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'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

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Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#81

Earlier quoted context omitted.

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.

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.

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).

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#82
post #73

Earlier quoted context omitted.

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.

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 av…

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.

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#83

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 ever…

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.

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#84

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 ever…

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.…

> 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'.

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#85
post #33

Earlier quoted context omitted.

" 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.

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…

>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

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#86

Earlier quoted context omitted.

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…

> 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…

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.

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#87
post #42

Earlier quoted context omitted.

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

A naïve 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.

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.

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#88
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.

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#89

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.

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

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#90

Earlier quoted context omitted.

> it will never get better Don't lose hope, other countries manage to be a lot better. It's possible if you only try.

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”

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.
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