|
WISeR (Wasteful and Inappropriate Service Reduction) Model The Wasteful and Inappropriate Service Reduction (WISeR) Model will help protect American taxpayers by leveraging enhanced technologies, such as Artificial Intelligence (AI) and Machine Learning (ML), along with human clinical review, to ensure timely and appropriate Medicare payment for select items and services. The voluntary model will encourage care navigation, encouraging safe and evidence-supported best practices for treating people with Medicare. WISeR will run for six performance years from January 1, 2026 to December 31, 2031. The application period opened on June 27, 2025. <Source> |
If you think the phrase “death by bureaucracy” is an exaggeration, think again. The federal government, in partnership with private companies, is piloting a program that weaponizes prior authorizations and algorithmic gatekeeping against the very people Medicare was designed to protect: older adults and the disabled. And make no mistake—this is about profit, not patients
Imagine being sick, in pain, or needing a life-altering procedure, and being told you might not get it.
Not because your doctor said no, but because an algorithm said no. Because a private company, paid by taxpayers, decided it wasn’t “worth it.”
That’s exactly what’s coming next year when the so-called “Wasteful and Inappropriate Service Reduction Model” is set to begin in six states next year.
Medicare, the program millions of Americans rely on, is piloting a system where private contractors use AI to approve—or deny—procedures before patients get care. Spine surgeries. Pain injections. Devices that help with incontinence. Deny. Delay. Profit.
Here’s how the system works: private companies, incentivized to deny claims, will use artificial intelligence to pre-screen whether patients “qualify” for certain procedures—like spinal surgeries, steroid injections, or even devices that help with incontinence. The more they deny, the more they—and their executives—profit. Humans are involved, they say, but in practice, the AI recommendations are weighted heavily, and the ultimate decision often favors the bottom line over the patient.
Let’s be clear: this isn’t about saving lives or preventing waste. It’s about protecting corporate profits. Executives at these for-profit companies take home millions, while patients are trapped in endless red tape, denied treatments, and forced to fight for basic care. Most never appeal. Many simply go without.
This is the same nightmare already seen in Medicare Advantage plans, the part of Medicare where private companies make money by rationing care. And now the government wants to apply it to traditional Medicare, the program people trusted to actually work.
Bottom Line
Delay. Deny. Death. It’s not just a slogan—it’s the reality of turning patient care into a profit game. That is the future being pitched under the guise of “innovation” in Medicare
And if we don’t speak up now, it will expand. Algorithms will rule. Human suffering will pay the price.
Our healthcare system is supposed to save lives, not pad executive bonuses. This is beyond unfair. It’s dangerous. And it’s happening right now.
We are so screwed.
— Steve
