They Put Your Doctor’s Judgment Under Review to Pay for a Tax Cut You’ll Never See

The Firing Line | Barking Justice Media
Daily Intelligence Briefing
August 24, 2026
By Mika Douglas and Robert Anderson

On January 1, Medicare started requiring an AI vendor's approval before some seniors could get treated. The law that made that possible also hands the top 1 percent an average $30,000 tax cut this year. Here is who built both halves of that trade, in their own words.

Somewhere in Arizona, New Jersey, Ohio, Oklahoma, Texas, or Washington right now, a Medicare patient is waiting. Not for a doctor. For a for-profit technology vendor to finish reviewing whether the doctor is allowed to treat them. That wait is new. For 60 years, Original Medicare has operated on a simple premise: if a service was medically necessary, a physician did not have to ask permission first. On January 1, that changed for the first time in the program’s history. It is called the WISeR model, and it puts artificial intelligence between roughly 6.4 million seniors and 17 specific outpatient procedures, from epidural injections to vertebral augmentation, that CMS has flagged as vulnerable to overuse.

Here is the mechanism, named plainly. The law that opened the door to this shift, the One Big Beautiful Bill Act, financed itself in part by cutting federal health spending and made the 2017 tax cuts permanent on top of new ones. The richest 1 percent of Americans get an average tax cut of about $30,000 this year from the rate and bracket changes alone. The poorest fifth gets about $40. Compared to what current policy would have delivered without this law, the poorest fifth actually pays $140 more next year once the expired health credits are factored in. The tax cuts alone cost $4.5 trillion over ten years. The deficit still grows by $3.4 trillion over that same decade, the same debt spiral this newsletter covered Wednesday when the number crossed $40 trillion.

At a White House Easter lunch on April 1, in remarks the White House later scrubbed from its own YouTube page, Trump told guests the federal government cannot fund “daycare, Medicaid, Medicare, all these individual things,” because “we’re fighting wars” and “we have to take care of one thing: military protection.”

The math does not close, and war spending is the other half of the squeeze. Treasury Secretary Scott Bessent has named Iran war costs directly as one of the drivers pushing this year’s deficit higher, alongside the tax law itself. The Pentagon has requested roughly $200 billion in additional funding tied to that war. None of that money is being asked of the people who benefit most from the tax cuts. It is being drawn from the same pool of federal health spending that just started rationing a senior’s access to a spinal injection through an AI reviewer. Tax cuts go up. War spending goes up. The bill lands on whichever program is administratively easiest to squeeze without a headline-grabbing vote. This week that program is Medicare.

The Senate had a direct chance to reverse the AI gatekeeper on July 16 and did not take it. Two members of Congress warned CMS in writing before the model even launched. Nobody stopped it.