DOCTOR AI

A medical practitioner, educator, administrator, and activist outlines a comprehensive program for a new, unified, data-driven American health care system.

Raised in Arizona’s Grand Canyon National Park, where the struggles of American health care are on full display, Blackstone proposes a program to improve outcomes and rebuild public trust in this book. Beginning with the 1965 Medicare and Medicaid Act, the author describes the development of the American medical system, highlighting shocks like the opioid epidemic and Covid-19 that revealed the brittleness of this system. Discussions of medical bankruptcies, the opacity and arbitrariness of insurance billing codes, and the insidiousness of intermediaries like Pharmacy Benefit Managers will be painfully familiar to many American readers and demonstrate the author’s command of the subject matter. “The system [is] working exactly as designed,” Blackstone writes, meaning extracting profit rather than providing care. Her proposed response is the Health 4.0 (H4) system. H4 would use AI products and blockchain technology to allow patients greater autonomy for decision-making by recognizing cultural factors in health care decisions and lighten doctors’ workloads to allow for more careful consultation with patients. The author renders this vision in vignettes featuring imagined patients whose care and overall well-being are looked after by Doctor AI/the H4 system. While Blackstone is clearly speaking from professional, provider-side experience and an intimate familiarity with the struggles of everyday Americans, her central argument feels incomplete, in part due to its overreliance on free-market capitalism to solve the very problems it has created. The same feeling pervades the discussion of AI, since H4 is built on a substantial overestimation of the capacities of Large Language Model AI products, which still regularly produce undesirable output. Blackstone’s case feels like a kind of ideological laundering—it’s easier to sell a common-sense socialized health care system with futuristic AI marketing.

An optimistic vision of health care that fails to fully convince.