Currently, our health care debate concerns the best method to provide universal access to health care. The recent changes from the affordable care act concern the problem of costs. Because health care providers are expensive, people need universal access to universal health insurance coverage. Universal coverage requires policies that can not be denied based on preexisting conditions. It also requires government subsidies for premiums for qualifying low incomes.
The bulk of the law addresses the cost side of the problem. Health care practitioners have high fees. The practitioners must follow many regulations including strict licensing and credentialing proceeds that are expensive to obtain and maintain. The high cost of entry into the field also drives up cost by limiting the supply of providers. The solution for limiting the cost of these providers is to increase patient loads so that their costs can be spread over more patients. The practitioners spend less time with each patient.
There are many technologies that are improving the productivity of doctors. Many of these same technologies are becoming affordable for consumers to operate themselves to provide self care. In the past, these include thermometers, home blood-pressure and pulse readings, blood glucose monitoring, and finger pulse oximeters. More recent technologies available to consumers involve more advanced diagnostics and monitoring with smart phones and wearable activity trackers that operate without the patient’s awareness and even during their sleep. These are technologies that not long ago would require at least a doctor’s visit if not a hospital stay.
There are advances in internal imaging technologies are safe enough for people to use themselves and rapidly becoming affordable. Cameras can placed in capsules that a patient can swallow or in catheters that the patient (or a colleague) can insert. Other technologies such as ultrasound and thermal imaging or electric-monitoring (electrocardiogram, electroencephalogram) can become affordable enough at least to rent or to permit a small-business owner to provide the services cheap enough that would not require insurance reimbursement. In addition, there are increases in computing technology to process these images automatically and provide instant assessments or recommend escalating the care to a specialist.
Meanwhile the medical knowledge is increasingly becoming better publicized for public reading on the Internet. The medical information is provided in easy to understand terms and often organized in forms of question-and-answer wizards to present the most relevant information. Although many of these sites have a disclaimer that the information is not a substitute for a real doctor, the information provided increasingly appears competitive to what a doctor will provide. Given the minimum time a doctor is allowed to spend with patient, the online information may be superior to a doctor’s visit because there is more time to consider the match of the symptoms with the conditions.
I am not saying anything original here. Dr Eric Topol has a recent book expressing the potential of these technologies to transform health care by allowing patients treat themselves. I have not read the book, but based on this review, it seems to reach the same conclusion that people can soon provide much their own medical care.
I agree with an earlier review that suggested that many patients prefer to have someone else be involved in their care:
Sick people have a primal need to be cared for; almost always, the sickest patients find that relinquishing the tough decisions to someone else brings huge relief. Healthy people may certainly enjoy monitoring their own physiology, but that activity can take up an awful lot of time. There are many wonderful things to do in this world other than keeping track of your own organs. Sometimes, it just makes sense to have someone do it for you.
However, I would suggest that that someone else can be a family member, a trusted friend, or a neighborhood small-business owner who will invest in low cost technologies and read up on available information to come up with information. Such intermediates do not need professional training because they will be doing what the patient could do himself. The intermediaries could still have paths to escalate concerns to a doctor (and thus costing more money) but this can still be productive because the intermediary will reapply what he learned without needing further interaction with the trained doctor.
Personally I believe in the need to have personal healers: people who can spend time in direct interaction with a patient to communicate through voice, touch, and sight. This interaction is indispensable for providing calming reassurance from another person. In addition, there are many people who are eager to provide this kind of intense inter-personal care. Although this kind of interpersonal care is valuable, it is very non-productive so that the professions are necessarily low-paid. Often these services are volunteered or performed at poverty-level wages. It is impractical (and prohibitively expensive) to require this level of interaction from trained doctors, or even physician assistant, or even a nurse. The above technology discussion permits untrained (or minimally trained) persons to perform this level of inter-personal health care.
I am using the health care as an example of how technology is moving in the direction to allow the population to become increasingly liberated from the highly credentialed experts. In health care increasingly more care is available from home through self-administration or through the assistance of some relative or friend with access to the right technology or information source. There will always be a need for doctors for the more difficult cases, but it is conceivable that most of the routine or even the management of chronic conditions will not require a certified doctor or nurse.
I tie this into the my discussion on dedomenocracy that automatically make short-term rules to set policies based only on data and not any human interpretation of the data. In modern democracy, we rely heavily on authority of experts to provide studies and testimony to support policy decisions either by congress or by the bureaucratic agencies. In my vision of data-driven decision making, the automated analytics of trusted data replaces the need for human expertise. The analytics will find patterns in data and make recommendations to take short-term advantages of opportunities for benefits or for avoidance of hazards. The population permits these rules to have authority without the need for persuasive human arguments or approval by designated experts. The population learns to trust dedomenocracy by the track record of benefits exceeding the damages, and by access to scrutinize the input data for quality and the algorithms for lack of flaws (such as preconceived biases or theories).
A population led only by data is a population that is free from the authority of experts. As technology improves, individual experts become more irrelevant. In particular, the celebrity experts will become less relevant. Technology enables more people to make decisions previously reserved to experts who required education or testing. Take for example the home medical technologies such as blood glucose monitoring that trains its users about the meaning of glucose measurements while automating the actual blood testing that once required a trained lab technician. The technology trains people to become blood glucose experts within the discipline of their particular conditions.
In a dedomenocracy, the automation of decisions occurs without human cognitive interference. However, everyone will be able to observe the technology in action. They will understand the nature of the sources of the data and the nature of statistical or machine-learning algorithms. They will also observe the resulting rules and how the rules affect future rules. The dedomenocracy technology trains the population to become knowledgeable about the operation of government in a way that is analogous to how we currently rely on appointed experts to explain it to us. Within dedomenocracy, we do not need experts to explain the rationale of the rules. Instead the technology trains the population to understand all of this for themselves.
This progression of data-driven technologies for decision-makng surprises me. When I started my technical education in the late 1970s, I expected computing technology to replace human decision makers through artificial intelligence techniques. This concept is to have the computer fully emulate the thinking powers of humans and thus become experts that can replace humans. At that time, there was a milder objective of something called expert systems that attempted to automate a narrow expertise. In either case, the idea was that the technology would come to decisions basically following the model of human thinking including both modeling the real world as well as considerations of imagined fears or luck. Machines would replace humans by mimicking humans.
Recently there have been many reports of scientists and luminaries warning that that level of artificial intelligence is very close to reality. The technology will be so powerful that humans will becomes second-class citizens to the vastly more intelligent machines. The linked article presents a case that we are still far from having that kind of machine intelligence. I don’t think that kind of human-emulated (or even non-human emulated) intelligence will ever happen. As the article states, this kind of project is a low priority even for AI researches. In order for machine intelligence to emerge, machines will have to come up with it themselves. Perhaps that explains the fears: that we will accidentally create something that will then begin to evolve like biology did to create intelligence by itself. I don’t share this fear for various reasons such as machines will never have the life experiences inherent in biological beings that are self-contained for reproduction, generation of energy, seeking of sustenance and avoidance of dangers. At least as far as human technology is progressing, we are not building such complete self-sufficiency in machines. Even autonomous robots are dependent on factories (and supply chains) for their production and power-plants for their energy. Machines might mimic biological intelligence, but they will not mimic biological survival.
Recent advances of data technologies, however, are not intelligent in that same sense. Data analytics are primarily statistical in nature to find and validate data patterns without any goal of making any cognitive sense out of it. These algorithms work fine without any concept of sentience of self-awareness. Instead, the abundance and velocity of data permits rapid rule making that offer beneficial advice. This advice is competitive (an increasingly superior) to the advice from human experts. The technologies we are adopting to replace human decision makers do not have any intelligence at all. It turns out that intelligence is not a requirement for making good decisions. We can obtain good decisions from abundant trusted data and trusted analytic algorithms.
Dedomenocracy or its lesser versions as we are seeing in personal health care, liberates people from the need for highly specialized, credentialed, or exclusive experts to govern their lives. Although the alternative involved automated technologies that make formerly human decisions automatically, these technologies permit the users to observe the operation of the process as observable input data, a knowable algorithm, and an observable outcome. Instead of being artificially intelligent, these machines train the population to become more intelligent although in areas that are specific to their particular lives.
This has implications for the future of economy. In recent decades, our economy has moved toward a celebrity economy where few people enjoy celebrity status in their fields of expertise that are similar to entertainer or sports celebrities. This has resulted in an income equality that compensates celebrity status far more than non-celebrity status. As a result, we have a small number of people who enjoy widespread recognition of their status and this enables them to earn high incomes. The celebrity’s income achievements come from the attention they receive from the population. When the celebrity expresses something, a large number of people will pay attention.
With data technologies moving toward a dedomenocracy, there is less need for celebrities, especially in the area of cognitive expertise. As in my analogy to health care, we increasingly perform health-care services on ourselves without the need for trained doctors or nurses. I expect that trend to continue. For the areas covered by these technologies, we are no longer in need for expert guidance from humans. Of course human experts will still exist, but increasingly we will ignore them. We will instead look toward data technologies to teach us what we need to know.
As this happens, there will be fewer opportunities for celebrity status and celebrity-scale incomes that come from that status. While this may result in less income inequality, that is not the primary benefit. It may not even be a benefit at all. I suspect even for what we consider to be middle class incomes, a good portion of that income derives from a localized celebrity status. Technology will also lessen their celebrity status for whatever expertise they may have. The future of economy may be toward much lower incomes for all.
This is not a goal. We would want to improve incomes for all. My observation that most higher (including middle-class) incomes involve some kind of specialty that leads to a celebrity status that provides a following that can provide a cash flow. That flow of cash will stop when people find technological alternatives for that expertise. People will find those alternatives in data technologies.
It is human nature to seek out knowledge and expertise so I doubt it will ever go away. However, it will likely be less lucrative in the future as fewer people will pay any attention to that expertise of others.
The economic trajectory for dedomenocracy that involves automated decisions with non-intelligent algorithms may turn out to be similar to the fears of a future ruled by intelligent machines. Humans will become a lower class as a result of technology. I’ve previously described the authoritarian dimensions of dedomenocracy that demands obedience to data solutions. This too is analogous to the fears of becoming servants to machine overlords. There remains a difference in that data technologies are not intelligent, sentient, or self-aware. There is no requirement for such qualities in data technologies. Indeed, I argued that data technologies needs to exclude such qualities to get the purest-form of data solutions.
However, the end result is similar to being governed by machine with superior intelligence. We are obligated to follow the machine-generated decisions, and our lives will become poorer because we will lack access to specialized expertise that will grant us higher incomes that come from the resulting celebrity status.
Certainly many people are driven by the need for success where success is measured by income. A loss of opportunity for such success will cause problems. Medical technologies will increasingly make the practice of medicine to be far less prestigious as it is now (already less prestigious than previously). Similarly, dedomenocracy will have a similar affect on politicians, lawyers, economists, and other policy professions. As data technologies improve, we are going to find that automated data solutions out perform the experts. We simply need these professions much less than we needed them in the past. There will be unhappiness as a result of fewer opportunities to obtain celebrity status.
There are others who would benefit. I discussed before how some people prefer to devote their lives to helping other people instead of achieving high incomes. These are people who find most enjoyment by being helpful to a small number of individuals within their families or their local communities. Data technologies empower these individuals to pursue what they find brings happiness in helping others. Medical technologies allows individuals to provide services that previously required a doctor or a capital-expensive facility. Not only do the individuals benefit by enjoying their contribution to making someone else’s life better, but the patient benefits from having lengthier interactions with their providers than is practical from certified doctors or even nurses.
Similarly, in a dedomenocracy, there will be more attention on the community to assist that community in getting beneficial treatment from the automated decision-making. They can coach each other to tolerate conditions to avoid corrective rules by the data algorithms. More importantly, they can observe the input data and recognize the implications so that they can assist each other in taking advantage of the current rules and the likely future rules. The satisfaction of a job well done is the satisfaction of observing the benefits to the community. Dedomenocracy will benefit the people who prefer that kind of reward over a monetary one.