Dr. Oz pushes AI avatars as a fix for rural health care

I was watching an interview of one of the white parents who opposed bussing in Boston in the 70s. He said something along the lines of, "We worked hard for new neighborhood schools and facilities, it was unfair that our kids couldn't go to them." Well, didn't the black parents work hard to get their kids access to a quality education? Of course. The next person interviewed was a black mother who quit her job so that she could work at the school her children attended, to make sure that they were safe.

It turns out that she opposed bussing, too; the goal of the black parents' lawsuits hadn't been bussing per se, but equitable access to resources. The government had engaged in malicious compliance: rather than keep all kids, regardless of race, at newly-improved neighborhood schools, they opted for a "solution" that only solved the problem on a surface level, and which was sure to draw ire, knowing that this rage could eventually justify walking back the changes. Look at Boston school demographics today; they achieved their aim.

To your "well-meaning" friends - and to everyone caught up in this type of situation - I ask you to think deeply about who is the actual bad actor. It's usually not the person that the wealthy or powerful or influential or "professional" are telling you want to take something from you. You have to actually be well-meaning to see through that smokescreen, though, and not just zealously self-interested.

The actual limiting factor is federally funded residency positions which are funded by CMMS, and were artificially capped by the Balanced Budget Act of 1997 during a widespread climate of financial austerity after Gingrich had led Republicans to retake the House in 1994 for the first time in decades.

At the time, AMA apparently did release a report that included support for reducing the number of residency slots, so that detail is correct. But the decision wasn't made by them, and federal healthcare spending was already on the chopping block (and was a politically attractive area to make cuts given the Clinton's administration failed healthcare reform proposal).

As early as 2006 [4], the AMA started releasing policy position statements requesting caps on federal funding to be increased, but it wasn't until the CARES ACT in 2020 that Congress funded 1000 new CMMS funded slots were funded (but limited to small gradual increases each year) and started to be implemented in 2021-2022. And they continue to advocate for increases that so far haven't been adopted.

So while there's a kernel of inarguable truth that the AMA and other medical professional groups did support certain caps back in 1997, it has always been, then and now, a policy decision by Congress. With the motivation to set limits driven by concern over federal healthcare spending inflating budget expenditures.

But it makes for a simpler, emotionally resonant narrative of a shadowy self-interested group pulling the strings at the expense of the public (that also conveniently redirects outrage away from the people actually empowered to fix the problem, or that federal spending is a crucial lever to fix the problem).

[1] https://www.ama-assn.org/press-center/ama-press-releases/ama...

[2] https://washingtonian.com/2020/04/13/were-short-on-healthcar...

[3] https://www.openhealthpolicy.com/p/medical-residency-slots-c...

[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC1785175/

Douglas Adams

I've come to the place where every time we think we have solved a problem, we may not have and have created a new tree of problems.

I am one of those knuckle heads that decided to give carnivore diet a try, and my wife and I have had amazing results on a number of metrics. We were also not even eating junk food or that much processed food.

The sheer complexity of how we live demands humility, and in many ways the skeptics have valids point in many ways.

I look to the Amish, for example, as a way that probably not that bad to live considering how much of the modern world has problems.

At core, some people choose to be experiments, and some decide to the control. This is the reality I believe, and this is how the whole remains robust over the long term.

Healthcare is a necessary service. The healthy foods website that RFK Jr set up was recently in the news for describing the "best foods to put up your ass". That's the technology that's being advocated for here. There's no quality bar. There's no regulation on accuracy. It's almost certainly the case that if you meet with an AI avatar, you couldn't sue its operator for medical malpractice.

The issue, fundamentally, isn't that you're giving people a choice. It's that this will be the only choice. If healthcare companies don't need to open offices in rural locations, they won't. Even if you're fine with this technology, it'll quickly become the case that it's the only option many people have regardless of whether they want it or not.

I read a thread of stories today about people's parents using technology. One person's mom tried searching for energy drink ingredients and accidentally registered her house as a business on Google Maps. These are the people who are suddenly going to have to interface with an AI avatar about their health. We're replacing medical professionals with a glorified phone tree with RAG search. It's literally going to kill people who don't have a choice.

The Hacker News casual misanthropy bubbles up to the top yet again.

Instead of trying to use your hacker instincts to find a solution you're just got to rest on your heels and let people suffer? What a waste of talent this represents.

The solution is to regulate insurance companies so these communities could actually afford healthcare and expand social programs for rural areas.

Tesla fsd was the same thing. You needed to have people to try it. Some paid for it with their lives. Will it make progress, sure. Do I want to be the one that dies to make that progress? No

> Marcus. He is twenty-eight and did two tours in Iraq. He has nightmares four to five nights a week. He drinks to fall asleep. His girlfriend left because she couldn't live with someone who woke up swinging. He tried therapy three times. The first therapist was a civilian who asked how combat made him feel. The second used Cognitive Processing Therapy but sessions were every two weeks, and when she said “trauma narrative,” his chest closed. The third was private practice, $160 a session. Marcus started to describe what happened in the house in Mosul — the one with the family in the back room — and the therapist's face changed. A microexpression, less than a second. Marcus caught it. He stopped talking. He never went back. The 73% problem, made human. Marcus has things inside him that are killing him slowly, and he has never found a room safe enough to say them. Not because the therapists were bad. Because the therapists were human, and the things Marcus needs to say are the things that change how a human looks at you.

It is full of text that is hard to decipher as being meaningful in any way, and that has unfortunately been true of LLMs for a long time, they are great at bullshitting.

Yet, to determine if the content makes any sense takes a substantial effort, an effort I am highly confident you did not do.

Still, I believe you're right, this will be enough. This will be "not everything you read on the Internet is true" x1000.

Is that something we should cultivate in our society? Being emotionally attached to balls of linear algebra controlled by massive corporations?

1. an AI cannot effectively deliver on its own.

2. requires physical testing and actual facilities rather than just prescriptions.

If it works for the workers, ...