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In the Advocate July 2025: Anne Shields Are You Considering Residential Solar? Resources and Tools to Help You Get Started Anne Shields Are There Still Financial Incentives for Installing Solar? Yes! State sales tax exemption: Washington provides a sales tax exemption for solar energy systems, including rooftop solar panels,other materials and their installation. The exemption is available through 2029 and is usually provided through your contractor. You can request a refund if you are charged sales tax on eligible materials. Residential renewable energy tax credit: The federal government first enacted a solar investment tax credit in 2006, which allows people who install solar panels on their homes or businesses to claim a reduction in the income taxes that they would normally pay to the IRS. The amount of this reduction is capped at 30% of the amount invested in the solar array. WA’s Community Solar Program Might Save You Money Olympia Community Solar’s non-profit group purchasing model might reduce your costs and help simplify the installation process. The Solarize program is currently open to enrollment by residents of Island, Mason, Lewis, East King, Skagit, Thurstonand Whatcom counties and the cities of Bellevue, Issaquah, Mercer Island, Redmond, Sammamish, Kirkland, and Kenmore. What about the Tariffs on Solar Panels? The Trump administration tariffs on solar imports are unlikely to slow the rollout of solar power in the US. Even if it becomes a little more expensive, solar remains one of the cheapest clean energy sources. The good news is that Washington State’s solar panel manufacturing industry is growing rapidly and now supplies many local installers. Where Can I Learn More? The Dept. of Energy online Homeowner’s Guide to Going Solar is a great resource for learning the basics of residential solar installation. Olympia Community Solar’s 11-minute video, Five Steps to Going Solar, might also be a useful starting point. These resources and tools will help you get started, but make sure to work with solar installers for custom estimates of how much power your own system would be likely togenerate. Getting Bids and Choosing a Contractor The non-profit Solar Washington recommends getting at least three bids and checking references on all contractors that you decide to consider. Solar WA also recommends finding vetted local installers through the Washington Solar Energy Industries Association (WASEIA). You will be able to find a wide range of reputable, local solar installers through the WASEIA online tool foridentifying installers in your region. Comparing Installation Bids Solar WA offers a detailed list of Questions for Solar Shoppers and advice on comparing bids that you may find useful. Many factors go into an installer’s bid and cost structure, including labor required, the equipment used, the amount of power generated, warranties, and financing options. Overhead costs: Some solar equipment suppliers have high overhead costs, resulting in higher bid amounts. However, homeowners should be wary of bids significantly lower than other bids, as this may signal that an installer is cutting corners. Equipment costs: The number, type and quality of panels installed can be a significant factor in the estimates you receive. Different types of solar panels produce varying amounts of electricity, and some panels last longer than others. Warranties and production guarantees: Many installers provide warranties, but what those warranties include and do not include will vary. Generally, higher solar bids may include better warranties that could save you money in the long run. Some companies provide additional guarantees, such as production guarantees and coverage for any potential damage to your roof. When reviewing your bids, you should always read through warranty information carefully and check if the information you receive is clear about its coverage, process, and coverage amounts. Permits and policies: Your bids should include state or local permit costs for solar panel installation or usage. Be sure to review and compare these costs across all your bids. Anne Shields is a member of PSARA's Climate and Environmental Justice Committee and Third Act Washington. BACK TO THE ADVOCATE

The Retire Advocate < Back to Table of Contents September 2025 Rest, Recharge, Find Joy in Our PSARA Community and Resist Facism! In-Person Concert Featuring Janet Stecher, Mark Aalfs, and Peter Costantini Saturday, October 25th We are delighted to welcome back by popular demand PSARA members Janet, Mark, and Peter on October 25th from 2:00 – 4:00 p.m. The concert will be held in the Beaumont Room of the Bay Vista Residential Tower on the sixth floor, 2821 2nd Avenue, Seattle, WA 98121. Appetizers and sparkling waters will be provided. Bring a dish to share if you would like. Janet, Mark, and Peter have played for us over the years and will once again lead us in song with some of our favorite tunes from the labor, peace, civil rights, and climate justice movements. Janet Stecher has been a figure in topical music in Seattle through her participation in the singing group Shays’ Rebellion, and in the duo Rebel Voices, with Susan Lewis. She conduct- ed the Seattle Labor Chorus since its founding in 1997 to 2019. She was also a longtime Board Member of the Pacific Northwest Labor History Association. Janet was a member of Musicians Local 76-493, and a recipient of the Joe Hill Award, granted by the Labor Heritage Foundation of Washington, DC. The award, named after labor organizer and songwriter Joe Hill, is a lifetime achievement award for persons who have contributed to the successful integration of arts and culture in the labor movement. It is granted to persons based on their dedication, participation, and promotion of labor, labor arts, culture, organizing, and/or history. Previous recipients include artists Pete Seeger, Utah Phillips, Anne Feeney, and labor organizer Cesar Chavez. Mark was active in the late 1970s, volunteering to support the United Farmworkers. He spent four decades working in the energy industry, managing green power and green building programs. His greatest satisfaction has been working with the large community of energy efficiency and renewable energy workers and citizens of the Pacific Northwest to achieve historic levels of energy efficiency and renewable energy acquisition. For Mark, music has been a part of his life, always inspiring, energizing, and encouraging others to stand together for our social fabric and democracy. Peter arrived in Seattle from the East Coast in 1973. He Joined Mark and other bright lights of the Seattle protest music scene. He spent 20 years working construction and was active in two locals of the Laborers International Union. He was a founding member of the Seattle Tenants Union and sat on the executive board of the National Tenants Union. Peter spent most of his life involved with the immigrant justice movement, spent 20 years in the software industry, and at the same time was a journalist producing several specials on Mexico and Nicaragua for MSNBC News and later for Inter Press Service, a Roma-based non-profit newswire. We are joyful our PSARA family can be together again to sing along with Janet, Peter, and Mark and recharge ourselves to continue our fight against fascism. For more information, watch for PSARA email updates. If you don't get regular emails from PSARA, please email organizer@psara.org to get on our email list. < Back to Table of Contents

PSARA Oral Histories Project: Bob Barnes Interview Pvt. E-2 Bob Barnes Return to Oral Histories Main Page Bob Barnes Interview PSARA Advocate Archives May 2022 Page 5 (Part I) June 2022 Page 6 (Part II) Swimming Against the Current, Interview with Bob Barnes By Angie Bartels When he enlisted into the US Army in 1968, Bob Barnes intended to join a branch of the service where he wouldn’t see combat. “I wasn’t opposed to combat in principle, but I was in a pretty unformed way opposed to the Vietnam war.” In college, Bob played bass in rock and roll and jug bands where they played Country Joe and the Fish’s Fixen’ To Die Rag, their anti-Vietnam war anthem, sentiments which he himself felt. He had also met members of SDS (Students for a Democratic Society) out of Austin, TX, who tried to talk him out of enlisting. But Bob’s opposition in those days was theoretical. It hadn’t yet taken form in reality. Enlisting in the armed services after college just seemed like the next thing to do. Bob came from a hard-working middle-class family whose members enjoyed hunting. Guns did not intimidate him. He wasn’t part of the resistance in those days, and he didn’t want to go to graduate school just to get a deferment. Besides, he had talked with his friendly Army recruiter and was told that he could join the Adjutant General’s Corps and go to Embassy parties in DC for four years. “I thought that sounded marvelous, and being dumb as an East Texan rock, I bought it hook, line, and sinker.” He was shipped off to Fort Polk, LA, and ended up in the Infantry. But that didn’t worry him – he was going to embassy parties for the next four years. Ft. Polk, LA, was where most infantry troops were trained before going to Vietnam. The Army called it “Tigerland,” as its climate and geographical conditions were like those of the jungles of Vietnam. As Bob settled into his barracks, he started to feel that something was very wrong. He found that most of the other guys were kids, 3, 4, 5 years younger than himself. “Most of them were not white. Most of them did not join. They were either drafted or they were given a choice by some judge – enlist in the Army or go to jail. So they joined the Army.” “It was a whole different world than I had ever been exposed to, not just military life in the barracks, but a whole different bunch of people that had not been part of my frame of reference. I had gone to a segregated high school and the color lines in my privileged life were pretty much invisible. But they were sure as hell there in retrospect.” Once he got over the disorientation, he cruised along on automatic pilot knowing that this was something he had to get through but wouldn’t have to worry about once he was out of training. “So we got through Basic Training and then onto Advanced Infantry Training where, during target practice, what were once just targets were now human silhouettes that had the letters ‘VC’ (Viet Cong) printed on them. That was done to acclimate us to shooting enemy combatants. And that’s when I really started questioning (1) Is this something I really wanted to participate in? And (2) did I want to be in a leadership position over anybody in this war, particularly kids whom I knew were not there out of any commitment on their part? They were strictly cannon fodder and they knew it. And I said to myself, I ain’t going to do that.” Soon the new soldiers were confronted with a crisis that did not directly affect Bob. Graduation from Advanced Infantry Training was to take place a few weeks after Christmas. Everyone was sent home on leave for the holidays with the promise that at the end of graduation, they would be allowed to go home again before they received their orders and shipped out to their assignments. The holiday happened and everybody came back to the base. They were then told, “No, sorry, we’re going to have to cut your orders right now, as soon as you graduate, and you’re going to wherever you’re assigned.” Most of them were going to Vietnam. “There was this spontaneous, all-encompassing, ‘We can’t believe this is happening, this can’t be happening.’ When we marched in formation we counted, about 200 people, ‘1-2-3-4, 1-2- AWOL.’ It was just crazy.” After graduation, Bob spent that night shuttling people into Leesville, Louisiana, where the bus station was located. He was not at risk of going to Vietnam right then. He was waiting for orders to Officers Candidate School (OCS). Yet he wanted to help these guys who were very upset. He didn’t know what to do. Bob estimates a couple hundred men took off that night for home. The Army put the word out instantly, “If you took off and then reported back within two weeks, there would be no consequences.” He’s unsure how many folks came back, but he suspects most of them did and accepted their orders. He remembers that a few went to Canada. Bob had begun researching the implications of going AWOL. He called his friends from SDS and explained the situation, about the guys who were being ordered to go to Vietnam without a chance to say goodbye to their loved ones. What could they do? Bob was told they had three options: they could go AWOL, they could go to Canada, or they could file as conscientious objectors (CO). SDS folks provided articles about why the US was in Vietnam, something to do with oil, tungsten, and resources. They also provided a copy of the Army’s handbook and contacts for conscientious objector counselors. That’s when Bob learned that one could file as a CO for discharge from within the service. He compiled this information and shared it with the guys in his unit, who in turn shared it with others. “The anti-war movement within the military was at that point vibrant. The army was in rebellion. What we were doing was just a microcosm. There were air force pilots refusing to fly their B-52 bombers on bombing sorties, and hundreds of active-duty soldiers signed a letter published in the New York Times denouncing the war.” “I was left at Ft. Polk awaiting my assignment to Officer Candidate School (OCS), and I started thinking, what am I going to do? At that point, I didn’t know what I was going to do, but I was not going to Vietnam.” Bob entertained fantasies of going through OCS, which was a six-month program, and “then at graduation, when I was given my little gold bars, throwing them on the stage and denouncing the war. I thought, wow, that’s a big waste of my time, going six months just to do that? Instead, I dropped out of OCS and filed as a conscientious objector. I marched the application into my commanding officer’s office, and he tore it up. Then I handed him a copy of the army regulation, which they didn’t have in their books, and he tore that up too. What I was doing was outside of his and the army’s frame of reference. No one in anyone’s memory had filed for CO status from within the service. When I look back on this, I think, how in the hell did I think that I could pull something like this off? I was not a political activist. I had no one but my then wife, Peggy, who stood by me as an ally. I had a copy of the application and the regulation, and I was finally able to convince the officers that they had to accept my application.” Bob did a lot of KP for a while. He was the first person at Ft. Polk to file as a CO since WWII. And the Army literally did not know how to deal with him. The regulation wasn’t even in the book, as they had removed it. Bob had to carry it around with him, and one commanding officer ripped it up when Bob handed it to him. But they couldn’t stop him. “It was army regulation 635-20 which said clearly that one had the right to file as a CO from within the military. So I did, and I wasn’t alone in this. I gave others the information, and I shared it as far and wide and with as many people as I possibly could. I was assigned to drive around the base and deliver mail and by a certain point, I was distributing The Ally, which was a national underground newspaper. It was not put out by active-duty people, but it was for them, and there were articles written by soldiers. I could see what bad shape the army was in. It was already in a state of crumble when I joined. There was a guy I went through Basic with who talked way over my head. He had joined the army with the intent of organizing against the war. That was brave. Another guy was trying to unionize soldiers. I’m not sure how successful they were, but this was the lake I was swimming in. The resistance was growing.” Bob was finally kicked out of Ft. Polk upon the denial of his second application for discharge, on the grounds that he did not sincerely hold the beliefs that he professed. “The base commander told me that I could punch him in the face and he would not bring charges because he wanted me ‘off his fucking base!’ I had my third set of orders for Vietnam, and I wasn’t going to get away with staying around Ft. Polk any longer.” So Bob and Peggy flew out to Ft. Lewis in Washington State, and he wrote his third application on the plane ride out here. When he turned his paperwork in at the Overseas Replacement Station at Ft. Lewis, he was assigned to a barracks with 50 other CO applicants. By the fourth night, Bob and company had made contact with the antiwar movement in Tacoma. They began sneaking off base and making and distributing leaflets on the base. Finally, their commanders decided they had to assign the CO applicants somewhere while their applications were pending. “It took them over a year to process my first application. It took a lot less time for the second. So I knew a decision on the third application would come back quickly.” In the meantime, the leadership assessed their skills and assigned them to different units. “Several of us had what they considered office skills so they put five of us in the company’s office.” Soon the five soldiers were running the office, where they had access to phones and long-distance calls. They were in touch with all of the US Senators from around the country who were in any way anti-war. They used the office mimeo machine to print their leaflets. The leadership didn’t catch on for a couple of months, but finally they did. There was a heated rebuke of all that Bob and company had done and an instant assignment to other places. “We were scattered out around the base. But there was no disciplinary action. I had less than six months left in the Army, so they couldn’t send me overseas. The worst they could do was throw me in the back of a delivery truck, which they did. I spent the last several weeks doing KP as part of a delivery crew, delivering potatoes to different kitchens. And then my time was up, and I was discharged honorably with full benefits. Since my interview with Bob, I’ve thought a lot about his story and what he might have been feeling. It takes a lot of courage and strength to swim against the current. Life is sometimes easier if we do what “authority” expects of us. But Bob took the high road “and that has made all the difference.” In my eyes, he is truly a hero. Angie Bartels is PSARA's Membership VP. This story is one of a series of interviews she's doing with PSARA members.

The Retire Advocate < Back to Table of Contents December 2025 PSARA Education Fund End-of-Year Donations What a year it has been, and 2026 is shaping up to be even more challenging for so many of us. As you think about end-of-year giving, please consider donating to the PSARA Education Fund. The Ed Fund, a 501c3 nonprofit organization, produces the Retiree Advocate every month and is filled with information you won’t find anywhere else. The educational work we do has had a national impact. For more details on our work this past year, please read Robby Stern’s article on the front page of the November, 2025 Advocate . You can donate by either mailing a check to the PSARA Education Fund, 321 16th Ave South, Seattle, WA 98144, or click here to donate from our webpage , and donate to the Education Fund. If you are doing a required minimum distribution from your retirement account, please remember us. Thank you for your membership and your support! < Back to Table of Contents

The Retire Advocate < Back to Table of Contents May 2025 March 27 Detention Center Rally Richard Burton Approximately 300 labor and community activists, including many PSARA members, gathered outside the ICE concentration camp in Tacoma, aka the “Northwest Ice Processing Center” on the evening of March 27. They gathered to express their collective outrage over the ongoing human rights abuses in the camp and specifically the summary detention of two labor activists, Alfredo ‘Lelo’ Juarez Zeferino and Lewelyn Dixon. Dixon (known to loved ones as “Aunty Lyn”) has lived in the US for more than five decades. She works at the University of Washington Medical Center as a Lab Technician and is a member of SEIU 925. In early March, she was abducted at the airport, returning from a trip. A family relative traveling with her waited for hours while she went through the security line with no information. The family member was finally informed via a phone call from Dixon that she’d been detained by ICE. She’s been held now for nearly two months Alfredo “Lelo” Juarez is an organizer and member of Familias Unidas por la Justicia and Community to Community (groups primarily working in Whatcom and Skagit Counties). He came to this country as a young teenager. He was detained and sent to the detention center on Tuesday, March 25. According to witnesses, Lelo was on his way to drop off his partner at her workplace. When he stopped his car, ICE agents confronted him. Not leaving his vehicle, he tried to exercise his rights. But ICE agents broke his car window. At the rally, Lelo’s younger brother took the mic to thank attendees for showing up for his brother and to call for his brother’s release. Unfortunately, these are only two of the estimated 1,500 people being detained in this prison camp, run by a for-profit private company, GEO, which is contracted by ICE. Despite right-wing rhetoric, this ICE facility, like hundreds of other such facilities around the country, is a site for civil, not criminal, detention. That is, those held in this prison camp are not detained because a court has concluded that they are a threat to public safety, nor because they have committed a crime, but simply because they are awaiting the outcome of their immigration proceedings. There are nearly continuous protests and hunger strikes being undertaken by detainees inside this prison against their mistreatment. One reason for these protests is the fact that gross violations of international law are a matter of course there. The United Nations’ Standards of Rules for Treatment of Prisoners, known at the “Nelson Mandela Rules, explicitly prohibit indefinite and prolonged solitary confinement and the imposition of solitary confinement in the case of detainees with mental or physical disabilities. Despite this, however, ICE’s own data reveals that, on average, this ICE prison camp detains people longer in solidarity confinement than any other ICE facility in the country, and detainees are regularly subjected to the use of chemical agents. PSARA activists in Pierce County have participated in many rallies and community events denouncing this prison camp in our midst. We have developed ties with other groups and activists working both to improve conditions for detainees while also calling for the place to shut down. A small but important piece of progress is a piece of legislation in Olympia, HB 1232, allowing officials from our state’s Department of Health to inspect the facility. This bill has passed both chambers in Olympia but with an amendment from the Sen- ate that will now need to be considered by the House. Please contact your state reps to urge them to pass this bill be- fore the April 27 end-of-session. Richard Burton is PSARA's Co-VP for Outreach. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents August 2025 How To Make America Sick The Trump administration’s plan to “Make America Healthy Again” will make Americans’ health worse. Donald M. Berwick, MD. Reprinted from the Center for American Progress website. It might seem obvious that the United States, the wealthiest country on earth, would have the best health and health care. But we do not. Not even close. So when President Donald Trump, Secretary of Health and Human Services Robert F. Kennedy Jr., and their allies in Congress propose to “Make America Healthy Again,” it’s easy to get on board. The trouble is that their plan won’t work. In fact, it will make Americans’ health worse. They are currently proposing to cut Medicaid and Medicare, decimate public health structures, withdraw support for food security and other basic needs, and harm the environment all of which is dead wrong from a scientific viewpoint. There is no disputing that America’s health care system needs a dramatic overhaul. U.S. life expectancy ranks 49th globally at more than four years lower than that of the world’s healthiest countries. Our children’s health ranks 36th among the 38 richest nations. Not a single U.S. state has an average life expectancy longer than that of comparably wealthy nations. If the goal is to make America as healthy as other wealthy nations, it would be hard to do worse than we are doing right now. And for that terrible performance, the United States spends twice as much per capita on health care as the average wealthy country—with more than 110 million Americans struggling with medical debt. So, yes, by all means, let’s “make America healthy.” However, unlike how the Trump administration and RFK Jr. are going about it, doing so requires following the science. In 2015, the revered British epidemiologist Michael Marmot wrote “The Health Gap,” arguably the best playbook for making any country healthier. The book summarizes decades of research on why health varies enormously among places with ostensibly similar conditions. The gap in health outcomes can be between nations, between sub- groups within nations, and even across the tracks in a single city. For example, Black Americans had a lifespan six years shorter than that of white Americans in 2021; residents of west Chicago live 14 years less than residents of the Chicago Loop; and across the city of Boston, lifespan varies by more than two decades. Marmot sorts known causes of health gaps into buckets including early childhood experiences, education, workplace conditions, supports to the elderly, and community “resilience”; he also looks at the impact of attributes such as food security, housing security, transportation systems, clean air, compassionate criminal justice systems, and recreational opportunities. Through that lens, a scientifically guided plan for “making America healthy” is simple to devise: Invest in what drives health. This is why what RFK Jr. and the Trump administration are doing makes no sense. Watch the administration, and it would be hard to find a better way to “make America sick.” It’s like “opposite day”: Every single component of the Marmot playbook is being not only neglected but controverted through the administration’s actions. Let’s run the list. Kids Healthy societies tend to place their bets on safe perinatal care, strong supports for the early years—say, from birth to age 3—and school readiness, which means not only helping children but also their parents. Contrast that with the House-passed One Big Beautiful Bill Act that instead cuts food stamps by nearly $300 billion and enacts a historic $793 billion cut to Medic- aid and the Children’s Health Insurance Program, which cover 50 percent of the children in America. Education People in countries and regions with strong educational systems, especially those that include girls and women, tend to live longer. Overall, the U.S. education system ranks 31st in the world, and it varies widely, with many schools performing poorly and many students underachieving. This is neither the teachers’ fault nor the students’. It boils down to ensuring that all children and youth, regardless of where they live or how wealthy their families are, have access to the highest quality education. The proper response would be to pour resources into delivering on that promise. On the contrary, the Trump administration’s plan calls for slashing funding for the Department of Education, cutting support to K-12 programs, and eliminating federal subsidies for student loans. Workers Job security is also foundational to national health. Unionization, which has been backwatered in the United States, is one straight shot to improving worker power. So is raising the federal minimum wage far above its embarrassingly low level of $7.25 per hour, instituting stronger legal protections for workers’ rights, and establishing more equity in tax and compensation policies. The Trump administration, meanwhile, seeks to abolish the Consumer Financial Protection Bureau, hamstring the Department of Labor, reduce bargaining rights for federal workers, weaken worker protections, and cut the essential food assistance and health care programs that the working class relies on, all to give massive tax cuts to the wealthiest Americans. Seniors How a nation supports its aging and elderly population affects not only how long and well its older citizens live, but also the health and well-being of a country’s entire population. The Trump administration claims to want to protect Medicare—a mainstay of security for those age 65 and older in the country—but study the details of what the president and his congressional allies are doing so far, and you will find steadily weakening protections for coverage, reduced access to care, and thousands of dollars more in out-of-pocket costs. For example, Medicaid, which has been torpedoed by the Trump-signed reconciliation bill, is the primary payer for 63 percent of people in nursing homes. Where are the elderly Americans who rely on that care supposed to go? Communities Healthy communities help ensure access to nutrition, housing, safety, mobility, and opportunity for everyone. The Trump administration is already weakening every one of those things and is poised to damage them further. The administration is hurting public transportation systems and rolling back environmental controls for particulate air pollution. It is also publicly in favor of coal and against wind power, against public housing expansion, against mental health supports to help reduce violence, and has backpedaled on criminal justice reform. Conclusion President Trump and Secretary Kennedy can preach all they want about making us healthy again, but their rhetoric is no substitute for facts. The right way to “Make America Healthy Again” is to invest in the infrastructure, programs, and priorities that we know, based on scientific evidence, will actually improve health—the very same ones that the Trump administration seems intent on destroying. Donald M. Berwick, MD, is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement, and a former Administrator of the Centers for Medicare & Medicaid Services (CMS). < Back to Table of Contents

The Retire Advocate < Back to Table of Contents October 2025 How WISeR Will Enable Companies to Profit from Pain – A Retired Physician’s Story Jaisri Lingappa, MD PhD As a retired and otherwise healthy physician, I recently endured weeks of intense pain this summer due to a herniated disk, which developed out of the blue without an obvious cause. This pain was beyond anything I had previously experienced – I am generally quite stoic, but these episodes reduced me to tears in the middle of the night. Disk herniation is a common spine condition that causes intense back pain and sciatica. The herniated (bulging) disk impinges on a spinal nerve causing inflammation that in turn increases pressure on the nerve leading to worse pain and inflammation in a vicious cycle. Epidural steroid injections are simple outpatient procedures that are performed in a few minutes without general anesthesia but must be done by a specialist using fluoroscopy (real- time X-ray imaging) to guide the injection to the site of the herniation. By delivering anti-inflammatory steroids to the exact site of the herniation, the epidural injection reduces the inflammation, thereby breaking the vicious cycle of pain and providing short term relief, often to a dramatic extent. In the long term, the patient’s immune system can trim the bulging disc, leading to a full recovery, but it is difficult for that healing process to begin when a patient is struggling with the vicious cycle of painful inflammation worsened by daily activity or impaired sleep. Thus, epidural steroid injection is a straightforward and minimally invasive procedure that can play a critical role in management of a common form of back pain. Pain specialists spend years learning when and how to use this important tool. Shockingly, “epidural steroid injection for pain management” is one of the 17 procedures that will soon require prior authorization for patients in Original (Traditional) Medicare in Washington State, thanks to a new program called WISeR(1) about to be instituted by Dr. Oz, the new Director of the Center for Medicare and Medicaid Services (CMMS). My herniated disk prevented me from sleeping for more than 90 minutes at a time without severe pain for much of this past summer. Because my Washington State town lacks practitioners who offer epidural injection, I tried other approaches for pain relief, including nonsteroidal anti-inflammatory medications, oral steroids, and intra- muscular steroid injections. But after seven weeks of repeated setbacks and severe sleep deprivation, I searched outside our area for the procedure. Because I am on Original Medicare, I was able to choose the best physician for this purpose regardless of location or network affiliation. A highly regarded pain specialist an hour away was able to schedule the initial visit in two weeks and the procedure, which included a diagnostic and therapeutic component, a week later. Within days after the procedure, I was sleeping pain-free for the first time in 10 weeks, and a couple days later I resumed my previous level of exercise. A month out from the procedure, I continue to be pain-free and my spine appears to be well on its way to healing. Under the new WISeR program, Washington State residents on Original Medicare will need prior authorization (PA) to obtain epidural steroid injections for pain management in the future, along with 16 other procedures - a list that could grow over time. Authorization will be decided by companies that use AI to make decisions and will gain profit through denying authorizations. This approach will be modeled on the current use of PA by Medicare Advantage (MA). MA, which is offered by for-profit insurers as an alternative to Original Medicare, has gained attention for the use of PA as a mechanism for enhancing corporate profits(2,3). “Data submitted by MA insurers show that 81.7% of prior authorization denials were overturned in 2023” upon appeal according to a recent article from Healthcare Uncovered (4). The success of most appeals shows that prior authorization denials are often medically inappropriate – in which case why is CMMS replicating MA programs already proven to be problematic (5) and imposing them on Original Medicare? I cannot begin to imagine how much worse it would have made my life to endure weeks or even months of additional excruciating pain and sleep deprivation while awaiting prior authorization and perhaps even an appeal. Is this what our country has come to? Will seniors now be forced to endure pain and illness, while knowing that relief used to be easily available if their physician deemed it necessary? Important procedures will soon be out of reach because our government allows corporations to reap huge profits by denying necessary healthcare. Citations: 1. WISeR Model RFA. Center for Medicare and Medicaid Services. P. 20. https://www.cms.gov/files/document/wiser-model-rfa.pdf 2. Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds. Reed Abelson, The New York Times, April 28, 2022. https://www.nytimes.com/2022/04/28/ health/medicare-advantage-plans- report.html 3. Insurers Pledge to Ease Controversial Prior Approvals for Medical Care. Reed Abelson, The New York Times, June 20, 2025. https://www.nytimes.com/2025/06/20/ health/health-insurance-prior-authori- zation.html 4. CMS is Trying to Expand Prior Authorization in Traditional Medicare Even Though All Data Points Say That’s a Bad Idea. Rachel Madley, Healthcare Uncovered, July 7, 2025. https://healthcareuncovered.substack . com/p/cms-is-trying-to-expand-prior- authorization 5. About the Current Prior Authorization System. AMA Website FixPrior- Auth. https://fixpriorauth.org/issue Jaisri Lingappa is a retired physician and professor of global health, and a member of PSARA's Level the Playing Field task force. < Back to Table of Contents