| Speaker | Time | Text |
|---|---|---|
|
unidentified
|
We'll have more live NASA coverage as the SpaceX Crew 9 splashes down to Earth after departing the International Space Station. | |
| The mission includes the return of astronauts Barry Butch Wilmore and SUNY Williams, who have been living in space since last June. | ||
| Our coverage begins at 4.45 p.m. Eastern with the expected splashdown at around 6 p.m. | ||
| That's all live on C-SPAN. | ||
| Also on C-SPAN Now, our free mobile video app or online at c-span.org. | ||
| And we take you back now to our previously scheduled program. | ||
| All of a sudden, we're paying more for single, able-bodied, working-age adults. | ||
| And from my perspective, that has allowed states to really gain the system with provider taxes, all those types of things. | ||
| When we met, I didn't talk about my budget ideas here, how if we take a look at pre-pandemic spending levels and inflate them by population growth and inflation, we could be saving a lot of money because we're spending a lot of dollars above and beyond what we spent in the past plus inflation. | ||
| Let me just give you some numbers on Medicaid. | ||
| Obama in 2014, the first year of Obamacare, total Medicaid spending was $301 billion. | ||
| And $24 billion of that was the new Obamacare. | ||
| Inflated, that'd be $431 billion. | ||
| This year, we're spending about $600 billion. | ||
| The last good year we have for spending is 2023, where they break out. | ||
| That's a problem, too. | ||
| You can't get information. | ||
| You know, my staff had to get quarterly and add them up together to figure out what the Medicaid expansion, the Obamacare was in 2023, is $131 billion. | ||
| So it went from $24 billion in 2014 to now $131 billion. | ||
| And what would be inflated from Obama's number, $431, we're spending about $600 billion. | ||
| So I kind of want you to just comment on what has been the impact of Obamacare, Medicaid expansion, and anybody who is concerned about disabled children having access to Medicaid ought to be concerned of this new benefit to able-bodied, working-aged adults that are now allowing states to game the system and draining the federal coffers and making it more difficult to maintain benefits for disabled individuals. | ||
| And people that Medicaid was truly designed to help. | ||
| By the way, with a shared responsibility, so states would actually try and control the process. | ||
| Because right now, too many states, I'm looking across the dais here, too many states are gaming the system and could care less about eligibility and in fact are siphoning off Medicaid dollars for illegal immigrants, for example. | ||
| Open up to you. | ||
| Senator Johnson, I think I could probably start most effectively where you started, which is those physicians speaking to you about what they were most frustrated by. | ||
| It is a concern to me that doctors don't like Medicaid because they don't get paid in their minds. | ||
| And because of that, they try to avoid getting Medicaid patients. | ||
| So most physicians will take care of a certain percentage of patients in their practice for free. | ||
| It's a calling of the art form. | ||
| Historically, doctors always took care of patients who didn't have resources for free. | ||
| But then we also have the Stark laws, right? | ||
| And there are stark laws that can also limit the role that they play in owning facilities, which is a whole separate discussion point that I know we've touched on in the past. | ||
| But the ability of physicians to take care of people who don't have resources, which is partially compensated by Medicaid, is not infinite. | ||
| And so when you expand the number of people on Medicaid without improving the resources required for those doctors to take care of those patients, you stretch resources very thinly for the people for whom Medicaid was originally designed. | ||
| As you highlighted, our young, our pregnant women, our vulnerable populations that are disabled. | ||
| These elder people don't have resources, the dual-eligible populations. | ||
| They cannot be compromised. | ||
| So we have to make some important decisions to improve the quality of the care. | ||
| Again, we've talked about the fact we're spending twice as much as any other developed country. | ||
| So we are putting resources into the system. | ||
| I don't think we're getting value for those resources. | ||
| And some of the areas that I'm hoping I can work together with this members of this committee and have confirmed with other senators as well is to ensure that we have wise, effective modernization approaches to deal with the numbers you just highlighted. | ||
| Because the rapid expansion of required monies for Medicaid is far beyond what was ever envisioned when the ACA was originally passed. | ||
| And it's one of the areas we can do better. | ||
| On the other hand, Medicare part day, the pharmaceutical part of it, the drug component, that's actually done better. | ||
| So there are ways for government to do this well. | ||
| And I think I maybe speak for many folks here that our biggest enemy is nihilism, is a lack of hope that we can fix what's going on at CMS. | ||
| I am very confident, and I do believe that we have a generational opportunity to seismically shift the way we deliver health care services so that we don't have the highest mortality rate for women delivering babies amongst the top 50 countries in the world, that we're not having folks falling through the cracks wrongly, immorally in our system. | ||
| And I think being wise about those maneuvers can allow all of us to proudly stand up and say we are the great society. | ||
| And like all great societies, we take care of our most vulnerable. | ||
| Well, thanks for your willingness to serve. | ||
| Thank you, Mr. Chairman. | ||
| Thank you. | ||
| Senator Cortez-Masto. | ||
|
unidentified
|
Thank you, Mr. Chairman and to our ranking member. | |
| Dr. Oz, good to see you again. | ||
| Thank you for taking the time to visit with me in my office and welcome to your family. | ||
| Let me start with this question. | ||
| There's a couple, men and woman, they're married. | ||
| They have a daughter. | ||
| They're both working, working hard every day, but their daughter has a rare disease. | ||
| Unfortunately, the only way they can afford her medical care and treatment is with the help of Medicaid. | ||
| Would you think that this couple should be taken off Medicaid? | ||
| As you describe it, no. | ||
|
unidentified
|
And that's a bulk of the people that I hear from every day that need Medicaid. | |
| It's not what some of my colleagues are talking about, these people milking the system. | ||
| It is true, hardworking families that need help, because you've said it earlier: health care in this country is just too costly. | ||
| There's not enough access, it's not affordable, and we've got to do a better job of addressing it. | ||
| But until we do, we can't kick people to the curb when they need help for their kids in this instance. | ||
| Let me also address something else here, which I just find offensive in so many ways. | ||
| As my colleagues looking across the aisle at I see two of my colleagues sitting between me and Ben Ray, would you? | ||
| I don't even know if my colleagues know this. | ||
| Do you know how many Medicaid fraud units actually exist in the States to go after Medicaid fraud and prosecute for abuse? | ||
| You don't. | ||
| I don't. | ||
|
unidentified
|
So it's in, so you should know because there are 53. | |
| There are 53 Medicaid fraud units. | ||
| They cover every state, District of Columbia, Puerto Rico, and the U.S. Virgin Islands. | ||
| And in 2024, they recovered $1.4 billion in fraud. | ||
| Now, granted, most people, and I have not even heard this from my colleagues, that fraud was provider fraud. | ||
| That was provider fraud. | ||
| So I am all about addressing waste abuse and fraud. | ||
| But let's be real here in how we do it and make sure now we're not kicking this couple and their needs for their daughter off of Medicaid because we have some concept which is false about who it is actually benefiting. | ||
| I also want to jump back here real quick. | ||
| Senator Lankford has concerns about nursing homes closing in rural America. | ||
| So do I, absolutely. | ||
| In rural Nevada, I have concerns. | ||
| But I also like to note that cutting Medicaid the way that my colleagues and Republican leadership want to do, which they are proposing, would also close nursing homes in rural America, including in Nevada. | ||
| It would close hospitals and it would close clinics. | ||
| So that is something we have to keep in mind. | ||
| And the reason why I bring this up is because, like Senator Lankford said, in my state, if they don't have it in rural Nevada, they are driving four hours to get it somewhere else. | ||
| That's ridiculous. | ||
| And that's why I support your conversation around telehealth. | ||
| I think it's important. | ||
| Senator David and I support it together. | ||
| It's bipartisan support. | ||
| We need it. | ||
| We need to make it permanent. | ||
| There's so much that needs to be done to address health care. | ||
| And one of the things that I want to bring up is the ACA tax credits. | ||
| We currently have in Nevada the lowest uninsured rate in our nation's history, thanks in part to the ACA marketplaces, which helped over 24 million get coverage last year, many with tax credits to lower their premium costs. | ||
| If Republicans refuse to work with Democrats to extend these credits, costs will skyrocket and people will lose coverage. | ||
| In Nevada alone, 85,000 people could see hikes or thousands of dollars forcing them to drop their insurance. | ||
| And the health insurance market will destabilize. | ||
| So, Dr. Oz, if confirmed, do you agree that Congress must extend these tax credits to prevent massive premium hikes and coverage losses for working families? | ||
| Senator, if confirmed, I need to learn more about the specifics of how much additional resource is required and for what parts of the system. | ||
| But directionally, I like the idea of having transition programs to get folks who are able to work but are on Medicaid for whatever reason. | ||
| They have a family member that's ill, they've fallen ill and lost their job and lost their insurance. | ||
| It's wise for us as a nation, as we take care of them, to get them back on their feet and then transition them to programs where they can actually afford the insurance. | ||
| If you can't afford the insurance, you just don't have to. | ||
|
unidentified
|
Can I stop you there? | |
| Because now your assumption is that it is people who are not working that are accessing Medicaid. | ||
| And I just told you there's a good segment, over 66 percent or more, that are actually working and getting this benefit. | ||
| So I would hope that you would keep that in mind as you go back to study this issue. | ||
| And I would want you to study all of the facts because we don't want to harm people that we are actually providing an essential benefit to, and they are working. | ||
| They are working. | ||
| My time is up. | ||
| Thank you. | ||
| Thank you. | ||
| Senator Tillis. | ||
| Thank you, Mr. Chair. | ||
| Dr. Ayas, thank you for the time that we spend in the office. | ||
| How many members do you meet with? | ||
| I met with every single member except Senator Sanders, who I caught in the elevator coincidentally yesterday. | ||
| But he's been on my show, so I met him before. | ||
| Well, I appreciated the time. | ||
| I thought we had a very good discussion and we covered most of the topics that I needed to to convince me I was going to support your nomination. | ||
| You and I spent a fair amount of time geeking out over organization change. | ||
| And give me an idea of how you're going to spend your first 90 days. | ||
| Your advice actually took to heart, and it was directed at how do you lead a large organization. | ||
| So there's, first up, the whole broader idea of what's the shared vision? | ||
| Where do we want to head? | ||
| And as a group, if we can get people excited about their jobs, they'll show up, not just show up physically, but emotionally. | ||
| You also cautioned me that I should look beneath the leadership to what people in the rank and file, maybe three or four levels down, are thinking and saying about the organization, because they have remarkable wisdom and often they're not heard. | ||
| So these are the career officials. | ||
| There are almost 7,000 people at CMS. | ||
| So it's a lot of folks that we want to talk to. | ||
| CMS has another interesting dynamic, which is it's got about 40,000 contractors that it does the work through. | ||
| So we want them to feel the same pride of authorship for what comes out of CMS. | ||
| You want them to believe that the charge they've been given is a sacred one to take care of our most vulnerable. | ||
| And because it defines who we are, it's something that we cannot skirt in any way. | ||
| I think you can be an enabler. | ||
| And all of my experience with enterprise transformation, the best ideas came from the organization, not consultants. | ||
| We just got their recommendations elevated, and then we created sustainable change. | ||
| And I think you have to get resources out outside of the agency to get the best of all the ideas inside of the agency. | ||
| It's counterintuitive. | ||
| I do have a question for you. | ||
| If confirmed, as we're going through and trying to do all the enterprise efficiencies that the Doge effort is after, when you're confirmed, I strongly believe that Senate-confirmed leaders of agencies have to be at the helm. | ||
| They have to be the ones. | ||
| It will undermine your ability to manage your organization if they think there are two different ways or two different bosses, for example. | ||
| Doge makes a lot of sense, but pretty quickly, all of that has to be operationalized in a way that you, the leader of CMS, can manage and execute. | ||
| Do you agree with that concept? | ||
| I agree. | ||
| I'm a heart surgeon. | ||
| You don't go to the OR with two surgeons. | ||
| One person has their name on the chart. | ||
| It's an ongoing discussion point at Columbia that in your time of need, you don't want to be surrounded by intellectuals. | ||
| You want to be surrounded by people of action. | ||
| So one person goes in there when there's a bleeder, they decide what stitch to place. | ||
| They put their finger on the hole. | ||
| They deal with those issues because they're the one that's responsible to the family. | ||
| When I was Speaker of the House in North Carolina for four years, and I had a lot of people coming up to me recommending health care, proposing legislative fixes, I told them all the same thing. | ||
| Don't come to me unless you have an idea for obviously maintaining current outcomes. | ||
| But unless you have an idea that reduces costs, improves outcomes, or increases access. | ||
| If you have one of them, I may be interested. | ||
| If you have two of them, you've definitely got my attention. | ||
| If you have three of them, we're going to get the bill passed. | ||
| And we did. | ||
| And we worked on the Medicaid program in North Carolina. | ||
| We did not allow Medicaid to get expanded under Obamacare when I was there because we had to clean up the mess that I inherited. | ||
| And then the subsequent speaker did expand Medicaid, and I think it's working pretty well. | ||
| I did have a question on there were a couple of people. | ||
| By the way, I complimented Senator Whitehouse on Ferret being after you like a ferret. | ||
| We all need to be after you like a ferret. | ||
| I used to have a ferret named Garrett. | ||
| Actually, I just realized I got a staff named Garrett. | ||
| But I like the analogy. | ||
| We need to be after you because it's interesting in these questions that are being, everybody's frustrated with Medicaid, right? | ||
| Everybody thinks we can do some work on Medicare, but this has been a bipartisan failure to really modernize and make leaner and put more money in patient-facing operations. | ||
| We've got to have less money in all the plumbing. | ||
| And so I just want a commitment from you. | ||
| Within your first 90 days, would you be willing to host a meeting on your turf with any of the members of the finance committee that would like to see your vision for enterprise transformation for CMS? | ||
| Senator Tillis, I would welcome the opportunity to host members of this committee and other interested parties. | ||
| In fact, I need your help. | ||
| And let me just speak to one issue since you brought it up, and your expertise historically had been enterprise transformation. | ||
| There are probably 150 people who control health care in America, and they don't really want anything to change. | ||
| This is not an accident that we're here. | ||
| In Tennessee, Marshall, you know, I can't. | ||
| Well, I've got to be sensitive to everybody's time, but that's why I'm going to give you a copy of this book. | ||
| Do you remember this book? | ||
| Yes. | ||
| I'm going to give copies for a lot of my colleagues. | ||
| It's called Who Moved My Cheese. | ||
| It's a story of a maze that you're going to find yourself in at CMS. | ||
| And there are two types of people that are going to be in that maze. | ||
| Sniff and Scurry, who were the mouses who figured out where the cheese was and they embraced change. | ||
| And him and Ha. | ||
| They were the little people in the maze who just resisted any idea of change. | ||
| But ladies and gentlemen, all the frustrations we have, whether Democrats are in control, we're complaining about it, or Republicans in control, they're complaining about it, are structural problems where we need to set politics aside and enable a leader to fix it. | ||
| There have been capable Democrat nominees and Republican nominees that were never given a chance. | ||
| So we want to move the cheese. | ||
| We want to produce better outcomes. | ||
| We want to do it at a lower price point. | ||
| And we want more people to have access. | ||
| And clearly, anybody who needs Medicaid should be on it. | ||
| The only thing, we're not talking about caregivers, we're not talking about sick people. | ||
| We're not talking about people with a diagnosed behavioral health problem. | ||
| We're talking about people that we do want to provide Medicaid for, if they can't afford it, but work so that they actually get the benefit and the freedom that comes from a job. | ||
| That's all we're asking about. | ||
| All these other things are insane. | ||
| We're probably only talking about a single-digit portion of the population. | ||
| And if we keep on playing those games, we're going to have a problem. | ||
| I hope you're there for change. | ||
| Thank you. | ||
| God bless you, sir. | ||
| Senator Warren. | ||
| Thank you, Mr. Chairman. | ||
| So, Dr. Oz, if confirmed, you would oversee Medicare coverage for more than 66 million Americans. | ||
| Now, nearly half have traditional Medicare, where the federal government provides health care coverage directly. | ||
| The other half are on Medicare Advantage, where the federal government pays a private for-profit insurer to administer the health benefits instead. | ||
| And surprise, surprise, the privatized Medicare costs a whole lot more. | ||
| So, let's talk about the top trick that Medicare Advantage insurers use to gouge taxpayers, upcoding. | ||
| I understand Senator Cassidy started on this this morning, and I just want to dig a little deeper. | ||
| In Medicare Advantage, taxpayers give insurers a set amount per patient. | ||
| The more diagnoses or the codes the patient has, the higher the payment. | ||
| Now, in theory, this covers higher costs for sicker patients, but insurance companies get the money for the codes, not actually for the services they do or don't deliver. | ||
| So Medicare Advantage insurers have figured out that if they can add a bunch of fake diagnoses that they don't actually have to spend money treating, they can really boost their profits. | ||
| One example, last year the Wall Street Journal identified 66,000 Medicare Advantage patients diagnosed with diabetic cataracts who had already gotten cataract surgery. | ||
| Now, that is, as you know, anatomically impossible. | ||
| So Dr. Oz, insurers pocketed an extra $178 million in taxpayer money last year thanks to just this one fake diagnosis. | ||
| Does that sound like Medicare fraud to you? | ||
| Senator Warren, I appreciated you spending time with me in your office. | ||
| The answer is yes. | ||
| It's anatomically impossible. | ||
| And I'll give you one more example. | ||
| Okay. | ||
| Which is sending someone to your home, which you brought up in the office. | ||
| If you're going to say it, I won't say it, but you pointed out something that's very real, which is if you send someone to someone, if an insurance company sends someone to your home, there's probably a reason for it. | ||
| And so if they're doing ultrasounds to look for minor atherosclerotic plaques, which is not really something that needs to be treated, and most Americans have, it's primarily done to upcode you, which has two problems. | ||
| One, it's cheating because you're able to charge more for those patients, but then people who truly have limb-threatening peripheral vascular disease who have that box checked in their care, those companies, insurance companies, don't get paid more. | ||
| Those doctors don't get reimbursed more for doing what is ethically correct. | ||
| So it doesn't just help the scoundrels who are stealing from the vulnerable. | ||
| It's actually hurting the people trying to take care of those vulnerable populations. | ||
| In fact, let's talk about how bad that upcoding is that comes from the home visits. | ||
| HHS Inspector General found that in 2022 alone, United Health used these home visits to add about $2.3 billion worth of diagnoses, diagnoses that led to absolutely no treatment. | ||
| And I take it you think that sounds like fraud as well. | ||
| We are, I think as an agency, aware of this. | ||
| I haven't been in there yet, but if confirmed, this will be one of the topics that is relatively enjoyable to go after because I think we have bipartisan support. | ||
| I love hearing this. | ||
| So upcoding is a scandal. | ||
| And overall, we know that Medicare Advantage overpayments cost at least $83 billion in a single year. | ||
| So $83 billion, remember that number. | ||
| Last month, Republicans in the House passed a budget framework that sets up $88 billion in annual cuts to health care, Medicaid funding for seniors in nursing homes and for people with disabilities who have a home health aid and more. | ||
| So Dr. Oz, I have a simple question. | ||
| If you had the choice, would you rather cut waste fraud and abuse by a Fortune 50 health insurance company in Medicare Advantage or cut funding for Medicaid, which covers half of all seniors in nursing homes and one in three of America's children? | ||
| My goal is to improve the health care of the American people. | ||
| And as you create the argument, the former sounds like a more rational way to do that. | ||
| I appreciate that. | ||
| You know, I am happy to work with Republicans to go after waste fraud and abuse, but let's cut out waste fraud and abuse where it actually occurs, like upcoding in Medicare Advantage. | ||
| Republicans cutting health care for seniors and for babies and for people with disabilities, while the waste and the fraud just roll right along for a multi-billion dollar insurance company is sickening. | ||
| And I will fight that every step of the way. | ||
| Thank you, Dr. Oz. | ||
|
unidentified
|
Thank you. | |
| Thank you. | ||
| Senator Blackburn. | ||
| Thank you, Mr. Chairman, and welcome. | ||
| We are delighted that you are here and look forward to having you move out of this committee, be confirmed on the floor, and get over to CMS and get busy to work. | ||
| You have quite a job in front of you, and I appreciate the time that you gave when you came to visit with me. | ||
| As we discussed changes to health care delivery, transparency, electronic health records, all of that is not going to happen here in D.C. | ||
| It's going to happen in places like Nashville, Tennessee. | ||
| And individuals that are entrepreneurial in their new starts in their companies that are addressing so many of these delivery and access issues. | ||
| And as you've heard, there's great frustration with Medicare, Medicaid, the fraud that exists. | ||
| There's frustration with entities like CMMI that can't do their job and they need to either get to work or they need to be shuttered and that money used elsewhere. | ||
| And there is frustration with coding. | ||
| I would remind my colleagues that it is the American Medical Association that supports many of them, that is responsible for coding. | ||
| And it is time, I agree, to simplify that system. | ||
| And I know you have thoughts on that. | ||
| And I look forward to your being able to tackle that issue. | ||
| Senator Blackburn, I enjoyed our visit, particularly highlighted the reality that everyone should be aware of that Nashville has become the health care finance capital of the country with a lot of very innovative souls making major advances in health care. | ||
| We want to empower those kinds of companies to start playing a role with the development of better services for Americans and also cost savings for the American people by building a better mousetrap. | ||
| To do that, they have to know where we're headed. | ||
| The first thing you learn in hosting, whether it's a television show or a garden party, is telling your guests where they're going. | ||
| And I don't think CMS has done that adequately. | ||
| I'm hoping that if confirmed with strong leadership, we'll be able to message very clearly where we need help, where there are opportunities for us to do better. | ||
| By engaging the private sector wisely, I think we can challenge some of the incumbents, get some wise insurgent ideas to be seen and tested. | ||
| CMMI has a history of failed projects, but I think with strong leadership, it will do very well. | ||
| Well, let's hope that they do. | ||
| I do want to talk with you about the low-wage index. | ||
| As I mentioned to you, we've had 16 hospital closures over the last decade in Tennessee. | ||
| 13 were in rural areas. | ||
| The first Trump administration put a fix on this, and then the Biden administration let it expire. | ||
| No guidance, no direction, and it was like our rural hospitals just had the rug pulled out from under them. | ||
| Can I get a commitment from you that you will indeed address this disparity? | ||
| You have my commitment, if confirmed, to address broadly what we have to do with rural health care in America. | ||
| It's not just hospitals. | ||
| As we discussed in your office, there's some great institutions, 300-bed hospitals built in 1970 that really shouldn't be a 300-bed hospital anymore, even though it is the only place to get care in that area. | ||
| We have to provide a better solution for the people in those areas, a financially viable one for the community, and one that actually protects the state coffers. | ||
| If Medicaid is consuming a third of the budget in Tennessee, which is approximately what it is doing, it's crowding out schools, it's crowding out infrastructure, it's crowding out education, I mean, services that are valuable for folks around the state, and we're eating our souls from the inside out by not dealing with this wisely. | ||
| And you've heard several of us mention Medicaid funding and concerns there with the fraud that exists in Medicare and Medicaid programs. | ||
| And every time someone defrauds one of these programs, whether it is on providing care or receiving money that is not theirs, it really hampers the ability to get care to people that need it. | ||
| Another area of fraud that we've noticed is the non-U.S. nationals that are crowding into the program and individuals that are illegally in the country that are receiving Medicaid benefits that ought to be going to U.S. citizens. | ||
| Will you work with us on cleaning up these roles and moving them out of the program? | ||
| I look forward to ensuring that the determination of Medicaid eligibility is done accurately and honestly. | ||
| Same for Medicare. | ||
| I saw an article yesterday highlighting what California has been able to accomplish, taking money from federal coffers to fund exactly the programs you're describing within their state. | ||
| It's a smart move if you're a state that can pull it off, but it's not the right thing for the American people because we're all in this together. | ||
| Thank you. | ||
| Yelbank. | ||
|
unidentified
|
Thank you. | |
| Senator Smith. | ||
| Thank you, Chair Crapo, and welcome, Dr. Oz and to your family for joining us. | ||
| And I want to just note thanks to my colleague, Senator Blackburn, for her focus on rural hospitals and rural health, which I is concerned that I share. | ||
| Dr. Os, I want to talk a bit about artificial intelligence in health care and technology. | ||
| You've expanded on the many potential uses of AI and technology for delivering health care. | ||
| And I agree that we need to make the best use of technology to improve access to high-quality care. | ||
| And in fact, I think we learned a lot from the pandemic in terms of, for example, advances in telehealth. | ||
| And that is important to not forget those lessons. | ||
| But so I'd like to spend my time just getting a better understanding of your thinking on the role of AI and health care delivery. | ||
| So let's start with this. | ||
| Let's start with how health insurance companies are using AI to make decision about prior authorization decisions. | ||
| Could you talk a bit about that? | ||
| How do you think or do you think that AI should be used in prior authorization decisions? | ||
| Senator Smith, I enjoyed visiting with you and thank you for sharing some of your ideas at that time. | ||
| And this is a good place to start. | ||
| AI can be used for good or for evil. | ||
| And it, to a large extent, depends on who's using it for what purpose. | ||
| I think AI could play a vital role in accelerating pre-authorization. | ||
| One reality in the health care system right now is the average insurance company has about 3,000 procedures that they use, they rely on pre-authorization from, but they're not the same 3,000 procedures. | ||
| So if you switch insurance companies, you may move from one that used to pre-authorize a knee replace, but the new one doesn't. | ||
| So I would argue that to use AI wisely, we would make a decision, which is we're only going to pre-authorize 1,000 procedures. | ||
| Everything else just should get done because it's only 1,000 where there's a concern. | ||
| And this, I'm sorry to interrupt you, but what I think you're referring back to what you said earlier, which is that we use pre-authorizations too much. | ||
| And I think I heard you say that earlier. | ||
| But I want to dive in on this a little bit more because there have been reports and lawsuits that have alleged that AI has been used by three of the largest Medicare Advantage insurers to determine how long patients can stay in hospitals, denying those claims, kicking people out of hospitals or even out of step-down clinics when they're not able to take care of themselves at home. | ||
| And this is a big concern. | ||
| I think my view is that a human needs to have a final say in these decisions that insurance companies are making. | ||
| And I'm wondering if you would agree with that. | ||
| I agree with you. | ||
| If I can add just one more layer, this sounds like our conversation in your office. | ||
| I think that we should be using AI in the agency to be able to tell what insurance companies are doing with their AI. | ||
| The best way to detect bank fraud is not a person looking at whether a fraudster is going in to steal money because most of us aren't thinking about fraud, so you're not very good at detecting it. | ||
| So if we see that there's something being done, for example, inappropriate use of AI or inappropriate denial of services with AI, we should be using AI within the agency to identify that early enough that we can prevent it and we should do it real time, not six months down the street. | ||
| Use it as a tool to address whether an insurance company is using prior authorization inappropriately. | ||
| And protect the American people. | ||
| They should actually know what that AI is telling us, so they should also feel empowered to push back when they don't think it's right. | ||
| So here's another example in the time that I have. | ||
| You've talked about using AI to augment care, especially in Medicaid, where we have serious shortages of mental and behavioral health care providers, I think. | ||
| Dr. Oz, how should AI programs be deployed to support patients that are experiencing mental health challenges? | ||
| After I was nominated, I started spending a lot of time looking at technologies just to understand what could be the future. | ||
| And after meeting with a lot of the leaders in artificial intelligence and seeing a lot of different demonstrations, I can attest to you that we are months away, not years away, from having AI tools that could have a conversation with someone that you care about, pick up subtle details about how they feel emotionally about a problem, whether they're going to follow through with dealing with it. | ||
| Do they really understand what the doctor or nurse told them? | ||
| All of this is going to become part of the fabric of how we expand services. | ||
| And this is not about removing doctors. | ||
| I agree with your first premise that humans have to be involved, but an internist who's capable with decision support and a little bit of help from AI dealing with the intake could see twice as many patients. | ||
| I'm making that number up. | ||
| We don't know that for sure, depending on the severity of the illness, but see a lot more patients in order to get through the day, and that's better resources for everybody. | ||
| So here's the concern that I have with this, because I think sometimes this is not transparent to patients. | ||
| And that to me is extremely important. | ||
| It's been documented that there are chat bots out there that have been advertised as providing social and emotional support and even representing themselves in one case as a real licensed mental health providers when they're not. | ||
| And we have documented that some of these bots have actually encouraged, in some cases, suicide or self-harm or even violence. | ||
| And addressing this misuse of the technology seems to me of grave need to our society. | ||
| It's a well-identified problem. | ||
| AI should worry us all, but I do believe it's a tool that, if used appropriately, and I think Congress will have to play a role in making sure we do that wisely, could help a lot of Americans and certainly will help the provider groups. | ||
| But we have to be able to put guardrails around its appropriate use. | ||
| I'm out of time. | ||
| Thank you, Mr. Chair. | ||
|
unidentified
|
Thank you. | |
| Senator Marshall. | ||
| Thank you, Chairman. | ||
| Welcome, Dr. Oz, Lisa, family. | ||
| Thanks for being here to support your husband and your dad. | ||
| It means a lot to us. | ||
| I'm glad they're still here. | ||
| Yeah, they're still here. | ||
| So welcome, Dr. Oz. | ||
| Just kind of a big picture question. | ||
| Why did you go into medicine and what are some of the highlights or the most rewarding parts of your career? | ||
| I don't think there's a joy greater than looking a patient in the eyes and recognizing both of you that you're there for each other, that nothing will get in the way of you providing the best care possible. | ||
| It's not that there won't ever be problems, but you'll be there emotionally supporting them. | ||
| And if you've been gifted with teachers as I was that could educate me about how to take care of patients, you get to watch them get better and feel a joy inside your heart that can't be matched. | ||
| I don't believe in another field. | ||
| It's why my son Oliver, this one over here, is going into medicine. | ||
| I think it's why I went into medicine because I saw my father go into the hospital and do things like putting needles in people, which that looks painful, but the patients would smile and thank him for it. | ||
| Paradoxically. | ||
| And that's why I think it's also appropriate for physicians as you have and other physicians on this committee, Dr. Cassidy, to enter government because we're trained to tell people things that they need to hear but aren't pleasant. | ||
| But that's how you get the system to work better. | ||
|
unidentified
|
Thank you. | |
| You know, everyone's giving you advice up here. | ||
| I get to give you one piece of advice. | ||
| You need more nurses at CMS. | ||
| Nurses solve problems. | ||
| They understand where the patients are, so encourage you to more nurses. | ||
| But beyond that, my grandma always said if you have your health, you have everything. | ||
| And America doesn't have her health right now. | ||
| 60% of us have a chronic disease. | ||
| Several people pointed out this country is spending multiples more than other countries do to take care of our sick. | ||
| There's not enough sick care out there to save Medicare and Medicaid. | ||
| You and I came here to save Medicare and Medicaid, but part of that is making America healthy again so that we don't have to do as many heart bypasses and give as much insulin and diabetic type of drugs. | ||
| What is your prescription for America? | ||
| How do you work with Medicare and Medicaid patients to help America become healthy again? | ||
| If I ask beneficiaries about Medicare, most people don't really know much about what we could do for them. | ||
| They know about the payment issues, but they don't appreciate that the incentives around the payments drive a lot of the decisions. | ||
| You know that because in your practice you saw that firsthand. | ||
| But it is remarkable outside of medicine how it looks like an opaque box. | ||
| If we incentivize wise moves by patients and their providers, their doctors, nurses, and I agree with you, the acting administrator of CMS is a nurse. | ||
| So it's in capable hands if something happens to me. | ||
| But the deeper promise that we should all be making to America is we're going to make it easy for America to do the right thing when it comes to their health. | ||
| Some of these decisions are not difficult. | ||
| Some of them need to be simplified and some of them need to be reminded frequently. | ||
| And Senator Wyden and I have spoken about this a little bit, the idea of giving incentives to patients is an idea that I think is a worthy one, especially for Medicaid beneficiaries. | ||
| If people don't feel like it matters what they do, if they don't think they have agency over their future, that their getting up in the morning doesn't really make the world a better place, then they're not going to take proactive steps to reduce their diabetes or another action that would dramatically reduce their life expectancy and their cost to the health care system. | ||
| So I think there's a lot of opportunity for us to do this, and we should be innovative and explore ideas. | ||
| And I think there's an ecosystem we can build together to engender that kind of enthusiasm from people on the outside of medicine who want to make it better. | ||
| We have got to challenge the incumbents in the system to have new ideas bubble to the top so we can pick the winners based on competent competition. | ||
| We're not going to save Medicare and Medicaid unless we make America healthy again. | ||
| I'm going to talk just a second about maternal care. | ||
| Came to this body on the other side of the Capitol and people were talking about maternity mortality then. | ||
| We were seeing a big spike in it. | ||
| And I asked people why, what, how come? | ||
| And we didn't have an answer. | ||
| So thanks to my A-plus staff, we funded a study. | ||
| And not surprising to me, the number one killer of women, pregnant women, delivered that year after is actually suicide and fentanyl poisoning overdose. | ||
| We don't need to study it more. | ||
| We need action. | ||
| Early access to prenatal care would be the other action point as well. | ||
| So look forward to continuing to work. | ||
| Half of our patients, half the patients I delivered were Medicaid patients. | ||
| They need access to care, and we also need to stop the flow of fentanyl. | ||
| My last question, though, speak briefly how price tags and health care savings accounts turn patients into consumers again and how that might actually help save Medicare and Medicaid. | ||
| Senator, I appreciate your leadership in the Make America Healthy Again movement, both in the Senate but also outside of the Senate, being an advocate for it years before it was in vogue. | ||
| There's a lot we can do with health savings accounts. | ||
| We could even investigate new ways of using them. | ||
| Maybe they should be part of your estate and passed on to your children because so many families don't really have anything to pass on and it would incentivize behaviors even at the end of life. | ||
| But I think there's an opportunity for us to give consumerism, give the power of the purse back to the American people, especially if they're beneficiaries on Medicare, and let them make the wisest decisions they can. | ||
| They got to that age by making some good decisions. | ||
| And so we might as well let them keep going. | ||
| Yeah, here we go. | ||
| Thank you. | ||
| I yield back. | ||
| Senator Luhan. | ||
|
unidentified
|
Thank you, Mr. Chairman. | |
| Dr. Oz, as I shared with you, New Mexico now has 33 people with confirmed cases of measles. | ||
| Cases have now spread to a new county in New Mexico. | ||
| One New Mexican has died of measles, a child. | ||
| In West Texas, the South Plains of Texas, 223 cases. | ||
| Child has unfortunately died in the state of Texas. | ||
| My question is simple. | ||
| Yes or no, do you believe the measles vaccine is safe? | ||
| Yes. | ||
| Yes or no, do you believe the measles vaccine is the most effective way to protect against infection? | ||
| It is, but if I could mention, as we discussed last night, and I think it's important to remember, CMS really should not be opining its own opinion or sharing its own thoughts on vaccines. | ||
| Our job is to follow the rules. | ||
| So if the CDC is making decisions about the use of a vaccine, and that's what's agreed on by the experts there, my job, if it confirmed, is to make sure we pay for those vaccines, seniors and for children. | ||
| Now, my colleagues and I have written twice to the Secretary of Health and Human Services to do more to address measles. | ||
|
unidentified
|
There's not been a response. | |
| The same question asked of you today: if confirmed, would you respond to letters from members of this committee? | ||
|
unidentified
|
I appreciate your strong response. | |
| Yes. | ||
| It might surprise the American people that Senator Kennedy or Secretary Kennedy said the same thing. | ||
| So, Mr. Secretary, if you're watching today, respond to the damn letter. | ||
| People are dying. | ||
| I'm going to get back to the questions, Dr. Osh. | ||
| The next question I had was to ask how many people need to die before the administration takes it seriously. | ||
| I'm not going to ask you that. | ||
| But I would like to enter into the record an article from The Atlantic detailing the story of a Texas father who just lost his daughter to measles, Mr. Chairman. | ||
| Without objection. | ||
| Now, Dr. Oz, I believe Medicaid is on the chopping block because of the Republican budget. | ||
| And, Mr. Chairman, I would like to ask to enter into the record the Republican budget resolution which passed on February 25th, 2025, a letter from the Congressional Budget Office March 5th, 2025, and an article from the Kaiser Family Foundation explaining the congressional budget letter from March 7, 2025. | ||
| Without objection. | ||
|
unidentified
|
Dr. Oz, I'm going to give these to you. | |
| Because you were asked a question earlier about cuts to Medicaid, not being aware, and I believe your response was something along the lines of not being aware of what House Republicans did. | ||
|
unidentified
|
Here's some material to read that explains what just happened. | |
| So I'm going to share this to you as well. | ||
| That's why I entered into the record. | ||
| Now, Dr. Oz, rural hospitals are in dire straits. | ||
|
unidentified
|
We've heard from Democrats and Republicans today. | |
| Now, they rely on Medicaid to stay afloat. | ||
| Now, yes or no, do you support Medicaid cuts when they will lead to rural hospital closures? | ||
| I don't want rural hospitals to close unless we have a better option. | ||
| But if I could offer a thought here, this is a good example where maybe there's an innovative approach that might work. | ||
| I have been talking to hospital systems, and one idea that comes up in rural systems is they don't feel like they've got a partner that maybe is a larger academic center or a bigger institution that might have resources for them to do best practices exchanges. | ||
| So imagine a rural hospital in central New Mexico, maybe around Mesa Verde, where you actually can have a partner that's in Phoenix or Salt Lake City or Dallas, and that could be your partner hospital. | ||
| So when you need telemedicine services, they're there. | ||
| They're not just there digitally. | ||
| They've been there. | ||
| They know the institution. | ||
| They know the people. | ||
| They develop a camaraderie that allows them to thrive. | ||
| We have to revisit how we deliver rural care in America. | ||
| We can't depend on 100-bed hospitals that do one delivery a day to provide state-of-the-art care. | ||
| So I share your concerns about losing these institutions. | ||
| I think we should look at additional alternatives to make them strong. | ||
| But Americans in rural areas, and I have heard it even in my office visits from every single one of the senators in large rural constituencies. | ||
| So Dr. Oz, I'll ask a follow-up to Dr. Cassidy's question, or I'm sorry, to Senator Tillis's questions in conversation. | ||
| Dr. Oz, will you stand against changes that will lower health outcomes to the programs that you will oversee? | ||
| Yes. | ||
|
unidentified
|
Should physicians or insurance companies dictate the care that a patient receives? | |
| I'm sorry, should insurance companies? | ||
|
unidentified
|
Should physicians or insurance companies dictate the care that a patient receives? | |
| Physicians. | ||
|
unidentified
|
I appreciate that. | |
| I agree with that. | ||
| Yes or no, will you continue to defend Medicare drug pricing negotiation programs in court? | ||
| It's the law. | ||
| I'm going to defend it and use it. | ||
|
unidentified
|
Yes or no? | |
| Will you commit to the process of negotiating prescription and drug prices in Medicare? | ||
| I'm going to look, as the President has instructed me to already, for every single way that we can reduce drices. | ||
| And there are lots of options available. | ||
| I feel compelled to pursue every one of them. | ||
| I'll ask you one more time because I think I heard it, but I'll give you another chance. | ||
| Yes or no, will you commit to the process of negotiating prescription drug prices in Medicare? | ||
| Senator, it's one of many approaches I want to use. | ||
|
unidentified
|
I appreciate it. | |
| I thought you might say yes a second time, but it's not yes or no from you. | ||
| That's fine. | ||
| Yes or no, do you believe that health care decision? | ||
| Well, I already asked that one, Dr. Oz. | ||
| Look, as we get through all of this, I have a series of questions that I have put together, not coming into this committee for, based on Senator Hassan's questions. | ||
|
unidentified
|
I'll submit them into the record. | |
| I have a lot of concerns in these spaces. | ||
| I won't get to it now. | ||
| I appreciated having a conversation with you. | ||
| I'm very concerned of this back and forth of my colleagues saying that they're going to not cut Medicaid or cut it when Republicans are voting for it. | ||
|
unidentified
|
Those are the realities. | |
| And as I shared with you, Dr. Oz, one thing that I've learned about Washington, D.C., the way that this place works better is when people keep their word, when people are honest. | ||
|
unidentified
|
The American people want honesty. | |
| If it's bad news, they'll take it. | ||
| And they're going to be stronger on how they're going to respond to it. | ||
| But when they get lied to and they think something's coming or they're going to be protected or a mom with a kid with cancer thinks they're going to have care and then it gets taken away like that, then what? | ||
|
unidentified
|
Just own up. | |
| If that's what you want to do, own up to it and admit it. | ||
| But stop lying to the American people is what I keep saying to all my colleagues, anyone that will listen. | ||
|
unidentified
|
God bless you and your family. | |
| I appreciate you being here today. | ||
| Thank you, sir. | ||
| Senator Warnock. | ||
| Thank you, Brother Chairman. | ||
| Dr. Oz, welcome to you and your family. | ||
| Congratulations on your nomination. | ||
| I enjoyed our conversation the other day and finding out the friends that we have in common. | ||
| My home state, Dr. Oz, the state of Georgia, is not only one of just 10 states in the country that still has not expanded Medicaid. | ||
| It also has the dubious distinction of being the only state, the only state in the country, where the limited number of families who do qualify for Medicaid are required to regularly complete bureaucratic paperwork to prove that they're still working the minimum number of hours to get health care. | ||
| State officials call it Georgia Pathways to coverage. | ||
| I call it Georgia Pathways to Nowhere. | ||
| The program is allowed under the state's Medicaid waiver, which is up for renewal this year. | ||
| And if confirmed as head of CMS, you would be responsible for approving or denying the state's application to renew this onerous paperwork requirement. | ||
| Dr. Oz, I'm not going to ask you, really, I'm not going to ask you to prejudge the state's renewal application. | ||
| That wouldn't be fair. | ||
| You need to see it. | ||
| But since you would oversee Medicaid if confirmed, yes or no, do you believe that families should have to complete government paperwork every single month to prove that they're working just to get health care when they're sick? | ||
| Senator, I appreciate your question. | ||
| I enjoyed visiting with you. | ||
| My wife, who went to Union Theological for a while, different time than you, I brought her as a support staff. | ||
| Good. | ||
| That gives me comfort. | ||
| Yes or no? | ||
| The answer to me is I am in favor of work requirements, and I don't believe we should. | ||
| Do you think a family should have to fill out paperwork every month just to get health care? | ||
| I don't think you need to use paperwork to prove a work requirement, and I don't think that should be used as an obstacle, a disingenuous effort to block people from getting on Medicaid. | ||
| However, I believe we would both probably agree that there's value in work, and it doesn't have to be going to a job. | ||
| It could be getting education. | ||
| It should be showing that you want to contribute to society. | ||
| Frankly, you could volunteer at Ebenezer Baptist Church, where I did a show with you once. | ||
| That would, for me, fulfill the requirements. | ||
| You'll never get any pushback from me about the value of a work ethic and the purpose that work provides, which is why I think people ought to have health care so they can get back to work. | ||
| Very often they can't get back to work in Georgia because they can't get the health care. | ||
| Let me give you an example. | ||
| There is a woman in Dalton, Georgia, that I got to know a while ago. | ||
| Her name is Heather Payne. | ||
| She's a traveling nurse. | ||
| And, you know, as a traveling nurse, some jobs were better than others. | ||
| Sometimes she had health care, sometimes she didn't. | ||
| She was among those folks who were in the gap. | ||
| She couldn't afford private insurance. | ||
| But she wasn't poor enough to get conventional Medicaid. | ||
| So her health challenges and the unpredictable nature of her work as a traveling nurse made it impossible for her to meet Georgia's onerous work verification requirements to get Medicaid. | ||
| She found out she had had a series of strokes. | ||
| She had to save the money to see a neurologist. | ||
| And then she found out she'd had a series of strokes. | ||
| Took a long time to be able to afford to go. | ||
| And now she's in the gap. | ||
| And she can't meet Georgia's onerous work requirements. | ||
| Do you think Heather Payne, a traveling nurse who spent her career providing health care to others, do you think she deserves Medicaid or not? | ||
| Yes. | ||
| Thank you. | ||
| I agree with you, and since we agree, I think that the Medicaid waiver that you will be responsible for reviewing, I think that Medicaid waiver, in fact, I know it, it says that Heather does not deserve Medicaid. | ||
| Let me tell you about another Georgian. | ||
| Amanda left her two jobs in New York and moved to Warner Robbins, Georgia to become a full-time caregiver for her 84-year-old father, Thomas. | ||
| Taking care of her father has become a full-time responsibility for Amanda. | ||
| He's 84 years old. | ||
| She's taking care of him, which means he's not in a nursing home, by the way. | ||
| She's taken on that responsibility. | ||
| But with all of this, she doesn't have time to hold a full-time job that meets the state's strict work requirements, and she has no income to cover her own health care costs should she get sick. | ||
| Dr. Oz, do you think Amanda deserves Medicaid? | ||
| From what you're describing, yes. | ||
| These are the opportunities we have to make the system better. | ||
| If we both agree that people should be trying to get off Medicaid if they can, we should be able to create a system where we can track that, because there's the twin paradox, which I think we touched on in the office. | ||
| Two brothers are at home. | ||
| One's working every day, flipping burgers, making minimum wage, maybe he's cobbling together $16,000, $17,000, puts him right above the poverty level. | ||
| And the other brother doesn't bother working because he'll have the exact same coverage if he doesn't work. | ||
| We want to make both of them want to move up the ladder. | ||
| Like every small businessman, what's their goal? | ||
| To become a big businessman. | ||
| So look, you and I have the basis, I hope, for a meaningful conversation. | ||
| Georgia's pathways to coverage is a roadblock to care. | ||
| They've literally gotten, I don't know, 6,000 people, I think, the last time I checked. | ||
| And we've got over 500,000 people in the gap. | ||
| So I'm going to give you a softball. | ||
| If you're confirmed, will you work with me and will you keep Amanda and Heather in mind as you consider whether or not to renew Georgia's waiver, which I think is filled with unnecessary and onerous work requirements, paperwork, filling out paperwork every single month? | ||
| Will you keep these two people in mind? | ||
| That's the question. | ||
| Heather and Amanda should be in all of our minds and many others like them. | ||
| I look forward to working with you. | ||
| Maybe if you invite me down on a Sunday, I'll come to church with you. | ||
| Thank you very much. | ||
| You're invited any Sunday. | ||
| You can't preach, but you can come. | ||
| Senator Welch. | ||
| Thank you very much, Mr. Chairman. | ||
| Welcome, Dr. Oz, and welcome to your family. | ||
| The big concern I have about our health care system is it costs too much. | ||
| It's a real disgrace that we spend the most and get the least. | ||
| I mean, so many other countries, with all the problems they may have with their health care system, citizens are not anxious about whether they can afford the care that they need. | ||
| Here, that's not the case. | ||
| And one of the big problems is that private equity, pharmaceutical pricing power, device manufacturer, pricing power, consolidation in the industry, all of this has made the cost of health care brutal. | ||
| It's brutal on taxpayers. | ||
| It's brutal on employers. | ||
| In Vermont, we have a lot of small employers. | ||
| They're paying sometimes $40,000 for a family plan for their employees. | ||
| They can't afford that. | ||
| And it's brutal, obviously, on individuals. | ||
| So I believe a major responsibility that you would have in your job would be to fight the excessive charging. | ||
| I'll ask you a little bit about pharmaceuticals, but you said you're going to pursue that. | ||
| You know, in his first term, President Trump said he favored a reference price for drugs. | ||
| So, you know, we're paying three, four, five times for the same drug that they buy in Canada or in Europe. | ||
| Would you support reference pricing so that we don't get ripped off compared to everybody else, even though we do the research? | ||
| Senator Welsh, thank you very much for taking time to meet with me before this event and for that question. | ||
| President Trump has been very clear that he wants me to reduce drug prices, not just that the government pays, but also for beneficiaries. | ||
| International reference pricing is a way of doing that. | ||
| All right, here's what I think we all need. | ||
| We have got to get a fair price, and it's not a fair price when we're paying six or seven times what they're paying for, the same thing in France or in Canada or wherever else. | ||
| Okay, so I'm just going to stop here but say that is absolutely top of mind. | ||
| President Trump has indicated a concern about this, and I hope you follow through. | ||
| Second, Medicare Advantage, it sounds good, but it's an incredible ripoff in some cases. | ||
| The Wall Street Journal did an expose, incredible investigation about what United Healthcare did. | ||
| And what it did, what it found, is that they packed diagnoses. | ||
| It was to their advantage to have a person seeking Medicare Advantage to have numerous diagnoses that really didn't necessarily require treatment. | ||
| They provided doctors and nurses with checklists of possible diagnosis, their patients, and they paid them bonuses for completing these checklists. | ||
| So they'd pay a doctor or a nurse more if when they examined me, they found more things wrong with me. | ||
| And this resulted in about $84 billion excessive overpayment in Medicare Advantage plans, these practices. | ||
| It's going to be your job to crack down on that. | ||
| Are you going to have any tolerance for that kind of ripoff from our insurance companies? | ||
| No, I think you've identified a place where a system which was in theory a good one. | ||
| Medicare Advantage is a community health-focused. | ||
| I understand that. | ||
| I just want to stay. | ||
| I don't mean to interrupt, but I just want to stay on this. | ||
| We cannot afford to have the health care system be taken over for private profit when it doesn't provide good service at an affordable price for our citizens. | ||
| You agree with that? | ||
| I agree, and I think the upcoding in Medicare Advantage programs has become the best example of this out there, and it's something that is addressable. | ||
| And I pledge have confirmed, I will go after it. | ||
| All right. | ||
| You're a very nice person. | ||
| I don't want you to be nice when it comes to dealing with this stuff. | ||
| All right? | ||
| So put that nice guy stuff behind you. | ||
| That's Oprah. | ||
| I'll be surgery. | ||
| You need a fighter. | ||
| No, I'm serious about this. | ||
| We just can't afford this. | ||
| You know, another thing that's happening in health care is private equity. | ||
| One of the things that you said is that physicians should be free from corporate ownership. | ||
| I'm sure you say that as a physician deep in your soul because you know it's about you helping a patient. | ||
| And now private equity is owning a significant percentage of doctor practices and they private equity has made 352 acquisitions in 2010. | ||
| In 2020, 10 years later, it's 937. | ||
| And what they do is they downsize, squeeze, and put the total emphasis on profit instead of patient care. | ||
| Is that private equity invasion of the health care space of concern to you for patient well-being and cost? | ||
| The one point I'd like to make is, as you point out, doctors who used to be generally completely free of corporate ownership, over the last decade, the doctors that are free practicing has gone from 70% to 30%. | ||
| So now most doctors are owned by a large insurance company, a hospital system, private equity. | ||
| We have to have a mechanism to disrupt the incumbents. | ||
| The only way to go after the big guys is to have smaller people who are willing to put money into initiatives that could conflict with their or go after their business models. | ||
| Private equity is one of the ways you can do that. | ||
| Yes, it could be misused. | ||
| Absolutely agree with the point that it's been abused, but this is an opportunity, too. | ||
| All right, thank you. | ||
| Here's my hope, because we can't measure this now, but we've got a starting point. | ||
| And my expectation is you'd be able to come in in six months, let's say, and report on whether there's progress on all these things, squeezing out the ripoff in private equity, squeezing out the ripoff in Medicare Advantage, and having lower drug prices. | ||
| So I yield back, Mr. Chairman, and I thank you for the little extra time. | ||
|
unidentified
|
Thank you, Senator. | |
| Thank you, Senator Young. | ||
| Dr. Oz, great having you here. | ||
| I enjoyed our office meeting. | ||
| And one of the things that I find so refreshing about your nomination and the general approach to health care that I think the administration is taking to make America healthy again is looking at the big picture before you dive into the details. | ||
| And one point of emphasis of yours, and I know of others in the administration, is making sure that we get a hold of chronic disease more effectively. | ||
| We have Americans that just for too long have not been getting the right care at the right time, and it makes our country unhealthy, and importantly, it also makes our health care a heck of a lot more expensive in the end. | ||
| So if we just do things more smartly, as opposed to the way it's always been done because there are entrenched interests, we can really, we can make people healthier, and we can spend less money on the things that could be done a lot more efficiently. | ||
| So I'm just going to ask you about prevention and chronic disease and what reforms, if confirmed, that you think we should make to existing federal programs that you'll have oversight over to include a stronger emphasis on prevention and early intervention for chronic diseases. | ||
| Senator Young, thank you for hosting me in office. | ||
| I went back and watched Hoosier's, by the way. | ||
| And I would love to take you up on the offer to sneak into the Senate gym when the time comes, if I'm confirmed. | ||
| The question you ask is fundamentally important to how we can make the money we're spending on health care work in America. | ||
| I don't think spending twice as much as every other country is enough if we're more than twice as sick as every other country. | ||
| And so the real question is, what's our obligation, each and every one of us? | ||
| I think it is our patriotic duty to be healthy. | ||
| First of all, it feels a heck of a lot better. | ||
| It's the right thing for your family. | ||
| You want to walk your daughters down the aisle. | ||
| You want to do the things that age allows you, including being a wise arbitrage of what's happening in society. | ||
| But it also costs a lot of money to take care of sick people who are sick because of lifestyle choices. | ||
| It's different if you're born with a defect that requires an operation. | ||
| Often those are fixable issues. | ||
| People don't want to be liabilities, to your point. | ||
| People want to be assets. | ||
| And they want to realize their full human potential. | ||
| And if three-quarters of them can't serve in the military when they're young, how many are going to be vital when they're older? | ||
| I think this sort of culminates in the bigger messages. | ||
| What do you have in your fingertips that you could do? | ||
| One thing that CMS can do is incentivize wiser moves. | ||
| An example. | ||
| In Medicare Advantage, most beneficiaries have some type of a food allowance, but there's no real advice on how to use that money wisely. | ||
| And we don't work with the private sector, maybe supermarkets, to provide better food support with that money if that's what the beneficiary decides. | ||
| We don't have to order people to eat healthy. | ||
| We have to make it easier for them to be healthy. | ||
| Even exercising a few minutes a day will have a massive impact. | ||
| There are people in the audience behind me who've done some of the pioneering work showing lifestyle reverses things like heart disease. | ||
| The fact that medications are at times useful, but sometimes not, for problems like heart disease and Evan Alzheimer's, where there was a large study recently showing that you could arrest the progression of disease. | ||
| This is wonderful. | ||
| Doctor, I'll be chairing the health subcommittee on this committee, the Senate Finance Committee, over the next couple of years. | ||
| So I look forward to working with you on some of those priorities so that we can make people healthier again, certainly creating an atmosphere in which people can make themselves healthier. | ||
| I don't have a lot of time here, so I'm going to run through some things. | ||
| Innovation in health care strikes me as one of the most obvious ways for us to bend the proverbial cost curve down and help make people healthier. | ||
| One of the things that I've emphasized is the importance of getting faster coverage through the FDA for emerging technologies. | ||
| I had some legislation on this over the last couple of years here in Congress. | ||
| Will you commit to working with me on this issue? | ||
| Should you be confirmed? | ||
| Senator Young, yes. | ||
| Indiana is a hotbed for devices, and you know I feel strongly about making sure meds get the best care. | ||
| Next quick thing: artificial intelligence. | ||
| Can you give me 20 seconds, if confirmed, how are you going to ensure that CMS's policies and programs foster an environment that encourages adoption and full utilization of this amazing potential technologies coming online? | ||
| Senator Young, the folks who are desirous of bringing AI into the mainstream of public health in this country need CMS as a partner. | ||
| We have to make it easy to get the high-quality data in a protected fashion if beneficiaries desire it. | ||
| If we provide it, they will build it. | ||
| Last thing, thank you. | ||
| I have emphasized in recent years that every committee of Congress ought to be a national security committee. | ||
| Believe it or not, the health care portfolio is now a national security portfolio. | ||
| We have China stealing our intellectual property and leveraging health technologies for their warfighters. | ||
| And so I would just encourage you, because I believe you're going to be confirmed. | ||
| I think we'll have an opportunity to work together to also periodically reflect on the important national security implications of your post. | ||
| And I thank you very much and your family for your desire to serve in this capacity. | ||
| Thank you, sir. | ||
|
unidentified
|
Thank you, Senator Cornyn. | |
| Dr. Oz, I don't believe in accidents, and I think maybe we were all very fortunate that you're not sitting on this side of the dais, but you're sitting on that side of the dais, because I think what you will be able to do in your new capacity will outstrip anything you might be able to do as a legislator. | ||
| And I'm excited about your nomination and the opportunities that will provide. | ||
| The General Government Accountability Office, well, let me premise this. | ||
| You said that there were people, and I'm interested in knowing their names, 150 people who don't want anything to change in terms of our health care system. | ||
| I'll ask you a written question so you can provide us those names. | ||
| I'd like to know who they are. | ||
| But I will tell you there are people in Congress that don't want anything to change when it comes to our health care delivery system. | ||
| That includes presumably $521 billion in fraudulent payments for our entitlement programs, including Medicare and Medicaid, $2.7 trillion in improper payments over the last two decades. | ||
| I presume when they criticize some of the suggestions for reform, that means they don't want that to change either, and it must change. | ||
| We are at $36 trillion in debt. | ||
| We're paying more money on interest on the national debt than we are on defense. | ||
| That's unsustainable and in a very, very dangerous world. | ||
| I know you will agree. | ||
| So let me talk to you about something that I think you're uniquely qualified to address, and that is preventative care and keeping people healthy. | ||
| Part of the problem is, you know, we talk a good game when it comes to health care, but then Congress has policies, particularly in our farm bill, with the food stamps, the snack programs, where we subsidize people eating and drinking exactly the wrong kinds of foods in order for them to stay healthy. | ||
| And then we consider we come up with a shot, which will presumably help you lose weight, and we say, well, maybe we ought to subsidize that too. | ||
| It just strikes me as crazy. | ||
| So what can we do to incentivize the health care community? | ||
| Because right now we don't do it. | ||
| We pay doctors and hospitals to treat people when they're sick, if it's coded by HHS or CMS. | ||
| What can we do to incentivize the health care community to help people stay healthy longer and avoid chronic disease and the pain and misery and expense that go along with that? | ||
| Senator Corner, I appreciate all the help you've given me throughout my career and your kind words. | ||
| When I called a good friend after the nomination who had been involved in the campaign, he said, it's just like we planned it out. | ||
| It is remarkable that although we all agree that value-based plans and programs should be the foundational way that we incentivize doctors, nurses, and others' hospital systems to deliver care, we make it difficult to use those plans. | ||
| We use third parties as intermediaries who often charge so much that they take away the benefit of the value-based program to begin with. | ||
| But at its very core, physicians need support. | ||
| Everyone providing care needs support to be able to do what you just said. | ||
| Giving patients advice on lifestyle takes a lot longer than telling them to take a pill. | ||
| Doing surgery on people pays so much more than giving them advice about how to avoid operations that it's difficult to imagine anyone not doing the wrong thing in that model. | ||
| I remember early in my career, I was asked to help develop the advertising plant for a New York Presbyterian hospital. | ||
| I was practicing, and they wanted to talk about new technologies and this and that. | ||
| I said, that's not the question patients ask. | ||
| Patients want to know when you offer them heart operations, do I really need it or not? | ||
| That's the first question. | ||
| And we don't reimburse that question's answer, which is what we should be doing. | ||
| I believe, and we've been asking questions back and forth about AI, that we can use technology, information technology, artificial intelligence in particular, to provide more of that infrastructure support so that when the physician talks to you, the main thing they say is, I endorse what you just heard about a lifestyle change for you in particular based on your background, any history we have on you, and all of the other places that the health care system has touched you. | ||
| For much of this to happen, we have to know who you are. | ||
| So one idea that I think will come up eventually is this concept of how we can tell which patients have been in which centers. | ||
| All that interoperability of information and transparency safely shared with you, the patient, I think will arm you with a bit more motivation to take charge. | ||
| And for people who are recalcitrant, as Senator Wyden has been talking about for more than a decade, I do think reward systems could be beneficial. | ||
| Well, there's so much more I want to talk to you about, and we'll do that after you get confirmed. | ||
| But let me just say that if modern medical science can devise a shot or a pill which will give me the self-discipline to exercise on a regular basis and to eat a healthy diet, I want to be first in line for that shot. | ||
| Unfortunately, I don't think that shot or that pill exists. | ||
| So we need you to use the bully pulpit because you're a great communicator. | ||
| I believe you can be a tremendous asset to communicating to the American people the importance of doing some of the things that will make their life happier and healthier. | ||
| Thank you. | ||
| God bless you, sir. | ||
| Senator Scott. | ||
| Thank you. | ||
| Todd Oz, thanks for being here. | ||
| Good to see you again. | ||
| Certainly I'm excited about your process here. | ||
| I'll go along with John Cornyn there. | ||
| If there is such a shot that makes you want to exercise more, I may have to wait until this generic brand comes out to be able to afford such a shot because that should be really, really expensive for a short period of time. | ||
| But to that point, I'm not going to ask you to comment on it, but my theory is that we have a lot of, we need to have a long conversation about how expensive drugs are these days. | ||
| But at the same time, we should have a similar conversation about how when drugs hit the generic market, they drop precipitously in price, and it's that way forever. | ||
| So I would hate to, for the lack of a better way of saying it, shortchange the American people by focusing on the original sticker price without having the value proposition long-term over the ultimate cost of a drug when it's in the generic forms. | ||
| I do think we're not really having a serious conversation with the American people about the fact that 94% of the morbidities that we face every day are on a generic medicine and that because of that, you can go to Walmart or Publix or wherever you go and get a 30-day regimen for four bucks or $10. | ||
| And that value proposition that we bring to the American people because of patent protection is really important, though we very rarely focus on the back end that lasts for a lifetime and the front end that lasts for five to 12 years. | ||
| And we probably need to figure that out. | ||
| But ultimately, protecting that patent protection is really important from my perspective. | ||
| Not necessarily need to hear your thoughts on it yet, but I am hoping that you will commit to coming to South Carolina, having a conversation with my folks in South Carolina about the job that you are going to have. | ||
| Is that a commitment you'll make? | ||
| A commitment. | ||
| My roommate from college is from Greenville, South Carolina, so it's a good excuse to see him too. | ||
| Well, I hope he's not a tiger. | ||
| Anyways, he's a tiger. | ||
| As a game dog fan, I knew he was. | ||
| There's something about that thin air in Greenville that causes people to be a Clemson fan. | ||
| For those of us listening to us, it is just a joke. | ||
| I just lost several votes there, by the way, so I'll move on. | ||
| I want to say thank you for the compassion that was woven into your opening statement. | ||
| We are both men of faith, and I think those of us from a faith background share the philosophy that we find embedded, at least in the Bible, in Matthew 25, that we have a responsibility to help those in certain categories, whether it's the widow or those folks suffering and going through challenges. | ||
| I think it's really important for us as a nation to embed that ethos in our approach to solving problems as a nation, especially for the most vulnerable. | ||
| And your opening statements reflected that kind of compassion that I think we desperately need to see more of on our national screens around the country. | ||
| To that end, the sickle cell anemia challenge that you talked about when you met with our staffs, thank you for bringing it up without having to be prompted to it. | ||
| I do think that CRISPR technology as we know it today is going to transform medicine as we know it tomorrow. | ||
| I'd love your thoughts on that, and I hope that you have a commitment in your new position to move forward with some of the cell and gene therapy access models that we're talking about, making it affordable for people stuck in Medicaid or Medicare or not stuck, but on Medicaid or Medicare. | ||
| Well, Senator Scott, thank you for bringing sickle cell anemia and similar CRISPR solutions into the forefront. | ||
| There's a lot that we have benefited from that is only there because we've incentivized innovation. | ||
| And so sickle cell anemia, a disease which I've taken care of patients with because they often develop problems with organs that require surgery, is a crippling problem that causes a lot of pain and then you die, but you spend a lot of money on the way. | ||
| And there's a treatment, let's just say it costs a million dollars. | ||
| It's roughly the number that I'm hearing. | ||
| That if we could offer these young children, often of African American descent, this treatment, then they would be cured. | ||
| So I think there are ways for us to amortize that cost to save the child's life and reap the benefits of them not being in the hospital, running up big bills while they die in pain. | ||
| That seems to me a pretty good investment. | ||
| We just have to get our minds around the idea of paying a million dollars to save someone's life and demonstrating that if it works, that the drug company should get paid over a period of time to make up for the fact they made a massive investment to build that solution. | ||
| Those are the kinds of innovations that I think we can bring to bear, where you could actually imagine medications only being reimbursed if they provide a benefit that we all agree is true over time. | ||
| And just to the earlier comment, because you brought up faith in the broader issues, the oldest hospital that I'm aware of that still exists is in Cairo. | ||
| And this hospital historically would take patients in. | ||
| You wouldn't pay for care because you're sick, you don't have money. | ||
| When you left the hospital, they would give you money. | ||
| It's the opposite. | ||
| Why? | ||
| Because when are you going to have the least amount of money? | ||
| When you're sick and you're getting better. | ||
| So they would actually give you something to get going again. | ||
| I think those are the kinds, at least metaphorically, ideas we want to support to get people back on their feet again and then make them feel obliged, responsible, because it is a shared responsibility to be our health system to do what they can to stay healthy so the system works for everybody. | ||
| I know that I'm out of time, but I'll ask my last question and ask for a yes or no answer, if that's okay with you, Chairman. | ||
| Yes, go ahead. | ||
| Thank you, sir. | ||
| During one of the silver linings, if there was a silver lining during COVID, and it's really hard to think of that catastrophic occurrence having any silver linings, if there was a silver lining in COVID, it was the development and the acceleration of telemedicine. | ||
| And I think it's going to save millions, if not trillions, of dollars over time. | ||
| I hope that you are committed to doing as much investigation as necessary to make sure that telemedicine is not just here to stay, but that it is embraced and adopted throughout our country wherever it is practical to be used. | ||
| I pledge that if confirmed, I'm going to pursue telemedicine. | ||
| I think it's essential, especially in our rural areas. | ||
| Thank you, sir. | ||
| Thank you. | ||
| Dr. Oz, we're almost there. | ||
| Senator Wyden has one more question for you, and then he'll give a brief wrap-up statement, and then I will give a wrap-up statement, and we'll be able to. | ||
|
unidentified
|
Thank you, Mr. Chairman. | |
| Dr. Oz, I wanted to ask a question about something that has really been part of your wheelhouse, as far as I can tell, for decades, and that's the insurance sector, and particularly marketing abuses. | ||
| And I go way back to the days when insurance salespeople would sell five or six policies to a senior citizen. | ||
|
unidentified
|
Traditional Medicare stuff wasn't worth the paper it was written on. | |
| And I came to Congress and Bob Dole, I didn't think even knew my name. | ||
| We got it fixed. | ||
| But the abuses continue. | ||
| And I'd be interested in your thoughts about what you think the biggest abuses are now. | ||
| And then I'm going to ask you, I make this half of my question, a quick response in terms of what you're going to be dealing with if confirmed. | ||
| What do you think the biggest abuses are right now in the private insurance sector? | ||
| Medicare Advantage sales. | ||
|
unidentified
|
Such as. | |
| I mean, give me an example. | ||
| There's brokers that get involved in churning policies. | ||
| So they get you to switch from policy to policy. | ||
| We should potentially consider whether you need to re-elect Medicare Advantage every year and potentially offer multi-year programs for seniors because that would save some of the money that the brokers are taking out of the middle. | ||
| Some brokers do a great job, some don't. | ||
| We probably have too many. | ||
| I think there are ways for us to ensure that that marketing process works better for the folks involved. | ||
| But it's also what the Medicare Advantage plans also do with the monies that they use to incentivize the American people, the 32, 33 million people on Medicare Advantage to come into their programs. | ||
| And we should examine whether some of that money should be reimbursed to the American people to ensure that Medicare Advantage does not cost more than fee-for-service Medicare. | ||
| I'll have some additional questions for the record on this, but let me leave you with a thought. | ||
| We finally got some rules that have been put in place really in the last few years. | ||
| There's probably going to be a big effort because the Trump administration has been talking about rolling back a lot of the health standards. | ||
| I want to get a sense before we vote on which ones that you would be sympathetic to if anybody tries to do that, because I think that is a sure bet in terms of what's coming, that there will be some sleazy operators. | ||
| We both know that there's some good people out there, but there's some sleazy operators, and I think they're going to push for a rollback in some of the rules that have been adopted recently. | ||
|
unidentified
|
And I want your assessment of that. | |
| Thank you, Mr. Chairman. | ||
| All right. | ||
| Thank you, Senator Wyden. | ||
| And Dr. Oz, thank you again for appearing before us today. | ||
| There is no doubt that you are qualified to serve as the next administrator of the Centers for Medicare and Medicaid Services. | ||
| And I look forward to voting in favor of your nomination and am urging all of my colleagues to do the same. | ||
| With that, I remind my colleagues that the deadline for submitting any questions for the record, and you will get some more questions to answer, is 5 p.m. on Wednesday, March 19th. | ||
| So for my colleagues, the deadline is 5 p.m. on Wednesday. | ||
| The Finance Committee stands adjourned. | ||
| Thank you. | ||
| Oh, what do you think? | ||
| Yeah, it was good to get it. | ||
| Let's get a picture of it. | ||
|
unidentified
|
Do you have two questions? | |
| Do you have a phone? | ||
| Yes. | ||
| Do you want a five? | ||
| No, no. | ||
|
unidentified
|
I want to just... | |
| Yep. | ||
| Here, I have one. | ||
| Would you like to take a picture? | ||
| You can take a picture. Thank you. | ||
| Thank you so much. | ||
| Everyone sit there. | ||
| Let's just sit. | ||
| We have one that looks... | ||
|
unidentified
|
Oh, you won't be able to stand behind me. | |
| Oh, okay. | ||
|
unidentified
|
Okay. | |
| Then, honey, you come here. | ||
|
unidentified
|
I'll get some on your lap. | |
| Perfect. | ||
| Here, one second. | ||
| Here, Rodney. | ||
|
unidentified
|
Rodney, can you get in here? | |
| Come on. | ||
| I trust you guys with the folks. | ||
| I'll let you walk over here. | ||
| Get all these folks over here. | ||
| You too? | ||
| Thank you, guys. | ||
| Okay. | ||
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