K Street, Wall Street, and the White House: Dr. Oz Rewrites the American Healthcare Landscape

Introduction

In the spring of 2025, Baltimore. Under a light drizzle, Dr. Mehmet Oz, the 17th Administrator of the U.S. Centers for Medicare & Medicaid Services (CMS), took office. He will now command a vast healthcare system that covers 160 million Americans and has an annual budget of $1.7 trillion. The flow of this funding determines the health and well-being of nearly half of the American population and shapes a trillion-dollar industry.

Oz's resume is full of contrasts: from a cardiothoracic surgeon to a television celebrity, he sold vitamins and weight-loss secrets on "The Dr. Oz Show," winning public affection but facing frequent criticism from the scientific community and scrutiny from Congress. After his failed Senate bid in 2022, he pivoted to the heart of healthcare policy. Now, he must navigate the complex web of interests between Capitol Hill, Wall Street, and pharmaceutical giants. His appointment is a key part of President Trump's "Make America Healthy Again" vision, aimed at combating healthcare fraud, curbing waste, and promoting preventive medicine.

The question is: can a TV doctor truly solve the chronic ailments of American healthcare? As the federal government forcefully intervenes in drug pricing, as privatized "Medicare Advantage" plans gain favor, and as Medicaid faces unprecedented pressure for cuts, this is not just a reform within the CMS. It is a debate about the core identity of the U.S. healthcare system: should it be treated as a quantifiable market commodity or as a social safety net to be provided equitably? Dr. Oz's answers will determine the health future of countless Americans and even the life and death of patients worldwide.

1. The Celebrity Administrator: The Dual Identity of a TV Doctor and Policy Power Broker

Born on June 11, 1960, in Cleveland, Ohio, Mehmet Oz holds dual American and Turkish citizenship. In the 1980s, he completed a 60-day mandatory military service in the Turkish army. He grew up in Wilmington, Delaware, and attended Tower Hill School. Oz's family background blends tradition with a secular outlook: his father, Mustafa Oz, from Bozkır, Konya Province, Turkey, moved to the U.S. after medical school and eventually became the Chief of Thoracic Surgery at the Medical Center of Delaware. His mother, Suna Atabay, came from a wealthy family in Istanbul, with her maternal family having Circassian ancestry and historical ties to the Ottoman court (Suna's great-grandmother was a concubine in the harem of Mahmud II). Oz grew up in this cross-cultural environment, alongside two sisters.

His wife, Lisa Oz, born in 1963 in Philadelphia, is a graduate of Bryn Mawr College, a writer, and a TV and radio host who has published several best-selling books. She was also a driving force behind "The Dr. Oz Show." The couple has four children.

Oz's academic and professional path was marked by prestige: an undergraduate degree from Harvard University, an M.D. from the University of Pennsylvania School of Medicine, and an MBA from the Wharton School. He then joined the faculty at Columbia University Medical Center, rising to the rank of professor and becoming a professor emeritus in 2018. In 2022, due to his political campaign and scientific controversies, Columbia University officially severed ties with him, removing his profile from its website.

However, Oz's true entry into the public eye was through the media, not academia. In 2003, he first appeared on television as the host of "Second Opinion with Dr. Oz" and quickly became a regular health expert on Oprah Winfrey's talk show. In 2009, with Oprah's backing, "The Dr. Oz Show" premiered and quickly became a hit, transforming him from a cardiothoracic surgeon into a household name—"Dr. Oz." The show not only earned him Emmy Awards but also made his name familiar to millions of American families.

Yet, Oz's fame was always shadowed by controversy. While celebrated for popularizing health knowledge, he was also criticized for promoting weight-loss products, alternative therapies, and even supernatural beliefs. In 2014, he faced a tough grilling in a congressional hearing, where lawmakers accused him of recommending products without scientific evidence. A study in the British Medical Journal also found that more than half of the advice on his show was not supported by sufficient scientific evidence and was even contradictory. One senator bluntly stated that Oz's actions "mix medical advice, news, and entertainment, ultimately harming consumers." This dual questioning from the scientific and political communities contributed to his narrow loss in the Pennsylvania Senate race.

Now, the former "TV doctor" stands as the CMS Administrator, and the controversy surrounding his personal identity is directly projected onto the trillion-dollar healthcare empire he now oversees. The Medicare and Medicaid programs managed by CMS cover nearly half of the U.S. population. These programs are themselves a focal point of intense partisan battles in American politics, with Republicans emphasizing cost control and privatization, and Democrats advocating for broader coverage and government regulation. Oz's appointment, supported by Trump and Secretary of Health and Human Services Robert F. Kennedy Jr., has a core mission to "Make America Healthy Again" by modernizing the healthcare system through fighting fraud, cutting waste, and promoting preventive care.

However, as he transitions from a TV health guru to a policy power broker, what is the basis of public trust in him? Is it his credentials as a doctor, or his affability as a TV personality? When he tries to push for privatized "Medicare Advantage" plans and reform Medicaid, how will his past statements and business practices be scrutinized? Dr. Oz's contradictory identity places him at the forefront of American healthcare reform, and his every move will be closely watched by Congress, Wall Street, and ordinary citizens.

A controversial figure is now leading a highly controversial institutional reform—this is a grand social experiment on trust, power, and ideology.

2. The Deep-Seated Problems of Medicare and Medicaid

The challenges Dr. Oz faces are not a blank slate, but a vast, long-troubled system. To understand the grand narrative of his reform, one must first trace the origins of the U.S. health insurance system and its current structural challenges, especially the inherent paradox of its "third-party payment" model.

The evolution of U.S. health insurance began with the market but was ultimately shaped profoundly by political forces. A century ago, while European countries widely adopted health insurance, the U.S. government and insurance companies were reluctant to enter the field due to the difficulty of quantifying individual health risks. The process only began with the emergence of grassroots "Blue Cross" and "Blue Shield" plans. However, during World War II, the Roosevelt administration's "wage controls" unexpectedly tied health insurance to employer-employee relationships. A tax law amendment in 1954, which made employer-paid health insurance premiums tax-exempt, directly incentivized employers to keep wages low and increase health benefits. This gave rise to the "third-party payment" model, where "the pig gets sick, and the dog pays." This model distorted price signals, making consumers indifferent to costs, while hospitals felt free to issue exorbitant bills, leading to over-treatment and uncontrolled costs.

The culmination of this system was the Affordable Care Act (ACA), signed by President Obama in 2010. The law's creation was a political spectacle in itself. It required all U.S. citizens to purchase health insurance or face a penalty. It brought everyone into a "communal pot," prohibiting insurance companies from denying coverage or charging different premiums based on pre-existing conditions. While this sounded incredibly fair, it fundamentally violated the basic insurance principle of "segmentation and aggregation," transforming what should have been a self-sustaining market activity into a government-mandated wealth redistribution plan.

In 2012, the ACA was challenged in the Supreme Court. The courtroom debate was brilliant. Opponents argued: "If the government can force us to buy health insurance, can it also force everyone to buy broccoli twice a week?" The implication was that the government had no power to mandate purchases. The Obama administration's lawyer countered that health insurance was different from broccoli. If someone doesn't buy insurance and gets sick, their medical costs are often borne by hospitals or society, which ultimately drives up premiums for everyone. This is why insurance must be mandatory, but broccoli is not.

Ultimately, Chief Justice John Roberts, a Republican appointee, "defected." He did not uphold the law under the "Commerce Clause" but instead defined it as a government "tax" and "wealth redistribution" plan, ruling that Congress had the power to tax, thus making the law constitutional. This "master stroke" both saved the law and avoided setting a precedent for government-mandated consumption, but it also ignited outrage among Republicans. Critics described it as a cost-free buffet that led to immense waste of healthcare resources and an unsustainable fiscal burden, "like termites eroding the nation's economic foundation."

Although Trump vowed to "repeal" Obamacare during his first campaign, he realized upon taking office that a complete repeal would be political suicide, as the public had grown accustomed to certain benefits. The Senate's "skinny repeal" bill failed in July 2017, and in December of the same year, the Tax Cuts and Jobs Act reduced the individual mandate penalty to $0 starting in 2019. Trump claimed this had turned Obamacare into a "tiger without teeth." The result, of course, was little more than a symbolic victory.

During Dr. Oz's tenure as CMS Administrator, the U.S. healthcare system is facing an unprecedented fiscal cliff. According to projections, the Medicare Hospital Insurance Trust Fund, which covers the elderly, is expected to be depleted by 2031. At the same time, the Medicaid program for low-income individuals is under severe pressure due to an aging population and rising healthcare costs. Despite the U.S. having the highest healthcare spending in the world, accounting for 18% of its GDP, its health outcomes are lackluster, with average life expectancy ranking near the bottom among OECD countries. A JPMorgan report even stated that U.S. healthcare stocks were "gravely ill," with valuations at historical lows, serving not just as a market issue but as a "critical condition warning" for the entire healthcare system.

Dr. Oz's reform blueprint is unfolding against this backdrop, with his strategy centered on six core pillars: price transparency, provider accountability, strengthening oversight of Medicare Advantage plans, fighting fraud, promoting preventive care, and negotiating drug prices. Of these, combating healthcare fraud is a core mission he views as essential to protecting taxpayer money.

This is far from an empty claim. The U.S. spends over $900 billion annually on Medicare, and it's rumored that about $100 billion is lost to fraud. Official statistics from CMS and the GAO, however, counter that improper payments for Medicare and Medicaid combined amount to tens of billions to over a hundred billion dollars annually, with most being procedural or data issues, and fraud being only a portion. There are reports of elaborate fraud rings in Miami, Florida, where contractors build fake clinics and use "one-stop-shop" services to induce elderly patients into receiving unnecessary treatments, with medical facilities that are little more than props. This reveals a deep-seated conflict between trust and regulation in the U.S. healthcare system and reinforces Oz's emphasis on using AI and new technologies to "turn over every stone" to curb this systemic corruption.

However, Oz's reform blueprint is also full of institutional paradoxes. His support for the privatized Medicare Advantage plans is one of the most controversial aspects of his reform. Critics worry that this will cede more regulatory power to private insurance companies, potentially leading them to "cherry-pick" healthier patients and leave high-risk individuals to the public system. Oz's vision is to promote preventive medicine, viewing personal health as a "patriotic duty," but critics see this ideology as ignoring the decisive impact of socioeconomic status on health outcomes. When a controversial figure leads a highly controversial institutional reform, he touches the most sensitive nerves of K Street lobbyists, Wall Street financial titans, and countless vested interests.

In a system in critical condition, every reform plan is a redistribution of benefits, and Oz's scalpel can no longer be wielded solely for the patient's sake.

3. The Redistribution of $1.7 Trillion

Dr. Oz's reform blueprint is far from a simple technical upgrade or administrative efficiency optimization. It is a resource redistribution that affects the core interests of the American healthcare system. In this massive $1.7 trillion game, pharmaceutical giants, hospital systems, doctors, and insurance companies are being reshuffled, and their respective reactions and actions are collectively defining the future direction of U.S. healthcare.

First and foremost is the pharmaceutical industry, a core component of the U.S. healthcare landscape. For a long time, the U.S. market, with its high drug prices, has provided the most lucrative profit margins for global pharmaceutical innovation. However, from the beginning of his tenure, Administrator Oz, in line with Trump's intentions, plans to push for "most favored nation" drug pricing and actively use the federal drug price negotiation power granted by the Inflation Reduction Act (IRA) to shake this foundation. The leading pharmaceutical lobbying group, the Pharmaceutical Research and Manufacturers of America (PhRMA), along with major companies like Pfizer and Merck, quickly formed the "IRA Oversight Alliance." They have deployed their vast resources, including over $47 million in lobbying funds and at least 143 lobbyists, to try to block or amend this policy through legislative lobbying, legal challenges, and public relations campaigns. Their core argument is that government-mandated price controls will stifle innovation, reduce new drug development, and ultimately harm patients. At the same time, some companies have begun to adjust their R&D strategies, reducing investment in small-molecule drugs and betting instead on biologics and orphan drugs, which have longer exemption periods, to circumvent policy risks.

Among hospitals and doctors, this transformation has also created complex emotions and actions. On one hand, they worry that drug price negotiations and payment cuts will directly reduce their income, while new price disclosure and audit requirements will increase administrative burdens. Doctors complain that stricter "prior authorization" and medication management rules force them to spend more time on paperwork than on patients. This is consistent with the long-standing "third-party payment" paradox of the U.S. healthcare system: when patients don't directly pay the bill, price signals are distorted, leading to over-treatment by hospitals, and doctors lack the motivation to focus on health outcomes. On the other hand, Oz's reforms also bring new hope. His emphasis on preventive medicine and "Value-Based Care" provides more funding support for primary care and chronic disease management. This encourages healthcare providers to shift from "treating illness" to "preventing illness," incentivizing doctors to compete on "health outcomes" rather than "service volume." Therefore, hospitals and doctors are being forced into a new era, where they must both adapt to the challenges of cost control and seek new models of collaboration with insurance companies and even community organizations to find new avenues for growth.

Insurance companies, as a key "middleman" connecting the government and healthcare providers, play a dual role in this game. They are the biggest beneficiaries of the Medicare Advantage plans that Oz supports, but they also face stricter regulation and audits. Although this program is controversial for "overpayment" and "cherry-picking healthy patients," Oz still sees it as a core tool for promoting privatization and market competition. In response, insurance companies are actively adjusting their prescription drug plans, using more low-cost generics and biosimilars to control costs and strengthen their bargaining power. They are also leveraging technology, using AI to monitor patient medication adherence and fraudulent behavior, trying to maintain their profit margins even as government oversight tightens.

Ultimately, the winners and losers of this reform are gradually emerging. Pharmaceutical giants face profit squeeze and a structural shift in their R&D focus. Hospitals and doctors are forced to transform, breaking away from the traditional "fee-for-service" model and moving toward "value-based payment." And insurance companies are poised to consolidate their power in the healthcare system through the expansion of Medicare Advantage and strengthened cost control.

This redistribution of $1.7 trillion has no absolute winners or losers; it simply pushes the contradictions and dilemmas of American healthcare into a new historical phase.

4. Wall Street's Critical Condition Alert

If Dr. Oz's policy reforms are the White House's surgical operation on the U.S. healthcare system, then Wall Street's capital market had already issued a "critical condition alert" to the industry. As the policy authority of the CMS and the capital pricing power of Wall Street interact, a fierce competition for future value is quietly unfolding, the outcome of which will reshape the entire healthcare industry's investment logic.

Wall Street's alarm was sounded by a harshly worded report. On August 12, 2025, JPMorgan published a report titled "Gravely Ill: The Cheapness of U.S. Healthcare Stocks and the Battle Over Publicly Funded Science." The report, authored by senior strategist Michael Cembalest, noted that since 2020, U.S. healthcare stocks had completely stagnated, significantly underperforming tech stocks, with which they had been highly correlated for the previous 30 years. Healthcare industry valuations are at historical lows, with P/E ratios at only about 70% of the S&P 500's overall level. The biotech sector, in particular, is the most heavily discounted area in the entire market, with over half of biotech IPO companies seeing their market caps shrink by more than 80% since 2018.

For Wall Street analysts, this is not a simple market fluctuation; it is a profound systemic risk that has entered their Discounted Cash Flow (DCF) models, driving up the risk premium. In their view, Trump administration policies, such as "drug tariffs" and the "most favored nation" drug pricing, are directly eroding the profits of pharmaceutical companies. According to JPMorgan's projections, if the "most favored nation" policy is implemented, profits for large U.S. pharmaceutical companies could be reduced by 9% by 2031.

In addition, the new Health Secretary Robert F. Kennedy Jr.'s "unusual and unexplained interventions" at the top of the FDA, the noticeable slowdown in drug approval progress, and the fact that about 80% of proposed budget cuts are from basic research fields, are all attacking the industry's ability to innovate at its source. This means that the future profit windows and valuation logic of biotech companies, which rely on innovation, are facing a complete restructuring.

A deeper concern is that the capital market has clearly seen the "ceiling" of the U.S. healthcare system. In the past, the proportion of U.S. healthcare spending to GDP was continuously rising, but it has stagnated since 2008. This means that this industry, once considered "recession-proof," can no longer drive growth by "expanding the pie" but must engage in a zero-sum game within the existing one. In this context, the reforms pushed by Dr. Oz, such as drug price negotiation, inflation rebates, and strict oversight of Medicare Advantage plans, directly hit the industry's profit core. While these measures are intended to save money for the government and patients, for investors, they are like a new cut on an already pressured profit margin.

This creates a sharp paradox: on one hand, policy corrects market distortions and saves money for taxpayers and patients; on the other, it exacerbates the capital market's pessimistic outlook, squeezing future R&D and innovation. Wall Street's "critical condition alert" is a reflection of this contradiction: the healthcare industry's plight stems from both internal structural imbalances and the policy shocks from the Trump administration.

Wall Street's capital vote reveals more honestly than any politician's speech that the U.S. healthcare behemoth has sailed into an unprecedented stormy sea.

5. The Invisible Battlefield of the 2026 Midterm Elections

In his second term, Trump brought more radical changes. In July 2025, he signed the controversial "Big and Beautiful Act." The law aims to drastically cut social welfare spending, including funding for Medicaid and the Affordable Care Act. The Congressional Budget Office estimates that Medicaid spending will be reduced by $911 billion over the next decade, causing 16 million people to lose their health insurance.

Although the reforms are ready, the effective dates of some of the most controversial policies, those that could directly affect voters' lives, have been carefully delayed. This is a precise calculation about who gets to control the political narrative. When the impact of a policy is delayed, the political struggle shifts from the reform itself to the power to define it.

In Washington, all policies eventually translate into votes. Dr. Oz's series of reforms at the CMS, such as imposing work requirements for Medicaid and adjusting the deductibles and premiums for Medicare, have been cleverly scheduled to take effect after the 2026 midterm elections. This timeline is no accident; it is designed to ensure the "Big and Beautiful Act" can proceed smoothly and to avoid a large-scale public backlash before the election, allowing voters to cast their ballots "without feeling any pain." This shifts the debate on healthcare policy from specific cost and benefit calculations to an abstract battle of values and ideologies.

Democrats quickly seized this opportunity, framing the reforms as "harming the vulnerable." They describe Oz's reforms as yet another example of the Republican Party's long-standing effort to cut social welfare and sacrifice the interests of low-income and elderly people. Their core narrative is that while Republicans emphasize cost-cutting seemingly to reduce government intervention, the result is the sacrifice of protections for the vulnerable and federal-level oversight. Democrats are trying to use this moral narrative to resonate with rural and elderly voters, mobilizing them to vote to protect their existing benefits. For these voters, any change in healthcare policy is directly linked to their life in retirement, especially in an aging American society.

At the same time, Republicans are packaging the reforms as a "stemming the bleed" effort. They emphasize that Dr. Oz's measures are aimed at fighting fraud in the healthcare system, improving efficiency, and ensuring the fiscal sustainability of the Medicare and Medicaid programs. The Republican Party wants to elevate this reform to the level of "fiscal responsibility" and "the public good." They argue that the plight of the U.S. healthcare system is partly due to the Democrats' excessive subsidy policies distorting the market and causing healthcare prices to rise without limit. Therefore, they describe their cost-cutting measures as "righting the ship" for the entire country, rather than simply a reduction in benefits. This allows them to debate within a grander framework of non-personal interests, aiming to win over voters concerned about the nation's fiscal health and opposed to excessive government spending.

Despite the fierce narratives from both camps, voters' real-world feelings are divided. According to polls, most Americans oppose cuts to Medicaid, viewing it as an essential safety net for the poor. However, since the direct effects of Oz's reforms have not yet appeared, most people have not felt any substantial losses in the short term. This provides both parties with a vast space for a public relations war. Democrats need to repeatedly emphasize the potential negative impacts of the policy, turning abstract future risks into concrete voter fears. Republicans, on the other hand, can continue to promote the positive vision of the reforms until the policy is truly implemented. Therefore, the invisible battlefield of this election will be a cognitive war dominated by political propaganda machines. The one who can first shape and lead the collective sentiment of the voters will win this political game.

6. The K Street Lobbying Machine's Counter-Offensive

On the political stage of Washington, every one of Dr. Oz's reform proposals will be placed under a microscope by the powerful K Street lobbying machine. These lobbying groups are not just representatives of interests; they are also shapers of policy discourse, and their actions together form a silent war over $1.7 trillion.

To understand how K Street operates, one must first trace the origins of the U.S. lobbying system. The term's origin is tied to a legend about the 18th U.S. President, Ulysses S. Grant, who used to relax in the lobby of a Washington hotel. Petitioners found it easier to approach him there than at his office, and so the term "lobbying" was born. From the president's hotel lobby to today's famous K Street, lobbying has evolved from a grassroots petitioning act into a mature industry that spends billions of dollars annually and has many "revolving door" elites. Many of these lobbyists are former members of Congress or high-ranking government officials who convert their networks into their most valuable asset, "arguing on behalf of their employers" to policymakers.

In this game, the pharmaceutical industry is undoubtedly the most heavily-funded player. Data shows that pharmaceutical and health products companies have spent more on federal lobbying for years than all other industries combined. Faced with the drug price negotiation power granted by the Inflation Reduction Act (IRA), the pharmaceutical industry immediately activated its massive lobbying engine. The core lobbying group, PhRMA, has lobbying expenditures in the tens of millions of dollars and more than 100 registered lobbyists. They maintain close ties with Congress and the executive branch, influencing the legislative process through political donations and information provision.

The tactics of K Street are not one-dimensional; they form a tight loop of legislative lobbying, legal challenges, and public relations. First, at the legislative level, pharmaceutical companies, through organizations like the "IRA Oversight Alliance," seek to directly block or amend the drug price negotiation mechanism pushed by Oz. Their lobbying focus shifts to the technical details of the policy, such as how CMS should select drugs for negotiation, how to set prices, and which drugs can be exempted. Second, at the legal level, they don't hesitate to file lawsuits. Merck, Bristol Myers Squibb, and Johnson & Johnson are among several pharmaceutical companies that have filed lawsuits challenging the constitutionality of the IRA, claiming the law violates "due process rights" and is an "exaction" of their property. While these legal challenges take time, they effectively delay the policy's implementation, buying more time for lobbying groups. Finally, in terms of public relations, they shape public perception by funding numerous advertisements and research reports. Their core narrative is highly consistent: government price controls will stifle innovation, reduce new drug development, and ultimately limit patient access to medication and harm America's leadership in medical innovation.

This carefully planned lobbying effort constitutes one of the biggest obstacles to U.S. healthcare reform. While Oz's reforms aim to save money for patients and the government, K Street, through its powerful narrative authority, has successfully twisted the nature of the reform into a "harm to innovation." They have precisely leveraged the public's desire for medical progress, turning a complex economic issue into a simple moral dilemma. Under the microscope of K Street, any reform faces the risk of being deconstructed, redefined, or even completely dismantled.

When the rational light of policy tries to shine on K Street, the area is already shrouded in a fog of capital and narrative power.

7. The Public's Bill: The Anger of Patients and Taxpayers

In Washington's budget spreadsheets, healthcare is often just a large number: $1.7 trillion, 160 million people. But for ordinary Americans, these numbers ultimately turn into co-pays on pharmacy bills, medical debt on credit card statements, and federal deficits on tax returns.

For chronic disease patients who rely on medication, the start of IRA drug price negotiation is a glimmer of hope. The first ten high-expenditure drugs selected for negotiation account for about 20% of Medicare Part D spending, covering millions of patients with diabetes, cardiovascular diseases, and cancer. It is expected that starting in 2026, the government-set "maximum fair price" (MFP) will lower drug prices, saving patients tens of billions of dollars. For diabetes patients, this means insulin may return from being a "luxury drug" to a "daily drug."

However, the pace of reform cannot immediately eliminate anxiety. According to a survey, Americans have at least $220 billion in medical debt, with about 14 million people (6% of adults) owing more than $1,000 in medical bills, and 3 million owing over $10,000. Behind these numbers are ordinary people like Susan: her retirement income is not enough to pay for her heart failure medication, and every time she sees a doctor, she has to weigh whether to buy medicine or pay her mortgage.

If patients feel the direct pressure of drug prices, taxpayers bear the systemic deficit. In 2023, Medicare spending exceeded $1 trillion, with a deficit of $449 billion, accounting for 27% of the federal budget deficit for that year. The burden of Medicaid is also increasing. In other words, every policy choice made by the CMS concerns not only the well-being of patients but also the wallets of taxpayers.

In the debates on Capitol Hill, the voices of lobbyists are the loudest, and the presentations of pharmaceutical companies are the most refined. But the true silent majority—patients and taxpayers—lack a voice. Surveys show that the American public widely opposes cutting Medicaid funding and that most support government intervention in drug price negotiation.

For them, the institutional debate of "market or contract" is not abstract. They want affordable bills and sustainable coverage. But amid policy swings, capital games, and partisan conflicts, these voices are often drowned out. As one patient whispered outside a hearing, "The lawmakers are arguing about numbers; we're worrying about whether we can make it to the next month."

8. The Spillovers of the Global Drug Price War

The drug price reform led by Dr. Oz has extended its impact beyond national borders, becoming a structural shift that affects the global healthcare landscape. As the U.S., the world's largest pharmaceutical market, begins to pressure pharmaceutical giants, the ripple effects of its cost control will transmit to other parts of the world in unpredictable ways.

For a long time, high U.S. drug prices not only supported the profits of multinational pharmaceutical companies but also, in effect, subsidized global R&D costs. U.S. taxpayers and patients, by themselves, paid for the world, allowing pharmaceutical companies to compromise and even make up for losses with lower prices in Europe and Asia. But with the Inflation Reduction Act (IRA) initiating the drug price negotiation mechanism, this "global public good" pattern is being broken.

This drug price war, which started in the U.S., is triggering a global downward price spiral. Since many countries reference U.S. market prices when setting drug prices, a decrease in U.S. drug prices due to negotiation will lead other governments to demand price reductions in their own markets. This will force pharmaceutical companies to accept lower prices in multiple markets, thus intensifying their battles with governments worldwide.

This confrontation is playing out in different ways: the U.S. relies on legislation and market games to gradually compress space, while China's "soul-baring negotiation" is a form of administrative pricing under government centralized procurement, often slashing prices by 70% in a single round of talks. Although both mechanisms make pharmaceutical companies suffer, the U.S.'s gradual negotiation still provides a buffer for the industry and capital, whereas the Chinese model is more of a one-time shock. This is not just a game between pharmaceutical companies and governments but also a demonstration of U.S. "soft power" that directly exports its domestic policies globally.

This macroeconomic pressure is also fundamentally changing the direction of global pharmaceutical R&D and the investment landscape. Faced with the IRA's mandatory negotiation for small-molecule drugs (which have a protection period of only 7 years), investor interest is significantly declining. To avoid policy risks, capital and R&D resources are massively shifting toward biologics (which have a protection period of 11 years) and orphan drugs and gene therapies that are not subject to negotiation. The consequence is that R&D for common diseases (such as diabetes and cardiovascular diseases) may be marginalized, and biotech companies in the inherently high-risk, high-reward field will face increased difficulty in fundraising and valuation pressure.

Furthermore, U.S. drug pricing policy has also become a new bargaining chip in its geopolitical and diplomatic games. The Trump administration may use drug price reform as a tool in trade negotiations with other countries, demanding concessions on pharmaceutical patent protection and market access. However, this approach could also cause international friction, as it is seen as a manifestation of American exceptionalism in the healthcare sector. The contraction of pharmaceutical profits could also trigger a structural shock to the global drug pricing system, affecting U.S. relations with other countries on healthcare and trade issues.

In short, when the U.S. sneezes, the global pharmaceutical industry catches a cold. Dr. Oz's drug price war is not just a domestic policy experiment but a rewriting of the global order of resource allocation: who will pay for future medical innovation is becoming a borderless political and moral question.

Epilogue: The Institutional Question—Is Healthcare a Commodity or a Social Safety Net?

As Dr. Oz reviews the $1.7 trillion budget on his desk at the CMS headquarters in Baltimore, he is not just facing administrative details but the most fundamental institutional question in American healthcare for decades: Is healthcare a market commodity that can be bought and sold freely, or is it a social safety net that must be provided equitably?

This is a deep-seated conflict that has long torn American politics apart. Republicans, including Oz, emphasize market logic: efficiency, competition, and personal responsibility. They believe that government intervention creates distortions and that reform must rely on cutting spending, fighting fraud, and strengthening privatization, with fiscal sustainability as the core goal. Democrats, on the other hand, firmly believe that healthcare is a basic human right. The philosophy of Obamacare was to achieve universal coverage through government subsidies and a mandate to purchase insurance. They view Republican cuts as a deprivation of protection for the vulnerable. It is this ideological opposition that keeps any healthcare reform swinging back and forth on a pendulum between "expansion" and "contraction."

During Oz's tenure, Medicare and Medicaid are not just fiscal programs; they are a litmus test for social security. If policy leans toward the market, privatization plans might bring personalized services, but high-risk groups will be left behind. If it leans toward social security, the government deficit might swallow up the healthcare fund, causing the entire system to collapse.

Oz's background as a TV doctor makes him adept at packaging complex issues into slogans like "patriotic duty" and "healthy living." He also attempts to use AI and telemedicine to improve efficiency, which may fix the books in the short term but cannot touch the deep-seated problems. As the book Social Transformation of American Medicine points out, the U.S. healthcare system has continuously compromised with cultural authorities and vested interests, and this compromise has ultimately led to market failure and distorted prices. When American politics treats healthcare as a perpetual zero-sum game, both patients and taxpayers will be the ultimate losers.

Oz may be skillful in navigating between K Street, Wall Street, and the White House, but he cannot, by himself, answer this core question that has plagued American society for decades. The real answer to this question lies not in an administrative order or a court ruling, but must emerge from the broader political, economic, and cultural struggles within American society.