39C3: “AI”, Longevity, and the Illusion of a Repairable Healthcare System

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At the 39th Chaos Communication Congress, Manuel Hofmann from Deutsche Aidshilfe analyzed the exaggerated technology promises for the German healthcare system in his presentation “‘AI’, Digitalization, and Longevity as a Fix for a Broken Healthcare System?”. His talk revealed a dangerous mix of naive faith in technology, libertarian ideology, and the systematic disregard of social inequalities.

Looking at the headlines, the German healthcare system is in a veritable crisis: costs are exploding, demographic change is rolling unstoppably towards the system, and in the next ten to fifteen years, hundreds of thousands of employees will retire. At the same time, large birth cohorts are reaching an age where they will become ill and require care more frequently. The Charité CEO warns of collapse, the GKV-Spitzenverband (umbrella organization of statutory health insurance funds) sounds the alarm, and Germany ranks second to last in an international survey on disease prevention.

The response from politics and the healthcare industry to these structural problems follows a surprisingly uniform pattern, Hofmann explained: technology is supposed to fix it. In the Digitalization Strategy of the Federal Ministry of Health (PDF) from 2023, it states: “Digitalization in healthcare and nursing enables a healthier and longer life for everyone.” But how realistic are these promises actually?

The Efficiency Illusion: When Charité CEOs Dream of AI Replacement

In his analysis, Hofmann illustrated the dimensions of the disconnect from reality with concrete statements from leading healthcare managers. Prof. Dr. Heyo K. Kroemer, Chairman of the Board of Charité – Europe's largest university hospital – stated in a Tagesthemen interview that one-third of his employees will retire within the next ten years. Hofmann quoted Kroemer's conclusion: "Therefore, we clearly have the goal of being able to replace one-third of employees with these technologies within a decade."

Hofmann countered this statement by referring to the history of digitalization in healthcare: “I would like to remind you that we had the first idea for the electronic patient record 20 years ago.” The electronic patient record, the flagship project of health digitalization, was the subject of devastating criticism at the Chaos Communication Congress exactly one year ago – security researchers had pointed out numerous technical deficiencies. Against this background, the idea of replacing one-third of hospital staff with AI within ten years seems downright unrealistic, Hofmann said.

It goes even further in an opinion piece in Die Welt, sponsored by Siemens Healthineers, which Hofmann quoted in his presentation: “What can we do about it? We can't conjure up more doctors, but by using technology, we enable them to do ten times more than today in the future. Why shouldn't a doctor who treats 1000 patients per quarter today treat 10,000 patients per quarter in the future?”

Hofmann reported that he tested this thesis at a workshop at a medical congress of the Association of Democratic Female Doctors. He described the reaction of the attending physicians to the question of why they couldn't treat ten times as many patients in the future as: “They were moderately enthusiastic and didn't tend to complain about overly lax working conditions.”

Quantum Computing and Cancer Prognoses: The Future Fantasies of Strategy Consultants

Hofmann particularly dramatically illustrated the detachment from reality of some future visions using a magazine from a strategy consultancy that describes the healthcare system in 2030. The scene depicted there: A patient sits in an oncology practice to receive his cancer prognosis – the answer to the question of whether he will survive. This patient is described as “curious” in the vision, Hofmann said.

His criticism was clear: “I really don't want the future of our healthcare system to be designed by people who think that people who are just finding out if they can survive are sitting in their treatment appointments curiously.” In the vision, AI simulations, “supported by quantum computing,” calculate an individualized probability of success. The doctor then has much more time for “great psycho-oncological conversations” because the administrative tasks are eliminated. The discrepancy between such glossy scenarios and the reality of a healthcare system that is still heavily reliant on fax machines could hardly be greater.

Personal Responsibility as a Political Program

Parallel to the technology euphoria, a second narrative is establishing itself, according to Hofmann's analysis: the emphasis on personal responsibility. The speaker referred to Chancellor Friedrich Merz, who stated at the VDMA congress that Germans go to the doctor too often.

Federal Minister of Health Nina Warken expresses similar views. Hofmann quoted her from a press conference on the Public Health Report: “To establish affordable and good healthcare for the future, changes are unavoidable. And the personal responsibility of citizens will also play a central role in this.”

This development leads to increasing digital initial assessments, Hofmann analyzed: Before people gain access to the healthcare system, chatbots and symptom checkers are supposed to pre-filter who “really” needs treatment.

This development becomes particularly problematic in the area of mental health. In view of the shortage of psychotherapy places, AI is increasingly being discussed as a substitute. Hofmann warned emphatically: “No, ChatGPT will not replace the psychotherapist.” As evidence, he referred to a new phenomenon: AI-induced psychosis. People with existing obsessive thoughts often receive reinforcing answers from language models that exacerbate their problems instead of alleviating them.

Tech Billionaires and the Dream of Eternal Life

Another strand of Hofmann's analysis concerned the longevity movement – an approach that promises longevity through a combination of technology, self-optimization, and experimental treatments. The ideological roots of this movement lie in Silicon Valley, with tech billionaires holding libertarian beliefs and a strong desire not to die.

As a prominent representative, Hofmann named Ray Kurzweil, AI visionary and Chief Technical Officer at Google. Kurzweil promotes the concept of “Longevity Escape Velocity” – the point at which medical progress advances so rapidly that every year lived brings an additional year of life expectancy. Hofmann explained Kurzweil's vision: one eventually reaches a state “where we can leave behind our all too weak, failing bodies” and where disease, as we know it, is eradicated. According to Kurzweil's predictions, this point will be reached in just a few years. “I think the fax machine will survive this point in the German healthcare system by a few decades,” Hofmann said.

The practical manifestation of this ideology can be found in institutions like Fountain Life, which Hofmann described as an “insanely expensive longevity center” in the USA, where wealthy customers can book experimental examinations. One of Fountain Life's founders recommended that one should “be the CEO of your own health” – a phrase that has now also been adopted by German health influencers.

As a particularly bizarre example, Hofmann named longevity enthusiast Brian Johnson, who describes himself as the most measured person in the world. Johnson is known for obsessive self-measurement, which, according to Hofmann's description, sometimes takes on grotesque proportions. He referred to an article in the New York Times that analyzed the centuries-old search for eternal life and found that this search is predominantly driven by men. Hofmann drew connections to social psychological research, which suggests that the suppression of death is significantly more widespread in individualistically organized societies than in community-oriented cultures.

Social Inequality and Global Health

Hofmann saw the fundamental problem of all these approaches in their systematic disregard of social inequalities. Health depends heavily on social positioning, he emphasized in his presentation. People who are queer or trans experience minority stress throughout their lives, which affects their health. People who deliver packages for ten hours a day have no energy left for wellness rituals in the evening. “Poverty kills,” Hofmann summarized – a statement that the Robert Koch Institute scientifically confirms with its data on the “life expectancy gap” between rich and poor.

The individualization of health makes people responsible for things for which they have little control, Hofmann argued. Those who live on a noisy street, who work shifts, who are precariously employed, cannot simply choose a healthier lifestyle.

Hofmann became particularly emphatic about the global dimension. Deutsche Aidshilfe published a wake-up call on World AIDS Day: after the US withdrawal from international HIV programs, a catastrophe threatens. People will die from a treatable disease because they lack medication. Hofmann appealed: “Perhaps we should fix that problem first before we continue to discuss whether some tech bros from Silicon Valley can reach 130.”

Who Benefits from the Narrative of a Broken System?

In his presentation, Hofmann also warned of the political implications of crisis discourses. The narrative that the healthcare system is broken is not a neutral description of the situation, but a narrative in itself. Of course, problems must be named and solutions discussed. “But if you only push the narrative that the system is breaking down and everything is going down the drain anyway, and we are doomed to destruction, then in the end, only that one right-wing extremist party will benefit, which itself certainly will not have competent, far-sighted answers for structural problems in healthcare.”

(mack)