PNHP

DOGE to Merge Federal Healthcare Funding Programs

DOGE to Merge Federal Healthcare Funding Programs

In pursuit of budget savings, Elon Musk’s Department of Government Efficiency has decided to combine disparate government health care financing programs into one streamlined operation using a standardized provider payment model. DOGE claims $250 billion in annual savings from this “unified financing.”

DOGE Consolidating Healthcare Benefits, Intrepid News, April 1, 2025, by Dorough E. Sizdah

The Department of Government Efficiency (DOGE), headed by Elon Musk, appears poised to consolidate all federal mechanisms that pay for healthcare. The new agency, “Caring for America,” will absorb funding and personnel from dozens of existing departments and programs. Overall spending will be reduced by a claimed $250 billion per year, via procedural streamlining and elimination of contracting overhead.

The programs to be combined include Medicaid and Medicare (currently part of CMS), the Veteran’s Health Administration, the Children’s Health Insurance Program (CHIP), Affordable Care Act exchanges, PACE (for seniors), the Ryan White Care Act (HIV care), the Indian Health Service, Federal Employees Health Benefits Program (FEHBP), Federally Qualified Health Centers, and dedicated immunization efforts, among others. Benefits will be standardized at the highest existing level.

DOGE employees and senior policy staff from the affected agencies envision this shift as start of a “Unified Financing” approach to health care. All medical providers would be paid directly for services, without use of intermediaries, and based on prices set in collective bargaining with representatives of the provider groups. Mr. Musk developed procedures for payment efficiency based on his design of PayPal, a popular electronic payment software which was his first major business success.

One confidential source characterized this consolidation of federal health program bureaucracy and payment mechanisms as a first step to broader health insurance streamlining. Next on the DOGE insurance agenda is integrating coverage currently provided via job-based insurance, with the massive savings from eliminating tax subsidies to companies for insurance premiums redirected to the new payment agency. Any funds needed beyond projected savings will derive from trims to tax cuts, said the source.

Congressional progressives were shocked, though pleasantly so. Senator Bernie Sanders said, “That’s spectacular. It’s the first big step toward Medicare for All! I’m so glad Mr. Musk finally endorses real efficiency. I will work with him, if he’s serious about this.”

The plans were leaked initially from a health policy chat room in Signal.

Comment:

By Jim Kahn, M.D., M.P.H.

A few days ago, HJM warned about DOGE’s dismantling of federal health capacity. Now there is a truly pleasant surprise: a sheep in wolf’s clothing. “Unified Financing” is what single payer is all about. Consolidation of sprawling federal healthcare financing streams set the stage for administrative simplification, elimination of costly intermediaries, and standardization of comprehensive coverage. A huge step forward … we then just need to bring in people insured at work and of course the uninsured.

How is it possible that Elon Musk pivoted in this way to a favorite policy of progressives? Is the “E” in “DOGE” now to be taken seriously? – using government reform to eliminate waste and foster efficiency? Did PayPal provide the technical expertise needed to achieve payment reform?

Alas, it seems impossible. For those still asking “Can this be true?” I remind them, it’s April 1 – April Fool’s Day. This vision for Musk and DOGE is a prank. In these tumultuous times, I hope you’ll forgive – even enjoy – a short satire break.

The fact is, single payer IS efficient, as well as generous. We must keep spreading the word, and fighting for the proverbially (but not truly) elusive “free lunch” – we CAN get universal health care and save money, by focusing on health care justice and eliminating profiteering.

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.

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.

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…

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.

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…

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.

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…

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…

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Seniors, Trump pick Dr. Oz wants to take you out of Medicare. Call your senator

By Carol Paris, M.D.
The Knoxville News-Sentinel, March 5, 2025

Seniors: Who do you trust with your health care? If you’re like me, you place a great deal of trust in Medicare, which you’ve paid into for your entire working life. If you’re like most Americans, you definitely don’t trust corporations like UnitedHealth (UHC) to pay for the care you need, when you need it.

Despite public opinion, President Donald Trump’s administration is gearing up to hand even more of our Medicare over to insurers like UHC. They’re planning to push hard for the “Medicare Advantage” (MA) program, which generates huge profits for insurers while punishing seniors with restrictions, surprise costs, and outright denials of care.

Republicans have a blueprint, Project 2025, which seeks to make MA the default enrollment option for Medicare beneficiaries, and a champion, Dr. Mehmet Oz, who supports an even more aggressive plan: Medicare Advantage for All.

The “Advantage” program has been very kind to UHC over the years, boosting its profits into the billions. In 2024, UHC captured 29% of the MA market. It also captured the anger of everyday Americans trying to use their substandard insurance − as well as the scrutiny of Congress and the wrath of medical professionals who are denied the ability to care for their patients.

I know this from personal experience, having recently consulted an orthopedic surgeon for knee pain. My doctor recommended trying an injection before jumping to surgery and explained the various options. I asked what he would recommend personally.

“It doesn’t matter what I recommend,” he said, “only what your insurance will authorize.” When I told him I had traditional Medicare, not a corporate MA plan, his dejection changed to enthusiasm. “That’s wonderful,” he said. “Now I can give you my best advice and administer the injection today.”

Patients and physicians suffer because of the roadblocks thrown up by firms like UHC: prior authorization requirements, restrictive provider networks, and frequent denials of care. These tactics bankrupt patients, lead to physical suffering, and fuel an epidemic of burnout among medical professionals.

Unlike most doctors practicing in the U.S., Dr. Oz sees all this and applauds. He has consistently promoted MA plans, and even proposed putting all Americans into the program. For seniors, that would mean no more public Medicare, not even as an option for those who want it.

Mehmet Oz’s dangerous prescription for health care puts profits over patients

By Sneha Kapil, Mitchell Stoddard, Manasvi Khullar, and Erin Everett
South Florida Sun-Sentinel, March 4, 2025

“I don’t believe in antibiotics!” My patient told me, frustrated that I was not going along with her faith in the healing powers of a supplement. As a young doctor in training, I was unprepared for the current landscape of severe mistrust in health care. My patient had a bacterial urinary tract infection that has long been treated with antibiotics. However, she was refusing antibiotics despite weeks of pain, much to my disappointment. Although this happened to one of us (Manasvi Khullar), all four of us have countless similar stories.

The lack of trust in the health care system has led patients to turn to false promises, not physicians, for their health care needs. Although many failures led to this point, there are multiple people who have perpetuated lies in the name of profit. One of these individuals is Dr. Mehmet Oz, the nominee to run the Centers for Medicare and Medicaid Services (CMS) who will oversee the process of care coverage decisions, the Affordable Care Act and a $1.5 trillion budget.

Oz is a cardiothoracic surgeon, famous for his daytime talk show that reaches millions of Americans. He follows many evidence-based principles — a belief in a healthy diet, the power of activity and social connection. However, he has also often promoted questionable therapies like “magic weight loss cures” and claimed that cellphones can cause breast cancer. One study found that half of his recommendations had zero evidence. Given this, how will Oz use taxpayer money to decide what therapies are covered by Medicare? How does he plan to respond to therapies not based in scientific evidence?

One plan for CMS that Oz has touted is “Medicare Advantage (MA) for All,” which allows CMS to contract with private insurance companies to fulfill Medicare requirements. But reports show that MA patients were denied care by insurance companies that should have been covered, with the plan pocketing the difference. MA plans have also been shown to overcharge the government by adding unnecessary codes to charts. The $88 billion to $120 billion upcharged annually is enough to expand traditional Medicare to include dental, vision and hearing coverage.

Oz proposes making MA the default enrollment option, restricting patient choice and funneling $200 billion annually to insurance companies, which jeopardizes traditional Medicare. Experts estimate expanding MA to cover 75% of enrollees could waste nearly $2 trillion over the next decade without improving health care quality. Rural seniors would suffer the most, as restricted provider networks and underfunded hospitals already limit access to care in these areas. By advocating for “Medicare Advantage for All,” Oz puts the pockets of private corporate interests before quality patient care.

Oz also owns stock in many companies that he would be tasked with regulating. For example, he owns shares in the UnitedHealth Group and CVS Health Corp, the owner of Aetna Insurance. This appears at odds with past statements in which Oz said, “I’ve fought Big Pharma, I’ve gone to battle with Big Tech, I cannot be bought.”

As future physicians, we refuse to inherit a system where patients die while insurance companies post record profits. This nomination leaves millions — especially seniors and women — at risk of losing reliable health care. The American public has demanded change at all levels of government and has elected President Trump to shake things up. Oz is an out-of-the-box thinker who has claimed that he cares about the health of Americans. But senators should act urgently to confront his apparent conflicts of interest and controversial beliefs during the confirmation process. The American people deserve a gifted cardiothoracic surgeon who can provide a steady hand during a time of crisis, not a con man who will sacrifice your health and taxpayer money to make a quick buck.

Sneha Kapil is a third year MD/MS candidate at the University of Miami Miller School of Medicine.

Mitchell Stoddard is a second year DO/MPH candidate at Western University of Health Sciences College of Osteopathic Medicine of the Pacific.

Manasvi Khullar is a fourth year medical student at Touro University California College of Osteopathic Medicine.

Erin Everett is a fourth year MD/MPH candidate at Tulane School of Medicine.

The views represented in this op-ed are their own and not that of their universities.

https://sun-sentinel.com…

Looming Medicaid Cuts & Pushback

The House of Representatives budget resolution suggests massive upcoming cuts to Medicaid, likely via reduced eligibility. Voters of both parties are surprised and worried, expressing disapproval. So are potent media voices. The public values government-funded health care; imagine how popular single payer would be!

FLASH BREAKING: Major news on Republicans CUTTING healthcare, YouTube video (8 min), Feb. 25, 2025, by Brian Tyler Cohen

Liberal Redneck – On Gutting Medicaid and Food Stamps to Cover More Tax Cuts for the Wealthy, YouTube video (8 min), Feb. 26, 2025, by Trae Crowder

“I was a poor kid, I know gross, but I was I was on all these programs. Food stamps subsidized my education all through college; don’t know what I would have done without them and in the intervening years since I have paid back far more in taxes than I ever got for the government. So the point is stop looking at these programs as an endless money glitch for a bunch of freeloaders, and look at them instead as an investment in one of our most vital resources: each other. I am walking breathing talking proof that the ROI can be pretty damn good. We can use these programs to lift up countless other Americans out of poverty.”

“All right, look, giving these rich people even more money is not going to work. You know how I know? Cuz we’ve been doing it for more than 40 goddamn years. If the Blessed urine of our betters was ever going to trickle down to us, I think we’d have felt a drop or two by now. All right so I’m imploring you — wake up stop tongue-polishing the boot that’s on your throat, and recognize the value of investing in your fellow Americans.”

The Debate Over Federal Medicaid Cuts: Perspectives of Medicaid Enrollees Who Voted for President Trump and Vice President Harris, KFF (Kaiser Family Foundation), Feb. 25, 2025, by Amaya Diana, Jennifer Tolbert, & Robin Rudowitz

  • Many Trump and Harris voters said that … they did not recall hearing about changes to health care programs (including Medicaid) during the campaign. Most participants said the government has a role to play in making health care more affordable and accessible … both Trump and Harris voters [said] that state verification procedures prevent individuals from defrauding the program on a large scale …
  • … Participants opposed cutting Medicaid funding to pay for tax cuts that they did not believe would benefit them. Both Trump and Harris voters expressed fears that these changes would jeopardize the program, take away access to health care, result in worse health outcomes, and increase out-of-pocket costs. A few Trump voters did not believe Trump would follow through on the cuts to Medicaid because they believed he understood their financial struggles.
  • Both Trump and Harris voters valued their Medicaid coverage and the access to health care services, mental health services, and medications for themselves and their children it provides. Participants also valued Medicaid because it helps to protect them from financial disaster, alleviates stress, improves health outcomes and often supports their ability to work. Participants said losing Medicaid would “be devastating” and lead to serious consequences for their physical and mental health and exacerbate pre-existing financial challenges.
  • If work requirements were introduced to Medicaid, participants who were working generally felt confident in their ability to meet the requirements; however, they worried about the burden of monthly reporting requirements when those were described to them. Many participants across parties noted that access to treatment for chronic conditions, including prescription medications and mental health treatment, were key in helping to support their ability to work. More Trump voters supported a work requirement but some who were not working were convinced they would qualify for an exemption. Other participants, including both Trump and Harris voters, who were not currently working felt they would face challenges in meeting the requirements. Those who were not working said they wanted to work (and many had been previously working for many years) but were generally unable to because of disability or because they were caring for young children or a sick parent.
  • Both Trump and Harris voters wanted policymakers to focus on improving Medicaid instead of cutting it. For example, some participants said they would like to see enhanced dental benefits, increased doctor availability, and fewer prior authorization requests. Focus group participants wanted policymakers to consider the implications of federal cuts to Medicaid for people, their health, financial stability, and ability to be productive members of society.

Comment:

By Jim Kahn, M.D., M.P.H.

This week’s House budget resolution sets targets for subsequent detailed appropriation bills. The two largest priorities: cut Medicaid for the poor, and slash taxes (predominantly) for the rich. Net result: an increase in debt of nearly $3 trillion – that’s $8500 per person, >$25,000 for a family of three, while growing the ranks of the uninsured.

These strategies are widely unpopular, including the Medicaid cuts, as heard by KFF in their bipartisan focus groups.

The $880 billion in Medicaid cuts is about 10%. Where will that come from? Payment rates are already dangerously low. Benefits are slim. A GOP Congressman in the Tyler Cohen video, when repeatedly asked if he’ll vote against “cuts to Medicaid”, robotically intones with a smirk: “No benefit cuts.” What does that mean? How is that possible? Presumably: the budget cuts will arise from restrictions in eligibility (who qualifies), without removing benefits for those covered. So what’s better, less for the same number of beneficiaries, or excluding millions of beneficiaries? Cruel either way, IMO. But for the GOP rep, it’s all political subterfuge.

I do appreciate that economics was highlighted in both of these decidedly non-economic forums. Brian Tyler Cohen presents the Center for American Progress graphic summary of the budget proposals. And Trae Crowder talks about “return on investment” – his taxes as a worker far exceeding what the government invested in his healthy growing up.

Progressives have been losing the social media wars. With entertaining and whip-smart presenters like these YouTubers, we are making up lost ground!

But what’s most encouraging to me is how much a wide swath of voters like and rely on Medicaid. Not that it’s a perfect program, far from it. Despite its limitations. Just imagine how they’d feel about lifelong universal health insurance, with broad benefits, paying fair rates to providers, and no significant cost-sharing. It would be heaven. It’s called single payer. It’s an important way to unite left, middle, and right against the billionaires (but they’d be covered too).

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.

Modern Medicare vs. Single Payer

Sadly, Medicare has been twisted into a morass of complex choices and financial vulnerability. Coverage in other nations and with single payer is simple and effective. Let’s take that path!

Bridging the Medicare Cost Gap: Knowing Your Options, The New York Times, Feb. 15, 2025, by Mark Miller

Medicare can cover most of your health care needs when you turn 65, but it doesn’t pay for everything. And one of the most significant financial challenges to watch out for are the out-of-pocket costs you can face aside from monthly premiums — including deductibles and other types of cost sharing.

Just how much you’ll pay, and when, depends on the type of Medicare enrollment that you choose: traditional Medicare, which is operated by the government and provides care on a fee-for-service basis, or Medicare Advantage, which is run by private insurance companies and operates on a managed care model.

There is no built-in annual out-of-pocket limit in traditional Medicare for outpatient and hospitalization services. Protection is available from supplemental insurance coverage – most often it means purchasing Medigap — a policy offered by private insurance companies that covers part or all of Medicare’s cost-sharing requirements.

Medicare Advantage plans come with out-of-pocket limits — but they can be high. When serious medical conditions arise, out-of-pocket costs can be a significant financial hit or make it difficult to afford care altogether. Medicare Advantage plans offer one-stop shopping and extra benefits, but they restrict care to in-network providers and have been criticized for techniques such as “prior authorization.” Traditional Medicare offers the widest access to health providers, and only a small group of medical services require prior authorization.

Medigap

Buying Medigap can be daunting, since the policies come in an alphabet soup of lettered plan choices (A, B, C, D, F, G, K, L, M and N). Medigap premium prices will differ, but the benefits offered by plans are standardized. All Medigap policies cover hospital coinsurance — the costs that you pay for longer stays after deductibles are met. Many cover all or part of the hospital deductible. Medigap plans also cover all or part of the 20 percent of fees for most physician services. They are required to also cover some or all of the cost sharing for outpatient services, and the more robust plans cover the annual hospital deductible and cost-sharing in skilled nursing facilities.

When you first sign up for Part B, which covers doctor visits and outpatient care, that’s when Medicare forbids Medigap plans from rejecting you. The opportunity is available to you during your six-month Medigap Open Enrollment Period, which starts on the first day of the month in which you’re 65 or older. After this period ends, Medigap plans in most states can reject applications or charge higher premiums because of pre-existing conditions.

Medicare Advantage

Jan. 1 through March 31 — this is the time when people enrolled in Advantage can switch plans or move to traditional Medicare. Before making a decision to move to traditional Medicare, make sure you can obtain a Medigap policy. Once you’ve identified a plan that interests you, contact the insurance company for details. The premium will vary.

High-deductible MediGap G plans are not a well-publicized option since Medigap commissions generally are a percentage of the premium, it incentivizes brokers to sell the G plans with the higher premiums.

With Advantage, the exposure can be high in years when you need lots of health care, and out-of-pocket features in the Advantage program vary by plan. It’s not necessarily true that Medicare Advantage will save you money. “The information is published, but it’s very difficult to compare,” Dr. Tricia Neuman of KFF said. “It’s really on the consumer to try to sort through which plan provides the most or least protection, and that’s tough to do.”

More generally, people enrolled in traditional Medicare with supplemental coverage are the least likely to report problems managing their costs, because they have the greatest level of protection, KFF research shows.

Health Care Affordability for Older Adults: How the U.S. Compares to Other Countries, Commonwealth Fund, Dec. 4, 2024, by Munira Z. Gunja, et al.

Nearly a quarter of older adults in the U.S. spent at least USD 2,000 over the past year on out-of-pocket expenses, compared to less than 5 percent in France and the Netherlands who spent an equivalent amount.

Comment:

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

We have long tried to simplify the single payer concept of financing health care by labeling it “Medicare for All,” with the idea that Medicare is a straightforward publicly administered and financed program that serves everyone well. But no longer. These days, it’s a diverse and overwhelming set of options: public traditional Medicare, dozens of supplementary private insurance options (Medigap), and hundreds of private insurance plans (Medicare Advantage) – representing massively complex variation in out-of-pocket costs, benefits, and providers. There is also dual eligibility with Medicaid to assist poor and disabled seniors. Understanding and choosing rationally among Medicare options is impossible.

Simply stated, modern Medicare is a convoluted nightmare that even trained professionals can barely understand. Imagine how intimidated the the average consumer is when receiving reams of information from Medicare, and from private insurers who seek to extract maximum profit from enrollees.

Seniors in other wealthy nations (such as in the OECD) have far superior financial protection for their healthcare, as documented by the recent Commonwealth survey.

What’s behind that success?

  • Seniors don’t need to hassle with intimidating choices. They’re just covered, like everyone else.
  • The coverage is broad and standard. There are no complex and variable rules about benefits, coverage circumstances, and provider panels.
  • Cost-sharing – deductibles especially – is modest. Skipping care for financial reasons is much less frequent, and medical bankruptcy isn’t a phenomenon.

So, we certainly don’t want to keep the current US system with its profoundly complex and expensive administrative excesses that are designed to divert health care funds to wealthy investors while limiting access and choice in health care and leaving millions of people with minimal health care or none at all.

How would US single payer help seniors? Unsurprisingly, it echoes successful foreign practices:

  • Streamlined coverage: Standardize and thus radically simplify the process to obtain insurance. Indeed, nothing would change at age 65 – just a continuation of lifelong insurance.
  • Reduced financial risk: Cover all necessary medical services, with minimal cost-sharing.

US single payer would be equitably funded by using progressive taxes based on ability to pay, ranging from free for those with very low incomes to more generous funding by our billionaires who would be able to fully maintain their current lifestyles with the riches they would retain. Thus payments into the system would be affordable for all.

We would make health care free or nearly so at the point of service, funding the system through global budgets and other rational economic methods that would fairly compensate providers. Physicians, nurses and other health care professionals would be able to devote all of their time to patient care without worrying about their incomes being based on the amount and intensity of services provided.

Everyone would receive the care they needed. It would be both universal and comprehensive.

It would be publicly administered, eliminating the excessive administrative costs and private profits of our current system.

In opinion polling in the US, two-thirds of adults say “yes” to the following proposition: “Would you support the government paying for all health care, if taxes would rise but premiums and cost-sharing would disappear?” Our online household cost calculators confirm that the vast majority of households would save money with single payer.

In today’s massive political upheaval our beneficial institutions – including public insurance programs — are being threatened. How about affordable, comprehensive health care for all (left and right politically)? Wouldn’t that be a giant step toward making America great?

https://healthjusticemonitor.org…

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Dr. Mehmet Oz holds millions from companies that he’d wield power over if confirmed, report shows

By Amanda Seitz and Brian Slodysko
AP News, Feb. 20, 2025

WASHINGTON (AP) — The wealth of Dr. Mehmet Oz, the celebrity heart surgeon nominated by President Donald Trump to lead the Centers for Medicare and Medicaid Services, has swelled in part from for-profit health care companies over which he’d wield significant power if confirmed, according to a newly filed government ethics report.

In the filing, the 64-year-old former talk show host pledged to divest from those companies within three months of confirmation and said that until then, he wouldn’t participate in any matter that could affect his investments.

Oz’s net worth is between $98 million and $332 million, according to an analysis of the disclosure, which lists asset values in ranges but does not give precise dollar figures. Oz shot to fame and made millions off his daytime talk show. His most recent disclosure shows he also holds millions of dollars worth of shares in health insurance, fertility, pharmaceutical and vitamin companies.

Oz said in the filing that he will sell off parts of his significant and diverse investment portfolio, which ranges from retail giants such as Walmart to tech companies such as Apple.

His roster of investments includes up to $5 million in Inception Fertility, a company with a network of fertility clinics; a maximum of $100,000 with pharmaceutical giant AbbVie; and as much as $600,000 with the nation’s largest health insurer, UnitedHealth Group. He also holds up to $5 million with Nvidia, an artificial intelligence company that outfits hospitals.

And his work as an adviser for iHerb, a website that sells health and beauty supplements, has earned Oz as much as $25 million in company stock, which he pledged to forfeit “as soon as practicable but not later than 90 days after confirmation.” He indicated he would also resign from his position with the company if confirmed.

His investments touch nearly every aspect of the health care system, said Lawrence Gostin, a public health professor at Georgetown University.

“He has his fingerprints and his financing all over the health care system, from services to artificial intelligence to medical products,” Gostin said. “It seems to me that those conflicts are so intertwined in his and his families finances, I don’t know how he disentangles himself from it all.”

A spokesman for Oz did not immediately respond to a request for comment.

If confirmed by the Senate, Oz would be responsible for the programs that more than half the country relies on for health insurance: Medicaid, Medicare and the Affordable Care Act.

Medicaid provides nearly-free health care coverage to millions of the poorest children and adults in the U.S. while Medicare gives older Americans and the disabled access to health insurance. The Affordable Care Act is the Obama-era program that offers health insurance plans to millions of Americans who do not qualify for government-assisted health insurance, but do not get insurance through their employer.

As the administrator for CMS, Oz would make decisions on how the government covers procedures, hospital stays and medications in these programs and the reimbursement rates doctors and other providers get for their services.

Oz ran a failed 2022 bid to represent Pennsylvania in the U.S. Senate as a Republican. During the campaign, he called to expand Medicare Advantage, the increasingly popular version of Medicare that’s run by private insurers who have been accused of defrauding the government by billions of dollars through the program.

Before his turn to politics, Oz was a renowned heart surgeon at Columbia University. He rose to fame on “The Oprah Winfrey Show” with appearances where he discussed weight-loss diets, Botox and anti-aging techniques. Eventually, he landed his own show, which was popular but attracted deep criticism from the scientific community. Some colleagues at Columbia University called for his removal over claims he made about products on TV. Senators, too, scolded him during a 2014 hearing over the weight-loss drugs he promoted.

He has formed a kinship, though, with Robert F. Kennedy Jr., who was sworn in as the nation’s top health official last week. Kennedy and Oz have shared concerns over pesticides and unhealthy foods.

Oz’s confirmation hearing to become CMS administrator has not been scheduled.

https://apnews.com…