Category: Conservative Review
For once, Medicare is trying something that actually saves money
Medicare is the second-largest program in the federal budget, topping $1 trillion last year. In 2023, it accounted for 14% of federal spending — a share projected to reach 18% by 2032. After years of ballooning costs, something is finally being done to slow the growth. A new Medicare pilot program, the Wasteful and Inappropriate Service Reduction model, borrows a successful private-sector tool: prior authorization. And that’s good news.
Medicare Part B premiums now sit at $185 per month — up 28% from five years ago and a staggering 76% since 2015. Last year, 12% of the 61 million Americans enrolled in Part B spent more than a tenth of their annual income on premiums. That burden is unsustainable.
In a system as expensive and fragmented as ours, no one can afford to keep writing blank checks for low-value care.
WISeR, set to launch in Ohio, Texas, Washington, New Jersey, Arizona, and Oklahoma, will require prior approval for a short list of “low-value” services — procedures that research shows are frequently overused, costly, and sometimes harmful.
To some, the idea of Medicare reviewing certain treatments before covering them may sound like red tape. But when done correctly, prior authorization is not a barrier. It is a guardrail — one that protects patients, improves quality, and helps ensure that both tax dollars and premiums are spent appropriately.
The goal of WISeR is simple: Cut unnecessary treatments and shift resources toward more effective, evidence-based care. Critics warn about the possibility of delays or extra paperwork, and those concerns are worth monitoring. But they don’t negate prior authorization’s potential to make U.S. health care safer, more efficient, and more financially stable.
Prior authorization directly targets some of the most persistent problems in health care. Medicare spends billions each year on low-value services. A 2023 study identified just 47 such services that together cost Medicare more than $4 billion annually. Those are taxpayer dollars that could be put to better use.
The private insurance market shows the same pattern: unnecessary imaging, avoidable specialist referrals, and brand-name drugs chosen over generics all contribute to rising premiums. Prior authorization, when used properly, reins in this waste by ensuring coverage lines up with medical necessity and evidence-based best practices. Research from the University of Chicago shows that Medicare’s prior authorization rules for prescription drugs generate net savings even after administrative costs.
Consider one striking example. Medicare Part B covers wound-care products known as skin substitutes. But an Office of Inspector General report found that expenditures on these products skyrocketed over the past two years to more than $10 billion annually. Meanwhile, Medicare Advantage plans — which rely heavily on prior authorization — spent only a fraction of that amount for the same treatments.
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More importantly, prior authorization helps promote evidence-based medicine. It curbs outdated clinical habits and reduces financial incentives to overtreat. Health plans consistently say that prior authorization aligns care with gold-standard clinical guidelines, particularly in areas prone to misuse.
Of course, the system must be designed responsibly. A well-functioning PA process should be transparent, fast, and grounded in strong clinical evidence. Decisions should be made in close coordination with the patient’s treating provider. The appeals process must be straightforward. And both public and private payers should be held accountable for improper denials or harmful delays.
When structured this way, prior authorization is far more efficient than the current “pay-and-chase” model, where Medicare pays first and tries to recover improper payments later.
Prior authorization already works in the private sector. It can work in Medicare.
Public and private payers have an obligation to steward the dollars they spend — whether those dollars come from taxpayers or premium-payers. In a system as expensive and fragmented as ours, no one can afford to keep writing blank checks for low-value care. When implemented wisely, prior authorization keeps coverage aligned with medical necessity, elevates the value of care, and helps deliver better outcomes at a sustainable cost.
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Political Islam is playing the long game — America isn’t even playing
A political system completely incompatible with the Constitution is gaining ground in the United States, and we are pretending it is not happening.
Sharia — the legal and political framework of Islam — is being woven into developments, institutions, and neighborhoods, including a massive project in Texas. And the consequences will be enormous if we continue to look the other way.
This is the contradiction at the heart of political Islam: It claims universal authority while insisting its harshest rules will never be enforced here. That promise does not stand up to scrutiny. It never has.
Before we can have an honest debate, we’d better understand what Sharia represents. Sharia is not simply a set of religious rules about prayer or diet. It is a comprehensive legal and political structure that governs marriage, finance, criminal penalties, and civic life. It is a parallel system that claims supremacy wherever it takes hold.
This is where the distinction matters. Many Muslims in America want nothing to do with Sharia governance. They came here precisely because they lived under it. But political Islam — the movement that seeks to implement Sharia as law — is not the same as personal religious belief.
It is a political ideology with global ambitions, much like communism. Secretary of State Marco Rubio recently warned that Islamist movements do not seek peaceful coexistence with the West. They seek dominance. History backs him up.
How Sharia arrives
Political Islam does not begin with dramatic declarations. It starts quietly, through enclaves that operate by their own rules. That is why the development once called EPIC City — now rebranded as the Meadow — is so concerning. Early plans framed it as a Muslim-only community built around a mega-mosque and governed by Sharia-compliant financing. After state investigations were conducted, the branding changed, but the underlying intent remained the same.
Developers have openly described practices designed to keep non-Muslims out, using fees and ownership structures to create de facto religious exclusivity. This is not assimilation. It is the construction of a parallel society within a constitutional republic.
The warning from those who have lived under it
Years ago, local imams in Texas told me, without hesitation, that certain Sharia punishments “just work.” They spoke about cutting off hands for theft, stoning adulterers, and maintaining separate standards of testimony for men and women. They insisted it was logical and effective while insisting they would never attempt to implement it in Texas.
But when pressed, they could not explain why a system they consider divinely mandated would suddenly stop applying once someone crossed a border.
This is the contradiction at the heart of political Islam: It claims universal authority while insisting its harshest rules will never be enforced here. That promise does not stand up to scrutiny. It never has.
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Photo by AASHISH KIPHAYET/Middle East Images/AFP via Getty Images
America is vulnerable
Europe is already showing us where this road leads. No-go zones, parallel courts, political intimidation, and clerics preaching supremacy have taken root across major cities.
America’s strength has always come from its melting pot, but assimilation requires boundaries. It requires insisting that the Constitution, not religious law, is the supreme authority on this soil.
Yet we are becoming complacent, even fearful, about saying so. We mistake silence for tolerance. We mistake avoidance for fairness. Meanwhile, political Islam views this hesitation as weakness.
Religious freedom is one of America’s greatest gifts. Muslims may worship freely here, as they should. But political Islam must not be permitted to plant a flag on American soil. The Constitution cannot coexist with a system that denies equal rights, restricts speech, subordinates women, and places clerical authority above civil law.
Wake up before it is too late
Projects like the Meadow are not isolated. They are test runs, footholds, proofs of concept. Political Islam operates with patience. It advances through demographic growth, legal ambiguity, and cultural hesitation — and it counts on Americans being too polite, too distracted, or too afraid to confront it.
We cannot afford that luxury. If we fail to defend the principles that make this country free, we will one day find ourselves asking how a parallel system gained power right in front of us. The answer will be simple: We looked away.
The time to draw boundaries and to speak honestly is now. The time to defend the Constitution as the supreme law of the land is now. Act while there is still time.
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My crooked house made me rethink what really needs fixing
Our new addition is finally finished — level floors, wide doors, and a space where my wife, Gracie, can move freely despite her severe disabilities. After years of improvising in tight quarters, we’re grateful to have a place that works for us, even if it’s not perfect.
The new part of the house went up during Trump’s second non-consecutive term; the original part went up during the second term of the only other president to do the same, Grover Cleveland. Joining the two is a bit like welding a Tesla to a horse-drawn buggy — functional, charming, and only slightly defiant of gravity.
When most of life leans, you can still make one crooked thing right.
During construction, the fridge in our tiny kitchen got bumped off the carefully placed shims and tilted just enough to drive me crazy. Admittedly, that’s not a long trip.
I ignored it for about a week but finally couldn’t stand it anymore. Leveling a refrigerator in a cabin built during the Cleveland administration isn’t simple. There are pulleys, levers, questions about physics, and — in my case — a call to the engineering department at Montana State. They were not amused. My neighbor Charles, who often “pity helps” me, wasn’t available. I can’t prove it, but I think he hung up and immediately burst into laughter.
So I did it myself.
I knew it would be a project — and once I started, it could not easily be interrupted by caregiving duties. But exasperation collided with need, and I got down on the floor (at a slant) and went to work. It went exactly as expected: mild swearing, a few tears, and then a small victory. When the bubble on the level finally drifted near the center, I declared success, remembering that old rancher’s saying: “Most things can be fixed with baling wire and bad language.”
It’s level — well, Montana level — but I’ll take it.
Much of what I’ve faced as a caregiver over 40 years can’t be fixed. But small victories, like leveling a refrigerator in a house built when bread was 3 cents and buffalo still outnumbered politicians, remind me that even when most of life leans, you can still make one crooked thing right.
Everyone has a version of that tilted refrigerator — something off-kilter you keep meaning to fix but never quite reach. It might be a strained relationship, a stack of bills, or a heart worn down by too much bad news. You can’t straighten the world, but you can steady what’s right in front of you.
When life feels unsettled, taking time to level something — even a small thing — matters more than we think. Sometimes that quiet act of setting one thing right gives us just enough footing to stand through the rest of it.
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Years ago, city officials talked about “broken-window” policing: Neglect one thing, and the whole neighborhood starts to crumble. The opposite is also true. Fix one small thing, and a bit of order comes back. Leveling even one ordinary object pushes back against the chaos.
Most caregiving must be repeated tomorrow, but every so often something stays fixed. A grab bar anchored in the right place. A ramp that finally fits the chair. The day may still be full of mess and pain, but that one thing won’t need doing again. It stands there quietly, reminding you that not everything leans. Some things still hold. And sometimes that’s enough to remind you that you still can too.
When I turn on the news, I see dysfunction I can’t do anything about. But when I fix dinner, my refrigerator no longer leans.
There’s an old Appalachian saying: “Fix what you can. The rest was never yours to mend.”
Level what you can. Let the rest lean.
