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.
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.
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.
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…
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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?
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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.
To Attack Waste, Go After the Source, Not the Patient
By Jay Brock, M.D.
FXBG Advance, Feb. 19, 2025
It looks like President Donald Trump has given the world’s richest man, Elon Musk—who some are already calling co-president—the responsibility for cutting government spending. If Musk were serious, he would start with eliminating the roughly $1 trillion we will waste this year running our very broken health insurance system. It would save the government money, and it would save every taxpayer and consumer money.
We’ll spend around $5 trillion on “healthcare” this year. Of that, roughly $1 trillion is wasted on costs that have nothing to do with healthcare and everything to do with perpetuating a health insurance system that, unlike those in every other advanced nation, has failed to ensure everyone here has affordable healthcare.
Here are some general estimates of what’s wasted: the numbers are approximate to give an idea of the scope of the problem.
- Administrative costs: $600 billion (in 2019 dollars) wasted in billing and other bureaucratic burdens compared to what those costs would be in a single payer system like Canada’s. Inflation has likely significantly increased that amount.
- Excess pharmaceutical costs: $100 billion wasted each year—again, in pre-inflation dollars. (Some healthcare experts think it might be twice that amount.) We pay higher medication prices here than in any other nation.
- So-called Medicare “Advantage” plans excess costs: $100 billion wasted/year, give or take, according to some healthcare experts. These plans are run largely by for-profit mega corporations, companies that have a fiduciary duty to their stockholders to keep profits as high as possible. If this means that as an enrollee you get less healthcare (or none at all, if your insurance claim is denied), so be it. These plans overcharge the federal government—that is, the American taxpayer (you and me)—without producing better clinical outcomes. These overcharges help the company bottom line but detract from enrollee healthcare.
- Total profits for just the major health insurance companies averaged $25 billion/year since Obamacare was passed in 2010: $371 billion so far.
These wasted dollars are extraneous costs that have nothing to do with any actual healthcare and everything to do with growing both more profits and a bigger medical bureaucracy.
How best to save all that money? Switching to a single payer system would eliminate that trillion dollar waste. That money could then be spent on actual healthcare, cover everyone with affordable healthcare, and still save hundreds of billions of consumer and taxpayer dollars a year.
Instead, the Administration seems to be focusing more on reducing fraud and abuse regarding Medicaid recipients who are “able bodied” but not working than on making sure everyone has affordable healthcare. Trump aims to cut Medicaid funding as one way to allow him to give further tax cuts to the very wealthiest Americans.
Medicaid cuts will mean reducing access to healthcare for the very people who voted for him.
Take just one example: cutting Medicaid funding jeopardizes rural hospitals and increases the risk of their disappearing. According to a report in Becker’s Hospital Review this week, 432 rural hospitals around the nation are at risk of closing. The top five states affected all went for Trump in 2024:
- Texas: 47 hospitals at risk
- Kansas: 46 at risk
- Mississippi: 28 at risk
- Oklahoma: 23 at risk
- Georgia: 22 at risk
Arkansas, Mississippi, and Kansas have the highest percentage (approaching or at 50%) of rural hospitals at risk.
Florida, South Carolina, Tennessee, and Missouri are also among those states with the highest percentage of rural hospitals at risk.
Trump won all those states.
Trump’s base is vulnerable to the negative healthcare impacts of reducing healthcare spending to help pay for those tax cuts.
A Hart Research poll last month revealed that about 8/10 Americans opposed healthcare funding cuts in general, including cuts to Medicaid.
You’d never know from last year’s presidential campaign that unaffordable healthcare was a major concern for a huge number of voters: it was second only to inflation as a topic voters wanted discussed during the campaign. With good reason: three-quarters of Americans worry they won’t be able to afford to pay their medical bills if they get sick.
One can make a valid argument that failing to adequately address unaffordable healthcare helped cost the Democrats the election last year: many people may have voted for Trump more out of punishing Democrats than supporting Trump’s agenda. But Trump’s agenda is what we’ve got.
It looks like Trump will pursue his agenda of cutting healthcare funding, thus reducing healthcare access for many Americans, especially affecting his political base. One can only guess how the electorate will react at midterm elections next year—and in the next presidential election in 2028 —if the Trump Administration in its turn bungles this kitchen table issue that is so important to so many Americans.
Additional Sources
- New Evidence Suggests Even Larger Medicare Advantage Overpayments
- Medicare Advantage Overpayment >$100 Billion