By KIM BELLARD
Everything’s about AI these days. Everything is going to be about AI for a while. Everyone’s talking about it, and most of them know more about it than I do. But there is one thing about AI that I don’t think is getting enough attention. I’m old enough that the mantra “follow the money” resonates, and, when it comes to AI, I don’t like where I think the money is ending up.
I’ll talk about this both at a macro level and also specifically for healthcare.
On the macro side, one trend that I have become increasingly radicalized about over the past few year is income/wealth inequality. I wrote a couple weeks ago about how the economy is not working for many workers: executive to worker compensation ratios have skyrocketed over the past few decades, resulting in wage stagnation for many workers; income and wealthy inequality are at levels that make the Gilded Age look positively progressive; intergenerational mobility in the United States is moribund.
That’s not the American Dream many of us grew up believing in.
We’ve got a winner-take-all economy, and it’s leaving behind more and more people. If you are a tech CEO, a hedge fund manager, or a highly skilled knowledge worker, things are looking pretty good. If you don’t have a college degree, or even if you have a college degree but with the wrong major or have the wrong skills, not so much.
All that was happening before AI, and the question for us is whether AI will exacerbate those trends, or ameliorate them. If you are in doubt about the answer to that question, follow the money. Who is funding AI research, and what might they be expecting in return?
It seems like every day I read about how AI is impacting white collar jobs. It can help traders! It can help lawyers! It can help coders! It can help doctors! For many white collar workers, AI may be a valuable tool that will enhance their productivity and make their jobs easier – in the short term. In the long term, of course, AI may simply come for their jobs, as it is starting to do for blue collar workers.
Automation has already cost more blue collar jobs than outsourcing, and that was before anything we’d now consider AI. With AI, that trend is going to happen on steroids; jobs will disappear in droves. That’s great if you are an executive looking to cut costs, but terrible if you are one of those costs.
So, AI is giving the upper 10% tools to make them even more valuable, and will help the upper 1% further boost their wealth. Well, you might say, that’s just capitalism. Technology goes to the winners.
We need to step back and ask ourselves: is that really how we want to use AI?
Here’s what I’d hope: I want AI to be first applied to making blue collar workers more valuable (and I’m using “blue collar” broadly). Not to eliminate their jobs, but to enhance their jobs. To make their jobs better, to make their lives less precarious, to take some of the money that would otherwise flow to executives and owners and put it in workers’ pockets. I think the Wall Street guys, the lawyers, the doctors, and so on can wait a while longer for AI to help them.
Exactly how AI could do this, I don’t know, but AI, and AI researchers, are much smarter than I am. Let’s have them put their minds to it. Enough with having AI pass the bar exam or medical licensing tests; let’s see how it can help Amazon or Walmart workers.
Then there’s healthcare. Personally, I have long believed that we’re going to have AI doctors (although “doctor” may be too limiting a concept). Not assistants, not tools, not human-directed, but an entity that you’ll be comfortable getting advice, diagnosis, and even procedures from. If things play out as I think they might, you might even prefer them to human doctors.
But most people – especially most doctors – think that they’ll “just” be great tools. They’ll take some of the many administrative burdens away from physicians (e.g., taking notes or dealing with insurance companies), they’ll help doctors keep current with research findings, they’ll propose more appropriate diagnoses, they’ll offer a more precise hand in procedures. What’s not to like?
I’m wondering how that help will get billed.
I can already see new CPT codes for AI-assisted visits. Hey, doctors will say, we have this AI expense that needs to get paid for, and, after all, isn’t it worth more if the diagnosis is more accurate or the treatment more effective? In healthcare, new technology always raises costs; why should AI be any different?
Well, it should be.
When we pay physicians, we’re essentially paying for all those years of training, all those years of experience, all of which led to their expertise. We’re also paying for the time they spend with us, figuring out what is wrong with us and how to fix it. But the AI will be supplying much of that expertise, and making the figuring out part much faster. I.e., it should be cheaper.
I’d argue that AI-assisted CPT codes should be priced lower than non-AI ones (which, of course, might make physicians less inclined to use them). And when, not if, we get to the point of fully AI visits, those should be much, much cheaper.
Of course, one assignment I would offer AI is to figure out better ways to pay than CPT codes, DRGs, ICD-9 codes, and all the other convoluted ways we have for people to get paid in our existing healthcare system. Humans got us into these complicated, ridiculously expensive payment systems; it’d be fitting AI could get us out of them and into something better.
If we allow AI to just get added on to our healthcare reimbursement structures, instead of radically rethinking them, we’ll be missing a once-in-lifetime opportunity. AI advice (and treatment) should be ubiquitous, easy to use, and cheap.
So to all you AI researchers out there: do you want your work to help make the rich (and maybe you) richer, or do you want it to benefit everyone?
Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor
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