Feb. 15, 2025

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By Jessie Hellmann
Roll Call, Feb. 3, 2025

The nomination of Robert F. Kennedy Jr. to lead the Department of Health and Human Services has concerned doctors and public health experts across the world who are alarmed by Kennedy’s decades-long mission to sow distrust in vaccines.

But key groups representing physicians in Washington have stayed silent in the face of what their members call a threat to public health.

The American Medical Association and the American Academy of Pediatrics, groups with tremendous influence in Washington, are among the professional societies for physicians that have not directly weighed in on Kennedy’s nomination — even after last week’s confirmation hearings in which Kennedy refused to unequivocally disavow falsehoods connecting vaccines to autism.

By Daniel Stone, M.D.
The Health Care Blog, Jan. 29, 2025

As a doctor, I consider Secretary Xavier Becerra and his Department of Health and Human Services (HHS) to be allies of practitioners like me. The behemoth federal agency administers Medicare and Medicaid, the Food and Drug Administration, and an army of public health workers. The Surgeon General, symbolic leader of the nation’s healthcare providers, reports to HHS. For decades, the Department has supported medical science in safeguarding the public’s health. Now that sacred trust faces the threat of Donald Trump’s nomination of Robert F. Kennedy Jr. to run HHS.

RFK’s first problem is a stunning lack of qualifications. After a laudable triumph over drug addiction, he used his legal background to work on environmental protection. Kennedy never held a federal government position nor administered any public agency. He now appears poised for on-the-job training at an agency with 80,000 employees and a $1.7 Trillion budget. In contrast, Becerra served for years in Congress and on its Health Sub-Committee. He also served as State Attorney General, managing 4,800 employees. The qualification issue is not political. During Trump’s first term, his last HHS secretary, Alex Azar, had served as HHS general counsel and president of pharmaceutical giant Eli Lilly. RFK has nothing remotely resembling his would-be predecessors’ qualifications.

Unfortunately, RFK’s shortcomings go well beyond mere lack of qualification. His distortions and public denials of established medical science infuriate practitioners like me. He casts baseless doubt on the well-established benefits of vaccines and on the polio vaccine in particular. Despite the seven decades since polio vaccine’s introduction, doctors still see patients who were infected before it was available. My patient Donna, born in 1955, counts herself among this group. She wears leg braces and often struggles with daily activities. For me, she symbolizes those who by accident of birth or happenstance missed the profound benefits of vaccines that RFK now disparages.

RFK also opposes fluoridation of water. Another patient, Judith, age 80, scoffs at such skepticism. She grew up in Niagara Falls, NY, before fluoridation and its dental protection. She remembers her childhood dentist finding 13 cavities and the trauma and pain of prolonged dental work at an early age.

Primary care doctors like me spend our professional lives working to prevent life limiting and life-threatening conditions like those affecting Donna and Judith. We struggle with the challenges of insurance denials, clunky electronic records, healthcare bureaucracy and ballooning patient loads. We don’t need an HHS administrator opposing our efforts to provide standard preventive care. And if RFK’s judgment on vaccines is so poor, who can trust him on other critical healthcare issues like pandemic management or drug authorizations?

How should physicians respond? I recently exchanged messages with a politically diverse group of local medical leaders. They all opposed RFK but disagreed on tactics. Some said that the American Medical Association leadership believes RFK to be headed for confirmation. They fear that failed opposition might jeopardize RFK’s support on Medicaid and Medicare reimbursements.

The local doctors’ reasoning reflects the same transactional “what’s in it for me” approach that led to RFK’s nomination. RFK mortgaged a share of the Kennedy legacy to help Trump win the Presidency. Now Trump is returning the favor with a cabinet position despite RFK’s lack of qualifications and practitioners’ opposition. Should organized medicine really adopt the same “what’s in it for us” approach?

I told my colleagues that I can accept being on the losing side. Despite my efforts, my patients sometimes get sick and even die. But I don’t quit on them or ask, “what’s in it for me?” So I will not shrug my shoulders as those representing America’s doctors swallow RFK’s nomination like a dose of castor oil. The senators voting on RFK have their own doctors and medical societies in their home states. Those doctors must explain to their senators why RFK is unacceptable to those on healthcare’s front lines.

I have belonged to the California Medical Association for more than 20 years and to the American College of Physicians, the nation’s largest medical trade association, for over 30. Although proud of those associations, I will resign from both if they fail to issue strong, evidence-based statements explaining why the RFK nomination is unacceptable. I hope my colleagues do likewise.

As physicians, we take an oath to do no harm. Sometimes doing nothing causes harm. It is time for organized medicine to do the right thing and fight the RFK nomination.

Dr. Daniel Stone is Regional Medical Director of Cedars-Sinai Valley Network, a practicing internist and geriatrician with Cedars Sinai Medical Group, and a member of Physicians for a National Health Program. The views expressed in this column do not necessarily reflect those of Cedars-Sinai.

https://thehealthcareblog.com…

By Will Stone
NPR, Shots Health News, Jan. 28, 2025

Robert F. Kennedy Jr. will appear before senators this week as he tries to secure his bid to lead the Department of Health and Human Services.

President Trump’s controversial pick — an environmental lawyer descended from a political dynasty who spent years leading a prominent anti-vaccine advocacy group — has emerged as one of the most recognizable figures in the new administration’s proposed cabinet.

The prospect of his confirmation has resulted in opposition from many people in the medical field, who cite his extensive history of promoting inaccurate claims on vaccines, infectious diseases and other areas of medical science. The Senate hearings before two separate committees are slated for Wednesday and Thursday.

Nobel laureates have written that Kennedy would put the nation’s health in jeopardy. The American Public Health Association, representing 25,000 professionals in that field, has come out against his nomination, based on his “consistent disregard for scientific evidence.” And recently thousands of physicians and others in health care have signed onto letters echoing these concerns.

“All we need is a handful of senators,” says Dr. Rob Davidson, executive director of Committee to Protect Health Care, a progressive advocacy group that reports gathering more than 18,000 signatures from physicians (though the list hasn’t been made public). “They should look at his record and it will absolutely confirm that he is a danger.”

As health secretary, Kennedy would wield enormous influence — overseeing agencies that steer public health, biomedical research, pharmaceuticals, health coverage for more than 160 million people, and other essential functions for the country’s health care.

Supporters have embraced his pledge to disrupt the medical establishment, overhaul federal health agencies and research priorities, and reverse the “chronic disease epidemic.”

Kennedy does face “a lot of organized opposition,” says Jay Richards, a senior research fellow at the right-leaning Heritage Foundation, who views that as further evidence of industry efforts to resist his agenda to tackle the “corrupting influences of Big Pharma, Big Food and Big government.”

Backers of Kennedy have launched their own efforts to signal support — one such letter says it has gathered more than 5,000 signatures from physicians, scientists and others in academia (the full list is not public).

When reached for comment over the phone, a spokesperson said Kennedy had met with over 60 senators and is “prepared and excited.”

In his alliance with Trump, Kennedy has played up his promise to address chronic diseases, branded under the slogan “Make America Healthy Again.”

While it’s a broadly appealing message, Kennedy has ascended to this point — not in spite of his past record on vaccines and questioning of the scientific consensus — but because of that, argues Dr. Jeffrey Flier, former dean of Harvard Medical School and an endocrinologist who researches obesity and diabetes.

“Anyone could stand up and say, ‘We have a lot of chronic diseases. We need to look at it,'” Flier says, “The idea that he represents some new insight into the importance of that area and how we should be thinking about it is ludicrous.”

Ross Brownson notes there are many “well-qualified middle to right-leaning experts” who could lead HHS, without the same troubling track record as Kennedy.

“He would not be my choice,” says Brownson, an epidemiologist and expert in chronic disease prevention at Washington University in St. Louis. “Whether the public health world can affect that is a political question.”

Vaccine record to face scrutiny

And Dr. Brett Giroir, former assistant secretary for health under the first Trump administration, says Kennedy’s path to confirmation — and the upcoming hearings — may hinge on whether senators believe that he has “moderated” his views on vaccines.

“Vaccination is one of the cornerstones of public health,” says Giroir, who’s now CEO of Altesa BioSciences, “His reliance on pseudoscience or quasi-science to form his opinions needs to be changed.”

Kennedy has repeatedly brought up the debunked link between vaccines and autism and other misleading claims about their safety. In a 2023 podcast interview, he stated “there’s no vaccine that is safe and effective.” And about five months into the COVID-19 vaccine rollout, he petitioned the federal government to revoke the authorizations for the shots.

Vaccines are considered some of the most studied medical interventions in the world and are estimated to have averted more than 150 million deaths over the last 50 years, according to a recent analysis in the Lancet.

For his part, Kennedy denies spreading misinformation, though his criticism of vaccines is well known.

During an NPR interview in November, Kennedy said his priority is to study vaccine safety and that he will not take vaccines away from anybody. But Giroir says that alone isn’t sufficient because there’s a lot the HHS secretary could do to “negatively impact vaccines” short of pulling them from the market.

For instance, as HHS secretary Kennedy could remove shots from the immunization schedule adopted by the Centers for Disease Control and Prevention, change who sits on the advisory committee that makes recommendations and selectively release data that doesn’t represent overall vaccine safety.

Giroir says Kennedy’s confirmation has some “potential upsides” if he commits to following the scientific process and supporting immunization.

But Dr. Paul Offit, who has followed Kennedy’s activism for years, disagrees vehemently, saying he “has little doubt” Kennedy will take steps to disrupt vaccine programs were he to be confirmed.

“No matter how much data you show him, he refuses to believe it,” says Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, “He’s an anti-vaccine zealot.”

Physicians organize as others remain silent

Despite the outpouring of opposition to Kennedy on social media and in op-eds, some of the most prominent physician organizations have refrained from taking a public stance one way or the other on Kennedy’s confirmation, including the American Academy of Pediatrics and the American Medical Association.

By David Dayen
The American Prospect, Jan. 27, 2025

Sometime between the 2024 election and the 2025 inauguration, Americans discovered that they had actually voted for Elon Musk for president. Since the election, Donald Trump has faded into the background, while center stage has been taken by the South African–born billionaire with the Twitter addiction of an adolescent, whose frenetic posts are often being treated like official government statements.

Musk and Vivek Ramaswamy were named co-chairs of the Department of Government Efficiency (DOGE), which sounds like a federal agency (and was actually tucked into an existing White House department) but is actually an outside agitator, tasked with devising recommendations to reduce the size and scope of government. During the campaign, Musk said he was confident he could remove $2 trillion in unnecessary waste from the budget. If he meant annually, that’s nearly one-third of total federal expenditures.

Skepticism is heavily warranted. Presidents going back to Ronald Reagan have impaneled blue-ribbon commissions to hack away at deficits, with minimal success. Nongovernmental advisers carry no formal power, and Congress holds the purse strings tightly. “One person’s waste is another person’s vital congressional jobs program,” said Michael Linden, a former official with the White House Office of Management and Budget.

There are signals that DOGE will be even more useless than its predecessors, with early proposals consisting primarily of things that sound funny but serve valuable functions, or things that are far too minuscule to make a meaningful dent in the budget. Hilariously, Musk gave up on his $2 trillion goal before the Trump presidency even started, calling the number a “best-case outcome” in an interview on his social media site and declining to identify specific cuts. And he also gave up Ramaswamy, who was unceremoniously dumped before the project ever got started.

Many Republicans, however, are dead serious about slashing social spending and obliterating the administrative state. House leaders have been passing around a menu of $5.7 trillion in cuts over ten years, including a large chunk from health care and food assistance for the poor. Musk’s following among the rank and file could provide ballast for these long-held conservative wishes, while catering to his own pocketbook in the process.

How Democrats should deal with DOGE has become a top-level conversation. One school of thought argues for calling out Musk’s game of using spending cuts to make room for their own tax cuts. Others draw red lines on cherished, popular programs like Social Security and Medicare, or highlight serial conflicts of interest. Still others counsel constructive engagement.

But the focus on federal spending could also teach Americans how their government really works. I’ve tallied up the savings from redesigning a handful of policies to improve effectiveness, and you really could find $2 trillion in net annual federal outlays, with no direct impact on the most vulnerable. The key lies in knowing where to look: profit-hungry contractors, privatized boondoggles, systemic overpayments, and a mountain of tax avoidance.

The world’s richest man, himself a serial tax evader and one of the nation’s biggest federal contractors, isn’t likely to touch any of this.

This article should come with a warning label: We should not cancel the equivalent of 7 percent in annual GDP all at once, which would trigger a deep recession. But identifying the real sources of inefficiency in our government—the trillions funneled to elites—can preserve resources for programs to help those in need. And it can display the values of an opposition party that has strayed from its core purpose of fighting for the little guy.

Too often, Democrats have leapt to defend institutions that most Americans look upon with scorn. Now it’s the Republicans who control all branches of government; they are the establishment in every sense of the word. The Musk/DOGE plan is one of self-enrichment and outward punishment. Someone should outline a different path.

DOGE’s Game

It’s hard to critique DOGE because it’s hard to divine its actual intentions. Making government more responsive can sit in tension with cutting spending. Smaller government may be ideologically satisfying but also fantastically wasteful. And when billionaires are making the decisions, self-aggrandizement is sure to follow.

Take the preoccupation with labor costs. Ramaswamy has called for a 75 percent personnel reduction across federal agencies. This would hardly save anything. According to the Congressional Budget Office, there are about 2.3 million federal employees with total compensation in 2023 of $271 billion; that’s 4 percent of the U.S. budget. Federal employees were roughly 4.3 percent of all workers in 1960 and 1.4 percent today. As a result, we’ve seen an explosion in contractors undertaking tasks that government workers used to perform. Nearly three times as much money is spent on contractors than federal workers.

Slashing the federal workforce, almost two-thirds of which is at the Departments of Defense, Veterans Affairs, and Homeland Security, would likely lead to more expensive contractors, and also increase the $247 billion in improper payments the government makes every year. “When you talk about cutting people in the Pentagon, these are people overseeing military contracts,” said economist Dean Baker. “There’s already fraud and there would be a lot more.”

Another chunk of the bureaucracy is devoted to processing federal benefits. Social Security’s administrative costs are legendarily low, down to 0.5 percent. Cutting 75 percent of its staff would delay benefit claims, make checks more difficult to process, and invite fraudulent scams. That’s the opposite of the alleged efficiency goal.

Or take what Public Citizen co-president Rob Weissman calls “policymaking by anecdote.” Musk’s brain-poisoned antipathy to anything that sounds woke led him recently to attack the “fake job” of Ashley Thomas, the U.S. International Development Finance Corporation’s director of climate diversification. But Thomas has nothing to do with diversity, equity, and inclusion; she works with farmers to diversify crops, to deal with changing weather patterns. So is efficiency the goal, or merely reverse political correctness and slipshod word-policing?

At times, DOGE’s goals collide with ignorance over governmental procedures. Ramaswamy claimed that $516 billion could be excised by ending programs that are “unauthorized” by Congress. But in every case, lawmakers have allocated funding and therefore inherently authorized those programs, which include things like health care for nine million veterans. Congress can and should reauthorize and improve programs, but any savings would be far lower than throwing out the entire Veterans Health Administration, the Justice Department, or NASA (where Musk has had $11.8 billion in contracts over the past decade).

The closest thing to an official vision for DOGE was laid out in a Wall Street Journal op-ed with Musk and Ramaswamy’s byline. The only named programs slated for cuts are the Corporation for Public Broadcasting and Planned Parenthood, which total about .012 percent of federal expenditures. And there’s a legally suspect claim that the president can nullify congressionally appropriated spending, which would be an enormous grab at Congress’s power of the purse that would trigger a constitutional crisis.

But the main target of the op-ed is regulations written by “unelected bureaucrats.” (I’m straining to understand who elected Musk or Ramaswamy.) Supreme Court rulings, the DOGE duo claim, prohibit agency discretion on rulemaking, and therefore allow the president to simply pause any regulation that he imagines exceeds congressional authority, and subsequently fire the workers overseeing them.

This isn’t what the Supreme Court said; Loper Bright Enterprises v. Raimondo specifically protected past regulations devised under the older framework of deference to agency interpretation. And a president cannot pause regulations without going through administrative procedure, nor fire employees with civil service protections. But these half-truths do serve the goal of rolling back or curtailing enforcement of regulations, which happens to benefit companies that are habitually under regulatory scrutiny, like, oh, I don’t know, Tesla and SpaceX.

Guided by this vision, Musk will pick the lists of regulations the president can insta-vanish. You can see how the incentives would run. “Every regulation has net positive savings for the country,” said Weissman. “They may cost corporations, they may cost billionaires, but they do not cost the country.”

In this sense, DOGE intends to rewire government for personal use. There has been an unusual interest in a $6.6 billion Department of Energy loan to electric truck manufacturer Rivian. Which electric-vehicle maker do you suppose would like to cancel government support for a rival? Musk has also targeted the bipartisan infrastructure law’s program to build out rural broadband; might he be mad about how his own broadband service, Starlink, was excluded from the grant process, and want to reverse that? Is high-speed rail development truly a “wasteful” program, or an old vendetta from a car manufacturer who opposes mass transit? Do bank regulators have to go because they impede the free flow of capital, or because the Securities and Exchange Commission has been fighting with Musk for seven years?

Maybe it seems too parochial to suggest that the “government efficiency” effort is simply cover for defunding Elon Musk’s regulatory police, steering more contracts his way, depriving rivals of the same treatment he gets, and building oligarchy in America. Maybe Musk is a real efficiency expert who wants to bring his style of business cuts to government as a public service. Maybe he’s truly concerned about burdens being left to his children and grandchildren. Maybe he will nobly share in the sacrifice.

Color me unconvinced. And let me submit as evidence a litany of items that DOGE is likely to leave mostly untouched in its drive for austerity.

Health Care

The federal government is often described as a health insurance company with an army. About 75 percent of all spending is concentrated in four buckets: Social Security payments, health care programs (e.g., Medicare and Medicaid), veterans’ benefits, and the Department of Defense. If you’re not touching them, to cut $2 trillion you’d have to eliminate everything else government does, in total.

But health care in particular is lousy with private-sector profiteering, providing several options for savings.

Nearly 33 million seniors are enrolled in Medicare Advantage, a private insurance substitute for traditional Medicare. It’s heavily advertised to seniors as offering better benefits (including gym memberships and wellness programs) at a lower cost. And it’s true that MA plans typically include dental, hearing, and vision coverage, which is not part of traditional Medicare, as well as reduced premiums.

But Medicare Advantage has been criticized heavily for overbilling the government, not just by liberal activists but also by gold-standard independent auditors. The Medicare Payment Advisory Commission (MedPAC), a congressionally established expert panel, calculated that Medicare Advantage overpayments came to $83 billion in 2024 alone.

There are two reasons for these overpayments. First, Medicare reimbursement is weighted depending on the health of the patient. Insurers are compensated at higher levels for enrolling sicker patients with more diagnostic codes that correspond to ailments. Insurers have exploited this in Medicare Advantage by “upcoding” patients to make them appear sicker, regardless of the actual care they receive. The Wall Street Journal recently found that UnitedHealth, the leading MA plan sponsor and also the largest employer of doctors in the U.S., routinely encouraged its doctors to add codes to their patients.

Physicians for a National Health Program (PNHP), which advocates for a single-payer system, noticed even greater savings potential in the MedPAC report. Traditional Medicare sets a “benchmark” for spending on the average beneficiary. Several studies have shown that MA plans spend between 11 and 14 percent less, because they cherry-pick healthier patients, even after accounting for upcoding to make them look sicker. Increasing denials of care allows MA plans to rake in even more profit.

In all, PNHP found that MA plans charge the government at rates $140 billion per year higher than traditional Medicare. Dr. Ed Weisbart, national board secretary with PNHP, estimated that Congress could use savings from MA overpayments to add an out-of-pocket spending cap, a public drug benefit, and dental, hearing, and vision benefits to traditional Medicare, and have tens of billions left over.

“If you’re serious about DOGE, here’s something you can do,” said Weisbart. “At least let’s agree that Medicare Advantage is being outrageously subsidized.” But with the incoming administrator of Medicare and Medicaid, Dr. Oz, a longtime booster of Medicare Advantage, that’s an unlikely avenue for DOGE.

Reforming physician pay schedules for Medicare could yield more savings. As my colleague Robert Kuttner has written, pay rates are determined mostly by a secretive advisory committee mostly made up of specialists, who give themselves higher reimbursements at the expense of primary care. The government rubber-stamps the recommendations, and private insurers typically use them as a benchmark. Lowering these rates, which incoming Health and Human Services Secretary Robert F. Kennedy Jr. has expressed interest in, would not only slash specialist pay but properly value primary care, reducing health expenditures over time by finding medical problems before they fester.

Dean Baker estimates that bringing U.S. doctor pay (now at $350,000 per year on average) to the level of physicians in Germany or Canada would reduce national health expenditures by around $200 billion per year. Some of that could be done through reductions in the federal pay schedule, but allowing qualified doctors in other countries to practice in the U.S. could also constrain costs through competition. “We have free trade in manufactured goods but we don’t do anything in services,” Baker said. “It would still be a well-paid profession, just not as much as it is now.”

Federal health programs like Medicare (which serves 68 million enrollees) and Medicaid (72 million) account for roughly half of all national health expenditures. So a good estimate for federal savings would be $100 billion per year.

The government also spends massive amounts of money on prescription drugs. In 2022, U.S. drug prices were 178 percent higher than in 33 other industrialized nations, according to a report funded by the Department of Health and Human Services. Some of these drugs are sold at 20 to 30 times the cost of production and distribution; pharmaceutical profit margins are significantly higher than private-sector counterparts.

Democrats did take some action in 2022 by allowing Medicare to negotiate drug prices with manufacturers for the first time; new prices on ten drugs will begin to come online in 2026. But more can be done. “It’s not all drugs right away negotiated to the best price possible. Anyone would look at that deal and say you should get the best deal right away,” said pharma activist Alex Lawson of Social Security Works.

Using federal statutes to seize certain drug patents and distribute them to generic manufacturers that charge less would also save billions. But more structurally, we could overhaul the monopoly patent system that gives drug companies exclusive rights to charge whatever they want for a set period.

Baker has proposed having the government pay for clinical trial research up front, rather than distributing patents to private companies so they can recoup research and development costs. Paying for clinical trials wouldn’t be cheap—maybe $100 billion annually—but the savings realized by free-market prices for drugs without monopoly protection would be considerable: $500 billion per year by Baker’s estimates. Again, some of that would accrue to patients and private health plans; let’s call it $200 billion per year in government savings. The fact that Trump and RFK Jr. literally dined with pharma executives during the transition, however, makes this unlikely to get onto the DOGE list.

There are smaller opportunities. Group purchasing organizations, which help hospitals buy bulk supplies, have been shown to inflate health care prices and cost Medicare and Medicaid $17.3 billion a year, according to a 2010 report; with conservative inflation assumptions, let’s raise that to $20 billion. Medicare and Medicaid made $101 billion in improper payments in 2023, according to the Government Accountability Office, and have been criticized for weak enforcement even when they find health care scofflaws. Moderately better enforcement could yield $10 billion a year. Boosting funding for community health centers, which efficiently fund direct primary care, saves Medicaid $2,371 per enrollee according to one study. Spending $3 billion to get ten million more people care through these clinics would therefore save about $20 billion a year on net.

Of course, moving to a single-payer system wholesale could yield over half a trillion dollars in savings from administrative expenses alone, per the People’s Policy Project. But even if the nation isn’t ready for single-payer, limiting private-sector profit-taking and boosting public provision comes to roughly $490 billion per year.

Military Spending

In 2023, Congress appropriated $841 billion in military spending, nearly equivalent to all nondefense discretionary spending combined. And the Department of Defense (DOD) is not a model of efficiency. In 2024, it failed its seventh consecutive audit, which means it could not account for all its spending in the last fiscal year, or the six preceding ones either. The best the Pentagon could muster in response was a press release claiming it “has turned a corner in its understanding of the depth and breadth of its challenges.” Even Musk had to admit that “DoD gets terrible value for money.”

He ought to know! His companies have $3.6 billion in contracts with the Defense Department, and SpaceX is in talks with a consortium of tech firms seeking to win a greater share of military spending. But this merely doubles down on a prime source of waste in how we finance our military.

“Our budget wouldn’t be justified if the DOD did pass this year’s audit,” said Julia Gledhill, research associate for the National Security Reform Program at the Stimson Center. “Contractors continue to be rewarded for not doing their jobs terribly well.”

One of the best examples of this underperformance is Lockheed Martin’s F-35 Joint Strike Fighter, now slated to cost $2 trillion over its lifespan. As with most new weaponry, the Pentagon invested heavily in producing F-35s before the design was complete, and before thorough testing had been conducted. The F-35 is not optimal for traveling long distances or close-range combat; in 2021, over 800 continuing defects were found on the plane. Yet after 20 years of spending, it was greenlit for full-rate production in 2024, because to do otherwise would be too colossal a waste of prior funds.

Weapons systems that are excessively over budget breach the Nunn-McCurdy Act, triggering reviews of whether to continue the program. But when Northrop Grumman’s Sentinel, the land-based missile part of the nuclear triad, exceeded the Nunn-McCurdy threshold last year, DOD determined that it could go forward, arguing that it was critical to national security. “There haven’t been any significant consequences for that critical breach, and we’re just chugging along,” Gledhill said. “We do have guardrails in place, but corporate interests are so entrenched.”

By Belinda McIntosh, M.D. and Toby Terwilliger, M.D.
The Atlanta Journal-Constitution, Jan. 26, 2025

America is more polarized today than it has been at nearly any point in its history. Again, President Donald Trump has capitalized on this division to rise to the most powerful office in the land. As he enters his final term in office, he has a historic opportunity to bridge this divide and heal our fractured nation.

Though we remain deeply divided on most political matters, there is one issue that most Americans agree upon: the U.S. health care system is broken.

A 2024 Gallup Poll found that Americans are more dissatisfied with our health care system today than at any point during the poll’s 24-year history. Importantly, the dissatisfaction crosses party lines, with only 30% of Democrats and 25% of Republicans rating our health care system favorably.

Medicare for All is not a zero-sum game; there are no losers. An ultra-wealthy class of elites would finally be paying its fair share, and the rest of America would pay less for their health care.

When asked how he envisioned replacing the Affordable Care Act, Trump stated “I have concepts of a plan.” Though this plan has yet to materialize, we can look at his past statements for clues.

In 2017, Trump praised the Australian health care system, a hybrid public-private system that operates similarly to that proposed by the Medicare for All Act. In 2015, he spoke admiringly about the Scottish health care system, which is one of the purest forms of nationalized health care in the world.

Most famously, in his 2000 book, “The America We Deserve,” Trump expressed his full-fledged support for a single-payer system stating:

The tragic shooting of UnitedHealthcare’s CEO has ignited a national conversation — not just about violence but about the anger and desperation felt by many who are trapped in a health care system that prioritizes corporate profits over people.

As a nation, we must unequivocally condemn all forms of targeted violence. At the same time, we must acknowledge the overwhelming consensus that has become apparent: Americans, regardless of political affiliation, are fed up with a system that often denies care, burdens families with insurmountable costs and enriches corporate elites.

This shared frustration presents Trump with a unique opportunity to align his actions with the populist message that won him the presidency. If Trump truly stands for the working class, he will lead the charge for Medicare for All.

Not only would this fulfill his unyielding promise to “drain the swamp,” but it would also secure his legacy as the president who finally fixed America’s broken health care system.

Belinda McIntosh is an Atlanta-based physician who served as chair for Georgians for a Universal Health Program and now sits on the Board of Directors of Physicians for a National Health Program.

Toby Terwilliger is an Atlanta-based physician who serves as cochair of Georgians for a Universal Health Program and sits on the Board of Directors of Physicians for a National Health Program.

https://www.ajc.com…

By Michael Sainato
The Guardian, Jan. 26, 2025

American doctors are accusing US health insurance giants of causing deadly delays to vital medical procedures and care – and putting profits ahead of their patients’ health.

Firms including United Healthcare have denied basic scans, and taken months to reconsider, according to physicians who spoke to the Guardian.

“There’s good evidence that these kinds of delays literally kill people,” said Dr Ed Weisbart, former chief medical officer for Express Scripts, one of the largest prescription benefits managers in the US. “For some people, this isn’t just an inconvenience and an annoyance and an aggravation.

“It’s a death sentence, and the only reason the insurance companies do that is to maximize their profits. The fact that they might be killing you is not in the equation of what they care about.”

Americans spend the most on healthcare in the industrialized world – an estimated $4.9tn in 2023 – but have the worst health outcomes, according to analysis by the Commonwealth Fund.

The fatal shooting of UnitedHealthcare CEO Brian Thompson last month prompted an outpouring of public anger toward the healthcare industry. While private insurers report billions in profits every year, many patients – and their doctors – struggle to navigate a complex financial system to get what they need.

Lobbyists for the insurance firms insist they are “working to protect” people from higher costs, and stress that everyone in the space, including doctors, are responsible for making the US healthcare system care more affordable and easier to navigate.

But in a series of interviews, medical professionals described their frustration with a powerful industry which had prevented them from helping patients.

‘We’re stuck in this terrible, vicious circle’

Dr Cheryl Kunis, a board member at the Physicians for a National Health Program and nephrologist in New York City, still thinks about what happened when one of her patients needed a PET scan. He had a tumor, and before deciding on how to treat it, Kunis and her colleagues wanted to establish if it had spread.

“The surgeon was very honest that he only wanted to operate if the tumor was localized, and without the PET scan, he really would not be able to make that decision,” said Kunis. “The surgeon and his office, as well as my office, spent hours on the phone. We were speaking to somebody who was sitting at UnitedHealthcare in front of a computer screen who was really not knowledgeable on the underlying medical problem or the test that we are asking for the patient to have.”

After an initial denial, the patient’s appeal for the scan was ultimately approved six months later. By that the time, the patient had died.

“We assume that if he had been diagnosed earlier, he may have been able to do better,” said Kunis. “There’s no way of proving it, but there was a reasonable chance he would have been in better shape had there not been a six-month delay in getting the scan.”

The healthcare system is “just really stuck in this terrible, vicious circle”, she said, “of prices constantly going up, lack of regulation and the insurance companies unfortunately having leverage over the patients who are trying to receive the care”.

‘It’s both demoralizing and insulting’

Health insurance companies often require “peer to peer” reviews, where doctors are required to speak with a medical representative from a health insurance company to justify treatment. But the insurance representatives are often far less experienced, according to physicians who spoke to The Guardian, and may not even have training in the specific field they are weighing in on.

“When I have engaged in ‘peer to peer’ review, the peer is never a physician that has my training,” said Dr Philip Verhoef, an Intensive Care Unit physician based in Honolulu, Hawaii, and former president of Physicians for a National Health Program. “It’s kind of a farce to even call it ‘peer to peer’. I’ve never had a ‘peer to peer’ conversation that was actually with a real peer.”

Instead, the representatives are “second-guessing our judgment as clinicians”, he claimed. “To be totally clear, I don’t have a financial incentive to admit patients to the ICU. It’s both demoralizing and insulting when a bureaucrat somewhere looks at a submitted claim from the hospital and says, ‘The decision to admit to the ICU was wrong.’”

Verhoef said he often sees patients coming into the intensive care unit for preventable illnesses caused by health insurance company denials, such as refusing to cover required medication, like insulin, or an inhaler for asthma.

“When people need to use their private health insurance, it actually fails them,” he added. “Insurance is supposed to be there to cover you from financial calamity, when unfortunate things happen, and the current system that we have based on private health insurance has really failed everyone. I don’t think that we’re going to regulate our way out of this mess.”

Much of the friction patients encounter when seeking medical care or assistance is fundamental to the insurance firms’ business models, according to Weisbart. “They don’t care about you, and they see you as an expense, not someone whose health needs to be improved,” he said. “The healthier you are, the more they want you to have them as their insurance, and the sicker you are, the more comfortable they are with you being dissatisfied with them and searching for a different insurance company.

“Once they have that money, every time somebody has to get health care, that’s just an expense that they don’t want to let go of.”

The insurance industry’s profits revolve around delaying and denying medical care, Weisbart claimed. “When they delay your care by a day, by a week, by a month or totally deny it, it’s not a random event,” he said. “It’s a calculated business strategy to maximize their profits.”

‘Problem getting much worse’

Many doctors have recently expressed similar issues with private insurers. Physicians are “forced to become insurance experts on top of our medical expertise, spending countless hours on paperwork instead of patient care,” Dr Bayo Curry-Winchell of Nevada wrote in an article for Katie Couric Media, while Dr Claudia Fagan, chief medical officer of Cook County Health, wrote in an article for Common Dreams that she had “seen patients suffer and die in order to pad the bottom lines of corporate health insurers – and in recent years I have seen this problem getting much worse.”

UnitedHealthcare did not respond to multiple requests for comment. AHIP, a lobby group for the industry, said in an emailed statement: “In the fragmented and heavily regulated healthcare system, health plans, providers and drugmakers share a responsibility to make high-quality care as affordable as possible and easier to navigate for the people we collectively serve. Health plans are working to protect patients from the full impact of rising costs while connecting them to care that is safe, evidence-based and coordinated.”

Doctors who spoke to the Guardian suggested fixing problems with the US healthcare system will require more than tinkering at the edges.

Both Weisbart and Verhoef argued the solution would require moving away from private health insurance, toward a single payer healthcare system, similar to other wealthy countries that provide healthcare to all.

“The solution is effectively to overhaul the system entirely and then start from scratch with the national health insurance system,” said Verhoef. “Solutions that depend on trying to regulate the private insurance industry are simply going to fail.”

There is “no way to modestly reform a fundamental flaw in a business model”, added Weisbart. “Their business model is designed on delaying, denying and redirecting healthcare We know a much better way: the much better way is to build a system on the traditional Medicare program. Fix the things that are wrong with Medicare … and then simply provide that to everybody.”

Moving to a single-payer, universal healthcare system would likely cost less than current national healthcare expenditure, according to a 2020 academic analysis – and save tens of thousands of lives each year.

https://theguardian.com…