Elf Sternberg

A headline this morning on NBC read, Arizona Moves to Ban AI Use in Reviewing Medical Claims. This law is profoundly idiotic, and one of the most important bits of idiocy is obvious right in the body of the law. The law is a PDF, so I’ll paste the whole thing here. It’s not long:

H.B. 2175

A. Artificial intelligence may not be used to deny a claim or a prior authorization for medical necessity, experimental status or any other reason that involves the use of medical judgment.

B. A health care provider shall individually review each claim or prior authorization that involves medical necessity, experimental status or that requires the use of medical judgment before a health care insurer may deny a claim or a prior authorization.

C. A health care provider that denies a claim or a prior authorization without an individual review of the claim or prior authorization commits an act of unprofessional conduct.

D. For the purposes of this section, “health care provider” means a person who is certified or licensed pursuant to title 32.

Notice in section D they define “health care provider.” They chose not to define “artificial intelligence.”

In insurance, an actuarial table is a database that takes in a collects a massive pile of data and creates a statistical relationship between your current health (and lifestyle) statistics and the likelihood of your death, future disability, or the likelihood of any given treatment having a benefit that justifies the cost.

Insurance companies will stop calling their AIs “AIs” and start calling them “Actuarial attention models,” since the “model” in “large language model” is just a massive pile of data about the statistical relationships between phrases to determine what phrase is likely to follow another in human speech. The “AI” models used by insurance companies use a similar algorithm (“these medical and lifestyle events in this order are likely to create this outcome…”) but respond with a spreadsheet, not a conversation.

This bill effectively bans actuarial tables, since both actuarial tables and machine learning models do the same thing: statistical analysis. LLMs are especially bad at it because they’re just probabilistic parrots without any actual human intent behind what they’re saying; all the intent went into choosing the training data, the outcome is still broadly incomprehensible to even the best computer scientists. But this is an illusion; behind the curtain, it’s just statistics about likely outcomes.

The problem here is not the use of statistics. The problem here is systems that require low-level workers to make judgments that “maximize shareholder value” at the expense of human lives, while at the same time shielding upper-level management from any criticism or penalty for expending human lives. “That’s just what the numbers say” is the whole of the reason, even if the one real number that matters to insurance executives is “If you save too many lives, my bonus goes down.”

Accountability drain, the ability to say “no one person is responsible for this outcome,” will persist until we as a civilization decide “for every decision, there must be someone who has the final say in what it is and how it can be changed, and that person is accountable for what follows.” Banning statistical analysis of any kind isn’t the change we need. It’s just window dressing over ongoing human misery.

The 1940 film adaptation of The Grapes of Wrath, by John Ford, nails this perfectly:

THE MAN: All I know is I got my orders. They told me to tell you you got to get off, and that’s what I’m telling you.

MULEY: You mean get off my own land?

THE MAN: Now don’t go blaming me. It ain’t my fault.

SON: Whose fault is it?

THE MAN: You know who owns the land — the Shawnee Land and Cattle Company.

MULEY: Who’s the Shawnee Land and Cattle Comp’ny?

THE MAN: It ain’t nobody. It’s a company.

SON: They got a pres’dent, ain’t they? They got somebody that knows what a shotgun’s for, ain’t they?

THE MAN: But it ain’t his fault, because the bank tells him what to do.

SON: All right. Where’s the bank?

THE MAN: Tulsa. But what’s the use of picking on him? He ain’t anything but the manager, and half crazy hisself, trying to keep up with his orders from the east!

MULEY: (bewildered) Then who do we shoot?

Arizona decided to shoot the computer, for all the good that’ll do.

This has to be one of the weirdest things I've read in awhile. Daniel Sarewitz at Slate has an article today about how in a survey of scientists associated with the American Association for the Advancement of Science (I think that's an important caveat missing from other discussions), only 6% identify as Republican, and 55% identify as Democratic.

Sarewitz then gets weird:

As a first step, leaders of the scientific community should be willing to investigate and discuss the issue. They will, of course, be loath to do so because it threatens their most cherished myths of a pure science insulated from dirty partisanship. ... The issue here is legitimacy, not literacy. A democratic society needs Republican scientists.

Weird because becoming a scientist isn't the same as being a specific race or gender; you don't get to choose those, and there is no difference in performance between individual black, or Latino, or Asian, or white scientists, or male or female scientists.

But being "Republican" is an identity; it's a choice. Even more to the point, it's a choice that embraces an entire slew of identifying beliefs. I have no wonder at all that scientists reject the "Republican" label; Republicans are explicitly anti-science. I don't know why the party of Lincoln has decided to become the party of the Luddites. Quiggan's reasoning that they'd like science to keep putting out nifty new toys but cannot reconcile their need to constrain the discourse with science's need for free and accurate exchange sounds nice but doesn't quite fit the vehement stupidity of someone like Cantor or Bethell.

Over the past 16 years, Republicans have become more and more opposed to the scientific endeavor. Global warming, intelligent design, cosmology, even nutrition this week, have all become part of a partisan divide.

And it's not just the hard sciences. In the political sciences, too, there is a dearth of graduates who identify as Republican or Conservative. As much as we may mock the discipline, we need people with those degrees to go into public service and manage policy-driven offices throughout the executive. The Republican Party has no standing with the people who find and make the inventions that make America great, and as time goes on they'll find it harder and harder to staff their offices with qualified personnel.

Maybe Sarewitz should acknowledge that the legitimacy problem he describes is exactly backwards: It ought not to be that scientists risk losing their legitimacy with the American people because they're overwhelmingly not-Republican, but that Republicans ought to lose their legitimacy with the American people because they are overwhelmingly opposed to reality.

An article going around the web this week, The Decline and Fall of the American Empire, puts the blame exactly where I've been putting it for the past eight years: at the feet of the Bush Administration and the ongoing, overwhelming paranoia that the whole world, and not just a few hundred bad-tempered men with beards, are out to get us. As author Alfred McCoy puts it, "Chinese innovation is on a trajectory toward world leadership in applied science and military technology sometime between 2020 and 2030, just as America's current supply of brilliant scientists and engineers retires, without adequate replacement by an ill-educated younger generation."

Unfortunately, I think Charlie Stross has it right when he writes:

I think somewhere in the range from 15-30% of our fellow hairless primates are currently in the grip of future shock, to some degree. ...It's no surprise that anyone who can offer dogmatic absolute answers is popular, or that the paranoid style is again ascendant in American politics, or that religious certainty is more attractive to many than the nuanced complexities of scientific debate. ...

Deep craziness: we're in it, and there's probably not going to be any reduction in the prevalence of authoritarian escapism until we collectively become accustomed to the pace of change. Which will, at a minimum, not happen until the older generations have died of old age — and maybe not even then.

At which point, sadly, the US won't even be a fading superpower, the way Britain is; we'll be more like Italy, with bare memories of having once been the center of the world but now just another batshit crazy country barely able to manage its own affairs.