▶ 0:20:33Chair Crapo: The committee will come to order and we will go into executive concession to consider the nomination of michael faulkender to be deputy secretary of the treasury. It is my understanding that some of my members -- our members want to make remarks in addition to the ones that you and I will make. And so we will have time for any senator, three minutes, to make remarks.
▶ 0:21:00Chair Crapo: And following that, we will recess the executive session and scheduled a vote on Mr. faulk and her off of the floor at 1:15 as we go into the first vote on the floor. We will immediately as we recess , follow that by going into the hearing going back into session for the hearing for -- Sen.
▶ 0:21:28Wyden: My understanding is that members think there will be a five-minute rake.
▶ 0:21:33Chair Crapo: We will have a break and then we will go into the hearing for mehmet oz. As I indicated, today we are voting on the nomination of michael faulkender to be deputy secretary of the treasury under -- to the treasury. He has years of private and public sector experience as well as strong academic credentials. That -- his background makes him the quintessential picture served.
▶ 0:22:00Chair Crapo: As I said in my opening statement, the finance committee has an arduous nomination process. And, once the nominee completes the steps, he or she deserves a public hearing followed by a vote. Mr. faulk and her sat from -- faulkender sat for hours and provided thoughtful answers. He responded's judicial that responded judiciously to for josh to further questions.
▶ 0:22:28Chair Crapo: My colleagues received further responses for their queries and if confirmed, he pledges to provide a briefing on treasury payment system. I thank him for his commitment and for his time working through this rigorous process. Qualified nominees for this position inquire -- in prior congresses is garnered bipartisan support. I encourage my colleagues on both sides of the aisles to join me in favor of voting in his nomination.
▶ 0:22:58Chair Crapo: I now recognize the ranking member for his remarks.
▶ 0:23:01Sen. Wyden: Thank you very much. It is clear in my mind that donald trump and elon musk are intent on violating taxpayer privacy laws and weaponizing the irs against american taxpayers. Look at what happened yesterday. They forced out the nonpartisan officials and the only two senate confirmed positions at the irs, the commissioner and chief counsel.
▶ 0:23:28Sen. Wyden: They installed a person as chief counsel who appears to be willing to break laws that were designed specifically to prevent somebody like donald trump from committing this very abuse of power. In my view, this will end with donald trump and elon musk driving innocent taxpayers to misery.
▶ 0:23:47Sen. Wyden: That is setting aside the hardship that will be inflicted by decimating taxpayer service and the debt spiral they are risking by destroying tax enforcement among corporations and the wealthy. With respect to my office -- opposition to the nomination. He has a veteran of the first trump administration who has been working in the treasury building since january 21.
▶ 0:24:11Sen. Wyden: Yet he did a dog -- a whole lot of dodging and reinventing -- weaving when it came to the damage that they are doing. He dodged questions on the doge infiltration to spice -- despite the admission that it set up. Showed up with the intent to illegally impound funds appropriated by congress.
▶ 0:24:31Sen. Wyden: He dodged questions about plans to slash the workforce and got billionaire tax enforcement despite the fact that he is already serving unofficially in a role that directly oversees the irs. I asked him whether the president has the authority to impound funds, a clear violation of the article one authority over federal spending.
▶ 0:24:54Sen. Wyden: His answer was "I do not know the legal authority of the president when it comes to impoundments" but during a television interview last year he said he supported impoundments and talked about how the president uses it to trample over appropriations and our constitutional authority. He did not give many forthcoming answers meaning that he spent his hearing basically covering up for nearly two months of reckless and anti-constitutional behavior.
▶ 0:25:24Sen. Wyden: It was not all ducking and dodging. Even though the treasury department has no role in overseeing important programs like health care, he went out of his way to defend the republican plan to take tens of millions of americans off medicaid.
▶ 0:25:46Sen. Wyden: For example in response to strong questioning from senator warnock who asked "do you think it is a good idea to take families off of medicaid" he answered with the same old spin about self-sufficiency and getting off of government dependency. I cannot imagine that he would say that to senior citizens. Colleagues, medicaid covers 30 million kids in america including half of the kids with special needs and half of all nursing home beds.
▶ 0:26:15Sen. Wyden: It is essential for people with disabilities and a lifeline for rural hospitals and doctors. The republican lingo that we heard from Dr. falconer -- we heard from him papers over the fact that if republicans follow through, rural communities will become health care deserts and a lot of children, seniors and those with disabilities will be driven into misery, many of them are likely to die as a result.
▶ 0:26:44Sen. Wyden: The reality is that if he has confirmed he will be right in the middle of that agenda. It will be about paying more for handouts to billionaires and multinational corporations. I cannot support a nominee who has already dirtied his hands on that very work. I oppose us nomination and urge my colleagues to do the same.
▶ 0:27:04Chair Crapo: Thank you. Traditionally at this point we would move to the vote. I understand that a number of colleagues want to make remarks. We will do so. We will give three minutes to each and we ask you to stay within the timeframe. Because, we do need to move to the hearing, which will immediately follow these remarks. And, I am going to go through in order of appearance, and also as -- anyway.
▶ 0:27:35Chair Crapo: With the order that the clerk has given me. Senator tillis. You are the first on the list. Do you want to make remarks at that time? Thank you. Next is senator cantwell.
▶ 0:27:47Sen. Cantwell: I do not know if I can do this in three minutes but I will tell you this that it is 52 days of the trump administration that was promised to bring lower costs and deal with inflation. And we have seen no solutions, even presented or put on the table that would help us understand what this administration is going to do. Mr.
▶ 0:28:09Sen. Cantwell: Faulkender could have come before the committee and told us what they are going to do on more affordable housing, one of the stickiest parts of inflation, and yet we have heard nothing on what they are going to do to lower costs. They could have said that they supported the pbm efforts to lower drug costs and we have not heard anything about their desire to lower drug costs.
▶ 0:28:36Sen. Cantwell: On the cost of food we know this, they are proposing tariffs that are raising the cost on average americans for what we are going to have to pay at the grocery store. The chaotic tariffs that this administration is pushing is not the agenda, the trade agenda approved by this congress, nor is it an agenda that has ever proved successful in the history of the united states.
▶ 0:29:04Sen. Cantwell: And yet, that is the preposterous, preposterous trail that now we are on. So, as part of the first trump administration, where was he when the retaliatory tariffs hit farmers? He saw markets disappear under our nose and yet he still believes in this tariff first approach. Mr.
▶ 0:29:25Sen. Cantwell: Chairman, I hope that our committee will do more in reining in what is article one responsibilities of this congress to make sure that the issues of tariffs are covered and that we have the responsibility to do so. So until he and the treasury part -- department recognize the terrible damage that tariffs are doing, I am a no.
▶ 0:29:47Chair Crapo: Next is senator whitehouse.
▶ 0:29:52Sen. Whitehouse: Lee zelden made perhaps the most idiotic and dangerous statement ever made by an epa administrator saying that the concern about climate change amounted to religion. I believe that every single one of the states of my republican qualities -- colleagues has a state university that does not only believe in climate science that teaches it.
▶ 0:30:20Sen. Whitehouse: And the idea where we are now at a place where that lie is being propagated from the top of the epa is appalling. Why do I raise that here? I raise it because we are at the edge of an insurance crisis that has already manifested in florida where unpredictable climate risk makes insurance unavailable to homeowners, which makes mortgages unavailable to homeowners, which crashes property values and, according
▶ 0:30:50Sen. Whitehouse: To the chief economist for freddie mac, cascades into the economy in a 2008 style recession. That was just about the coastal risk. We now have wildfire risk as the evil sibling standing up. Until we have people willing to recognize the risk then I am going to be no votes on people who have responsibility here for our economy.
▶ 0:31:15Sen. Whitehouse: What is particularly evil is behind all of this is a long, powerful and semi-covert scheme by the fossil fuel industry to effort -- to assert their influence in congress and mislead the american public. Second the muskrats are getting into data wherever they can and good perk -- and good career people are being fired when they try to protect data systems. Data is money for the big tech pros who are backing trump.
▶ 0:31:45Sen. Whitehouse: This is very likely there payback to get access to americans' private information and we need to do a better job of defending the data systems from these muskrats envoys. Last, the corporate transparency act, a law enforcement and national measure supported by president trump in the first trump administration has now been undone by the treasury and I would like to offer three documents and ask unanimous
▶ 0:32:16Sen. Whitehouse: Consent that they be put in the record. One is my statement for the record with respect to this. The other is a letter to treasury secretary dated march 10 about this matter. The third is a cursory response that we got the following day from the office of legislative affairs at treasury.
▶ 0:32:34Chair Crapo: Without objection.
▶ 0:32:36Sen. Wyden: Thank you.
▶ 0:32:38Chair Crapo: Next is senator hassan.
▶ 0:32:41Sen. Hassan: Thank you for this markup and making it possible that members can voice their significant concerns about how elon musk's action at the treasury department are harming families across the country. I will echo the comments of the senator from washington. We have been waiting for the trump administration to do the work to lower costs and make life affordable for americans, and they are not.
▶ 0:33:11Sen. Hassan: They are ruining the economy, and they are creating chaos and corruption everywhere they go. For my entire time in public service, I have worked on many bipartisan efforts to cut waste, fraud, and abuse across state and federal government. And I strongly support efforts to make government efficient.
▶ 0:33:33Sen. Hassan: But his actions only serve him to gain power, increases personal wealth and sow chaos at the expense of american families. In his first week in office president trump fired 18 independent watchdogs whose whole jobs are to stop waste, fraud, and abuse including the firing of the independent watchdog at the treasury department.
▶ 0:33:55Sen. Hassan: With that watchdog gone, elon musk moved to install his own loyalists at the treasury department and to give them unlimited access to americans' personal financial information, as well as the power to block any payment by the federal government to a community nonprofit or small business that elon musk dislikes. Fortunately, some of his illegal attempts have been blocked by federal courts for now.
▶ 0:34:23Sen. Hassan: As we have heard from our ranking member, the violations of law treasury continue and the harm to the american people grows. I understand the value that a respected outsider with significant private sector experience could bring to government operations. But that is not who elon musk installed at treasury to sift through americans' private personal information.
▶ 0:34:46Sen. Hassan: The staff are given efficient access -- official access to sensitive personal information is a loyalist who previously worked for spacex and twitter. Following the attempt in february to unilaterally take federal grants through a funding freeze, I believe that all members of this committee should be concerned about what elon musk will take away from our communities as he regains access to the treasury payment system.
▶ 0:35:20Sen. Hassan: Now, one last comment about the nominee. To his credit, and I cannot believe I have to say this, in a committee in the united states senate. He stated that he would follow the law rather than illegal directive from the president. He stated that he would follow the law rather than an illegal directive from the president. And that is the exception among nominees right now to this administration.
▶ 0:35:46Sen. Hassan: That I have to ask this question of every nominee is an outrage and every member of this committee should be outraged by it. Despite the fact that he at least showed the character to say that he would follow the law, again, there should be a prerequisite for any nominee, given elon musk's power grab at the expense of american families, I have to oppose his nomination today. Thank you.
▶ 0:36:13Chair Crapo: Thank you. On my list the order is senator welch, warnock and then warren.
▶ 0:36:23Sen. Welch: You know, Mr. faulkender has significant qualifications. But there is a reality that we are trying to deny that is inescapable. We have a cabinet of one, whose name is elon musk. We have a cabinet official who come before us with distinguished records and probably everything in their bones wants them to serve well.
▶ 0:36:50Sen. Welch: But they are under the thumb of a president who demands fealty and is supposed assert -- as opposed to service to this country. The best example of that is what has happened with this continuing resolution. Congress is abdicating its article one authority. The so-called cr is not on the level. What this does is not maintaining current spending.
▶ 0:37:24Sen. Welch: On the numbers, and on the directions of how it will be spent. What it does is make significant cuts, but more importantly, it delegates to the president of the united states flexibility to move money around as he sees fit. That is a total surrender of our responsibility. It is a disgrace.
▶ 0:37:51Sen. Welch: On the tariffs that my colleague spoke about, they are a disaster for vermont. They make no sense. Any economist says they are bizarre. Bazaar because of the way they are being granted -- implemented, on-and-off again that causes suffering for families. They will be paying higher bills and higher gasoline prices and for what? For the whim of a president.
▶ 0:38:20Sen. Welch: Every single one of these cabinet officers who comes in here takes the pledge and I know it makes no sense and you are the president and we will do it. And, in the cr that we will be voting on, there is a provision that says the united states congress, in whom the responsibility and authority for imposing tariffs rests, cannot
▶ 0:38:52Sen. Welch: Change the tariffs that president trump is imposing. That is so disgraceful. It is a total surrender of our responsibility. We have these punitive tariffs that make no sense and are hurting everyone that we represent. And we passed a law saying that we have to close our eyes and lock our ears and not do anything? I vote no. This charade has to end.
▶ 0:39:19Chair Crapo: Thank you. Senator warnock.
▶ 0:39:23Sen. Warnock: Thank, brother chairman. A week like this in washington a reminds me of why I return every week to my pulpit. Spending time with people in my church and all across my community. They are the folks who keep me grounded. These are the folks who are seeing their paychecks buy less and less.
▶ 0:39:50Sen. Warnock: These are ordinary people who I am thinking about whether acts consider whether congress should spend trillions of dollars on a huge tax cut that overwhelmingly build fits -- benefits millionaires and billionaires while the entire half of working families pick up the tab through cuts to their health care. In addition, a $4.5 trillion hold in the debt. I am disappointed that Dr.
▶ 0:40:18Sen. Warnock: Faulekender does not understand or care about the concerns of hard-working georgia families, the people I know. When we talked about washington republicans plans to cut medicaid, and I asked the nominee his thoughts, he suggested that people just need to "be self-sufficient" and just get better jobs with better benefits.
▶ 0:40:44Sen. Warnock: I was raised by a dad who gave me a serious work ethic so I believe in self-sufficiency. Almost all of the adults on medicaid are either working or in school where they are caregivers. If they can work they do work. They have jobs and responsibilities. They are construction workers, home caregivers, farmhands, and they are doing everything that the nominee wants them to do.
▶ 0:41:11Sen. Warnock: But he in washington republicans want to kick them off of medicaid anyway. Who else to this nominee think should be self-sufficient? I wonder if he thinks elon musk should be self-sufficient. He has received $38 billion in government contracts, government loans, government subsidies and tax credits. Who does he think should be subs -- self-sufficient? Should children and seniors in nursing homes, veterans? One in 10 veterans.
▶ 0:41:43Sen. Warnock: People with mental illness or substance abuse? Who is he talking about. Let us be clear. If folks want to have a serious, bipartisan conversation about reducing our debt, I am all in on the conversation. I am deeply worried about the debt that we will leave our children and grandchildren as the father of two young children myself. When we want to have a conversation about that, I am.
▶ 0:42:10Sen. Warnock: When we want to talk about lowering health care costs, I am willing to do that. I am unwilling to give a hand out to the wealthiest people in our country while blowing a huge hole in the debt. In another reason that this nominee does not share this commitment, I will vote no on his nomination and I urge my colleagues to do the same.
▶ 0:42:31Chair Crapo: Thank you. Senator rourke -- warren followed by senator lujan.
▶ 0:42:38Sen. Warren: I will be voting no on his nomination as deputy treasury secretary. I cannot support a nominee who wants to support trump's plan to slash taxes for millionaires, billionaires and corporations. Or one who is ok with the takeover of the irs.
▶ 0:43:02Sen. Warren: And I cannot support a nominee who is willing to gut medicaid and take money away from old people in nursing homes in order to give the wealthy more tax cuts. I will give him some credit.
▶ 0:43:16Sen. Warren: Despite his strong support for donald trump's billionaire tax cuts, he admitted to me last week in our hearing that republicans plan to use magic math to ram through the tax cuts makes no sense. Republicans have a problem on their hands. They love to talk about how they care about the deficit.
▶ 0:43:40Sen. Warren: But congress's independent scorekeepers has said that there plan to tell -- to cut taxes for the ultra-wealthy will cost about $4.6 trillion. So the republicans' response, magic math. They want to use a gimmick called current policy baseline to say that these tax cuts for the rich will cost a whopping zero.
▶ 0:44:07Sen. Warren: So I asked him last week, does using some magic words to describe republican tax cuts mean that those tax cuts will deliver more revenue for the government? And to his credit he said no. It does not. Here is the thing.
▶ 0:44:25Sen. Warren: When republicans' opponent nominee to be the number 22 guy at the treasury department is admitting that the math for the republican tax plan does not work, then the republicans have a problem. But admitting that republicans cannot repeal math does not make this guy qualified to run the treasury department. He has said over and over that he is all on board with donald trump and elon musk's plans.
▶ 0:44:57Sen. Warren: And what are those plans, hell-bent on cutting medicare, medicaid and social security. Either to pay for those giant tax cuts, or I guess just for the cruelty of it all. I cannot support a nominee who is willing to sell out working families for billionaires, millionaires, and corporations. I urge my colleagues to vote no.
▶ 0:45:23Chair Crapo: Thank you. Senator lujan.
▶ 0:45:27Sen. Lujan: Thank you. You know, Mr. chairman, here we go again. You know, some folks are familiar with "groundhog day" and even familiar with the film. And what republicans are trying to pull is another fast one.
▶ 0:45:52Sen. Lujan: Last time, a few years back, what my colleagues told the american people was that the 2017 trump tax policy, which constituents told me was a tax scam, was paid for. It would not add to the debt or contribute to the deficit. Well, the facts, are clear and the truth is that it was not.
▶ 0:46:21Sen. Lujan: Folks back home tell me that they want people to just be honest. Tell them like it is because they will be able to make adjustments as long as they get the truth. They are not getting it again. Now my colleagues are pushing for trump tax scam 2.0 using a budget trick to say that they will not blow up the national debt.
▶ 0:46:43Sen. Lujan: This comes from colleagues who share when they are on the campaign trail or when they are on news outlets or visiting that they want to get the fiscal house in order of america. They want to lower the debt and do something about deficits so it is not left to future generations. It turns out that all my colleagues have to say is everything that we have done in the past does not cost anything. Do not worry, the cost is zero right now.
▶ 0:47:13Sen. Lujan: The accounting trick is that they will go forward and say whatever we do going forward is how we will pay for it. Last week when Mr. f aulkender was before the committee and he said he paid rent. And I said if it cost you $2000 a month and the landlord ask you to pay $50 a -- $50 more a month going forward how much will it cost you?
▶ 0:47:38Sen. Lujan: To his credit, he told me it would be the cost of the 2000 plus 50, not just $50. I know that is oversimplifying, but sometimes we should do it so we can all understand what is in front of us. It is deeply concerning that the trump administration and congressional republicans are taking the same gimmick and running with it. The wealthiest americans in this country are at home and wondering what they will get with this new giveaway. I applaud people that do well.
▶ 0:48:12Sen. Lujan: I hope more and more people across the country do well and are able to secure wealth. At the constituents do not understand why if you are making $10 million a year, $100 million a year, $500 million a year, even $1 billion a year, how a tax cut will help them when they should be the ones getting it when they are making less than the median income. The median income in america is not 80 grant -- is 80 grant. It is not that in new mexico.
▶ 0:48:43Sen. Lujan: It does not seem right. I am concerned on how this is rolling. I just plead with my colleagues and I pray for all of us and them that people just be honest. Tell the american people like it is. And, we will do better. Things are not on the up and up and people know it back home. I yield back.
▶ 0:49:04Chair Crapo: Thank you very much. My understanding is that none of the other senators in the room are seeking recognition to speak except senator tillis, did you want to? Very good.
▶ 0:49:16Sen. Tillis: On the subject of being honest we should be honest about what happens if the jobs and tax cuts do not get extended. Everybody is saying that this is tax cuts for the ultrarich. But all I want to say is that 62% of people who filed taxes every year will get a tax increase.
▶ 0:49:40Sen. Tillis: If you are a family of -- making $80,000 a year and you have a couple of kids, you will pay about $1700 more. That is a tax increase on hard-working families. I could go down the list.
▶ 0:49:56Sen. Tillis: But my colleagues on the other side of the aisle need to understand that advocating against what we are trying to do, to and extend the jobs and tax cuts act is a request to put a burden on struggling families and 62% of the americans who filed taxes. Mr. chair, I think that needs to be said.
▶ 0:50:17Chair Crapo: Thank you. I will follow-up and then we will reassess and I will explain what will follow. The one thing that I want to say in response to it is the multiple claims that we are considering a tax cut for billionaires. The reality is, as senator tillis has just said. We are not talking about a tax cut, but stopping a tax increase.
▶ 0:50:47Chair Crapo: And that tax increase falls overwhelmingly on people who make less than $400,000 a year. Overwhelmingly on middle-class families. It is a $2.6 trillion tax increase that we are stopping on people making less than $400,000.
▶ 0:51:10Chair Crapo: And I think the record needs to be made clear on that in the face of the allegations that there are big tax cuts coming from billionaires. With that, we are done with the speaking with regard to the faulkender nomination. We will go into recess on the markup for his nomination until we can convene on the floor and that would be at our first vote at 1:15. The committee is instructed that we will resume this markup --
▶ 0:51:43Chair Crapo: -- Sen. wyden: excuse me, please finish.
▶ 0:51:47Chair Crapo: We will resume this on the floor for the vote on Mr. faulkender.
▶ 0:51:55Sen. Wyden: I would ask unanimous percent to put in that 50% of the tax cut goes to 5% of the people which is what the tax system is about and that is why we think it is wildly unfair and I will put it into the record.
▶ 0:52:08Chair Crapo: You can certainly put it into the record but I will dispute your numbers. With that, the markup with regard to Mr. faulkender is in recess until 1:15. We will take a five minute break while we get set up for the hearing on mehmet oz.
▶ 0:59:04Chair Crapo: The committee will come to order and this is a hearing for Dr. oz to be the director of the centers for medicare -- medical and medicaid services. The cms administrator. Dr. laws, my o --z, my staff and I have enjoyed working for you and your team and I appreciate your candor or and responsiveness.
▶ 0:59:31Chair Crapo: You have provided a significant amount of documentation to substantiate your tax returns and followed all of the law. You have met the same due diligence standard applied to every nominee and every previous administration. I will say again that I believe that the finance committee has a most thorough and rigorous vetting process of any committee and you have gone through that and have proven yourself to be an outstanding nominee worthy of this nomination.
▶ 1:00:01Chair Crapo: I again thank you for your cooperation throughout this process and for your conducting yourself with kindness and professionalism. I look forward to continuing our work together. For those outside of washington, cms can seem like a bureaucratic black box largely removed from everyday challenges facing patients and clinicians.
▶ 1:00:24Chair Crapo: You offer a wealth of first-hand experience and expertise having studied, practiced and taught as a physician. You understand how D.C. legalese looks on the ground and how policy plays out in practice. This is exactly the mindset that we need for a cms administrator.
▶ 1:00:44Chair Crapo: From our discussions you clearly recognize the importance of this role and the programs that cms manages, along with the tremendous responsibility that taking the helm entails. As the world's largest health insurer, cms sets coverage and payment policies for tens of millions of americans and their providers. Medicare enrolls more than 68 million americans.
▶ 1:01:14Chair Crapo: Medicaid and the children's health insurance program compromise close to 80 million. And more than 24 million consumers have selected individual market plans. Over the course of the next 25 years, analysts project that the medicare age population will grow by an additional 47 percent. Further underscoring the high stakes of cms policymaking.
▶ 1:01:41Chair Crapo: Ensuring sustainable, stable and proactive rules of the road for these programs will necessitate a collaborative and constructive approach. Medicare seniors deserve better prescription drug affordability. Along with stronger access to pharmacists and doctors. This committee has taken steps to achieve these goals on a broad bipartisan basis and we look forward to working with you to advance those measures.
▶ 1:02:12Chair Crapo: This includes pharmaceutical benefit management reform, a stated priority for president trump your background also offers the ideal experience for guiding efforts to reform our broken clinician payment system. An issue that you understand from a policy and pragmatic perspective. Modernizing federal health care programs will require rethinking our outdated approach to treating the symptoms rather than the underlying causes of chronic disease.
▶ 1:02:44Chair Crapo: Equipping providers with the training to employ my date -- a diverse away of interventions from nutrition and lifestyle changes to cutting-edge drugs and devices. It will save lives and taxpayer dollars. Technological advancements like telehealth offer an opportunity to reshape health care delivery in rural communities. Including, in idaho where access to basic services remains challenging.
▶ 1:03:14Chair Crapo: Medicare advantage's market driven structure provide seniors with more timely access to these and other novel approaches to care. Its successes should serve as a model for other federal programs. Similarly the essential safety net coverage relies on a balance between state-based flexibility with key patient protections.
▶ 1:03:37Chair Crapo: Based on our conversations I am confident that your experience as a physician serving medicaid beneficiaries will be an asset to cms. I look forward to learning more about your vision today about how we can work together to strengthen our health care system for patients, providers, and taxpayers. Thank you again, and I now recognize our ranking member for his opening remarks.
▶ 1:04:02Sen. Wyden: Thank you very much. Our nominee would oversee the centers for medicare and medicaid services and be responsible for the health and well-being of over 160 million americans. Once again, finance committee investigators start the process by bringing the receipts. Dr.
▶ 1:04:26Sen. Wyden: Oz is the second from nominee to come before the committee with a record of dodging medicare and social security taxes. This tax loophole hurts medicare and has benefited Dr. oz by $440,000 in the last three years.
▶ 1:04:48Sen. Wyden: Now, the doctor will testify about his concern for medicare's well-being. Yet, he is unwilling to pay the same taxes that millions of americans pay out of every paycheck.
▶ 1:05:06Sen. Wyden: So, what that means is the person who is nominated to run medicare, thinks that it is acceptable to not pay his taxes into social security and medicare like nurses and firefighters do, out of every paycheck. That is number one.
▶ 1:05:26Sen. Wyden: Number two, the nominee has been a big promoter of private, for-profit health insurance that too often displays little interest in protecting older people who enroll in these plans. And I have seen it as a former director of the oregon gray panthers.
▶ 1:05:46Sen. Wyden: On our side we are concerned that the seniors signing up to these plans are being lured by deceptive marketing and to good -- too good to be true practices and then they get walloped by business practices that delay and deny can.
▶ 1:06:02Sen. Wyden: When he ran for senate he proposed putting all seniors into private medicare advantage plans, leaving traditional medicare, which serves almost half of the medicare population, those folks in their coverage would just wither on the vine. Traditional medicare. Dr. oz has demonstrated no interest in improving traditional medicare for the 34 million americans account on the program. That will be a big priority for us going forward.
▶ 1:06:31Sen. Wyden: He has made a lucrative career out of advertising these options , targeting seniors with shady marketing tactics on his television program. He even went so far to sign up to be an insert -- insurance salesman himself. Dr. oz has used his program to promote some of the most ludicrous wellness scripting that I have heard about to date. Green coffee extract, raspberry ketones, supplements for cancer prevention.
▶ 1:07:01Sen. Wyden: Several weeks ago this committee third -- heard a slew of similar claims and now our country is facing the biggest measles outbreak in decades while the trump administration touts the benefits of cod liberal -- cod liver oil and terrifies. About vaccinating their kids.
▶ 1:07:25Sen. Wyden: Meanwhile, donald trump, elon musk, and congressional republicans are gearing up to deal the biggest blow to medicaid in history. They will be devastating for adults and those with disabilities. It could destroy care in nursing homes as we know it and it would mean ripping health insurance away from millions of families struggling to get by.
▶ 1:07:47Sen. Wyden: If confirmed he will be responsible for executing whatever destruction is brought down on the medicaid program by the cuts that republicans are preparing to make. He would be responsible for the premium hikes for families who sponsor their health insurance through the affordable care act and he would be calling the shots about what gets cut and what stays.
▶ 1:08:10Sen. Wyden: He would be the one to allow or stop any attempts by elon musk and his doge brigade to control medicare and medicaid payment systems. Meanwhile republicans and those like Dr. oz are more than happy to ignore the predatory tactics that for-profit insurers used to deny and delay care for patients who are trying just to get decent and good quality care.
▶ 1:08:38Sen. Wyden: Families across the country want to know that there health care will be protected and that premiums are affordable. Instead republicans march ahead with plans to take an axe to health insurance. They want to put for-profit insurance companies and private equity firms in the driver's seat of america's health care. That is not what the american people voted for. It is not what they deserve.
▶ 1:09:07Sen. Wyden: Based on the evidence that I have just laid out. The american people have a variety of reasons to believe that Dr. oz will be on board with the trump and republican effort to cut medicaid and coddle the for-profit insurance companies. This hearing is an opportunity for Dr. oz to show the committee otherwise. Thank you.
▶ 1:09:26Chair Crapo: Thank you ranking member. In a moment we will give Dr. oz the opportunity to share his opening statement. For he does I want to provide a short introduction. A graduate of harvard college, the university of pennsylvania and wharton business school, he was a faculty member and full professor at columbia university college of physicians and surgeons before the age of 40.
▶ 1:09:53Chair Crapo: He led the columbia university surgical labs where he pursued cutting-edge solutions to heart disease, and published hundreds of original peer-reviewed papers and wrote 16 books, half of which became new york times bestsellers.
▶ 1:10:11Chair Crapo: In 2003, he and his wife founded health corps which emulates the peace corps by putting recent college graduates into high schools around the country to teach diet, fitness and mental resilience. Of course, many know him from " the Dr. oz show" where he discussed health and wellness strategies and received various emmy awards. Before giving you your opening statement opportunity.
▶ 1:10:40Chair Crapo: I have four obligatory questions that we ask all nominees who come before this committee. Is there anything that you are aware of in your background that might present a conflict of interest with the duties of the office to which you have been nominated?
▶ 1:10:53Dr. Oz: No.
▶ 1:10:55Chair Crapo: Do you know of any reason, personal or otherwise that would prevent you from fully and honorably discharging the responsibilities of the office to which you have been nominated?
▶ 1:11:06Dr. Oz: No.
▶ 1:11:07Chair Crapo: Do you agree without reservation to respond to any reasonable summons to appear and testify before any duly constituted committee of congress if you are confirmed?
▶ 1:11:18Dr. Oz: Yes.
▶ 1:11:19Chair Crapo: Do you commit to providing a prompt response in writing to any question addressed to you by any senator of this committee?
▶ 1:11:28Dr. Oz: Yes.
▶ 1:11:28Chair Crapo: As you or before you begin you are welcome to introduce your family.
▶ 1:11:34Dr. Oz: They are sitting behind me. This whole slew as a family. One could not get here because of a baby at home. My wife lisa, right there. I should point out that I married her in the wisest decision of my life 40 years ago. If I could come close to being that insightful when I am administrating medicare, then I think we will battle some of the challenges that we will face.
▶ 1:12:01Chair Crapo: Thank you. Proceed.
▶ 1:12:05Dr. Oz: Ranking member, chairman, thank you for inviting me to appear. I have met with everybody on this committee and at one point or another and I am hoping that it will inform the committee hearing. I would like to thank president trump for his passionate desire to make america healthy again and nominating me. I would like to thank secretary kennedy in the confidence in my capacity to make a measurable difference in the health and well-being of the american people.
▶ 1:12:36Dr. Oz: Let me start off with a simple premise. All great societies, all great societies protect their most vulnerable. I would argue that we are a great people. With that in mind, I commit to doing whatever I can, working tirelessly to ensure that cms provides americans access to superb care, especially those the most vulnerable. Young, disabled, and elderly. This has been a lifelong passion.
▶ 1:13:06Dr. Oz: My father, when he immigrated, saw america as a beacon of hope, a land of opportunity where everyone's decisions mattered. That gave me a confidence that I mattered and had agency. I was a student athlete at harvard, like you. That was the original make america healthy again concept. That you would work hard, play hard, eat well and watch her body thrive.
▶ 1:13:34Dr. Oz: Because of my experience I was surprised when I matriculated at the university of pennsylvania that there was no nutrition class. I thought I had agency, I ran for school president and won and created that class.
▶ 1:13:49Dr. Oz: I became a student at the wharton business school and I learned the skills necessary to manage large organizations like cms where we have nearly 7000 hard-working career civil servants and 40,000 outside contractors involved with the delivery of our services. Next I I began my career at columbia.
▶ 1:14:17Dr. Oz: At the time I was training, it was the murder capital of the world, an area heavily populated by medicaid patients. I saw firsthand how our health care system underserved these communities. So, I went to work. I began developing high-tech solutions, life-saving breakthroughs ranging from mechanical hearts to a small device you can put into the heart without stopping the heart that fixes heart valves and it saves lives.
▶ 1:14:48Dr. Oz: In one large study, 50% reduction in deaths at half the price. Those are the kind of advances I wanted to be involved in. I also pushed for low tech solutions like getting my patients to use preventive strategies to recover from the heart surgery I was often performing on them. My wife and I started healthcorps, a team foundation which has touched the lives of millions of americans over the last 20 years.
▶ 1:15:15Dr. Oz: Working in schools trying to get energetic kids to play a role, college graduates, and the well-being of kids a few years younger than them, teenagers. All along, I was working hard to publish hundreds of peer-reviewed, academic articles in some of our top journals. A bunch of new york times best-selling books, as senator crapo mentioned. All of these culminated in the creation of the Dr. oz show.
▶ 1:15:46Dr. Oz: We hosted advocates from all walks of life and we did it well which is why we won 10 emmy awards. I share my story to highlight everything I have done in my life educationally and professionally has prepared me for this precise moment in time which I believe offers a monumental opportunity and a challenge for us at cms. My tv audience has heard me say this many times but many of you are too busy to watch television so I will repeat it.
▶ 1:16:16Dr. Oz: I believe a physician has the responsibility to tell patients what they need to know even if the message is uncomfortable. Here is some painful truths that should concern everyone in this room. I will list them quickly. Health care expenditures are growing 2% to 3% faster than our economy. Not sustainable. The medicare trust fund will be insolvent within a decade. That is the 2.9% taken out of your paycheck. Medicaid is the number one expense item in most states consuming 30% of state budgets.
▶ 1:16:48Dr. Oz: That is crowding out essential services like schools and public safety that many of you spent your careers trying to develop. Health care cost per person in this country is twice of other developed nations. It is not just about the money. We are already putting twice as much money into the system. Why is it costing us so much? Because of chronic disease. We made it easy to be sick in america.
▶ 1:17:12Dr. Oz: Those are linked to poor lifestyle choices and they drive three quarters of the $1.7 trillion cms spends a year to support americans' health. 43% of americans are over beas -- obese. That has quadrupled since I was in college. More importantly, we are twice as obese as europeans, nine times as obese as the japanese.
▶ 1:17:40Dr. Oz: Three quarters of our young people cannot even qualify for military service. Our maternal mortality rate, and I want to highlight this because we talked about this, it puts us in last place behind 50 other countries, maternal mortality, women dying during childbirth. Medical errors the number three cause of death in america.
▶ 1:18:06Dr. Oz: This is some of the reasons why our life expectancy is five years shorter than comparable countries. This public health crisis threatens our national security because it adds to the national debt that is defeating us from within, crowding out other essential services, and we are witnessing fellow americans suffering needlessly which I believe is a moral failing. As a heart surgeon, I can attest that the most expensive care we give is bad care.
▶ 1:18:36Dr. Oz: You paid to do the wrong thing, you pay to fix what was done wrong, and you pay to deal with the complications. It is morally wrong and expensive. We have a generational opportunity to fix our health care system and help people stay healthy for longer. That is why president trump wants to love and cherish medicare and medicaid because he believes every american should get the care they want, need, and deserve.
▶ 1:19:04Dr. Oz: They will work with congress to find efficiencies that can stabilize insurance markets which will make it easier and more affordable for americans to adopt healthy lifestyles. I would argue america is too great a nation for small dreams. Here are some big ideas. I will limit it to three so I can get to the questions, that I want to pursue if I am confirmed by the senate.
▶ 1:19:28Dr. Oz: First, we should empower beneficiaries with better tools and more transparency so the american people navigate their health as well as dealing with the complex health care system we have created for them. As an example, I think president trump's executive order on transparency shifts power to the american people. Let's make america great again and make it healthy again by informing people so they can be in charge of their well-being. Second, we should incentivize doctors and all health care providers to optimize care.
▶ 1:19:57Dr. Oz: We have to do that with real-time information while they are taking care of patients and within their workflow. Artificial intelligence I believe can help. It can liberate doctors and nurses from all the paperwork, which they spend as much time on paperwork as taking care of patients. They should focus on patients. Let's be aggressive modernizing tools to reduce fraud, waste, and abuse. This. Unscrupulous people from stealing from vulnerable americans and extend the life of the medicare trust fund.
▶ 1:20:29Dr. Oz: I asked for permission to start sprinting after these goals so we can deliver better outcomes and make america healthy again. I look forward to your questions and pray for your support.
▶ 1:20:41Chair Crapo: Thank you, Dr. oz. As I mentioned in my opening statement, your background and experience brings a fresh perspective to the role of cms administrator. As an accomplished physician, you have first-hand experience not only with the bureaucratic nature of federal government payment programs but also the impact of chronic disease, as you discussed in your statement.
▶ 1:21:04Chair Crapo: I would be curious if you would expand a little more on your vision for cms and how you would integrate nutrition and lifestyle-based interventions into our health care system.
▶ 1:21:15Dr. Oz: Dr. oz: senator crapo, when I walked into your office, you gave me an idaho potato chip. You also gave me a large potato. That is where those potato chips came from. Nothing else was added. If you look at the ingredient list, it was potato and salt. You also had yogurt in your office which was low-fat, flavored, and I would argue not as healthy. The average american has a difficult time making that choice.
▶ 1:21:47Dr. Oz: We often incentivize products that are not as healthy for the which is confusing. One of the points I mentioned at the end of my opening comment was that if we gave people in their hands tools, resources that are useful, not information, but tactics and support teams that can work with them to improve their well-being, many would take advantage of it. I pointed out obesity at 43%. That is not overweight. That is obesity. Those folks want to lose weight.
▶ 1:22:17Dr. Oz: There are many reasons they do not. Part of the reason is they do not have support teams around them. They do not have lifestyle advice they can implement into their life day in and day out. For anyone on this committee who was able to go running or exercising for 20 minutes yesterday, you probably did the equivalent of reducing $100 billion of expenses from medicare and medicaid just by being active. If americans would do that every day, that is what we would experience. We have not done that.
▶ 1:22:45Dr. Oz: One tactic I believe will work effectively as if we can get real-time information from physicians and other help providers taking care of patients and using that real-time information give feedback to people worried about their well-being. That is when they are more likely to use that advice. Tool would allow them to call an expert if they needed that resource, we would provide the tools to do that. Would we -- we would reimburse healthy lifestyles generated and make them inactive participant in their well-being. I think that dramatically changes the power dynamic.
▶ 1:23:16Dr. Oz: It makes the american people feel like they can be the experts at their well-being.
▶ 1:23:19Chair Crapo: Thank you. I strongly agree with your focus in these comments on lifestyle-based interventions that can actually help people help themselves to get much more healthy. I am also interested in how you might reform our payment programs to become more efficient to serve and save patient lives and taxpayer dollars.
▶ 1:23:43Dr. Oz: When I sat with senator wyden last night, he asked about a similar issue which is preauthorization. We spend about 12% of the cms budget on bureaucratic processes, the administration of the program. Most of that money is taken by middlemen in ways I do not think need to be true in the long term. I believe we have the power right now with technology that did not exist even three or four years ago to automate a lot of these processes.
▶ 1:24:13Dr. Oz: Preauthorization is a good example. There are about 15,000 procedures that go through preauthorization. Insurance companies in aggregate probably have 5000 ableist. But they only have to have about 1000 to truly make a difference and make sure the right procedures are done the right way.
▶ 1:24:30Dr. Oz: We should be able to create an experience for physicians and patients that we know almost immediately what they are going to requires preauthorization and what they do to qualify for it. That could be instantaneous. By doing this rapidly, we cut out administrative costs and intense frustration the american people have with preauthorization which was raised by many members of the committee.
▶ 1:24:58Dr. Oz: We would improve the care of people without costing or taking money out of the system. Those are the kinds of advances I believe we can champion.
▶ 1:25:05Chair Crapo: Thank you. That concludes my questioning. We have a vote on so I will step out and go vote. That is probably why you have seen a number of the members slip out. Senator wyden will go next and then senator grassley. Hopefully, I will be back by then. Thank you.
▶ 1:25:22Sen. Wyden: Dr. oz, I was listening carefully to your remarks and you talked about cherishing medicaid. I think that is a very good sentiment. I want to ask about how we are going to do that. Will you agree this morning, since you want to cherish medicaid, to oppose any cuts to the medicaid program?
▶ 1:25:49Sen. Wyden: And I want a yes or no because we all agree that we need to do more to fight fraud and such matters. But I want to know, yes or no, since you cherish medicaid, will you agree to oppose cuts in the medicaid program?
▶ 1:26:06Dr. Oz: I cherish medicaid and I have worked within the medicaid environment extensively, as I highlighted at columbia university.
▶ 1:26:14Sen. Wyden: That is not the question. The question is, will you oppose cuts to the program you say you cherish? Time is short.
▶ 1:26:22Dr. Oz: I want to make sure patients today and in the future have resources to protect them if they get ill. The way you protect medicaid is by making sure it is viable at every level which includes having enough practitioners to afford the services, paying them enough to do what you request, and making sure the patients are able to use medicaid.
▶ 1:26:39Sen. Wyden: Let the record show that I asked a witness who said he cherishes this program, will you agree to oppose cuts, and he would not answer yes or no. That me ask you about rural communities because they get hit -- let me ask you about rural communities because they get hit by medicaid cuts like a wrecking ball. It will be devastating to rural america. We have a lot of senators who care about this.
▶ 1:27:09Sen. Wyden: Oregon county has a higher share of residents who get their health care through medicaid on the border with idaho. By the way, this is an area donald trump won in the election by 70%. I want you to be able to do more to actually cherish medicaid and help people. I would like to invite you to come visit that county if you are confirmed and see what this really means to rural communities. I have had more than 1100 of these town hall meetings.
▶ 1:27:40Sen. Wyden: We would make you a guest at one if you are confirmed. Would you come?
▶ 1:27:43Dr. Oz: If confirmed, I commit to visiting with you if you will teach me your jump shot.
▶ 1:27:48Sen. Wyden: I like that part. But I would like to know, will you come to this county?
▶ 1:27:53Dr. Oz: I promise you I will be with you in that county or everywhere you wish to travel within oregon.
▶ 1:28:02Sen. Wyden: For 60 days so we can do it while it counts when these cuts are being debated?
▶ 1:28:07Dr. Oz: If you do not mind, I want to ask somebody in cms what the rules are. If I am allowed to do it, I will be there within 60 days.
▶ 1:28:15Sen. Wyden: That. Let me -- good. Let me ask you about how we are going to rain in -- reing in going to rain in -- reing in doge. Everybody in the senate as a privacy hawk because of doge because we are troubled about doge going into the treasure trove of health care data that has all the information on these patients. What are you going to do to protect them?
▶ 1:28:45Sen. Wyden: Right now, we know nothing, nothing from this administration about how they are going to protect the patients. And we have asked and asked some more. What are you going to do if confirmed to protect people from overreach by doge on health care?
▶ 1:29:01Dr. Oz: I, like you, have not been involved with doge. I am only reading in the papers and keeping up with the news in that fashion. I have treasured building teams my whole career. The first thing I am going to do --
▶ 1:29:13Sen. Wyden: You have talked to no one in the administration about doge to date?
▶ 1:29:18Dr. Oz: No.
▶ 1:29:20Sen. Wyden: Did not talk to secretary kennedy?
▶ 1:29:23Dr. Oz: No.
▶ 1:29:23Sen. Wyden: Go ahead, please.
▶ 1:29:25Dr. Oz: I know in order to run a large organization you have to get people excited about going to work. They have to see the vision that you have. There is a fine line between vision and hallucination. Other people have to see it for it to be a vision. I intend to spend my first precious few weeks and the agency if confirmed speaking to the staff, raising morale, getting people excited, and addressing what is going on with doge. I will know a lot more if I am confirmed.
▶ 1:29:52Sen. Wyden: Do you think it ought to be a priority issue for you if confirmed, doing more to protect privacy at doge?
▶ 1:29:58Dr. Oz: I would like to know more what is going on with privacy at doge. I have read the cms homepage. The website says only people who have gone through training program are allowed to see the records and it can only be the records. They cannot touch them.
▶ 1:30:14Sen. Wyden: One last question. Do you believe in a nursing home there should be a registered nurse available around the clock 24/7? The reason I ask this is because that is the rule that is coming up, but there is going to be an effort to roll it back. Do you think we ought to have nursing homes without nurses?
▶ 1:30:33Dr. Oz: Senator wyden, as you know, it is a complicated question.
▶ 1:30:37Sen. Wyden: No, it is not. We need a nurse in a nursing home. It is not that complicated.
▶ 1:30:43Dr. Oz: We need a nurse that will work in a nursing home. I believe we can provide quality care equivalent to having a nurse in the nursing home using tools and technology with tele mel gibson -- telemedicine. We have a massive crisis where we have a lot of people aging.
▶ 1:31:04Dr. Oz: In the opening statements, it was pointed out we will go from 68 million people in medicaid to 90 million people on medicaid when the next left in the next decade. If confirmed, I would like to focus on this issue for older people.
▶ 1:31:18Sen. Wyden: My time has expired. Right now, the proposal gives rural communities five years to come into compliance. If confirmed, I hope you will not take the nurses out of nursing homes because there will be an effort in the senate to do that I will be opposed to it. Senator grassley?
▶ 1:31:37Sen. Grassley: I have six issues, no questions. At the end of my issues, you can agree, disagree, or not say anything, whatever you want to do. I have been working to lower prescription drug costs. I expect you to work with us to hold these powerful drug middlemen accountable and support rural pharmacists. Last year, there were at least three bills introduced on pharmacy benefit managers with a total of about 65 senators.
▶ 1:32:10Sen. Grassley: So, this is a big issue in the united states senate. On rural health care, I expect you to support access to rural health care. To achieve this, I believe cms should take the following actions right away prefilled the open slots in the rural community hospital program, distribute the new physician residency slots to rural hospitals as the law requires, ensure rural emergency hospital program, a program I got past five years ago, is working for rural communities.
▶ 1:32:42Sen. Grassley: I have had a big interest in kids with exceptional needs. I expect you to take action to improve care and reduce red tape for kids with complex medical needs. This includes working with states so they can establish health homes for these kids as my bipartisan law enabled. Transitional health plans is the fourth one.
▶ 1:33:07Sen. Grassley: Since 2013, cms under president obama, trump, and biden have issued nonenforcement memos to allow transitional health plans to be maintained. Thousand iowa farmers and small business owners have maintained these health insurance coverage with these plans for over a decade. This is health insurance purchased after obamacare became law but before it was implemented.
▶ 1:33:38Sen. Grassley: I would expect you to keep access to these programs. On the subject of waste, fraud, and abuse, improper payments in our major health care programs have averaged $122 billion annually over the past five years. I am the author of a major and more recent updates to the federal government's most powerful tool in fighting fraud. That is the post claims act.
▶ 1:34:06Sen. Grassley: Since its enactment, it has brought $78 billion of taxpayer money lost to fraud back to the federal treasury. Cms with the justice department must aggressively go after waste, fraud, and abuse and empower whistleblowers which brings it to the attention of most of the people following up on the enforcement of the law. My last one is oversight.
▶ 1:34:39Sen. Grassley: In other words, the congressional responsibility of oversight to see that the president faithfully executes the laws, allows us to hold bureaucrats accountable to the rule of law, and helps keep faith with taxpayers. I expect cms to provide timely and complete responses to congressional oversight. You have answered that question for the chairman of the committee.
▶ 1:35:01Sen. Grassley: When you are in my office, I said you should have said maybe instead of yes because then you will not turn out to be a liar like we have found over the last 20 or 30 years with the people who have answered that question. With whistleblowers, you do not know what is going on down in the bowels of that big bureaucracy you have and you need a culture that will make sure that middle-management will pay attention to things that are
▶ 1:35:31Sen. Grassley: Brought to their attention by whistleblowers and get things corrected. Then, they do not have to come to me to get correction made. You can answer anyway you want to. You have 58 seconds.
▶ 1:35:42Dr. Oz: [laughter] I will use all 15 seconds. Yes, yes, yes, yes, yes, and maybe, only because you said to say maybe because the reality is we may not get to every bill. Every single member of the committee has brought up the fact cms has not been responsive. Directionally, we want to make sure that you hear back from us. Not just the committee.
▶ 1:36:08Dr. Oz: I believe this is a firmly held reality by many folks on the outside. They do not believe they can speak to cms. They do not know where we are going. The private sector can't. The american people can't. We mail pieces of paper to people. It costs $50 million a year to do that. Has anyone ever read their medicaid mail?
▶ 1:36:30Dr. Oz: I believe we can do a much better job by telling the american people what we are going to do, to the point you could imagine us having what most industries do, which is a developer conference where you go out until industry what you need, tell the american people what you can offer. Communicate with them in a consistent fashion using digital tools. I believe based on our conversation the biggest piece of advice I might take from you is to look down in the depths of cms for the people willing to tell you the truth of what is going on.
▶ 1:37:02Dr. Oz: Do not talk to the head person or the second or third person below them. Go down to the levels were people will tell you the truth because they are frustrated. That is where we will be able to make a massive improvement in the culture of the organization. >> I'm going to defer to my colleague. I voted already and he has not. I will defer to him and go next. >> Mr. chairman, let me say to the staff, the ranking member allowed me to take over for him. I may never give up this gavel.
▶ 1:37:33Dr. Oz: I do want to say senator cantwell has been kind enough to allow me to go next. My colleague from new hampshire said that I can. You should be the next democrat. I want to make sure that is where we are. Dr. oz, thank you for your visit to my office. Thank you for your willingness to serve.
▶ 1:37:55Dr. Oz: It is a refreshing moment to hear somebody in the finance committee hearing room talk about the challenges of our existing system of health care. Our existing system is twice as expensive as any other system in the industrialized world.
▶ 1:38:15Dr. Oz: Our life expectancy, you had said five years, it may actually be six years shorter than other countries around the world and if you are african american in our country, on average life expectancy is 12 years shorter than other countries around the world which is a staggering fact. I cannot think of anything more at war with our sense of self than that, honestly.
▶ 1:38:45Dr. Oz: In all of those other countries we are talking about, there is universal health care. And parents do not have to struggle every day as they do in colorado with where they are going to get primary care for their child, where they are going to get mental health care for their child. Those two things I think, especially if you accept your view that primary care is important, how people eat is important.
▶ 1:39:20Dr. Oz: How we think about our health is important. It is really important for people to have access to medical care. Every year that goes by, people at home in colorado, as I told you in our office feel there is more scarcity and more scarcity, whether that is a rural hospital closing or an insurance company not allowing them to get their reimbursement, or drug prices going up so high that seniors are forced to spend their retirement debating pharmacies
▶ 1:39:51Dr. Oz: About whether or not they can fill their prescriptions. Every single day, that is how people in the richest country in the world are dealing with this. Because you have said in my office and in your opening statement that you are concerned about the poorest people in the country and the most vulnerable, it would seem to place we would not want to start is by throwing the poorest people off the only insurance they have, which is medicaid.
▶ 1:40:21Dr. Oz: I think there is a lot of, we have heard a lot of debate over the years about fraud, waste, and abuse in medicaid. Every system needs to be reformed. Every system in america needs to be reformed. But do you or do you not oppose the medicaid cuts that so many people in the administration have said they support? What is your position on these medicaid cuts?
▶ 1:40:45Dr. Oz: I enjoyed our visit very much.
▶ 1:40:48Sen. Bennet: Thank you.
▶ 1:40:50Dr. Oz: I want to come back to what you did before you took this position. As administrator of the denver school system, you were acutely aware of the problems that exist nutritionally giving the kids what they need to function. We need to invest especially in the care of young people because that is probably 40% of young people in america are on medicaid. Mothers, the disabled. Those are groups we should be investing into.
▶ 1:41:21Dr. Oz: When I was in your office, you brought up the story of a young woman suffering from inflammatory bowel disease, lost her job because she could not work, and then lost her insurance. How do we get her back on her feet to work again? We do that and we do the same thing in our school systems. We do this in our school systems and for folks on medicaid picking sure it is not just about throwing money at them.
▶ 1:41:45Sen. Bennet: I understand. I do not think they feel there is money being thrown at them. That is the last thing. If we lived in a world where there was money being thrown at the poorest people in america to get health care, that would be an issue in case. That is not the case -- that would be an interesting case. That is not the case. They are barely able to get medical services for themselves and their families.
▶ 1:42:09Sen. Bennet: I would just say that I am sure you would believe any parent thrown off of insurance would do whatever it is they could, if their kid got sick, they would do whatever it is they could to get their kid in front of a doctor. Would you agree with that?
▶ 1:42:23Dr. Oz: Yes, I would.
▶ 1:42:25Sen. Bennet: Because of that, I think it is very important for us all to deal with the fact that if we pursue medicare, medicaid cuts the administration is proposing and people have to get care for their kids, they will, and they will get that care and often a hospital setting which will be the most expensive place they could go to get the care. We are out of time.
▶ 1:42:54Sen. Bennet: I think it is very unclear at this moment what the administration is planning on doing because the president said over and over again different things on this question of medicaid. I hope very much we can find a way to work together to make the system a better system than the one that we have and that the approach is not to throw the most vulnerable people off the only care they have. Thank you, Dr. oz. Thank you, Mr. chairman.
▶ 1:43:23Chair Crapo: Thank you. Senator cantwell.
▶ 1:43:28Sen. Cantwell: : thank you so much for the visit in our office. I wanted to put up we are not into and I got you as much as a long-term commitment you have from 2009 the every american should have coverage. That was probably on a visit to seattle. We appreciate that.
▶ 1:43:55Sen. Cantwell: In continuing the line of questioning my colleague just had, you believe in the medicaid expansion that was done under the affordable care act?
▶ 1:44:04Dr. Oz: For some states, it made sense. For some, it did not. That is a good example of how estate has to have a plan.
▶ 1:44:13Sen. Cantwell: The states that do not have a plan, what plan did they have?
▶ 1:44:18Dr. Oz: As we discussed in your office with the affordable care act, they have an opportunity to expand medicaid where they can use other tactics. 10 states have not expanded.
▶ 1:44:28Sen. Cantwell: You are saying that is ok?
▶ 1:44:30Dr. Oz: As long as they have a plan to address their challenges of dealing with the underserved populations.
▶ 1:44:35Sen. Cantwell: What plan? I don't have the numbers in front of me but I will get those. I guarantee you they have lots of people unserved. As my colleague just said, that oftentimes exacerbates the cost on to hospitals and more expensive care instead of getting coverage.
▶ 1:44:56Sen. Cantwell: You and I talked about this concept of bundling up the working population at 150% above the medicaid rate as new york has done, as minnesota has done, as other states are trying to do, and creating that incentive juxtaposed to the exchange. Do you believe in that concept?
▶ 1:45:16Dr. Oz: Dr. oz: we discussed in washington state how you had a very innovative program before the affordable care act that seemed to make sense to me as you described it. I have not studied in detail. But I like the idea there are multiple different approaches to moving people from medicaid, if they are able to get off medicaid, into the workforce. To do that, you have to support them in order to afford insurance.
▶ 1:45:41Dr. Oz: Some transition process if you are able to get off medicaid to get you onto a private insurance company prevents the gaps in care that often result in extraordinarily expensive admissions.
▶ 1:45:53Sen. Cantwell: I am asking you if you believe in a virtual bundle delivered by the private sector, getting access to that as a way to reduce the exorbitant payments on the silver plans.
▶ 1:46:08Dr. Oz: It is a detailed question that I have to research a bit. If confirmed, I look forward to following up with you on that. I think some of the ideas we discussed in your office including that are promising ways that would allow people the flexibility to choose what type of insurance they want if they are starting to work. It financially does not make sense to get off medicaid get.
▶ 1:46:32Dr. Oz: If they are able to get above the poverty level which is $16,000 a year for a single individual, it is not much money, you have to have ways for people making slightly more to feel confident they are protected.
▶ 1:46:42Sen. Cantwell: I think the american people want to know from your nomination and this process that we are going to go through, what is it that republicans believe? If they are saying next year which I think the president is saying that we are going to cut off all of those silver plan subsidies, I am saying I at least want to hear from you whether you believe that bundling those people up into a virtual bundle I think is what you called it in my office and allowing them to have that market power is an idea that you
▶ 1:47:13Sen. Cantwell: Agree with.
▶ 1:47:14Dr. Oz: I look forward if confirmed with this committee to researching that in detail. It is a promising enough idea that I would love to visit with you on.
▶ 1:47:25Sen. Cantwell: My vote will be predicated on this. I need you to think about this. You are coming with the ability to be an advocate so we want to know what you will be an advocate for. All of my colleagues are going to want to know, are you going to cut medicaid? We want to know that from everybody. We want to know if you are going to cut medicaid. We do not believe in cutting medicaid. It is 1.8 million people in the state of washington.
▶ 1:47:50Sen. Cantwell: It is basically the number of people in my state who are getting maternal care from this is exorbitant. The number of kids getting care from this is high. 47% of kids in my state receive insurance from medicaid. We have population centers of our entire state that are well above 50% medicaid/medicare populations. How do you deliver health care to central washington when it is that level?
▶ 1:48:21Sen. Cantwell: We want to know whether you will commit to concepts. If you do not like some aspects of the affordable care act, you should say which ones you do not like. Thank you very much. I hope you will learn that the affordable care expansion of medicaid works and virtual bundles that give consumers more clout also work.
▶ 1:48:40Chair Crapo: Thank you. Senator lankford.
▶ 1:48:45Sen. Lankford: You have been outspoken for years for the health of americans and for americans taking better care of themselves and us learning how to do that better as a nation. You and I have visited already on these issues prate I want to pope farther. The pharmacy benefit manager issue has been one this committee has taken up in a bipartisan way.
▶ 1:49:09Sen. Lankford: We spent a significant amount of time last year as a committee paid we passed overwhelmingly the pharmacy benefit manager bill out of the committee. We tried to get it to the floor. Senator schumer did not bring it to the floor last session. We tried to get it crammed in and it did not fit. Some of them cms can take care of, some of them this committee has to take care of as well.
▶ 1:49:43Sen. Lankford: 450 independent pharmacies closed last year, more than one a day. Most of those pharmacies if you talk to them would say the breaking point was what pharmacy benefit managers are doing. That is mostly rural health care and the access to the pharmacist in the rural areas all over the country is lost. People to have to mail it in because the pbm makes more money to do that.
▶ 1:50:11Sen. Lankford: There has been a rule for cms, the noninterference rule, that has created a challenge for cms to engage. What do you feel you will need as far as authority to engage on the issue of pbm's, and thought she may have on that?
▶ 1:50:24Dr. Oz: You have deep insights into pbm's. I appreciate taking time to learn about them. Although they provide an important service, taking medications from the pharmaceutical company that created the product and putting it into the pharmacy system, as you pointed out mailing it directly to patients, they also create a pricing spread. That is where some problems occur.
▶ 1:50:47Dr. Oz: The lack of transparency into what goes on when the pill ends leaves the pharmaceutical company and ends up in your home is where a lot of the money is made. I think if we can insist on complete and radical transparency on what is going on with the drug markets, it would help cms tremendously because it would allow us to understand if there is spread pricing going on where the pharmacies going out of business are paid a much lower number than people are charged for the medications they are getting.
▶ 1:51:19Dr. Oz: In and paid for by the U.S. government or other sources. Those are a problem. It is also an issue if the actual rebates given which are part and parcel of the pbm system, archaic but widely used approach, if those rebates are fully rebating the money saved by the negotiations done by the pbm's.
▶ 1:51:41Dr. Oz: I do not think anyone in this room or anyone watching would think of doing a transaction with a did not have a little bit of insight into what everyone else in the party was involved in and how much money they would make as a result of the negotiated result. I believe in order to protect the american people, president trump has been clear on this, wants to reduce the cost of medications to the government and the american people, the co-pay. That is not happening now. We can do better. Pbm's are one way.
▶ 1:52:12Sen. Lankford: It is a challenge all over the country. There are occasionally folks in washington or urban areas that do not think as much about rural america. Those of us who live in rural america and those we know firsthand know that they have heart attacks, babies, and struggles. They need access to health care. They also need someone to be able to talk to to say I have a question about drugs and the interactions. That is the local independent pharmacist often.
▶ 1:52:40Sen. Lankford: One of the areas pbm's has been particularly bad on is the issue of brand-name drugs will come out, they will give a rebate if the generic will go on the branded tier. That tribes of the cost for taxpayers and the federal government -- that drives up the cost for taxpayers and the federal government. More than half of the generic drugs are only the wrong tier. That is an issue we need to be able to address legislatively.
▶ 1:53:10Sen. Lankford: It is also an issue cms can engage with directly. I look forward to that conversation of how we can do that. I want to bring up another issue. We have a shortage of nurses around the country. President biden's cms put out a new rule saying to nursing homes and other facilities they have to have 24 hour care with an r.n. In that location. That sound like a great idea unless you are in a town of 5000 people and there is not another nurse available.
▶ 1:53:41Sen. Lankford: The real results as it will close wuerl nursing homes all over the country. This is an action the biden administration cms took directly. This is an issue you will have to address soon. I would ask that you review that because we would like to keep rural nursing homes long-term care facilities open and available for those families, not have them closing and telling rural america drive two hundred miles for your family to get access to care.
▶ 1:54:06Dr. Oz: Thank you for raising that. It is an issue I have spoken about with community groups quite a bit in preparation for this meeting. If confirmed, I pledge to come back with my thoughts. Senator wyden brought up the same issue from the other perspective. I appreciate the arguments waged here. They are thoughtful ones that deserve more attention. They will be the early things I focus on.
▶ 1:54:28Chair Crapo: Senator cassidy.
▶ 1:54:31Sen. Cassidy: I will overlook the fact that behind you are some of my former cabinet member stolen by the department.
▶ 1:54:37Dr. Oz: Well-trained, sir.
▶ 1:54:43Sen. Cassidy: , you are a provider. You know how sometimes care delayed his care denied creed speaking to a surgeon in florida said if he had gotten preauthorization, the outcome would have been better. You are a provider. What do we do about prior auth issues?
▶ 1:55:05Dr. Oz: Thank you for the years of service to your patients and the clinics you helped run and create great I have enjoyed our conversations about broad health care policy. The issue of preauthorization is a pox on the system. Preauthorization is misused in some settings. There needs to be a mechanism to confirm procedures are worthwhile. I will offer some ideas on how this might work.
▶ 1:55:34Dr. Oz: If confirmed, I would love to share them with other members of the committee. There are about 15,000 procedures that could have preauthorization. They represent most of the things done preyed on not just operations but medications, etc.. Insurance companies today use preauthorization for about 5500 of those procedures. Not all insurance companies focus on the same things.
▶ 1:55:59Dr. Oz: Even within the idea the procedure being preauthorized the criteria are all over the place so it is difficult to automate that. It tends to be misused because it stalls the process and makes it more expensive and we are spending money, wasting money trying to do a process that should be automated. I would argue we could limit the list to 1000.
▶ 1:56:27Dr. Oz: Be clear if you need a knee replacement and you can bend your knee more than 120 degrees, you do not get it, or whatever number. If we know those numbers ahead of time, credit card approval does not take three months. You know immediately whether the transaction is approved or not. We will be able to do something similar so preauthorization can happen rapidly.
▶ 1:56:49Sen. Cassidy: Let me ask you this. My doctors are so frustrated because they have gone through therapy with the patient. This medicine did not work, this one finally does. They change plans and they are being asked to go through step therapy again giving the patient a lack of response until they get to where they should be.
▶ 1:57:11Dr. Oz: That is one of the most frequent complaints I hear from physicians and patients on the others that I cannot get the treatment. I am in pain, I know what works for me but no one will give it to me even though I have insurance. I am part of medicaid, I should be allowed to get access to this medication which I am told is in the plan and it gets slowed down. This is a place where it is a matter of competency. This is not a republican/democrat issue.
▶ 1:57:41Dr. Oz: If we can do the job assigned to us at cms in a competent fashion and revisit some assumptions we have taken for granted for decades, and use technology that can help us, because we have ai support tools and navigation systems that can quickly adjudicate whether you should have to wait even a day to get medication that will get you out of pain or a week for the procedure you should be allowed to have, it would take a lot of the angst out of the system for the american people.
▶ 1:58:10Sen. Cassidy: I am with you on that. I have limited time. Let me ask you one more thing. A couple more things, actually. There are local decisions, regional determinate decisions. Medicare is supposed to cover something unless it is said not to be covered.
▶ 1:58:38Sen. Cassidy: I'm told there are plans reversing that and saying they will only cover something if there is a positive determination that it should be. I am told this by pain doctors who say I can get the patient back to work, that sort of thing. Any awareness of that, any thoughts on that?
▶ 1:58:53Dr. Oz: I am not aware that was happening.
▶ 1:58:55Sen. Cassidy: I will bring that up to you. There is some evidence plans are getting one hunter 6% to 120% -- 106% to 120% of medicaid patients not enrolled. As we look at the trust fund going insolvent and our budget deficit expanding, is this a place she would look? How would you look in terms of getting better value for the dollar?
▶ 1:59:19Dr. Oz: The assessments have revealed what you shared. We are apparently paying more for medicare advantage than regular medicare. It is upside down. I think there are ways for up to look at the upcoding happening systemically in many programs to make sure people are being appropriate leave paid for taking care of sick patients but not for patients that are not ill.
▶ 1:59:46Dr. Oz: If someone is showing up at your home to figure out if you have a small plaque in your carotid because they will charge a lot more for the care that they are not going to do anything for, that is wrong. We have numerous tools. Part of this is recognizing there is a new sheriff in town. We have to go after places and areas where we are not managing the american people's money well.
▶ 2:00:12Dr. Oz: If we can do that effectively, and both of us I think agree there are opportunities to do that that are massive in scope, but they are also important emotionally for the program. You want people to have confidence in the program. The career employees administrating medicare and the beneficiary should feel it is working for them.
▶ 2:00:32Sen. Cassidy: We are out of time. We have a bill the chiefs that -- that achieves that. If you are confirmed, we will discuss that at a later date.
▶ 2:00:44Sen. Hassan: Congratulations to you and your family on your nomination. The first question I am asking of every nominee, if directed by the president to take action that would break the law, would you follow the law or the president's directive.
▶ 2:01:00Dr. Oz: The president would never do that.
▶ 2:01:05Sen. Hassan: . That is absurd and a disappointing action. The congressional budget office has confirmed the republican budget plan would require taking way medicaid coverage for millions of people. In new hampshire, the republican budget to take away as many as 30,000 children. Do you support the republican budget plan that terminates the health coverage of millions of americans including as many as 30,000 children in my state?
▶ 2:01:31Dr. Oz: Senator hassan, I have not seen the decades of the house bill that says that. I look forward to examining it with great care if confirmed.
▶ 2:01:40Sen. Hassan: Let me ask it another way. How many children losing health insurance would be acceptable to you?
▶ 2:01:45Dr. Oz: I do not want children losing health insurance.
▶ 2:01:48Sen. Hassan: Then you will need to object to the republican budget plan. You and I did talk about maternal health crises. Medicaid covers 40% of berths in america. 50% of all rural births. Will you prevent to preventing -- will you commit to preventing any cuts that will deny mom's health care coverage?
▶ 2:02:09Dr. Oz: I am very focused on maternal health care. We have to make investments in maternal care to provide better outcomes.
▶ 2:02:19Sen. Hassan: Will you make sure there are no cuts in the republican budget plan that would deny coverage to pregnant moms and postpartum?
▶ 2:02:29Dr. Oz: I have to be more knowledgeable about what is happening within cms. I have no idea where the money currently --
▶ 2:02:37Sen. Hassan: The medicaid cuts are draconian in the republican plan. The cbo has said it will lead to significant cuts and the cuts will likely lead to 10 states losing the medicaid expansion coverage. Let's move onto another issue. Last week, the trump administration put out a list of federal offices to close including the only office in the north country of new hampshire where seniors can enroll in social security benefits and medicare in person.
▶ 2:03:03Sen. Hassan: If confirmed, will you work to confirm seniors can continue to enroll in person in littleton, new hampshire?
▶ 2:03:13Dr. Oz: I do not know about why there was the decision to remove this in northern new hampshire. I do believe seniors will be better treated if they can see somebody in person.
▶ 2:03:21Sen. Hassan: Do you think they will be better or worse off in rural areas of my state if they have to drive 100 miles to the next closest officer new hampshire to receive assistance with medicare enrollment?
▶ 2:03:32Dr. Oz: One of the changes I believe we have to make within medicare in general is to modernize the way we communicate with our beneficiaries. It is not just about in-person visits. There should be a continuous, frequent, weekly even, discussion that goes on. If we cannot communicate with our seniors and their families digitally, we are giving up a huge opportunity.
▶ 2:03:56Sen. Hassan: Guess what. Some of the plans from the other side of the aisle going to cut the efforts to bring broadband internet to this exact area of my state. It is not just that some seniors did not want to use digital access. And a lot of america, they cannot -- in a lot of rural america, they cannot. We need to have rural offices that are staffed.
▶ 2:04:19Sen. Hassan: In 2012, you enthusiastically recommended several supplements for weight loss on your television show including a substance called green coffee extract which we now know was fraudulently marketed. For the record today, can you confirm that you no longer believe green coffee extract is a miracle weight loss drug?
▶ 2:04:34Dr. Oz: I never said that medication with a miracle weight loss drug.
▶ 2:04:38Sen. Hassan: Can you confirm this was fraudulently marketed and green coffee extract is not a miracle weight loss drug? Yes or no?
▶ 2:04:47Dr. Oz: Yes.
▶ 2:04:49Sen. Hassan: You promoted a supplement called raspberry ketones claiming it is a number one miracle in a bottle to burn your fat. That is your quote. Will you confirm some of the record today you no longer believe raspberry ketones to be a miracle in a bottle?
▶ 2:05:06Dr. Oz: There are many things I said on the show I take great pride in the research we did at the time to identify which of these work and which ones did not. Many are still being researched like the green coffee extract just mentioned.
▶ 2:05:17Sen. Hassan: How much were you paid to promote these supplements?
▶ 2:05:21Dr. Oz: The television show was distributed by the corporation.
▶ 2:05:26Sen. Hassan: How much were you paid to promote the supplements?
▶ 2:05:29Dr. Oz: I was paid nothing to promote the supplements.
▶ 2:05:31Sen. Hassan: But you promoted them on your show. There was something called the dog -- Dr. oz effect. You would mention them and sales would go up.
▶ 2:05:42Dr. Oz: That was mentioned by the press.
▶ 2:05:44Sen. Hassan: I will go on the record. You have been nominated to run the largest health program, the set of largest health programs in the united states of america and it seems to me you are still unwilling to take accountability for your promotion of unproven snake oil remedies to millions of your viewers. That is really consumer -- concerning.
▶ 2:06:07Chair Crapo: Senator whitehouse.
▶ 2:06:10Sen. Whitehouse: As we spoke about when you visited, I want to talk about some rhode island issues. Rhode island has a fundamental issue which is that between 2018 and 2023, which is the most recent years for which we have data, rhode island hospitals were paid less than nearby massachusetts and connecticut hospitals by a margin of over 20%.
▶ 2:06:40Sen. Whitehouse: The margin of underpayment for rhode island hospitals compared to hospitals across the border ranged from between 20% and 28%. As a doctor, I think you understand if you have two hospital facilities less than an hour apart from each other in the same regional health care market, and one is paid 26% less than the other, you have created
▶ 2:07:12Sen. Whitehouse: A massive and harmful distortion. Rhode island has been on the losing end of that distortion for years. And I am sick of it. I am flagging that for you right now. One of the potential ways is the ahead program. A fee-for-service building will screw rhode island and we cannot fix that. The way to do that is to get out of fee-for-service and evaluate -- into a value-based program. We just heard the head program will continue forward.
▶ 2:07:42Sen. Whitehouse: I am delighted about that. You and I are going to be in touch about making sure rhode island's program competes fairly with connecticut's ahead program because they work off a cost basis. Our cost basis has been suppressed by 20% to 20% lower payments. -- 28% lower payments.
▶ 2:08:07Sen. Whitehouse: You cannot pay your nurses, you cannot play your -- pay your cleaning crews the same amount when your revenues are 28% below your competition. Let me add to this by pointing out you know this area, you practiced in boston.
▶ 2:08:24Dr. Oz: I went to school in boston but practiced in new york.
▶ 2:08:28Sen. Whitehouse: If you have gone to school in boston, you probably know rhode island's hospital complex in providence includes rhode island hospital, the only level one trauma center in southeastern new england, the only level one pediatric trauma center in southeastern england.
▶ 2:08:47Sen. Whitehouse: The only verified burn center, academic medical center, teaching hospital, pulmonary hypertension system -- hypertension system center, obstetrics, and nicu. It is connected buildings that provides extremely high-level care. If a president is in martha's vineyard and gets hurt, rhode island hospital trauma center is where they are taken.
▶ 2:09:16Sen. Whitehouse: They fly right over saint ann's hospital in fall river to get to our hospital in rhode island because we made investment in level one trauma care. Saint ann's hospital would be paid 20%-plus more for the same services while delivering none of those options. I'm going to be on you like a fair at -- ferret saying get this fixed.
▶ 2:09:49Sen. Whitehouse: The other hospital is probably a 25 bennett drive. It is probably a 25-minute ride from our trio of world-class hospitals. To st. Ann's. The same service, we get paid 20% to 28% less. I am so sick of cms right now. It makes me infuriated.
▶ 2:10:20Sen. Whitehouse: For years, cms sat idly by, look at the payment differential and said we are not going to do anything about it. When we tried to fix it through the ahead program, maybe but I don't think so. We really need to get this fixed. It is wrong and it is dislocating health care in rhode isla. We have doctors moving over the border to take advantage of better payments.
▶ 2:10:47Sen. Whitehouse: We have a fight for staff when we have to compete with other hospitals within the same commuting range but get better payments. I have 10 seconds left. I will leave it at that. You heard a lot from me when you came to sit with me. I am going nowhere on this. In the years I have been fighting it, not once has any person at cms been able to find any excuse or justification for it.
▶ 2:11:18Sen. Whitehouse: They do not even try to justify it. They do not give a red-hot damn about this incredible unfairness that is dislocating and warping our health care system. If you would like to respond briefly, please do. I suspect I will hear that you look forward to working with me on it.
▶ 2:11:34Dr. Oz: [laughter] I did a little homework after the office visit, the thrashing I experienced.
▶ 2:11:45Sen. Whitehouse: I am thrashing cms, not you. You are not responsible for this yet.
▶ 2:11:50Dr. Oz: It does seem to require a statutory solution. The ahead program is a promising potential opportunity. I do not know enough about how the reimbursement would be altered. I looked at the numbers you shared with me. It is interesting how they were calculated. It was driven by a congressional formula. He is paid 25% less than you.
▶ 2:12:20Dr. Oz: Vermont is really below the average. I think there are opportunities to revisit that. I think it is probably something that with your passion will be revisited by this chamber.
▶ 2:12:30Sen. Whitehouse: Thank you. You and I will be talking about it. Thank you very much, Mr. chairman.
▶ 2:12:36Chair Crapo: Senator daines.
▶ 2:12:39Sen. Daines: You are the self appointed chairman of the newly minted ferret caucus. Dr. oz, it is good to see you again.
▶ 2:12:49Sen. Whitehouse: The ferret is an underappreciated animal.
▶ 2:12:55Sen. Daines: We have them too. It was great meeting with you talking about the experience you have that you bring to this job. You are exactly the right person at the right time to take over this huge responsibility.
▶ 2:13:15Sen. Daines: As you know, president biden took several actions during his term to expand abortion access and travel for abortion using taxpayer dollars in many ways including for the medicaid program which is explicitly in violation of the hyde amendment. It is in violation of the law.
▶ 2:13:35Sen. Daines: If you are confirmed, will you commit to upholding the hyde amendment and ensuring our federal health care programs are not providing abortions on the taxpayer's dime?
▶ 2:13:47Dr. Oz: I appreciate your taking time with me. You were able to haul that elk I don't know how far in the back lands of montana. The hyde amendment has been around a long time. Cms should obey the rule and fund accordingly.
▶ 2:14:08Sen. Daines: Thanks, Dr. oz. I want to talk about medicare coverage for new technologies and innovations. During president trump's first term, he spearheaded efforts to ensure seniors could have access to innovative medical advice is the medicare program.
▶ 2:14:29Sen. Daines: The biden administration repealed these efforts and replaced them with the rule that provided a pathway to expedited coverage for a limited number of innovative medical devices. However, the rule requires new clinical evidence for eligible c1 -- the question is would you consider addressing this limitation the biden administration placed or
▶ 2:15:00Sen. Daines: Creating a coverage pathway for innovative devices with existing strong clinical data?
▶ 2:15:06Dr. Oz: Yes. I think we create a major opportunity when we create ambiguity in how devices are created safely but also marketed wisely. The gap between when the fda says this is a good product that can save lives and when the american people, beneficiaries of medicare or medicaid programs within the states are able to access those, I will use the clip as an example.
▶ 2:15:35Dr. Oz: It was a device I bought early on. It's a device that was traded with smart engineers that eventually received ce mark, european approval for sales in 2008. It took five more years for the U.S. fda to approve the device that would save lives with clinical trials proving this and save money at the same time.
▶ 2:15:58Dr. Oz: Despite that fact, it took another seven or eight years for cfs to fund patients getting this device if they are dying with heart failure and the leaky valve. We wasted a lot of money and maybe lost some lives because of it. I believe we can do better. To your point, we should make it easier for an industry to create lifesaving tools by aligning when the fda approves a product.
▶ 2:16:29Dr. Oz: That's our job, to provide the best quality care to the american people who are on medicare and medicaid. These tools should be used. >> I appreciate your expertise in the area, Dr. oz. I want to shift gears and talk about montana rural health. I packed the elk out and that is a workout to pack the elk and walk miles back to the pickup.
▶ 2:16:58Dr. Oz: It's important in my front tier home state of montana. Its distance, weather, workforce shortages are a few difficulties we face in montana as they try to access health care. Given the challenges of rural health care, how could cms support the expansion of telehealth services?
▶ 2:17:22Dr. Oz: I recognize telehealth is not one silver bullet but it's an important tool in the overall tool chest to help us provide better access. What are your ways to ensure health care can be more accessible to these rural populations?
▶ 2:17:36Dr. Oz: As you know, this house -- congress has a responsibility to extend telehealth widely throughout the nation. I think part of the opportunity for telehealth is to link it to large institutions in those areas. An institution, a big one like salt lake city might be available to be a telehealth partner to montana.
▶ 2:18:05Dr. Oz: It's not just you pick up the phone when they call. It's not just a country far away answering a cry for help. It's someone in your institution that knows your protocols and maybe they've shared theirs. You have a release -- a relationship that goes beyond the stream signal. That's how we will build telemedicine.
▶ 2:18:25Dr. Oz: It's vital in places like montana, especially where we have many people suffering from undiagnosed mental health illnesses and there's no place to go in a consistent fashion to get those therapies. If confirmed, it's one of the areas I think we will make major inroads. There are no opponents to this. >> thank you. Senator johnson?
▶ 2:18:47Senator Johnson: I've had to go in and out. A number of years ago, I held an event with two or three dozen doctors and I said what's your evaluation of the biggest problem we have today? To a doctor, the state of medicaid. I was shocked. It's not the question I'm asking right now.
▶ 2:19:16Senator Johnson: I wanted to talk about medicaid because one of the problems we have is we keep referring to medicaid as one thing. But it's really medicaid and it's obamacare. All of us want to help people who can't help themselves. We want to provide health care for disabled individuals. Moms and children. We want to help people. We don't want to cut their benefits.
▶ 2:19:41Senator Johnson: But obamacare, all of a sudden, we are paying more for single, able-bodied, working age adults. From my perspective, that's allowed states to really game the system.
▶ 2:20:00Senator Johnson: When we met, I didn't talk about my budget ideas here and 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 are spending a lot of dollars above and beyond what we spent in the past plus inflation. Let me give you some numbers on medicaid.
▶ 2:20:25Senator Johnson: Obama in 2014, the first year of obamacare, told obamacare, t total medicaid spending was $301 billion. Inflated, that would be $431 billion. This year, it was about $600 billion. The last goodyear we had for spending is 2023. That is a problem too. We can't get information.
▶ 2:20:53Senator Johnson: My state had to get quarterly and add them up together to figure out what the medicare expansion for obama was in 2023. It went from 24 billion in 2014 to $131 billion. What would be inflated from obama's number, about $600 billion.
▶ 2:21:12Senator Johnson: I want you to 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 dollars and making it more difficult for disabled
▶ 2:21:42Senator Johnson: Individuals and the people that medicaid was truly designed to help. By the way, with a shared responsibility so states would try and control the process. Right now, too many states. 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.
▶ 2:22:04Dr. Oz: Senator johnson, I think I could start most effectively where you started which is those physicians and speaking to you about what they were most frustrated by. It's 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. Most physicians will take care of a certain percentage of patients in their practice for free. Historically, doctors always took care of patients who didn't have resources for free.
▶ 2:22:34Sen. Johnson: We also had the stark loss, right?
▶ 2:22:37Dr. Oz: They had stark laws. That's a point we touched on in the past. The ability of positions to take care of people who don't have resources, which is personally compensated by medicaid, is not infinite.
▶ 2:22:54Dr. Oz: 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 who medicaid was originally designed, as you highlighted. Our young, pregnant women, vulnerable, disabled. Elderly people don't have resources. They cannot be compromised. We have to make some important decisions to improve the quality of care.
▶ 2:23:22Dr. Oz: We talked about the fact we are spending twice as much as developed countries. We are putting resources in the system and I don't think we are getting value for those resources. Some of the areas I'm hoping we can work together with members of the committee, they have confirmed with other senators as well, is to ensure we have wise, effective modernization approaches.
▶ 2:23:43Dr. Oz: Because the rapid expansion of required moneys for medicaid is far beyond what was ever envisioned when the aca was originally passed. It's one of the areas we can do better. The medicaid and pharmaceutical and drug component has actually done better. There are ways for the government to do well.
▶ 2:24:05Dr. Oz: I think I speak for many folks here that our biggest enemy is a lack of hope that we can fix what's going on at cms. I believe 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 among the top 50 countries in the world. That we are not having folks falling through the cracks, wrongly and a morally in our system. -- immorally in our system.
▶ 2:24:37Dr. Oz: And we can stand up and say we are the great society and like all great societies, we take care of our most vulnerable. >> senator cortez masto? >> Dr. oz, good to see you again . Welcome to your family. Let me start with this question. There is a couple, man and woman, they are married and they are working and have a daughter.
▶ 2:25:05Dr. Oz: They are working hard every day but the daughter has a rare disease. 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?
▶ 2:25:19Dr. Oz: As you describe it, no.
▶ 2:25:23Sen. Masto: That's a bulk of the people I hear from everyday that need medicaid. That's not what some of my colleagues are talking about, people milk the system. It's true, hard-working families that need help.
▶ 2:25:51Sen. Masto: Get it earlier, health care in this too costly. Is not enough access, it's not affordable and we have to do a better job of addressing read until we do, we can't keep -- kick people to the curb when they need help in this instance. Let me address something that I find offensive in some -- so many ways. I see two of my colleagues seeing -- sitting between me and ben are a. Would you -- I don't know if my colleagues know this. Do you know how many front -- medicaid fraud units exist?
▶ 2:26:23Dr. Oz: I don't.
▶ 2:26:25Sen. Masto: You should know. There are 53 medicaid fraud units. They cover every state. The district of columbia, puerto rico and the U.S. virgin islands. In 2024, they recovered $1.4 billion in fraud. Granted, most people, I had not heard this from my colleagues, that fraud was provider fraud. That was provider fraud.
▶ 2:26:50Sen. Masto: I am all about addressing waste abuse and fraud. It's be real here in how we do it and make sure we are not kicking this couple and their needs for their daughter off of medicaid because we have some concept which is false about who is actually benefiting. I want to jump back here real quick. Senator lankford, he has concerns about nursing homes closing in rural america. So do I.
▶ 2:27:20Sen. Masto: Absolutely. Enroll nevada, I have concerns. 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 nevada. It would close hospitals and it would close clinics. So, that is something we have to keep in mind.
▶ 2:27:53Sen. Masto: 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 for hours to get it somewhere else. That's ridiculous. That is why I support your conversation around telehealth. It is bipartisan support. We need to make it permanent. There is so much that needs to be done to address health care. One thing I want to bring up is the aca tax credits. In nevada, we have the lowest uninsurance rate in our state's history.
▶ 2:28:22Sen. Masto: -- 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 thousand people could see hikes or thousands of dollars, forcing them to drop their insurance. And the health insurance market will destabilize. Dr.
▶ 2:28:45Sen. Masto: Oz, if confirmed, do you agree that congress must extend these tax credits to prevent massive premium hikes and coverage losses for working families?
▶ 2:28:56Dr. Oz: If confirmed, I need to learn more about how much resources are required. Directionally, I like the idea of having transition programs to get folks were able to work but on medicaid for whatever reason, they have a family member who is ill or they have fallen ill and lost their job and lost their
▶ 2:29:31Dr. Oz: Insurance, it's wise for us as a nation as we take care of them to get them back on their feet and transition them to programs where they can afford the insurance. If you can't afford the insurance -- >> can I stop you there it's your assumption that people who are not working are accessing medicaid. I told you there is a good segment, over 66% or more that are actually working. I would hope 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. 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. >> senator tillis.
▶ 2:30:04Sen. Tillis: How many members have you met with?
▶ 2:30:11Dr. Oz: I met with every single member except for senator sanders who I caught on the elevator. He's been on my show so I've met him before.
▶ 2:30:25Senator Tillis: We covered most of the topics that I needed to make sure I would support your nomination. Give me an idea of how you will spend your first 90 days?
▶ 2:30:37Dr. Oz: Your advice, I took to heart. It was directed at how delete a large organization? The broader idea of what is a shared vision? As a group, if we can get people excited about their jobs, they will show up, not just physically but emotionally. You cautioned me I should look beneath the leadership to what people in the rank and file, maybe three or four levels down our thinking and saying about the organization because they have remarkable wisdom and often they are not heard.
▶ 2:31:09Dr. Oz: There are almost 7000 people at cms. There's a lot of people we want to talk to. Cms has another interesting dynamic, it has 40,000 contractors it does the work through. You want them to feel the same pride. You want them to believe the charge they've been given is a sacred want to take care of the most vulnerable. Because it defines who we are, it's something that we can't -- in any way.
▶ 2:31:37Sen. Tillis: In all of my experience with enterprise transformation, the best ideas came from the organization. Not consultants who just got there recommendations elevated and re-created sustainable change. You have to get resources outside of the agency to get the best of all of the ideas inside of the agency. It's counterintuitive. I have a question for you.
▶ 2:32:05Sen. Tillis: If confirmed, as we are going through and trying to do the enterprise efficiencies of the doge effort, when you are confirmed, I strongly believe that sent a 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.
▶ 2:32:34Sen. Tillis: 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?
▶ 2:32:42Dr. Oz: I agree. I am a heart surgeon. You don't go to the or with two surgeons. It is an ongoing discussion point in 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. One person goes in there when there is a bleeder. They put the finger on the hole and deal with those issues because they are the one responsible to the family.
▶ 2:33:07Sen. Tillis: I was speaker of the house in north carolina for four years. A lot of people are coming up to me and recommending health care. Proposing legislative fixes. I tell them all the same thing. Don't come to me unless you have an idea for maintaining current outcomes. Unless you have an idea that reduces cost or increases access. If you have one of them, I might be interested.
▶ 2:33:36Sen. Tillis: If you have two, you have my attention. If you have three, we will get the bill passed. We work on the medicaid program in north carolina that did not allow medicaid to get expanded under obama care when I was there because we had to clean up the mess that I inherited. The subsequent speaker did expand medicaid and I think it's working pretty well. I had a question, there were a couple of people, I complemented senator whitehouse on being empty like a ferret.
▶ 2:34:06Sen. Tillis: We all need to be empty like a ferret. I used to have a ferret named garrett. [laughter] I like the analogy. It's interesting in these questions, everybody is frustrated with decay. Everybody thinks we can do some work on medicare.
▶ 2:34:26Sen. Tillis: This has been a bipartisan failure to modernize and make leaner more money in pacing patient operations. I just want a commitment from you, within your first 90 days, would you be willing to host a meeting on your term with any of the members of the finance committee that would like to see your vision for enterprise transportation for cms?
▶ 2:34:53Dr. Oz: I would welcome the opportunity to host members of this committee. In fact, I need your help. You brought it up, your expertise historically have been enterprise transformation. There are probablywho control hn america and they don't want anything to change. This is not an accident that we are here.
▶ 2:35:16Sen. Tillis: I will be sensitive to anybody's time but that's why I will give you a copy of this book. Do you remember this book?
▶ 2:35:25Dr. Oz: Yes.
▶ 2:35:27Sen. Tillis: It's called "who moved my cheese?" it's a story of a maze you will find yourself in at cms. There are two types of people who will be in the maze. Sniff and scurry who figured out where that cheese was and they embraced change. And then hemant and then heman and hawes, who resisted change.
▶ 2:35:59Sen. Tillis: There 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 and 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 are not talking about caregivers or sick people.
▶ 2:36:26Sen. Tillis: We are not talking about people diagnosed with a behavioral health problem. We are talking about people we want to provide medicaid for if they can't afford it but work. So that they actually get the benefit of the freedom that comes from a job. That's all we are asking about. All these other things are insane. We are probably only talking about acing the digit portion of the population. If we keep on playing those games, we are going to have a problem. I hope you're there for change. Thank you.
▶ 2:36:55Dr. Oz: God bless you, sir. >> senator warren.
▶ 2:37:01Senator Warren: If confirmed, you would oversee medicare coverage for over 66 million americans. Nearly half have traditional medicare where 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. Surprise, surprise. The privatized medicare costs a whole lot more.
▶ 2:37:30Senator Warren: So, let's talk about the top trick that medicare advantage insurers use to gouged taxpayers. Up coating. I understand senator cassidy started this. It gives a set amount per patient. The more diagnoses or the more codes a patient has, the higher the payment. In theory, this covers higher costs.
▶ 2:38:01Senator Warren: But insurance companies get the money for the codes. Not actually for the services they do are 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.
▶ 2:38:20Senator Warren: One example, last year, the wall street journal identified 66 thousand medicare advantage patients diagnosed with diabetic cataracts, who had already gotten cataract surgery. That is, as you know, anatomically impossible. So, Dr.
▶ 2:38:41Senator Warren: Oz pocketed -- thanks to this one fake diagnoses. Does that sound like medicare fraud to you?
▶ 2:38:55Dr. Oz: The answer is yes. I will give you one more example.
▶ 2:38:59Sen. Warren: Ok.
▶ 2:39:00Dr. Oz: Which is sending someone to your home what you brought up in the office. If you are going to say it, I won't say. You pointed out something that is very real. If a company sends someone to your home, there's probably a reason for it.
▶ 2:39:15Dr. Oz: If they are doing ultrasounds to look for a minor thing that doesn't need to be treated and most americans have, it's dumb to uphold you, which has two -- done to uphold done to uphocode you, which has two problems. The insurance companies don't get paid more. The doctors don't get reimbursed more for doing what is ethically correct.
▶ 2:39:42Dr. Oz: It doesn't just help the scoundrels were stealing from the vulnerable. It's actually hurting the people trying to take care of the vulnerable populations.
▶ 2:39:50Sen. Warren: Let's talk about how bad the up coating is that comes from the -- of comes from the -- oupcoding is. In 2022, united health used these home visits to add about $2.3 billion worth of diagnoses, diagnoses that lead to absolutely no treatment. I take it you think that sounds like fraud as well.
▶ 2:40:19Dr. Oz: Of this. If confirmed, it will be one of the topics that's relatively enjoyable to go after because we have bipartisan support.
▶ 2:40:29Sen. Warren: I love hearing it. Up coding is a scandal. Medicare payments cost at least. Rumor that number. Last month, republicans in the house passed a budget framework that sets up $88 billion in annual cuts to health care.
▶ 2:40:57Sen. Warren: Seniors in nursing homes and people with disabilities who have home health aide and more. 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 in three of america's children.
▶ 2:41:26Dr. Oz: My goals to improve the health care of the american people. As you create the argument, the former sounds like a more rational will -- rational way to do that.
▶ 2:41:41Sen. Warren: Let's cut out abust actually occurs like upcoding and medicare advantage. Republicans cutting health care for seniors and for babies and for people with disabilities. While the waste and fraud role right along for a multibillion-dollar insurance company is sickening. And I will fight that every step of the way. Thank you, Dr. oz. >> senator blackburn.
▶ 2:42:12Senator Blackburn: Welcome. We are delighted and look forward to having you move out of this committee and being confirmed on the floor and get over to cms and get ready to work area you have quite a job in front of you. I appreciate the time that you gave when you came to visit with me. As we discussed, changes to health care delivery, transparency and electronic health records, all of that will not happen here in D.C.
▶ 2:42:43Senator Blackburn: It's going to happen in places like nashville, tennessee. And individuals that are entrepreneurial and are addressing so many of these delivery and access issues. As you've heard, there's great frustration with medicare and medicaid, the fraud that exists.
▶ 2:43:14Senator Blackburn: There's issues with cmmi that can do their job. They need to get their work or be shuttered and have that money used elsewhere. There is frustration with coding. The it is time to simplify that system and I know you have thoughts on that and I look forward to your being able to tackle that issue.
▶ 2:43:44Dr. Oz: I enjoyed our visit, highlighted the reality everyone should be aware that nashville has become the finance capital -- health care finance capital of the country. 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 had to know where we are headed.
▶ 2:44:13Dr. Oz: The first thing you learn in hosting, whether a television show or garden party come is tell your guests. Engaging the private sector wise that can challenge some of the incumbents, get some wise ideas to be seen and tested.
▶ 2:44:41Dr. Oz: Cmmi has a history of failed projects but with strong leadership it will do very well.
▶ 2:44:51Sen. Blackburn: Let's hope they do. I want to talk about the low wage index. As I mentioned to you, we have had 16 hospital closures in the last I get in tennessee, 13 in rural areas. The first trump administration put a fix on this and then the biden administration let it expire. No guidance, no direction. It was like a rural hospitals just had the rug pulled out from under them.
▶ 2:45:24Sen. Blackburn: Can I get a commitment you will address this disparity?
▶ 2:45:26Dr. Oz: You have my commitment to address broadly but we have to do with rural, not just hospitals. There are some great institutions built in 1970 that really should not be a 300 bed hospital anymore. We have to provide a better solution for the people in those areas, financially viable one for the community and one that protects the state coffers.
▶ 2:46:00Dr. Oz: It is crowding out schools, crowding out infrastructure, crowding out education -- services that are valuable for folks around the state.
▶ 2:46:12Sen. Blackburn: You have heard several of us mention medicaid funding and concerns there with the fraud that exists in medicare and medicaid programs. Every time someone to frauds one of these programs, whether it is on providing care or receiving money that isn't theirs, it really hampers the ability to get care to people that need it.
▶ 2:46:40Sen. Blackburn: Another area fraud we have noticed is the non-us 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. We work with us on cleaning up these roles and moving them out of the program?
▶ 2:47:00Dr. Oz: I look forward to ensuring the determination of medicaid eligibility is done accurately and honestly. Same for medicare. I saw an article yesterday highlighting california has been able to accomplish, taking money from federal coffers to fund exactly the programs you are describing within their state. It is not right for the american people because we are all in this together.
▶ 2:47:28Chair Crapo: Senator smith.
▶ 2:47:31Sen. Smith: Welcome. Thank you for joining us. Thanks to my colleague senator blackburn for her focus on rural hospitals and rural health which is a concern I share. Dr. oz, I want to talk a bit about artificial intelligence. You have expanded on the many potential uses of ai and technology for delivering health care.
▶ 2:47:59Sen. Smith: I think we learned a lot from the pandemic in terms of advances in telehealth and that is important to not forget those lessons. I would like to spend my time getting a better understanding of your thinking on the role of ai and health care delivery. Let's start with how health insurance companies are using ai to make decision about prior authorization decisions. Could you talk about that? Do you think ai should be used in prior authorization decisions?
▶ 2:48:29Dr. Oz: Thank you for sharing some of your ideas in our visit. This is a good place to start. Ai can be used for good or evil. It depends on who is using it for what purpose. I think ai can play a vital role in accelerating preauthorization.
▶ 2:48:49Dr. Oz: One reality and the health care system right now is the average insurance company has about 3000 procedures they rely on preauthorization from but they are not the same 3000 procedures. If you switch insurance companies, you may move from one that used to reauthorize a knee replacement and the new one does not. I would argue to use ai wisely we need to make a decision which is were only going to preauthorized 1000 procedures come everything else should just get done.
▶ 2:49:19Sen. Smith: Sorry to interrupt but what I think you're referring to what you said earlier is we use pre-authorizations too much. I think I heard you say that earlier. I want to dive in a little more because there have been reports and lawsuits that have alleged ai has been used by three of the largest medicare advantage insurers to determine how long patients can stay in hospitals, denying those claims to keep people out of hospitals or even out of step down clinic when they are not able to take care of themselves at home. This is a concern.
▶ 2:49:50Sen. Smith: My view is a human needs to have a final say in these decisions that insurance companies are making. I am wondering if you would agree with that?
▶ 2:49:58Dr. Oz: I agree but if I can add one more layer. I think 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 fraudsters are going in to still money because most of us aren't inking about frauds you are not good at detecting it.
▶ 2:50:21Dr. Oz: If we see there something to be 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 we can prevent it and do it real-time gnostics was down the road.
▶ 2:50:37Sen. Smith: Weather and insurance companies using prior authorization inappropriately.
▶ 2:50:40Dr. Oz: They should know. They should feel empowered to push back when they don't think it is right.
▶ 2:50:50Sen. Smith: Another example in the time I have, have talked about using ai to augment care especially medicaid were we have serious shortages of mental and behavioral health care providers -- I think. Dr. oz, how should ai programs be deployed to support patients expensing mental health challenges?
▶ 2:51:07Dr. Oz: After I was nominated, I looked at technologies. To understand what could be the future. After meeting with a lot of the leaders in artificial intelligence and sing a lot of demonstrations, I can attest to you that we are months away not years from having ai tools that could have a conversation with someone you care about, pick up subtle details about how they can emotionally -- whether they're going to follow through with dealing with the problem,
▶ 2:51:37Dr. Oz: Can they understand what the doctor or nurse told them. All of this will become part of the fabric. Humans have to be involved but an internist who is capable with a little bit of help from ai I think with the intake could see twice as many patients. I'm making that number up. We don't know depending on the severity of the illness. It gives you more patients and that is better resources for everybody.
▶ 2:52:08Sen. Smith: Concern I have come sometimes this is not transparent to patients. To me that is important. It is been documented there are checkboxes 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 provider when they are not.
▶ 2:52:27Sen. Smith: We have documented some of these thoughts have encouraged in some cases suicide or self-harm or even violence and addressing this misuse of the technology seems to be of great need to our society.
▶ 2:52:40Dr. Oz: It is a well identified problem. Ai should worry us all that I do believe it is a tool if used appropriately -- I think congress will have to play a role in making sure we do that wisely -- can help a lot of americans and certainly will help their provider groups. We have to be able to put guardrails around its appropriate use.
▶ 2:53:01Sen. Smith: Thank you.
▶ 2:53:01Chair Crapo: Senator marshall.
▶ 2:53:04Sen. Marshall: Welcome. Thank you for being here to support your husband and your dad and it means a lot to us. : I am glad they are still here.
▶ 2:53:19Sen. Marshall: Just a big picture question, why did you go into medicine and what are some of the highlights for the most rewarding parts of your career?
▶ 2:53:27Dr. Oz: I don't think there's a joy greater than looking patient in the eyes and recognizing both of you, that you are there for each other, that nothing will get in the way of you providing the best care possible. It is not that there will never be problems but you will be there emotionally supporting them. If you have been gifted with teachers as I was that can 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 be matched I don't believe in another field.
▶ 2:53:57Dr. Oz: It is why my son oliver come this went over here come is going into medicine. I think this why I went into medicine because I saw my father go to the hospital like putting needles and people that looks painful but the patients would smile and thank him. Paradoxically. I think it is appropriate for physicians to enter government because we are trained to tell people things they need to hear but are not pleasant read but that is how you get the system to work better.
▶ 2:54:27Sen. Marshall: Everyone is giving advice. I get to give you one piece of advice, you need more nurses at cms. Nurses solve problems. They understand where the patients are. Beyond that, my grandma always said if you have your health, of everything. America does not have her health right now. 60% of us have a chronic disease. Several people have pointed out this country spinning multiples more than other countries do to take care of our sick.
▶ 2:54:57Sen. Marshall: There is not enough sick care out there to save medicare and medicaid. We came here to save medicare and medicaid but part of that is making america healthy again so we don't have to do as many heart bypasses and give as much insulin and diabetic-type drugs. What is your prescription for america? How do you work with medicare and medicaid patients to help america become healthy again?
▶ 2:55:22Dr. Oz: If I ask any fisheries about medicare, most don't know much about what we could do for them. They know about the payment issues but they don't appreciate the incentives around the payments drive a lot of the decisions. You know that because in your practice you saw that first handout it is remarkable outside of medicine how it looks like an unpaid box. If we incentivize wise moves by patients and their doctors and nurses -- I agree acting in a ministry or cms is the nurse.
▶ 2:55:54Dr. Oz: It is in capable hands. The deeper promise we should all be making to america is we are 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 need to be reminded frequently. Senator wyden I spoke about giving incentives to patients. An idea I think is a worthy one, especially for medicaid beneficiaries.
▶ 2:56:24Dr. Oz: If people don't feel like it matters what they do, they don't think they have agency over their future, that they're getting up in the morning does not make the world a better place, and they are not going to take proactive steps to reduce their diabetes or other actions that would dramatically reduce their life expectancy and cost of health care system. I think there's a lot of opportunity for us to do this. We should be innovative and explore ideas.
▶ 2:56:50Dr. Oz: There is ecosystem we can build together to engender that kind of enthusiasm from people on the outside of medicine who want to make a better. We have got the challenge -- we have got to challenge the income is to have new ideas double to the top so we can pick the winners based on competition.
▶ 2:57:09Sen. Marshall: I'm going to talk about maternal care. Came to this body I'll be at side of the capital and people were talking about maternal mortality. We were seeing a spike and I was asking why. We did not have answers. Thanks to my a-plus staff, we funded a study.
▶ 2:57:30Sen. Marshall: Not surprising to me, the number one killer of women -- pregnant women delivered year after is 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. Look forward to working -- have to patients are delivered were medicaid patients. They need access to care. We also need to stop the flow of fentanyl.
▶ 2:57:58Sen. Marshall: 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.
▶ 2:58:10Dr. Oz: I appreciate your leadership in making america healthy again movement in the senate and also outside of the senate, being an advocate years before it was in vogue. We can investigate new ways of using health-care accounts. Maybe it should be part of your estate and pass your children because so many families don't have anything to pass on and it would incentivize behaviors even at the end of life.
▶ 2:58:37Dr. Oz: There is an opportunity for us to give consumers come and give the power of the purse back to the american people, especially beneficiaries on medicare and let them make the wise decisions they can take they got to that age by making the decisions.
▶ 2:58:53Sen. Marshall: Thank you.
▶ 2:58:55Chair Crapo: Senator lujan.
▶ 2:58:58Sen. Lujan: Dr. oz, new mexico 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 come the south plains of texas, 223 cases. Child has died in the state of texas. Yes or no, do you believe the measles vaccine is safe?
▶ 2:59:27Dr. Oz: Yes.
▶ 2:59:31Sen. Lujan: Do you believe the measles vaccine is the most effective way to protect against infection?
▶ 2:59:35Dr. Oz: It is. If I can mention as we discussed last night, I think it is important to remember cms should not be opining his own opinion or sharing its own thoughts on vaccines. Our job is to follow the rules. If the cdc is making the decisions about the use of a vaccine and that is what is agreed on by the experts, my job , if confirmed, is to make sure we pay for those vaccines, seniors and children.
▶ 3:00:05Sen. Lujan: My colleagues and I have written twice to the secretary of health and human services to do more and to address measles. There is not been a response. The same question asked of you today if confirmed, would you respond to letters from members of this committee? I appreciate your strong response, yes, it might surprise the american people that secretary kennedy said the same thing. Mr. secretary, if you are watching today, respond to the damn letter!
▶ 3:00:37Sen. Lujan: People are dying! I'm going to get back to the questions, Dr. oz. 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 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.
▶ 3:01:01Chair Crapo: Without objection.
▶ 3:01:05Sen. Lujan: Dr. oz, I believe medicaid is on the chopping block because of the republican budget. Mr. chairman, I would like to ask to enter into the record the republican budget resolution which passed on february 25, 20 25, letter from the congressional budget office march 5-2025 and an article from the kaiser family foundation explaining the congressional budget letter from march 7, 2025.
▶ 3:01:30Chair Crapo: Without objection.
▶ 3:01:34Sen. Lujan: Dr. oz, I'm going to give these to you because you are asked earlier about cuts to medicaid. Not -- I believe your response was something along the lines of not being aware of what house republicans did. Here are material to read that explains what just happened. I am going to share this to you as well which is why I entered it into the record. Rural hospitals are in dire straits. We have heard from democrats and republicans today. They rely on medicaid to stay afloat.
▶ 3:02:04Sen. Lujan: Yes or no, do support medicaid cuts when they will lead to rural hospital closures?
▶ 3:02:08Dr. Oz: I do not want rural hospitals to close unless we have a better option. This is a good example where maybe there is an innovative approach that might work. I've been talking to hospital systems and when I did that comes up in rural systems is they have a partner that may be is a large academic center or institution that my have resources for them to do the best practices exchange.
▶ 3:02:35Dr. Oz: I mention a rural hospital in central new mexico where you actually can have a partner that is in phoenix or salt lake city or dallas and that could be your partner hospital. So you need telemedicine services they are not just there digitally, they have been there. They know the people. They develop a camaraderie that allows them to thrive. We have to revisit how we do business -- how we deliver rural care.
▶ 3:03:01Dr. Oz: We cannot depend on 100 bed hospitals to provide state-of-the-art care. I share your concerns about losing these institutions and think we should look at alternatives to make them strong. American in rural areas. I have heard it from every single one of the senators.
▶ 3:03:19Sen. Lujan: I will ask a follow-up to Dr. cassidy -- I'm sorry come to senator tillis questions, conversation, Dr. oz, will you stand against changes that will lower health outcomes to the programs you will? Oversee?
▶ 3:03:33Dr. Oz: Yes.
▶ 3:03:37Sen. Lujan: Should insurance or doctors dictate the care that a patient receives?
▶ 3:03:46Dr. Oz: Physicians.
▶ 3:03:50Sen. Lujan: I agree. Will you continue to defend medicare drug pricing negotiation programs in court?
▶ 3:03:55Dr. Oz: It is the law, I will defend it and use it.
▶ 3:04:00Sen. Lujan: Will commit to negotiating prescription drug prices in medicare?
▶ 3:04:04Dr. Oz: I will look as they present has expected me every single way we can look at prices and there are lots of options available. I feel compelled to pursue every one of them.
▶ 3:04:15Sen. Lujan: I think I heard it but I will give you another chance, yes or no, will you commit to the process of negotiating prescription drug prices in medicare?
▶ 3:04:23Dr. Oz: It is one of many approaches I want to use.
▶ 3:04:27Sen. Lujan: I thought you might say yes. That's fine. Do you believe -- I asked that when. Look, as we get through this, of a series of questions I put together not coming into this committee for based on senator hassan's questions. I have a lot of concerns. I won't get to it now. I appreciated having the conversation with you.
▶ 3:04:54Sen. Lujan: I am very concerned of this back and forth of my colleagues saying they're going to not cut medicaid or cut it. Republicans are voting for it. Those are the realities. As I shared, one thing I've learned about washington, D.C., the way this place works better is when people keep their word. When people are honest. The american people want honesty. If it is bad news, they will take it and they will be stronger on how they respond to it.
▶ 3:05:25Sen. Lujan: But when they get lied to and I think something is coming and they will be protected or mom with kids with cancer things are trouble have care and he gets taken away like that? Just own up. If that is 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. God bless you and your family.
▶ 3:05:43Dr. Oz: Thank you, sir.
▶ 3:05:46Chair Crapo: Senator warnock.
▶ 3:05:51Sen. Warnock: , 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 of 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 in the country where the limited number of families who do qualify for medicaid are
▶ 3:06:21Sen. Warnock: Required to regularly complete bureaucratic paperwork to prove 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 know where -- nowhere. The medicaid waiver is up for renewal this year.
▶ 3:06:46Sen. Warnock: If confirmed as head of cms, 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 to prejudge the state's renewal application. You need to see it.
▶ 3:07:04Sen. Warnock: But since you would oversee medicaid if confirmed, yes or no , do you believe families should have to complete government paperwork every single month to prove they are working just to get health care when they are sick?
▶ 3:07:19Dr. Oz: I appreciate your question and enjoyed visiting with you. My wife -- I brought her as a support staff.
▶ 3:07:32Sen. Warnock: That gives me comfort. Yes or no.
▶ 3:07:36Dr. Oz: I am in favor of work requirements.
▶ 3:07:40Sen. Warnock: Do you think a family should have to fill out paperwork every month just to get health care?
▶ 3:07:45Dr. Oz: I don't think you need to use paperwork to prove work requirement and I don't think it should be used as a disingenuous obstacle to block people from getting medicaid. I think we both agree there is value in work and it doesn't have to be going to a job. It could be getting education. It should be showing you what to contribute to society. You can volunteer at ebenezer baptist church where I did a show with you once. For me that would fulfill the requirement.
▶ 3:08:12Sen. Warnock: You will get any pushback from me about the value of a work ethic 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 because they can get health care. Let me give you an example. There's a woman in dalton, georgia, I got to know a while ago named heather. She is a traveling nurse. As a traveling nurse, some jobs were better than others. Sometime she had health care and sometime she didn't.
▶ 3:08:41Sen. Warnock: She was among the folks in the gap. She cannot afford private insurance. She was important enough to get conventional medicaid. The unpredictable nature of her work as a traveling nurse made it impossible for her to meet georgia's owners work verification requirements to get medicaid. She found out she had a series of strokes.
▶ 3:09:08Sen. Warnock: She had to save money to see a neurologist and then she found out she had had a series of strokes. Took a long time to be able to afford to go. Now she is in the gap. She can't meet georgia's owners work -- onerous work requirements. Do you think she deserves? Medicaid or not?
▶ 3:09:30Dr. Oz: Yes.
▶ 3:09:33Sen. Warnock: I agree with you. And since we agree, I think the medicaid waiver that you will be responsible for reviewing, I think that medicaid waiver -- I know it, it says that heather does not deserve medicaid. Let me tell you about another georgian. Amanda left her jobs in new york and moved to 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.
▶ 3:10:04Sen. Warnock: He is 84 years old. He is not in a nursing home, by the way. She has taken on that responsibility. With all of this, she does not 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. Do you think amanda deserves medicaid?
▶ 3:10:26Dr. Oz: From what you're describing, yes. These are the opportunities we have to make the system better. If we both agree 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 is the twin paradox which I think we touched on in the office. Two brothers, what is working every day flipping burgers making minimum wage, maybe calling together $16,000. But some right above the poverty level.
▶ 3:10:56Dr. Oz: The other brother doesn't bother working because he will have the exact same coverage if he doesn't work. We have to make them both want to move up the ladder.
▶ 3:11:06Sen. Warnock: You and I have the basis for meaningful conversation. Georgia's pathway to coverage is a roadblock to care. They have literally gotten I don't know 6000 people I think the last time I checked and we have over 500,000 people in the gap. I'm going to give you softball.
▶ 3:11:31Sen. Warnock: If 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? We keep these two people in mind? Dr. oz: they should be in all of our minds and many others like them. I look forward to working with you.
▶ 3:12:00Sen. Warnock: If you put me down on sunday, I'll will come to church with you.
▶ 3:12:04Sen. Warnock: You are invited any sunday. You can't preach but you can come. [laughter]
▶ 3:12:08Chair Crapo: Senator welch.
▶ 3:12:14Sen. Welch: Thank you, 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 is a real disgrace that we spend the most and get the least. So many other countries with other problems may have their health care system, citizens are not anxious about whether they can afford the care that they need. Here that is not the case.
▶ 3:12:44Sen. Welch: One of the big problems is that private equity, pharmaceutical pricing power, device manufacturing, consolidation in the industry -- all of this has made the cost of health care brutal. It is brutal on taxpayers, brutal on employers. In vermont, we have a lot of small businesses that are paying $40,000 for their family plan for their employees and they can afford that. It is brutal on individuals.
▶ 3:13:12Sen. Welch: I believe a major responsibility that you would have in your job would be to fight the excessive charging. I will ask you a little bit about pharmaceuticals. You said you're going to pursue that. In his first term, president trump he favored a reference price for drugs. So we are paying 3, 4, 5 times for the same drug that they buy in canada or in europe.
▶ 3:13:42Sen. Welch: When you support reference pricing so we don't get ripped off compared to everybody else even though we do the research?
▶ 3:13:47Dr. Oz: Thank you for taking time to meet with me before the event. President trump has been clear he wants to reduce drug prices not just the government pays but also for beneficiaries. International reference pricing is a way of doing that.
▶ 3:14:02Sen. Welch: We have got to get a fair price. It is not a fair price when we are paying six or seven times what they're paying for the same thing in france or in canada or wherever else. I'm just going to stop here but say that is absolutely top of mind. President trump has indicated a concern and hope you follow through. Medicare advantage, it sounds good but it is an incredible ripoff in some cases.
▶ 3:14:31Sen. Welch: The wall street journal did an expose, incredible investigation about what united health care did not what it found is that a packed diagnoses to their advantage to have a person seeking medicare advantage, to have numerous diagnoses there really did not necessarily require treatment. They provided doctors and nurses with checklists of possible diagnoses. They paid them bonuses for completing these checklists.
▶ 3:15:03Sen. Welch: So they would pay a doctor or nurse more when examined me, they found more things wrong with me. And this resulted in about $84 billion excessive -- overpayment medicare advantage plans. These practices. It is going to be your job to crackdown on that. Are you going have any tolerance for that kind of ripoff from our insurance companies?
▶ 3:15:28Dr. Oz: No. You have identified a place where system which was -- medicare advantage is a community health focused effort.
▶ 3:15:40Sen. Welch: I understand that. I don't mean to interrupt but I 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. Do you agree?
▶ 3:15:56Dr. Oz: I do and I believe the upcoding has become the best example of this out there and it is something that is addressable and I pledge if confirmed I will go after it.
▶ 3:16:09Sen. Welch: You are very nice person. I don't want you to be nice when it comes to dealing with this.
▶ 3:16:12Dr. Oz: Ok.
▶ 3:16:16Sen. Welch: Put that nice guy stuff behind you.
▶ 3:16:17Dr. Oz: I will be surgical.
▶ 3:16:22Sen. Welch: We just can't afford this. Another thing that is happening in health care's private equity. One of the things you said is physicians should be free from corporate ownership. You know it is about you helping a patient. And now private equity is owning a significant percentage of doctor practices.
▶ 3:16:50Sen. Welch: Private equity has made 352 acquisitions in 2010. In 2020, 937. They downsize, squeeze, and put the total emphasis on profit and set patient care. Is that private equity invasion of the health care space of concern to you for patient well-being and cost?
▶ 3:17:14Dr. Oz: The one point I would like to make, doctors who used to be generally completely free of corporate ownership, over the last decade, doctors -- free practice has gone from 70% to 30%. Most doctors are owned by large insurance company, hospital system, private equity. We have to have a mechanism to disrupt the incumbents.
▶ 3:17:38Dr. Oz: The only way to go after the big guys is to have smaller people who wouldn't put money into initiatives that would conflict with or go after their business models. Private equity is one of the ways you can do that. Yes, it can be misused. I agree with the point it has been abused.
▶ 3:17:56Sen. Welch: Thank you. Here is my hope because we can't measure this now but we have got a starting point. My expectation is you come in in six months let site and report on whether there is progress on all of these things. Squeezing out the ripoff in private equity, squeezing out the ripoff in medicare advantage. Having lower drug prices. I yield back.
▶ 3:18:22Chair Crapo: Sen. young: Dr. oz, I enjoyed our office meeting. One of the things I found the refreshing about your nomination and the general approach to health care that I think the administration is taking that the make america healthy again is looking at the big picture before you dive into the details.
▶ 3:18:47Chair Crapo: 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 for too long have not been getting the right care at the right time. It makes our country unhealthy. Importantly, it also makes our health care a heck of a lot more expensive in the end.
▶ 3:19:16Chair Crapo: If we just do things more smartly as opposed to the way it has always been done because they are entrenched interests, we can make people healthier and you can spend less money on the things that could be done a lot more efficiently.
▶ 3:19:35Chair Crapo: I'm just going to ask you about prevention and chronic disease and what reforms if confirmed that you think we should make two existing federal programs that you will have oversight over to include a stronger emphasis on prevention, early intervention for chronic diseases.
▶ 3:19:54Dr. Oz: I went back and watched "hoosiers" by the way and I would love to talk when the time comes when I'm confirm. The question you ask is fundamentally important on how we can make the money we spend on health care work. I don't think spending twice as much as every other country is enough if we are more than twice as sick as every other country. The real question is, what is our obligation to each and every one of us? I think it is our patriotic duty to be healthy.
▶ 3:20:25Dr. Oz: First of all, it feels a heck of a lot better. It is the right thing for your family. You want to walk your daughter down the aisle. You want to do things that age allows you commit to be a wise arbiter in society. It can also take a lot of money to take care of sick people who are sick because of lifestyle. It is different if you're born with a defect that requires an operation. Often those are fixable issues.
▶ 3:20:48Sen. Young: But people want to be assets and they want to realize their full human potential.
▶ 3:20:54Dr. Oz: And three quarters can't serve in the military when they are young, howell they be vital when they're older -- how many will be vital when they are older? What do you have at your fingertips? One thing cms can do is incentivize wiser moves. As an example, medicare advantage, most beneficiaries have some type of food allowance but there is no real advice on how to use that money wisely.
▶ 3:21:19Dr. Oz: We don't work with the private sector, maybe supermarkets, to provide better food to support with that money if that is 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. People in the audience behind me lived on pioneer work on things like heart disease. The fat medications at times -- the fact medications that times are useful and at times not.
▶ 3:21:50Dr. Oz: Alzheimer's, recent studies showing you could arrest the progression of the disease. Wonderful.
▶ 3:21:54Sen. Young: I will be chairing the health subcommittee on this committee the next couple of years so I look forward to working with you on some of those priorities so we can make people healthier again. Create an atmosphere which people can make themselves healthier. I don't have a lot of time so I'm going to run through some things.
▶ 3:22:18Sen. Young: 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 I have emphasized is the importance of getting faster coverage through the fda for emerging technologies. I had some legislation on this. Will you commit to working with me on this issue should you be confirmed?
▶ 3:22:47Dr. Oz: Yes. You know I feel strongly about devices.
▶ 3:22:55Sen. Young: Artificial intelligence. Can you give me 20 seconds, if confirmed, how you can ensure that cms's policies and programs foster an environment that encourages adoption and full utilization of this amazing potential technologies? ?
▶ 3:23:13Coming Online Dr. Oz: The folks who desired to bring ai into the mainstream 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 beneficiary's desire it. If we provided, they will build it.
▶ 3:23:31Sen. Young: Thank you. I have empsized 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. Leveraging health technologies for their war fighters.
▶ 3:23:55Sen. Young: I would encourage you because I believe you're going to be confirmed, I think we will have an opportunity to work together, to also periodically reflect on the important national security implications of your post. I thank you very much and your family for your desire to serve in this capacity.
▶ 3:24:12Chair Crapo: Senator cornyn.
▶ 3:24:18Sen. Cornyn: Dr. oz, I don't believe in accidents. And I think maybe it was we were all very fortunate that you are not sitting on this side of the dais but 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 or. I'm excited about your nomination and the opportunities that will provide.
▶ 3:24:46Sen. Cornyn: The general government accountability office, you said there were people -- I'm interested in knowing their names. 150 people who don't want anything to change in terms of our health care system. I will ask you a written question so you can provide us those names. I would like to know who they are. But there are. But there people in congress that don't want anything to change when it comes to our health care delivery system.
▶ 3:25:10Sen. Cornyn: That includes presumably $521 billion in fraudulent payments included for our entitlement programs, including medicare, 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.
▶ 3:25:41Sen. Cornyn: Paying more money on interest on the national debt that we are on defense. That is unsustainable and very dangerous world. I know you will agree. Let me talk to you about something I think you are uniquely qualified to address, and that is preventative care and keeping people healthy.
▶ 3:26:00Sen. Cornyn: Part of the problem is we talk a good game when it comes to health care, but congress has policies, particularly in our farm bill, with the food stamps, the snap programs, where we subsidize people eating and drinking exactly the wrong kinds of foods in order for them to stay healthy.
▶ 3:26:22Sen. Cornyn: 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? Right now we don't do it.
▶ 3:26:42Sen. Cornyn: We pay doctors and hospitals to treat people when they are sick, if it is 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 that pain and misery and expense that go along with that?
▶ 3:27:02Dr. Oz: I appreciate the help you've given me throughout my career and your kind words. We have been involved in the campaigns. Just like we planned it out. [laughter] it is remarkable that although we all agree the value-based plans and programs should be the foundational way we incentivize doctors and nurses and others from hospital systems to deliver care, we make it difficult to use those plans.
▶ 3:27:30Dr. Oz: We use third parties as intermediaries that have to charge so much that they take with the benefit of the value of these programs to begin with. But at its core, physicians need support. Everyone providing needs support to do what you just said. Giving patients advice on lifestyle takes a lot longer and telling them to take a pill.
▶ 3:27:50Dr. Oz: During surgery on people pays so much more than giving them advice about how to avoid operations that it is 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 plan for new york presbyterian hospital I was practicing and they wanted to talk about new technologies in this and that. I said, that is not the question they ask. Patients want to know we offer them hard operations, you really need it or not? That is the first question.
▶ 3:28:20Dr. Oz: We don't reimburse that question's answer, which is what we should be doing. We have been talking about ai. I believe we can use technology, artificial intelligence in particular, to provide more of that infrastructure support so 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 and history we have on you and all of the other places the health care system has touched you.
▶ 3:28:50Dr. Oz: For much of this to happen, we have to know who you are. When I do you think will come up eventually as this concept of how we can tell which patients have been in which centers -- all of 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. For people recalcitrant come senator wyden has been talking about for more than a decade, I think reward systems could be beneficial.
▶ 3:29:19Sen. Cornyn: There so much I want to talk about and we will do that after you get confirmed. Let me say if modern medical science can devise a shot were a pill which will give me the self-discipline to exercise on a regular basis and to eat a healthy diet, I wanted to be first in line for that shot. Unfortunately, I don't think that shot were that pill exists.
▶ 3:29:43Sen. Cornyn: We need you to use the bully pulpit because you are 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.
▶ 3:29:58Chair Crapo: Senator scott.
▶ 3:30:01Sen. Scott: Dr. oz, good to see you. I'm excited about your process here and I 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 the generic brand comes out. To be able to afford such a shot. That should be really, really expensive for a short period of time.
▶ 3:30:24Sen. Scott: To that point, I'm not going ask you to comment on but my theory is 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 and price.
▶ 3:30:49Sen. Scott: I would hate, for like a better way to set, 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 is in the generic forms.
▶ 3:31:06Sen. Scott: I do think we are not really having a serious conversation with the american people about the fact 94% of the morbidities we face every day or on generic medicine and because of that you can go to walmart or publix or whoever go and get a 30 day regimen for four dollars or $10.
▶ 3:31:24Sen. Scott: The value proposition we bring to the american people because of patent protection is really important that we very rarely focus on the backend that last for a lifetime in the front end that lasts for five to 12 years and 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. I am hoping you will commit to coming to south carolina and having a conversation about the job you are going to have.
▶ 3:31:57Sen. Scott: Is that a commitment gourmet?
▶ 3:31:57Dr. Oz: My roommate was from south carolina.
▶ 3:32:10Sen. Scott: I hope he is not a tiger fan. That is just a joke. I just lost several votes. I will move on. I want to say thank you for the compassion that was woven into your opening statement.
▶ 3:32:24Sen. Scott: 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 rather -- whether it is the widow or those folks suffering and going challenges. I think it is important for us as a nation to embed that in our approach to solving problems as a nation, especially for the vulnerable.
▶ 3:32:52Sen. Scott: Your opening statement reflected that kind of compassion I think we desperately need to see more of on our national screens around the country. To that end, the sickle cell anemia challenge you talked about we met with our staffs, thank you for bringing it up without having to be prompted to it. I do think crisper technology as we know it today is going to transform medicine as we know tomorrow.
▶ 3:33:17Sen. Scott: I would love your thoughts and hope you have a commitment in your new position to move forward with some of the cell and gene therapy access models were talking about making it affordable for people stuck in medicaid or medicare -- not stuck, but on medicaid or medicare.
▶ 3:33:33Dr. Oz: Thank you for bringing sickle cell anemia, crisper solutions to the forefront. There is a lot we have benefited from that is only there because we have incentivized innovation. Sickle cell anemia, disease which I have care of patients with because they often develop problems with organs that require surgery, is a crippling problem that costs a lot of pain and then you die but you spend a lot of money on the way.
▶ 3:34:02Dr. Oz: There is a treatment -- let's say it costs $1 million, roughly the number I am hearing, that if we could offer these young children, often of african-american descent this treatment, then they would be cured. I think there are ways for us to amortize the cost to save a child's life and meet the benefits of them not being in the hospital running up big bills while they die in pain. That seems to be a good investment.
▶ 3:34:27Dr. Oz: We just have to get our minds around the idea paying $1 million to save someone's life and demonstrating if it works, the drug companies 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 I think we can bring to bear where you could actually imagine medications only being reimbursed if they provide a benefit. We all agree is true over time.
▶ 3:34:54Dr. Oz: The earlier comment because you brought up faith in a broader issues, the oldest hospital I'm aware of that still exists is in cairo. This hospital historically would take patients in come you don't pay for care, sick and you don't have money. When he left the hospital, they would give you money. It is the opposite. Why? When are you going to have the least amount of money? When you're sick and getting better. They would give you something to get going again.
▶ 3:35:18Dr. Oz: I think metaphorically those are the ideas we want to support come to get people back on their feet again and make them feel obliged, responsible, because it is a shared responsibility to our health system, to do what they can to stay healthy so the system works for everybody.
▶ 3:35:36Sen. Scott: I will ask my last question and asked for yes or no answer.
▶ 3:35:40Chair Crapo: Go ahead.
▶ 3:35:42Sen. Scott: During -- if there was a silver lining during covid , hard to think of that having any silver linings, if there is a silver lining in covid it was the development, acceleration of telemedicine. I think it is going to save millions of not trillions of dollars over time.
▶ 3:36:02Sen. Scott: I hope you are committed to doing as much investigation as necessary to make sure telemedicine is not just here to stay but that it is embraced and adopted throughout our country wherever it is practical to be used.
▶ 3:36:15Dr. Oz: I will pursue telemedicine. It is essential especially in rural areas.
▶ 3:36:22Chair Crapo: Dr. oz, we are almost there. Senator wyden has one more question for you and then he will give a brief wrap up statement and then I will give a wrap-up statement and we will be able --.
▶ 3:36:34Sen. Wyden: 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. That is the insurance sector and particularly marketing abuses. I go way back to the days when insurance salespeople would sell five or six policies to a senior citizen, traditional medicare, not worth the paper was written on.
▶ 3:37:04Sen. Wyden: I came to congress and bob dole, I did not think even knew my name. The abuses continue. I would be interested in your thoughts about what you think the biggest abuses are now and then I'm going to ask you -- make this half of my question, a quick response in terms of what you're going to be dealing with if confirmed. What you think the biggest abuses are right now in the private insurance sector?
▶ 3:37:29Dr. Oz: Medicare advantage sales.
▶ 3:37:32Sen. Wyden: Give me an example.
▶ 3:37:34Dr. Oz: Brokers get involved. They get you to switch from policy to policy. We should potentially consider whether you need to reelect medicare advantage every year and potentially offer multiyear programs for seniors because that was save some of the money the brokers are taking out of the middle. Some brokers to a great job and some don't. We probably have too many.
▶ 3:38:01Dr. Oz: I think there are ways for us to ensure that marketing process works better for the folks involved. It is also the medicare advantage claims do with the moneys they use to incentivize the american people, the 33 million people on medicare advantage to come into their programs.
▶ 3:38:24Dr. Oz: We should examine whether some of that money should be reimbursed to the american people to ensure medicare advantage does not cost more than paying for service medicare.
▶ 3:38:31Sen. Wyden: I will have additional questions for the record on this, but let me leave you with that thought. We finally got some rules that have been put in place early in the last few years. There is 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 you would be sympathetic to if anybody tries to do that.
▶ 3:39:01Sen. Wyden: I think that is a sure bet in terms of what is coming that there will be some sleazy operators, we both know there are good people out there but there are some sleazy operators and I think they're going to push for a rollback in some of the rules that have been adopted recently and I want your assessment of that. Thank you, Mr. chairman.
▶ 3:39:22Chair Crapo: Thank you, senator wyden. Dr. oz, thank you again for appearing before us today. There is no doubt you are qualified to serve as the next administrator of the centers from medicaid services. I look forward to voting in favor of your nomination and urging all of my colleagues to do the same.
▶ 3:39:42Chair Crapo: With that, I agree -- I remind my colleagues the deadline for submitting any questions for the record -- and you will get more questions to answer -- is 5:00 p.m. On wednesday, march 19. For my colleagues come the deadline is 5:00 p.m. On wednesday. The finance committee stands adjourned.