July 30, 2025 • 50 mins
In observance of the 60th birthday of Medicare and Medicaid Services, Martha interviews Dr. Mehmet Oz, the newly appointed head of these foundational healthcare programs. They discuss the history of Medicare and Medicaid, national concerns about the rising costs of prescription drugs, and the potential for AI to help modernize care and improve access, especially in rural areas. Dr. Oz explains recent policy changes—including a $50 billion Rural Transformation Fund and new interoperability laws—while Martha raises questions about food quality, medical access, and how to keep Americans healthier longer. Their candid conversation blends policy insight with personal anecdotes that speak to the future of American healthcare.
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Episode Transcript
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Speaker 1 (00:05):
Good day everyone. This is Martha Stewart and you're listening
to my podcast. And today we have a birthday to
celebrate with none other than doctor Mehmet Oz. We've all
known Mehmet Oz for more than a decade as the
dispenser of medical advice beamed into our own living rooms
on his show Doctor Oz. He is the son of
(00:26):
Turkish immigrants and grew up in Delaware. In April, he
was confirmed as the seventeenth Administrator of Medicare and Medicaid
Services in the United States. It can be hard to
imagine now, but in nineteen sixty five there were no
national health plans. Only half of all senior citizens were covered.
(00:47):
The Medicare and Medicaid Act of nineteen sixty five changed that,
and this July we celebrate its sixtieth anniversary. Here to
join me is doctor Mehmet Oz. You're looking Doctor Oz.
Speaker 2 (01:01):
Not only do you look beautiful as always, and I
have to admit I was enthralled with your Sports Illustrated cover,
but I love this little studio because it's perfectly placed.
Like everything Arthur Stewart does, You've taken the ideal location
at thirty Rock and the art deco elements of it.
To me remind I should remind all of us of
how important story is to our country, because when this
(01:22):
building was being built almost one hundred years ago, the
stories we were telling ourselves are very different from the
ones we're telling now. And part of why I think
the story of Medicare Medicaid is so important is that
sixty years ago they had an audaciously big idea create
this backbone of the social safety in that that maybe
for the first time, could offer the kinds of support
you'd want to give folks who work their whole life
(01:43):
and contributed to society. You'd have a way of giving
people a hand up if they're having trouble in life,
and folks who were disabled likewise would be supported. It
was a very It was a kind but also classically
American thing to do. Great people are defined and we
define ourselves being great, so we should do it well.
Speaker 1 (02:01):
Many people then had trepidation about the government paying for
health care. What have we learned about how coverage has
impacted health outcomes?
Speaker 2 (02:12):
Well, having coverage gets you the care you need in
a timely fashion, and compensating the systems that provide that
affairly also make sure that you can keep reinvesting in
the healthcare system. But we have run a follow some
of the original beliefs of the founders of Medicaid Medicare.
I remember Medicaid was and then signing the law by
Lynnan Johnson, a Democrat. His first patient, the number one
(02:34):
patient on Medicare in the country was Harry S.
Speaker 3 (02:36):
Truman, a Democrat.
Speaker 2 (02:37):
They had tried to do something similar fifteen years earlier
and can not been able to get it through Congress.
Speaker 3 (02:42):
But the creation of this.
Speaker 1 (02:43):
And then President Kennedy worked on it also for a
short time.
Speaker 2 (02:47):
He did and this of course his life was cut
short so he couldn't complete that promise. But it does
take me back to the quote that Hubert Humphrey, who's
in that signing photograph. By the way, Hubert Humprey was
a senator from Minnesota, ran for president.
Speaker 1 (03:00):
Knew him, you know who I did. I used to
go to Washington to visit with him.
Speaker 2 (03:04):
But Hubert Humphrey has a quote on the building named
after him where Bobby Kennedy myself the head of an HFDA,
all of our offices are located there. And the quote
to the left as you walk in the building it's in.
Marble says it is the moral obligation of government to
take care of those, and he uses light as a
metaphor moral obligation in government to take care of those
(03:25):
at the dawn of their life. Those are the children,
those at the twilight of their life, the mature, and
those living in the shadows. Now think about that for
a second. Fifty three percent of kids in America when
they're born in the poverty are covered by Medicaid or CHIP,
which is the Children's Health Insurance. All seniors if they
wish it, could have Medicare at age sixty five. Others
can get it as well if they have disabilities. And then,
(03:46):
of course people living in the shadows, of those people
who have not been blessed with good health and for
one reason injurygue birth, have a disability of vulnerability that
hinders their ability to participate in the workforce. That was
the original population for whom this program was created. And
I think of how precious it is and how important
it is for us to preserve these programs to keep
them healthy, which is why you once in a while
(04:08):
have to make some tough decisions when it looks like
there's been fraud, waste, and abuse that's taking the federal
taxpayers dollars and spending it elsewhere.
Speaker 1 (04:16):
Well, let's start with Medicare and Medicaid. Who is eligible
for medicaid and what exactly is medicaid. Let's do the definition,
because I think people are confused. The more we talk
about big cuts in Medicaid and Medicare, everybody's getting frightened,
(04:37):
but nobody really realizes exactly what these very large programs
provide and what they do and why they're here. So
what is medicaid?
Speaker 2 (04:49):
And just to they have one's fears aside, we're putting
two hundred billion more dollars into medicaid and Medicare is
not being touched at all. Let's go through these. Medicaid
is a state program that's really important. It's run by
the states. They decide who needs help in their states.
That's a wise thing that the government does because states
know their own people better than the federal government. And
(05:10):
in an effort to try to make sure that people
took care of the system on their own and gave
it to the patients, to their citizens who needed it,
and then not the citizens who don't deserve to be
on Medicaid states run it, but the federal government picks
up part of the tab. Yeah, how much it depends,
and each state's different, but roughly seventy five percent of
the money that goes to a medicaid patient is paid
(05:30):
by the federal government and one quarter paid by the state.
Now this is important because the state can always spend more,
and by doing that forced the federal government to contribute more,
because that's the deal.
Speaker 3 (05:41):
You pay a quarter, we pay three quarters.
Speaker 2 (05:42):
If you want more money for your medicaid system, just
put more money into it and we'll match you three
to one. What's happened over the last few years, and
this has got worse during COVID because people began to
game the system. Governors and their health systems are smart people,
they said, you know, instead of it being twenty five
percent from us and seventy five percent from the federal government,
there are ways we could pack the system so it's
(06:03):
actually becoming eighty five percent from the government fifteen percent
from us, or we're going to pay for things that
the federal government didn't want to pay for. I'll give
you a couple examples. Illegal immigrants are not covered under medicaid.
If the state of California wants to provide illegal immigrants
with full health care, including dental by the way, which
Medicare patients don't even get. Then they shouldn't be able
to charge that to the federal government, but they had
(06:25):
been in the prior administration. In an analogous fashion, if
you can create a fictitious way of pretending you're having
expenses in your Medicaid program and pretend that you're spending
money in a way that gets the federal government to
match it even though you didn't spend the money, you're
cheating the system. It's legal, by the way, it's called
legalized money laundering, but you're able to do it and
(06:46):
pull more money down. These were rules that were changed
fairly dramatically and allow these gaps. But I'll give you
one very concrete example, Martha, this will speak to you.
Speaker 3 (06:54):
There was a rule passed last year.
Speaker 2 (06:56):
Again, this is part of what was changed in the
one big beautiful law that allowed Medicaid patients to pay
their doctors through the government three times more than Medicare patients. Remember,
Medicare is for older people over sixty five who are retired,
and so that doesn't make sense because if you paid
into Medicare your whole life, pay two point nine percent
(07:17):
tax in every check that you had. If you look
at your stub of your paycheck gills and you'll notice
it if you're still working, but you paid into it
your whole life. When you retire, the deal is you
get health care. But if I tell you, yeah, you
get health care, but I'm not going to pay your
doctor that much. I'm going to pay them only a
third of what a able bodied person on Medicaid pace.
You're actually limiting care to older Americans in order to
(07:38):
super subsidize it to folks who are on Medicaid who
aren't working. And that's a major challenge because now the
government is doing things that I don't think morally are defensible.
Everyone should be treated equally, right, Medicaid should not get
more than Medicare or less than Medicare.
Speaker 1 (07:52):
Which is the rule, so that Medicaid is for is
run by the states, primarily for.
Speaker 3 (07:57):
The folks, children, for old people, disabled people.
Speaker 1 (08:00):
That was the original or economically challenge.
Speaker 2 (08:02):
Right then they added a group of people in the
last ten to fifteen years. Who are the able bodied
people who aren't working. Now, who are these folks.
Speaker 1 (08:13):
Well, it's the fun unemployment.
Speaker 2 (08:14):
You mean they're there, Well, they're unemployed, but they're also
not seeking work.
Speaker 3 (08:19):
They're not trying to work.
Speaker 2 (08:21):
And that's a big issue for us because we think
that's bad for you as an individual. If you're unemployed
and not working, you should try to get a job.
If you're able bodied. Again, i'm not talking about people
who have vulnerabilities. They can't leave home. They're injured there
you know, don't You don't go to work with a
broken leg.
Speaker 3 (08:34):
Deal with that issue.
Speaker 2 (08:35):
But in the case of able bodied individuals, we have
data on this. They spend six point one hours a
day watching television or doing leads activities, just hanging out.
And I think that time is better spent getting an education, volunteering,
trying to get a job. And so it's not really
a work requirement, it's a community engagement requirement. Of this
(08:55):
law says, please get out of the home. You would
not put on the planet to sit home and watch television,
play video games. You go prove that you've got agency
over your future. And we're going to nudge you to
do that, and we're going to offer you a deal.
The deal is very similar, very clear, if you try
to get a job or get education or volunteer.
Speaker 3 (09:13):
You get pre health insurance.
Speaker 2 (09:14):
If you're not willing to leave home and do any
of those things, then we're not going to give you
free healthy You get.
Speaker 1 (09:18):
Free health insurance under Medicaid Medicaid. Okay, Now what about Medicare?
Who's eligible? What is it? How many people use it?
Have it? So?
Speaker 2 (09:29):
Eighty million people are on Medicaid or CHIP the prior group,
there's sixty eight million people on Medicare, which are people
over the age of sixty five. In general, there's some exceptions,
but over sixty five who just by reaching that birth
date are eligible for Medicare. And Medicare will cover your hospitalizations,
it'll cover your doctors appointments that it will also cover
your medication expenses.
Speaker 1 (09:50):
But with doctors who are in the system.
Speaker 2 (09:53):
Most doctors, the vast majority are they take Medicare because
it's such a huge number of their patients.
Speaker 3 (09:58):
But there is a copay.
Speaker 2 (10:00):
There's a contribution that people on Medicare might have to make.
If you don't have money, you don't have to make it.
But if you're able to pay into it, then we'll
collect some money from patients not more than twenty percent
of the bill in order to make sure that the
system is able to provide the right incentives.
Speaker 1 (10:15):
Well, now, with the aging population, Medicare is going to
be under even more pressure to provide for more adults
over sixty five. That percentage of Americans is growing exponentially
in the United States. I founded the Center for Living
at Mount Sinai Hospital dealing with patients over sixty five,
and we've seen a huge influx and people seeking help
(10:40):
because they're over sixty five. And the numbers are quite
astonishing that our population is really aging. So what are
we going to do with those people?
Speaker 2 (10:50):
We believe that there's going to be ninety million people
on Medicare over the next decade right now.
Speaker 1 (10:55):
I believe that too.
Speaker 2 (10:56):
And here's what's going to save us. Productivity in medicine
is quite low. We're not nearly as efficient as the
other major industries in this country. And one of the
reasons for that is there's no modernization movement in medicine.
The information flow is very is very calcified. So as
an example, sixty years ago, when you went to get
(11:17):
a doctor's appointment, you'd call, you wait on hold, talk
to the secretary maybe give some information and they book
your appointment. Today you do the same thing. It's not
like you go on your computer and book the appointment.
It's all done. Your insurance card's there. Even though we
have all that now, liken that to a credit card experience.
You go to get a credit card, you know, put
you put it into the machine, don't just tap it.
Now your phone and you can get your latte, your coffee.
(11:40):
But we should be making those sort of seamless transactions easier.
But more importantly, if we actually had data flow information
flow in Medicare and medicaid, then I'd be able to
give you empowering information. I can say, hey, Martha, you
know I know for your medical records, and you'll allow
me to do this.
Speaker 3 (11:56):
Of course, that did.
Speaker 2 (11:58):
You have a rash on your back like you were
given an appointment for it? Did it get better? If
it didn't get better, it could be a disease called X.
You should go see a doctor. Here's one that can
see you. And so by empowering you both to prevent
illness but also stay vitally engaged as you have been,
we can use this information flow to support you more importantly.
Speaker 1 (12:17):
So why hasn't that happened? Is it the lack of
competent medical people enough doctors? Are enough nurses, enough people
who are answering the telephones? Or can this be done
over with AI?
Speaker 2 (12:30):
AI can definitely help with this a lot, and we
are blessed. It's a generational opportunity to bring AI to
the forefront, not going to replace doctors and nurses, but
augment what they can do, do it more effectively. I
don't think we had the technology until recently to be
able to do this. But also there's an inherent distrust
in the healthcare system. Doctors don't trust insurance companies. Insurance
(12:51):
companies don't work with hospitals, so the information was purposely
not designed to flow back and forth effectively.
Speaker 3 (12:57):
That's changed.
Speaker 2 (12:57):
We now have laws for it's called for operability. You
have to be able to translate your data to other groups.
But also you need transparency. If you go to a
drug store right now, as an American, you don't know
what the drugs cost. So you show up the drug store,
you order, you take your prescription. The doctor may have
let you know a little about the drug, but never
shared the cost. Because doctors don't know what it costs either.
(13:18):
And now your pharmacist says, well, it's you know, three
thousand dollars a month. You say, I can't afford three
thousand dollars a month. You don't take the pill. One
in three times a prescription goes unfilled by the patient,
and money's often a driving factor. You should not have
to decide between groceries and your medications.
Speaker 1 (13:32):
No way. But I mean it seems like the administration
of such programs was adequate. Things could run better. I mean,
if if I need a certain kind of drug and
I should be told where to get it. I took
a prescription to a very well known pharmacy here in
(13:53):
New York City, and here I am a woman over
sixty five. I take this prescription. The prescription was four
hundred and fifty dollars, and I said, what are you
talking about? I took it to my local pharmacy in Katona,
New York. It was fifty five dollars. Okay, So what's
(14:15):
the story there?
Speaker 3 (14:16):
Makes you mad, doesn't it?
Speaker 1 (14:17):
No? It makes me very worried about everything. So the
reason that happens is a four hundred dollars difference for
the same silly drug exactly, And if you went to overseas,
it was probably cheaper. And this has been a so
what do you do about that? Well, we're asking, first
of all, there's transparency. When your prescription is put into
(14:37):
your phone by your doctor, you'll see that the Katona
pharmacy is fifty three dollars, the one downtown Manhattan it's
four hundred dollars. The one at Downtown's not gonna get
any business. They're going to drop their prices. The complexity
around drug pricing was affected years ago because they created
a mechanism called rebates. Now rebates is basically kickbacks, but
insurance companies working with pharmacy benefits management companies are allowed
(15:00):
to work side deals with the employer and with the pharmacies,
so that you, the employee, don't actually know what the
drug costs. If you try to go around it, you
can get hurt. If you work with it in the system,
you might have to pay more than you should. So
we want to take all that away and just say
it's transparent. Here's what the drug can cost in different pharmacies.
I don't care what else is going on. This is
actually take it can certainly help us with that and
(15:23):
eliminate the need for a person to do that.
Speaker 3 (15:27):
Right, it's hard to do with that AI.
Speaker 2 (15:29):
But AI can't do it unless people are forced to
share their data. We are doing that's that's a law
now and so we're pushing for that. And again now
they don't have any excuses because it's required by law
and this technology that allows them to do it.
Speaker 3 (15:41):
It's also reached a feverish pitch.
Speaker 2 (15:42):
I mean, there's blood in the streets here in New
York right if people we should be we should be listening,
We should be listening before.
Speaker 1 (15:48):
Yeah, we have to pay attention and make sure that
people are taken seriously and are treated seriously. So, how
does life expectancy in the United States compare with other countries?
How are those numbers different today than in nineteen sixty five,
when when our President Johnson was so astute to pass
(16:09):
this fantastic bill.
Speaker 3 (16:11):
Well in nineteen sixty five.
Speaker 2 (16:13):
In fact, until nineteen ninety, life expectancy in the United
States was very similar to that in Europe. And since
then we have dropped off about five years. I'll say
that again. It used to be the same even forty
years ago, but over the last few decades, life expectancy
in America has plummeted. There are a bunch of reasons
for that. Opiate addiction problem has become an issue, But
(16:34):
the bigger theme that I like to point focus on
is chronic disease. We are tolerant of it. We've become
normalized to chronic illnesses. You're not supposed to have hypertension, diabetes, obesity, dementia,
you know, several heart attacks for stans.
Speaker 3 (16:47):
You're not supposed to live a life like that.
Speaker 2 (16:49):
But we've gotten very comfortable feeding ourselves, treating ourselves in
ways that allow these chronic conditions to arise. The reason
that's critical, Mark is that one of the ways we
allow Medicare and Medicaid to st much further is by
having a healthier population. You cannot take care of folks
who are trying to hurt themselves. It's a shared responsibility,
and the irony of the whole situation is, of course,
(17:10):
it's in your best interest to stay healthy. But when
we look at the healthcare expenditures of the country, about
two thirds are driven by chronic illness. And it's come
to a point now where across the board there's a
recognition that we need to make America healthy again. And
part of the subtlety of that message is that the
mental health issues that hold so many back from doing
(17:32):
what's right for themselves have to be addressed, and we
don't have enough of those practitioners, especially in rural parts
of the country, and that's where AI might play a
role because the avatar's right now. I looked at one
recently that the Cleveland clinic brought me. I mean, you
can't tell this is not a doctor, and they're asking
you very subtle questions, Martha, not why did you not
take the medication, but was there a problem with your
(17:54):
daughter that upsets you so you didn't take your medication?
I mean, very pointed, because they know enough about you.
Speaker 1 (18:00):
And they this is done on zoom or something like
that on.
Speaker 2 (18:03):
Zoom video, and you see the avatar's face and they're
listening to everything you're saying in the tone of your voice,
and how much stresses in that tone, and other things
you may have said in the past that may have
you know, if you're really paying attention to somebody, the
things you would know about them. And that's a good
sign because that message could take an hour two hours
to get out. Then you get that message in the patient,
you share with the doctor.
Speaker 1 (18:23):
People have more information nowadays about healthy diets and lifestyle
than ever before. Why is chronic disease continuing to rise.
Speaker 3 (18:33):
Information is not the same as motivation.
Speaker 2 (18:35):
There are cousins, But if you look at the psychology
of change, about seventy percent of people are pre contemplative,
which means they're not even thinking of changing. So I
give you a healthy option and an unhealthy option, and
because something else going on in your life, you sell sabotage.
Speaker 3 (18:52):
And that happens all the time.
Speaker 2 (18:53):
It's not just about discipline, it's about creating an environment
where it's easy to do the right thing. That's why
focusing on the quality of the food we have in
America's soot and the additives and like, a part of
it is acknowledging that it's a shared responsibility. We all
have Medicare, Medicaid will take care of you, but you've
got to help. That's why, you know, when I point
to Arthur's Stewart, I say, this woman, she just reinvents
herself by the day. She's always has the vitality that
(19:15):
if people appreciate the importance of longevity, they'll want to
have and I think I don't.
Speaker 1 (19:22):
Use the word reinvent. I use the word evolve.
Speaker 3 (19:25):
Perfect.
Speaker 1 (19:26):
Yeah, I evolve because change is good. I like change,
and I think it's very important for the human the
human condition to adapt to change and evolution is like
all important.
Speaker 2 (19:40):
And we evolve for a reason. It keeps us alive.
And I think it's that's as an excellent addition. That's
a good thought, Martha.
Speaker 1 (19:46):
Continue to use it, please, Yes, I.
Speaker 2 (19:48):
Will use evolve. I want people to continue to evolve
in their lives.
Speaker 1 (19:51):
Exactly what is the government doing to encourage and support
medical education and encourage young people to go into the
(20:12):
medical field. Are we doing anything for that?
Speaker 2 (20:14):
We are in this one big, beautiful law, have a
fifty billion dollar fund to modernize to change the infrastructure
of how medicine is practiced right now. And a part
of that is the worst practice but learn Yeah, but
demandpower is a big problem. So we don't have enough nurses,
we don't have enough health professionals to extend to help doctors.
(20:36):
But you mentioned something earlier on navigators. This is an
important part of the bill as well. There are parts
of the country where you're not going to have enough doctors,
but you could have navigators, health coaches, people who are
between a doctor and a patient who can translate ninety
percent of what the doctor's trying to get you to
do to action, like get you out of the house,
get you eating better. But this is something that I've
been thinking about to talk to you through. Nutrition in
(20:59):
medical school is taught atrociously. In fact, I ran for
president of my class and ultimately student body at Penn
where I was in medical school, under the platform that
I would bring nutrition classes back into medical school and
we did. I won, and we did. But it needs
to be culinary medicine. It needs to be sexy cool,
Like don't just tell me to eat tomatoes. Tell me
(21:20):
that if you mix tomatoes in a stew it heated
up with oil, you release the lycopene that's naturally in there.
Speaker 3 (21:27):
That's also called pasta sauce.
Speaker 2 (21:28):
By the way, pasta sauce actually provides more of the
nutrients of the tomato, and by removing the skin, you
remove the inflammatory elements. So our ancestors learn much about
the secrets of eating well, not just from a taste perspective,
but also it's medical benefits.
Speaker 1 (21:44):
Well. I totally agree about eating habits or are bad
in America and could be greatly improved. But we need education.
We need people to listen, we need people to teach.
And I'm finding that less and less satisfactory. And so
what are we going to do about it? How are
we going to encourage it?
Speaker 2 (22:05):
Well, we are actively going to be recruiting young people
to go into health profession in vulnerable parts of the population.
I'll speak to Appalachia in specific, because I know the
area well. The number one job young people want to
do is healthcare. Why because it's the only job they
see in those communities.
Speaker 1 (22:20):
Now. Doctor Harvey Sloan, he's a friend of mine. He
ran for governor of Kentucky a long time ago. He's
still an active practitioner, and he's very, very worried about
Appalachia and about the way that people there are very
ignorant about good health, about taking care of themselves, and
also worried about the health centers, the community health centers closing.
(22:45):
So many of them have been underfunded and are closing.
So what are we going to do about that?
Speaker 2 (22:50):
The fifty billion dollar bill very explicitly talks about community
health centers explicitly.
Speaker 3 (22:54):
I mean those words are in there.
Speaker 2 (22:56):
It's well appreciated by those of us who study this
that we have to fund community health centers, federally qualified
centers better there.
Speaker 1 (23:03):
What's going to happen I worry. What I worry about
is like the rural hospitals. I worry about what's going
to happen with massive cuts in the in the.
Speaker 2 (23:13):
Remark that we're putting two hundred billion more dollars into
the system, and then in addition.
Speaker 1 (23:18):
Is it going to go to maintaining healthcare is in
as many places as possible.
Speaker 2 (23:23):
The fifty billion dollars extra money was designed. It's called
the Rural Transformation Funds. It's specifically designed for those hospitals.
Speaker 1 (23:31):
I'm going to read this bill. I'm going to read,
please do of this bill.
Speaker 2 (23:34):
You'll see that one thing is ready to cover a
lot of the money that goes to the healthcare system
goes to well funded institutions that have lobbyists. It doesn't
go to the rural hospital that you know you were
dependent on when.
Speaker 3 (23:47):
It's a kid.
Speaker 2 (23:48):
Those hospitals get left behind because they don't have the
same powerful connections to pull down from the piggybank. And
that's one of the things we realize only five percent
of the money that was being used for these so
called state directed funds that are designed to help.
Speaker 1 (24:00):
Hospitals get into rural hospital Wow, only five percent difference.
Speaker 3 (24:04):
Well the fifty billion dollars it's designed for them.
Speaker 1 (24:06):
Okay, well please, we need that desperately. I have lots
of friends in those places.
Speaker 2 (24:13):
We don't have enough primary care practitioners. Martha my son
graduated from Columbia Medical School this past month.
Speaker 3 (24:18):
He's an intern.
Speaker 1 (24:18):
Congratulations, thank you.
Speaker 3 (24:20):
They pay all the tuition.
Speaker 2 (24:22):
Now, if the parents have money, we have to pay
if but for the eighty percent of the kids whose
parents don't have enough money, it's very expensive to go
to medical school. It's paid for by the school completely free.
It's also true in n Why you other schools around
the country. Why because they argued that young people are
so much in debt by the time they finish training,
they can't become primary care practitioners. Unfortunately, despite the fact
(24:44):
that they provided that, there was not a significant change
the number of kids going to primary care. It is
an underfunded place. So we need to make the experience
a better experience. People leave them.
Speaker 1 (24:53):
So what's primary care? What's in turn care? What's general
practitioner care.
Speaker 3 (24:58):
This is a beautiful question.
Speaker 1 (25:00):
These are questions that nobody seems to know the answers to,
and we have to know.
Speaker 2 (25:04):
Well, those three terms overlap frankly, and they are used interchangeably.
Speaker 1 (25:08):
Internes is they're but it's not accurate.
Speaker 3 (25:11):
No, it's not.
Speaker 2 (25:12):
Interness are trained to practice internal medicine. Some of them
will become primary care providers. They'll go back and deal
with community health issues and serving the capacities of a
primary care doctor. General practitioners, likewise, are trained to do everything.
They can deliver babies and prescribe medications and do surgery
sometimes so they also can provide primary care. But the
(25:33):
key Phraser's primary. You want to be there first. You
want to be able to prevent the downstream problems. I'm
a heart surgeon. By the time you come to me,
you've been through a lot of doctors and probably made
some mistakes, which is the reason your arteries are blocked up.
And somewhere along the line, the system did not help
prevent you from meeting my services.
Speaker 3 (25:49):
That's a failure.
Speaker 2 (25:50):
I went into television in fairness because I thought I
should put myself out of business. You don't want heart
surges like me doing so much surgery, And I was
probably doing the most surgery in New York at Columbia
when I was practicing.
Speaker 1 (26:01):
But that's what move was the last time you did
an operation.
Speaker 2 (26:05):
Just before I ran for office for the Senate office
in Pennsylvania.
Speaker 3 (26:09):
So it's been three years now.
Speaker 1 (26:10):
So are you Are you relieved? No?
Speaker 3 (26:13):
I love medicine.
Speaker 2 (26:14):
Medicine is the best job from a group perspective, because
you look at someone's into someone's eyes who you're going
to help, and you make sure they know you're there
for them, and they know that they trust you on that,
and then you go off embark in some treatment that
with their big stakes. I mean, every single day you
feel rewarded. But the best job I've ever had is
this job because in this job, just like in the show,
(26:36):
just like in medicine, I have a group of very
dedicated people working around me. Their mission driven one hundred
percent focused on improving the healthcare of the American people.
They give up a lot to come in. We've got
thousands of wonderful, highly skilled individuals who can do every
single actuarial tables and analyzing what the right rates to
pay for different insurance. But we also have fraud investigators
(26:57):
and people who are world experts at making sure we
can get the right doctors and the right now people
in your apartment.
Speaker 3 (27:03):
So we have.
Speaker 2 (27:04):
Sixty five hundred people roughly in who work for me directly,
and we have forty thousand more who work for me
through contracts.
Speaker 3 (27:11):
So it's getting, you know, the mid forties.
Speaker 2 (27:15):
That's a lot of people, and that's why I'm sending
a very clear message that you should be able to
accomplish the goals you came here for.
Speaker 3 (27:21):
Matter.
Speaker 2 (27:22):
That's the biggest feedback I'm getting right now is a
lot of folks within the department say, I came here
to make a difference, and now there's a chance because
of technology advances, because we've got a very focused administration
on this topic, and because the American people are demanding it.
This is a tangent to point you're making earlier. We
have to make it easier to be healthy in America.
(27:43):
If you go to Europe and eat bread, it doesn't
seem to affect you the same ways if you eat
bread in America. It's a mundane example, but I hear
it so commonly that I would share it. You know,
you eat a week of pasta in Italy, you don't
gain weight.
Speaker 3 (27:55):
Here, you have one.
Speaker 2 (27:56):
Pasta dish and all of a sudden you're bloated. And
if it's the portion size, and you know, the other
factors could be involved. But there is also the possibility,
and we should kick the tires on this, that there
have been changes to our food supply that we can't
ignore it and maybe it's causing other problems that we
got to address. And that's it's a loud voice that
is being now I believe heard.
Speaker 1 (28:18):
But the other thing is the price. Yeah, the prices,
you have to do something about that. I go and
now when I used to spend maybe forty five dollars,
it's one hundred and ninety dollars for the same amount
of stuff. That's a very huge burden on the American family.
Speaker 2 (28:36):
This is the unfair tax of inflation. And this was
a criticism that was being thrown around during COVID.
Speaker 3 (28:42):
We took emergency measures.
Speaker 2 (28:43):
And we can spend the whole time talking about COVID,
what was done right, what was done wrong, But you
take emergency measures that caused inflation. It's the folks who
are struggling to pay the biggest price, and that's why
it's important to be physically responsible. Some of the discussions
we're having about Medicator a good example. The cowardly thing
to do is to just let the just run the
way this. The brave thing to do is to say,
(29:05):
I am charged with protecting this organization. I want it
there for people who might be struggling in the future.
To do that correctly, we have got to get our
arms around the budget, and that's best done by making
things more efficient, but also making sure people steal from
the kiddie.
Speaker 1 (29:19):
But that is also the scariest thing for the American
public when they hear budget cuts, budget cuts constantly every
single day from the minute of our president took office
till now, the budget cuts have terrified people. And I
would hope that maybe people like you could lay their
fears somehow, and a program like this could help them
(29:40):
understand that what you're trying to eliminate is the bad stuff,
not the help that we all need so desperately.
Speaker 2 (29:49):
There's an approach to changing organization that's not working at
high speed, and it is to go in there and say,
who doesn't want to be here, please leave and then
who can tell me what they do? And if you
can't tell me clearly what you're doing, you probably should
leave as well. These seem harsh, but in fairness, having
run organizations in the past, thing you have as well.
When people don't know the answers to why you hear
(30:10):
they probably aren't in the right job.
Speaker 3 (30:12):
You're probably helping them.
Speaker 2 (30:13):
So much of what we're doing is just asking people
some tough questions and getting them to be serious about
their responses. But the beauty of this whole process is
sometimes you find things that should have been discovered earlier.
Speaker 3 (30:24):
A week and a half ago, I.
Speaker 2 (30:26):
Was on a dais with the folks from the Department
of Justice and we announced the largest bust ever of
a fraud ring in America and it was run by
a foreign government. Foreign international governments are attacking us, and
they attack Medicare. Why because we have a huge bullseye
on our side. We're a massive entity. I mean, if
you put it all together, we're about one point eight
(30:47):
billion dollars Medicare and Medicaid and chip and everything. So
they when you put those all together, you have a
big target that people can go after it. And the
way you hack it is to get someone's Medicare beneficiary number.
So you have what I now have on had my
birthday last month. So if someone calls me up and says, hey, listen,
I need to get your number to do something. Don't
give it to them, by the way, because we would
never do that. But when they get your number, they
(31:08):
can pretend you're buying things, and they can charge the
government a wheelchair, you know, a special hospital bed. And
then foreign countries get access to your number, they of
course weaponize it and they fifteen billion dollars mark.
Speaker 3 (31:21):
That's a lot of money.
Speaker 2 (31:22):
And we were able to stop twelve billion from going
out the door, but they stole three billion. And when
it leaves the door, it goes to the Cayman Islands
or a moscow, goes overseas.
Speaker 3 (31:30):
You can't get it back.
Speaker 1 (31:32):
You're enrolled in Medicare yourself, yes, And do you have
a private coverage that supplements the Medicare program?
Speaker 3 (31:39):
I do.
Speaker 2 (31:40):
I have federal employee insurance now, so I don't use
my Medicare. I'm enrolled so that I'm ready for it.
There's a couple types of Medicare. The Medicare Part A
pays the hospital bill, and so if you have private
insurance that always pays the bill first. The taxpayer comes last.
They don't have to pay the bill unless there's no
money left. So hopefully you and I will never use
(32:00):
that Medicare Part B is to pay the doctor's salaries.
I have insurance, so to you, so that pays our
doctor's insurance. But when you get to sixty five, if
you don't have insurance, it's given to you. And through
that program, and then there's a drug benefit, you can
get your prescription medications supported by the federal government.
Speaker 1 (32:17):
And not totally paid for, but supplemented.
Speaker 2 (32:19):
After two thousand dollars is totally paid for it until
two thousand dollars, you.
Speaker 3 (32:22):
Have to contribute.
Speaker 2 (32:23):
There's the value of people paying part of the bill
because you don't spend other people's money the way you
spend your money. So we want you to have some
skin in the game. And there are other reasons for
that too. By the way, if you don't have any
money in the game, people steal your number and pretend
they're you and charge massive amounts of money and you
never know about it.
Speaker 1 (32:39):
What percentage of Americans have private supplemental coverage? People who
have already have Medicare, So if you can.
Speaker 3 (32:46):
Afford it, you'll probably buy supplemental coverage.
Speaker 2 (32:48):
So more than half, there are millions of people who
don't have enough money to afford additional coverage, and the
government will adjust pricing based on that.
Speaker 1 (32:57):
Well, the average American relying on Medicare have coverage as
good as the congress people and the senators voting to
change the existing levels of coverage.
Speaker 2 (33:07):
The federal insurance that I just got it three months
ago seems to be similar to what Medicare would pay.
I don't know the answer for that in every situation,
but most of us WI end up in Medicare. I
fully intend when I finally hang up my laces in
my shoes, my cleats.
Speaker 3 (33:24):
You're shingle, my shingle, that I would go on Medicare.
Speaker 2 (33:27):
But it is truly the backbone of this social safety
and that out of the country it works well. As
a doctor, I took Medicare unwaveringly. My Medicare patients got
the exact same care that my privately insured patients and
my Medicaid patients.
Speaker 3 (33:39):
That's the other thing.
Speaker 2 (33:40):
We're professionals, right, Doctors will provide excellent care the matter
of the coverage, but there needs to be some coverage
to get you in the door.
Speaker 1 (33:56):
So when Medicaid started in nineteen sixty five, about seventy
percent of people have annual doctor visits. Today, ninety five
percent of the people take annual exams. How do you
expect those numbers will be impacted by cuts from the
recent legislation.
Speaker 2 (34:13):
So I'm going to quibble with one data point. Nine
percent of people are eligible for annual visits, but they
don't take it.
Speaker 3 (34:23):
Now, this is important point for me.
Speaker 2 (34:24):
If I give you something for free, it's because I
think it's important. Seeing your doctor is critically important as
you get older, especially, but we think it's between maybe
a third of people are getting their primary care doctor visits.
Speaker 3 (34:38):
Most people do not.
Speaker 2 (34:39):
And so what we'd like to do maybe is use
your phone to be your communication tool. Maybe instead of
making you take a day off and go to the
doctor's office and find stuff out you don't want to
hear about, at least we can you know, your doctor
can call you, or you can dialogue with the healthcare
system and say, listen, I feel fine, I don't want anything,
or I don't want to go in there, But I
did have one question and just to get the dialogue out.
Speaker 1 (35:00):
I think we can modernize that enough that way.
Speaker 2 (35:03):
That is a primary UH instruction that I've given to
my entire team within the year. And we have a
big event happening on the thirtieth of this month. We're
going to announce the results of a large national request
for information that we put out. It's one of the
first things I did as the administrative for cmsaleers working
on Palenteer and other major companies. We're all working on
(35:24):
this RFI and you know what we said, We're open
for business, come help us. And you know what the
word meek means, Martha, like the meek sean here at
the earth. Yes, so I always thought it meant weak,
you know, shy, It could be shy, but the meek
also means in the Bibiblical sense that you have a
sword that's sharp, and you decide to sheathe it, and
(35:46):
so you decide not to attack each other, be shy
to use it. And so that's what we're asking all
these tech companies to do. The biggest AI companies are evolved,
the biggest health technology companies, biggest hospital systems, insurance companies,
but just swards away. We got to figure this out, guys,
because the system doesn't work the way it is. Healthcare
expenses are increasing three percent faster than the economy, almost
twice as fast as these economy. That doesn't make any sense.
(36:09):
We're not getting our money's worth. Life expectancy is dropping,
and yet it's more expensive.
Speaker 1 (36:13):
Is the life inspectancy in America? Now? For a male?
Speaker 2 (36:17):
I think the average age I should look it up
before I've done this podcast is in the high seventies.
Speaker 3 (36:21):
It used to be in the low eighties.
Speaker 2 (36:23):
Yes, and uh, and we are losing traction and a
lot of it again is because if young males are
killing themselves by mistake with opiates or sometimes you know,
they're taking their own lives and they're frustrated in life
and they're not engaged, then you're actually those that hurts
the system a lot.
Speaker 3 (36:39):
Obviously ethically, it hurts the system.
Speaker 1 (36:41):
And hurts the averages. Of course, some estimates say seven
million people will be dropped by Medicaid without insurance, won't
they just end up in emergency rooms at text payer cost.
Speaker 2 (36:52):
So we actually have an experiment that was inadvertently done
on this under the Biden administration they were under a
lot of pressure because there's so many pe people had
wrongly joined Medicaid that they went through the roles and
they took fifteen million people off Medicaid because they were two,
their incomes were higher. The incomes are not correct. They
should have been another program. They lived in multiple states. Again, up,
(37:15):
if Martha Stewart lives in New York and lives in Connecticut,
which state gets your money? They don't both get paid
full fare. The federal govermentsion paid both. So fifteen million
people dropped off. The ninety percent of people. Of those
of that fifteen ninety percent of them did not become uninshort.
So here's the real question, Martha, and the reason I
reject that number. If I give you a deal, I
(37:36):
come and you get home at night and someone's sitting
on your sofa right and hasn't moved from the sofa
all day long, and you say, listen, enough's enough. You
got to go out and try to help with the community.
So go volunteer, get an education, and go go try
to get a job. If you do any of those things,
I'll give you free health insurance. But if you're not
willing to leave the couch. I'm taking your health coverage away.
That's a pretty fair deal. Now, I have confidence in
(37:57):
the American people they will react favorably to that. They
will go out and go try to do one of
those things, get a job and get educated, etc. But
the Democratic criticizers of the of the law say, no,
they're not They're just going to sit there and not
take the job offer and therefore become unemployed. I know
that's not a math equation. That's a behavioral psychology question,
(38:18):
and people at home should be listening to that question carefully.
If offered the deal free health insurance in return for
community engagement, would you take it? And here's the real
deeper issue that I think I want to bring up.
It's not good for to sit at home watch six
hours of television and doing nothing every day.
Speaker 1 (38:34):
Yeah, and on the average age of America.
Speaker 2 (38:39):
So go out there and change the world. That's why
you were put on earth. You know, make a difference.
You do things that make that show you have agency
over your future. And I think people will take that challenge.
And that's why I believe confidence the American people will
reign supreme.
Speaker 1 (38:52):
Well, I hope you can keep up that confidence and
show it to us because it demonstrated somehow, because I
think I think people are feeling Are you depressed?
Speaker 2 (39:01):
Well, we have three years before the parts of this
bill are impacted. The work requirements more than a year
and a half away. In the meantime, I've got fifty
billion dollars to invest transforming healthcare for the better and
to make a lot of the changes that all of
us across the spectrum desire to have happened. And I
actually think within the health profession there are many people
(39:22):
see an opportunity now to change problems they've been around
for a long time they thought no one would ever address,
just just the beginning.
Speaker 1 (39:29):
Are you out on the road, are you going to
Appalachian looking at these community health centers?
Speaker 2 (39:34):
I spoke to the governor of West Virginia this past weekend.
I've been to homeless shelters. I've been their community health clinics.
I went to Kensington, which is the largest open air
drug market in the country. In Philadelphia, I went to
the West Coast equivalent, which is the meatpacking district, the
Tenderloin district.
Speaker 1 (39:51):
Do you go surreptitiously or do you go with your entourage.
Speaker 2 (39:56):
Well, I don't go anonymously because I can't do that anyway.
But I go there with people in between me and
the patients and talk to them directly. And I've told
some of those stories in public because I want people
to know that I care and I took this job
very important.
Speaker 1 (40:11):
I mean, you have an important job, and we're looking
to you to help maintain a status quo that we
expect as American citizens. That's what we really are hoping.
You posted advice on fighting loneliness. Why is that important?
Speaker 2 (40:27):
I'm so happy you asked that question, Martha, because if
I had to pick the one single most expensive problem
we have in America, it's loneliness.
Speaker 3 (40:36):
And there's a couple of reasons for that.
Speaker 2 (40:38):
People who are lonely because for whatever reason, they haven't
been able to build left long relationships. As you pointed
out as a key to evolving is having friendships. They
feel abandoned, so they're often depressed. But in addition, they
don't have anyone to help them when they do fall.
Because the healthcare system can help you a bit, but
there's nothing like a person helping you get back up,
(40:58):
you know, making sure your medications are correctly given, to you,
or picking them up from the pharmacy, giving a doctor
some feedback if the advice wasn't helpful, getting you to
take realize how important you are and you need to
take care of yourself.
Speaker 3 (41:13):
That's why families are so vital.
Speaker 2 (41:15):
And I say that not based on high level philosophical thinking. Literally,
when you look into the healthcare system and take care
of the vulnerable populations that tend to be more expensive,
that's the number one predictor. I, as a heart surgeon,
would never operate on a patient who did not have
family with them or someone who cared about them. And
I would see patients sometimes it came by themselves and
I'd say this. I'm going to say this because I
(41:36):
love you, but there's someone who cares about you, and
it could be the doormat of your building. You're not
as strange from everybody. And by the way, who am
I going to celebrate with after your operation goes?
Speaker 3 (41:45):
Well?
Speaker 2 (41:45):
If you don't bring someone here, so go home, come
back with somebody, we'll talk and you'll do the operation.
Speaker 3 (41:51):
And that's you know, it works very successfully.
Speaker 1 (41:54):
A friend asks is her information as a medicare patient
going to be accessible to doge in the future.
Speaker 2 (42:02):
DOSE is more interested in the process by which we
help the system, the healthcare system work better. They're not
interested individual people's medical records to try to audit if
you've got good care. I do think you as a
patient might want to use your information, which you own,
it's yours. You might want to have different companies who
are promised to help you and if you trust them,
help audit your information to make sure the right things
(42:24):
are happening to you and their company is doing this
right now. They'll take your health information and say, you know,
we went through everything. It looks like they didn't manage
your diabetes correctly, or we really help you if you
thought about switching out this medication for another less toxic medication.
Speaker 1 (42:38):
Well, you talked about telehealth and how important that could be,
and I hope that works. Everybody seems to have a
phone now, everybody could go online and get advice, and
how many people are working on that.
Speaker 2 (42:52):
Telehealth's a big initiative for us. We have a whole
Digital Transformation group and telehealth has multiple facets to it.
Part of it is having practitioners help, but part of
it is also having AI participate when it's important but
if we can make it work the way we hope,
we'll be able to provide people living in very remote
parts of the country with superb healthcare.
Speaker 1 (43:14):
Now down to some nitty gritties. Okay, what's your view
on vaccines, measles vaccine?
Speaker 3 (43:21):
I would get the measles vaccine.
Speaker 1 (43:23):
Okay. So can't you have any influence on what's going
on in this government?
Speaker 2 (43:27):
Well, Secretary Kennedy says the same thing. This is the
irony about many of these topics. People manufacture stories and
then of course it lives on inside of the minds
of people who consume that media. What Secretary Kennedy says
is very simple. If you love somebody, you double check, right,
what does a parent do they kick the tires?
Speaker 3 (43:47):
Did you really really need to do that?
Speaker 2 (43:49):
So what he's arguing is we have taken for granted
everything we've been told about these products, not just vaccines,
fluoride and water and use of antibiotics and this and that.
Speaker 3 (43:59):
So let's just kick the tires.
Speaker 2 (44:00):
Let's just make sure the scientific data is that's out
there is valid, and if there's not, let's do the
additional research to double check it. In the meantime, business
continues as usual. We still pay for all the vaccines
we you know, we have not changed how the childhood
vaccines are being distributed. But there should be I think
every once in a while an audit of the advice
(44:22):
we give the American people, because what if we're wrong?
Speaker 1 (44:24):
And well, who is monitoring the efficacy of each of
those vaccines too.
Speaker 2 (44:29):
There's active groups within CDC, NIH and even FDA looking
at this. But you know, there's there's many examples where
even doctors disagree about the timing of vaccines. Then even
that could be debated because you know, hepatitis B vaccine
is given at birth. Hepatitis B is sexually transmitted or
(44:50):
intravenously transmitted problems. So it's generally with prostitutes and drug consumers.
Speaker 1 (44:56):
You know, listen, given it birth because because the parent
might have had.
Speaker 3 (44:59):
Well, we checked the mothers.
Speaker 2 (45:00):
The mothers are always every mother gets checked for appatitis B,
so we know the mother doesn't have appatitis BE. So
doctors now start saying, well, geez, you know, I don't know,
maybe can we delay. By the way, I have nothing
about hypatitis B is a vaccine. I got my kids
to get it when they were older when there was
really a risk. All doctors have to have it because
I don't want to get hepatitis. Be's a terrible disease.
But that's the kind of story that when you hear
(45:23):
about it as a doctor, you think, well, geez, you
know there is some flexibility there. You know, we don't
have to do it the first thing out of the womb.
Speaker 1 (45:30):
So fake news is a is a problem with vaccines.
You think there's a lot of fake news.
Speaker 2 (45:36):
I think there's catastrophizing of the process that could be
addressed with blue chip science going back and investigating the
root research that led the much.
Speaker 1 (45:47):
Ends and the people who are getting measles, the kids
who are getting measles are belonging to the religious groups
or groups that don't believe in vaccines for other reasons.
Is that isn't that true?
Speaker 3 (45:57):
That is true?
Speaker 1 (45:58):
Okay? So I mean, so that has to be made
very clear in the press and on television so that
we can understand where we're all coming from. What vaccines
do you think over sixty five should be taking.
Speaker 3 (46:12):
Well, I got the shingles vaccine.
Speaker 1 (46:14):
Yep.
Speaker 2 (46:15):
That's an uncomfortable condition when you get shingles, and I
didn't have any complications with it, So I think that's reasonable.
Speaker 1 (46:22):
Just get it in your upper arm, right upper arm. Yeh,
I got it.
Speaker 2 (46:26):
The healthcare system works best when you have a relationship
with your doctor and you can actually have an honest
discussion about what your condition. It would also imply because
giving across the board recommendation about some of these things
is very difficult to do for a system, and we
do that, we sometimes have errors, and those errors are
the ones that make the news.
Speaker 1 (46:45):
So you're a noted cardiothoracic surgeon. You're also an award
winning I think how many nine or ten Emmys a
television host. Why politics? Now? Do you consider this a
political job.
Speaker 3 (47:00):
This is a policy job.
Speaker 2 (47:02):
I have always been fascinated by how we can build systems,
and I did it at the hospital I ran the
Herd Institute. Television is, as you know, because you've hosted
a very successful show for many years. It's you know,
to make it work well, you have to get the
machinery fine tuned and oil it once in a while.
Healthcare is a big challenge, but it happens. It has
(47:25):
a lot of very well meeting people involved, and some
people just want to make money, and we need to.
Speaker 3 (47:29):
Make sure we protect the taxpayer's money.
Speaker 2 (47:32):
So it's used wisely because all great societies take care
of those who are vulnerable, and we're great people, so
we're going to do that.
Speaker 1 (47:39):
Is this the hardest job you've ever had?
Speaker 3 (47:41):
That's interesting approach. I never think about it as hard.
Speaker 2 (47:45):
It is the job with the greatest opportunity to do good.
Heart surgery is hard and you have very little room
for air, and your mistakes don't do well, so it
has a huge emotional burden on you as well. You
have to feel that burden but not let it paralyze
you as you make decisions. So it is a unique occupation.
(48:07):
The beautiful part about medicine is that you get every
single day to help somebody and they know it and
you know it, so it's rewarding. And that's not always
the case in policy. Sometimes you have to make changes
that you're not going to know all the benefits for months,
even years.
Speaker 1 (48:21):
Well, I know Medicare and Medicaid are very complicated subjects.
I appreciate your time so much, doctor Oz to note
this milestone and look at the future of these programs
sixty years old and hopefully continuing and hopefully helping as
many people as it possibly can.
Speaker 2 (48:41):
So one bit of advice if we're going to celebrate
the sixtieth anniversary of Medicare and Medicaid. And I tried
to buy you because I couldn't get you to bring
me a cherry pie. I tried to buy you a
Martha Maha medicake. But what is the advice on how
you have evolved as an individual that you would share
with everybody? Because Medicare Medicaid really are the backbone of
(49:03):
the social web, the support system of our nation. But
it's a collaborative approach. We'll provide you coverage, but you
have to chip in as well. How does Martha Stewart evolve?
Speaker 1 (49:14):
I evolve each and every day by learning something new
every day. That's my my most important thing is to
learn something new every day. And remember change is good.
When you're through changing, you're through.
Speaker 3 (49:30):
This is how you stay vital is.
Speaker 2 (49:33):
It works, the secrets of vitality, it works evolving and change.
Speaker 1 (49:36):
Yes, and it's and it's kind of fun, I can
tell yeah. Thank you so much, God bless you
Good day everyone. This is Martha Stewart and you're listening
to my podcast. And today we have a birthday to
celebrate with none other than doctor Mehmet Oz. We've all
known Mehmet Oz for more than a decade as the
dispenser of medical advice beamed into our own living rooms
on his show Doctor Oz. He is the son of
(00:26):
Turkish immigrants and grew up in Delaware. In April, he
was confirmed as the seventeenth Administrator of Medicare and Medicaid
Services in the United States. It can be hard to
imagine now, but in nineteen sixty five there were no
national health plans. Only half of all senior citizens were covered.
(00:47):
The Medicare and Medicaid Act of nineteen sixty five changed that,
and this July we celebrate its sixtieth anniversary. Here to
join me is doctor Mehmet Oz. You're looking Doctor Oz.
Speaker 2 (01:01):
Not only do you look beautiful as always, and I
have to admit I was enthralled with your Sports Illustrated cover,
but I love this little studio because it's perfectly placed.
Like everything Arthur Stewart does, You've taken the ideal location
at thirty Rock and the art deco elements of it.
To me remind I should remind all of us of
how important story is to our country, because when this
(01:22):
building was being built almost one hundred years ago, the
stories we were telling ourselves are very different from the
ones we're telling now. And part of why I think
the story of Medicare Medicaid is so important is that
sixty years ago they had an audaciously big idea create
this backbone of the social safety in that that maybe
for the first time, could offer the kinds of support
you'd want to give folks who work their whole life
(01:43):
and contributed to society. You'd have a way of giving
people a hand up if they're having trouble in life,
and folks who were disabled likewise would be supported. It
was a very It was a kind but also classically
American thing to do. Great people are defined and we
define ourselves being great, so we should do it well.
Speaker 1 (02:01):
Many people then had trepidation about the government paying for
health care. What have we learned about how coverage has
impacted health outcomes?
Speaker 2 (02:12):
Well, having coverage gets you the care you need in
a timely fashion, and compensating the systems that provide that
affairly also make sure that you can keep reinvesting in
the healthcare system. But we have run a follow some
of the original beliefs of the founders of Medicaid Medicare.
I remember Medicaid was and then signing the law by
Lynnan Johnson, a Democrat. His first patient, the number one
(02:34):
patient on Medicare in the country was Harry S.
Speaker 3 (02:36):
Truman, a Democrat.
Speaker 2 (02:37):
They had tried to do something similar fifteen years earlier
and can not been able to get it through Congress.
Speaker 3 (02:42):
But the creation of this.
Speaker 1 (02:43):
And then President Kennedy worked on it also for a
short time.
Speaker 2 (02:47):
He did and this of course his life was cut
short so he couldn't complete that promise. But it does
take me back to the quote that Hubert Humphrey, who's
in that signing photograph. By the way, Hubert Humprey was
a senator from Minnesota, ran for president.
Speaker 1 (03:00):
Knew him, you know who I did. I used to
go to Washington to visit with him.
Speaker 2 (03:04):
But Hubert Humphrey has a quote on the building named
after him where Bobby Kennedy myself the head of an HFDA,
all of our offices are located there. And the quote
to the left as you walk in the building it's in.
Marble says it is the moral obligation of government to
take care of those, and he uses light as a
metaphor moral obligation in government to take care of those
(03:25):
at the dawn of their life. Those are the children,
those at the twilight of their life, the mature, and
those living in the shadows. Now think about that for
a second. Fifty three percent of kids in America when
they're born in the poverty are covered by Medicaid or CHIP,
which is the Children's Health Insurance. All seniors if they
wish it, could have Medicare at age sixty five. Others
can get it as well if they have disabilities. And then,
(03:46):
of course people living in the shadows, of those people
who have not been blessed with good health and for
one reason injurygue birth, have a disability of vulnerability that
hinders their ability to participate in the workforce. That was
the original population for whom this program was created. And
I think of how precious it is and how important
it is for us to preserve these programs to keep
them healthy, which is why you once in a while
(04:08):
have to make some tough decisions when it looks like
there's been fraud, waste, and abuse that's taking the federal
taxpayers dollars and spending it elsewhere.
Speaker 1 (04:16):
Well, let's start with Medicare and Medicaid. Who is eligible
for medicaid and what exactly is medicaid. Let's do the definition,
because I think people are confused. The more we talk
about big cuts in Medicaid and Medicare, everybody's getting frightened,
(04:37):
but nobody really realizes exactly what these very large programs
provide and what they do and why they're here. So
what is medicaid?
Speaker 2 (04:49):
And just to they have one's fears aside, we're putting
two hundred billion more dollars into medicaid and Medicare is
not being touched at all. Let's go through these. Medicaid
is a state program that's really important. It's run by
the states. They decide who needs help in their states.
That's a wise thing that the government does because states
know their own people better than the federal government. And
(05:10):
in an effort to try to make sure that people
took care of the system on their own and gave
it to the patients, to their citizens who needed it,
and then not the citizens who don't deserve to be
on Medicaid states run it, but the federal government picks
up part of the tab. Yeah, how much it depends,
and each state's different, but roughly seventy five percent of
the money that goes to a medicaid patient is paid
(05:30):
by the federal government and one quarter paid by the state.
Now this is important because the state can always spend more,
and by doing that forced the federal government to contribute more,
because that's the deal.
Speaker 3 (05:41):
You pay a quarter, we pay three quarters.
Speaker 2 (05:42):
If you want more money for your medicaid system, just
put more money into it and we'll match you three
to one. What's happened over the last few years, and
this has got worse during COVID because people began to
game the system. Governors and their health systems are smart people,
they said, you know, instead of it being twenty five
percent from us and seventy five percent from the federal government,
there are ways we could pack the system so it's
(06:03):
actually becoming eighty five percent from the government fifteen percent
from us, or we're going to pay for things that
the federal government didn't want to pay for. I'll give
you a couple examples. Illegal immigrants are not covered under medicaid.
If the state of California wants to provide illegal immigrants
with full health care, including dental by the way, which
Medicare patients don't even get. Then they shouldn't be able
to charge that to the federal government, but they had
(06:25):
been in the prior administration. In an analogous fashion, if
you can create a fictitious way of pretending you're having
expenses in your Medicaid program and pretend that you're spending
money in a way that gets the federal government to
match it even though you didn't spend the money, you're
cheating the system. It's legal, by the way, it's called
legalized money laundering, but you're able to do it and
(06:46):
pull more money down. These were rules that were changed
fairly dramatically and allow these gaps. But I'll give you
one very concrete example, Martha, this will speak to you.
Speaker 3 (06:54):
There was a rule passed last year.
Speaker 2 (06:56):
Again, this is part of what was changed in the
one big beautiful law that allowed Medicaid patients to pay
their doctors through the government three times more than Medicare patients. Remember,
Medicare is for older people over sixty five who are retired,
and so that doesn't make sense because if you paid
into Medicare your whole life, pay two point nine percent
(07:17):
tax in every check that you had. If you look
at your stub of your paycheck gills and you'll notice
it if you're still working, but you paid into it
your whole life. When you retire, the deal is you
get health care. But if I tell you, yeah, you
get health care, but I'm not going to pay your
doctor that much. I'm going to pay them only a
third of what a able bodied person on Medicaid pace.
You're actually limiting care to older Americans in order to
(07:38):
super subsidize it to folks who are on Medicaid who
aren't working. And that's a major challenge because now the
government is doing things that I don't think morally are defensible.
Everyone should be treated equally, right, Medicaid should not get
more than Medicare or less than Medicare.
Speaker 1 (07:52):
Which is the rule, so that Medicaid is for is
run by the states, primarily for.
Speaker 3 (07:57):
The folks, children, for old people, disabled people.
Speaker 1 (08:00):
That was the original or economically challenge.
Speaker 2 (08:02):
Right then they added a group of people in the
last ten to fifteen years. Who are the able bodied
people who aren't working. Now, who are these folks.
Speaker 1 (08:13):
Well, it's the fun unemployment.
Speaker 2 (08:14):
You mean they're there, Well, they're unemployed, but they're also
not seeking work.
Speaker 3 (08:19):
They're not trying to work.
Speaker 2 (08:21):
And that's a big issue for us because we think
that's bad for you as an individual. If you're unemployed
and not working, you should try to get a job.
If you're able bodied. Again, i'm not talking about people
who have vulnerabilities. They can't leave home. They're injured there
you know, don't You don't go to work with a
broken leg.
Speaker 3 (08:34):
Deal with that issue.
Speaker 2 (08:35):
But in the case of able bodied individuals, we have
data on this. They spend six point one hours a
day watching television or doing leads activities, just hanging out.
And I think that time is better spent getting an education, volunteering,
trying to get a job. And so it's not really
a work requirement, it's a community engagement requirement. Of this
(08:55):
law says, please get out of the home. You would
not put on the planet to sit home and watch television,
play video games. You go prove that you've got agency
over your future. And we're going to nudge you to
do that, and we're going to offer you a deal.
The deal is very similar, very clear, if you try
to get a job or get education or volunteer.
Speaker 3 (09:13):
You get pre health insurance.
Speaker 2 (09:14):
If you're not willing to leave home and do any
of those things, then we're not going to give you
free healthy You get.
Speaker 1 (09:18):
Free health insurance under Medicaid Medicaid. Okay, Now what about Medicare?
Who's eligible? What is it? How many people use it?
Have it? So?
Speaker 2 (09:29):
Eighty million people are on Medicaid or CHIP the prior group,
there's sixty eight million people on Medicare, which are people
over the age of sixty five. In general, there's some exceptions,
but over sixty five who just by reaching that birth
date are eligible for Medicare. And Medicare will cover your hospitalizations,
it'll cover your doctors appointments that it will also cover
your medication expenses.
Speaker 1 (09:50):
But with doctors who are in the system.
Speaker 2 (09:53):
Most doctors, the vast majority are they take Medicare because
it's such a huge number of their patients.
Speaker 3 (09:58):
But there is a copay.
Speaker 2 (10:00):
There's a contribution that people on Medicare might have to make.
If you don't have money, you don't have to make it.
But if you're able to pay into it, then we'll
collect some money from patients not more than twenty percent
of the bill in order to make sure that the
system is able to provide the right incentives.
Speaker 1 (10:15):
Well, now, with the aging population, Medicare is going to
be under even more pressure to provide for more adults
over sixty five. That percentage of Americans is growing exponentially
in the United States. I founded the Center for Living
at Mount Sinai Hospital dealing with patients over sixty five,
and we've seen a huge influx and people seeking help
(10:40):
because they're over sixty five. And the numbers are quite
astonishing that our population is really aging. So what are
we going to do with those people?
Speaker 2 (10:50):
We believe that there's going to be ninety million people
on Medicare over the next decade right now.
Speaker 1 (10:55):
I believe that too.
Speaker 2 (10:56):
And here's what's going to save us. Productivity in medicine
is quite low. We're not nearly as efficient as the
other major industries in this country. And one of the
reasons for that is there's no modernization movement in medicine.
The information flow is very is very calcified. So as
an example, sixty years ago, when you went to get
(11:17):
a doctor's appointment, you'd call, you wait on hold, talk
to the secretary maybe give some information and they book
your appointment. Today you do the same thing. It's not
like you go on your computer and book the appointment.
It's all done. Your insurance card's there. Even though we
have all that now, liken that to a credit card experience.
You go to get a credit card, you know, put
you put it into the machine, don't just tap it.
Now your phone and you can get your latte, your coffee.
(11:40):
But we should be making those sort of seamless transactions easier.
But more importantly, if we actually had data flow information
flow in Medicare and medicaid, then I'd be able to
give you empowering information. I can say, hey, Martha, you
know I know for your medical records, and you'll allow
me to do this.
Speaker 3 (11:56):
Of course, that did.
Speaker 2 (11:58):
You have a rash on your back like you were
given an appointment for it? Did it get better? If
it didn't get better, it could be a disease called X.
You should go see a doctor. Here's one that can
see you. And so by empowering you both to prevent
illness but also stay vitally engaged as you have been,
we can use this information flow to support you more importantly.
Speaker 1 (12:17):
So why hasn't that happened? Is it the lack of
competent medical people enough doctors? Are enough nurses, enough people
who are answering the telephones? Or can this be done
over with AI?
Speaker 2 (12:30):
AI can definitely help with this a lot, and we
are blessed. It's a generational opportunity to bring AI to
the forefront, not going to replace doctors and nurses, but
augment what they can do, do it more effectively. I
don't think we had the technology until recently to be
able to do this. But also there's an inherent distrust
in the healthcare system. Doctors don't trust insurance companies. Insurance
(12:51):
companies don't work with hospitals, so the information was purposely
not designed to flow back and forth effectively.
Speaker 3 (12:57):
That's changed.
Speaker 2 (12:57):
We now have laws for it's called for operability. You
have to be able to translate your data to other groups.
But also you need transparency. If you go to a
drug store right now, as an American, you don't know
what the drugs cost. So you show up the drug store,
you order, you take your prescription. The doctor may have
let you know a little about the drug, but never
shared the cost. Because doctors don't know what it costs either.
(13:18):
And now your pharmacist says, well, it's you know, three
thousand dollars a month. You say, I can't afford three
thousand dollars a month. You don't take the pill. One
in three times a prescription goes unfilled by the patient,
and money's often a driving factor. You should not have
to decide between groceries and your medications.
Speaker 1 (13:32):
No way. But I mean it seems like the administration
of such programs was adequate. Things could run better. I mean,
if if I need a certain kind of drug and
I should be told where to get it. I took
a prescription to a very well known pharmacy here in
(13:53):
New York City, and here I am a woman over
sixty five. I take this prescription. The prescription was four
hundred and fifty dollars, and I said, what are you
talking about? I took it to my local pharmacy in Katona,
New York. It was fifty five dollars. Okay, So what's
(14:15):
the story there?
Speaker 3 (14:16):
Makes you mad, doesn't it?
Speaker 1 (14:17):
No? It makes me very worried about everything. So the
reason that happens is a four hundred dollars difference for
the same silly drug exactly, And if you went to overseas,
it was probably cheaper. And this has been a so
what do you do about that? Well, we're asking, first
of all, there's transparency. When your prescription is put into
(14:37):
your phone by your doctor, you'll see that the Katona
pharmacy is fifty three dollars, the one downtown Manhattan it's
four hundred dollars. The one at Downtown's not gonna get
any business. They're going to drop their prices. The complexity
around drug pricing was affected years ago because they created
a mechanism called rebates. Now rebates is basically kickbacks, but
insurance companies working with pharmacy benefits management companies are allowed
(15:00):
to work side deals with the employer and with the pharmacies,
so that you, the employee, don't actually know what the
drug costs. If you try to go around it, you
can get hurt. If you work with it in the system,
you might have to pay more than you should. So
we want to take all that away and just say
it's transparent. Here's what the drug can cost in different pharmacies.
I don't care what else is going on. This is
actually take it can certainly help us with that and
(15:23):
eliminate the need for a person to do that.
Speaker 3 (15:27):
Right, it's hard to do with that AI.
Speaker 2 (15:29):
But AI can't do it unless people are forced to
share their data. We are doing that's that's a law
now and so we're pushing for that. And again now
they don't have any excuses because it's required by law
and this technology that allows them to do it.
Speaker 3 (15:41):
It's also reached a feverish pitch.
Speaker 2 (15:42):
I mean, there's blood in the streets here in New
York right if people we should be we should be listening,
We should be listening before.
Speaker 1 (15:48):
Yeah, we have to pay attention and make sure that
people are taken seriously and are treated seriously. So, how
does life expectancy in the United States compare with other countries?
How are those numbers different today than in nineteen sixty five,
when when our President Johnson was so astute to pass
(16:09):
this fantastic bill.
Speaker 3 (16:11):
Well in nineteen sixty five.
Speaker 2 (16:13):
In fact, until nineteen ninety, life expectancy in the United
States was very similar to that in Europe. And since
then we have dropped off about five years. I'll say
that again. It used to be the same even forty
years ago, but over the last few decades, life expectancy
in America has plummeted. There are a bunch of reasons
for that. Opiate addiction problem has become an issue, But
(16:34):
the bigger theme that I like to point focus on
is chronic disease. We are tolerant of it. We've become
normalized to chronic illnesses. You're not supposed to have hypertension, diabetes, obesity, dementia,
you know, several heart attacks for stans.
Speaker 3 (16:47):
You're not supposed to live a life like that.
Speaker 2 (16:49):
But we've gotten very comfortable feeding ourselves, treating ourselves in
ways that allow these chronic conditions to arise. The reason
that's critical, Mark is that one of the ways we
allow Medicare and Medicaid to st much further is by
having a healthier population. You cannot take care of folks
who are trying to hurt themselves. It's a shared responsibility,
and the irony of the whole situation is, of course,
(17:10):
it's in your best interest to stay healthy. But when
we look at the healthcare expenditures of the country, about
two thirds are driven by chronic illness. And it's come
to a point now where across the board there's a
recognition that we need to make America healthy again. And
part of the subtlety of that message is that the
mental health issues that hold so many back from doing
(17:32):
what's right for themselves have to be addressed, and we
don't have enough of those practitioners, especially in rural parts
of the country, and that's where AI might play a
role because the avatar's right now. I looked at one
recently that the Cleveland clinic brought me. I mean, you
can't tell this is not a doctor, and they're asking
you very subtle questions, Martha, not why did you not
take the medication, but was there a problem with your
(17:54):
daughter that upsets you so you didn't take your medication?
I mean, very pointed, because they know enough about you.
Speaker 1 (18:00):
And they this is done on zoom or something like
that on.
Speaker 2 (18:03):
Zoom video, and you see the avatar's face and they're
listening to everything you're saying in the tone of your voice,
and how much stresses in that tone, and other things
you may have said in the past that may have
you know, if you're really paying attention to somebody, the
things you would know about them. And that's a good
sign because that message could take an hour two hours
to get out. Then you get that message in the patient,
you share with the doctor.
Speaker 1 (18:23):
People have more information nowadays about healthy diets and lifestyle
than ever before. Why is chronic disease continuing to rise.
Speaker 3 (18:33):
Information is not the same as motivation.
Speaker 2 (18:35):
There are cousins, But if you look at the psychology
of change, about seventy percent of people are pre contemplative,
which means they're not even thinking of changing. So I
give you a healthy option and an unhealthy option, and
because something else going on in your life, you sell sabotage.
Speaker 3 (18:52):
And that happens all the time.
Speaker 2 (18:53):
It's not just about discipline, it's about creating an environment
where it's easy to do the right thing. That's why
focusing on the quality of the food we have in
America's soot and the additives and like, a part of
it is acknowledging that it's a shared responsibility. We all
have Medicare, Medicaid will take care of you, but you've
got to help. That's why, you know, when I point
to Arthur's Stewart, I say, this woman, she just reinvents
herself by the day. She's always has the vitality that
(19:15):
if people appreciate the importance of longevity, they'll want to
have and I think I don't.
Speaker 1 (19:22):
Use the word reinvent. I use the word evolve.
Speaker 3 (19:25):
Perfect.
Speaker 1 (19:26):
Yeah, I evolve because change is good. I like change,
and I think it's very important for the human the
human condition to adapt to change and evolution is like
all important.
Speaker 2 (19:40):
And we evolve for a reason. It keeps us alive.
And I think it's that's as an excellent addition. That's
a good thought, Martha.
Speaker 1 (19:46):
Continue to use it, please, Yes, I.
Speaker 2 (19:48):
Will use evolve. I want people to continue to evolve
in their lives.
Speaker 1 (19:51):
Exactly what is the government doing to encourage and support
medical education and encourage young people to go into the
(20:12):
medical field. Are we doing anything for that?
Speaker 2 (20:14):
We are in this one big, beautiful law, have a
fifty billion dollar fund to modernize to change the infrastructure
of how medicine is practiced right now. And a part
of that is the worst practice but learn Yeah, but
demandpower is a big problem. So we don't have enough nurses,
we don't have enough health professionals to extend to help doctors.
(20:36):
But you mentioned something earlier on navigators. This is an
important part of the bill as well. There are parts
of the country where you're not going to have enough doctors,
but you could have navigators, health coaches, people who are
between a doctor and a patient who can translate ninety
percent of what the doctor's trying to get you to
do to action, like get you out of the house,
get you eating better. But this is something that I've
been thinking about to talk to you through. Nutrition in
(20:59):
medical school is taught atrociously. In fact, I ran for
president of my class and ultimately student body at Penn
where I was in medical school, under the platform that
I would bring nutrition classes back into medical school and
we did. I won, and we did. But it needs
to be culinary medicine. It needs to be sexy cool,
Like don't just tell me to eat tomatoes. Tell me
(21:20):
that if you mix tomatoes in a stew it heated
up with oil, you release the lycopene that's naturally in there.
Speaker 3 (21:27):
That's also called pasta sauce.
Speaker 2 (21:28):
By the way, pasta sauce actually provides more of the
nutrients of the tomato, and by removing the skin, you
remove the inflammatory elements. So our ancestors learn much about
the secrets of eating well, not just from a taste perspective,
but also it's medical benefits.
Speaker 1 (21:44):
Well. I totally agree about eating habits or are bad
in America and could be greatly improved. But we need education.
We need people to listen, we need people to teach.
And I'm finding that less and less satisfactory. And so
what are we going to do about it? How are
we going to encourage it?
Speaker 2 (22:05):
Well, we are actively going to be recruiting young people
to go into health profession in vulnerable parts of the population.
I'll speak to Appalachia in specific, because I know the
area well. The number one job young people want to
do is healthcare. Why because it's the only job they
see in those communities.
Speaker 1 (22:20):
Now. Doctor Harvey Sloan, he's a friend of mine. He
ran for governor of Kentucky a long time ago. He's
still an active practitioner, and he's very, very worried about
Appalachia and about the way that people there are very
ignorant about good health, about taking care of themselves, and
also worried about the health centers, the community health centers closing.
(22:45):
So many of them have been underfunded and are closing.
So what are we going to do about that?
Speaker 2 (22:50):
The fifty billion dollar bill very explicitly talks about community
health centers explicitly.
Speaker 3 (22:54):
I mean those words are in there.
Speaker 2 (22:56):
It's well appreciated by those of us who study this
that we have to fund community health centers, federally qualified
centers better there.
Speaker 1 (23:03):
What's going to happen I worry. What I worry about
is like the rural hospitals. I worry about what's going
to happen with massive cuts in the in the.
Speaker 2 (23:13):
Remark that we're putting two hundred billion more dollars into
the system, and then in addition.
Speaker 1 (23:18):
Is it going to go to maintaining healthcare is in
as many places as possible.
Speaker 2 (23:23):
The fifty billion dollars extra money was designed. It's called
the Rural Transformation Funds. It's specifically designed for those hospitals.
Speaker 1 (23:31):
I'm going to read this bill. I'm going to read,
please do of this bill.
Speaker 2 (23:34):
You'll see that one thing is ready to cover a
lot of the money that goes to the healthcare system
goes to well funded institutions that have lobbyists. It doesn't
go to the rural hospital that you know you were
dependent on when.
Speaker 3 (23:47):
It's a kid.
Speaker 2 (23:48):
Those hospitals get left behind because they don't have the
same powerful connections to pull down from the piggybank. And
that's one of the things we realize only five percent
of the money that was being used for these so
called state directed funds that are designed to help.
Speaker 1 (24:00):
Hospitals get into rural hospital Wow, only five percent difference.
Speaker 3 (24:04):
Well the fifty billion dollars it's designed for them.
Speaker 1 (24:06):
Okay, well please, we need that desperately. I have lots
of friends in those places.
Speaker 2 (24:13):
We don't have enough primary care practitioners. Martha my son
graduated from Columbia Medical School this past month.
Speaker 3 (24:18):
He's an intern.
Speaker 1 (24:18):
Congratulations, thank you.
Speaker 3 (24:20):
They pay all the tuition.
Speaker 2 (24:22):
Now, if the parents have money, we have to pay
if but for the eighty percent of the kids whose
parents don't have enough money, it's very expensive to go
to medical school. It's paid for by the school completely free.
It's also true in n Why you other schools around
the country. Why because they argued that young people are
so much in debt by the time they finish training,
they can't become primary care practitioners. Unfortunately, despite the fact
(24:44):
that they provided that, there was not a significant change
the number of kids going to primary care. It is
an underfunded place. So we need to make the experience
a better experience. People leave them.
Speaker 1 (24:53):
So what's primary care? What's in turn care? What's general
practitioner care.
Speaker 3 (24:58):
This is a beautiful question.
Speaker 1 (25:00):
These are questions that nobody seems to know the answers to,
and we have to know.
Speaker 2 (25:04):
Well, those three terms overlap frankly, and they are used interchangeably.
Speaker 1 (25:08):
Internes is they're but it's not accurate.
Speaker 3 (25:11):
No, it's not.
Speaker 2 (25:12):
Interness are trained to practice internal medicine. Some of them
will become primary care providers. They'll go back and deal
with community health issues and serving the capacities of a
primary care doctor. General practitioners, likewise, are trained to do everything.
They can deliver babies and prescribe medications and do surgery
sometimes so they also can provide primary care. But the
(25:33):
key Phraser's primary. You want to be there first. You
want to be able to prevent the downstream problems. I'm
a heart surgeon. By the time you come to me,
you've been through a lot of doctors and probably made
some mistakes, which is the reason your arteries are blocked up.
And somewhere along the line, the system did not help
prevent you from meeting my services.
Speaker 3 (25:49):
That's a failure.
Speaker 2 (25:50):
I went into television in fairness because I thought I
should put myself out of business. You don't want heart
surges like me doing so much surgery, And I was
probably doing the most surgery in New York at Columbia
when I was practicing.
Speaker 1 (26:01):
But that's what move was the last time you did
an operation.
Speaker 2 (26:05):
Just before I ran for office for the Senate office
in Pennsylvania.
Speaker 3 (26:09):
So it's been three years now.
Speaker 1 (26:10):
So are you Are you relieved? No?
Speaker 3 (26:13):
I love medicine.
Speaker 2 (26:14):
Medicine is the best job from a group perspective, because
you look at someone's into someone's eyes who you're going
to help, and you make sure they know you're there
for them, and they know that they trust you on that,
and then you go off embark in some treatment that
with their big stakes. I mean, every single day you
feel rewarded. But the best job I've ever had is
this job because in this job, just like in the show,
(26:36):
just like in medicine, I have a group of very
dedicated people working around me. Their mission driven one hundred
percent focused on improving the healthcare of the American people.
They give up a lot to come in. We've got
thousands of wonderful, highly skilled individuals who can do every
single actuarial tables and analyzing what the right rates to
pay for different insurance. But we also have fraud investigators
(26:57):
and people who are world experts at making sure we
can get the right doctors and the right now people
in your apartment.
Speaker 3 (27:03):
So we have.
Speaker 2 (27:04):
Sixty five hundred people roughly in who work for me directly,
and we have forty thousand more who work for me
through contracts.
Speaker 3 (27:11):
So it's getting, you know, the mid forties.
Speaker 2 (27:15):
That's a lot of people, and that's why I'm sending
a very clear message that you should be able to
accomplish the goals you came here for.
Speaker 3 (27:21):
Matter.
Speaker 2 (27:22):
That's the biggest feedback I'm getting right now is a
lot of folks within the department say, I came here
to make a difference, and now there's a chance because
of technology advances, because we've got a very focused administration
on this topic, and because the American people are demanding it.
This is a tangent to point you're making earlier. We
have to make it easier to be healthy in America.
(27:43):
If you go to Europe and eat bread, it doesn't
seem to affect you the same ways if you eat
bread in America. It's a mundane example, but I hear
it so commonly that I would share it. You know,
you eat a week of pasta in Italy, you don't
gain weight.
Speaker 3 (27:55):
Here, you have one.
Speaker 2 (27:56):
Pasta dish and all of a sudden you're bloated. And
if it's the portion size, and you know, the other
factors could be involved. But there is also the possibility,
and we should kick the tires on this, that there
have been changes to our food supply that we can't
ignore it and maybe it's causing other problems that we
got to address. And that's it's a loud voice that
is being now I believe heard.
Speaker 1 (28:18):
But the other thing is the price. Yeah, the prices,
you have to do something about that. I go and
now when I used to spend maybe forty five dollars,
it's one hundred and ninety dollars for the same amount
of stuff. That's a very huge burden on the American family.
Speaker 2 (28:36):
This is the unfair tax of inflation. And this was
a criticism that was being thrown around during COVID.
Speaker 3 (28:42):
We took emergency measures.
Speaker 2 (28:43):
And we can spend the whole time talking about COVID,
what was done right, what was done wrong, But you
take emergency measures that caused inflation. It's the folks who
are struggling to pay the biggest price, and that's why
it's important to be physically responsible. Some of the discussions
we're having about Medicator a good example. The cowardly thing
to do is to just let the just run the
way this. The brave thing to do is to say,
(29:05):
I am charged with protecting this organization. I want it
there for people who might be struggling in the future.
To do that correctly, we have got to get our
arms around the budget, and that's best done by making
things more efficient, but also making sure people steal from
the kiddie.
Speaker 1 (29:19):
But that is also the scariest thing for the American
public when they hear budget cuts, budget cuts constantly every
single day from the minute of our president took office
till now, the budget cuts have terrified people. And I
would hope that maybe people like you could lay their
fears somehow, and a program like this could help them
(29:40):
understand that what you're trying to eliminate is the bad stuff,
not the help that we all need so desperately.
Speaker 2 (29:49):
There's an approach to changing organization that's not working at
high speed, and it is to go in there and say,
who doesn't want to be here, please leave and then
who can tell me what they do? And if you
can't tell me clearly what you're doing, you probably should
leave as well. These seem harsh, but in fairness, having
run organizations in the past, thing you have as well.
When people don't know the answers to why you hear
(30:10):
they probably aren't in the right job.
Speaker 3 (30:12):
You're probably helping them.
Speaker 2 (30:13):
So much of what we're doing is just asking people
some tough questions and getting them to be serious about
their responses. But the beauty of this whole process is
sometimes you find things that should have been discovered earlier.
Speaker 3 (30:24):
A week and a half ago, I.
Speaker 2 (30:26):
Was on a dais with the folks from the Department
of Justice and we announced the largest bust ever of
a fraud ring in America and it was run by
a foreign government. Foreign international governments are attacking us, and
they attack Medicare. Why because we have a huge bullseye
on our side. We're a massive entity. I mean, if
you put it all together, we're about one point eight
(30:47):
billion dollars Medicare and Medicaid and chip and everything. So
they when you put those all together, you have a
big target that people can go after it. And the
way you hack it is to get someone's Medicare beneficiary number.
So you have what I now have on had my
birthday last month. So if someone calls me up and says, hey, listen,
I need to get your number to do something. Don't
give it to them, by the way, because we would
never do that. But when they get your number, they
(31:08):
can pretend you're buying things, and they can charge the
government a wheelchair, you know, a special hospital bed. And
then foreign countries get access to your number, they of
course weaponize it and they fifteen billion dollars mark.
Speaker 3 (31:21):
That's a lot of money.
Speaker 2 (31:22):
And we were able to stop twelve billion from going
out the door, but they stole three billion. And when
it leaves the door, it goes to the Cayman Islands
or a moscow, goes overseas.
Speaker 3 (31:30):
You can't get it back.
Speaker 1 (31:32):
You're enrolled in Medicare yourself, yes, And do you have
a private coverage that supplements the Medicare program?
Speaker 3 (31:39):
I do.
Speaker 2 (31:40):
I have federal employee insurance now, so I don't use
my Medicare. I'm enrolled so that I'm ready for it.
There's a couple types of Medicare. The Medicare Part A
pays the hospital bill, and so if you have private
insurance that always pays the bill first. The taxpayer comes last.
They don't have to pay the bill unless there's no
money left. So hopefully you and I will never use
(32:00):
that Medicare Part B is to pay the doctor's salaries.
I have insurance, so to you, so that pays our
doctor's insurance. But when you get to sixty five, if
you don't have insurance, it's given to you. And through
that program, and then there's a drug benefit, you can
get your prescription medications supported by the federal government.
Speaker 1 (32:17):
And not totally paid for, but supplemented.
Speaker 2 (32:19):
After two thousand dollars is totally paid for it until
two thousand dollars, you.
Speaker 3 (32:22):
Have to contribute.
Speaker 2 (32:23):
There's the value of people paying part of the bill
because you don't spend other people's money the way you
spend your money. So we want you to have some
skin in the game. And there are other reasons for
that too. By the way, if you don't have any
money in the game, people steal your number and pretend
they're you and charge massive amounts of money and you
never know about it.
Speaker 1 (32:39):
What percentage of Americans have private supplemental coverage? People who
have already have Medicare, So if you can.
Speaker 3 (32:46):
Afford it, you'll probably buy supplemental coverage.
Speaker 2 (32:48):
So more than half, there are millions of people who
don't have enough money to afford additional coverage, and the
government will adjust pricing based on that.
Speaker 1 (32:57):
Well, the average American relying on Medicare have coverage as
good as the congress people and the senators voting to
change the existing levels of coverage.
Speaker 2 (33:07):
The federal insurance that I just got it three months
ago seems to be similar to what Medicare would pay.
I don't know the answer for that in every situation,
but most of us WI end up in Medicare. I
fully intend when I finally hang up my laces in
my shoes, my cleats.
Speaker 3 (33:24):
You're shingle, my shingle, that I would go on Medicare.
Speaker 2 (33:27):
But it is truly the backbone of this social safety
and that out of the country it works well. As
a doctor, I took Medicare unwaveringly. My Medicare patients got
the exact same care that my privately insured patients and
my Medicaid patients.
Speaker 3 (33:39):
That's the other thing.
Speaker 2 (33:40):
We're professionals, right, Doctors will provide excellent care the matter
of the coverage, but there needs to be some coverage
to get you in the door.
Speaker 1 (33:56):
So when Medicaid started in nineteen sixty five, about seventy
percent of people have annual doctor visits. Today, ninety five
percent of the people take annual exams. How do you
expect those numbers will be impacted by cuts from the
recent legislation.
Speaker 2 (34:13):
So I'm going to quibble with one data point. Nine
percent of people are eligible for annual visits, but they
don't take it.
Speaker 3 (34:23):
Now, this is important point for me.
Speaker 2 (34:24):
If I give you something for free, it's because I
think it's important. Seeing your doctor is critically important as
you get older, especially, but we think it's between maybe
a third of people are getting their primary care doctor visits.
Speaker 3 (34:38):
Most people do not.
Speaker 2 (34:39):
And so what we'd like to do maybe is use
your phone to be your communication tool. Maybe instead of
making you take a day off and go to the
doctor's office and find stuff out you don't want to
hear about, at least we can you know, your doctor
can call you, or you can dialogue with the healthcare
system and say, listen, I feel fine, I don't want anything,
or I don't want to go in there, But I
did have one question and just to get the dialogue out.
Speaker 1 (35:00):
I think we can modernize that enough that way.
Speaker 2 (35:03):
That is a primary UH instruction that I've given to
my entire team within the year. And we have a
big event happening on the thirtieth of this month. We're
going to announce the results of a large national request
for information that we put out. It's one of the
first things I did as the administrative for cmsaleers working
on Palenteer and other major companies. We're all working on
(35:24):
this RFI and you know what we said, We're open
for business, come help us. And you know what the
word meek means, Martha, like the meek sean here at
the earth. Yes, so I always thought it meant weak,
you know, shy, It could be shy, but the meek
also means in the Bibiblical sense that you have a
sword that's sharp, and you decide to sheathe it, and
(35:46):
so you decide not to attack each other, be shy
to use it. And so that's what we're asking all
these tech companies to do. The biggest AI companies are evolved,
the biggest health technology companies, biggest hospital systems, insurance companies,
but just swards away. We got to figure this out, guys,
because the system doesn't work the way it is. Healthcare
expenses are increasing three percent faster than the economy, almost
twice as fast as these economy. That doesn't make any sense.
(36:09):
We're not getting our money's worth. Life expectancy is dropping,
and yet it's more expensive.
Speaker 1 (36:13):
Is the life inspectancy in America? Now? For a male?
Speaker 2 (36:17):
I think the average age I should look it up
before I've done this podcast is in the high seventies.
Speaker 3 (36:21):
It used to be in the low eighties.
Speaker 2 (36:23):
Yes, and uh, and we are losing traction and a
lot of it again is because if young males are
killing themselves by mistake with opiates or sometimes you know,
they're taking their own lives and they're frustrated in life
and they're not engaged, then you're actually those that hurts
the system a lot.
Speaker 3 (36:39):
Obviously ethically, it hurts the system.
Speaker 1 (36:41):
And hurts the averages. Of course, some estimates say seven
million people will be dropped by Medicaid without insurance, won't
they just end up in emergency rooms at text payer cost.
Speaker 2 (36:52):
So we actually have an experiment that was inadvertently done
on this under the Biden administration they were under a
lot of pressure because there's so many pe people had
wrongly joined Medicaid that they went through the roles and
they took fifteen million people off Medicaid because they were two,
their incomes were higher. The incomes are not correct. They
should have been another program. They lived in multiple states. Again, up,
(37:15):
if Martha Stewart lives in New York and lives in Connecticut,
which state gets your money? They don't both get paid
full fare. The federal govermentsion paid both. So fifteen million
people dropped off. The ninety percent of people. Of those
of that fifteen ninety percent of them did not become uninshort.
So here's the real question, Martha, and the reason I
reject that number. If I give you a deal, I
(37:36):
come and you get home at night and someone's sitting
on your sofa right and hasn't moved from the sofa
all day long, and you say, listen, enough's enough. You
got to go out and try to help with the community.
So go volunteer, get an education, and go go try
to get a job. If you do any of those things,
I'll give you free health insurance. But if you're not
willing to leave the couch. I'm taking your health coverage away.
That's a pretty fair deal. Now, I have confidence in
(37:57):
the American people they will react favorably to that. They
will go out and go try to do one of
those things, get a job and get educated, etc. But
the Democratic criticizers of the of the law say, no,
they're not They're just going to sit there and not
take the job offer and therefore become unemployed. I know
that's not a math equation. That's a behavioral psychology question,
(38:18):
and people at home should be listening to that question carefully.
If offered the deal free health insurance in return for
community engagement, would you take it? And here's the real
deeper issue that I think I want to bring up.
It's not good for to sit at home watch six
hours of television and doing nothing every day.
Speaker 1 (38:34):
Yeah, and on the average age of America.
Speaker 2 (38:39):
So go out there and change the world. That's why
you were put on earth. You know, make a difference.
You do things that make that show you have agency
over your future. And I think people will take that challenge.
And that's why I believe confidence the American people will
reign supreme.
Speaker 1 (38:52):
Well, I hope you can keep up that confidence and
show it to us because it demonstrated somehow, because I
think I think people are feeling Are you depressed?
Speaker 2 (39:01):
Well, we have three years before the parts of this
bill are impacted. The work requirements more than a year
and a half away. In the meantime, I've got fifty
billion dollars to invest transforming healthcare for the better and
to make a lot of the changes that all of
us across the spectrum desire to have happened. And I
actually think within the health profession there are many people
(39:22):
see an opportunity now to change problems they've been around
for a long time they thought no one would ever address,
just just the beginning.
Speaker 1 (39:29):
Are you out on the road, are you going to
Appalachian looking at these community health centers?
Speaker 2 (39:34):
I spoke to the governor of West Virginia this past weekend.
I've been to homeless shelters. I've been their community health clinics.
I went to Kensington, which is the largest open air
drug market in the country. In Philadelphia, I went to
the West Coast equivalent, which is the meatpacking district, the
Tenderloin district.
Speaker 1 (39:51):
Do you go surreptitiously or do you go with your entourage.
Speaker 2 (39:56):
Well, I don't go anonymously because I can't do that anyway.
But I go there with people in between me and
the patients and talk to them directly. And I've told
some of those stories in public because I want people
to know that I care and I took this job
very important.
Speaker 1 (40:11):
I mean, you have an important job, and we're looking
to you to help maintain a status quo that we
expect as American citizens. That's what we really are hoping.
You posted advice on fighting loneliness. Why is that important?
Speaker 2 (40:27):
I'm so happy you asked that question, Martha, because if
I had to pick the one single most expensive problem
we have in America, it's loneliness.
Speaker 3 (40:36):
And there's a couple of reasons for that.
Speaker 2 (40:38):
People who are lonely because for whatever reason, they haven't
been able to build left long relationships. As you pointed
out as a key to evolving is having friendships. They
feel abandoned, so they're often depressed. But in addition, they
don't have anyone to help them when they do fall.
Because the healthcare system can help you a bit, but
there's nothing like a person helping you get back up,
(40:58):
you know, making sure your medications are correctly given, to you,
or picking them up from the pharmacy, giving a doctor
some feedback if the advice wasn't helpful, getting you to
take realize how important you are and you need to
take care of yourself.
Speaker 3 (41:13):
That's why families are so vital.
Speaker 2 (41:15):
And I say that not based on high level philosophical thinking. Literally,
when you look into the healthcare system and take care
of the vulnerable populations that tend to be more expensive,
that's the number one predictor. I, as a heart surgeon,
would never operate on a patient who did not have
family with them or someone who cared about them. And
I would see patients sometimes it came by themselves and
I'd say this. I'm going to say this because I
(41:36):
love you, but there's someone who cares about you, and
it could be the doormat of your building. You're not
as strange from everybody. And by the way, who am
I going to celebrate with after your operation goes?
Speaker 3 (41:45):
Well?
Speaker 2 (41:45):
If you don't bring someone here, so go home, come
back with somebody, we'll talk and you'll do the operation.
Speaker 3 (41:51):
And that's you know, it works very successfully.
Speaker 1 (41:54):
A friend asks is her information as a medicare patient
going to be accessible to doge in the future.
Speaker 2 (42:02):
DOSE is more interested in the process by which we
help the system, the healthcare system work better. They're not
interested individual people's medical records to try to audit if
you've got good care. I do think you as a
patient might want to use your information, which you own,
it's yours. You might want to have different companies who
are promised to help you and if you trust them,
help audit your information to make sure the right things
(42:24):
are happening to you and their company is doing this
right now. They'll take your health information and say, you know,
we went through everything. It looks like they didn't manage
your diabetes correctly, or we really help you if you
thought about switching out this medication for another less toxic medication.
Speaker 1 (42:38):
Well, you talked about telehealth and how important that could be,
and I hope that works. Everybody seems to have a
phone now, everybody could go online and get advice, and
how many people are working on that.
Speaker 2 (42:52):
Telehealth's a big initiative for us. We have a whole
Digital Transformation group and telehealth has multiple facets to it.
Part of it is having practitioners help, but part of
it is also having AI participate when it's important but
if we can make it work the way we hope,
we'll be able to provide people living in very remote
parts of the country with superb healthcare.
Speaker 1 (43:14):
Now down to some nitty gritties. Okay, what's your view
on vaccines, measles vaccine?
Speaker 3 (43:21):
I would get the measles vaccine.
Speaker 1 (43:23):
Okay. So can't you have any influence on what's going
on in this government?
Speaker 2 (43:27):
Well, Secretary Kennedy says the same thing. This is the
irony about many of these topics. People manufacture stories and
then of course it lives on inside of the minds
of people who consume that media. What Secretary Kennedy says
is very simple. If you love somebody, you double check, right,
what does a parent do they kick the tires?
Speaker 3 (43:47):
Did you really really need to do that?
Speaker 2 (43:49):
So what he's arguing is we have taken for granted
everything we've been told about these products, not just vaccines,
fluoride and water and use of antibiotics and this and that.
Speaker 3 (43:59):
So let's just kick the tires.
Speaker 2 (44:00):
Let's just make sure the scientific data is that's out
there is valid, and if there's not, let's do the
additional research to double check it. In the meantime, business
continues as usual. We still pay for all the vaccines
we you know, we have not changed how the childhood
vaccines are being distributed. But there should be I think
every once in a while an audit of the advice
(44:22):
we give the American people, because what if we're wrong?
Speaker 1 (44:24):
And well, who is monitoring the efficacy of each of
those vaccines too.
Speaker 2 (44:29):
There's active groups within CDC, NIH and even FDA looking
at this. But you know, there's there's many examples where
even doctors disagree about the timing of vaccines. Then even
that could be debated because you know, hepatitis B vaccine
is given at birth. Hepatitis B is sexually transmitted or
(44:50):
intravenously transmitted problems. So it's generally with prostitutes and drug consumers.
Speaker 1 (44:56):
You know, listen, given it birth because because the parent
might have had.
Speaker 3 (44:59):
Well, we checked the mothers.
Speaker 2 (45:00):
The mothers are always every mother gets checked for appatitis B,
so we know the mother doesn't have appatitis BE. So
doctors now start saying, well, geez, you know, I don't know,
maybe can we delay. By the way, I have nothing
about hypatitis B is a vaccine. I got my kids
to get it when they were older when there was
really a risk. All doctors have to have it because
I don't want to get hepatitis. Be's a terrible disease.
But that's the kind of story that when you hear
(45:23):
about it as a doctor, you think, well, geez, you
know there is some flexibility there. You know, we don't
have to do it the first thing out of the womb.
Speaker 1 (45:30):
So fake news is a is a problem with vaccines.
You think there's a lot of fake news.
Speaker 2 (45:36):
I think there's catastrophizing of the process that could be
addressed with blue chip science going back and investigating the
root research that led the much.
Speaker 1 (45:47):
Ends and the people who are getting measles, the kids
who are getting measles are belonging to the religious groups
or groups that don't believe in vaccines for other reasons.
Is that isn't that true?
Speaker 3 (45:57):
That is true?
Speaker 1 (45:58):
Okay? So I mean, so that has to be made
very clear in the press and on television so that
we can understand where we're all coming from. What vaccines
do you think over sixty five should be taking.
Speaker 3 (46:12):
Well, I got the shingles vaccine.
Speaker 1 (46:14):
Yep.
Speaker 2 (46:15):
That's an uncomfortable condition when you get shingles, and I
didn't have any complications with it, So I think that's reasonable.
Speaker 1 (46:22):
Just get it in your upper arm, right upper arm. Yeh,
I got it.
Speaker 2 (46:26):
The healthcare system works best when you have a relationship
with your doctor and you can actually have an honest
discussion about what your condition. It would also imply because
giving across the board recommendation about some of these things
is very difficult to do for a system, and we
do that, we sometimes have errors, and those errors are
the ones that make the news.
Speaker 1 (46:45):
So you're a noted cardiothoracic surgeon. You're also an award
winning I think how many nine or ten Emmys a
television host. Why politics? Now? Do you consider this a
political job.
Speaker 3 (47:00):
This is a policy job.
Speaker 2 (47:02):
I have always been fascinated by how we can build systems,
and I did it at the hospital I ran the
Herd Institute. Television is, as you know, because you've hosted
a very successful show for many years. It's you know,
to make it work well, you have to get the
machinery fine tuned and oil it once in a while.
Healthcare is a big challenge, but it happens. It has
(47:25):
a lot of very well meeting people involved, and some
people just want to make money, and we need to.
Speaker 3 (47:29):
Make sure we protect the taxpayer's money.
Speaker 2 (47:32):
So it's used wisely because all great societies take care
of those who are vulnerable, and we're great people, so
we're going to do that.
Speaker 1 (47:39):
Is this the hardest job you've ever had?
Speaker 3 (47:41):
That's interesting approach. I never think about it as hard.
Speaker 2 (47:45):
It is the job with the greatest opportunity to do good.
Heart surgery is hard and you have very little room
for air, and your mistakes don't do well, so it
has a huge emotional burden on you as well. You
have to feel that burden but not let it paralyze
you as you make decisions. So it is a unique occupation.
(48:07):
The beautiful part about medicine is that you get every
single day to help somebody and they know it and
you know it, so it's rewarding. And that's not always
the case in policy. Sometimes you have to make changes
that you're not going to know all the benefits for months,
even years.
Speaker 1 (48:21):
Well, I know Medicare and Medicaid are very complicated subjects.
I appreciate your time so much, doctor Oz to note
this milestone and look at the future of these programs
sixty years old and hopefully continuing and hopefully helping as
many people as it possibly can.
Speaker 2 (48:41):
So one bit of advice if we're going to celebrate
the sixtieth anniversary of Medicare and Medicaid. And I tried
to buy you because I couldn't get you to bring
me a cherry pie. I tried to buy you a
Martha Maha medicake. But what is the advice on how
you have evolved as an individual that you would share
with everybody? Because Medicare Medicaid really are the backbone of
(49:03):
the social web, the support system of our nation. But
it's a collaborative approach. We'll provide you coverage, but you
have to chip in as well. How does Martha Stewart evolve?
Speaker 1 (49:14):
I evolve each and every day by learning something new
every day. That's my my most important thing is to
learn something new every day. And remember change is good.
When you're through changing, you're through.
Speaker 3 (49:30):
This is how you stay vital is.
Speaker 2 (49:33):
It works, the secrets of vitality, it works evolving and change.
Speaker 1 (49:36):
Yes, and it's and it's kind of fun, I can
tell yeah. Thank you so much, God bless you
Host
Martha Stewart
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