This feels economically naïve.. If AI lets one nurse do the work that previously required two, the default pressure in a cost-driven system is not "great, now nurses can spend twice as long with patients" It is "great, now we can run the same operation with fewer nurses"
The actual, tangible form this is taking right now is concierge medicine, home health aids, private practice, etc. My wife's (very good) ob-gyn had enough of working in institutionalized medicine where she's paid about what a L4 FANG engineer makes and pretty much has to follow the script that the health-care system dictates, and quit. Now she does perimenopause consultations for FANG execs at $1200/hour.
My uphill neighbors are in their 90s. I think the wife was in VC or something back in the 70s and 80s. There's a steady stream of nurses and home health aids up to their property. Seems like they've got a full care team working out of their home.
Across industry and industry, we see the same pattern. The mass-market product gets cheaper and less labor intensive, at the expense of any human touch. Everybody displaced, if they're any good and wants to stay in the field, moves up-market to do custom professional services for rich people. They pay for it, because if you want people to do good work for you, you have to pay them more than they can get otherwise.
Reducing wealth inequality is not the same thing as making everyone poor. And you know that.
I live in Canada. Under the current government, business investment cratered, 40% of our 1% earners left and our GDP per capita relative to the US dropped by 40%.
Keep in mind that LLMs were basically invented in Canada and we've captured next to none of the economic activity.
Elon Musk, Ilya Sutskever, Andrej Karpathy and Geoffrey Hinton are all Canadian citizens lol...
With the assumption that this is true (I have no idea either way), has it made people more poor or worse off?
You tell me. Median household (+ individuals not in an economic family) income went up $5k from 2015-2024. Given what you've experienced inflation wise in that time period what do you think?
US median household income went up $15k in that time period ($22k CAD), so >4x more.
You built the killbots that prevent anyone from ever reallocating your wealth and holed up in your compound. But will your daughter and granddaughter be able to keep them operational and aligned to their interests?
If my blood pressure crashes because my nurse is caring for 15 patients at once and didn't notice that the AI decided to pause my norepinephrine, I won't consider "the AI did it" to be any acceptable excuse.
In fact, especially in those circumstances, if we take the warnings of X-risk even slightly seriously.
From Google:
"Annual Deaths: Over 250,000 people die each year in the U.S. due to medical errors made by healthcare professionals, including doctors and nurses. Ranking: This figure positions medical errors as the third leading cause of death in the United States, following heart disease and cancer."
It is highly possible that in a few years, AI will be a lot safer in the majority of healthcare situations.
AI can do none of this, and cannot be held accountable for mistakes.
I would take a human with a 10% mistake rate but who can be held accountable, over an AI with a 0.1% mistake rate that is totally unaccountable for its mistakes.
You would take those odds? 100x more deaths?
I agree that AI _companies_ should be accountable for the software they produce but I’m not convinced you would go for a 90% chance of survival if you can choose 99.9%.
But, yea, in general, it would take a huge (1000X or 10,000X) difference in expected outcome for me to trust something that is unaccountable. If the AI company was actually held accountable for its AI's mistakes, I'd definitely change my statement.
I am having a hard time imagining a future where “AI” isn’t just a tool that a given establishment decided to use much like anything else they use
Everything as much as possible, yes, and the company behind it will be an AI driven autonomous corporation as well. Although I suspect that by then there will be some industry specific AI model being used by hospitals, not just plain Claude.
AI will handle patient data, diagnostics, prescriptions, everything that doesn't absolutely require a human and can't yet be done by a robot.
Somewhere, some human will be making money but they will be far from any legal liability, probably safely ensconced in a bunker on a private island when the gravy train really hits the fan.
>I am having a hard time imagining a future where “AI” isn’t just a tool that a given establishment decided to use much like anything else they use
The people making the decisions, investing the money and writing the laws imagine so much more, though. You assume the future of AI is governed by rational people making rational decisions but it isn't, it's governed by Musk and Thiel and sociopaths and grifters and cultists who want to immanentize the eschaton so they can stand at the right hand of God.
They're inhuman(e). They hallucinate, and have devoured volumes of Harvard Business Review.
I might be naive to the core but I think, in the long run, I am not very Doom&Gloom about AI like you are sounding, people have a way of (eventually) making their own decisions and won't put up with this world you are pitching (I hope lol)
I can even see it being sold as part of healthcare reform. After all, we don't trust doctors anymore, we don't trust science, surely AI would be more fair, more rational and ethical. AI can't be paid off by big pharma to push pills you don't need. AI doesn't care what race or gender you are. AI doesn't get exhausted after a 24 hour rotation. Costs would go down, quality would go up. That would be the pitch anyway. The rest would be in the fine print, not a sign in front of the hospital.
I don't want to live in that world, but I can see a path to it from where we are now. I think some kind of legal personhood for AI as a pretense to apply legal liability to AI is inevitable.
Imagine having to do paperwork as a nurse after working a 12 hour physical job, overnight, 8pm to 8am.
The idea mistakes happen because the nurse doesn't "care" is utter bullshit.
I think of how if I am really tired I just don't do anything that risky at my job until the next day. A nurse doesn't really have that option and it is all the highest risk there is. Every day, all day. All with a chronic, massive work shortage for dogshit pay.
The most brutal thing I have read about nursing are nurses saying the lucky people are the ones who failed out of nursing school.
To be honest, I'm looking forward to more AI in healthcare if it can increase diagnosis success rates and improve treatment outcomes etc.
The next decade will be painful. We are in for a lot of surprises along the way
"Taking death statistics from a sample of Medicare patients and extrapolating it to all hospitalized patients is like turning apples into oranges"
"Using studies that identify medical errors that were followed by death to declare that these medical errors necessarily caused these deaths is not fair. What these studies do not take into account is how long these patients would have lived had they received optimal medical care."
It will, except it will be snuck in through the back door. It won't be some kind of robo-doctor making care decisions, it will come in the form of insurance eligibility steering the approved care plans, which absolutely will be decided by AI. The doctors will remain to act as liability sinks, but functionally they will probably join the ranks of the meat proxies.
https://stateline.org/2024/03/29/vets-fret-as-private-equity...
True.
> ... AI can't be allowed to be a decision maker
Non sequitur.
Part 2 only follows from the Part 1 if you can demonstrate that AI makes more errors, or more severe errors, than humans in the identical situation.
And for those situations, I agree with you.
But there are already many situations where the AI is making fewer errors than humans, and for those situations, it would be unethical to exclude AI (see Part 1).
Ah, they need to. Thanks for clearing this up.
If I pay a company to do something, and that company uses an AI to do the thing, and the AI messes it up, why isn't the company liable?
Let's assume you get paid 0$ for AI mistakes -- no liability at all. Then your EV is roughly:
(AI accuracy - human accuracy) * (cost of accident) - (1 - human accuracy) * (human payout)
Now I don't know about you, but even with pretty big numbers on the human payout scale and relatively small differences, I would not accept 10 million (presumably paid to my next of kin) to die. Does lead to weird situations where I may prefer humans for minor medical procedures where I can take the risk -- but only in edge cases.
Or is there some weird punishment thing going on here?
Ethically, we can easily justify refusing to delegate responsibility and accountability to a system that has no responsibility or accountability.
It will be depending on how much you paid. My bet is that in the near future normal people (like most of us) will be attended by AI in pretty much everywhere: the bank, the hospital, shops, hotels, etc.
You will need to pay extra premium to be attended by a human being. Actually that’s what’s been happening to the ultra rich since a very long time ago (e.g. a millionaire doesn’t book an appointment by using their phones, they ask their assistant to book for them; they don’t go online shopping, they get people do the shopping for them, etc)
I'd say society's, or maybe executive's, viewpoint has shifted on this.
There's a reason it's called a Limited Liability Company. The whole point is to separate the company's liability from the individual that participates in it. For example, corporate financial liabilities of a company that is bankrupt.
You would not sue the nurse that makes a mistake. You would sue the company she works for. And if that company is bankrupt, well, that's it. There are rare instances where this isn't true, but generally it is.
Whether this is ethical or not, it's the system that we already have.
The LLC might be fucked but it is not a flesh-and-blood person. There is no person responsible. Just a legal entity.
So nothing is changed. I think we're in agreement?
("Replace AI with 'company' and you realize that we're living in that world already." I 100% agree with this, though!)
While not quite as direct as automatically stopping vasopressors, using proprietary prediction models touted by vendors to be safe has backfired in a major way before:
https://jamanetwork.com/journals/jamainternalmedicine/fullar... https://www.statnews.com/2021/09/27/epic-sepsis-algorithm-an...
More than ever, I feel we need both grassroots activism and key players at the top of the hierarchy. Otherwise, it is all too obvious where most of the rewards from increased productivity will go. The wealth hoarding has got to be curtailed.
They have an incentive to play dumb and talk as if AI is net positive for the world.
This is why all the things you are supposed to believe are repeated and repeated and repeated some more.
A profound economic transformation
In the extreme scenario, AI is more productive than humans at the vast majority of knowledge-work tasks. It does nearly all of them autonomously, and it creates essentially no new knowledge tasks for people. This scenario would likely require recursively self-improving AI, adopted quickly for knowledge work.
As AI diffuses, annual GDP growth rates reach 15% a year, leading the economy to double in size every 4.5 years. As a society, we’re far richer than we’ve ever been, but many fewer workers have jobs in knowledge work, and unemployment has risen beyond typical recessionary levels.
Now replace all that and you still produce same overall. Not more actual physical stuff.
The Aletta autonomously handles each step of the blood draw, while a trained phlebotomist initiates each session and remains available to respond to any issues throughout. The device guides the patient to position their arm, after which the patient or supervisor presses a button to start the blood draw. The Aletta then uses near-infrared light and Doppler ultrasound to locate a suitable vein and tell it apart from arteries. If no appropriate vein is found, the device will not attempt the procedure.
Once a vein is identified, the Aletta proceeds through the remaining steps on its own: applying a tourniquet, preparing the skin, inserting and disposing of the needle, changing collection tubes and placing a bandage. The supervising phlebotomist confirms that collection tubes are filled in the correct order and verifies that all tubes are adequately full following the procedure.
I'm sure they aren't all, but friends who work in the hospital tell tales of woeful inefficiencies and pointless beauracracy. Of course YMMV and this is a public health system.
Now that you mentions labs, he spent the last 10 years of his career (maybe more, I don't remember clearly) working at a food analysis lab and there was a lot of waiting for results there, but it is what it is, microorganisms take their time to grow and no LLM in the world can make them go faster.
Rate limited by biology. Love that.
You mean the microbes have to double n-times (to get sufficient numbers of microbes) before tests can be run on them.
But maybe the LLMs figure out a way to run those tests on microbes that have only doubled 0.1(n-times).
You could then think of the LLMs as being a more honest version of Elizabeth Holmes.
You could try shortening the time to 6 or 12 hours, but then
1) if something grew then the food was contaminated, but if it didn't, how can you be sure it is good or you just didn't wait enough? You would get a lot of false negatives.
2) the lab followed a normal 8 hours a day schedule, so nobody would be there to analize the results. You would not gain anything.
I'm sure they aren't all, but friends who work in technology tell tales of woeful inefficiencies and pointless beauracracy. Of course YMMV and this is a publicly traded company.
i looked at very similar data as anthropic (was a bit amusing to look at these side by side) with physical tasks being part of the equation much more prominently (across all jobs).
if you're interested: https://largelabormodel.com/mirror?job=2221
AI leaves humans as the limbs of the machine, with less and less thinking or comprehension required on their part.
Its like the people who say "if you automate writing code, accounting etc is done too". Like ok bro.
https://www.moneygeek.com/insurance/health/aca-medical-loss-...
How do you know we live in the same place.
Perhaps where I live, efficiencies are to the benefits of everyone?
Yes, but the parent is saying that the middlemen will still charge the patients the same and pocket the difference. The patients have already shown what they are willing to pay. There is no reason to charge them less, even if your labor costs are now lower.
Theoretically competition will eventually squeeze the middleman, but it's not exactly straightforward to build a hospital on every street corner like you can a restaurant. There is somewhat of a natural monopoly there. Maybe less so for basic clinic care, but where the infrastructure needs are complex...
Yeah, but market itself is a function of labor costs.
In case you haven't noticed, all that our current system is able to do with increased efficiency is cutting staff and/or increasing the percentage of money that gets siphoned up to capital holders.
I doubt 99% of what a nurse does would be meaningfully aided by an LLM and where it would help it'd probably be a crappy band aid around a bigger festering issue anyway (e.g. poorly managed IT, deliberately confusing insurance processes).
It will just fester out of sight and out of mind: audit bots and compliance bots and malpractice bots and insurance bots will arms race creating such a mess it will become unfixable.
With AI I could actually see this being a possibility since it doesn't depend on a huge army of competent employees in a government office.
If something is not costing a lot, then it means there is sufficient supply that obtaining it is not going to require sacrifices elsewhere.
If something does cost a lot, then it means there isn't sufficient supply, and obtaining it is going to require sacrifices elsewhere.
Healthcare is obviously one of those things, especially with a top heavy population age histogram, where supply is not going to be sufficient so costs will remain high. And if costs are high, then obviously they will decide how resources get allocated, that is the very nature of something that is high cost.
Costs are just another way to say resources. If we only have $100, and it takes $100 to have a 33% chance to give Bob a 50% better life, but $50 to have a 15% chance to give either Sara or Rose a 100% better life, we need a rubric to make that decision.
We can't just do first come first serve (maybe the first person in line takes all the health care for a 1% chance of getting 1% better), or pick the person we like better (who is we?). We have to figure out how to manage and grow the limited resources we have. We manage them by coming up with algorithms on how to spend money, and we grow them by cutting costs and investing. This is better when it is done in public through democratic means than when it is done behind closed doors (to avoid the above problems.)
There will always be death panels. There are currently death panels. The reason for single-payer is not to avoid trying (imperfectly) to maximize these equations, it's to get rid of massive amounts of administration and graft (cutting costs.) If all that savings goes to the Pentagon, we wouldn't be any happier than before single-payer.
But it's not good to come up with some fuzzy way to determine who gets treated. Efficient spending is a way of minimizing injustice. To say a health system is not being driven by costs is just another way of saying that it's going to be driven by undeclared and unexamined biases.
I'm surprised they expect people to still believe that stuff.
Serious solutions to this would look like nationalizing tech companies, mandating shorter work weeks, seizing the assets of the oligarchs and redistributing them.
Not... letting the invisible hand of the market sort it all out.
The industry with an absence of government interference, software, has seen prices drop to zero.
The IT sector in general doesnt deal with comparably vital services and is due to its immaterial nature much more competive. Driving costs to zero/minimum is a logical outcome of healthy free markets, which is a direct contradiction to profit driven enterprise. That is why Peter Tiel hates competition and my profit margins for eg, grocerie stores (healthy localized market) are quite low. The only way to satisfy the fiscal pressure, baked into the system and upheld by propaganda, of "get more or loose", is to cut spending/quality in such a market. And the only way to prevent that are institutions above the free markets slowly failing to deliver.
This "slowly failing to deliver" is imo a key characteristic of late stage capitalism and i can see it everywhere (you too?). BC. in financialized economies, the incentive is elsewhere, than maintaining rural infra, "health care, housing, education".
not really. almost all technological processes have increased the quality of the service.
I wasn't flying first class 50 years ago, but everything I can see now leads me to believe that this isn't even slightly true. There might be a high def flatscreen in front of me in first class today, but I'm not getting more attention than someone would've gotten back then, I'm not in a less crowded airport while I'm boarding, and the security mess is more demeaning than ever.
The only reason that people aren't rioting for all the changes is that no one even remembers how good it used to be.
Because not that many people even used to fly. Because it cost a lot more.
A 1950s flight experience would have been on something with piston engines and propellors, like a DC-6 or a Super Constellation. Noisy, turbulent, and not particularly safe by modern standards.
Today's airliners fly high where the air is smooth, they've gotten very good at avoiding turbulent weather, and there are automated damping systems. The barf bags are still there, but I've never seen anyone use one.
The cool thing about piston airliners, though, is the the engine start.
Today's high bypass jet engines also qualify as a turboprop.
The sound of a Merlin V12 coughing into life is just pure joy. My dad had the best job in the world flying P-51s (powered by Merlins). I hired a P-51 to do a flyby at his funeral. I only had to pay for the gas.
The easiest way to make conditions get better is to make sure the people in charge have to use things, be it busses, bike lanes, trains, airports, public bathrooms, parks with bums, etc. Otherwise it always hits the middle and lower class to absorb it.
"Between 1950 and 2018, efficiency per passenger grew from 0.4 to 8.2 RPK per kg of CO2"
https://en.wikipedia.org/wiki/Fuel_economy_in_aircraft
https://www.explore.com/1762212/reason-why-plane-experience-...
They aren't.
Where the gains went are lower ticket prices.
And outside of industries with government enforced perversions of simple "supply and demand" forces (we're not talking Nth level effects here) this means more access to the service or lower prices or both.
Edit: Which is to say you won't see any benefit in healthcare but you will in a ton of other industries.
For example, I bet you could enumerate plenty of weight loss options off the top of your head.
Medicine is not "if A then B".
Right up until a competing hospital that charges substantially less for "close enough it doesn't matter" quality of service opens up in the same area?
Or right up until an equivalent specialist sets up shop in the strip mall across the street from you, brings the GP in house and can see people in one visit.
Oh, those things don't happen you say?
From do-gooders regulating right into the hands of waiting industry lobbyists to inelastic demand healthcare is an absolute poster child for perversion of the free market.
High finance will put solar panels on your roof and structure it so you pay nothing. The degree to which administrative overhead is washed away by technology would have been unfathomable in 1990.
A sketchy concrete crew that doesn't even speak english will show up wearing matching company attire and execute a job planned and timed to a degree of precision that was reserved for huge corporations 40yr ago.
Yet healthcare has resisted all of the advances of the past 40yr. In fact we pay more for it. Every advancement is absorbed by the system.
Why is that?
It has to be the regulation, not the parasitic layer of health insurance racket in the middle.
I'll settle for just letting the vets do people. Like if you can ultrasound a cat's heart for a grand and sew up a horse for a cool five hundo then you can do the same to me for the same prices.
>It has to be the regulation, not the parasitic layer of health insurance racket in the middle.
They regulation and the parasitic layer have a positive feedback loop with each other.
Greater access at the expense of the number of people employed is not necessarily a net positive. In the case of healthcare, the data is fairly clear that higher nurse staffing ratios lead to better patient outcomes (read: decreased chance of death or serious complications). This is particularly true for ED and ICU nurses.
Also, in the case of healthcare, I'm fairly certain that hospitals in the US are legally not allowed to turn patients away. So "lack of access" is not currently a problem for serious medical emergencies.
That's not what happened, though. Everyone worked the same amount for the same pay, just in more miserable repetitive working conditions, while the factory owners kept all profits from the gains in productivity.
Because this is what drives continual risk-capital.. very few countries are willing to upset this. Get over it man - I hate hardended capitalists but stop crying. This is the system we have. Wanna beat it? Go ahead and start a firm. Then you'll find out how tough it is.
The thing I cant get over is enough software engineering folks collectively hold immense power. Whats wrong with you lot (im not a software engineer)? Get your sht together.
P.s. Im starting a firm who's central mission is to attack capitalists (ofc I won't say it out loud in that way). I will find out for myself how much of a backbone software engineers etc have when I employ them.
You're in for a rude awakening.
I’ve worked with them and did a comp sci degree years ago. I’ve got enough exposure.
However I want to see given what is happening in the world now - are they still weak and feeble?
"The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread."
https://en.wikipedia.org/wiki/Das_Kapital#Legacy
My hypothesis is that if you go full socialism, you get stagnation, because no one is motivated to change anything. If you go full capitalism, you get Gilded Age, where wealth and political power is concentrated in the hands of few individuals, followed by Great Depression.
Healthy state is in the middle.
Under capitalism, man exploits man. Under socialism, it's the other way around!
Myself, I always exploited my employers by extracting money from them.
Those factories were not producing luxury goods. They produced everyday items for the masses. Things like knives, spoons, tools, textiles, ketchup bottles, shoes, furniture, nails, bicycles, etc.
Standard Oil, for example, improved efficiency and reduced the consumer price of kerosene 70%.
There's no evidence of outsized profits.
They improved efficiency by cutting exclusive deals with railroads and transport companies due to their size which froze out every other company.
SO's market share never exceeded 90% and it declined during the years of the anti-trust trial.
By cutting launch prices 90%, is SpaceX also an abusive monopoly?
SpaceX isn't a monopoly because they have domestic and international competition. Before they showed up, ULA was a deliberately constructed monopoly because Boeing and Lockheed didn't want to compete.
The other reason they're not a monopoly is that they may do 90% of total launches, but most are for themselves to support starlink (another "nonopoly" with no competitors). They have 60% of the US government launch contracts, a small percentage of ESA when Ariane is flaky, amd of course 0% of China and Russia.
Start with "Titan" by Chernow.
SO was basically convicted of "making too much money", and the government failed to convict SO of a monopoly.