> As the nurse incorporates AI into her job, the nurse is able to oversee and accomplish more. She can spend more time talking with patients and helping them understand diagnoses. Productivity increases.
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"
Nurses do actually end up spending more time with patients, it's just that they spend more time with rich patients.
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.
This has a surprisingly easy solution: get rid of the rich. It's never, in the history of the world, been in anyone's favor, except the oligarchy, to privatize everything.
It reaches a breaking point because ultimately, the rich are outgunned and outnumbered once the poor realize they have had enough. We are not too far off from a time with ai and robotics and automated factories that the rich are no longer outgunned or outnumbered by things capable of disobeying them.
This seems like a new spin on the "wealth fades after 3 generations" narrative.
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?
I think if the elites cared about their daughter and granddaughter they would have acted to not destroy the world to begin with, frankly. And it's no reprieve for the common man that after the world is ruined the elite bunkers will be trash after 100 years
Both are relative terms so they can be the same or different depending on who defines them. Nearly everyone that works in the US is rich by worldwide standards, so it's not clear that a lack of billionaires for example would make things better. Sans Amazon, Apple or Google, would the US be better off? I'm not convinced.
Most people's definition of rich is "one dollar more than I have". Just look at laptop class's hate on the 1 percenters - which actually includes them.
Getting rid of the rich by taxing them and getting rid of legal and financial loopholes that allows them to operate outside of the system with absolutely no contributions back does not make everyone poor. In fact, it's the complete opposite.
Reducing wealth inequality is not the same thing as making everyone poor. And you know that.
Lots of counterpoints. Peronist Argentina, France under Hollande, Canada from 2015-today, etc...
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...
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.
I know this is just an example, but I'm going to say this every time the subject comes up: since human lives are the cost of making the wrong decisions, AI can't be allowed to be a decision maker of any kind in healthcare.
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.
Replace AI with 'company' and you realize that we're living in that world already.
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.
Do you think there's no difference in material outcomes when a company faces consequences of a specific human nurse being negligent vs an AI hallucinating?
I could've sworn that malpractice insurance cost is viewed as one of the driver's of high health care costs, and that it's expensive precisely because medical lawsuit payouts are large...
Your understanding of LLCs is a bit off. The LLC (or other corporate) structure does not protect the nurse from liability, nor any of the other directly-involved workers. The LLC protects the owners of the LLC - ie the ones turning the screws that spread workers ever-more thin. Workers generally avoid being sued mostly by custom, following procedures set by the LLC and/or professional bodies, being "judgement proof" (ie not having significant assets), and various types of insurances.
("Replace AI with 'company' and you realize that we're living in that world already." I 100% agree with this, though!)
> AI can't be allowed to be a decision maker of any kind in healthcare.
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.
I see that already in veterinary medicine with the non-DVM office/practice managers (or whatever title that guy lurking around in the office may have) - in the vet practices belonging to large networks the DVMs and nurses constantly looking at those managers for approval.
Not to say that I don't agree with you to an extent, but you should see AI-delivered healthcare numbers to human-delivered and make it a fair comparison.
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.
"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."
The difference is that humans are at least supposed to be accountable for those 250,000 errors. Those humans can naturally care about doing a good job, or they can be motivated to care. They can fear consequences and take pride in avoiding mistakes.
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.
> 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%.
I guess if you're dead, then it ultimately doesn't matter if someone can be held accountable, although it might matter to your next-of-kin.
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.
AI is a tool just like any other tool. Holding “AI” accountable is like holding JetBrains accountable for the bugs I wrote with their tool than endangered lives of people
There is simply too much money and too many interests vested in the narrative (which many people already believe) that LLMs are thinking, feeling, sapient beings already beyond the threshold of AGI that deserve some status of legal personhood and liability. It is impossible to create the future that these people want to create - one in which AI comprises the new legal class of nobility in an age of technofeudalism - if AI remains just a tool.
how will this manifest itself!? like you envision a future where there will be say a hospital, ran by anthropic which is AI powered fully, no company behind it, just plain Claude running everything from the moment you walk in till you walk out?
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
> you envision a future where there will be say a hospital, ran by anthropic which is AI powered fully, no company behind it, just plain Claude running everything from the moment you walk in till you walk out
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.
You can bet that every major company CEO on the planet is creaming his jeans at the thought of AI doing every task (except their own) that they currently pay humans to do. Their ideal end state is that the company is themself, thousands of AIs and thousands of robots, zero payroll. Every one of them is dreaming of this.
I do not disagree but I also do not see how, without liability for its action, would a business have customers. Surely there are idiots but if someone put up a sign in front of the hospital like "we are not liable for anything that happens inside these walls" I will venture a guess that business will suffer. This will also open up business opportunities for other businesses to jump in with "we stand by what we do, you'd be crazy to go to _____ for services we are offering."
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'm not pitching it per se, I'm just claiming that's what I think the endgame for AI is. Corporations (especially in the medical, pharmaceutical and insurance fields) are already masters at avoiding legal liability. What are you [royal] going to do, bleed to death in the streets? Not get your insulin or heart medication? What decisions are you going to make when every company does the same thing? Get your chemo from a shaman? People already put up with massive cruelty and corruption from the medical industry, they would roll over for this as well.
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.
You’re painting a pretty dystopian picture of a hyper capitalist society where the rich have shaped the law in a way that the poor have no recourse. I think it could happen but it’s completely unrelated to anything AI and more to do with your government.
But what's the point of holding something accountable here? Creating an incentive for them to take your needs seriously? Why does an incentive matter if you already know that one has a superior expected outcome?
Human doctors and nurses are not accountable for outcomes, and they can not be accountable or our medical system (and any other medical system) would cease to function.
A nurse and doctor have personal liability in the US.
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.
> human lives are the cost of making the wrong decisions ...
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).
Surely the only rational reason to care about liability is you get paid in the bad outcome.
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?
Not true. The company deploying or using the AI (not the frontier AI lab building it) needs to make sure that the AI works. Just like anything else. Not sure why this is complicated.
Better error rates are an argument for AI into the process, but that doesn't justify making it the decision maker. Ethics concerns more than just the error rate, it also concerns the accountability, ability to appeal, due process, explainability, distribution of harm, and so on.
Ethically, we can easily justify refusing to delegate responsibility and accountability to a system that has no responsibility or accountability.
Why wouldn't they just blame the nurse anyway? The law always puts somebody on the hook. The nurse's job will be to do what the AI says and take the blame when it fails.
> 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.
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:
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)
This is the same faulty standard you constantly hear applied to self-driving cars, where human lives are also often at stake. You don't need the AI to be perfect. You just need it to be substantially better than the average human (which self-driving cars are). Your nurse who's caring for 15 patients at once might not make perfect decisions either. That doesn't categorically disqualify humans from delivering health care
I want to emphasize your point. As a basic matter of valuing humanity qua humanity, this holds even if the AI could be shown to make the decisions more accurately than a human could.
In fact, especially in those circumstances, if we take the warnings of X-risk even slightly seriously.
Our culture and the socioeconomic structures it reinforces will not change easily.
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.
What changes fast thou, is economic structures and societal structures will follow. This is classic marx (base<->superstructure) or the power aspect of economics. One true dystopia i see possible, is mecha hitler slowly displacing and controlling (white collar) city dwellers to the point of silent obedience. This Anthropic article is imo propganda to buy time for shareholders and to delay potential stroms. Claiming AI as actors in a capitlistic system will fix systemic issues, is like claiming super sonic planes will fix world hunger.
As long as it is repeated often enough, everyone will accept it and most will also believe it. Even when corrected later, whatever was repeated more often will live on.
This is why all the things you are supposed to believe are repeated and repeated and repeated some more.
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.
Mass automation will be disastrous for GDP in service economies. Service economies exist to provide services to other people who also provide services. If the services themselves get automated, you don't need that massive inefficient system to support service-providing workers anymore. GDP goes to zero.
I believe lot of "service" jobs are fundamentally make up work. Or not actually productive. Just there because it can be afforded. Or someone decided that it is "needed". Some amount of it produces net negative value. Some neutral and lot probably value we could even manage without it. Actual productive value is probably not that big part.
Now replace all that and you still produce same overall. Not more actual physical stuff.
My dad is a retired nurse. Most of his work was giving shots, treating wounds, extracting blood, putting IV catheters, etc. In other words, physical tasks. How is an "AI agent" or LLM going to take care of that?
When I watch medical professionals at work, a lot of the time they are writing or typing, reading or shuffling through notes, talking to others or waiting for results from some lab down the hall. Or any number of things that to me look like crappy admin tasks.
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.
When I watch software developers at work, a lot of the time they are writing or typing, reading or shuffling through stackoverflow, zoom chat to others or waiting for results from a github CI run. Or any number of things that to me look like crappy admin tasks.
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.
This was also a public health system (Spain), but I guess it might depend on the country.
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.
If I remember correctly, the procedure was to prepare a food sample, put it in a temperature-controlled environment for 24 hours, and next day see if something grew there or not. If it did, the food was contaminated.
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.
Obviously not an LLM, but AI models + robotics are likely to automate many healthcare tasks in the long term and are already beginning to automate tasks like blood draws.
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.
these days, i think most tasks come with significant administrative overhead as insurance companies want everything documented (and hospitals need to itemize everything to bill it).
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).
Not every country is like the US. My country has a public healthcare system; I never needed private insurance and never had to pay for a visit to the doctor.
Ironically, given the reputation of high costs and private care, that is how it is too in the US. It is just that you have to be broke, unemployed, or retired to be covered by the public single payer system. The clinic still needs to document what was done to get reimbursed by Medicaid.
i grew up between germany and the US — having dealt with the public insurance system in germany, it's not (much) less admin-intensive than the US. my mom works in the public healthcare system in germany and has to fill out heaps of paperwork.
Moreover, the nurse is frustrated, because she lost whatever agency and autonomy she had before. Her job is now obey whay AI said instead of making decisions by herself.
Anthropic is eyeing an IPO. Of course they're spinning a narrative where their product will reshape the entire economy. They have a vested interest in doing so in the most literal sense of the meaning.
No? Prices are market-driven in our society, not necessarily a function of labor costs. In the very long-term best case scenario, the increased profits going to the company from these efficiency gains may encourage more competitors to pop up, and either drive prices down or offer more for what you pay.
Healthcare costs (what I assume you mean by prices) are the least market-driven items in the US economy. And as much as the medical community would have you believe, the primary driver of costs are labor costs. If we had twice the number of doctors, PRNs, PAs, and nurses, their annual income would drop dramatically. But since they're constrained by a guild system, it's not going to happen.
> If we had twice the number of doctors, PRNs, PAs, and nurses, their annual income would drop dramatically.
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...
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'm not sure who even is priced out of healthcare considering if you are broke you get covered and if you are a little less broke you get subsidized care and if you aren't broke, then you finally pay up. It isn't really rooted in free market dynamics like you'd expect with theoretically falling labor prices because of stuff like ACA or medicaid covering the people who would have been more price sensitive.
Healthcare prices are not dictated by labor costs, but by how much the leeches who own everything are willing to charge people for it. For example, insulin is dirt cheap to make, yet billed at exorbitant amounts.
At least in the US, the ACA recalibrated how insurance companies get re-imbursed. Their margains are set as a percentage of the payment that goes to direct care. If the prices go up and their margin ratio is fixed, then it is in their best interest for charges to go as high as possible. Same as everyone else in the supply chain. Everyone is suddenly making money hand over fist and the insured can't say no to the premiums.
It feels economically naive because theyre presuming LLMs are magical boxes that replace humans.
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).
The whole idea that AI will usher in this utopia where workers in healthcare are able to realign their primary job functions with obvious value creation by sweeping all the paperwork under the rug is just silly.
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.
There's an optimistic future where Medicare becomes so much more efficient it becomes politically obvious to expand it because it's outperforming the mess that is private sector healthcare.
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.
It is possible to spend an infinite amount of money keeping a human being alive, and every year there are more ways to spend more money keeping someone alive a little longer. Once you're not spending an infinite amount of money for each person, you are in the territory of denied claims, "death panels", waiting lists, and all the other things people like to complain about depending on their political persuasion.
What does cost driven system and driver even mean? The cost of something is the ratio of demand to supply.
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.
It will always be the driver. The question is always going to be whether we spend X amount of resources to get Y probability of restoring Z health to someone (or someone to Z level of health.)
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.
What exactly do you think should be the motivator for people working in healthcare then? For companies creating healthcare products and services? For investors pouring money into health care research? The goodness of their hearts?
Use technological gains to reduce costs while maintaining results hasn't been the historical rule for healthcare so I think you should say what makes this technological gain unique.
Exactly. If their productivity fantasies are real, the precarious (and already very anti-worker) balance between capital and labor immediately disintegrates.
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.
youre comment is getting to the real economic future: nursing unions will not sit back and let this happen. if the "productivity fantasies" (well said) are real this will get ugly. the competent nurses where i live are in strong unions
Apples and oranges. You cannot allow certain vital services to be run profit driven, when you care about the quality of that service. Thats a nobrainer to me, because nobrain makes purchase descisions too.
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".
Air travel is a good counterexample here: technology made airlines far more productive, but much of the gain went into lower staffing, higher throughput, and cost cutting not a better passenger experience
I once saw a receipt for a cross-country train ride in the late 1950s and was shocked at the price. It was significantly slower and more expensive than a similar plane ticket today.
Yes, in the USA Amtrak tends to be quite a bit more expensive than the equivalent trip by air. And far slower. Maybe excluding some of the east coast commuter routes.
Being able to fly at all is a much better passenger experience than not having that choice in the first place. And I'll bet that flying first class today is far better than 50 years ago.
>And I'll bet that flying first class today is far better than 50 years ago.
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.
If you want to know what flying first-class 50 years ago was like (and you live in southern California, and you have money to burn) you can try the Panam Experience (https://panamexperience.com/). It's a replica of a Panam 747, together with a "crew" in period-correct costumes, that tries to recreate the entire experience of flying in the 1950s. (Bearing in mind that the plane is a replica, located on a soundstage.)
That sounds a bit weird, the 747 didn't enter commercial service until 1970.
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.
I flew in piston airliners long ago. They fly low and slow, and barf bags are supplied for a reason (low altitude means lots of turbulence).
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.
I have flown in turboprops, which start just like a jet engine. Yes I bet the startup of a big Pratt & Whitney Twin Wasp or Wright Cyclone, belching smoke and fire would have been something to see.
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.
Ah, I responded to "tries to recreate the entire experience of flying in the 1950s" and not the "50 years ago" yes in the 1970s it could certainly have been a 747.
Well that and the people who make decisions largely don't fly peasant. Remember that the US air force is mostly executive transport.
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.
In Brazil in the 1980s the VASP (Viação Aérea São Paulo) airline put their smoking section on the right side of the single aisle, and the non-smoking on the left side of the single-aisle. The smoke stayed on the right side just fine. (jk)
True, but you ignore the financialization and enshittification that typically follows the technological advances. The tech processes you cite don't inherently make money for the people who developed the technology.
>great, now we can run the same operation with fewer nurses"
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.
During the industrial revolution, people thought that all these new machines and factories and electricity meant that everyone would only have to work 4 hours a week since it made everyone so much more productive.
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.
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%.
Defending standard oil is an all-timer hot take. They only had 90% market share? In a commodity?
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.
Numbers aside, SpaceX has a technological lead. They're not strangling competitors in a commodity business with monopoly practices. I wouldn't call ASMR or TSMC monopolies either, anyone can compete with them in theory. Standard oil, by contrast, would cut their competitors off from rail transit and selectively dump to drive them out of business.
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.
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The central argument of Capital is that the motivating force of capitalism is in the exploitation of labour, whose unpaid work is the ultimate source of surplus value and profit.
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Marx's labour theory of value is only a theory of where profits come from and is largely rejected. Return on captial investment is not restricted to factory owners. All workers get a share of the surplus value and have the option to increase that by investing.
"Capital stands as one of the most influential and controversial books ever written. Its legacy is multifaceted, shaping intellectual discourse, political movements, and the historical trajectory of the 20th and 21st centuries."
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.
I learned to hate corpo jobs less by thinking of them as "farming gold out of a megacorp". Of course I'm losing my ability to do even that, as sloppotrons beat half-century-old grognards every damn time.
"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.
Being an employer means you will find out. Employees are not weak and feeble. They quit all the time for more money elsewhere, or just don't want to work. And there's NOTHING you, as employer, can do about it.
In a market with perfect competition, perhaps. Healthcare is far closer to a monopoly. Since people can't decide not to be sick, it means you can pocket the cost-saving.
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.
healthcare is one of the most highly regulated and state-controlled industries on the planet. surely that has nothing to do with it though. must be those damn capitalists!
>We should remove the red tape and let Joe down the street operate, that will surely fix everything.
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.
A good doctor will present many options for you. I had hernia surgery a while ago. I went over the options with the surgeon, the varying surgical methods used, including doing nothing about it.
>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.
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.
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"