September 11, 2025

A roadmap to sadism

Or ...  
How Not to Treat Seniors and People with Disabilities.

Bernie and two of his colleagues (Sens. Kaine and Alsobrooks) put together a list of the harms this madman and his sycophants have done in their first 100 days.

I’ll make this short, as the document speaks for itself. Down below is the Table of Contents, and you can click this link for details.

Let me just say: until Congress reinvents itself, lots of health delivery is going to get harder with these maniacs in charge of the nation’s procedures and medicines.  

Everyone who doesn’t have a retiree plan from someone should be checking their plan’s description for 2026. The ANOCs (Annual Notices of Change) are supposed to be sent out this month. That means if you don’t like what they’ve designed for next year, you can use the plan finders on Medicare.gov and this NYS website to find more suitable coverage and sign up for new ones between October 15 and December 7.   

Our OLR plans work differently.  Senior Care people shouldn’t be expecting any ANOC from Medicare itself, maybe becaise CMS considers it too stable a program to warrant the cost of an annual change notice. 

But for the supplemental coverage and other choices offered by our unions, you could check out the July versions of the OLR’s comprehensive plan manual and separate rate chart. We can change from one plan to another each November. 

A final thought, on COVID vaccines.  

Gov. Hochul signed an executive order allowing pharmacies to administer these to anyone who wants them for at least another month, but the details are less clear.  

As one pharmacist told a reporter for the Buffalo Spectrum News 1:  If the federal government isn’t giving clear guidance on the rollout, and particularly how these vaccines are going to be paid for, insurance companies are “not likely to follow suit and just cover these products.” Coverage may end up being plan-specific, so you need to make a phone call or two before assuming these will be free. 

Please do some homework this fall. Help yourselves, and help others who can’t help themselves so easily.




August 1, 2025

Just “Wow.”

We’re on a roll here with this RFK Jr. / Oz combo running healthcare.  Maybe “ruining” is a better word.

Continuing my rants against prior authorizations (see July 7 post below and a column I wrote for the Examiner), I came across a remarkable video by Dr. Elisabeth Potter trying to get information out of UnitedHealthcare on a procedure they had denied.   

Witnessing malfeasance this up close and personal is something else.

She can’t get proof the “doctor” she’s speaking to is even a doctor.
That’s because he refuses to give his name. 
Without a name, she can’t check him out.
He as much says he has no experience in the procedure she’s being denied.  His supposed field of expertise is not hers. 




Dr. Potter has done other videos.  In this one from a month ago on the Oz’s press conference on prior auths, she says:
We’re at a boiling point in our society...
What RFK/Ox are promising “doesn’t land”:  it’s a voluntary promise, there are no new rules, no repercussions, and no deliverables.
We as patients are demanding more from the system.

I’m joining an Elisabeth Potter fan club.


July 7, 2025

Things very slippery at CMS

Additional videos on the hypocrisy posted at the end of this article....

I had just finished a guest column for the Westchester Examiner on how Dr. Oz is scamming us into believing he and RFK Jr. are doing great things for us by making Medicare so easy. 

Oz is a showman. Several weeks ago he put out a video encouraging people to get help from the experts at Medicare. But he doesn’t point us at traditional Medicare – there’s no profit in that. He directs us squarely to the industry’s privatized version, Medicare Advantage. 

He’s also a salesman. Later in the month he put out a video about how CMS and their corporate collaborators are now pledging to clean up Medicare Advantage’s scandalous abuse of prior authorizations to delay or deny care. Mind you, they’re just pledging for the moment. No new laws or punishments as yet.

As I wrote in the Examiner, I believe fixing prior authorizations in Medicare Advantage is part of a larger campaign, to turn a proposal in Project 2025 into a reality, that Medicare Advantage (Part C) rather than traditional Medicare (Parts A and B) will become the default for new enrollees. 

Having no trust in Oz or his boss RFK Jr. already, I was not totally surprised reading yesterday’s CMS press release that said they’re going after prior authorizations in Original Medicare as well.

But, the thing about prior authorizations in O.M. is that there isn’t much use of it there at all. If doctors want you to have something done, there’s no middleman private insurance company gatekeeper barring your access to that procedure. Medicare will pick up its share of the cost, and you or your supplemental policy will pick up the rest. No unexpected delays or denials.

Today’s post in HEALTH CARE un-covered explains how the limited use of prior authorizations works in O.M.:

Not many people realize that prior authorization is used in traditional Medicare (TM) at all, likely because it applies to a very small small number of services. Currently, TM requires prior authorization for 52 outpatient medical services, some durable medical equipment, and repetitive scheduled non-emergent ambulance transport. The prior authorizations are processed by the Medicare Administrative Contractors (MACs) and are required to be reviewed in a very short timeframe. Perhaps most importantly, the prior authorization decisions under the current process have been found to be more than 98% accurate. The limited scope, MAC review, and high accuracy ensure that current policies and procedures governing the use of prior authorization in traditional Medicare meet the intended goal of preventing wasteful spending without delaying or denying necessary care.

In the guise of going after “fraud, waste, and abuse,” Oz’s newsletter says the agency is now planning to test something in traditional Medicare called the WISeR (Wasteful and Inappropriate Service Reduction) Model. Here’s how it’s described:

Combining the speed of technology and the experienced clinicians, this new model helps bring Medicare into the 21st century by testing a streamlined prior authorization process, while protecting Medicare beneficiaries from being given unnecessary and often costly procedures . . .
The WISeR Model will test a new process on whether enhanced technologies, including artificial intelligence (AI), can expedite the prior authorization processes for selected items and services that have been identified as particularly vulnerable to fraud, waste, and abuse, or inappropriate use. . .
Under the model, providers and suppliers in the assigned regions will have the choice of submitting prior authorization requests for selected items and services or their claim will be subject to pre-payment medical review.
In the 6 years they’re planning to run this model, there’ll be plenty of time to open up new pathways to abuse in our health care system. We’ll soon be seeing poorly regulated and widespread use of prior authorization in traditional Medicare as well.

And just like with Medicare Advantage, it’s not only that private companies who’ll be running these requests through their AI systems, the final decisions will be made by “licensed clinicians, not machines.” They don’t say doctors, and they specifically don’t say your doctor, the guy who asked for the procedure in the first place.

I don’t trust these people at all. 

And I don’t trust the link for an “overview” that CMS gives in the press release. You have to sign into read it, I’m not inclined to sign into anything from the government that should be open to the public.   

I did go to another link at the bottom of the release, which has more of the same gobbledygook we’re used to reading:  “working with companies experienced in using enhanced technologies to expedite and improve the review process,” “ensure people . . . receive the most appropriate care,” “best health outcomes,” “ease administrative burdens,” “empowers patients to partner” with their providers.  The whole thing was probably written by A.I.

Check out the more informative post in HEALTH CARE uncovered mentioned above. You’ll hate what you read, but consider it medicine. 

If only they’d stick to selling snake oil and not perpetrate the worst of their greedy, slimy instincts on us.


NEWS FLASH !

Christopher Westfall is as horrified as I was over this issue of prior auths in Original Medicare. 

In his latest video (July 29), he says that if they want to get rid of fraud, waste, and abuse, why not go after the corruption in the Durable Medical Equipment industry - $10.6 billion in fraudulent claims reported in 2025.  He also talks about the private industry that will be trusted with the algorithmic approvals (yup, the same ones that produce the denials in Advantage plans). Highly recommended 20 min., but only if your blood pressure can stand the stress.


Here’s another one just this morning, from Ed Weir, a  former Soc. Sec. manager. Gives more details on the use of A.I. in this process.