Dr. Oz wants to force Pennsylvania seniors into Wall Street-run health insurance plans

Not to mention, Dr. Oz would become much richer if that happens because he reportedly owns up to $550K worth of stock in UnitedHealth Group (the biggest operator of these Medicare Advantage plans).

Get this: Dr. Oz wants to force Pennsylvania seniors into Wall Street-run health insurance plans that numerous studies show cost taxpayers far more than original Medicare. And most of those private plans make doctors ask for permission before prescribing many medications and treatments for their patients.

If Dr. Oz gets his way, a majority of Pennsylvania’s (and America’s) seniors would lose their current coverage and be herded into private plans that have become insurers' new cash cow. 

If that happens, Dr. Oz would become much richer. That’s because he reportedly owns up to $550,000 worth of stock in UnitedHealth Group, the biggest owner and operator of so-called Medicare Advantage plans. 

UnitedHealth has been especially successful in reeling seniors into plans that offer fewer choices of doctors and hospitals than original Medicare. In those private plans, if you want to go to a doctor or hospital out of your insurers’ provider network, you could be on the hook for thousands of dollars out of your own pocket. 

And if you travel out of state and need care, you might have to pay for all your care out of your own pocket. 

As recently as April, the U.S. Office of Inspector General found that Medicare Advantage Organizations (MAOs) often delay or deny coverage for care that patients need, despite pleas from their doctors. Here’s an excerpt from that that OIG report:

Our case file reviews determined that MAOs sometimes delayed or denied Medicare Advantage beneficiaries' access to services, even though the requests met Medicare coverage rules. MAOs also denied payments to providers for some services that met both Medicare coverage rules and MAO billing rules. Denied requests that meet Medicare coverage rules may prevent or delay beneficiaries from receiving medically necessary care and can burden providers. Although some of the denials that we reviewed were ultimately reversed by the MAOs, avoidable delays and extra steps create friction in the program and may create an administrative burden for beneficiaries, providers, and MAOs. Examples of health care services involved in denials that met Medicare coverage rules included advanced imaging services (e.g., MRIs) and post-acute facility stays (e.g., inpatient rehabilitation).

The OIG report came on the heels of another important study by the Government Accountability Office, which found that many Medicare Advantage beneficiaries try to get out of their private plans late in life because of coverage denials and inadequate provider networks (especially rehab and skilled nursing facilities). This is from the GAO report: 

We found that Medicare Advantage beneficiaries in the last year of life disproportionately disenrolled to enroll in (original Medicare) fee-for-service, indicating possible issues with their care. Shifting end-of-life costs to fee-for-service increased Medicare spending by hundreds of millions of dollars.

That’s right. We’re talking about hundreds of millions of dollars that private Medicare Advantage plans won’t have to pay but that taxpayers have to pick up. That enables private insurers to avoid paying for an untold number of claims–and that makes Wall Street very happy.

As I wrote a few weeks ago, when one of the big insurers (Anthem, now called Elevance) had to disclose that it had paid more claims between April and June than Wall Street had expected, investors ran for the exits and tanked the stock. That’s what happens when a big insurer disappoints Wall Street.

Dr. Oz undoubtedly has already made a fortune on his holdings in UnitedHealth and CVS, which owns Aetna as well as one of the country’s largest pharmacy benefit managers (PBMs)--middlemen that take a big cut of what we spend on prescription drugs. UnitedHealth owns one of the other big PBMs and Cigna, where I used to work, owns another big one. Together, those three companies control 80% of the PBM market. 

Most Pennsylvania seniors have resisted insurers’ siren calls and have opted to stay in original, traditional Medicare. Dr. Oz would force them and all other American seniors into the arms of private insurers, which have gamed the system so much over recent years they’re getting billions of dollars from taxpayers unlawfully–ill-gotten gains that are going straight into their shareholders’ pockets. 

Many senators (like Dr. Oz wants to be) not only look the other way when they’re shown the evidence of this massive theft, they even sign letters drafted by industry lobbyists essentially daring the Center for Medicare and Medicare Services to clean up the corrupt Medicare Advantage program. 

UnitedHealth Group, by the way, has more Medicare Advantage enrollees than any other insurer. It spends massive sums of money on ads that obscure important facts (like limited networks, prior authorization demands, and out-of-pocket requirements that can exceed $11,000 a year. Because of misleading ads, many people enroll in Medicare Advantage plans thinking they’re enrolling in traditional Medicare, and many undoubtedly are completely unaware of the restrictions they’ll be subjected to when they need expensive care. 

Medicare Advantage has become such a cash cow for UnitedHealth and other private insurers that they hire pitchmen like Joe Namath, William Shatner, and Jimmy “JJ” Walker to shill for them. If the ads sound too good to be true, it’s because they are. The government does not require insurers to disclose the many “side effects” of Medicare Advantage plans like drug companies are required to do. 

So much of taxpayers’ dollars are going to UnitedHealth that it is now the 5th largest company on the Fortune 500. (CVS is now #4). As I wrote earlier this week, 99.3% of the growth in UnitedHealth’s health plan enrollment has been in government programs like Medicare and Medicaid. 

And 85% of the people who enrolled in Medicare Advantage plans were lured into plans operated by UnitedHealth and the other large for-profit insurers.

No wonder Dr. Oz wants to take away the option of traditional Medicare for the country’s seniors. With his current holdings in UnitedHealth and CVS, he would become massively richer if he were in a position to help pull it off, as he would be if he is elected to the Senate.