
The Guardrails
The Take — Medicare's denial pilot has the burden of proof backwards
Medicare's AI prior-authorization pilot is being argued about as if the scandal were the algorithm or the bounty. I think the real defect is smaller, plainer, and more fixable than either: the program never has to prove a denial was correct, and the only party who can force the question is the patient. Flip that burden of proof — put the reviewer before the patient rather than after — and most of this fight evaporates. Start with the money, because that's where the argument keeps getting stuck.










