Tom Scully, who led Medicare and Medicaid for President George W. Bush, encouraged Oz to “go have lunch” with Democrats on Capitol Hill, and says the former surgeon and TV star is well-suited to be a spokesman for Trump’s health care agenda.
For more on Dr. Oz’s nomination, check out our episode featuring Scully and STAT News reporter Tara Bannow.
Mehmet Oz — the surgeon-turned-TV-star better known as Dr. Oz — faced senators on Capitol Hill last week, asking them to confirm him as the new head of the federal Centers for Medicare and Medicaid Services.
“I commit to doing whatever I can, working tirelessly to ensure that CMS provides Americans with access to superb care, especially Americans who are most vulnerable: our young, our disabled, and our elderly,” Oz told the members of the Senate Finance Committee in his opening statement.
Most previous CMS administrators have come to the job with experience working on health policy in state and federal government. But President Trump’s pick is a relative newcomer. Oz’s background is, instead, as a heart surgeon at Columbia University and the host for 13 seasons of a daytime talk show before making an unsuccessful run for Senate in 2022.
CMS provides health insurance for 160 million Americans who get coverage through Medicare, Medicaid and the Obamacare exchanges, and its $1.5 trillion budget is nearly double that of the Department of Defense.
Last week, Democratic senators challenged Oz for pitching unproven treatments like green coffee beans and raspberry ketones for weight loss.
“There are many things I said on the show,” Oz said in response to a question from New Hampshire Sen. Maggie Hassan. “I take great pride in the research we did at the time to identify which [products] worked and which ones didn’t.”
“It seems to me you are still unwilling to take accountability for your promotion of unproven snake oil remedies to millions of your viewers, and that’s really concerning,” Hassan responded.
Oz notably sidestepped questions from senators about Republican plans to cut Medicaid. Trump has said he will not cut Medicaid, but experts say the budget resolution passed by House Republicans last month will necessitate hundreds of billions of dollars in Medicaid cuts over the next decade.
Oz has also come under fire for failing to disclose his financial stake in the products he’s promoted, and for financial conflicts of interest with private Medicare Advantage plans, which he would be in charge of regulating as the head of CMS. (Oz said he would sell his health care and pharmaceutical stocks if confirmed.)
Throughout the hearing, however, the doctor used a combination of personalized responses and well-researched answers to avoid significant clashes. The meeting proved far less contentious than when Robert F. Kennedy Jr., appeared before the same committee as the nominee to run the federal Department of Health and Human Services just a few weeks earlier.
It’s unclear when the committee will vote on Oz’s nomination, but he is expected, ultimately, to be confirmed by the Republican-majority Senate.
Tom Scully, who led CMS under President George W. Bush told Tradeoffs executive editor and host Dan Gorenstein about his take on Oz and the impact the head of this powerful health agency can have.
Here are highlights from that conversation, edited for length and clarity:
On why CMS administrators need strong political skills:
You have to deal with 535 [members of Congress] that are angry at you every day about their hospital not being paid right or their physicians being underpaid. Everybody’s unhappy all the time, Republican and Democrat. So I think just the political skills of keeping those 535 people happy is difficult in itself. And I was there in a much less partisan era. I helped lots of Democrats with their hospital problems and their physician payment problems. And that made it easier to deal with them when you had other things on Capitol Hill.
On whether Oz’s inexperience in health policy worries him:
I think everybody’s different. My job at the time I was there was to try to cook up and pass Medicare Part D and Medicare Advantage. I spent all my time on Capitol Hill. That was my job. For Dr. Oz, 150 million people know who he is. That’s an advantage. When he says something, people pay attention.
If [the Trump administration is] going to have a big fight over health care and you’re going to go defend your Medicaid changes or your Medicare [changes] or anything you’re doing, the Democrats are going to run around and say, you’re cutting [health care], you’re cutting, you’re cutting. If I were [the Trump administration], I would use Oz to make all the public policy fights. And I imagine he’ll do an awful lot of that.
On Oz’s lack of policy experience on issues like Medicaid and Obamacare:
He knows a lot about health care. He’s a very smart guy. As I told him [when we met before his confirmation hearing], he was months ahead, preparation-wise, where I was in 2001 when I took the job. And I had a lot of experience.
So anything Oz needs to know, he can learn. And I think it’s just a matter of what fights he wants to pick. … Medicaid, for better or worse, is probably the one that draws the most fire. At some point, he’s got to try to explain [the administration’s position to the American people], but I’m sure he can learn the basics in about three days.
On Oz’s position on Medicare Advantage, where he’s been criticized for boosterism and financial conflict of interests:
From what I saw of the hearing, I think he’s going to spend a fair amount of time trying to fix Medicare Advantage and make it better. He is a big fan of Medicare Advantage, as am I. But if you’re a big fan of Medicare Advantage, it has to be regulated appropriately.
There are a million little adjustments you can make. And basically the plans, in my opinion, aren’t doing anything illegal. They’re aggressively following the incentives that CMS has created. We’ve given insurers all kinds of ways to identify sick people and they get paid more for [those sicker patients]. And those things are kind of getting turbocharged and a little bit out of control. So fixing that and [changing] how you measure how sick people are and how much you get paid for [them], that is really the core to what Oz could do to fix this.
On Oz’s ability to influence health policy within the Trump administration:
He has a huge advantage in that he has direct access whenever he wants, it seems, to Trump. And he’s very personally friendly to Kennedy, who doesn’t seem to care as much about Medicare and Medicaid. So I think that’s a huge advantage. I think having a good relationship, which Oz clearly does, with RFK and the president, gives him a lot of running room.
On the advice Scully gave Oz when they met before the confirmation hearing:
I said I don’t know what the White House staff are telling you, but go have lunch with [Democratic Sen.] Ron Wyden. Don’t ask anybody. Go get to know some of these [Democrats]. It’ll take the edge off. They may not vote for you. You might have a fight with them all the time.
You’re always going to have some staff guy in the White House tell you what you can and can’t do. Just ignore them. They don’t know who you’re talking to. Go have lunch. Play basketball with Ron Wyden. That helps. Ron may never like anything you ever do, but it’ll be a lot easier if you have the ability to pick up the phone, and vice versa.