An Replace by Merrill Goozner on Public Well being and what this administration has in thoughts. It seems Trump has his eye on Medicaid and the ACA. Possibly gutting them and having nothing to interchange them.
Kennedy/Oz as champions of public well being?
– by Merrill Goozner
Let’s begin with some media criticism.
In an above-the-fold story on its entrance web page this morning, the New York Occasions studies “Democrats (are) fighting over how to talk about transgender rights.” On the identical time, the Occasions editors buried on web page 18 a strong piece concerning the Republican Congressional management’s plans to intestine Medicaid and the Inexpensive Care Act. Right here’s a hyperlink to the latter story as a result of it’s nearly unattainable to search out on its web site.
Objectively, what’s extra necessary? How the out-party ought to reply to vicious and unscrupulous assaults by Trump and the GOP on 1.6 million susceptible adults who establish as transgender? Or GOP plans to throw as many as 5 million People (estimates differ) into the ranks of the uninsured by imposing work necessities and block grants on the 73.4 million poor, disabled and aged served by Medicaid; and eliminating the expanded subsidies for the 21.4 million low- and moderate-income People who buy insurance coverage on the Obamacare exchanges?
Shouldn’t the media be asking why Home Speaker Mike Johnson (R-La.) desires to condemn the almost 100 million People in each packages to years of dwelling in concern that their treasured lifeline to entry to well being care will likely be taken away? Is it to keep away from “a debt spiral,” as claimed within the Occasions story by a former Trump coverage adviser who runs the Paragon Well being Institute, a conservative suppose tank? No. The GOP-run Home wants it to increase the 2017 tax cuts for big companies and the rich, which expire subsequent September.
Johnson’s Louisiana, it must be famous, has the second highest Medicaid participation fee within the nation. As of the tip of March, 39.2% of its 4.6 million individuals are on Medicaid. Over a 3rd of the state’s $1.8 million Medicaid beneficiaries joined in 2016 after Louisiana determined to broaden Medicaid beneath the ACA. That was the identical 12 months Trump first ran for workplace on a platform to repeal the ACA.
Conflicts of curiosity within the land of Oz
Trump’s appointments of Robert F. Kennedy, Jr. to go the Well being and Human Providers Division and Dr. Mehmet Oz to run the Facilities for Medicare and Medicaid Providers proceed to attract fireplace from Democrats, public well being officers, medical scientists and the media over points that will likely be removed from front-burner throughout 2025.
Moderately than repeat all of the well-documented conflicts-of-interest and science-defying pronouncements Dr. Oz has made through the years, particularly concerning the dietary dietary supplements hawked on his program, I refer you to an article posted this morning by Gary Schwitzer, a former journalism professor on the College of Minnesota, now retired. He simply relaunched his HealthNewsReview weblog on Substack. I extremely advocate you subscribe if you’d like incisive protection of how poorly the media cowl well being care.
Permit me to concentrate on probably the most damning aspect of Dr. Oz’s temporary profession in politics (he unsuccessfully ran for a Pennsylvania senate seat in 2022, dropping John Fetterman). Through the marketing campaign, he championed the whole privatization of Medicare by making Medicare Benefit common. A number of information retailers reported he owned inventory in medical insurance firms on the time. Medicare Benefit (MA) insurers had been additionally main advertisers on his tv present, which he cancelled simply earlier than coming into politics.
Oz first went public along with his complete Medicare privatization scheme in 2000 in a commentary on the Forbes web site, which he co-authored with George Halvorson, the previous CEO of Kaiser Permanente. Kaiser, a non-profit built-in supply system (it and a handful of different non-profit IDNs throughout nation personal not simply an insurance coverage arm however present care by their very own community of hospitals, doctor practices and clinics), is a significant supporter of Medicare Benefit. Whereas IDNs usually behave like for-profit insurers, Kaiser, Geisinger and different IDNs have been lauded through the years for each the standard of care they ship and the built-in nature of that care. Nonetheless, they’re geographically restricted and canopy a small minority of Medicare Benefit enrollees. For-profit firms like UnitedHealth, Humana and Cigna (quickly to be owned by Well being Care Providers Corp.) dominate the sector and are the true face of the MA trade.
Given MA plans’ relentless efforts to keep up revenue margins, it’s arduous to see how complete privatization of Medicare (let’s name it Necessary Medicare Benefit) will get monetary savings and thereby assist the GOP offset its deliberate tax cuts for the rich. In response to the latest Medicare Cost Advisory Fee report, MA plans value the Medicare belief fund and the federal authorities $106 billion or 29% extra in 2024 than it might have if these enrollees had remained within the conventional fee-for-service program.
About $83 billion of that quantity got here from up-coding, the place plans doc medical situations amongst plan members that physicians aren’t treating. CMS (i.e., taxpayers) then pays plans a better month-to-month premium for these “sicker” members.
MA plans additionally profit from doctored high quality scores, which earned them unjustified bonus funds of about $23 billion in 2024 (Medicare pays a high quality bonus to plans that earn 4 or 5 stars on a 5-star ranking system). Insurers manipulate their high quality studies to CMS by pairing poor-performing plans in a single a part of the nation with highly-rated plans in one other a part of the nation. The mixture brings down the general ranking, however solely to the purpose the place your complete group nonetheless will get a high quality bonus.
The doctored scores additionally hoodwink seniors once they go searching for plans throughout open enrollment season, which runs by December fifth. Native plans nominally rated 4 or 5 stars may very well have earned a 1, 2, or 3 star ranking had they been independently evaluated. CMS earlier this 12 months tried to roll again a number of the unjustified high quality bonuses, however the insurance coverage trade fought it in court docket and succeeded in suspending a lot of the cuts.
I’m considerably shocked that pronouncements about public well being, the meals trade, the persistent illness epidemic and the pharmaceutical trade cartel by Kennedy, Oz and Trump himself are being taken at face worth by some liberals. Neal Barsky, a well-respected Wall Avenue Journal reporter who based the Marshall Challenge on legal 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 Well being Affairs and I’ve written for his group’s web site) expressed related sentiments in an article on the HFMA web site (the Healthcare Monetary Administration Affiliation represents hospital system chief monetary officers). He approvingly quotes from RFK’s speech ending his marketing campaign for president and throwing his assist 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 query is whether or not Kennedy and Oz will even trouble to tackle the meals and pharmaceutical industries. What they are saying now or have stated prior to now is irrelevant.
In order for you proof of that, search YouTube for RFK, Jr.’s look on The Dr. Oz Present in 2013 the place he touted his e book about thimerosal, the mercury preservative utilized in vaccines. Kennedy blamed it for the expansion in diagnoses of childhood autism, though thimerosal had been banned in childhood vaccines greater than a decade earlier. Oz, who nodded approvingly at RFK, Jr.’s views all through the interview, began 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 earlier than Congress throughout their affirmation hearings. Ditto for Dr. Marty Makary, who’s rumored to be Trump’s appointee to go the FDA. His new e book, which has reached the New York Occasions finest vendor checklist, questions the science behind quite a few public well being orthodoxies, together with pediatricians recommendation to keep away from peanuts within the first 12 months of life (which he blames for the peanut allergy epidemic); the cardiovascular uncomfortable side effects of hormone alternative remedy for menopause; and placing fluoride within the water provide (“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 when these males are confirmed by the Senate, let’s see who Trump’s transition group appoints to political positions at key sub-agencies inside HHS like CMS, FDA, NIH, and the CDC. The federal government’s largest division has a $1.7 trillion annual funds, 83% of which works for Medicare and Medicaid.
Will they fill the political slots with ideologues from conservative suppose tanks just like the Heritage Basis and the Paragon Well being Institute? Will the Christian Nationalist authors of Challenge 2025’s well being care chapters, who, not like Oz and Kennedy, have intimate data of HHS company operations, achieve management of policymaking?
And what’s going to lobbyists for the drug, medical machine, meals and different businesses should say about adjustments Kennedy and Oz declare they wish to make? These firms and their commerce associations spend lavishly on politicians on each side of the aisle. I think many CEOs at firms that will likely be financially harmed by an all-out assault on meals dyes, sugar, salt and different components to processed meals are already planning their journeys to Mar-a-Lago to press their case with Trump.
Speaker Johnson and Senate Majority Chief John Cornyn additionally may have one thing to say concerning the legislative adjustments wanted to make a big enchancment in America’s meals provide. That may require extra regulation, not much less. As I wrote just a few weeks again, Kennedy says he desires to eradicate the FDA’s meals division, not unshackle it to really do its job.
And what’s going to both man say about abortion, contraception and reproductive well being care once they come earlier than the Senate for his or her affirmation listening to? Concerning the well being advantages of dietary dietary supplements? About plans to intestine Medicaid or totally privatize Medicare? About plans to cancel expanded subsidies for ACA plans?
If Kennedy and Oz achieve approval, let’s wait to see what they do earlier than proclaiming them champions of public well being.
