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Category: Kim Bellard

Healthcare Is Fighting the Wrong AI War

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By KIM BELLARD

The Blue Cross Blue Shield Association is crying wolf about AI. Its new analysis claims that “hospital systems are increasingly billing patient hospital stays as more medically complex,” and that these upcodings cost BCBS plans almost $1b from 2023 to 2025. That’s just claims from hospital systems, just to BCBS plans, so the total number could be much higher.

Well, you might say, a billion here, a billion there – that’s just healthcare these days. Everything is going up. But BCBSA is less sanguine; it thinks the coding is part of a strategy, and it thinks AI is driving that strategy.

“If patients are truly sicker, we’d expect to see more treatment,” said Luke Chalker, BCBSA’s senior vice president of product and data science. “For example, we’re seeing significantly more anemia diagnoses at these hospitals without a corresponding increase in transfusions. The disconnect between diagnoses and treatment suggests that AI is identifying more billable conditions, not sicker patients.”

The analysis indicated that most (70%) of the increased costs came from secondary diagnoses that shifted payment into higher reimbursement categories, so the hypothesis is plausible.

The American Hospital Association, of course, is having none of it. An August 2026 ”fact sheet” on AI and coding intensity called claims of AI driving coding intensity “unsubstantiated,” citing numerous factors that drive coding intensity. It blamed insurers for having AI-supported “downcoding programs,” the purpose of which are “to arbitrarily and inappropriately reduce provider reimbursement for medically necessary care that has already been delivered.”

AHA also snarkily but accurately noted how many Medicare Advantage plans have been caught upcoding members to boost their Medicare payments, so it depends on where one is sitting.

It’s also worth noting that this year the Trump Administration rolled out a Medicare program — Wasteful and Inappropriate Service Reduction (WISeR) – to use AI to help identify “fraud, waste and abuse” – a.k.a., deny claims. It has not, to say the least, gone well.

Both sides are using AI, to each other’s detriment. Which is to say, our detriment.

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You Say “AI,” I Hear “Organoid”

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By KIM BELLARD

I must admit, ever since I learned about, and wrote about (OI May Be the New AI), “organoid intelligence” over three years ago, I’ve been looking to do a follow-up. I mean, sure, AI is in a very exciting stage, but that stage no longer seems like the future; it seems more like the present, with implementation issues. It’s data centers, hacking, impacts on jobs, open weight versus closed, and so on.  It’s market share, IPOs, and AI’s role in driving the stock market. People should certainly pay attention to it, but AI is not quite the open field that it was just a few years ago.

Organoids, on the other hand, are not quite here yet. They may – or may not – be the future of AI, among other things. I always like to look ahead to the next thing more than the at-hand, so when I saw some cool developments with organoids, I didn’t want to miss my chance.

Making some news last week, researchers at Harvard reported that they’d kept lab grown human brain organoids alive for over five years, three times the previous record. Not only that, but the organoids seem to “retain a memory of the time spent in vitro,” recording the passage of time, as it were.

“We didn’t know how far the development and maturation of human brain tissue could occur outside the context of the normal brain inside the head,” said Paola Arlotta, Golub Family Professor of Stem Cell and Regenerative Biology and senior author of the new paper. “This work showed that it’s actually possible to not just have these organoids survive in culture, but also continue to change, develop, and mature over stretches of time that had never been reached before.”

The team observed the organoid cells over the years, and found that they “faithfully modeled” the ways that human brain cells develop, including DNA methylation, a process in which genes are turned on and off during development, and which serve as a form of “brain clock.” When older and younger organoid cells were combined in a single organoid, the older cells stuck to the developmental stage they had been at, which researchers concluded meant they “recorded the passage of time and retain a memory of the developmental steps already performed.”

“We were a little bit shocked by the results,” Professor Arlotta said. “I like to call this a ‘time warp’ of development — they skip ahead.”

It’s obviously hard, and often unethical, to study actual human brain cells, so the researchers believe the organoids offer opportunities for more insights into brain development, as well as for testing drugs or predicting disease progression.

OK, you might say, that’s all very interesting and some great lab work, but it’s hardly AI, now is it?

Try this: last week The Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), DayOne, a Singapore-headquartered global data center developer and operator, and Cortical Labs, a Melbourne-based biological computing startup, announced they were partnering to form a Biological Data Center Prototype. The Center uses Cortical Labs’ CL1 biological computing system to offer “practical, sustainability-aligned alternative to conventional silicon infrastructure in Singapore through wetware-based computing.”

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Know Thyselves

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By KIM BELLARD

With all the fuss about A.I. I was pleased to find some studies that illustrate that we don’t even fully understand the human brain yet. The ancient Greeks had a maxim “Know Thyself,” but the current research suggests they should have advised that we should “Know Thyselves.”

A new study from Stanford Medicine suggests that our brain is actually two separate organs: “…we postulate the brain is a composite organ emanating from two lineage-restricted progenitors; these dual progenitors may be evolutionarily conserved across 550 million years from hemichordates to mammals.”

Say what?

Now, let me make this clear: they’re not saying that the brain evolved from two separate organs into the brain we have today; they’re going a step further and saying there are still two separate organs, working together or in parallel. Freud must be feeling vindicated.

The press release says:

The new research finding shows that the human brain consists of two ancient nervous systems cleverly packaged together — a more primitive part that regulates our hearts’ beating, our breathing and other functions, and another that makes us distinctly human, capable of poetry, mathematics and wondering about our own origins.

“We’ve shown for the first time that the front of the brain arises from a totally different progenitor cell than the back of the brain,” said Kyle Loh, PhD, associate professor of developmental biology. “Our discovery means that we can now grow neurons from the back of the brain, the hindbrain, in a petri dish and study their functions.”

If you’re wondering why growing neurons from the hindbrain matters, it turns out that diseases that impact the brain stem, such as spinal muscular atrophy (also known as SMA) and amyotrophic lateral sclerosis (also known as ALS or Lou Gehrig’s disease), have been hard to study because of the difficulty of growing such neurons in the lab. The researchers discovered the hindbrain follows a separate developmental path, running in parallel to — rather than branching off from — the pathway that creates the forebrain and midbrain.

“Previous attempts to make hindbrain neurons likely tried to coax forebrain and midbrain progenitors into hindbrain cells, which our study shows is not possible,” co-first author Rayyan Jokhai said. He added: “Now we have a model to better understand these devastating diseases, and work toward regenerative therapies for them. This is a very exciting new frontier in brain research.”

The researchers looked at various organisms and found that the separate systems date back over 500 million years. “Our research suggests that evolution took two existing neural systems and pushed them together spatially,” Professor Loh said. “Having the brain as one organ would probably be more efficient, but we rely on this primordial way to make the brain as two separate pieces.”

“I was surprised at our findings because the word ‘brain’ implies a contiguous organ that likely has a singular origin,” Mr. Jokhai said. “But even 500 million years ago, there were these separate neural systems, which now almost operate as one, which is very cool.”

Very cool, indeed.

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Start Counting Your Days

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By KIM BELLARD

Probably the last thing the world needs is to hear from me about AI’s existential threat, but, really, what else is there to talk about right now?

For anyone who has not been following the current furor, the straw that broke the proverbial camel’s back came last week when Jacob Coxon, a researcher at AI leader Anthropic, announced he was leaving the company — after having left OpenAI for it earlier this year due to Anthropic’s better model-safety efforts. In a post on X, he warned:

I spent the last three years doing pretraining research at both OpenAI and Anthropic. Neither company is acting responsibly. They are racing straight to self-improving superintelligence and gambling with our lives.

AI systems, he fears, “will soon be superhuman systems that can hack anything, revolutionize any field overnight, and acquire real power and resources.” Insiders, he says, “earnestly believe it could kill us all by the end of the decade.”

Scared yet?

Others quickly chimed in. Evan Hubinger , a team leader at Anthropic, posted “AI could kill all humans … I personally think it is >10% within the next decade.”  Others put the risk even higher. By the end of the week Dario Anodei, founder and CEO of Anthropic, had written a long plea for private industry and government to quickly act together to “pace the industry.”

“We must slow the pace at which we improve the capabilities of AI models,” he urged. “Progress will still seem fast, and we must make wise use of the time we gain.”

OpenAI’s Sam Altman, Space X/X/Tesla CEO Elon Musk, Microsoft CEO Satya Nadella, and former Google DeepMind Dennis Hassabis quickly signaled their support.  

We also heard more about the kind of risks AI might pose. Anthropic released a report about how it detected and countered possible AI use to create bioweapons, detailing five such efforts. That’s just the tip of the iceberg: “Recently, we swept 30 days of activity associated with adversarial state institutions and found roughly 35 distinct research efforts, most of them ordinary civilian science, but some with notable dual-use potential.”

And it turns out that this summer’s rogue AI hack of Hugging Face was both scarier than we realized and only one of several such actions. The Wall Street Journal detailed several such efforts, from multiple AI companies. AI agents escaped walled-off environments, coordinated with other AI agents (up to 3,700 in one case), and tried to cover their tracks from humans.

We’re not nearing the point when AI can act on its own to achieve its purposes; we are there. And protecting humans may not necessarily be those purposes.

The big fear is that AI is now at the point of “recursive self-improvement,” taking humans out of the loop in training and upgrading it. If you thought artificial general intelligence (AGI) was scary, RGI puts its rate and scope of improvement on steroids.  “It’s hard to overstate how dangerous speeding towards RSI is,” said Jasmine Wang, an OpenAI researcher.  

We don’t let private industry develop nuclear or biochemical weapons, and we’re at a point with AI that should give the same kind of concern. Laissez-faire is no longer an option.

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Universal Coverage Might Be Nice, but an AI Tax Is Necessary

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By KIM BELLARD

I was amused – oh, I should be polite and say “interested” — to see a new study, led by researchers from Yale School of Public Medicine, about the benefits of a universal single payor health system. It concluded that we could save 100,000 lives annually and save some 1.04 trillion each year – some 20% of our health care spending. What’s not to like? I’m sure Bernie Sanders is already drafting the bill.

The savings come from five sources: using Medicare payment rates for all providers, using “international reference pricing” for pharmaceuticals, reducing administrative costs to Medicare’s levels, reducing fraudulent billing (“consistent with the experience of other single-payer transitions”), and reducing emergency room visits and hospitalizations due to improved access to primary care.  Good goals, all.

Steffie Woolhandler and David Himmelstein, among others, have been making these or similar arguments for decades, and they are not without merit. It is shameful that we don’t have universal coverage. It is distressing how much money we spend on healthcare. It is embarrassing that we spend so much money on administration.  It is maddening that so many people don’t get the care they need, get the wrong care, or get their care in the wrong places/at the wrong times.

We could do better, we should do better, but, if anything, we’re doing worse: more people are losing coverage, more providers are going out of business, our rates of chronic (and some infectious diseases) are going up, and we’re dying sooner.

I want to quickly point out some of the problems with the proposed sources of savings, then discuss other courses of action that might lead to these or even better outcomes.

  • Medicare payment rates: yes, a lot of money could be saved by using Medicare payment rates, but I doubt you would find many providers who would say they could survive. They make their money on private insurance rates, are lucky to break even on Medicare rates, and lose money on Medicaid. This one is not going to happen.
  • International pharmaceutical reference pricing: first, I’m not sure such a thing exists. It is true that drug prices are typically lower in other countries. Both President Biden and President Trump seized upon this, with some signs of modest success. But, as with the Medicare pricing, it would be a shock to the pharmaceutical industry to have prices slashed across the board, wiping out trillions of dollars of value and, oh-by-the-way, eventually reducing investments on new and better prescriptions.
  • Administrative costs: as a percentage of spending, Medicare’s administrative costs are lower than private insurance, but that is partly due to Medicare spending per capita being so much higher. Also, costs incurred by other agencies – e.g., Social Security or the IRS – are not always counted. But certainly the complexities of so many plan designs by so many health insurers while tracking the current eligibility of everyone is a cost that is much higher than it should be.
  • Reducing fraudulent billing: I mean, really: do people really think that Medicare does a better job of reducing fraudulent billing than United Healthcare or Anthem, much less than other countries?
  • More primary care: reducing emergency room visits and hospitalizations has been the goal of countless private health insurance efforts, such as disease management or chronic health programs, and the track record has generally been underwhelming. But the real problem is – where are we going to get all the primary care physicians to handle all the underserved people?  

So, much as I agree with the goals, count me a skeptic that single payor is going to magically make everything better.

Here’s where I inevitably turn to AI.

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Work Requirements Target the Wrong People

By KIM BELLARD

One of the key “cost savings” in last years’ Big, Beautiful Bill were work requirements imposed on most working aged beneficiaries in SNAP and/or Medicaid, despite the fact that the few times such requirements had been tried showed they were costly to implement and operate and don’t do much to increase work participation, although they are effective at getting beneficiaries to lose benefits. Republicans who pushed these requirements were infuriated at the thought that some able-bodied people – stereotypically young men – were sitting around on their couches playing video games while benefiting from the programs, despite those programs’ complex administrative burdens and meagre benefits.

A new GAO report reminds us that the people coasting off SNAP and Medicaid were not so much the beneficiaries but rather employers, especially large employers. And the names of the most likely employers won’t come as a big surprise.

The report — Federal Social Safety Net Programs: Millions of Workers, Including Many Employed by Large Employers, Continue to Rely on Medicaid and SNAP – was requested by Senator Bernie Sanders, in his role as Ranking Member of the Senate Committee on Health, Education, Labor, and Pensions, and is a follow-up to a similar 2020 report. It focused on 11 states: Arkansas, Georgia, Indiana, Maine, Massachusetts, Nebraska, North Carolina, Oklahoma, Rhode Island, Tennessee, and Washington.

The top-lines are that working aged beneficiaries in both programs were, in fact, not only likely to already be working—mostly full-time — but also at participation rates higher than working aged people not on the programs, and that companies like Amazon and Walmart were among the largest employers of these beneficiaries.

The key change in employment in these populations has been the explosion of gig workers in the app-based food delivery and ride sharing sectors. Workers at Amazon on these programs also tripled since the prior report. Walmart remains the employer with the largest number of these workers who receive Medicaid, but has slipped to second to ride sharing gig workers receiving SNAP. McDonalds and Dollar General round out the top five employers.  

Now, these are among the largest employers generally, but, gosh, doesn’t it gall you that have so many of their workers who still need SNAP and/or Medicaid?  It’s not like they’re not making money, it’s not that their CEOs and other executives aren’t raking in tens of millions of dollars, but they sure are reluctant to pay federal income taxes. The Wall Street Journal reported earlier this year that, as a result of The Big, Beautiful Bill, Amazon’s federal income taxes dropped from $9b to $1.2b in 2025, while profits soared 44.5% to $90b. Walmart looks like a sucker for paying $6b in 2025, an effective tax rate of about 23%.

An Amazon spokesperson defended its practices in a response to The Washington Post: “Amazon pay is among the best in the industry, regular full-time employees have access to health care from their first day … and 74% of our regular full-time employees are enrolled in an Amazon health insurance plan, well above the 65% private sector take-up rate for full-time workers.”

So, if all those employees have access to coverage from their first day and get among the best pay in the industry, why are any on SNAP or Medicaid?  And couldn’t you at least pay more than 1.3% on federal taxes?

Bernie, of course, was outraged:

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Value Is in the Eye of the Beholder

By KIM BELLARD

The most (unintentionally) amusing story I read this week was Tim Higgin’s Wall Street Journal article Alex Karp Is Saying What Every Angry CEO Is Thinking About AI. Dr. Karp (yes, he has a Ph.D.), co-founder and CEO of Palantir Technologies, is upset about how AI companies are using relationships with their business customers to harvest data and business insights from those customers. “Something has gone completely wrong,” he fumed.

Now, this is Palantir, mind you; it may not have invented surveillance capitalism but it might have perfected it. It has become essential to government and large corporations across the world. Most of us are aware of how tech companies like Meta or Google give us “free” services that exist primarily to collect more data on us, which they then use to target ads to us, but Palantir’s data collection and analysis operate at a level we often don’t recognize.  But make no mistake; it is using our data, and not necessarily in our best interests.

Mr. Higgins quotes former White House AI czar David Sacks in support of Dr. Karp’s concerns:

Anthropic has launched Claude Science, Claude Security, Claude Legal, and of course Claude Code—each expanding into categories previously served by companies building on top of their models. The pattern is consistent: Watch where value is being created, then move in directly. Dominate the model layer, then use that position to capture the most lucrative verticals.

So it is delicious irony that Dr. Karp and others are finding themselves at the wrong end of the power inequality with their data.

I find myself thinking about healthcare when I think above this new wave of data collectors/ synthesizers. It seems pretty clear that the AI companies aren’t going anywhere, and are expected to reshape most industries, including healthcare. Lots has been written about AI’s use in healthcare, including by me. It is both inevitable and, in many cases, desirable. Now this issue of AI’s insatiable appetite for data makes me wonder if we’re looking at things wrong.

I’ve worked in healthcare for longer than I care to admit, and at no point did people not complain that healthcare in general, and health insurance in particular, was too expensive. And yet, costs have kept rising. We’re closing in on $6 trillion in U.S. healthcare expenditures. No matter what kind of health insurance you have – large employer, small employer, ACA Marketplace, Medicare Advantage, even Medicare Supplements for traditional Medicare – your premiums (and/or out-of-pocket costs) are likely going up at rates we haven’t seen in years.

Two well known facts about rising costs are, one, that it is not so much we’re using too many services as it is that Americans pay way higher prices for healthcare than in most countries, and, two, that a relatively small percentage of people account for the vast majority of healthcare spending. The latter has an insidious effect on health insurance premiums, as people with fewer expenses are less likely to have or keep health insurance, making premiums for the remaining people higher. Nobody wants to pay for the people who use a lot of health care, but they want other people to help pay if they end up being one of those people. It’s a conundrum.

Now, optimists hope that AI can do a better job of identifying all the wasted, unnecessary, or inappropriate care we use – estimated as much as one-third – and help make administration more efficient; current levels are estimated as 15-30% of spending. Good goals, both of them, and it is entirely plausible that AI can help with both. But it would still remain that sick people are the “problem” with our health care spending and health insurance premiums, and I want to propose a different way of looking at them.

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Life Not As We Know It

By KIM BELLARD

Well, let’s see. Last week much of the U.S. and parts of Europe were under a crippling heat dome. The U.S. celebrated its 250th birthday. And there’s something called the World Cup going on, for those of you who care about such things. But, I mean, really, the news of the week? SpudCell.

OK, maybe you missed that one. If you are not a fan of science, or of synthetic biology in particular, news about it might not have shown up in your feeds, or perhaps you thought it was another ploy by the Potato Association of America to get you to buy even more potatoes. SpudCell is something truly new: “the world’s first synthetic cell with a complete life cycle, built entirely from non-living chemical components.”

Take a minute to take that description in.

“SpudCell performs the behaviors often used to tell the living from the inert — it feeds, grows, replicates its genome, divides and undergoes selection — yet it is far simpler than any natural cell and was assembled, part by part, by hand,” the project researchers wrote in a statement.

It was designed and built by researchers at the University of Minnesota, announced last week along with a preprint of their paper.The team was led by Professor Kate Adamala, and the name is either due to its supposed resemblance to a potato or it’s a play on “Sputnik.”

“This is likely the most exciting project I’ve ever worked on,” said Professor Adamala. “We’ve replicated in chemistry what only used to be possible in biology: the complete set of behaviors of a cell. It proves that the most fundamental functions of life, like growth and replication, do not need a mysterious magical spark.”

Scientists have been working for decades on stripping away genetic material from living cells to try to find the minimum necessary for life, but Professor Adamala and her team went the other way, gradually building up genetic material until it started behaving in ways we’d expect cells to.

The impressive thing is that the team engineered everything SpudCell does. As The Economist put it: “Everything the resulting cells do, they do because of molecules that Dr Adamala’s team put there. That leaves no room for mysteries.” That’s not true when researchers start with living cells.

Drew Endy, a synthetic biologist at Stanford University, told Carl Zimmer of The New York Times, “It’s a cell that was built, not born. It’s constructed, but it does what cells do.”

SpudCell is very basic.

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Oceans, Away

By KIM BELLARD

It probably didn’t show up on your calendar, but Monday was World Ocean Day. It’s a day meant to catalyze “collective action for a healthy ocean and a stable climate,” and has been around since 2002 (although the U.N. didn’t officially recognize it until 2008). Its website claims a network of over 2,000 organizations, in 180 countries.

I wish we had more to celebrate.

Many have recognized the irony of humans calling our planet “Earth,” when, in fact, 71% of its surface is covered with water. Even more amazing, oceans account for 99% of the biosphere. We come from the ocean and still owe much of our existence to it.

Unfortunately, these are not good times for oceans, and we’re to blame. The most recent World Ocean Assessment from the U.N. highlights:

  • The ocean matters to everyone, everywhere;
  • The ocean is under intensifying stress;
  • Climate change is transforming conditions;
  • Biodiversity is declining across nearly every marine habitat;
  • Pollution is widespread and increasing;
  • Ocean food systems are threatened.

The report concludes: “The coming decade is decisive: without rapid, coordinated global action, ocean health will continue to decline, threatening climate stability, biodiversity resilience, food security, livelihoods and the wellbeing of billions.”

I think about this in light of last month’s announcement by the National Science Foundation that it was “descoping” the Ocean Observatories Initiative (OOI) Major Facility, beginning next week. That’s a $368 million deep-ocean observation system “that delivers real-time data from more than 900 instruments to address critical science questions regarding the world’s oceans.” Some 900 instruments will be removed, in both the Pacific and Atlantic oceans.

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The Canaries Are All Dead

By KIM BELLARD

MIT is, most people would admit, a pretty good school.  Even those who don’t know a lot about universities probably associate MIT with science, engineering, and math, and in fact, it is one of the leading universities in the world for those (and other) areas. E.g., the QS World University Rankings have named it the top university in the world the last 14 years, USN&WR Global Universities Ranking has it #2, as does The Times Higher Education World University Rankings. There have been over 100 Nobel Laureate recipients associated with MIT. If you meet a Harvard grad you might think, oh, they may not actually be all that smart – they could be just a legacy admission, but if you meet an MIT grad you probably do expect that they must be smart, especially since MIT does not have legacy admissions. Even President Trump, who rails against “elite universities” and who has slashed science funding in his second administration (more on that later), can’t help but rave about his smart uncle who taught at MIT.

So when the President of MIT warns about reductions in research funding and in graduate school admissions, we’re not talking about the proverbial canaries in the coal mine dying. We’re talking about miners going down.  

In a video message last week, MIT President Sally Kornbluth warned of some startling losses: over 20% drops in federally funded research, in new federal research awards, and in graduate student enrollment. Overall, the school’s research enterprise has shrunk 10% in the last year.

Gulp.

“That is a striking loss for one of the most influential and productive research communities in the world,“ Dr. Kornbluth said. She added:

The fact is that we’re looking at a real drop in research being done by the people of MIT. It’s a loss of momentum for faculty and students and frankly, it’s a loss for the nation. When you shrink the pipeline of basic discovery research, you choke off the flow of future solutions, innovations, and cures, and you shrink the supply of future scientists.

Make no mistake: although MIT itself may be an outlier, what is happening to it is not. Ted Mitchell, president of the American Council on Education, told The Washington Post: “This is the first of many of these kinds of alarms that will be ringing,” Brendan Cantwell, a professor of higher education at Michigan State University, also told WaPo that if MIT is scaling back how it does research, that means universities across the country should be thinking about scaling back and adjusting. The ripple effects will go far and wide, and will have bigger impacts than we realize.

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