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Amodei Believes “AI-Enabled Autocracy” Could Be Imminent

By MIKE MAGEE

Last month, Dario Amodei, CEO of Anthropic, did it again – scaring the bejesus out of societal leaders worldwide with warnings that their grip on security and governance of human populations is dangerously close to AI extinction.

Amodei’s opening paragraph in his article titled “The Adolescence of Technology” wastes no time getting the reader’s attention. He writes, “There is a scene in the movie version of Carl Sagan’s book Contact where the main character, an astronomer who has detected the first radio signal from an alien civilization, is being considered for the role of humanity’s representative to meet the aliens. The international panel interviewing her asks, ‘If you could ask [the aliens] just one question, what would it be?’ Her reply is: ‘I’d ask them, How did you do it? How did you evolve, how did you survive this technological adolescence without destroying yourself?’”

Now, I should be clear. I was already nervous. As a Medical Historian, preparing for a major lecture on the birth of Immunology this Spring, I’ve been researching the field. What am I looking for? The same thing I always find missing when exploring the frontiers of scientific progress – historical context. In most cases, facts and figures abound, but their impact on the complex web of human relations over the years is often missing.

Amodei is attempting to provide that context in real time. Real times include headlines like this one from the New York Times: “ICE Already Know Who Protesters Are “ from AI powered facial recognition technology . But Amodei’s concerns are more fundamental. The challenge for him is the speed of change with generative AI which he clearly states is alarming. As he says, “Because AI is now writing much of the code at Anthropic, it is already substantially accelerating the rate of our progress in building the next generation of AI systems. This feedback loop is gathering steam month by month, and may be only 1–2 years away from a point where the current generation of AI autonomously builds the next.”

Clearly with Musk’s recent DOGE foray in mind, Amodei lays out a pretty plausible modern day vulnerability. He says, “It is somewhat awkward to say this as the CEO of an AI company, but I think the next tier of risk is actually AI companies themselves. AI companies control large datacenters, train frontier models, have the greatest expertise on how to use those models, and in some cases have daily contact with and the possibility of influence over tens or hundreds of millions of users.”

Getting a bit more specific without outright naming Musk-controlled Grok and X, Amodei leaves little doubt who he’s referring to when he says, “Some AI companies have shown a disturbing negligence towards the sexualization of children in today’s models, which makes me doubt that they’ll show either the inclination or the ability to address autonomy risks in future models.”

At one point during the ICE offenses last month, a legal observer in Portland, Maine, filming an ICE agent, was approached by the agent who had just filmed her car and was now filming her face. Asking why he was doing that, the ICE agent replied, “Cuz we have a nice little database and now you’re considered a domestic terrorist. So have fun with that.”

The activities of the past month, and the unprovoked murders of two innocent US citizens make Amodei’s final warning prescient. He says, “Current autocracies are limited in how repressive they can be by the need to have humans carry out their orders, and humans often have limits in how inhumane they are willing to be. But AI-enabled autocracies would not have such limits.”

Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex. (Grove/2020)

Ten Ten Ten – Trying to radically fix health care in the US

The goal of the new non profit Ten Ten Ten founded by TJ Tedesco & Bhargav Raman is to take America from being the most expensive health system in the world with the 48th best outcomes to the top Ten in outcomes, at 10% of GDP in Ten years. Are they crazy? Is there any hope of doing this? I spent a long time in conversation with them suggesting that they probably are, but it was a great conversation to hear why they are doing this and how they think we might do this–Matthew Holt

2026: A Year for Reimagining Healthcare’s Safety Net

By JEFF BRANDES

To say healthcare’s safety net experienced tectonic shifts in 2025 would be an understatement. The rapid introduction of multiple and massive policy shifts left many healthcare leaders reeling with more questions than answers.

As the industry turns the corner into 2026 and the dust begins to settle, it’s time for stakeholders to respond by leveraging all resources and tools available. Current industry shifts will necessitate structural and process changes that ensure the best health outcomes for all communities.

Foundational to any strategy is a recognition that AI and automation have found their place in countering administrative burden in healthcare, and mainstream use of these tools will help speed the industry’s race to greater value. Care teams that previously spent hours reviewing documentation, identifying risk-adjustment opportunities and organizing population-level insights can now claw back the time needed to get ahead of care gaps.

In 2026, healthcare leaders must acknowledge that new realities are here to stay and will require reimagining how the industry delivers optimal care for vulnerable populations. Safety net organizations that have not invested in automation for managing routine tasks will get left behind in the new world of managing population health. By leaning into the following three strategies, stakeholders can realize the promise of value-based collaboration.

Keeping Medicaid Patients Connected to Care

Sweeping changes to Medicaid eligibility, financing, and administrative requirements will have far-reaching impacts on coverage. Current workflows that address these challenges are complex and overwhelming for many resource-strapped safety net providers—not to mention patients and families.

On the Medicaid front, infrastructures that lean into unified data and integrated workflows can help providers become more proactive in identifying those at risk of losing coverage. Specifically, tools that pair eligibility data with clinical and social risk insights can guide outreach prioritization and patient assistance. In addition, providers can use automation to build multilingual renewal campaigns that personalize patient interactions such that vulnerable populations understand their healthcare options.

Safety net providers are already seeing success with the right strategy. For example, the California Primary Care Association (CPCA) leveraged automation and analytics to mobilize outreach and support Medi-Cal renewals and new enrollments across 38 counites. From January 2024 to June 2025, the initiative reached more than 1.3 million people, achieving more than 159,000 Medi-Cal enrollments and re-enrollments.

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Trust No One

By KIM BELLARD

You know, it’s gotten to the point when I just try to tune out the things Robert F. Kennedy Jr. says. “Schizophrenia can be cured with a keto diet”? Sure, whatever. “The war on protein is over”?  Who even knew there was such a war? The carnivore diet is a great way to lose weight and gain “mental clarity”? It sure doesn’t show.

His most dangerous statements, though, are probably those related to vaccines. He was known as a vaccine skeptic – no, make that critic – long before he was named as HHS Secretary, but being Secretary put him in position to put his anti-vaccine views into action. He has revamped the committee that make vaccine recommendations, putting people on them that share his skepticism.

The committee has already made significant changes to childhood immunization schedules, and they’re not done yet. The head of the vaccine advisory committee isn’t just skeptical of measles vaccines, he’s not keen on mandating the polio vaccine either. His committee is expected to go after COVID vaccines next.

One particularly outspoken committee member, Dr. Robert Malone said: “I’m not deaf to the calls that we need to get the Covid vaccine mRNA products off the market. All I can say is, stay tuned and wait for the upcoming A.C.I.P. meeting. If the F.D.A. won’t act, there are other entities that will.” He told The New York Times that scientists or regulators who claimed COVID vaccines were safe are “either being disingenuous, or they are not considering the context or are ignorant.”

Meanwhile, RFK Jr.’s nominee for Surgeon General is, shall we say, big in the MAHA movement but not so much in medical professional circles, having placed her medical license in “inactive” status. Her own website brags that she “is considered controversial because her work challenges the economic and cultural foundations of U.S. healthcare, agriculture, and food systems.”

The impacts of these attitudes are neither academic nor far in the future: we’re already in the midst of an unprecedented measles outbreak that many attribute to the vaccine skepticism that RFK Jr. and his ilk have spawned and encouraged.

What caused me to write about this is a new poll out from KFF: Trust in the CDC and Views of Federal Childhood Vaccine Schedule Changes. Top-line finding: “the public’s trust in the CDC remains at its lowest point since the COVID-19 pandemic.”  Well, you can’t be surprised by that.

“Six years ago, 85% of Americans, and 90% of Republicans, trusted the CDC. Now less than half trust the CDC on vaccines,” KFF President and CEO Drew Altman said. “The wars over COVID, science, and vaccines have left the country without a trusted national voice on vaccines, and that trust will take time to restore.”

What I found particularly interesting is that, as Dr. Altman said, pre-COVID trust in the CDC was both high and across party lines. Republicans, though, lost trust during the pandemic and basically have never recovered. It took the Trump Administration to get Democrats to lose their trust – but, in fact, their trust still remains higher (55% versus 43%). Independents hover slightly above Republicans, but well below Democrats.

Specifically, about trust in childhood vaccine recommendations only about 44% have some or a lot of faith in federal agencies such as the CDC and FDA, and that doesn’t vary much by either party ID or support for MAHA.  E.g., 47% for MAHA supporters versus 43% for Not MAHA Supporters. What does it say about MAHA that believers don’t have faith what the creator of MAHA is doing? 

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Carta Healthcare – AI for Registry Creation

It’s not well known but there’s a lot of people in hospitals who spend a lot of time creating patient registries for quality programs, CMS reporting, clinical trials and lots more. It requires extremely detailed abstraction of patient data from patient records and comparisons with registry demands. Wouldn’t it be clever if an AI system could read the chart and help the people doing that work (usually very expensive nurses) do it quicker? That’s the premise behind Carta Healthcare. Greg Miller and Jared Crapo from Carta demoed the system for me and told me about the market for it–Matthew Holt

Will HHS Enhance or Stall the Promise of Artificial Intelligence for Healthcare?

By STEVEN ZECOLA

In its Strategy for Artificial Intelligence (V.3), the Department of Health and Human Services (“HHS”) acknowledges that: “For too long, our Department has been bogged down by bureaucracy and busy work.” HHS promises that it will accelerate artificial intelligence (“AI”) innovation, including “accelerating drug and biologic approvals at the FDA.”

History shows that well-intended but cumulative regulatory intervention – more so than scientific complexity – is the primary deterrent to rapid technological progress. If AI is subject to the typical pattern of regulatory creep, its potential to accelerate drug discovery and development will be significantly reduced. To avoid this outcome, HHS should develop a plan that is premised on a zero-based regulatory approach. That is, each new technology such as AI should start with a clean slate and only the minimum requirements deemed necessary to show effectiveness and safety should be applied in the approval process for that technology.

The Pace of Innovation

Medical innovation has lagged the pace in the other sectors of the economy. As Dr. Scott Podolsky of Harvard Medical School observed: “Medicine in 2020 is much closer to medicine in 1970 than medicine in 1970 was to medicine in 1920.” Podolsky points to breakthroughs such as antibiotics, antihypertensives, antidepressants, antipsychotics, and steroids that have not been met with same impact as innovations in the later 50 years.

Two explanations have been offered for this phenomenon: 1) the inherent complexity of biological processes; and 2) the regulatory approval process.

As a benchmark for comparison to the following case studies, the development of 4G communications spanned less than a decade, with discussions starting around 2001, technical specifications being released in 2004, and the first commercial networks launching in 2009.

Regulatory Intervention in New Technologies

  1. The Human Genome (Great Science Leads to Regulatory Paralysis)

The Human Genome Project (HGP) ran from 1990 to 2003, and has been lauded as one of the world’s greatest scientific achievements. The project identified the specific location of genes and DNA, creating a “roadmap” of the human genetic code and facilitating the identification of disease-related genes.

The HGP focused on balancing rapid scientific progress with ethical safeguards. Oversight was primarily managed through internal ethical programs and international data-sharing agreements rather than a single overarching legislative or regulatory body.

Under this structure, the HGP beat its target date by two years. That is to say that the complexity of the problem did not cause any delays, and progress was not impeded by the standard drug-approval bottleneck.

However, once the genetic roadmap was handed off for drug discovery and development, progress slowed dramatically.

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Arnold Ventures Part II “Structuring Information Felicitously”

By JEFF GOLDSMITH

In the first part of our look at Arnold Ventures, we explored its business model and generous support of elite University health policy experts to further an ambitious health policy agenda. In this second part, we will explore some of the questions raised by Arnold’s aggressive approach.

Zack Cooper is an Associate Professor of Economics and Health Policy at Yale University*. He is the academic investigator at the heart of the so-called the 1% Solution, an Arnold Ventures funded project which encompasses most of its health policy agenda. The core idea of the “1% solution” is that while comprehensive health reform (e.g. “Medicare for All”) may not be achievable, pursuit of a bevy of policy goals with smaller price tags could generate savings that could be reinvested in policy improvements.

Cooper was the object of unwanted press scrutiny for receiving extensive sub rosa funding from United Healthcare for research work and writing instrumental in the enactment of the No Surprises Act in 2021, which was aimed at controlling out-of-network health insurance billing. United was expected to be the largest single beneficiary of this legislation. (The biggest “surprise” emerging from the No Surprises Act was that providers are winning 80% or more of the independent mediations of these disputes, suggesting that it was health insurers, not providers, who were gouging the public).

According to Arnold’s 990s, Cooper and his Yale policy shop, the Tobin Center for Economic Policy, received over $5 million from 2018 to 2024. Of this amount, $700 thousand funded the 1% Project itself, including more than a dozen papers by academic colleagues on topics ranging from surprise billing to PBM reforms to site neutral outpatient payment to hospital market concentration.

As part of this project, Cooper and a University of Chicago colleague, Zarek Brot-Goldberg, published a paper in early 2024 of the economic impact of hospital mergers: “Is There Too little Anti-trust Enforcement in the Hospital Sector?” which found that 20% of hospital mergers had an adverse economic impact on their communities. The alternative off-message headline, “80% of hospital mergers had no adverse economic on their communities” never surfaced.

However, a follow on piece got wide circulation thanks to a June, 2024 Wall Street Journal article, which exposed it to millions of readers without any reference to Arnold Ventures funding. The paper, which featured an astonishingly complex multivariate econometric model, was originally published by the National Bureau of Economic Research (NBER is also funded by Arnold Ventures). This paper linked hospital mergers to widespread layoffs in the communities where the mergers took place and a subsequent wave of suicides and drug overdoses (!).

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John Arnold: The Most Powerful Man in Healthcare Nobody has Ever Heard Of (Pt I)

By JEFF GOLDSMITH

It has happened at least a dozen times. I mention John Arnold and am greeted by knowledgeable healthcare colleagues with a blank stare. Houston billionaire John Arnold is the most powerful man in US healthcare that nobody has ever heard of. An investing savant, Arnold made $50k in high school trading collectors’ hockey cards over the Internet. He became the star natural gas trader at Enron in his early twenties. Arnold, who played no role whatever in Enron’s storied collapse, left the company in 2001 with an $8 million bonus. In 2002, at age 28, Arnold founded a hedge fund, Centaurus Advisors, focusing on energy investing, and reeled off a decade of 100% annual returns.

Bored with investing and by then a multi-billionaire, Arnold shut down Centaurus in 2012, and decided to change the world. With his Yale trained attorney wife Laura, John created a family foundation. and funded it with a large share of their personal wealth. For reasons we will explore more fully below, in 2019, Arnold converted their foundation to a ”for-profit charity” known as Arnold Ventures. At nearly $4.7 billion in assets in 2024, Arnold Ventures was about a third of the size of the lions in foundation world, Robert Wood Johnson ($14.7 billion in 2023) and Ford ($13.7 billion in 2024). Arnold Ventures 501c3 grantmaking subsidiary gave away a cool $194 million in 2024 to a bewildering array of grantees from American Enterprise Institute to Families USA.

But Arnold’s business model is fundamentally different than these legacy charitable foundations.

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Shifting Sands Part 3

By GEORGE BEAUREGARD

Fifteen months ago, I wrote in The Health Care Blog about the “incoming tide” of early-onset cancer.

At that time, the global rise in the incidence of early-onset cancer in younger people that had occurred over three decades had been noticed and was being monitored by researchers, scientists, and other healthcare professionals. Articles on research discoveries in this topic sporadically appeared in top medical journals such as Nature, The New England Journal of Medicine, and The Lancet.

From 2005 to 2011, some early warning articles surfaced in generalist publications in mainstream media outlets like The Wall Street Journal and The New York Times. Those stories were framed as tragic “one-offs” or medical mysteries. Following a landmark study published by the American Cancer Society (ACS) in 2017 (1), the narrative shifted from “anecdotal” to “epidemic”. In 2020, the death of actor Chadwick Boseman, who was diagnosed with colorectal cancer at the age of 43 catalyzed mainstream media reporting on the situation. Chadwick died one month before my son, Patrick, who was 32 years old. Patrick was featured in a WSJ article in January 2024.

Since then, other reputable national publications like Time magazine and The Economist, and major media news outlets have featured stories about the growing situation. Stories about it have even appeared in some popular supermarket tabloids.

Over the past year, articles about the potential causative roles of diets high in ultra-processed foods, obesity, environmental factors, sedentary lifestyle, and a gut bacterium’s genotoxin remnant mutagraph, so-called Colibactin, have appeared.

The recently released ACS report Cancer Statistics, 2026, presents a jarring “good news, bad news” dichotomy and has garnered wide attention. The good news: overall, five-year survival rates for people with cancer have increased from 50 percent to 70 percent since the mid-70s. A 40 percent increase. Certainly a cause for celebration. (Mary Lasker would be smiling.)

But a dark reality persists.

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