Right, because every other developed countries gets similar outcomes at lower costs (poor capita, per GDP, or on any other reasonable basis for comparison) because they are far ahead of us on automated administration and billing.
There might be countries where that's what's needed, but in the US there's clearly a lot of lower hanging fruit that doesn't require any new technology.
Currently in the US the largest health insurance provider is actually medicare/medicaid. When a patient with medicare goes to the doctor, the government says "This is what we will pay for that procedure, no exceptions." The hospital has a choice to either accept that rate, or to lose out on the massive medicare market.
Private health insurances plans have vastly fewer subscribers, and don't have the power to negotiate prices like the government does.
But regardless, why is health care and insurance a for-profit industry? It creates incentives to put profits ahead of people's health.
Medicaid is more 50 different insurance providers (it's run by each state—with separate programs for, at least, D.C., Puerto Rico, and Guam, and it's not even a single insurer in every state, e.g., California uses a number of county-level managed care plans as well as a traditional fee-for-service plan.) And all of them are separate from Medicare. Which also is less of a single insurer with common coverage policies than it seems on the face (even excluding Medicare Advantage, which is just publicly subsidized private insurance), since whether any given procedure in reasonable and necessary and therefore covered in any given geogrpahical area in Medicare depends on local coverage determinations made by the private insurer that is the Medicare Administrative Contractor for that region and claim type (there are separate contractors, with different geogrpahical regions, for regular part A&B claims, home health and hospice claims, and durable medical equipment claims.)
If you have insurance, the price tag will be X, and they will pay for some part (most?) of it.
If you don't have insurance, the price tag can easily be 100X and it's your responsibility.
If you have insurance, but you happened to pick up that can of pepsi from the left aisle (out of network) instead of the right aisle (in network), they won't cover it, and you're stuck with the 100X price. You won't know that before you buy the can of pepsi, of course.
If you try to ask your insurance if they cover the specific can of pepsi from the left aisle, they may or may not tell you. They may or may not give you the right answer, and if they tell you it's covered but then refuse to cover it, it's your problem (and again, the price will be 100X).
The whole model of negotiated rates, rebates, etc. needs to go.
I also think the concept of networks is bizarre on the face of it. A certified medical provider should be covered to perform procedures in their area of expertise. Period.
Personally I like the idea of anyone who wants to be able to buy into Medicare A & B. And if you don’t have Medicare then you can always pay the Medicare rate of the procedure at 100% (versus having Medicare where your copay is 20%).
If insurance companies can’t compete with that then great.
I think part of the problem is absolutely opaque, discriminatory, and predatory pricing.
I went to get a basic blood count last month. I gave the lab my insurance card, but they must have copied a number wrong, because when I got the bill they had me down as self insured, and had a bill which said;
Lab Services : $1,541.00
Patient Adjust : -$ 385.25
Total Due : $1,155.75
Last week I got the new bill:
Lab Services : $ 17.12
Insurance Pay : $ 12.12
Total Due : $ 5.00
Thanks but this sounds ridiculous to me. Doctors are people too who really do get paid and really do make mistakes.
Using AI to learn from the best of the best will improve results overall, and automating tasks that expensive doctors did will reduce cost.
Yes we need to handle the exploding and ridiculous administrative costs, but clearly there can be gains on both fronts of this battle.
This is an important factor in how we choose to build products out of AI advances. If your product replaces a part of a service chain that is not either right next to the transaction or in a competitive part of the supply chain, it might only help incumbents aggregate more power and charge more rent. If you can deploy in a way that improves the competitive landscape, you not only distribute gains more but probably keep more leverage as a solution.
This is harder for AI than many technology areas because incumbents tend to have more data and regulatory protection on that data. Health care might be the boss level for that problem.
In fact, it IS "a US thing": • Most major teaching hospitals mandate 24-hour weekend shifts for residents; • One "assistant" aka resident doctor for a psych ward overnight is standard
Retired neurosurgical anesthesiologist here who's been there and done that many, many times....
The Luddites are back! We'll see how this prediction holds up in 30 years.
However, a pragmatic approach would suggest that any form of AI and it's derivatives, would be assistive in the medical field and play a hybrid role, rather than being a panacea[2].
[1] https://news.ycombinator.com/item?id=17667375
[2] https://towardsdatascience.com/why-ai-will-not-replace-radio...
So many programs and devices are used where someone would be liable if they malfunctioned. In a production line for example, if something goes wrong and it has to be turned off, every hour costs $$$ to the production plant owner. Similarly for robots: there have been cases where industrial robots have killed people. Accidents with machines can happen in so many industries. If the machine is wrong in 0.2% of cases, that's a risk that can be calculated. If its rate of misdiagnoses is equal to the rate of a human expert, then replacing non-experts with it will improve patient experience. Of course, there might be super experts whose patients would be worse off if they were treated by an AI.
Every time I visit the doctors in the US there is a trail of paperwork produced. Outside of basic checkups (where you don't dare mention any niggling health issues because your instantly going to get billed consultation fees) there is always a back and forth between the patient, doctors office and insurance over what the doctors office is asking to be paid and what the insurance says it is prepared to pay. This is an enormous time wasting game - the doctors (or their medical group) ask for much more than the procedure cost to perform knowing full well that the insurance company will push back with a lower accepted payment and the patient will sat in the middle having to negotiate between the two.
Removing the pricing game would lower costs substantially (and vastly reduce the time wasted by regular Americans calling their insurance/doctors trying to sort out their individual billing messes).
Having lived in both the USA and the UK there is no question in my mind that the US health care system is a dysfunctional mess. In my experience the only place the US system has an advantage is that the healthcare providers are very (too) willing to send a patient for tests/scans to check for every eventuality and are happy to prescribe whatever medicine is 'best' for an ailment.
In the UK a fit person with a common cold would get sent home and told to not waste the doctors time, in the US you'll get a consultation and a dose of Z-Pack (and hey if I'm paying for my insurance I should use it when I get sick, shouldn't I).