Americans’ unhappiness with their healthcare is deep and getting worse. One reason above all accounts for that: corporate greed. We need top government officials committed to controlling the power of the giant corporations that are driving up prices, costing individuals more, abusing the time of doctors, and restricting access to care.
Unfortunately, Mehmet Oz — Donald Trump’s nominee to be the Centers for Medicare and Medicaid Services administrator, the agency that oversees Medicare and Medicaid — seems headed in the opposite direction.
Oz has published plans to further expand the reach of predatory, for-profit insurance corporations through the privatization of Medicare. That would put millions more Americans at risk of not getting the care they need.
Partial privatization of Medicare through Medicare Advantage has been underway — and growing — since 2005 and has been a disaster.
These private Medicare insurance companies impose costs far more significant than traditional Medicare — costing taxpayers $83 billion in overpayments in 2024, according to the Medicare Payment Advisory Commission, which reports to Congress on program issues. Over the next decade, overpayments to private Medicare corporations likely will total more than $1 trillion. And that’s before Oz unleashes his plan of “Medicare Advantage for All,” further expanding privatized Medicare!
Insurance corporations offering private Medicare plans use a variety of underhanded tactics to foist costs onto traditional Medicare and to jack up Medicare profits. These tactics include cherry-picking—taking steps to insure only healthier people; lemon-dropping — pushing patients to leave Medicare Advantage plans once they become ill and need more expensive care; upcoding — through which Medicare Advantage plans to make patients appear to be more ill than they are to get higher payments from Medicare; and crosswalking — making Medicare Advantage plans’ quality ratings appear higher than they should be.
These businesses play a massive and costly game with our money and risking our health.
To add insult to injury, even though privatized Medicare costs much more than traditional Medicare and touts additional benefits for those who enroll, it often provides inferior care. According to the inspector general for the Department of Health and Human Services, privatized Medicare plans delay or deny medically necessary care to many large enrollees. Many private plans deny cancer patients access to the best cancer centers in the country. When enrollees in Medicare Advantage plans need significant care, particularly in the final year of their lives, will likely get rid of Medicare Advantage and seek care through traditional Medicare, where they have better access to care without insurer hoops to jump through.
Privatized Medicare companies impose onerous prior authorization standards. More than 46 million prior authorization requests were submitted to Medicare Advantage insurers in 2022, up 20 percent from three years earlier. Insurers denied, in whole or part, more than 3 million (nearly 7.5 percent). Of these denials, only one in 10 were appealed. Of those who appealed, more than 80 percent were overturned upon review.
Doctors also struggle with privatized Medicare plans. When they try to ensure their patients can get recommended treatments or try to seek payment for their services, they often get the runaround, forced to spend time wrestling approvals from unqualified administrators or AI bots, trained to automatically carry out harmful — even cruel — denials of care or payment. Our private insurance payment system has become so complex and broken that we need people whose full-time job is focused on wrangling insurance executives to overturn denials.
Medicare privatization is distorting the healthcare system, not just Medicare. For example, many rural hospitals are struggling to keep their doors open. Medicare Advantage plans make that worse by abusing prior authorization and even retroactively denying payment on many services.
With this record of failure, anyone who prescribes more Medicare privatization or who wants to unleash profit-driven insurers further ought not to serve as the leader of the Centers for Medicare and Medicaid Services. Notably, Oz has concerning financial interests, including significant holdings in the largest Medicare Advantage insurer, UnitedHealth Group, that may color his judgment even if he divests those holdings.
As CMS administrator, Oz would be responsible for overseeing the healthcare of 150 million Americans. We need a CMS administrator who will fight to protect patients’ access to care, reduce their out-of-pocket costs, and improve the care that all Medicare beneficiaries and their families depend on. Given his plans to expand privatized Medicare and further disadvantage American seniors, that person is not Oz. The Senate should reject his nomination.