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When Algorithms Decide Who Lives and Who Suffers

Writer's picture: Adi TantravahiAdi Tantravahi

Updated: Jan 28

The choices we make now will determine not just the future of healthcare, but the kind of society we leave to our children. Will we continue to allow faceless algorithms to decide who lives and who suffers? Or will we finally reclaim healthcare's moral center and build a system worthy of our highest values?

 

The murder of UnitedHealthcare Chief Executive Brian Thompson was shocking, but the schadenfreude and the ‘why’ of it all was unsurprising to those of us on the front lines fighting to protect the financial health of our communities’ healthcare organizations.


Across America, clinicians walk into hospitals having taken an oath to heal. And every day, they find themselves going up against an impossible adversary: artificial intelligence systems designed by insurance companies not to save lives, but to save money.

The death has sparked a national conversation, not just about one man or one company, but about a system that has fundamentally lost its way. While the violence is condemnable, the raw outpouring of stories in its wake reveals a deeper truth: we have created a healthcare system that has turned healing into a zero-sum game between profits and human life.


The stories emerging are not just administrative disputes – they are modern parables of systemic cruelty. Some are heart-wrenching stories of systemic disregard for patient health: a 9-year old denied a prosthetic arm. A stroke victim forced out of necessary hospital care. A child refused a wheelchair, and more. Behind each denial is a family’s desperation, a doctor’s frustration, and an algorithm’s cold calculation. They create barriers to care, contribute to financial distress, and create adverse health outcomes for all of us.


We’ve allowed artificial intelligence to become the arbiter of human suffering. UnitedHealth Group deployed AI to deny claims en masse, allegedly knowing it had a 90% error rate. Companies like EviCore proudly advertise their ability to boost denial rates by 15%, as if preventing care were a metric of success rather than a moral failure. It got so bad that earlier this year, CMS released guidance that told Medicaid Advantage payers, including UHC, to stop using AI to adjudicate CMS claims.


Using AI might be great at helping insurers like UHC make a few million dollars more per quarter, but the long-term damage to the doctor-patient relationship and trust in the American healthcare system may be incalculable.


But we can’t only blame AI. We also need to look closely at the day to day operations of these insurance companies. Earlier in 2024, ProPublica reported that a Cigna employee was being pressured by her bosses to review patients’ cases ‘too quickly’ and to ‘deny, deny, deny,’ making proper medical consideration impossible. 


The crisis extends beyond individual denials. We are witnessing the industrialization of healthcare rationing, where insurance companies leverage algorithms to optimize for quarterly profits while hospitals — the very institutions meant to heal our communities — struggle to keep their doors open. Each denied claim isn’t just a number on a spreadsheet; it’s a blow to the financial health of organizations that form the backbone of our communities.


The question is: where do we go from here? 


Part of the answer will likely lie in better regulation across the country’s statehouses. In Illinois, Congressman Bob Morgan has introduced legislation to limit AI’s role in coverage decisions and to require payers to tell people if AI was used in the adjudication process. And in Washington, DC, legislation driven by the demands of angry constituents is no doubt coming. But providers know they can’t afford to wait for new laws, and some are taking a page from the payer playbook and turning to technology to fight back, using AI of their own to limit and automatically appeal denials. But these are merely band-aids on a mortal wound.


The fundamental question we face isn’t about technology or policy — it’s about values and our social contracts. What does it mean when we entrust life-and-death decisions to machines programmed to prioritize profit over human wellbeing? How did we reach a point where insurance companies need to be reminded that their primary duty is to enable care, not obstruct it? This tension between for-profit care and equitable access to care continues to define the American healthcare system. 


The Affordable Care Act expanded coverage but left intact the core contradiction of American healthcare: treating human wellbeing as a market commodity. We are still left contending with many of the core issues that led us to this point such as employment-based insurance, state-by-state oversight, and a complex web of payers with a myriad of rules and processes.  We need more than incremental change or technological countermeasures. We need a complete moral reset to rebuild trust in the American healthcare system.


Perhaps it’s time for insurance companies to take their own version of the Hippocratic oath – a binding commitment to prioritize patient care over shareholder value. But more fundamentally, we need to ask ourselves: What kind of society do we want to be? One where algorithms determine who deserves care, or one where we recognize healthcare as a fundamental human right?


The path forward requires more than policy tweaks or better algorithms. It demands that we, as a society, reject the premise that it’s acceptable to sacrifice human welfare on the altar of quarterly earnings. Until we make this fundamental shift — until we stop treating healthcare as a market commodity and start treating it as a public good — we will continue to see the human toll of our moral failure mount.


One place to start is by implementing interoperability rules, standardizing billing practices, reducing administrative burdens on providers, establishing price transparency requirements, and creating meaningful oversight of payers. 


The choices we make now will determine not just the future of healthcare, but the kind of society we leave to our children. Will we continue to allow faceless algorithms to decide who lives and who suffers? Or will we finally reclaim healthcare’s moral center and build a system worthy of our highest values? Until we as Americans align around the concept of treating medical care as a public good rather than a market commodity, this healthcare crisis will continue, and so will the extreme desperation and reactions of the American public.


This article was published by MedCity News on January 12, 2025. To read the published article, click here.



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