Medicare Advantage for All.”

There are two ways Republicans could orchestrate a frontal attack on traditional Medicare, with Oz’s boosterism for Medicare Advantage leading the way. The first and most difficult would involve an act of Congress that transfers current Medicare enrollees into Medicare Advantage plans. This would almost certainly trigger pushback in the courts, led by the 30 million Americans happily enrolled in Medicare.

The second gambit is slower, stealthier, and more likely to succeed. Operating beyond the reach of Congress, the Center for Medicare and Medicaid Innovation (CMMI) is a policy hub created within CMS by the Affordable Care Act. CMMI’s charter grants considerable powers to implement pilot projects to test different payment and delivery methods, waiving any troublesome provisions or statutes that may stand in the way. If these pilots are determined successful—defined as reducing costs without impacting quality, or improving quality without increasing costs—then CMS can ramp them up nationwide without Congressional oversight.

A source on the Hill and another within CMMI confirm that multiple pilots are being prepared to advance Medicare Advantage enrollment at the expense of Medicare. As called for in Project 2025, the first would make Medicare Advantage the “default enrollment” for newly eligible seniors. The second approach would move an as-yet unknown percentage of those currently in traditional Medicare into a Medicare Advantage plan.

The third would automatically assign all existing Medicare enrollees within certain counties to something very similar to a Medicare Advantage plan. This third project is likely to use a variation of the “geographic direct contracting model,” developed during the first Trump administration, but halted by the Biden administration.

All that’s required to implement these pilot projects across all of Medicare is for Oz, if confirmed, to deem them “successful.” Observers expect that thumbs will be placed on the scale during any assessment of the merits.

“They are likely to ignore comparative data from last twenty years, because all of that data shows Medicare Advantage and similar programs drive up the cost of health care while harming millions of Americans,” said Ed Weisbart, a retired family physician and national secretary of the Physicians for a National Health Program, a non-partisan organization representing more than 25,000 physicians and health care advocates. “Instead, they’ll fabricate their own measurements of success and use these pilots to turn our beloved Medicare program over to the investment community, indifferent to the untold harm it would cause.”

Any momentum in Washington to blunt the expansion of Medicare Advantage will face the headwinds of the industry’s immense lobbying power. The big six health insurers have quintupled their lobbying budgets since George W. Bush swung open the door to Medicare Advantage plans in 2003. Together, the big private insurers now spend more than $50 million on general lobbying, with many millions more going to individual political campaigns, including many of the Senate Finance members tasked with grilling Dr. Oz. The committee chair, Mike Crapo of Idaho, has alone received $446,000 in direct donations from the insurance industry since 2019.

This lobbying machine has grown apace with Medicare Advantage, the ascendance of which has only fed the insurance industry’s desire to complete the privatization of Medicare once and for all.

Disadvantaging Medicare

The project of privatizing Medicare began in the 1980s. For two decades after its 1965 inception, the Great Society program operated as designed, its success at once dull and spectacular: Doctors and hospitals cared for seniors then billed the government. Defined by clear rules and predictable reimbursements, Medicare provided security and quality care for tens of millions of Americans. The program had its imperfections, vulnerabilities, and unscrupulous actors, but insurers hyped small-time corruption into the program’s defining feature. This charge aligned with the Reagan administration’s operating assumption that the private sector could deliver the same care at lower cost and with more efficiency. The companies’ access window to Medicare was expanded by the Balanced Budget Act of 1997. With the 2003 Medicare Modernization Act, it was flown wide open.

Medicare Advantage plans have since eaten steadily into traditional Medicare, expanding its share from 13 to 54% of Medicare enrollment. MA now covers 32 million seniors. Spurred by this growth, the big six insurers have all entered the Fortune 500 for the first time. In 2003, UnitedHealthcare, the biggest of the big six, generated just over $1 billion in profit. By 2023, having captured 20 percent of the Medicare Advantage market, that number was $33 billion.

By imposing a private insurance template onto Medicare, MA plans subject seniors to the systematic depredations of managed care. Enticed through deceptive marketing, people trade in their traditional Medicare coverage only to find themselves at the mercy of a rigged and increasingly automated care approval process known as pre-authorization. Pre-authorization is a profound inversion of the payment system in traditional Medicare. Whereas Medicare overwhelmingly reimburses hospitals post-care, pre-authorization requires approval before care is provided—based on analyses most often performed by computers. In recent years, led by UnitedHealthcare, the companies have begun using AI to tighten the noose around an ever-broadening range of procedures and services.

Last year, pre-authorization denials forced three and half million seniors to pay out of pocket or forgo their doctor’s recommended treatment altogether. According to a 2022 report by the Office of Inspector General, denials are increasingly blocking care that doctors deem medically necessary. “Medicare Advantage insurers are intentionally using prior authorization to boost profits,” the U.S. Senate Committee on Governmental Affairs concluded in a report from last year, specifically by “targeting costly yet critical stays in post-acute care facilities.”

The surge in denials is no accident. Companies have been developing artificial intelligence programs that excise the human element from the pre-authorization review process. The algorithms are programmed to “deny, delay, depose”—the now infamous phrase etched on the bullet casings found at the scene of the assassination of Brian Thompson, a former UnitedHealthcare CEO. In 2020, UnitedHealthcare bought a tech firm, NaviHealth, because its proprietary algorithm was shown to “increase adverse determinations” in approving post-acute care. Known internally as Machine-Assisted Prior Authorization, UnitedHealthcare publicized the program as an efficiency tool that reduced by a handful of minutes—the time needed to conduct prior-authorization reviews.

An investigation by STAT News, however, uncovered internal documents that show the company mostly valued the technology for producing “an increase in adverse determination rate,” i.e., more overall denials of coverage. In its first year using NaviHealth, UnitedHealthcare’s denial rate for post-acute care doubled to 22 percent, and its denial rate for admission to skilled nursing facilities spiked from under 2 to 12 percent. The company’s remaining human case reviewers, meanwhile, were told to respect the new algorithmic recommendations, while those who were let go by the company had trouble finding similar work with competitors. As part of its AI pivot, UnitedHealthcare runs a profitable side business subcontracting NaviHealth to other Medicare Advantage providers, which have seen similar spikes in denial rates. Denial rates for long-term acute care, for example, is up 54 percent at Humana, where a company medical director has described the new technology as “important for denial purposes” and the ability “to uphold a denial on appeal.”

The appeals process—the “depose” in “delay, deny, depose”—has been made so intentionally long and arduous by Medicare Advantage insurers that only around 10 percent of seniors even try it. That number is far lower among policy holders struggling with serious illnesses, since they are often cautious about how they spend their remaining months of life. Last year, the Journal of Clinical Oncology published a study showing that cancer patients with Medicare Advantage plans waited significantly longer for treatment than those in traditional Medicare. Moreover, their requests to visit National Centers of Excellence in health care were almost always denied. Patients with cancer or those who are terminally ill often disenroll from Medicare Advantage at a disproportionate rate—that is, if they can find a Medigap insurance company willing to sell them an affordable policy.

“All the shenanigans that the Medicare Advantage corporations engage in are scary if you need treatment,” said Weisbart. “If you have cancer and you’re told to wait, that’s more than just expensive and terrifying—it’s deadly. It’s infuriating that they are killing people to maximize their returns to Wall Street. Especially when you couple it with the knowledge that traditional Medicare represents a more humane, less expensive way to organize health care.”

For Medicare’s enemies, the persistence of this cheaper, more humane alternative represents a standing double-threat—to the continued growth of Medicare Advantage, as well as to the myth that there is no better way. This is why the insurers and their pitch man Dr. Oz are so eager to get to work destroying what remains of it.

Intensified Rural Health Crisis

The effects of further displacing Medicare, even if only one county at a time, would be most immediate and acute in rural America, where hospitals are already buckling under the force of AI-powered exploitation by Medicare Advantage providers. Since 2003, nearly 200 rural hospitals have closed across the United States, with more than 700 of the remaining 2,000 medical centers nearing bankruptcy and closure. The situation is also bleak for many urban hospitals with a similarly high proportion of patients on Medicare and Medicaid. Connecticut’s Bristol Hospital announced last year that it was eliminating sixty positions due to delays in payment and coverage rejections by Medicare Advantage insurers.

Hospitals serving older and poorer communities face a number of problems, and a growing literature shows that Medicare Advantage compounds them all. According to a study by the American Hospital Association, the burdens that commercial insurer policies place on rural hospitals—growing denial rates, time-consuming appeals, and underpayments compared to Medicare—are the primary culprit behind the epidemic of closures. “Nearly 4 in 5 rural clinicians report higher administrative tasks, with 86% seeing negative impacts to patient outcomes,” the American Hospital Association concludes. More than a quarter of doctors say the denials handed down after the exhausting preauthorization process cause “serious adverse events,” including hospitalization, life-threatening illness, and death.

Mark Craig, an independent researcher with twenty years working in “revenue cycle management”— a growth field that mostly involves helping doctors get reimbursed by Medicare Advantage plans—reached similar conclusions after conducting a national survey of rural hospital administrators.

“Three-quarters say Medicare Advantage is their ‘most challenging’ insurance payer, responsible for the most denials and underpayments,” said Craig. “Since the pandemic, rural hospitals report supply costs are up 300 percent, labor is up 40 percent, while Medicare Advantage payments are coming in under costs and less than traditional Medicare payments. In some cases, over 50 percent of Medicare Advantage claims are denied. For institutions on thin margins, it’s a dagger. These corporations have transformed Medicare Advantage into the tale of Count Dracula, who lived in his well-appointed castle while devouring the nearby community.” To grasp the absurd situations imposed on doctors and hospitals by Medicare Advantage, he invokes the example of teachers repeatedly forced to sue school boards to get paid for teaching, or firefighters forced into long negotiations with corporations before attending to a five-alarm fire.

Doctors and administrators who live these absurdities have not missed the core irony of the situation: Medicare Advantage—sold as a way to reduce costs and reduce small-ball corruption—has resulted in higher costs and more systemic and destructive forms of corruption. “We thought the hospitals and doctors were driving everything so that we could line our pockets, right?” said Robin Rau, CEO of Miller County Hospital, a twenty-five-bed hospital in southwest Georgia. “We took all the control away from doctors and hospitals, and put it into Fortune 500 companies who are increasing their bottom line by denying critical care to patients.”

At the same time that they reject and underpay for care, Medicare Advantage plans have been caught overcharging the government for unnecessary tests and false diagnoses. According to the Medicare Payment Advisory Commission, the program’s watchdog agency, Medicare Advantage plans cost taxpayers 22% more than traditional Medicare, amounting to a projected $83 billion in 2024. Multiplying this number by ten gives you $830 billion—almost the exact amount that Republicans want to cut from to Medicaid over the same period. That number also equals what it would cost to add hearing, vision, and dental benefits to traditional Medicare.

As the situation reaches a breaking point, more hospitals are withdrawing from Medicare Advantage altogether. Nearly 20 percent of health systems have stopped accepting one or more Medicare Advantage plans, while another 60 percent are considering phasing out Medicare Advantage patients by 2026. A similar sea change is taking place among physicians fed up with the pre-authorization process. By some estimates, the pre-authorization process requires doctors to spend two hours on bureaucratic wrangling for every hour spent with patients. In a recent American Medical Association poll, 48% of physicians reported feeling burned out, a major driver of a projected national shortage of up to 124,000 physicians by 2034.

“We mostly hear about the patient perspective, but the moral injury to physicians is pushing them out of the profession,” said Craig. “Why go to med school if you can’t practice what you learned, and the insurance companies override you? These tugs of war are so exasperating, many doctors just leave. You should have easy communication, but the insurers are using tech to create obstacles. The Healthcare Financial Management Association continues to grow, with more and more resources going to think of ways to fight insurers instead of patient care. Soon it will be industry’s Terminator bots fighting the hospitals’ Terminator bots over the right to provide care. It’s gotten out of control.”

All of this has scrambled the political economy of health care. Once close allies in the fight against “nationalized healthcare,” the house of organized medicine is increasingly fed up with and willing to attack the insurance industry. Last June, when the American Medical Association (AMA) urged a series of measures to address the rural healthcare crisis, the list was topped by cracking down on Medicare Advantage underpayments and reducing prior authorizations.

Another item on the list suggests the group isn’t holding its breath. The AMA also recommended expanding a program associated with underdeveloped countries: importing international doctors to address the deepening crisis created by privatized health care. Seen in this light, the Trump administration’s new crackdown on Cuban medical missions might be a preemptive strike against the national humiliation of seeing doctors from Bayamo greeted with hugs of gratitude in Bridgeport.

Unlikely Allies for Traditional Medicare

In the nascent pushback to Medicare Advantage, hospitals and doctors are finding some unlikely allies in anger. Among them is Republican Sen. Chuck Grassley, a longtime Medicare Advantage champion who last month sent a stinging letter to UnitedHealthcare Group CEO, Andrew Witty, demanding internal documents related to the company’s billing practices. The letter was instigated by a Feb. 21 Wall Street Journal report that revealed one of the tactics Medicare Advantage insurers use to overcharge the government billions of dollars every year. In other words, the industry that inserted itself into Medicare on the basis of fraudulent billing has proceeded to drain Medicare on both ends—rejecting and underpaying for needed care, then defrauding the government for “ghost care.”

One actor that is notably absent in the nascent coalition: the AARP. Although the venerable advocacy group is at the forefront of the movement to rein in drug prices, it has been aligned with the Medicare Advantage industry for two decades and is a major vector for the aggressive and deceiving marketing campaigns that have always driven its growth. Income from UnitedHealthcare alone represents more than two-thirds of AARP’s marketing revenue, amounting to nearly $700 million, and its insurance business brings in twice as much as its annual membership dues. For the privilege of using the AARP name, UnitedHealthcare pays a large monthly fee, and describes the marketing partnership as a “strategic alliance.”

The rise of Medicare Advantage would not be possible without a continuous marketing blitz on American seniors—from AARP-branded robocalls to Dr. Oz informercials. Ads for the plans typically hype certain supplemental benefits not offered in traditional Medicare, such as dental, wellness programs, and sometimes meals or transport. But they are not required to mention the downsides, such as restricted provider networks, out-of-pocket costs, preauthorization, or the new industry-standard of AI-based denial machinery. Often the sales pitch is designed to trick seniors into thinking they are getting a supplemental plan to traditional Medicare. “Patients really have no idea what they’re getting,” said Mark Burket, CEO of Platte Health Center Avera, a seventeen-bed rural facility in rural South Dakota. “It’s the phone calls and TV commercials.”

One does not have to be Medicare-eligible or live in a rural community to have a stake in the future of Medicare. If the insurers and their frontman Dr. Oz destroy traditional Medicare with a series of detonations placed along the CMMI track, as they are currently preparing to do, it will remove the country’s sole bridge to a universal single-payer system.

“I always tell universal healthcare advocates they need to pay attention to what’s happening with Medicare,” said David Lipschutz, co-director of the Center for Medicare Advocacy. “Traditional Medicare is the pathway to a viable single-payer system. If it continues to erode, the only thing left will be Dr. Oz’s vision of ‘Medicare Advantage for All.’”

https://dropsitenews.com…

Trump Abdicates US Leadership in Global Health

Trump again, as in his first term, withdrew the US from the World Health Organization. This action not only thumbs our nose (or flips our middle finger) at the world, it’s also short-sighted – ignoring selfish interests in pandemic control and other public health needs.

The US, the World Health Organization, and the Global Health Infrastructure, JAMA Health Forum, March 14, 2025, by Sandro Galea, M.D., Dr.P.H., Editor in Chief

The US has, in the Centers for Disease Control and Prevention, one of the premier public health agencies in the world. In addition, state and local health departments add a further level of public health action that serves the country well in tackling public health challenges. And yet, it has been amply documented that the US spends less money on public health than it should for a country of its size and complexity, and that ongoing cuts to public health funding pose a threat to population health. This was perhaps most evident during the COVID-19 pandemic, when public health systems were frequently threatened and had a difficult time keeping up with a rapidly changing infectious threat. More than 1 million individuals died of COVID-19 in the US. This death toll plus the estimated $16 trillion cost of the COVID-19 pandemic in the US are a sobering reflection of the underinvestment in public health that exposes the country to risk.

The COVID-19 pandemic is also a recent reminder of how difficult it is to separate the work of public health domestically from the work of public health globally. COVID-19 amply showed that pandemics do not respect national boundaries, and that global coordination is a key element of global disease control. However, in recent years, US engagement in global efforts to control disease has been challenged by its domestic political changes. In 2020, under the first Trump presidency and during the COVID-19 pandemic, the US withdrew from the World Health Organization (WHO), only to return in the first few months of the Biden Administration. The second Trump Administration similarly withdrew from the WHO during its first week in office. This immediately threatened the function of the WHO. The WHO Director-General subsequently issued a hiring freeze, and noted a range of consequences that US withdrawal may have on the capacity of the WHO to carry out its mission.

Academic analysis has also noted a range of harmful consequences that may follow the US withdrawal from the WHO. These include, but are certainly not limited to, having less access to surveillance data needed to anticipate outbreaks and losing influence on what remains the world’s most important health agency. The global consequences may be even more severe given the funding cuts, threatening the organization’s ability to function effectively, particularly during global health crises. Therefore, the US finds itself at a worrisome inflection point in its alignment with global health infrastructure. Time will tell whether the anticipated consequences—for the US and global health—of disengagement from the WHO will emerge, but if they do, they will be an unfortunate and self-inflicted undercutting of US leadership in global health.

Comment:

By Don McCanne, M.D.

The World Health Organization? In the first Trump administration, the underfunding of public health, and especially the termination of our participation in the WHO, contributed significantly to the death of more than one million individuals in the United States, not to mention the other world-wide suffering and deaths in the COVID-19 pandemic. And this is only one of the many crucial functions of the WHO. More than one million US deaths!

Though the Biden administration renewed our participation in the WHO, did the voters in our last presidential election really ask Trump to withdraw us again from the WHO? The media tells us that their minds were on immigration and the price of eggs. But it was also quite clear that people thought that Trump would be more effective in reducing taxes (though primarily for the top 1% of incomes) and would reduce government spending (believing that those reductions would be in waste, fraud and abuse, but not in programs such as Social Security and Medicare). Very little thought and discussion was given to other programs such as WHO (not to mention USAID, education, CDC HIV prevention, diabetes prevention, food security – especially for children, and federal employment opportunities). Although half of the nation still does not recognize the potential impact of these reductions in spending on important government programs, the other half does, and that recognition is increasing. As people begin to feel the impact of reductions in government services, and the impact of price increases because of Trump’s tariffs and other flawed economic policies, it is likely that they will recognize the emptiness of Trump’s promises and be ready for policies that will meet their needs.

But right now, most recognize that we do not want these attacks on our health and well-being, and we do want the health of our country and of the world protected. Those who are informed know that we do want the WHO and USAID protected and supported, and those who don’t realize that need to be educated to find out what these programs do and support them to protect us and our families and friends at home and throughout the world. We don’t have the luxury of waiting to see how much harm terminating these programs will do since the cost in suffering and lives will be too great. We need to let our legislators know now (as we are already doing in their town hall meetings), and they will let the president and his administration know. Preserving the health of all citizens of the world is not selfish and not all that expensive. We certainly cannot stand by and watch the wealthiest man in the world tear these systems apart.

https://healthjusticemonitor.org…

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US Punishes Cuba for Providing Foreign Medical Assistance

In the Trump administration’s latest attack on health aid for poor nations, Marco Rubio is punishing Cubans who participate in that nation’s highly beneficial medical assistance program. The US abandonment of health aid is reprehensible, and we must work to reverse it.

Cuba Sends Doctors, the US Sends Sanctions, JACOBIN, March 8, 2025, by Helen Yaffe

The United States calls Cuba’s medical internationalism “human trafficking” – but it’s really an internationalist lifeline for the Global South.

On February 25, US secretary of state Marco Rubio announced restrictions on visas for both government officials in Cuba and any others worldwide who are “complicit” with the island nation’s overseas medical-assistance programs. A US State Department statement clarified that the sanction extends to “current and former” officials and the “immediate family of such persons.” This action, the seventh measure targeting Cuba in one month, has international consequences; for decades tens of thousands of Cuban medical professionals have been posted in around sixty countries, far more than the World Health Organization’s (WHO) workforce, mostly working in under- or unserved populations in the Global South. By threatening to withhold visas from foreign officials, the US government means to sabotage these Cuban medical missions overseas. If it works, millions will suffer.

The predominant global approach, exemplified by the United States, is to regard health care as an expensive resource or commodity to be rationed through the market mechanism. Medical students “invest” in their education, paying high tuition fees and graduating with huge debts. They then seek well-paid jobs to repay those debts and pursue a privileged standard of living. To ensure medics are well remunerated, demand must be kept above supply. The World Economic Forum projects a shortfall of ten million health care workers worldwide by 2030. But the Cuban investment in medical education raises the supply of professionals globally, thus threatening the status of physicians operating under a market system. Critically, the Cuban approach removes financial, class, race, gender, religious, and any other barriers to joining the medical profession.

The key features of the Cuban approach are: the commitment to health care as a human right; the decisive role of state planning and investment to provide a universal public health care system with the absence of a parallel private sector; the speed with which health care provision was improved (by the 1980s Cuba had the health profile of a highly developed country); the focus on prevention over cure; and the system of community-based primary care. By these means, socialist Cuba has achieved comparable health outcomes to developed countries but with lower per capita spending — less than one-tenth the per capita spending in the United States and one-quarter in the UK. By 2005, Cuba had achieved the highest ratio of doctors per capita in the world: 1 to 167. By 2018, it had three times the density of doctors in the US and the UK.

Today Cuba is in the midst of a severe economic crisis, largely resulting from US sanctions. The public health care system is under unprecedented strain, with shortages of resources and of personnel following massive emigration since 2021. Nonetheless, the government continues to dedicate a high proportion of GDP on health care (nearly 14 percent in 2023), maintaining free universal medical provision, and currently has 24,180 medical professionals in fifty-six countries.

Revolutionary Cuba was never solely concerned with meeting its own needs. Between 1999–2015 alone, overseas Cuban medical professionals saved 6 million lives, carried out 1.39 billion medical consultations and 10 million surgical operations, and attended 2.67 million births, while 73,848 foreign students graduated as professionals in Cuba, many of them medics. Add to that the beneficiaries between 1960 and 1998, and those since 2016, and the numbers climb steeply.

The beneficiary nations have been the poorest and least influential globally; few have governments with any leverage on the world stage. Recipient populations are often the most disadvantaged and marginalized within those countries. If Cuban medics leave, they will have no alternative provision. If Rubio and Trump are successful, it is not just Cubans who will suffer. It will also be the global beneficiaries whose lives are being saved and improved by Cuban medical internationalism right now.

Comment:

By Don McCanne, M.D. and Jim Kahn, M.D., M.P.H.

The world community respected the United States for its humanitarian support via USAID which helped to meet the medical needs of countries that lack the resources to do so on their own. One of the first major actions of the Trump administration was to slash the resources and functionality of USAID such that the nations we served were stripped of life-saving medical prevention and care, and further denied food resources to prevent starvation, especially in children. USAID was moved to the State Department wherein Secretary Marco Rubio was set to supervise the degradation of this important agency.

Fortunately, Cuba has made it a national priority to try to fulfill these unmet health needs. Though not as wealthy as the United States, the extent of their success has been phenomenal.  Millions of lives saved; massive suffering and grief averted.

As we abandon the humanitarian mission of USAID, what approach have we taken to honor the work of Cuba in providing these valuable services? None. We don’t honor Cuba for meeting needs that we have abandoned. Instead, we place restrictions on visas for government officials in Cuba and others worldwide who are complicit with Cuba’s overseas medical-assistance.

What? We not only lay waste to our own humanitarian efforts, we try to slow Cuba’s? Hard to fathom, unconscionable.

People of good will in the US have been trying for decades to provide affordable, broad health care for everyone here, while offering meaningful support to poorer nations with even greater needs. President George W. Bush, in his most noble act, founded and fostered the PEPFAR program for foreign health assistance in HIV, and thus super-charged global health assistance. Strong foreign aid in health has been a bipartisan consensus (albeit still just 1% of the US federal budget). Now, in 2025, not only does the new Trump administration want to undo our own programs, it plans to punish a country whose offense is to fulfill the unmet medical needs of poverty-stricken nations.

We ask what kind of government leadership is it that we have elected that would drive us in the direction voiced by Trump, Musk, Miller, and now Rubio? We’re sure that the actions are illegal and impeachable. We also recognize that such outcomes are all but impossible in the foreseeable future.

For now, we ask you to link the ongoing fight for US Health Justice via universal publicly financed health insurance (single payer) to the ongoing fight for global Health Justice via foreign assistance. Write to your representatives and senators, donate to organizations that are advocating for USAID programming and staff, and for Cuba, and participate in public protests. Unified outrage is the only appropriate response.

https://healthjusticemonitor.org…

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Health justice groups host “shadow hearing” opposing the nomination of Dr. Mehmet Oz to lead CMS

“Dr. Oz is a TV doctor, and does not represent the views of practicing physicians. He is certainly not someone we can trust to run Medicare.”

FOR IMMEDIATE RELEASE: Friday, March 14, 2025

Media Contact: Anika Thota, PNHP Policy Specialist, anika@pnhp.org

As Dr. Mehmet Oz takes the stage at his confirmation hearing before the Senate Finance Committee, Physicians for a National Health Program (PNHP), and a coalition of labor and health care advocates are hosting a shadow hearing on Friday, March 14 at 9:00 a.m. Eastern to expose the truth about Medicaid cuts, Medicare privatization, and the detrimental effects of Medicare Advantage (MA). You can watch the shadow hearing LIVE here.

Dr. Oz, Trump’s pick to lead the Centers for Medicare & Medicaid Services (CMS), has a history of promoting corporate-backed health schemes rather than prioritizing patient care. That’s why we’re holding a shadow hearing—to expose his dangerous agenda. Throughout his career, Dr. Oz has advocated for dubious medical practices and privatized insurance plans that prioritize profits over patients.

“Dr. Oz is a TV doctor, and does not represent the views of practicing physicians. He is certainly not someone we can trust to run Medicare,” said PNHP President Dr. Diljeet K. Singh. “His record of pushing questionable medical products and corporate-friendly insurance plans mirrors the deceptive tactics of Medicare Advantage, which promises better care but instead delivers delays, denials, and higher out-of-pocket costs.”

Numerous organizations are co-sponsoring our event to shine a light on corporate greed driving the expansion of Medicare Advantage. 

“Medicare Advantage is a scam, and Mehmet Oz is a profiteering hatchet man looking to cash in on people’s pain,” said Sulma Arias, Executive Director of People’s Action. “If Oz is confirmed, he will allow insurance companies to deny and delay our care more often and raise the cost of health care. And because he’s a shareholder, Oz himself will make more money while we get hurt.  Our lives are on the line, and senators need to stand up for us by voting no.”

“Medicare Advantage is a concession that can have negative consequences for retiree health care,” said Rose Roach, National Coordinator of the Labor Campaign for Single Payer. “The Labor Movement fought for – and won – our public Medicare program to secure accessible and affordable health care for all seniors in this country. We demand restoration and expansion of our traditional Medicare.”

Nancy Hagans, RN, President of National Nurses United, said “Our health care system is in crisis. Nurses know that the only way to resolve the fundamental problems in our current profit-driven system is to guarantee health care through Medicare for All. Dr. Mehmet Oz does not support guaranteed health care and has repeatedly shown his commitment to increasing the profits of health insurance companies at the expense of patient care. We urge the United States Senate to listen to the concerns of patients and health care workers across the U.S., and to vote NO on the nomination of Mehmet Oz as CMS Administrator.”

MA plans routinely fail patients when they need care most, trapping seniors in plans that promise choice but instead limit access to doctors and life-saving treatments. At our hearing, speakers will share stories of harm caused by privatized health care, highlighting that Dr. Oz’s perspective on privatized health care is self-serving and disregards the health of the American people.

Primary sponsors for this shadow hearing include Physicians for a National Health Program and Social Security Works. Cosponsors include Be a Hero; Committee of Interns and Residents, SEIU; Cross-union Retirees Organizing Committee (CROC NYC); Healthcare-NOW; Labor Campaign for Single Payer; National Alliance for Retiree Healthcare; National Nurses United; People’s Action; Popular Democracy; Progressive Democrats of America; Puget Sound Advocates for Retirement Action; and Students for a National Health Program.

Medicine Demands Trust—Dr. Oz Has Spent His Career Undermining It

If given the reins of CMS, Dr. Mehmet Oz will not only fail to improve healthcare for our seniors but also use privately managed care to actively harm Americans. The Senate must reject his nomination.

By Dr. Sanjeev K. Sriram, M.D., M.P.H. and Chiamaka Okonwo
Common Dreams, March 13, 2025

Medicine is about trust. As a medical student, I’ve been taught that trust in medicine is built on honesty, evidence, and a commitment to patient well-being—principles that should guide physicians and leaders in healthcare. But how can we trust a man who built a career on misleading patients to oversee healthcare for 160 million Americans?

Dr. Mehmet Oz, a former TV doctor notorious for promoting unproven “miracle cures,” has been nominated by U.S. President Donald Trump to lead the Centers for Medicare and Medicaid Services (CMS)—an agency that millions of seniors, children, and low-income families depend on for care. Yet, he promotes predatory Medicare Advantage programs and unscientific remedies that harm citizens. His nomination cannot stand.

As I take care of my own patients, I am consistently trained to practice evidence-based medicine and uphold ethical standards that prioritize patient well-being. Dr. Oz, in contrast, has used his platform to spread misinformation, undermining the very trust that medicine depends on. Formerly a well-regarded cardiothoracic surgeon, Dr. Oz began his journey toward harm over healing on the “Dr. Oz Show,” a nationally televised program on which he promoted unproven treatments that interfered with patients’ appropriate medical care.

Medicine is about trust. As a medical student, I’ve been taught that trust in medicine is built on honesty, evidence, and a commitment to patient well-being—principles that should guide physicians and leaders in healthcare. But how can we trust a man who built a career on misleading patients to oversee healthcare for 160 million Americans?

Dr. Mehmet Oz, a former TV doctor notorious for promoting unproven “miracle cures,” has been nominated by U.S. President Donald Trump to lead the Centers for Medicare and Medicaid Services (CMS)—an agency that millions of seniors, children, and low-income families depend on for care. Yet, he promotes predatory Medicare Advantage programs and unscientific remedies that harm citizens. His nomination cannot stand.

As I take care of my own patients, I am consistently trained to practice evidence-based medicine and uphold ethical standards that prioritize patient well-being. Dr. Oz, in contrast, has used his platform to spread misinformation, undermining the very trust that medicine depends on. Formerly a well-regarded cardiothoracic surgeon, Dr. Oz began his journey toward harm over healing on the “Dr. Oz Show,” a nationally televised program on which he promoted unproven treatments that interfered with patients’ appropriate medical care.

https://commondreams.org…

Dr. Diljeet Singh on “Healthcare-NOW”

PNHP president Dr. Diljeet Singh appeared on the “Medicare for All” podcast on March 12, 2025. Dr. Singh previewed PNHP’s shadow hearing for Dr. Mehmet Oz, which will expose the many reasons why he cannot be trusted to lead the Centers for Medicare and Medicaid Services.

Oz is “deeply, deeply, deeply invested in for-profit Medicare,” said Dr. Singh, “and this is the guy we’re putting in charge of Medicare.”

Republican cuts to Medicaid would be a waste

By Henry L. Abrons, M.D., M.P.H.
San Francisco Chronicle, Letters, March 9, 2025

Why are Republicans even talking about cutting Medicaid? Don’t they realize that Medicaid is a lifeline to health care for 15 million Californians and over 70 million Americans?

The Republican leadership claims that there is “fraud, waste and abuse” in federal health insurance programs that need to be eliminated.

But fraud and abuse in the Medicaid program don’t add up to much, so the cutters will attack Medicaid eligibility, benefits and provider reimbursements.

Republicans have ignored the enormous savings from bringing all health insurance and health care delivery under a nonprofit program.

Economic research shows that a national single-payer health care program could save over $600 billion per year while making access universal, lowering costs and expanding benefits to include dental care, prescription drugs and even long-term care.

In essence, enacting a single-payer program would be the equivalent of the huge tax cut that the Republicans are promising, but it would go primarily to working families instead of the billionaires.

The specter of cuts to Medicaid has sent tremors through all 50 states and members of Congress are reacting. This could intensify pressure on California’s nine Republican House members to insist on saving Medicaid in the budget reconciliation process.

If Republicans could set politics aside and focus on fiscal responsibility, they would defend Medicaid, improve health care and stop wasting taxpayer money.

https://sfchronicle.com…

Trump Voters Seek Robust Government Role in Health Care

New polling finds that most Trump voters favor government health insurance and regulation to lower prices and financial vulnerability. Our next task is to educate Trump supporters on the advantages of single payer (public) health insurance.

Republicans Once Wanted Government out of Health Care. Trump Voters See It Differently, KFF Health News, Feb. 27, 2025, by Noam N. Levey

Government regulation of health care prices used to be heresy for most Republicans. GOP leaders fiercely opposed the 2010 Affordable Care Act, which included government limits on patients’ costs.

But as Trump begins his second term, many of the voters who sent him back to the White House welcome more robust government action to rein in a health care system many Americans perceive as out of control, polls show.

Republican voters strongly back federal limits on the prices charged by drug companies and hospitals, caps on patients’ medical bills, and restrictions on how health care providers can pursue people over medical debt.

Even Medicaid, the state-federal insurance program that Republican congressional leaders are eyeing to dramatically cut, is viewed favorably by many GOP voters.

Skepticism about government lingers among rank-and-file Republicans. And ideas such as shifting all Americans into a single government health plan, akin to “Medicare for All,” are still nonstarters for many GOP voters.

But as tens of millions of Americans are driven into debt by medical bills they don’t understand or can’t afford, many are reassessing their inclination to look to free markets rather than the government.

In a recent national survey, Fabrizio Ward and Hart Research, which for decades has polled for Democratic candidates, found that Trump voters were more likely to blame health insurers, drug companies, and hospital systems than the government for high health care costs.

Three-quarters of Trump voters back government limits on what hospitals can charge, Ward’s polling found.

Mike Perry, who’s convened dozens of focus groups with voters about health care in recent years, said the support for government price caps is all the more remarkable since regulating medical prices isn’t at the top of most politicians’ agenda. “It seems to be like a groundswell,” he said. “They’ve come to this decision on their own, rather than any policymakers leading them there, that something needs to be done.”

Other forms of government regulation, such as limits on medical debt collections, are even more popular. About 8 in 10 Republicans backed a $2,300 cap on how much patients could be required to pay annually for medical debt.

As Trump and his allies in Congress begin shaping their health care agenda, many Republican leaders have expressed more interest in cutting government than in expanding its protections.

“There is oftentimes a massive disconnect,” Ward said, “between what happens in the caucuses on Capitol Hill and what’s happening at family tables across America.”

Comment:

By Don McCanne, M.D.

The important message here is that it is not only Democrats who are concerned about health care costs so much that they want the government to take action—it is Republicans as well, including those who voted for Trump in 2024. In fact, many Trump supporters think he would do a better job in controlling their health care costs.

Yet there is still significant opposition to single payer / Medicare for All. This is despite numerous studies showing that such a model would be more effective in controlling costs while ensuring access to comprehensive, high quality care for all, affordable for each one of us. They want the government to help, but they remain uncomfortable with the single payer model. So what is going on here?

Most of all, the private insurance industry has been very effective in marketing their products. A predominant example: people on Medicare believe that private Medicare Advantage plans will provide greater benefits at a lower cost than traditional government-managed Medicare. When the insurance product is marketed to them, it seems like that is true. They get a few additional, nominal benefits that are not offered in traditional Medicare, and the up-front costs are lower than premiums in the traditional program especially if including Medigap plans needed to fill coverage holes.

But the financial advantage is illusory. The purpose of health insurance is to provide better access to necessary health care while controlling costs that they would otherwise be exposed to when they need to access that care. Is that the way private Medicare Advantage plans work? No. When beneficiaries need to use their plans, they usually have a limited choice of providers because of the narrow networks covered; they face prior authorization requirements; and they often have greater out-of-pocket expenses because of the deductibles and copays required by the plans, often creating financial hardship. At that point, they might want to return to the greater choices and more affordable coverage of traditional Medicare, but the Medigap plan may no longer be available because of pre-existing conditions (which are ignored at the time of original enrollment).

Actually, what patients want at the time of medical need would be choice of providers, truly comprehensive benefits, with elimination of cost-sharing at the time of service. The way you would get that is through a single payer system, an improved Medicare for All.

Paying for it? This would happen via a public insurance program which would be progressively financed through taxes with those in poverty paying nothing, and increasing with income, with the billionaires paying significantly more than the actual costs. This would be the most equitable method, with no person suffering a financial hardship (when unaffordable costs happen to be one of the greatest sources of dissatisfaction with today’s health care system).

Of course, Republicans have heavily opposed single payer since they greatly favor further reduction in taxes for the billionaires while having the masses fund care through reduced benefits and greater financial contributions. They currently support a privatized Medicare Advantage for All that would do this: fewer paid benefits for lower income individuals and greater cost sharing at the time of service – the opposite of what our system should be providing.

We see that the public broadly does want the government to be involved in fixing our system, providing better care at lower costs. But we really need to do this through the more humanitarian single payer model, rather than through tweaking a system designed to shift our health care dollars to wealthy private investors and away from care.

Our task now is to explain to everyone (including Trump voters!) that they can have the government controls that they want, but that the system needs to be designed so that it works for the people, all of us, rather than being designed to increase the wealth of the private investors at a cost to the average citizen of affordability and access to the care that they need.

Once they understand the system, that’s what they’ll want.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.