Prior Auth: The AI Arms Race, Medicare’s Cliff, and the Boomer Trade-Off

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Original Substack Release Date: July 20,2025

🎯 Why Listen

Prior authorization is the bureaucratic chokehold strangling American healthcare. But this episode isn’t just venting — it’s a masterclass in how the system got built, why it persists, and where leverage actually lies. From AI-driven denials to Medicare’s looming funding cliff, we break down the forces shaping care today and what physicians and patients can do about it.

 👥 Co-Hosts

• Dutch Rojas – Founder, Bliksem Health
• Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher
• Anish Koka, MD – Cardiologist, Philadelphia; healthcare policy commentator
• Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; healthcare advocate and social media voice
• Sanat Dixit, MD, FACS – Neurosurgeon, Huntsville, AL; Faculty, Vanderbilt University; healthcare entrepreneur

📌 Episode Overview

What happens when AI is weaponized on both sides of prior authorization? One side uses it to deny care, the other to fight back with automated letters of medical necessity. In this episode, the panel dives into:

• How insurers and employers hold the real keys to pre-auth.
• Why 66% of patients covered by self-funded plans could eliminate it tomorrow.
• The Medicare cliff — and how boomer physicians’ choices set up today’s workforce.
• Whether raising the Medicare eligibility age or tying licensure to Medicare participation are realistic fixes.
• Why restoring physician autonomy may be the only path to sustainable care.

This is a roadmap for doctors and patients alike who want to see through the illusion of “insurance as healthcare.”

💬 Notable Quotes

• “This system isn’t designed for patients. It’s not designed for physicians. It’s designed for delay, denial, and distraction.” – Dutch Rojas
• “Every week, I get calls: friends of friends who can’t get in to see a specialist for months. That’s the storm coming.” – Dan Choi, MD
• “If you took lifetime Medicare contributions and put them in an HSA, indexed to the S&P 500, every retiree would have $2 million. Are you telling me they couldn’t manage their care better than Medicare can?” – Anthony DiGiorgio, DO
• “Doctors don’t value themselves. They accept crumbs, when they’re sitting on a goldmine of skill and trust.” – Dutch Rojas
• “We’re spending billions managing the money instead of managing the medicine.” – Sanat Dixit, MD

📚  What You’ll Learn

• Why AI is now a central player in the prior auth wars.
• The real difference between self-funded and fully insured plans — and why HR may hold the key to faster approvals.
• How boomer physicians’ decisions shaped today’s lack of autonomy in medicine.
• The economic and political pressures that make Medicare access increasingly fragile.
• Practical steps doctors can take now to push back on pre-auth and reclaim time for patients.

⏱ The Episode (Timestamps)

• [00:00] Welcome & Dan Choi’s foot drop case
• [05:30] Prior auth: emergency vs elective realities

🔗 Connect with the Hosts:

• Dutch Rojas on X

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X