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You're implying that insurance companies will allow prices to fall and lower their profits. That seems like a really unlikely event in the current economy. They fire a lot of doctors and nurses, but they won't lower prices.
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The ACA requires 80-85% of health insurance to go toward medical care (medical loss ratio). The way they work around that is to figure out how to charge more for medical care.
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This is assuming no competition materializes from the lowered friction
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"Baumol's cost disease hurts the lower classes by restricting their access to services like health care and education, and LLMs/agents make it possible to increase productivity in these areas in ways which were once unimaginable."

You've expressed very clearly what LLMs would have to do in order to be economically transformative.

"If you can get high quality medical advice for effectively nothing, if you can get high quality individualized tutoring for free, that's a pretty big game changer for a lot of people. Prices on these services have been rising to the stratosphere over the past few decades because it's so difficult to increase the productivity of individual medical practitioners and educators. We're entering an era that could finally break this logjam."

It's not that process innovations are lacking, it's that product innovations are perceived as an indignity by most people. Why should one child get an LLM teacher or doctor while others get individualized attention by a skilled human being?

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> Why should one child get an LLM teacher or doctor while others get individualized attention by a skilled human being?

Is the value in the outcome of receiving medical advice and care, and becoming educated, or is the value just in the co-opting of another human being's attention?

If the value is in the outcome, the means to achieving that aren't of much consequence.

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The supply/demand picture here is more complicated than it looks.

If AI displaces human educators, yes, their supply shrinks -- but we can't assume what direction its demand will go.

We've seen this pattern before: as recorded music became free, live performance got more expensive, and therefore much less accessible than it used to be.

What's likely to happen is that "worse" (read: AI) education will become much cheaper, while "better" (read: in-person) education that involves human connection-driven benefits will become much less accessible compared to what it is today.

Most people may be consider it a win. It's certainly not a world I'm looking forward to.

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More subtly, what is an education? What is care? As you point out, the LLMs are (or probably will become) perfectly good at the measurable parts of those services; but I think the residual edge of “good” education/care is more than just the other human’s co-opted attention.

How many of us have a reminiscence that starts “looking back, the most life-changing part of my primary or secondary education was ________,” where the blank is a person, not a curriculum module? How many doctors operate, at least in part, on hunches—on totalities of perception-filtered-through-experience that they can’t fully put into words?

I’m reminded of the recent account of homebound elderly Japanese people relying on the Yakult delivery lady partly for tiny yoghurt drinks, but mainly for a glimmer of human contact [0]. Although I guess that cuts to your point: the value in that example really is just co-opting another human’s attention.

In most of these caring professions, some of the value is in the measurable outcome (bacterial infection? Antibiotic!), but different means really do create different collections of value that don’t fully overlap (fine, I’ll actually lay off the wine because the doctor put the fear of the lord in me).

I guess the optimistic case is, with the rote mechanical aspects automated away, maybe humans have more time to give each other the residual human element…

[0] https://news.ycombinator.com/item?id=47287344

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The premise of your argument is that "the outcome" can be separated from the process. This is true enough for manufacturing bricks: I don't much care what processes was used to create a brick if it has certain a compressive strength, mass, etc.

But Baumol's argument, which you introduced to the conversation, is that outcome and process cannot actually be distinguished, even if a distinction in thought is possible among economic theorists.

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It's very true for healthcare (especially mental healthcare) and education today as well, because for most people, the choice isn't LLM vs. human attention - it's LLM vs. no access at all.
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Even if you have perfect medical information and advice through an LLM, can you perform surgery on yourself? Can you prescribe yourself whatever medication you think you need?

For education, if you know as much as the average Harvard grad, can you give yourself a Harvard degree that will be as readily accepted in a job application or raising funds for a new business?

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> the value just in the co-opting of another human being's attention?

Thats a weird way of describing it.

A machine telling me to exercise and eat right will be ignored, even if the advice is correct. A person I trust taking me aside, looking me in the eye and asking me the same would be taken far more seriously.

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That may well be true if you need to be persuaded to exercise and eat right.

OTOH, if you don't need to be persuaded and just want information on how best to go about doing it, then I think it makes little difference where the information comes from as long as it's of reasonable quality.

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It also seems like the value of quality tutoring that doesn't primarily function as social/class signaling goes down as tools capable of automating high quality intellectual work are more widely available.
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It depends on outcome again: is the value of tutoring the social class elevation, or is it in the outcome of becoming more skilled and knowledgable?

There's also the deeper philosophical question of what is the meaning of life, and if there's inherent value in learning outside of what remunerative advantages you reap from it.

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Can a robot write a medicine prescription? A medical procedure prescription? If yes, that would be a game-changer. But the medical insurance providers would be very cautious about honoring these. Then, if things go wrong, what entity would be held accountable for malpractice?

You already can get a good-quality medical advice "for nothing", unless it requires e.g. a blood test. The question is, how actionable such an advice is going to be, and how even the quality is going to be.

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By the time it replaces doctors, nobody but today's investors will be able to afford anything at all. The X-shaped economy would have owners in the V and manual laborers (assuming this doesn't translate to gains in automation) in the ^. This outcome is worth avoiding...
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I’m sick of this idea that “free” services are beneficial to society. There is no such thing as a free lunch; users are essentially bartering their time, attention, IP (contributed content) and personal/behavioral data in exchange for access to the service.

By selling those services at a cost of “free”, hyperscalers eliminate competition by forcing market entrants to compete against a unit price of 0. They have to have a secondary business to subsidize the losses from servicing the “free” users, which of course is usually targeted advertising to capitalize on the resources paid by users for access. Or simply selling to data brokers.

With the importance of training data and network effects, “free” services even further concentrate market power. Everyone talks about how AI is going to take away jobs, but no one wants to confront how badly the anticompetitive practices in big tech are hurting the economy. Less competition means less opportunity for everyone else, regardless of consumer benefit.

The only way it works if the “free” service for tutoring or healthcare is through government subsidies or an actual non-profit. Otherwise it’s just going to concentrate market power with the megacorps.

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> I’m sick of this idea that “free” services are beneficial to society. There is no such thing as a free lunch; users are essentially bartering their time, attention, IP (contributed content) and personal/behavioral data in exchange for access to the service.

In aggregate, this is true, but there are many ways to game the system to one's advantage and get a true "free lunch." For example, people watching Youtube with an adblocker and logged out don't provide Google with any income or useful telemetry. Likewise you can get practically unlimited GPT/Claude/etc by using multiple accounts.

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This 1000x. "Free" is only a viable business model if the govt funds it. Otherwise, the $$ has to come from somewhere else in the company - how long will it take for the company to lose interest in a loss-leader when they're making $$ from other parts?

Look at all the deprecated Google products. What happens when Gemini-SaaS makes billions from licensing to other companies, and Gemini-Charity-for-the-poors starts losing money?

Sadly, the bigger the $$ in the tech pie, the more we have attracted robber barons, etc.

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