Who can solve the ‘healthcare crisis’?

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 each of them how they could 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 1946two years before a landmark Supreme Court decision sparked a boom in employer-sponsored health insurance. It was popularized by children in the 1970s, the same decade in which rising health care costs pushed the “health care crisis” into the public vocabulary.

The healthcare crisis is still with us, and so is Magic 8 Ball, which thanks to its current owner Mattel, can now be accessed in person (i.e. by holding it and shaking it) or online. With a hotly contested presidential election campaign underway, I decided that using the black box versus the black ball to answer crucial questions about health policy would probably provide as much clarity as sifting through weasel-worded white papers.

Both ChatGPT (costs for OpenAI: $400,000 a day to operate) and Magic 8 Ball (one-off costs: $14.99) were up for the challenge, even though they recognized it wouldn’t be easy.

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

“Tackling 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 great language model offered a very large portion of language. There were eight “key strategies,” each containing three bullet points, and each of which, I was told, involved “detailed planning, resource allocation, and collaboration among various stakeholders, including government, healthcare providers, insurers, and the public .â€

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

I decided to go into the details.

“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 a possible solution to the healthcare crisis, and it comes with its own benefits and challenges,” the chatbot responded. It added: “Whether this is the ‘correct’ answer depends on several factors†— and then again provided a long list of relevant answers.

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

“It certainly is,” the Magic 8 Ball said immediately. But ChatGPT waited, usually at lightning speed, maybe 20 seconds before not only responding positively, but also presenting an overview and specific suggestions. There were five benefits and five challenges, plus three examples of possible strategies (accountable care organizations, bundled payments, and patient-centered medical hospitals), all tied together with five considerations for implementation.

“Ultimately, VBHC can be an important part of a broader strategy to reform healthcare systems and achieve sustainable cost containment,” ChatGPT concluded.

That pattern continued when I researched the need for more effective financial incentives to reward high-quality, cost-effective care, a central component of VBHC. ‘It’s for sure,’ Magic 8 Ball quickly agreed. ChatGPT, meanwhile, again waited a long period (by its standards) before responding “thoughtfully” (by human standards).

“Yes,” it said, “effective financial incentives are critical to promoting high-quality, cost-effective care. Well-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 five types of financial incentives, five key elements of effective incentive programs, and three specific examples that incorporate them.

Continuing the theme of financial incentives, I asked if health savings accounts could help with this. Magic 8 Ball simply responded, “Yes,” while ChatGPT was careful to point out that while HSAs “offer some benefits, they are not a comprehensive solution to the broader healthcare crisis.”

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

“Is private equity buying up doctors’ practices good or bad for patients?” I asked. “Concentrate and ask again,” Magic 8 Ball dodged, followed by an incomprehensible “Very likely.” ChatGPT admitted that this was “a complex issue, with potential benefits and harms for patients,” before he continued. into the kind of pro-and-con balancing act that any politician could admire.

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

“Will America’s health care costs ever be effectively controlled?” I asked.

Magic 8 Ball tried to spare my feelings — “It’s better not to tell you now†— while ChatGPT pointed out the unpleasant truth to me in its elliptical way. While the challenge was not “insurmountable,” ChatGPT responded, it would require a “multifaceted approach,” involving “strong political will, collaboration with stakeholders, and continuous evaluation and adjustment of strategies.”

In other words: “No.”