An Update by Merrill Goozner on Public Health and what this administration has in mind. It appears Trump has his eye on Medicaid and the ACA. Maybe gutting them and having nothing to replace them.
Kennedy/Oz as champions of public health?
– by Merrill Goozner
Let’s start with some media criticism.
In an above-the-fold story on its front page this morning, the New York Times reports “Democrats (are) fighting over how to talk about transgender rights.” At the same time, the Times editors buried on page 18 a solid piece about the Republican Congressional leadership’s plans to gut Medicaid and the Affordable Care Act. Here’s a link to the latter story because it is almost impossible to find on its website.
Objectively, what’s more important? How the out-party should respond to vicious and unscrupulous attacks by Trump and the GOP on 1.6 million vulnerable adults who identify as transgender? Or GOP plans to throw as many as 5 million Americans (estimates vary) into the ranks of the uninsured by imposing work requirements and block grants on the 73.4 million poor, disabled and elderly served by Medicaid; and eliminating the expanded subsidies for the 21.4 million low- and moderate-income Americans who purchase insurance on the Obamacare exchanges?
Shouldn’t the media be asking why House Speaker Mike Johnson (R-La.) wants to sentence the nearly 100 million Americans in both programs to years of living in fear that their precious lifeline to access to health care will be taken away? Is it to avoid “a debt spiral,” as claimed in the Times story by a former Trump policy adviser who runs the Paragon Health Institute, a conservative think tank? No. The GOP-run House needs it to extend the 2017 tax cuts for large corporations and the wealthy, which expire next September.
Johnson’s Louisiana, it should be noted, has the second highest Medicaid participation rate in the country. As of the end of March, 39.2% of its 4.6 million people are on Medicaid. Over a third of the state’s $1.8 million Medicaid beneficiaries joined in 2016 after Louisiana decided to expand Medicaid under the ACA. That was the same year Trump first ran for office on a platform to repeal the ACA.
Conflicts of interest in the land of Oz
Trump’s appointments of Robert F. Kennedy, Jr. to head the Health and Human Services Department and Dr. Mehmet Oz to run the Centers for Medicare and Medicaid Services continue to draw fire from Democrats, public health officials, medical scientists and the media over issues that will be far from front-burner during 2025.
Rather than repeat all the well-documented conflicts-of-interest and science-defying pronouncements Dr. Oz has made over the years, especially about the dietary supplements hawked on his program, I refer you to an article posted this morning by Gary Schwitzer, a former journalism professor at the University of Minnesota, now retired. He just relaunched his HealthNewsReview blog on Substack. I highly recommend you subscribe if you want incisive coverage of how poorly the media cover health care.
Allow me to focus on the most damning element of Dr. Oz’s brief career in politics (he unsuccessfully ran for a Pennsylvania senate seat in 2022, losing John Fetterman). During the campaign, he championed the complete privatization of Medicare by making Medicare Advantage universal. Multiple news outlets reported he owned stock in health insurance companies at the time. Medicare Advantage (MA) insurers were also major advertisers on his television show, which he cancelled just before entering politics.
Oz first went public with his total Medicare privatization scheme in 2000 in a commentary on the Forbes website, which he co-authored with George Halvorson, the former CEO of Kaiser Permanente. Kaiser, a non-profit integrated delivery system (it and a handful of other non-profit IDNs across country own not just an insurance arm but provide care through their own network of hospitals, physician practices and clinics), is a major supporter of Medicare Advantage. While IDNs often behave like for-profit insurers, Kaiser, Geisinger and other IDNs have been lauded over the years for both the quality of care they deliver and the integrated nature of that care. However, they are geographically limited and cover a small minority of Medicare Advantage enrollees. For-profit companies like UnitedHealth, Humana and Cigna (soon to be owned by Health Care Services Corp.) dominate the field and are the true face of the MA industry.
Given MA plans’ relentless efforts to maintain profit margins, it’s hard to see how total privatization of Medicare (let’s call it Mandatory Medicare Advantage) will save money and thereby help the GOP offset its planned tax cuts for the wealthy. According to the most recent Medicare Payment Advisory Commission report, MA plans cost the Medicare trust fund and the federal government $106 billion or 29% more in 2024 than it would have if those enrollees had remained in the traditional fee-for-service program.
About $83 billion of that amount came from up-coding, where plans document medical conditions among plan members that physicians aren’t treating. CMS (i.e., taxpayers) then pays plans a higher monthly premium for these “sicker” members.
MA plans also benefit from doctored quality ratings, which earned them unjustified bonus payments of about $23 billion in 2024 (Medicare pays a quality bonus to plans that earn 4 or 5 stars on a 5-star rating system). Insurers manipulate their quality reports to CMS by pairing poor-performing plans in one part of the country with highly-rated plans in another part of the country. The combination brings down the overall rating, but only to the point where the entire group still gets a quality bonus.
The doctored ratings also hoodwink seniors when they go shopping for plans during open enrollment season, which runs through December 5th. Local plans nominally rated 4 or 5 stars may actually have earned a 1, 2, or 3 star rating had they been independently evaluated. CMS earlier this year tried to roll back some of the unjustified quality bonuses, but the insurance industry fought it in court and succeeded in postponing most of the cuts.
I am somewhat surprised that pronouncements about public health, the food industry, the chronic disease epidemic and the pharmaceutical industry cartel by Kennedy, Oz and Trump himself are being taken at face value by some liberals. Neal Barsky, a well-respected Wall Street Journal reporter who founded the Marshall Project on criminal justice reform, authored a laudatory article on Kennedy this morning in The Guardian. Kennedy, he wrote:
My colleague David Johnson of 4SightHealth (we’ve co-authored articles in Health Affairs and I’ve written for his organization’s website) expressed similar sentiments in an article on the HFMA website (the Healthcare Financial Management Association represents hospital system chief financial officers). He approvingly quotes from RFK’s speech ending his campaign for president and throwing his support to Trump:
“Let’s assume that RFK has good intentions,” Johnson wrote. “Widespread chronic disease is robbing the American people of their vitality, lowering their productivity and decreasing their life quality. … Whether we agree with his political positions or not, we should support giving Kennedy the opportunity to build his team and present his reform program before Healthcare Inc. and Food Inc. have a chance to launch all-out campaigns, which they likely will do, to neutralize his impact.”
Barsky concludes his piece by writing: “The larger question hanging over RFK Jr’s term as HHS secretary is whether Donald Trump will back him up when he takes on the pharmaceutical and food industries.”
No, the prior question is whether Kennedy and Oz will even bother to take on the food and pharmaceutical industries. What they say now or have said in the past is irrelevant.
If you want evidence of that, search YouTube for RFK, Jr.’s appearance on The Dr. Oz Show in 2013 where he touted his book about thimerosal, the mercury preservative used in vaccines. Kennedy blamed it for the growth in diagnoses of childhood autism, even though thimerosal had been banned in childhood vaccines more than a decade earlier. Oz, who nodded approvingly at RFK, Jr.’s views throughout the interview, started by asking him, “Robert, are you anti-vaccine?”
RFK, Jr. replied: “No, both Mark [co-author Dr. Mark Hyman] and I are fiercely pro-vaccine. I have six kids. I get them all vaccinated. We believe hundreds of millions of lives have been saved by vaccines.”
Let’s wait to see what these two nominees say before Congress during their confirmation hearings. Ditto for Dr. Marty Makary, who is rumored to be Trump’s appointee to head the FDA. His new book, which has reached the New York Times best seller list, questions the science behind numerous public health orthodoxies, including pediatricians advice to avoid peanuts in the first year of life (which he blames for the peanut allergy epidemic); the cardiovascular side effects of hormone replacement therapy for menopause; and putting fluoride in the water supply (“If someone tells you that fluoridation of the water supply is entirely safe and essential for public health, that is an opinion, not a fact.”).
Even if these men are confirmed by the Senate, let’s see who Trump’s transition team appoints to political positions at key sub-agencies inside HHS like CMS, FDA, NIH, and the CDC. The government’s largest department has a $1.7 trillion annual budget, 83% of which goes for Medicare and Medicaid.
Will they fill the political slots with ideologues from conservative think tanks like the Heritage Foundation and the Paragon Health Institute? Will the Christian Nationalist authors of Project 2025’s health care chapters, who, unlike Oz and Kennedy, have intimate knowledge of HHS agency operations, gain control of policymaking?
And what will lobbyists for the drug, medical device, food and other agencies have to say about changes Kennedy and Oz claim they want to make? These companies and their trade associations spend lavishly on politicians on both sides of the aisle. I suspect many CEOs at companies that will be financially harmed by an all-out assault on food dyes, sugar, salt and other additives to processed foods are already planning their trips to Mar-a-Lago to press their case with Trump.
Speaker Johnson and Senate Majority Leader John Cornyn also will have something to say about the legislative changes needed to make a significant improvement in America’s food supply. That will require more regulation, not less. As I wrote a few weeks back, Kennedy says he wants to eliminate the FDA’s food department, not unshackle it to actually do its job.
And what will either man say about abortion, contraception and reproductive health care when they come before the Senate for their confirmation hearing? About the health benefits of dietary supplements? About plans to gut Medicaid or fully privatize Medicare? About plans to cancel expanded subsidies for ACA plans?
If Kennedy and Oz gain approval, let’s wait to see what they do before proclaiming them champions of public health.
