Tag: Millenson

ChatGPT Vs. Magic 8 Ball: Who Can Solve “The HealthCare Crisis”?

Aug 15, 2024

By MICHAEL L. MILLENSON

Long before ChatGPT, whose question-answering choices still remain somewhat of a black box, there was an equally mysterious, question-answering black ball. I decided to ask them each of them how to solve the cost, quality and access issues labeled for more than half a century as “the healthcare crisis.”

The hard, plastic Magic 8 Ball was invented in 1946, two years before a landmark Supreme Court decision spurred a boom in employer-sponsored health insurance. It catapulted into kid-driven popularity in the 1970s, the same decade that rising healthcare costs propelled “healthcare crisis” into the public vocabulary.

Magic 8 Ball and ChatGPT — *ChatGPT is a “black box,” Magic 8 ball a black ball.*

The healthcare crisis is still with us, as is Magic 8 Ball, which, thanks to current owner Mattel, can now be consulted either in person (i.e., by holding and shaking it) or online. With a fiercely fought presidential election campaign underway, I decided that pitting the black box vs. the black ball to answer crucial health policy questions would likely provide just as much clarity as wading through weasel-worded white papers.

Both ChatGPT (Cost to OpenAI: $400,000 per day to operate) and Magic 8 Ball (One-time cost: $14.99) were up for the challenge, though they acknowledged it wouldn’t be easy.

“Can you help me solve the healthcare crisis?” I asked. “Signs point to yes,” Magic 8 ball replied, in its typically pithy, understated manner. ChatGPT, on the other hand, took my question as an invitation to show off its artificial intelligence.

“Addressing the healthcare crisis is a complex and multifaceted challenge that requires a holistic approach,” ChatGPT began. Then, as if a Washington think tank had been crossed with an academic policy conference, the Large Language Model offered a very large helping of language. There were 8 “key strategies,” each of which contained three bullet points, and each of which, I was advised, “involves detailed planning, resource allocation, and collaboration among various stakeholders, including government, healthcare providers, insurers, and the public.”

Then there was this diss when I asked about its competitor. “It’s a fun toy,” sneered the chatbot (if chatbots could sneer), “but it doesn’t provide reliable or informed answers.”

I decided to home in on specifics.

“Is a government-run single payer system the right answer?” I asked. “My sources say ‘no,’” Magic 8 ball told me. ChatGPT was more positive, with caveats.

“A government-run single-payer healthcare system is one potential solution to the healthcare crisis, and it comes with its own set of advantages and challenges,” the chatbot replied. It added, “Whether it is the ‘right’ answer depends on various factors” – and then, once more, went on to provide a long list of relevant ones.

I decided to inquire about an approach with bipartisan support. “Is value-based healthcare the best way to control costs?”

“It is decidedly so,” said the Magic 8 Ball immediately. But ChatGPT, usually lightning quick, waited perhaps 20 seconds before not only responding positively, but presenting an overview and specific suggestions. There were 5 advantages and 5 challenges, plus 3 examples of possible strategies (accountable care organizations, bundled payments and patient-centered medical homes), all tied together with 5 considerations for implementation.

“Ultimately, VBHC can be a key component of a broader strategy to reform healthcare systems and achieve sustainable cost control,” ChatGPT concluded.

That pattern continued as I probed about the need for more effective financial incentives to reward high-quality, cost-effective care, a central component of VBHC. “It is certain,” Magic 8 Ball quickly agreed. ChatGPT, meanwhile, again paused for a lengthy period (by its standards) before responding “thoughtfully” (by human standards).

“Yes,” it said, “effective financial incentives are crucial for promoting high-quality, cost-effective care. Properly designed incentives can align the interests of healthcare providers, payers and patients, leading to better health outcomes and more efficient use of resources.”

The chatbot then listed 5 types of financial incentives, 5 key elements of effective incentive programs and three specific examples incorporating them.

Continuing the financial incentives theme, I asked whether health savings accounts could help. Magic 8 Ball simply replied, “Yes,” while ChatGPT carefully pointed out that while HSAs “offer some benefits, they are not a comprehensive solution to the broader health care crisis.”

Like politicians, both ChatGPT and Magic 8 Ball sometimes hedged. “Are hospital mergers good or bad for patients?” I asked. “Ask again later,” said Magic 8 Ball. “Hospital mergers can have both positive and negative impacts on patients,” responded ChatGPT, before presenting a long list of why either might be the case.

“Is private equity buying doctors’ practices good or bad for patients?” I inquired. “Concentrate and ask again,” evaded Magic 8 Ball, followed by an incomprehensible, “Most likely.” ChatGPT allowed that this was “a complex issue, with potential benefits and drawbacks for patients,” before going on to the kind of pro and con balancing act any politician might admire.

I decided it was time to cut to the heart of the matter.

“Will health care costs ever be effectively controlled in America?” I demanded.

Magic 8 Ball tried to spare my feelings – “Better not to tell you now”– while ChatGPT, in its elliptical way, pointed me towards the unpleasant truth. While the challenge was not “insurmountable,” answered ChatGPT, it would require a “multi-faceted approach” involving “strong political will, stakeholder collaboration, and continuous evaluation and adjustment of strategies.”

In other words, “No.”

Michael Millenson is President of Health Quality Advisors and a long time THCB regular, he’s also a Forbes columnist where this piece first appeared.

Recalling To Err’s Impact and a Small (But Telling) IOM Mistake

Nov 28, 2014• 1

By MICHAEL MILLENSON

This year marks the 15th anniversary of the Institute of Medicine (IOM)’s To Err is Human report, which famously declared that from 44,000 to 98,000 Americans died each year from preventable mistakes in hospitals and another one million were injured. That blunt conclusion from a prestigious medical organization shocked the public and marked the arrival of patient safety as a durable and important public policy issue.

Alas, when it comes to providing the exact date of this medical mistakes milestone, the IOM itself is confused and, in a painful piece of irony, sometimes just plain wrong. That’s unfortunate, because the date of the report’s release is an important part of the story of its continued influence.

There’s no question among those of us who’d long been involved in patient safety that the report’s immediate and powerful impact took health policy insiders by surprise.

The data the IOM relied upon, after all, came from studies that appeared years before and then vanished into the background noise of the Hundred Year War over universal health insurance. This time, however, old evidence was carefully rebottled in bright, compelling new soundbites.Continue reading…

Did CDC laxness on one infection help spread another?

Oct 25, 2014• 6

BY MICHAEL MILLENSON

There’s an infection that afflicts thousands of Americans yearly, killing an estimated one in five of those who contract it, and costs tens of thousands of dollars per person to treat. Though there’s a proven way to dramatically reduce or even eliminate it, the Centers for Disease Control and Prevention (CDC) inexplicably seems in no hurry to do so.

Unlike Ebola, this infection isn’t transmitted from person to person, with the health care system desperately racing to keep up. Instead, it’s caused by the health care system when clinicians don’t follow established anti-infection protocols – very much like what happened when Texas Health Presbyterian Hospital encountered its first Ebola patient. That hospital’s failure flashes a warning sign to all of us.

The culprit in this case is called CLABSI, short for “central-line associated bloodstream infection.” A central line is a catheter placed into a patient’s torso to make it easier to infuse critical medications or draw blood. Because the lines are inserted deep into patients already weakened by illness, an infection can be catastrophic.

CLABSIs are deadlier than typhoid fever or malaria. Last year alone they affected more than 10,000 adults, according to hospital reports to the CDC, and nearly 1,700 children, according to an analysis of hospital discharge records. The infections also cost an average of nearly $46,000 per patient to treat, adding up to billions of dollars yearly.

At one time, CLABSIs were thought to be largely unavoidable. But in 2001, Dr. Peter Pronovost, a critical care medicine specialist at Johns Hopkins, simplified existing guidelines into an easy five-step checklist with items like “wash hands” and “clean patient’s skin with an antibacterial agent.” Hopkins’ CLABSI rate plunged.

Jessie Gruman: Tribute to a Tightrope Walker

Jul 17, 2014• 6

By Michael Millenson

When I heard that Jessie Gruman had died, that her powerful voice on behalf of patients had been stilled and gone silent years too soon, I thought of Phillipe Petite, the high-wire artist who famously tread a cable strung between the two World Trade Center buildings back in 1974.

Jessie’s balancing act did not take place on so visible a stage, but her death-defying dance equally amazed those who knew, worked with, respected and loved her.

On the one side, she was persistently pulled down by cancer. There was Hodgkin’s lymphoma in 1973 when she was just 20, setting the stage for repercussions of treatment that would dog her ever after: cervical cancer eight years later; colon cancer in 2004; and a diagnosis of stomach cancer in 2011 that returned after a too-brief hiatus. There was also pericarditis, a dangerous heart condition.

Counterbalancing that burden was the uplift of a woman whose “bouts” with cancer shaped, but never defined her. She was a social psychologist who was an early part of work on the chronic care model; the founder of a policy and research center dedicated to empowering patients in health care and in health; a prolific writer and author of a landmark book on what to do with a diagnosis of serious disease; and for many, a personal inspiration.

On the morning of July 14, Jessie finally fell off the tightrope, as we all must eventually do, dying at home. She was 60 years old.

You can’t really understand the outpouring of affection, appreciation and aching loss Jessie inspired just by browsing her impressive bio. She was sharp and funny, with wry asides directed at any pretension exhibited by allies or adversaries alike.

However, Jessie did far more than dish and dis. She was a superlative builder; of an organization, yes, but more importantly, of a body of work that prompted government policymakers and uncounted health care organizations to pay greater attention to the unmet needs of patients. She also reached out directly to fellow patients to help. In all these activities, she married intellectual rigor and careful attention to evidence – techie trendiness, for example, did not impress her – with emotional honesty. Jessie spoke what often goes unspoken, candidly acknowledging how horribly scary and alone it feels to be seriously ill.

As she wrote in her book, AfterShock: What to Do When the Doctor Gives You – or Someone You Love –a Devastating Diagnosis:

Every time I have received bad health news, I have felt like a healthy person who has been accidentally drop-kicked into a foreign country: I don’t know the language, the culture is unfamiliar, I have no idea what is expected of me, I have no map and I desperately want to find my way home.

Jessie told one interviewer: “I want people to know how to take care of themselves and pay attention to the urgency of their situation even when their heart is broken.” Later, she repeated that theme in an article for Health Affairs that called for policies to support patients and their families in their time of distress.Continue reading…

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