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Ali discusses all the ways in which President Trump’s brutal and pervasive immigration crackdown is still happening everyday with MS NOW's Jacob Soboroff; how a new Republican bill in Ohio would force the state to go full Handmaid’s Tale and track every pregnancy; Dr. Mehmet Oz turned artificial intelligence loose on Medicare in several states… and it’s going very badly.
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Good morning, it is Saturday, March the 21st.
I'm Ali Vellcian.
We begin this hour with a warning.
President Trump is trying to change the narrative of his brutal indiscriminate and deliberately
cruel immigration crackdown.
He wants to change the narrative, but he can't change the story.
The one that we see with our eyes and on video and the ones brought to us by journalists
who are committed to bearing witness.
Having sustained public outrage and sliding poll numbers over violent deployments by federal
immigration officers in cities like Minneapolis and Los Angeles and Washington, D.C. and Chicago,
this administration has signaled a reset.
They started in late January.
Christy Nome then still head of DHS.
Step back a bit.
The borders are.
Tom Homan was brought into Minneapolis with a tacit promise to rein in ICE and CBP after
officers killed two American citizens and the administration lied about the circumstances
of their deaths.
And this week, Trump made clear what the real problem was with that operation.
Because as the Wall Street Journal reports, quote, President Trump is seeking to lower
the profile of his mass deportation effort, end quote.
The president, the journal reports, has told advisors that he wants to see more attention
on arresting bad guys and less chaos in American cities according to people familiar with
the matter.
End quote.
The report goes on to note that the change is being driven by Trump's chief of staff,
Susie Wiles, who believes his immigration team turned one of his marquee issues into
a challenge for the midterms, and that the firing of Christy Nome as DHS secretary is
being seen as the moment for a reset.
Pay attention to what they're saying here.
For the White House, the problem is the optics.
What it looks like on TV, how it's talked about, what the headlines in the polls say,
and crucially, the reporting on the reset talk at the White House is source to quote people
familiar with the matter, end quote.
The official statement to the journal from the White House spokesperson Abigail Jackson
is quote, nobody's changing the administration's immigration enforcement agenda.
President Trump's highest priority has always been the deportation of illegal alien criminals
who endanger American communities, end quote.
Keep that top of mind, who endanger American communities.
The United States Senator Mark Wayne Mullin of Oklahoma, Trump's picture replaced Christy
Nome, brings to the role all the qualifications that you'd expect from someone who spent
the last decade fixing pipes and picking physical fights at Senate committee hearings.
He's described the revamped this way during his Senate confirmation hearing this week.
My goal in six months is that we're not in the lead story every single day.
Ah, the goal is to not be the lead story every single day.
Again, listen to what's being said.
This isn't about retreating from a widely unpopular mass deportation effort.
For Trump, the crackdowns become a political liability because we see the violence and the
brutality and the cruelty with our own eyes and what reporters show us.
Listen to what the Minnesota Governor Tim Walls told my colleague Jacob Sobrough in this
exclusive interview in late January, which was essentially confirmed this week by the
journals reporting.
I talk to the White House.
I talk to Tom Homan.
I talk to numerous people and not once did they ever say Alex or Renee's name.
Not once did they ask how the people Minnesota were doing.
So look, I know who I'm dealing with and I know the reason that he was calling me was
he needed something from us.
The reason he was calling was his poll numbers dropped and it looked bad on TV.
But the White House wants is for these scenes on the streets to stop because it's tanking
their approval ratings and according to the president, it looks bad.
As Malcolm Ferguson noted in the New Republic, quote, even if Trump has finally realized
that mass federal agents kicking down doors and killing people in the street as a bad
look for the midterms, Stephen Miller is still in the room.
End quote.
Meanwhile, amid the so-called reset, we learned just this week that a 19-year-old who was
arrested after being stopped over a minor traffic infraction died while in ice custody
at a facility in South Florida is the youngest person to die in ice detention during this
administration.
Royer Perez-Hemenes died on Monday of a presumed suicide in his cell according to a statement
from ICE.
His official cause of death remains under investigation, but Royer Perez-Hemenes is dead
after being stopped over a minor traffic infraction.
In Minnesota, we saw in a visceral way what enforcement looks like when it was impossible
to ignore, particularly after the viral killings of Renee Good and Alex Pretty, the crackdown
became the biggest flashpoint in the debate over Trump's mass deportation agenda.
And former Borbitral Commander-at-large Greg Bovino's Auster came as a new AP Nork poll
found that most U.S. adults say Trump's immigration policies have gone too far.
But here's the key.
Most of the enforcement was never happening in the flashpoints that drew all that public
outrage.
New analysis from the New York Times gives us one of the clearest pictures yet of how
immigration enforcement is actually unfolding across the country, and it's not what you
might think.
The bulk of the effort is taking place far more quietly and away from the public view.
Here's what the Times found.
ICE arrests are surging nationwide, now averaging more than 1,100 arrests a day in 2006.
With nearly double from about 600 a day last spring, but enforcement is uneven, and
the busiest areas are not actually the ones making headlines.
Miami leads the country, more than 41,000 arrests since Donald Trump took office, followed
by Dallas, Atlanta, San Antonio.
Most enforcement is actually happening away from the cameras, cooperation with local
law enforcement is key.
About half of arrests are custodial, meaning there are arrests of people who are already
in custody, and those are much more common in Republican-led states where local police
are actually willing to collaborate with the Trump administration.
Crucially, many of those arrested have no criminal record, undercutting the claim that this
effort is in fact focused on criminals and the worst of the worst.
Meanwhile, ICE is operating in a massive scale.
More than 7 million people are on its non-detained docket, meaning that they're not in custody,
but they are considered deportable, 7 million.
According to the Brennan Center for Justice, previous administrations prioritized detaining
immigrants with criminal records while releasing most others pending hearings.
As of last month, according to Brennan, 74% of those in ICE detention have no criminal
record.
ICE air operations has rapidly expanded, for example, driven in part by the growth of its
subcontracted private charter network, according to human rights first latest report.
As that report notes, for the month of February, quote, the findings show a continued escalation
of the Trump administration's mass deportation agenda, including 183 removal flights to 31
countries, and the continued use of forced third country transfers.
In February alone, after the administration's supposed reset, there were 3630 immigration
enforcement flights.
155% increase from February of last year, private contractors are really doing well, by the way.
ICE awarded Corsific, which is a private prison company, a no-bid contract to reopen a
1,033 bed facility in Kansas, later expanded into a deal expected to bring in about $60 million
annually.
ICE also signed a $1 billion 15-year contract with Geo Group, another major private prison
operator to run a detention facility in New Jersey, 15 years as an unusually long deal.
Trump's shift in strategy is about moving this effort out of sight, and for the long term,
but the machine machinery has not stopped churning.
And as reporting continues to show, enforcement is increasingly reaching into the most vulnerable
populations, including pregnant, postpartum, and nursing immigrants.
As of February 16th, 121 people in ICE detention fell into those categories, including 9 women
who were in their third trimester, despite federal policy stating that such individuals
should only be detained in limited circumstances.
In January 2025, and February 16th of 2026, 16 miscarriages were recorded by people in federal
custody, and as enforcement expands another deeply troubling development is getting far
less attention than it should be, the surveillance of political dissent.
There's growing evidence that federal agents are tracking and documenting American protesters.
Not immigrants, not undocumented immigrants, American citizens who are protesters, filming
them, logging their information with the help of tech companies like Palantir, and ultimately
relying on that same data system that powers your phone, and your texts, and your emails.
According to reporting by the Washington Post and the New York Times, and now, according
to new reporting from NPR, in some cases, it goes further.
According to NPR, ICE officers are taking DNA samples from American protesters who they
arrest.
One protestor described being tackled while filming and arrest detained, and then without
warning, having his DNA swab.
Legal experts warned this could amount to what one attorney calls a catalogue of political
dissidents, a catalogue of political dissidents in America.
And that changes the stakes for anyone who does not support this administration, which
right now is actually a majority of this country, and growing, which is why more than ever
this moment demands reporting, grounded not in the beltway, but in the lived experiences
of the people who are most affected by these policies.
Which brings me to my next guest, Jacob Soberoff.
Jacob has spent years on the ground in communities across the country, across the world, actually,
telling so many stories, but this one in particular, the story of the cruelty and the human
cost of Donald Trump's anti-immigrant program.
Not as an abstraction, not through Washington punditry, but through the lived experiences
of everyday Americans navigating it in real time.
Now as many of you have probably heard by now, I will be leaving this, my name's sake
weekend program in the next few months, to host the 11th hour on weeknights, and to track
the midterm cycle as MSNOW's new chief data reporter.
And while I am excited for this new chapter, I'm departing with a heavy heart, knowing
that I'm leaving a show that's given me so much.
And that's allowed me as a long time reporter to center the voices of everyday Americans.
That work will continue, because Jacob Soberoff will be taking over the show.
I've known and worked with Jacob for years, and I could not ask for the show to be in
better or steadier hands.
Jacob Soberoff joined me now.
Jacob, my friend, welcome to a place you're going to be spending a whole lot of time over
the next few months.
And I want to talk to you about that in just a few minutes, but I want to start with
this issue of immigration.
The New York Times data that I was just talking about shows that the busiest enforcement
hubs, places like Miami and Dallas, aren't necessarily the ones dominating the headlines.
Why is there such a disconnect between where the enforcement is actually happening and
what we all think we're seeing?
Jacob Soberoff I'm going to come back around to that
in a second, Ali, but you made me emotional and I can't just dive right into this.
I want to say to you that I am so profoundly grateful to you for not only that beautiful
introduction, but your friendship over my 11 years here and us working together.
We are not just buddies, but you are a role model for me.
The connection that you have forged with the viewers of this broadcast and this network.
And just everybody who was in your room, but I had such an incredible time talking with
your entire staff of this wonderful, wonderful show yesterday is second to none.
And so I love you.
I love this show.
I love this network and I am so excited.
We'll talk more about that.
But I'm glad I'm leaving it in your hands so much.
But you really are.
You have for a long time.
This is not new to you studying this particular issue.
This issue of immigration, you've written a book about it.
You studied it in great detail in Donald Trump's first term.
You've covered the separations, family separations.
I don't know if even you thought it could get more cruel.
No, and I think that the way that this was laid out by you and your team is extraordinary
because before Donald Trump came back for the second term, I used to say, mass deportation,
those signs that I saw on the floor of the convention as I reported from the Republican
convention during the last presidential election is family separation by another name.
But as you have so brilliantly stated here, it's not just family separation.
It is abject cruelty.
It is a violation of all of our civil rights and civil liberties.
It is stripping away some of the basic fabric of American society in a way that, well,
I think if you look at this stuff closely, you understand that this is where this was
headed.
It has gone to a degree that I don't think perhaps many Americans did expect when they
saw those signs and they saw those balloons dropping with Donald Trump in that celebratory
nature.
This is, it is now starting to play out below the surface as they have always intended inside
jails, local jails, prisons around the country where, in many cases, people may not get their
due process rights afforded to them under the Constitution of the United States that we may see
pretrial, pre-conviction, deportations of people who haven't had a chance to go through
the system and that is what they have always wanted to do.
They use the cruelty that you're looking at on the left hand side of your screen
as an excuse to go in and do this under the radar and that's exactly where we are in this
moment.
Today, Christy Nome and her jet in Corey Lewandowski and all the rest of it might be on the way out,
but Mark Wayne Mullen has just another face for the same exact strategies that Stephen Miller has
always wanted to effectuate in this country.
This story of immigration is not disconnected from the story of oligarchy and big money that we
follow very closely.
We know that for profit, prisons have profited handsomely from Donald Trump's deportation campaign.
In fact, just this last month, one of the companies that I was talking about that you know
well, Core Civic held its quarterly earnings call and it laid out just how much money it's
making along with its expectations for the coming year.
I want to play a quick clip from that call with Core Civic's CEO Patrick Swindle speaking
about this.
ICE was our first customer 43 years ago.
It has been our largest customer for over a decade.
As we continue to look for additional ways to meet our government partner's needs,
we believe we can make available substantial capacity to meet future demands.
We've informed ICE that we could provide it with nearly 13,000 additional beds.
And this does not include additional capacity.
We may be able to provide it through other means.
I'll be with that Jacob.
When you hear the CEO talking about expanding capacity to meet future needs,
what does that tell you about the role of profit and investor expectations in shaping
what we think shouldn't probably be policy that's shaped by them?
That the current state of the American immigration system is on its way to being
supersized. And that is an immigration system that is defined largely by for profit,
immigration detention. And I have been inside one of the most notorious ICE detention
facilities for profit, run not by Core Civic, but one of the other large companies
of the Geo group, the Adelanto ICE detention facility in the high desert here outside of
Los Angeles. Just a couple hours away, hop in your car and you drive up there as I did with
Lindsay Taslowski from the immigrant defenders law center during the first Trump term.
And inside what I saw as what was reflected inside Inspector General reports, just
deplorable conditions. I saw a man curled up in a fetal position in solitary confinement.
These Inspector General reports talk about people hanging themselves, making makeshift
nooses. You already talked about a suicide at a time when death and ICE custody is at record
levels just in the course of the very recent past here. And so we've heard these stories
before. I have seen what has looked like inside these facilities. And now with profit driving
the expansion of all of this with this so-called big, beautiful bill, putting literally
unprecedented amounts of money in the hands of this immigration apparatus, there will only be
more of it in more places and it will only become more deadly.
You know, we have noted that Christy Nome has gone from the scene.
Mark Wayne Mullin is saying to some people the right things like we're going to have
judicial warrants or whatever the case is. Steven Miller is the architect of this thing. He's still
there. Steven Miller in the first Trump term alley not only want to separate the 5,500 children
from their parents that they deliberately did in that family separation policy that was deemed
don't take it from me. Take it from the Republican appointed judge who called it one of the most
shameful chapters in the history of our country. Physicians for human rights, which won a Nobel
Peace Prize set up at the United Nations definition of torture and the American Academy of
Pediatrics called it government sanctioned child abuse. He wanted to separate 25,000 children
from their parents, not 5,500 before it was stopped by people all around the country and around
the world. And that to me ultimately is I think was one of the most instructive things that you
said earlier in this broadcast, which is Donald Trump is not backing away from this because of some
moral opposition. This is a repeat. This is deja vu found the first Trump term. When he stopped
the family separation policy as Kirsten Nielsen stood behind him, the person who
effectuated by signing option three on the decision memo. He didn't say, whoa, I'm morally opposed.
He said, I didn't like the sight and the feeling of the families being separated. Didn't look good
on TV. Didn't look good in that audio from pro public of the ginger Thompson found.
But Stephen Miller was still there and they still tried to find ways to do it below the radar.
And now we're back doing it again. And Stephen Miller hasn't gone anywhere.
Jacob, viewers of the show are going to get to know you real well very soon. But I want to just sort of
I want to give him one little piece of insight into why you do what you do. It was 2022. It was
the first day you and I were together in Ukraine. Let's play a little of this conversation you and I had.
One of the things that my viewers are often curious about is how how you all end up here.
What motivates you to run toward danger? It's the people for me. It's always the people in the
two and a half weeks that I've been here. You get to talk to people from the east that are
sleeping in red cross stance at the train station. I got to spend time with people who
survived the Holocaust only to flee another born invasion. People serving hot meals to people
all around the country. It's through those stories and not just the politics of the
negotiations or the familiar faces that I think for me it makes it makes us all worth coming to do.
Jacob, that's your lens, right? That's your lens is not Washington. Your lens is not it's not
power. It's it's people everywhere you go in the world. You're reporting on people and how
they're affected by stories. It is, as I said, it's an honor to follow in your footsteps because I
feel like you do this better than anyone. For me being a part of this place has always been about
the people not about the politics and I'm talking about you and my colleagues here at MS and I
am talking about our audience, the most engaged audience, the most extraordinary people that I've
ever met in my career in broadcasting, but also the people that we cover who allow
us to enter their lives oftentimes on the worst day. And it is a profound privilege and honor.
And for me, whether it was in Ukraine with you, or in Haiti, or in Guatemala, or in Greenland,
or in Mexico, or in so many places around the United States of America, to be able to come face to
face with people. For me, on a voting line sometimes, it might be down on the border other days.
For a while, it was on the plaza at the Today Show. I love human beings. And to have three hours
on Saturday and three hours on Sunday to spend time connecting with them is the biggest blessing
that I could ask for. And I mean that sincerely. We're looking forward to spending a lot more time
with you, my friend. Thank you for your friendship and for your amazing reporting. And for the
job you're about to do when you take over this show, Jacob Soberoff, MSNL, Senior Political National
Reporter, and in just a few months, the new host of this time slot. Thank you. Thanks, my friend.
You too. Coming up, the Senate's in session this weekend taking up Donald Trump's voter suppression
bill, ironically called the Save Act. We're watching Capitol Hill for the votes and we'll keep
you posted. Plus, Republicans in Ohio are taking a page out of Margaret at literally a page out of
Margaret Atwood's The Handmaid's Tale with legislation that would track every pregnancy from beginning to end.
Margaret Atwood joined the Velsheband Book Club to talk about her seminal dystopian novel The Handmaid's
Tale. She reminded us that she got all the ideas for the book set in a near future autocratic
theocracy from actual history, from real things that had happened in the world and could happen again.
She actually kept the newspaper clippings that she used as research when she wrote this book in 1985.
In this week, there's a story out of the state of Ohio that reads like a building block of Gilead
come to life. Ohio Republicans introduced a bill that would allow the government to track every
pregnancy from beginning to end. The measure called House Bill 754, HB 754, would create a
state-run registry of pregnancies requiring medical providers to file a certificate of life within
the Ohio Department of Health within 10 days of examining a pregnant patient and detecting a
fetal heartbeat. First, noting here that what we call a fetal heartbeat is more accurately
described as fetal heart activity, which the Cleveland Clinic notes begins as the cells that will
later form the fetal heart begin to cluster early in the first trimester and can create electrical
pulses. The medical provider would be required to provide a copy of that certificate of life to
the pregnant woman. The bill also mandates that fetal deaths be registered with the state and
that provider specify whether a pregnancy ended in miscarriage, abortion, or stillbirth. I'm not
done. Then, a cause of death would need to be certified within 48 hours and if a fetus is deemed
to have died in a, quote, violent, suspicious, unusual, or sudden, end, quote, manner, a coroner or
a medical examiner would be brought in. So who decides which fetal deaths, which are otherwise
known as miscarriages, which are also very common, should be deemed suspicious? And for that matter,
a miscarriage is medically defined as a sudden or spontaneous loss of a fetus. It is always sudden.
That's literally what a miscarriage is. According to the Mayo Clinic, about 10 to 20% of known
pregnancies result in a sudden loss of a fetus, a miscarriage. The actual number is likely
much higher because many miscarriages happen very early in a pregnancy in some cases before a woman
realizes that they are pregnant. As the journalist Jessica Valenti writes, quote,
let's be clear about what this really is, an attempt to build an infrastructure for pregnancy
surveillance, not just tracking who's pregnant, but documenting how every pregnancy ends and
creating a pathway for scrutiny if the state decides that something looks off. While this
legislation would be insane, no matter where it was introduced, the fact that it's being proposed
in a state like Ohio, where in 2023 voters passed an amendment and shrining the right to abortion
in the state's constitution is telling. The state already requires a death certificate for miscarriages
passed 20 weeks of gestation. So while this bill, if it signed into law, would certainly face
legal challenges. It's not entirely clear whether it would be overturned in a post-row legal climate.
And regardless of whether or not legislation like HB754 passes, it's a terrifying signal of intent.
It tells us exactly what kind of regime conservative lawmakers are trying to implement.
It lays bare the purpose of the anti-abortion movement, which has always been about controlling
women and their bodies. And it heralds a sort of reproductive police state that sounds a lot,
like chapter 11 of the Handmaid's Tale. Quote, yesterday morning I went to the doctor, was taken by
a guardian, one of those with the red arm bands who were in charge of such things. We rode in a red
car him in front, me in the back. No twin went with me. On these occasions, I'm solitaire.
I'm taken to the doctor's office once a month for tests, urine, hormones, cancer, smear, blood tests,
the same as before, except that now it's obligatory.
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Joining me now is Michelle Goodwin, professor of constitutional law and global health policy at
Georgetown Law. She's the host on the issues podcast. She's the author of the very important
book, Policing the Wulm, Invisible Women and the Criminalization of Motherhood. Michelle,
thank you for being here. I love having you on the show and we've talked about this
so many years, but I was sort of mixed about having you on the show because I thought that's,
you may be too heavy a hitter for this given your expertise because this is just, this is just
basic, weird, policing of women. There's not even, there's no science or medicine to discuss here.
Thank you for having me on and thank you for being so consistent and shining in a very
important light about what's happening in our country with regard to women and reproductive
health rights and justice and your right. It's absurd. It reminds me of a speech that Dr. King
wrote upon receiving a humanitarian of the year award from Planned Parenthood in 1966 and he began
that speech with saying if aliens were to drop down from outer space, they would say that our
nation is governed by a group of insane men. Well, in this case, we see the majority of these
legislatures as being male control, though the author of this bill happens to be a woman in the
state of Ohio and it is absolutely insane and what it purports is exactly what you suggest it
was is surveillance and the potential, the very real potential and probability of criminal
punishments and civil fines and various other horrors. So miscarriages are very, very, very common.
I mean, part of the whole discussion you and I've been having for years is if men knew a little
bit more about reproductive stuff, some of the stuff wouldn't happen, right? And if you tried this
on men, if you suggested there was anything that men do that should be surveilled, people would burn
everything down. Remember all the stress about whether you should be on a contact list if you had
COVID and how great. Can you imagine this, this degree of tracking women? In many cases in a
traumatic period for them, if they, if they have lost a child and now you've got 48 hours,
you got to file documents and you got to do all this stuff, it's, it's, it's really just basic
policing to what end? Oh yeah, no, that's absolutely right. I mean, what we see right now are proxies
and you've been talking about this and we've talked about this, the connection between democracy
and reproductive health rights and justice. So right now, we have the potentiality that many
will women, like millions potentially could lose their right to vote if the save act gets across
the line. We see actions like this, which are minted, you know, this is all a part of a,
a flood the zone that is targeted at women. And what we know with this is that when the Supreme
Court overturned Dobbs in 20, well, when the Supreme Court overturned Roe and Blanford Hood,
V. Casey in 2022 with its job decision, our Supreme Court only years before had acknowledged that
a woman is 14 times more likely to die in this country by carrying a pregnancy to term than by
having an abortion. Full stop. 2016, the Supreme Court acknowledged that in a Texas abortion case.
We also know as you've mentioned that miscarriages are frequent. They are a part of life of a woman
and a part of pregnancies upwards of 30% of pregnancies will end in miscarriage. That's a reality
and also still a birth. But what you see with this pronatalism, this anti-abortionism is the
surveillance, this tracking, this desire to criminally punish, to civilly punish. What this
is meant is that doctors have had a very hard time intervening when they otherwise would have
across this country because they want to save a woman's life, right? Because something may have
to happen, but that might mean the result is an abortion. And now the doctor or the hospital
doesn't want to get involved in that. No, they don't because, you know, you risk 99 years in
incarceration and $100,000 fine for each patient that you provide ethical, professional care towards.
I mean, this is the lunacy that's been unleashed by the Supreme Court with its DOBS decision.
And notably the then diagrams that overlap between the anti-abortion states and the American
Confederacy. I mean, we're talking about states that have had a very strong taste for the subordination
of groups of people, including women and including people of color, particularly black women.
And you notice then those who've become most harmed by this, you know, all women are harmed,
but there's a specific kind of terror that is unleashed in the lives of low-income women
and women of color and particularly black women. And it's a real tragedy that isn't being spoken
to in his explicit terms as needed. A taste for subjugating groups of people.
Note to myself, when in doubt, asking Michelle Goodwin to come on the show is always a good idea.
Thank you for being with us. As always, Professor Michelle Goodwin, Professor
Georgetown law host of the On The Issues podcast and author of the increasingly relevant and
important book, Policing the Will. All right, coming up, a TV doctor, Donald Trump hired to run
Medicare and Medicaid is unleashing artificial intelligence on Medicare approvals that used to be
handled by humans. What could possibly go wrong? If there's one thing that Americans agree on right
now, it's that our healthcare system is sick. Our premiums are too high. Our access is shrinking.
Americans deserve affordable quality healthcare. And AI should not be determining whether you get
healthcare.
They paint a picture for you. You're living with chronic debilitating pain. You've got Medicare
and your plan covers a procedure that could bring you immediate and long-term relief except
that your coverage claim just got denied by AI. That's what's happening to many Medicare
patients in several states thanks to a new program by the Trump administration. At the start of
the year, Dr. Mehmet Oz appointed by Donald Trump to lead the Centers for Medicare and Medicaid
Services, called CMS. It launched the so-called wasteful and inappropriate service reduction model
known as wiser, which is interesting because the letters don't actually match. The agency says
the program is designed to reduce spending on unnecessary care using what it calls enhanced
technologies, including artificial intelligence and machine learning. Machine learning is a subset
of AI that enables computers to learn from data and make decisions. These tools are now being used
to review a pre-selected list of medical services that the agency says are most vulnerable to fraud,
waste, and abuse. What's actually happening is that vulnerable people are having their care
delayed or even denied. As the Seattle Times explains, quote, that means patients seeking certain
medical services now have to wait for a third-party tech company to give them the green light before
they can get treatment. The wait for approval can be long and disruptive. The new program adds a
first-of-its-kind layer of scrutiny for patients trying to get certain services, as well as for
doctors attempting to provide care, end quote. Democratic Congresswoman Becca Belent of Vermont warned
about this in September. Over at the Center for Medicare and Medicaid Services, the administrator,
Dr. Oz. Yes, that guy decided to curb waste the government. He decided they should curb waste by
letting the government use AI to decide if your medical procedure is really necessary. That means
for-profit companies will use VOS to deny care for seniors and working people and will get rich
doing it at your expense. Now, CMS told the Seattle Times that the agency monitors turn around times
and will, quote, refine the model as appropriate. Medicare primarily serves American 65 years of age
or older, a population that is more likely to experience serious illness and chronic pain. In
other words, the people who need timely care the most. So far, the wiser model has been rolled out
in six states, Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington, and there are plans to
expand it nationwide and to apply it to even more medical services. But just a little more than
two months in, patients say the impact is already being felt. Treatments that once took days to
access are now delayed for weeks or even months or denied altogether. Treatments like those for
spinal degeneration and severe back pain. Patients who spoke to the Seattle Times say the delays are,
quote, robbing them of their quality of life, end quote. Joining me now is the Technology Journalist
Jacob Ward. He's the host of the podcast, the rip current and the author of the book, The Loop,
how AI is creating a world without choices and how to fight back. I recommend everybody read
this book. It's really, really important and timely. Jacob, my friend, let me ask you something.
I would have thought, I've often made the case that you can hate AI for a lot of reasons,
but I've always thought in the provision of healthcare and research and the, you know,
finding cures to diseases and things, it might actually be more helpful. How come AI being applied to
this application in Medicare seems to be making things worse for people?
That's a great question, Ali, and it's true. You know, so I'm constantly accused of being,
you know, of not accused, but, you know, I'm a bummer at parties when it comes to this topic
a lot of the time because so much of the time I think about the trouble that AI gets us into.
But one of the bright spots has been healthcare. You're absolutely right. You aim, you know,
a pattern recognition system at, you know, a huge database of pictures of, you know,
discoloration on people's backs and it can figure out which ones are cancerous and which ones
are not better than humans can. I mean, it is an incredible tool for discovering new,
you know, chemicals you can synthesize. I mean, there's incredible stuff you can do with it.
That's medical. This isn't that. What this is is bureaucracy, right? And where people have imposed
these sorts of systems on bureaucracy in the past tends to go very wrong. And that's because
what wiser is is part of a long tradition of basically experimenting on powerless people.
That's really what this is. We have seen, you know, since 2013, case after case in which
authorities will look at typically a welfare system and do big experimentation on those sorts
of systems because the people involved are powerless. It's a place you can make big mistakes and
nobody can really push back on you. You know, we've seen this in cases where California during
COVID was spiking one in 10 unemployment applications because they'd bought an off the shelf piece of
AI from Thompson Reuters and wound up, you know, creating this just havoc in people's lives. And
that's a case where you can't find somebody to get them on the phone and say, hey, the
right computer did this wrong, right? It's disenfranchising people while automating this kind of thing.
And here's the real thing, Ali, I'll just say there is an incentive mismatch here because the
private companies that make systems like wiser typically are paid more for the number of denials
their system issues. So they are incentivized not to fix those kinds of mistakes because they
make more money off. So I have a dry eyes. I get I have a prescription that I get filled for
that and I've been getting filled for a while and suddenly it got denied the other day for no
particular reason. Wow. And I don't know whether it's AI or not, but I actually can't get a human
to say, hey, you know, I've been on this medication. The doctor says I should use it. What's the problem?
You studied this. The the idea that you use automation for this doesn't end up
solving the problem in some cases. And I don't know is that because sometimes you just need
human intervention for someone to say, hey, well, she's been getting this these eye drops for
like five years. Why did we why did we suddenly stop? The machine may be made a mistake.
That's absolutely correct. I mean, I just think we have this long tradition in in the
United States of of believing that efficiency is a good enough reason to experiment on,
you know, on people live in the wild. And everything that we do in the private sector right is
informed by the idea that you got to make money off of each step of the process of you trying to
get the drops that you need, right? But in truth, that may not be a profitable thing. You may need
somebody on the phone in such a way that that people can get in touch. And so what we're seeing here,
I think is just, you know, this is a I mean, you know, and there's the case of of it, you know,
when it's something like the, you know, I feel for you with the with the different the bureaucratic
bureaucratic difficulty there, you know, but there are people I've spoken to, you know,
folks at the University of Baltimore, the law clinic there, they have to go in and appeal people
who are being denied snap benefits, right? Housing. That's right. I've got the resources
to solve this problem. One way the other time in the luxury and the resources to solve this problem,
a lot of people don't. That's right. You know, and those disempowered people are the people
being experimented on first. And in this particular case, it's worth noting here, right? That
Dr. Oz is talking about this as if somehow the efficiency will then convince people to trust
a system like this. You know, the studies show right now, 31% of people over the age of 65 on
Medicaid have no trust in the, sorry, are only 31% of them have any trust in a system like this.
So that means you've also got somebody at home who's been denied their medical, their medical
coverage. And they're totally demoralized and have no ability how to, you know, to how to even
appeal this stuff. So again, it's just experimenting on the powerless, which is a theme we see over and over.
It's one thing to trust AI in a vacuum when it doesn't actually affect you. But if it's actually
going to stop you from getting your prescription drug, I suspect your level of trust is going to
is going to decrease. Jacob, as always, thank you so much for helping us understand this little
slice by little slice. Jacob Ward is a technology journalist. He's the host of the podcast,
the rip current, and he's the author of the book, The Loop. We'll be right back.
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