[HN Gopher] 'AI' Is Supercharging Our Broken Healthcare System's...
___________________________________________________________________
'AI' Is Supercharging Our Broken Healthcare System's Worst
Tendencies
Author : rntn
Score : 178 points
Date : 2023-11-21 14:01 UTC (9 hours ago)
(HTM) web link (www.techdirt.com)
(TXT) w3m dump (www.techdirt.com)
| pixl97 wrote:
| https://en.wikipedia.org/wiki/Computers_Don%27t_Argue
| musha68k wrote:
| Also continuing the trend of unaccountability at least on a
| personal level.
|
| https://en.m.wikipedia.org/wiki/Skin_in_the_game_(phrase)
| kruft wrote:
| Also also https://twitter.com/SwiftOnSecurity/status/13855657
| 371677245...
| satellite2 wrote:
| This is not healthcare per se but insurance policy. It doesn't
| say anything about the use of AI in actual medicine.
| falcolas wrote:
| Given how tightly integrated insurance is with what treatments
| Doctors are allowed to give you, it's absolutely a problem for
| the entire healthcare system.
|
| "Before you go on this medication that's specifically targeted
| at your symptoms and diagnosis, you must first try and fail
| these 5 other treatment methods, including a round of anti-
| anxiety meds and counseling."
| hotpotamus wrote:
| I've actually had anti-anxiety medications relieve a whole
| raft of symptoms that obviously turned out to be anxiety.
| There are many problems with healthcare systems, but I have
| to say that lorazepam is really the best drug I ever took; I
| can see why people become dependent, so I take it quite
| sparingly.
| falcolas wrote:
| There's a lot that could be said about how an "anxiety"
| diagnosis is abused by doctors and insurance companies
| (especially against women), but in the end it really boils
| down to one thing:
|
| The medications you're taking should be a determination
| between you and your Doctor, and not an AI working for your
| insurance company.
| hotpotamus wrote:
| I could probably expound quite a bit on the problems of
| interjecting an insurance company into healthcare, but
| I'd say that as a principal, I completely agree with you.
| dfxm12 wrote:
| The title says "Healthcare _system_ ". Insurance is part of
| that.
| haltist wrote:
| Insurance companies in America determine which patients are
| worth treating and which ones are unprofitable. In theory AI
| can enable better and cheaper treatments for everyone but that
| would mean insurance companies would have to start caring about
| something other than profits. Their main metric is profit so AI
| will be used to maximize profit and minimize costs just like in
| every other industry.
| anonzzzies wrote:
| Well, they don't say medicine, they say healthcare system. That
| seems accurate considering your actual access to healthcare and
| the level of quality depends on insurance.
| arolihas wrote:
| Insurance policy is unfortunately a large part of healthcare in
| America.
| terminous wrote:
| I'm sorry, did the title say "medicine"? What's your problem?
| If you think these kind of low effort comments are contributing
| to the discussion, please reconsider.
| tbihl wrote:
| Medical Insurance has _all_ of the characteristics of a bad
| insurance business: small claims, frequent claims, horrendous
| adverse selection risk, and moral hazard everywhere.
|
| Undoubtedly, AI will help it reach its logical conclusion even
| faster.
| kelseyfrog wrote:
| Sadly, there is no state of malfunction that will result in
| the people having the ability to affect change feel compelled
| to affect change. With incentives or "that's just how the
| world works" effectively conspire against improvement.
| verdverm wrote:
| agree, this is a low quality article, using a single example to
| define an entire industry
|
| They put no effort into finding places where AI is making
| things better in healthcare. One example I know of,
| https://ferrumhealth.com/
| adolph wrote:
| To all the sibling comments saying "insurance is part of the
| 'Healthcare System,'" well, the headline could have said
| "Health Insurance" but instead chose a broader category. The
| parent comment is helpful because it adds context.
|
| Further, the anecdatum of one provided in the article doesn't
| support the use of "AI" in the headline nor the thesis that
| "'AI Is Supercharging" anything. It refers to an algorithm that
| the company never divulges. It could just as well be a random
| number generator or a magic eight ball as much as it is "AI."
|
| The article is a clickbait moment of hate.
| rchaud wrote:
| Earlier discussion on this topic, with the original source link
| from ArsTechnica:
|
| https://news.ycombinator.com/item?id=38299921 (Nov 17, 2023)
|
| As I said on that thread: the dangers of AI will always come down
| to human decisions made on how it should be applied. These
| 'solutions' will come from the McKinseys and IBMs of the world to
| serve hospital CEO needs, not those of patients or care
| providers.
|
| For those thinking that AI will reduce healthcare costs by
| improving efficiency, I point you to the 'electronic medical
| records' hype of 15 years ago. Are per capita healthcare costs
| any lower now?
| hotnfresh wrote:
| Yep. The actual risk of "AI" in the medium term is that these
| things are gonna mostly be used for optimizing the shit out of
| extracting money from normal people (i.e. pushing down the
| standard of living) while all normal folks will get out of it
| is fancy autocomplete.
|
| Great. Shifting the power and information imbalance farther
| toward large corporations is _exactly_ what our flavor of
| capitalism needed. /s
|
| (Mostly, in the legitimate, if you will, economy, that is--
| they're also gonna be hugely useful to scammers and
| astroturfers)
| geodel wrote:
| > The actual risk of "AI" in the medium term is that these
| things are gonna mostly be used for optimizing ...
|
| I like this. I will further add since _In the long term we
| are all going to die_ it will be fine for everyone :-)
| snowpid wrote:
| " For those thinking that AI will reduce healthcare costs by
| improving efficiency, I point you to the 'electronic medical
| records' hype of 15 years ago. Are per capita healthcare costs
| any lower now? " Can you elaborate? In countries like Denmark
| or Estonia electronic medical records are well used among
| doctors and patients.
| LegibleCrimson wrote:
| I think the point is that one of the big hype phrases is that
| it will decrease costs of healthcare and lower people's
| bills, but even if you lower the cost, there is no actual
| incentive to lower patient bills, so the extra value simply
| goes to owners and investors rather than the end consumer.
| staunton wrote:
| Would you rather be treated in a modern hospital or one
| from 50 years ago? Would you choose the historical hospital
| if it charged you the same fraction of median income as it
| did back then?
| LegibleCrimson wrote:
| It's not that black and white. There's more at play than
| just charges. Things can be better and still shockingly
| corrupt, with extreme amounts of unjustified overhead.
| Things are minimally better for any individual patient,
| while being extremely more expensive, and the insurance
| overhead has skyrocketed.
|
| The question is a little bit like responding to a
| complaint about industrialized agriculture's effects on
| the environment by saying "Would you rather eat sausage
| from 100 years ago or now?" It's not actually that
| relevant to the initial complaint, and it reads like it's
| trying to just terminate the conversation on a loophole.
| Things can be better and still also be filled with many
| problems, particularly modern problems that weren't
| relevant in the time period you're comparing to.
|
| To actually answer the question honestly, it depends on
| my condition. For the kind of thing I would typically see
| my GP for, including run-of-the-mill checkups, definitely
| one from 50 years ago. For any serious medical issues,
| modern (as long as I can convince the doctors that it's
| actually serious so they spend more than 30 seconds on
| investigation).
|
| As far as charges go, per-capita healthcare expenditure
| is now over 5 times as high as it was in 1980. Are we
| getting a 5-fold improvement in medical care? When I go
| to the doctor for anything more than a checkup, 90% of my
| time is spent waiting, and I spend twice as much time
| with RNs who repeatedly ask me the same questions, before
| a frazzled doctor comes in, asks a couple questions, then
| rushes out, maybe handing me a prescription for
| antibiotics regardless of what my concern is.
| staunton wrote:
| > It's not that black and white
|
| The reason I wrote anything was that your original
| comment sounded very black and white to me.
|
| I think we tend to overlook how much things improve in
| the long term. Knowing that they do hints at potential to
| do better still and should encourage us to take action
| and improve the situation.
|
| Pointing out the current problems is necessary for that
| to happen. However, your comment came across as denying
| that healthcare can be improved, or at least that
| improvements can benefit patients. This is obviously
| false and I'm sure you didn't mean to claim it, so it's
| great we're able to add a bit more nuance.
| rchaud wrote:
| Ceteris paribus is doing a lot of heavy lifting here.
|
| If the 50 year old hospital has an available operating
| room and the modern hospital does not, I'm going there. I
| won't have a choice if the treatment needed is urgent.
| sofixa wrote:
| That's assuming the extremely broken and frankly
| incomprehensible American model.
|
| Over in the EU, where most of the healthcare is single-
| payer (sometimes with optional add-ons/extra payers/private
| care), cost of care has been growing too. There are simply
| many more treatments which are available now than before,
| more tests possible to discover issues, etc. as well as of
| course the higher life expectancy and higher average age
| across the board. That doesn't mean improvements shouldn't
| be undertaken. Such as electronic medical files (which are
| the norm in multiple EU countries but sadly not everywhere,
| and not on an EU scale - as born in one EU country and now
| living in another, it would have been extremely useful to
| be able to automatically share my childhood records), or
| maybe ML to do predictions and stuff.
| LegibleCrimson wrote:
| I agree 100%. In America the capitalist dream of
| competition and technological innovation actually driving
| costs lower for the consumer has mostly just died in
| almost every category. Any savings are now passed onto a
| cabal of private equity firms and legislatively-
| entrenched insurance corporations.
|
| Goodhart's Law is in full force, and the measure of
| business health, profit, has become the target, rather
| than consumer welfare and rights. Boy have we optimized
| for profit at the expense of anything else.
| linuxftw wrote:
| The idea was that with all this healthcare data, patients
| would realize better outcomes. Like, your super-Doctor is
| going to realize that 6 months ago, you went to urgent care
| of XYZ condition, and that's going to shine some kind of
| light on your situation now, so he's going to be better
| prepared to treat you.
|
| The reality is, the vast majority of that data is useless
| noise, nobody has the time to make any kind of analysis on
| it, and it's just another healthcare cost center providing
| zero value to the patient.
| jeffdn wrote:
| A major contributing factor to the lack of realized
| benefits with electronic health records in the United
| States is that the interoperability specification, CCDA, is
| only loosely complied with under the "meaningful use" rule
| from Health and Human Services. Certification is done on
| site at the EHR manufacturer, in an environment controlled
| by the manufacturer. The demonstration of compliance does
| not have to be done in a default "out of the box"
| environment, but merely that the system is _capable_ of
| being configured in a way that allows for emitting
| standards-compliant CCDA.
|
| In practice, this means that most manufacturers do not
| build systems that are standards compliant by default, and
| definitely do not install systems that are standards
| compliant in their initial configuration. Then, individual
| healthcare practices add customization on top of that,
| which further complicates data integration.
| norir wrote:
| Ultimately I believe electronic records are a huge factor
| contributing to the assembly line like experience of modern
| health care. I pray that I don't die in a hospital.
| cmiles74 wrote:
| In the US, the cost of health care has not significantly
| decreased since the introduction of rules, regulations and
| government money pushing healthcare organizations to
| implement and use EHR systems.
|
| I would say all of the intervention by the US federal
| government has made everything much worse. The EHR vendors
| (I'm looking at you, Epic) managed to consume the money
| thrown at the problem and yet have only moderately improved.
| In my opinion it also pushed smaller hospitals into expensive
| contracts with EHR vendors, eroding their already tenuous
| financial health and leading to even more consolidation.
| mixdup wrote:
| >I would say all of the intervention by the US federal
| government has made everything much worse
|
| This is assuming without intervention things would've
| gotten better. It's entirely possible things would be just
| as bad as they are, or worse, without said intervention
| to11mtm wrote:
| Epic is an extremely weird case.
|
| I knew someone who worked at a company that was contracted
| to be a support provider; they had at least one nervous
| breakdown.
|
| Also interesting to note that the wikipedia article for the
| company mentions that in some European countries, moving to
| Epic was a huge pain that caused doctors stress.
|
| OTOH apparently their actual corporate campus is some
| whimsical Alice-in-wonderland world with no expense spared.
| lotsofpulp wrote:
| Lack of timely access to accurate information is and was a
| huge problem, that can be solved by electronic health
| records.
|
| Whether or not the currently implementation is worth the
| cost/benefit ratio is debatable.
|
| I envision a scenario though, where all EHR vendors
| integrate with Apple/Google, and someone's phone can give
| access to their healthcare data, maybe even involuntarily
| in the event of an emergency.
| rchaud wrote:
| Precisely, and for this reason, AI will be the snake oil
| panacea, just as computerization of records were. Both will
| be important, but the size of the contract will be based on
| the "transformative" messaging around the pitch. The real
| value as you've said will accrue to the consultancies and
| vendors as it always has, so even without the enormous
| compute bills for AI tools, prices will keep going up.
| dinvlad wrote:
| It seems the Big Data hype never really died down - it just
| changed the name
| tuatoru wrote:
| The Economist thinks things are better[1]. In that costs are
| not rising faster than average inflation any more.
|
| So not lower than before, but lower than was expected for 2023
| a few years ago.
|
| For those blocked by the paywall, the article lists causes for
| the slowing growth as: productivity improvements in paperwork,
| cheaper technology for dialysis, among other things, the
| Affordable Care Act, non-US countries insisting on generic
| drugs more often, and slower-than-inflation growth in median
| income (the rich hoovering up all the money).
|
| 1.https://www.economist.com/finance-and-
| economics/2023/10/26/h...
| rqtwteye wrote:
| " These 'solutions' will come from the McKinseys and IBMs of
| the world to serve hospital CEO needs, not those of patients or
| care providers."
|
| That's the pattern for most internal enterprise software that's
| being purchased.
| miah_ wrote:
| Its supercharging the worst in everything its applied to. Try
| getting a job right now. All of the automated systems that are
| doing screening will throw you out if you aren't 100% compatible
| with whatever they're looking for. Sure, its cheaper than human
| screening, but now you've got a position not filled for even
| longer, which is probably costing you in other ways.
| apwell23 wrote:
| > screening will throw you out if you aren't 100% compatible
| with whatever they're looking for
|
| how does one know if this it the reason they are being thrown
| out.
| lordnacho wrote:
| You make up a CV that exactly matches the job advert and see
| whether there's a response
| sevagh wrote:
| This doesn't rule out that there were enough good or
| "better" applicants that crowded yours out.
| lordnacho wrote:
| Of course it does, you send a few of these perfect CVs
| and see what happens.
| apwell23 wrote:
| Why would a human also not choose a perfect CV over other
| options. What does this prove about AI.
| avgDev wrote:
| Human can look at a CV which doesn't match but say I like
| what this person has done, learning our stack should be
| no big deal.
| quickthrower2 wrote:
| You want a perfect candidate not a perfect CV. A perfect
| CV is highly likely to have lies and was made up based on
| the job ad, addressing every single requirement bullet.
| RajT88 wrote:
| Even without the lies, you can meet every single bullet
| point and still be a worse fit than someone who doesn't
| match every single bullet point.
|
| Maybe the gal or guy who fits every bullet point has a
| long career and quite broad knowledge. Maybe the gal or
| guy who doesn't fit every single bullet point is much
| smarter, a much harder worker with far more grit, and a
| quick learner.
|
| You end up hiring the first person who may be mediocre,
| and missing out on the second who may be a super high
| performer.
| apwell23 wrote:
| > A perfect CV is highly likely to have lies and was made
| up based on the job ad, addressing every single
| requirement bullet.
|
| Wouldn't "AI" also know this though. I would imagine AI
| is doing more than keyword match type stuff.
| antisthenes wrote:
| If I sent out completely truthful CVs, I'd still be
| working a $15/hr data entry job or whatever.
|
| Obviously you can't fake it forever if you don't have the
| skills to back it up, but the reason people lie and
| embellish on CVs is because they know they are reasonably
| fast learners, so any skills mismatch can be quickly
| adjusted while _on the job_. Easier to ask for
| forgiveness than permission, etc. etc.
|
| This pretty much became a necessity since ~2005, when IT
| demand skyrocketed and became mainstream and automatic
| candidate rejection and filtering became pervasive
| poidos wrote:
| You can never precisely be sure, but here are some of the
| behaviors I've been observing that give me the feeling I was
| auto-rejected:
|
| - rejection coming in nearly instantly - rejection coming at
| "odd" times -- weekend evenings, 3 AM in my time zone for a
| company in my time zone
|
| The latter one doesn't hold up too well for remote-first
| companies but I would hope few tech firms have recruiting
| staff going through applications on weekends.
| FireBeyond wrote:
| Yup. I applied for a PM position, within 20 minutes of it
| going up. Quite a specific one: "'expert level' health
| insurance system knowledge and experience integrating
| between multiple EHR vendors and partners'". I have all of
| this. Have built claims benefits management systems being
| used by some household names in healthcare. I'm an expert
| in EPIC, Cerner, ESOsuite EHR systems.
|
| 10 minutes later: "we are looking for someone whose
| skillset and experience better aligns with our requirements
| and the position".
|
| I guess my resume needed more buzzwords.
| siva7 wrote:
| I guess it hurts less if you can blame ai?
| NovemberWhiskey wrote:
| As a hiring manager, based on the average candidate that gets
| forwarded to me after presumably several rounds of filtering
| (some mechanical, some human), the idea that there is some kind
| of smart matching going on is slightly ridiculous: they can't
| tell a security-focused software developer resume from an
| assurance-focused security specialist, for example.
| Eumenes wrote:
| AI isn't scanning job applications lol ... lazy recruiters
| can't review them fast enough.
| honkycat wrote:
| I got a new job recently and I have been saying this is what I
| will be doing, writing AI to deny claims, AS A JOKE.
|
| We pay taxes so the government can pay to subsidize these
| healthcare corps that just serve to funnel money to its already
| rich shareholders.
|
| Healthcare is a pathetic broken mess and it will never get
| better.
| cornel_io wrote:
| https://www.marketwatch.com/investing/index/sp500.35?country...
| is up by less than the S&P over the last few years.
|
| I'm not saying the healthcare system is great or anything (I
| generally agree with "pathetic broken mess"), but it's _not_
| making its investors particularly rich. Most of the excess cost
| is getting spread out within the system itself and never makes
| it through the other end. If you want to blame doctors, nurses,
| admins and suppliers that 's arguably a better place to start.
| staunton wrote:
| > it will never get better
|
| Don't lose hope, other countries manage to be a lot better.
| It's possible if you only try.
| adnmcq999 wrote:
| You would have to somehow scare our elected reps into doing
| what is right
|
| Or start our own "people's hospitals" or even insurance
| (there should not be insurance schemes IMO)
|
| Or maybe not pay existing hospitals/ insurance companies
|
| I do not know how else to "try"
| tstrimple wrote:
| We were one congressional vote away from a public option
| for healthcare. Let's not pretend it isn't explicitly one
| party obstinately refusing to do anything on healthcare and
| dozens of other issues. The answer isn't to scare our
| elected reps into doing what is right. It's to stop voting
| for Republicans.
| robocat wrote:
| > We pay taxes so the government can pay to subsidize these
| healthcare corps that just serve to funnel money to its already
| rich shareholders.
|
| Americans are about 4% of people but gets 25% of world GDP.
| There's 333 Mega Americans, with 8 GigaPeople in the world.
| Most Americans are doing just fine financially in comparison to
| the rest of the world.
|
| To make things fair, then the wealth of the richest US citizens
| (about 55% of equity ownership by value[1]) should to be spread
| to the rest of the world, not spread to other Americans by US
| taxation changes.
|
| I'm from New Zealand. Our ownership of US shares is likely
| reasonably fair. NZ has three billionaires[3] (not one
| inherited their wealth). We are still a relatively wealthy
| country, but our median income is about 60% of the US median
| income. I'm not sure what % of NZers would be classified as in
| poverty by US standards.
|
| 40% of US equities are owned by foreigners. If we assume rich
| foreigners use Cayman Islands and Luxembourg for their
| ownership, then from [2] a third of that 40% is rich
| foreigners. Probably better to assume wealth distribution is
| similar to US so 55% of that 40% is wealthy foreigners.
|
| [1] https://www.taxpolicycenter.org/taxvox/who-owns-us-stock-
| for...
|
| [2] https://home.treasury.gov/news/press-releases/jy0613
|
| [3]
| https://en.wikipedia.org/wiki/List_of_New_Zealanders_by_net_...
| asdajksah2123 wrote:
| I'm not sure I understand why AI is supposed to make anything
| better, at least under the regulatory regime we have right now.
|
| 1. AI doesn't do anything new. It's just human thinking done
| better in the best case scenario. So the plus side is that we may
| come up with ideas that a human might have come up with 10-15
| years later. However, a lack of ideas is not the problem we face
| at all. We have solutions to nearly every problem we face. We
| have enough wealth to implement nearly every solution we have.
| The real issue we face is that the wealth is concentrated in
| certain hands that do not want it to make it to others' hands,
| and those who are capable of implementing the solutions we have
| prioritize maximizing the wealth they capture with those
| solutions. AI, as long as it remains in private wealth focused
| hands, will only serve to turbo charge these issues.
|
| 2. Under the current regulatory regime the responsibility of what
| AI does wrong is not clear. Much like how Uber, and the other gig
| economy companies leveraged the opportunities created by the
| spread of the smartphone to create a regulatory innovator, whose
| only real purpose was to dismantle regulations and impose costs
| on 3rd parties and capture profits for themselves, AI will and is
| initially again being used as little more than a legal
| innovation, using the gray area in terms of legal responsibility
| as an advantage to do things a company would never have a human
| employee do or to allow companies to use other people's works
| without paying for it, and not getting sued for the theft.
|
| Expect AI to continue spreading into more legal gray areas as
| companies take advantage of the lack of clarity on legal
| responsibility to raid and pillage our economy and societies.
| thesuitonym wrote:
| You don't understand because you think we have a society built
| around making life better for everyone. It's not. Our society
| currently is optimized for one thing: Making sure the rich stay
| rich, and the poor stay poor. In that respect, AI is amazing.
| AI requires a small upfront cost, then can do the job of
| thousands of people for the pay of less than one. It works 24
| hours, and will never ask for more money. And it works exactly
| to the specification you set, and will never, ever do anything
| to help your customers.
| BobaFloutist wrote:
| >you think we have a society built around making life better
| for everyone.
|
| You know, I don't think they do think that?
|
| I think they think that's what society _should_ be, though.
| infamouscow wrote:
| > Making sure the rich stay rich, and the poor stay poor.
|
| It doesn't explain how Sears managed themselves into
| bankruptcy, handing everything to the likes of Amazon despite
| having all the money in the world, comparatively.
|
| It also doesn't explain how EVs are taking off. I've seen
| multiple conspiratorial documentaries about why the oil
| companies will never allow EVs to ever take hold.
| asdajksah2123 wrote:
| I disagree with this. There's a lot of evidence that modern
| society has made things much better for everyone.
|
| That doesn't mean that there aren't negative influences in
| modern society. The rich wanting to get richer is definitely
| one of the major ones that is particularly powerful right
| now.
|
| But that's why society is a process. You gotta fight back and
| moderate the negative influences, and boost the more positive
| ones.
|
| I think the question whether AI will fall on either the
| positive or negative side of the ledger is wrong in itself.
| AI will provide a lever to magnify whichever direction
| society and people were going in anyways independent of AI.
| It's a tool, and hopefully a really powerful tool, but it's
| not a God. It can be used equally for good and bad.
|
| And if you believe, like I do (and by all appearances you do
| too), that our current society is balanced to benefit bad
| actors over good actors (where bad/good are being defined in
| terms of benefiting society overall), the magnifying effect
| of AI is likely to magnify the net negative.
|
| The one advantage of something new like AI coming around is
| that, I believe, the primary reason open democratic societies
| allow themselves to become tilted in favor of bad actors is
| because of complacency...it's usually a slow shift rather
| than a single big change. The arrival of a major chance like
| AI forces society and everyone in it to once again take stock
| of where society stands.
|
| This gives us an opportunity to change the tilt of our
| society to promote good actors again, before AI truly starts
| having an impact, which gives us an opportunity to ensure AI
| magnifies a net benefit, rather than a net negative, for
| society.
|
| And frankly I think we are closer to having that reckoning
| than we've ever been in my few decades on this planet, so
| overall I'm optimistic about AI. But again, whether we
| benefit or suffer with AI will be independent of AI itself.
| hackerlight wrote:
| > AI requires a small upfront cost, then can do the job of
| thousands of people
|
| That's the same with every efficiency improvement. Efficiency
| improvements (like AI) aren't zero sum. When production costs
| go down, competition forces prices to also go down, which
| then leads to more wealth for everyone not just the capital
| owners (even if it disproportionately benefits capital
| owners).
|
| People are made redundant and then find jobs in other parts
| of the economy where they're actually needed. This is a
| painful but necessary corrective mechanism for the economy to
| remain dynamic and productive and innovative.
|
| That said, I still want a global wealth tax.
| michaelmrose wrote:
| You are assuming over the coming years that most parties so
| displaced simply shift to other parts of the economy as
| lucrative and are able to take advantage of those benefits.
| You are also assuming collusion explicit or implicit and
| the wealth of remaining buyers doesn't just keep prices
| high.
|
| EG you you have 100 people who can't afford steam off a
| hotdog and 100 customers with n units of disposable income
| per day. You end up with 150 customers who can't afford
| shit and 50 with 2n units of disposable income. The price
| was never bounded by the actual cost in the first place so
| the smaller wealthier clientele leads to higher prices.
|
| One could easily imagine many tens of millions of new poor
| making much less while prices driven by wealth of other
| segments of society continues to rise who both have less
| coming in to pay higher prices.
|
| Meanwhile you have tens of millions of people who are
| presently create little value NOW whose jobs end up
| politically difficult to deprecate. You need to have SOME
| people on your side after all.
|
| I don't see our society being a good one now or in 20
| years. There is no political will to do anything hard and a
| thread of greed, cowardice, anti intellectualism and
| weakness woven through our society.
| hackerlight wrote:
| > You are assuming over the coming years that most
| parties so displaced simply shift to other parts of the
| economy as lucrative and are able to take advantage of
| those benefits.
|
| That's how it's always been historically, but you are
| right that I can't predict it'll be the same in the
| future, especially when it comes to AGI.
|
| > You are also assuming collusion explicit or implicit
| and the wealth of remaining buyers doesn't just keep
| prices high.
|
| Collusion to fix prices can't happen in highly
| competitive markets with declining production costs,
| because of game theory reasons. You always get this
| graph[1] unless you have regulatory capture such as with
| insulin supply in the US. Or unless you have a labor-
| heavy cost base such as with the education industry.
|
| [1] https://pbs.twimg.com/media/E314pxwXMAI2ZIn?format=pn
| g&name=...
|
| The risk with AI is that it won't be highly competitive.
| As a general rule, only in a monopoly-like situations can
| you have abnormal profits. That's where the global wealth
| tax comes into play, among other policies targeted at
| monopolistic practices.
| skohan wrote:
| That's the problem with healthcare. Due to inelastic
| demand, it doesn't succumb to market forces the way as
| other markets. Also in many places you have issues with
| provider collusion, monopoly, and regulatory capture
| keeping prices high.
|
| The US is particularly bad in this respect. Market sources
| only seem to prevail in rare cases - like elective
| procedures which are not covered by insurance (i.e. laser
| eye surgery).
|
| It's hard to make decisions based on price when you don't
| even know the price in many cases before receiving care,
| and you may not have any choice of provider.
| cscurmudgeon wrote:
| Hasn't the poverty rate consistently decreased?
| johnnyworker wrote:
| The gap between rich and poor is growing at increasing
| pace, just like the gap between rich and mega-rich is.
|
| If you went completely hungry yesterday, nearly starved to
| death, but today you get enough calories that you feel less
| pain so you can at least stand up and walk around a bit,
| while you watch your brother stuff his face with so much
| cake he has to puke 3 times to make room for more, to then
| play frisbee with the rest, what would you think? How it
| was for you yesterday isn't the standard. How it is for
| others, today, is the standard. It's about fairness and
| human dignity, nothing more and nothing less. If everybody
| was starving, we wouldn't even have a name for it, or a
| problem with it. It wouldn't be a slight on anyone.
|
| Some people shriek in anguish or sob in darkness, kill
| themselves, over issues that would be a 2 minute phone call
| and a check that is 0.0001% of their monthly income for
| someone else. That's a problem, and that kings used to have
| less than the average homeless do today doesn't change
| that, and isn't something capitalism gets to take credit
| for either. Humans have been inventing and improving things
| since before history, even animals do it, that's just
| normal.
| cscurmudgeon wrote:
| > The gap between rich and poor is growing at increasing
| pace, just like the gap between rich and mega-rich is.
|
| Why the hell should that matter? If the system wanted to
| keep poor people poor, won't the poverty rate stay the
| same? Thats the assertion I was countering.
|
| Why keep moving the goalpost? But I will play along:
|
| > If you went completely hungry yesterday, nearly starved
| to death, but today you get enough calories that you feel
| less pain so you can at least stand up and walk around a
| bit, while you watch your brother stuff his face with so
| much cake he has to puke 3 times to make room for more,
| to then play frisbee with the rest, what would you think?
| How it was for you yesterday isn't the standard. How it
| is for others, today, is the standard. It's about
| fairness and human dignity, nothing more and nothing
| less. If everybody was starving, we wouldn't even have a
| name for it, or a problem with it. It wouldn't be a
| slight on anyone.
|
| 1. You should first ask if your brother got his cake fair
| and square. If so, then you should be happy you are not
| puking and be happy for him. Don't be selfish. Let's say
| your brother worked 10 times more than you (80 hrs) and
| smarter than you while you stayed in bed and watched TV
| all day on his dime. Isn't inequality the fairer but
| still painful outcome in this case? F
|
| 2. Should you and your brother have the same quality of
| life despite the efforts you put in? Why should you be
| entitled to his fruits of action beyond sustenance?
|
| 3. If you agree there in diversity in level of effort and
| thought, then inequality is the fairer outcome.
|
| 4. Also, one should stop comparing only outcomes, you
| should also compare inputs.
| altairTF wrote:
| Do you think rich people should be responsable for others
| or they have the freedom to get rich and do nothing?
| a_gnostic wrote:
| There are no solutions, only tradeoffs. The over-reliance on
| one size fits all "solutions" are what got us into this mess,
| and AI will prove just another bandaid with its' own problems,
| until we realize this.
| skohan wrote:
| Yes and no - sometimes you need tailored complex care from a
| professional. Sometimes you need routine treatment, but it's
| going to take 3 months to get an appointment with the given
| specialist, or maybe in the case of rural areas there isn't
| even one within 1000km of you.
|
| A lot of good can be done by extending "one size fits all"
| solutions for simple things there's just no capacity for
| forgetfreeman wrote:
| A naive readthrough would lead one to that conclusion
| perhaps but the elephant in the room here is capitalism.
| Pragmatically, any "good enough" solution will be used to
| replace skilled care to improve patient throughput and thus
| the bottom line.
| skohan wrote:
| The problem is that "skilled healthcare" is essentially a
| cartel which uses artificial scarcity to increase the
| price. You can see the counter-example in Cuba, which has
| an incredibly high number of MD's per capita compared to
| other countries, and achieves very good healthcare
| results, especially in the context of other metrics of
| development and economy.
|
| There are so pitifully few health care practitioners
| compared to what we need in most developed countries I
| don't think too many jobs are going to be at risk any
| time soon if AI picks up some of the slack.
| losteric wrote:
| What about nursing? That seems to be the flip side where
| there isn't the protection of the cartel around doctors,
| so wages get driven to the floor and we see scarcity due
| to cost of living and mismanagement.
| skohan wrote:
| Nurses might not get paid what they are worth in all
| cases, but they have amazing job security.
|
| Ironically it's probably easier to replace a lot of what
| doctors do with AI than what nurses do.
| forgetfreeman wrote:
| We've already got NPs and PAs "picking up the slack" in
| the US. Prices are still outrageous for folks without
| health insurance and healthcare outcomes continue to
| decline. Adding another half-assed tool to the chain
| isn't how this gets fixed.
| skohan wrote:
| The US is not the only country with healthcare needs.
| There are plenty of developed nations with public health
| care systems which primarily suffer from scarcity rather
| than cost to patient, and AI could help with that.
| forgetfreeman wrote:
| Artificial scarcity? Maybe. There aren't but so many
| households with children that fit inside the venn diagram
| of can afford med school, has the intellectual capacity
| and bloody-mindedness to actually finish med school, and
| is interested in going to med school.
| skohan wrote:
| Yes and no. No doubt the medical profession requires
| talent and rigor, but I think to some extent the hurdles
| which are placed in front of students who want to become
| doctors are artificially high to help justify the small
| number of graduates medical schools put out, which
| protects the artificially high salaries.
|
| For instance, if you read up on the frankly cruel
| residency process which doctors are forced to clear in
| the US, the insane hours are in large part because one of
| the doctors who was influential in shaping the current
| practice was an abuser of stimulants.
|
| So I think it's a bit of a "just so" story to assume that
| the version of the medical profession we have is the best
| possible version.
|
| And indeed Cuba is a good counter-example to your
| argument. Unless Cubans are just a lot more clever and
| resilient on average than Americans for example.
| RecycledEle wrote:
| > There aren't but so many households with children that
| fit inside the venn diagram of can afford med school, has
| the intellectual capacity and bloody-mindedness to
| actually finish med school, and is interested in going to
| med school.
|
| That is the artificial scarcity he was referring to.
|
| There is no reason to lump all medicine together in a MD
| degree /certification.
|
| Why not have one certification for each common problem?
| cuteboy19 wrote:
| Cuba is hardly the example if their indentured servant
| doctors defect to Brazil.
|
| Things must really really bad for someone to defect to
| _Brazil_
| skohan wrote:
| Exactly - it just shows how terrible the rest of the
| world is doing if _Cuba_ of all places puts their medical
| system to shame, simply by training more doctors
| idopmstuff wrote:
| 1. AI is broadly accessible. While it definitely has its
| downsides, I think there's a valid argument to be made that
| access to AI medical advice is better than access to no medical
| advice.
|
| 2. AI can hold vastly more knowledge in its "head" than a
| doctor. There are many rare conditions that a doctor rarely
| sees. That doctor doesn't have enough time to spend researching
| these kinds of things for their patients, but an AI might be
| able to analyze their medical records/test results/etc. and
| come up with possible diagnoses that a regular primary care
| physician couldn't. If these diagnoses go to the PCP for
| evaluation (as opposed to going straight to the patient), what
| is the downside or harm?
| malcolmgreaves wrote:
| > valid argument to be made that access to AI medical advice
| is better than access to no medical advice.
|
| This is not true. And it's where I believe your whole
| response takes a wrong turn.
|
| Why is it wrong? Because of risk of harm.
|
| Giving out wrong information can easily kill people. Or
| permanently insure them. There's a tremendous amount of harm
| that can occur if you do things wrong in medicine.
|
| When you attach "an AI said X" to something, it adds the
| appearance of authority. This makes it incredibly dangerous.
| Folks that don't know enough will believe that the "advice"
| is true because it "comes from an AI" (and how could an AI be
| wrong? It's advanced! It's smart! It _can't be wrong_ because
| the company is using it instead of a real Doctor, and _they
| wouldn't want to harm me with something that can be
| wrong_...right?)
|
| For example, let's take COVID. If you had GPT say "go take
| hydroxychloroquine for COVID", you'd end up with a lot of
| people getting harmed by (1) taking a drug that's not going
| to help them when they _think_ it would (so they're not going
| to do something else for treatment, because they incorrectly
| think they're already being treated) and (2) there's always
| side effects to taking _any drug_, and these side effects may
| actually cause _more harm_ than doing nothing.
| idopmstuff wrote:
| I agree with what you're saying here - absolutely, bad
| medical advice from AI (or anywhere) can cause harm.
|
| What I disagree with is the way that you're drawing the
| conclusion that there isn't even a valid argument to be
| made for using AI. To be clear, I didn't say we absolutely
| should do this - the part of my post you quoted is where I
| said there's an argument for it (i.e. we should have the
| discussion and evaluate).
|
| If an AI says take hydroxychloroquine for COVID then
| absolutely that will cause harm. But that theoretical
| possibility isn't enough to determine whether an AI should
| be a source of medical advice - you have to actually
| evaluate whether/how often it will do that. If .0001% of
| the time it says to do that and the rest of the time it
| gives good advice on how to treat COVID at home and what
| symptoms to look out for that would cause you to need to
| call an ambulance, then the harms are probably greatly
| outweighed by the benefits.
|
| This is especially true in the case that I argued - where
| the alternative is no medical advice, because people don't
| have access to doctors. Lots of people died at home of
| COVID when they could have been saved at a hospital - we
| have to consider what the benefits to them might be in
| addition to what the detriments of AI giving bad advice
| could be.
|
| The last thing I'll say is that your position seems to be
| that if a source of medical advice sometimes gives bad
| advice, we should not use it. The problem is that based on
| that position, people should not go to doctors. Doctors are
| humans who make mistakes - plenty of evidence of that to go
| around. All of these points that you've made apply to human
| doctors:
|
| > Giving out wrong information can easily kill people. Or
| permanently insure them. There's a tremendous amount of
| harm that can occur if you do things wrong in medicine.
|
| > When you attach "[a doctor] said X" to something, it adds
| the appearance of authority.
|
| > If you had [a doctor] say "go take hydroxychloroquine for
| COVID", you'd end up with a lot of people getting harmed
|
| I want to point out that there absolutely were doctors who
| told patients to take hydroxychloroquine.
|
| This is all to say that I think you have to weigh relative
| harms and benefits. Should someone with access to top tier
| medical care get advice from an AI? Almost certainly not.
| Somebody who has access to no medical care or to the sort
| of doctor who prescribes hydroxychloroquine? As I said
| initially, it's not necessarily a hard yes but there is
| certainly an argument to be made that it's a yes.
| cmiles74 wrote:
| Right now, the only products I've seen leveraging LLMs are the
| tools from Nuance[1] that fill in physician notes. Arguably
| this is not an improvement; physician notes are already an
| incomprehensible garble of cut-and-paste content (often from
| other systems).[2] But at least it is unlikely to negatively
| impact patient care.
|
| So far, AFAICT, the drive is to cut costs by saving the time
| the physician spends with the EHR. This has been a goal of the
| EHR systems for as long as they've existed as it saves money.
| There is a lot of press releases about products that do more
| but it's not at all clear to me that these products being
| widely used.
|
| The UnitedHealthcare example in this article is interesting in
| that is was being used in production. OTOH, it sounds much more
| like something evaluating business rules or some heuristics
| rather than an LLM or even an ML based solution.
|
| [1]: https://blogs.microsoft.com/blog/2023/08/22/microsoft-and-
| ep...
|
| [2]: https://ehrintelligence.com/news/ehr-clinical-note-length-
| co...
| to11mtm wrote:
| > The UnitedHealthcare example in this article is interesting
| in that is was being used in production. OTOH, it sounds much
| more like something evaluating business rules or some
| heuristics rather than an LLM or even an ML based solution.
|
| I'm fairly certain that at least one insurance company VP out
| there is using the LLM/ML hype to trumpet what is actually a
| statistical model evaluation. OTOH if it provides cost
| savings does the business truly care what it is? Especially
| if they can spin it as 'The computer makes more informed
| decisions thanks to AI'.
| EdwardDiego wrote:
| My employer is exploring LLMs in our existing product for
| transcription purposes in a clinical setting, especially
| telehealth.
|
| It's pretty damn impressive tbh.
| codr7 wrote:
| 2) is pretty much the definition of a modern startup if you ask
| me.
|
| Precious few actually make a positive difference.
|
| Obviously that's not the story they'll tell you, or even
| themselves, but once you start scratching the surface you'll
| find that they're all about squeezing profits and pushing costs
| just like everyone else.
| sporkland wrote:
| > I'm not sure I understand why AI is supposed to make anything
| better
|
| It's probably because you don't understand how the world works.
| Most things aren't revolutions they just allow us to good
| things more often and cheaper and so create wide spread
| "wealth". In this case imagine a doctor who isn't magically
| better than all doctors combined, but instead is the best of
| all doctors and specialists and performs very consistently and
| is available on 24/7 basis. It didn't revolutionize everything
| but I imagine the collective impact on health and lifespans
| will be tremendous.
| userinanother wrote:
| " Expect AI to continue spreading into more legal gray areas as
| companies take advantage of the lack of clarity on legal
| responsibility to raid and pillage our economy and societies."
|
| This is exactly what's happening, it doesn't even need ai just
| an algorithm that allows companies to have an excuse for
| denying care. If there is no human in the loop nobody is
| responsible. You can't send an AI to jail so they can just
| abuse the system.
|
| Judges need to force companies to stop using algorithms and
| allow approve all expenses when an algorithm is found to be
| illegal or potentially illegal and that will end the practice
| quickly. The burden of proof should be on the algorithm writer
| to show its legal
| protoman3000 wrote:
| > Even when users successfully appealed these AI-generated
| determinations and win, they're greeted with follow up AI-
| dictated rejections just days later, starting the process all
| over again.
|
| Wait, what? Does that mean they can just take your money and
| reject your request to cover treatment until you die even if you
| had every right to do so?
| manicennui wrote:
| Yes, this is what Americans mean when they parrot bullshit
| about freedom: the freedom for corporations to do whatever they
| like in pursuit of profit.
| cryptonector wrote:
| We don't have a free market in healthcare in the U.S. though.
| You can be for a free market and against the abomination we
| currently have. If we just went back to 80%/20%, high-
| premium-or-high-deductible proper _insurance_ , no HMOs, no
| PPOs, no co-pays, none of that nonsense, with published
| pricing, then we'd have a free market.
| sofixa wrote:
| Is the regulations that are forcing co-pays, networks,
| obscured pricing? From the outside it sounds like the
| market doing it's best to extract as much money as
| possible, with the occasional regulation designed to look
| like someone is trying to fix the mess with a pretty
| bandaid (like the recent one on detailed upfront pricing).
| manicennui wrote:
| Thanks for proving my point.
| mindslight wrote:
| I'm all for reforms to move towards a more market based
| system. But one has to recognize that at this point we're
| nearing a century of anti-market meddling - a quick search
| says 1943 is when healthcare started getting bundled with
| employment!
|
| And talking about a "free" market is a red herring. There's
| no reason to believe that the current industry actually
| wishes to converge on uniform prices with upfront
| transparency - they could just start publishing such prices
| at any time currently, but rather continue to benefit from
| heavy price discrimination. So getting to a functioning
| healthcare market would actually take _a lot_ of regulation
| that actively _undoes_ the cancerous behemoth that 's been
| slowly grown. Try asking any doctor how much something
| might cost and most of the time they will scoff - the
| rejection of any market dynamics has become pervasive by
| the entire system.
|
| Also to have an actual _free_ market we 'd need to
| eliminate things like mandatory pharmaceutical
| prescriptions and patents, which there is unfortunately
| very little support for doing.
| mcosta wrote:
| Isn't the medical field one of the most regulated?
| __loam wrote:
| The answer is not less regulation, it's to have publicly
| owned healthcare. Those regulations were written in blood.
|
| Also go listen to one of the latest episodes of Odd Lots
| where they interview Lena Khan about anti-trust. Private
| equity has been rolling up medical companies for decades,
| essentially doing things like buying up all the
| anesthesiology clinics in an area so they can jack up
| prices. Some of the bloat is due to regulations but a lot
| of the bloat is due to over-financialized bullshit like
| private equity buying up providers.
| TheCleric wrote:
| Unless you have expertise in fighting them, yes.
|
| https://www.propublica.org/article/blue-cross-proton-therapy...
| dsaavy wrote:
| Yep, and ever since a certain insurance provider has switched
| to an AI system, I've had nearly all my Type 1 Diabetic
| prescriptions rejected (that I've had no problem getting for
| over a decade).
|
| Then it takes hours on the phone for every prescription to
| finally get one approved. Rinse and repeat every 3 months.
| sofixa wrote:
| This is inhumane.
| hotnfresh wrote:
| We've had a flex spending account (HSA wasn't an option) that
| we were only putting as much in as we were sure we'd spend,
| rejecting a very high rate of payments this year, even from
| doctor's offices (WTF do you _think_ that's for?!) and
| demanding documentation, seemingly with no rhyme or reason.
| Seems like they're actively trying to keep us above the roll-
| over limit so they can steal our money, which isn't something
| we've experienced with health flex accounts in the past.
|
| Wonder if we're "beneficiaries" of the AI revolution. Or just
| an "if" statement triggering off a random number.
| rqtwteye wrote:
| Technically no, but you need to be able to afford paying for
| lawyers to fight them or spend an enormous amount of time and
| energy.
|
| For some reason health insurances and hospitals can get away
| with practices that no other business would get away with. They
| can commit fraud and when they get caught, all they have to do
| is to say "oops" and fix the mistake. No other consequences.
| It's pretty crazy
| zaptheimpaler wrote:
| Alternate headline: "Our Healthcare System continues to deny
| claims, now with AI". Makes it clearer who the culprit is.. its
| not AI. They have been denying claims for decades without any
| help from AI too.
| tempodox wrote:
| Yes, but if "AI" denies you, humans are suddenly no longer
| responsible.
| manicennui wrote:
| It will almost certainly be used make customer service worse as
| well. In "Ways of Being" James Bridle provides other examples of
| how corporations are going to use "AI" to exacerbate the problems
| they already cause in pursuit of profit.
| poszlem wrote:
| > "AI" (or more accurately language learning models nowhere close
| to sentience or genuine awareness) has plenty of innovative
| potential. Unfortunately, most of the folks actually in charge of
| the technology's deployment largely see it as a way to cut
| corners, attack labor, and double down on all of their very worst
| impulses.
|
| Having read the first paragraph with its profound and non-bias
| insight, I can only expect that the remainder of the article will
| offer a well-rounded and impartial exploration of the issue.
| __loam wrote:
| Are you saying that statement is untrue?
| gumballindie wrote:
| In the UK it's already bad as it is - seeing a GP or doctor in
| person is essentially impossible. AI use will only worsen the
| issue. You can already use "virtual gps" where if you tell them
| you broke a nail or farted they-ll tell you you either have covid
| or cancer. Buyers beware.
| w1ntermute wrote:
| From the article linked by Techdirt: "executives have sought to
| almost entirely subordinate clinical case managers' judgment to
| the computer's calculations"
|
| Sounds like the issue is the executives. What does this have to
| do with "AI"? Also, the company that built this tech (naviHealth)
| was started in 2012. Their product existed long before large
| language models were created.
| mixdup wrote:
| AI is the new crypto. If you can turn your head sideways and
| squint hard enough to make it seem like it might be in the same
| room as AI, it's going to get labeled as such
|
| I wager that 3/4 of the products out on the market purporting
| to be "AI" in the style of LLMs like GPT are just what was
| referred to as ML a year or two prior, or even worse just a
| standard computer program in the style of the past 20 years
| xrd wrote:
| Never in a million years could I have imagined there would be
| something worse than navigating the health care system. Hours of
| phone calls with deliberately confusing systems, impotent
| customer service representatives and no choices. It's like the
| movie Brazil already. Why wouldn't they add AI? Great idea.
| friendly_deer wrote:
| Hah. There's literally an AI startup designed to automatically
| navigate confusing phone trees to get information from health
| systems:
|
| https://outbound.ai
| HankB99 wrote:
| > How bad is the AI? A recent lawsuit filed in the US District
| Court for the District of Minnesota alleges that the AI in
| question was reversed by human review roughly 90 percent of the
| time:
|
| Isn't that about the same for non-AI interactions with US health
| insurance carriers? Their job is to make money and they do that
| by denying claims whenever they can. It's truly an awful
| experience.
| RajT88 wrote:
| > Though few patients appeal coverage denials generally, when
| UnitedHealth members appeal denials based on nH Predict estimates
| --through internal appeals processes or through the federal
| Administrative Law Judge proceedings--over 90 percent of the
| denials are reversed, the lawsuit claims.
|
| The PHB's in charge probably view this as a win. A 10% savings!
| bawana wrote:
| Do any of you remember how healthcare was in the 60s before
| corporate America got involved? It just worked. The uninsured got
| taken care of. A 300 bed hospital had 3 administrators. Now we
| have a whole army of people in the hospital who have to justify
| their jobs by the number of emails they send.
| ngai_aku wrote:
| The '60s were 55+ years ago, so it's unlikely that many here
| remember that.
| ok123456 wrote:
| Doctors should start using LLMs to deal with the appeals.
| secretsatan wrote:
| It's probably working exactly as intended, they can hide behind
| the appeal process, but i would bet they're thinking of the
| savings on those that don't appeal
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