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“They will spend an enormous amount of money fighting us. They will lie about what is in the program. They will frighten the American people,” he said.

But he says the time has arrived to have a debate he believes is fundamental: is healthcare a right or a privilege in America?

Sanders will formally unveil the bill at a press conference on Wednesday, with the backing of nearly a third of the Democratic caucus in the Senate – a record level of support for a bill he introduced just four years ago with only one signature, his own.

The Sanders plan would radically reform the American healthcare system, transitioning it over the course of four years to a federally administered insurance program.

For many patients and their families, hospital fees are already complicated, opaque and stressful. The Kingsburys show just how little control consumers have.

None of this has been clear to consumers—until this year. Hospitals and insurers have long set prices through confidential negotiations. Starting Jan. 1, hospitals were required to make their prices public under a Trump administration policy that sought to expose the sector’s pricing to greater market pressure.

Compliance with the rule has been spotty, but the available data show that prices vary widely among the plans that negotiate contracts with hospitals. While the data remains difficult for consumers to use, knowing the full range of rates could ultimately help patients negotiate their bills.

Healthcare economists note that prices in other sectors, such as airlines, can also vary for the same service, but hospitals’ steep prices mean the dollar difference between the highest and lowest rates can amount to tens of thousands of dollars. “The order of magnitude of healthcare costs is different,”

Even within an insurance plan, prices aren’t consistently low or high. A plan’s prices for one service can be among the lowest a hospital negotiates, but among the highest for another,

A person insured by Minnesota-based HealthPartners would have received the most favorable price for a hospital stay because of back problems, but the cost of an emergency room visit with the same insurance was among the highest, according to the Journal’s analysis of the data.

When insurance didn’t cover some treatments, the Journal found, Avera McKennan Hospital set its own prices that ranked among the highest anywhere in the U.S. in the Journal’s analysis.

The LifeShield price of about $780 amounted to a discount of 53% off the hospital’s charge. Ms. Kingsbury paid all of it because her plan’s benefits didn’t cover the rest of the bill. The insurance was exempt from some federal rules that protect healthcare consumers. LifeShield didn’t respond to requests for comment.

Ms. Kingsbury earned roughly $17,700 last year, tax records reviewed by the Journal show. Her husband, who is retired, received about $22,800 in yearly income from Social Security. They bought insurance in 2019 from LifeShield National Insurance Co.

The range of prices is the product of a complex interplay of multiple payers and hospitals, and a lack of competitive pressure to hold down costs, economists said. Rates have been determined by trade-offs at the bargaining table between hospitals and insurers—such as an offer of cheaper prices in return for more business—and by market power, with higher prices where hospitals dominate.

Hospitals and insurers ultimately bargain for prices to meet financial targets for revenue and profit, said David Dillon, a healthcare actuary with the consulting firm Lewis & Ellis Inc. “It is kind of as simple as both sides of the table have their revenue requirements,” he said.

“The market for healthcare just doesn’t look at all like the market for tomatoes because somebody else is literally negotiating and purchasing on your behalf,” Mr. Cooper said.

The cost for the scan under LifeShield was $1,497, almost half the price charged under Avera. However, Ms. Kingsbury’s plan at LifeShield was exempt from Affordable Care Act rules to prevent gaps in coverage. LifeShield didn’t cover this scan. So Avera charged Ms. Kingsbury the price it sets for patients not covered by insurance, at $8,451, one of the highest prices in the Journal’s analysis of publicly available rates nationwide.

“Healthcare is a service and it can be an expensive service, especially for a serious condition. That’s why health insurance exists,” said Avera spokeswoman Ms. Meyers. “It is important for consumers to understand what they are buying and the coverage it provides.”

The Journal compared Avera McKennan’s 2019 PET CT price for Ms. Kingsbury with the price Medicare would pay, as calculated by price-comparison startup Turquoise Health Co. The hospital’s cash price for Ms. Kingsbury in 2019 was 5.7 times the Medicare rate, according to the Journal’s analysis using newly public data collected by Turquoise. That’s one of the highest multiples of any of the more than 1,200 U.S. hospitals in the analysis.

nearly five million Americans fall into what’s called the “Medicaid gap”

In Germany, employees' premiums are a percentage of their incomes, so low-wage workers simply pay rock-bottom insurance rates.

Germany actually pioneered this type of insurance—it all started when Otto von Bismarck signed his Health Insurance Bill of 1883 into law. (It’s still known as the “Bismarck model” because of his legacy, and other parts of Europe and Asia have adopted it over the years.)

You can think of this setup as the Goldilocks option among all of the possible ways governments can insure health. It's not as radical as single-payer models like the U.K.’s, where the government covers everyone. And it's also not as brutal as the less-regulated version of the insurance market we had before the ACA.

Since there are no provider networks in Germany, doctors don’t know what other providers patients have seen, so there are few ways to limit repeat procedures.

All things considered, it’s good to be a sick German. There are no network limitations, so people can see any doctor they want. There are no deductibles, so Germans have no fear of spending hundreds before their insurance ever kicks in.

There’s also no money that changes hands during a medical appointment. Patients show their insurance card at the doctor’s office, and the doctors' association pays the doctor using money from the sickness funds. "You don’t have to sit at home and sort through invoices or wonder if you overlooked fine print,”

That insurance card, by the way, is good for hospital visits anywhere in Europe.

of all of the countries studied, Germans were the most likely to be able to get a same-day or next-day appointment and to hear back from a doctor quickly if they had a question. They rarely use emergency rooms, and they can access doctors after-hours with ease.

And Germany manages to put its health-care dollars to relatively good use: For each $100 it spends on healthcare, it extends life by about four months, according to a recent analysis in the American Journal of Public Health. In the U.S., one of the worst-performing nations in the ranking, each $100 spent on healthcare resulted in only a couple of extra weeks of longevity.

those differences aside, it’s fair to say the U.S. is moving in the direction of systems like Germany’s—multi-payer, compulsory, employer-based, highly regulated, and fee-for-service.

The German government is similarly trying to push more people into “family physician” programs, in which just one doctor would serve as a gatekeeper.

like the U.S., Germany may see a shortage of primary-care doctors in the near future, both because primary-care doctors there don’t get paid as much as specialists, and because entrenched norms have prevented physician assistants from shouldering more responsibility

With limitations on how much they can charge, German doctors and hospitals instead try to pump up their earnings by performing as many procedures as possible, just like American providers do.

Similarly, “In Germany, it will always be an operation,” Göpffarth said. “Meanwhile, France and the U.K. tend to try drugs first and operations later.”

With few resource constraints, healthcare systems like America's and Germany's tend to go with the most expensive treatment option possible. An American might find himself in an MRI machine for a headache that a British doctor would have treated with an aspirin and a smile.

Perhaps the biggest difference between our two approaches is the extent to which Germany has managed to rein in the cost of healthcare for consumers. Prices for procedures there are lower and more uniform because doctors’ associations negotiate their fees directly with all of the sickness funds in each state. That's part of the reason why an appendectomy costs $3,093 in Germany, but $13,000 in the U.S.

Now, Maryland is going a step further still, having just launched a plan to cap the amount each hospital can spend, total, each year. The state's hospital spending growth will be limited to 3.58 percent for the next five years. “We know that right now, the more [doctors] do, the more they get paid,” John Colmers, executive director of Maryland’s Health Services Cost Review Commission, told me. “We want to say, ‘The better you do, the better you get paid.’”

certain U.S. states have tried a more German strategy, attempting to keep costs low by setting prices across the board. Maryland, for example, has been regulating how much all of the state’s hospitals can charge since 1977. A 2009 study published in Health Affairs found that we would have saved $2 trillion if the entire country’s health costs had grown at the same rate as Maryland’s over the past three decades.

“In Germany, there is a uniform fee schedule for all physicians that work under the social code,” Schlette said. “There’s a huge catalogue where they determine meticulously how much is billed for each procedure. That’s like the Bible.”

“The red states are unlikely to follow their lead. The notion that government may be a big part of the solution, instead of the problem, is anathema, and Republican controlled legislatures, and their governors, would find it too substantial a conflict to pursue with any vigor.”

no other state has Maryland’s uniform, German-style payment system in place, “so Maryland starts the race nine paces ahead of the other 46 states,” McDonough said.

the unique spirit of each country is what ultimately gets in its way. Germany’s more orderly system can be too rigid for experimentation. And America’s free-for-all, where hospitals and doctors all charge different amounts, is great for innovation but too chaotic to make payment reforms stick.

rising health costs will continue to be the main problem for Americans as we launch into our more Bismarckian system. “The main challenge you’ll have is price control,” he said. “You have subsidies in health exchanges now, so for the first time, the federal budget is really involved in health expenditure increases in the commercial market. In order to keep your federal budget under control, you’ll have to control prices.”

Clinton said any moves to scrap the current Affordable Healthcare Act risked plunging the Democrats into "contentious debate". Instead, the party should work on improving the programme, known as Obamacare.

US Democratic debate: Candidates spar on gun control

Before the debate in South Carolina, Mr Sanders unveiled a healthcare plan for all American citizens.

move risked derailing healthcare legislation introduced under President Obama.

Gun control was the first subject in the debate, that was held near a church where nine parishioners were shot dead in June 2015

released an advertisement this week attacking Mr Sanders for his attitude towards gun control

There is a high level of health seeking behaviour in Taiwan. It is part of the Taiwanese culture to take medicines or to seek medical help frequently, even for minor ailments. The average outpatient department visit rate is 14 times per year per person2. This is substantially higher than the equivalent rate in the UK

As in the health systems of many countries including the UK, significant financial problems exist in Taiwan. The payment systems for healthcare providers are formulated in global budget and based on the care provided. The new pharmaceutical agents and medical technologies that emerge also pose financial dilemmas to the health system. Currently, the Taiwanese NHI does not take in enough money from premium payment to cover the entire healthcare provided by the hospitals and other healthcare personnel. The government often has to provide additional funds to keep the system running.

an "ACA for All" system would prevent government from operating health insurance while allowing it to regulate and finance health insurance for most Americans. The ACA for All would not be "socialized medicine" -- where government not only finances healthcare but supplies it through public hospitals, clinics, and the direct employment of clinicians. ACA for All would continue to rely on private industry (private doctors and private hospitals) and personal responsibility, and would limit the government's role in healthcare delivery.

A Republican plan for universal healthcare would offer those with non-employer-based coverage an adequately sized tax deduction, big enough to cover the cost of a family health insurance plan. And, for the first time since the 1940s, individuals would pay taxes on the value of employer-based health insurance above a certain threshold (based on the average costopens in a new tab or window of a family health insurance plan).

what we are witnessing is not criminal negligence, but an outright crime against humanity. Virologists predict that the number of cases in India will grow exponentially to more than 500,000 a day. They predict the death of many hundreds of thousands in the coming months, perhaps more

Fredrick Douglass said it right: “The limits of tyrants are prescribed by the endurance of those whom they oppress.” How we in India pride ourselves on our capacity to endure. How beautifully we have trained ourselves to meditate, to turn inward, to exorcise our fury as well as justify our inability to be egalitarian. How meekly we embrace our humiliation.

So here we are now, in the hell of their collective making, with every independent institution essential to the functioning of a democracy compromised and hollowed out, and a virus that is out of control.

Less money is spent on black patients with the same level of need as white patients, causing the algorithm to conclude that black patients were less sick, the researchers found.

Reformulating these biases in the algorithm would more than double the number of black patients flagged for additional care

black patients actually had 48,772 more active chronic conditions than white patients who had been ranked at the same level of risk

Biases like these are inadvertently built into the technology we use at many different stages, said Ruha Benjamin, author of Race After Technology and associate professor of African American studies at Princeton University.

“Pre-existing social processes shape data collection, algorithm design and even the formulation of problems that need addressing by technology,” she said.

When researchers tweaked the algorithm to make predictions about patients’ future health conditions rather than which patients would incur the highest costs, it reduced biases by 84%. “These results suggest that label biases are fixable,” the study said.

Predictive algorithms that power these tools should be continually reviewed and refined

researchers suggested similar biases probably exist across a number of industries. As algorithms are increasingly used for job recruiting, housing loans and policing, Benjamin noted that more legislation is needed to ensure algorithms take into consideration historical biases.

“Indifference to social reality is, perhaps, more dangerous than outright bigotry.”

People have to understand that when we overrun our healthcare – our hospitals – that people will still come in with heart attacks, people will still have car accidents. These things that happen every day on top of Covid-19 will make our healthcare system collapse in the same way that you’re seeing that happen in New York and you’re seeing it happen across the globe,”

Until Wednesday morning, Georgia also had the fourth-highest death toll of coronavirus patients, until Louisiana’s cases soared. With over half a dozen Georgia hospitals shutting down during the past decade across rural communities, much of the state’s healthcare has been lacking. In 2017, a study found Georgia had one of the worst healthcare systems in the country, ranking it 49th for access.

Biden said his position had changed in response to changing circumstances, including increasing efforts by Republican lawmakers to restrict abortion. "It was not under attack," Biden said. "As it is now."

At the same time, Republican state lawmakers have continued a nationwide push to limit abortion, introducing hundreds of restrictions this year alone. Anti-abortion rights groups hope one of those laws will invite the U.S. Supreme Court to reconsider the Roe v. Wade decision that legalized abortion nationwide in 1973.

The budget plan, released late last week, would drop the policy which has restricted funding for abortion through federal programs such as Medicaid. The rule, in effect since 1980, includes exceptions in cases of rape, incest, or to save a pregnant woman's life.

Biden, a lifelong Catholic, supported Hyde for decades — as did many other Democrats, often as a compromise position with Republicans. It often has been a sticking point in negotiations over healthcare policy, including the debate surrounding the Affordable Care Act and subsequent legislation.

Later that month, in a forum on abortion rights hosted by Planned Parenthood in South Carolina, Biden explained his reversal, saying he'd supported Hyde in an effort to expand federally-funded healthcare. But he suggested that for low-income women who rely on federal programs, Hyde had become an obstacle to full healthcare access.

Promising to reverse multiple Trump-era abortion restrictions, Biden ultimately marshaled the support of Planned Parenthood and other reproductive rights advocacy groups, who put the weight of their campaign operation behind him in his fight against Trump in 2020.

Since taking office, Biden has taken steps toward providing federal funding for abortions for low-income people. Like other Democratic Presidents before him, Biden announced plans soon after taking office to reverse the Mexico City Policy, or what critics describe as the "Global Gag Rule." It forbids international aid groups who receive U.S. funding from providing or referring patients for abortion.

Abortion rights groups are asking the administration to take additional steps, including reversing the Helms Amendment, which also restricts the use of U.S. dollars in paying for abortions abroad.

"It's even worse than what passed out of the Republican House last Congress," the aide said. "The whole notion of that sort of block granting idea just rips out even more of the protections."

House Republicans are rolling out their complex plan as Trump struggles to articulate broad ideas for the nation's health care, and as Democrats campaign across the country on an easy-to-explain vision for extending coverage to everyone.

That plan -- so far a patchwork quilt of health care proposals that Trump's team hopes will stack up to a comprehensive vision -- will serve as the White House's answer to the growing support on the left for the kind of universal health care system that Republicans have spent years warning against.

"The White House welcomes the RSC announcement and their contributions to improving our healthcare system," Judd Deere, White House spokesman, told CNN. "The Trump Administration continues to work to improve healthcare more broadly, which includes creating a system that protects the vulnerable and those with pre-existing conditions and delivers the affordability Americans needs, the choice and control they want, and the quality they deserve."

The House GOP plan comes against the backdrop of a court case that has the potential to upend the nation's health insurance system and the 2020 election campaign. Federal appellate court judges in Louisiana are now considering a case brought by a coalition of Republican-led states, and backed by the Trump administration, that argue Obamacare as a whole is unconstitutional because Congress essentially eliminated the penalty for not having health insurance, the so-called individual mandate. A US District Court judge in Texas in December sided with the Republican states.

The Trump administration has chosen not to defend the law, leaving many Republicans concerned that they will not have a replacement ready if the appellate court upholds the lower court's ruling. Democrats are already attacking Trump and the GOP for threatening the coverage of millions of Americans, and if the court invalidates the ACA, Republicans could be left with the blame for dismantling the country's health care system without preparing a realistic replacement.

"Do you want a president who wants to have the government take over your health care, or do you want personal choices?" Marshall said Monday. "So even though there's impeachment and all those other things going on here, I think this -- healthcare -- is the issue of 2020."

Thursday’s announcement was billed as “President Trump’s Healthcare Vision for America” but contained no tangible action. Trump has long promised a “beautiful” and “phenomenal” healthcare plan that provides everyone with better coverage for a lower cost, but his administration never unveiled any comprehensive reform plan, even as it was trying to overturn the Affordable Care Act.

The plan also promises to ban surprise medical billing, but only after the election.

While widely derided as unethical exploitation of vulnerable patients, surprise billing is nonetheless lucrative business for those doing the billing. Doctors and insurance companies have been in a lobbying war over how to fix the problem, and Congress has done nothing to stop it.

If Congress fails to meet the deadline, Azar will be tasked with exploring other options. Azar did not say what those might be. When asked why they are not taking action now, Azar said the plan "is what it is." Twitter Tweet Facebook Share Copy Copy

"They don't have a massive eraser pen. They've got to go through the rule-making process," said Allison Orris, a former Obama administration official and counsel with Manatt Health, a professional services firm. "They are going to have to think about what comes first, second and third and be realistic about timing."

Plus, the Biden administration may opt to keep and continue several Trump administration efforts, including shifting to value-based care, rather than paying doctors for every visit and procedure, and increasing access to telehealth,

The two administrations also share common views on some measures to lower drug pricing, including basing Medicare payments on the cost of prescription medications in other countries and importing drugs from abroad. But Trump officials have not actually put these proposals in place.

While Trump focused on dismantling the Affordable Care Act, Biden will emphasize expanding the law and access to health coverage.

The Trump administration took the historic step in early 2018 of allowing states to require certain Medicaid recipients to work in order to receive benefits. Eight states have received approval, seven have pending requests and four had their waivers set aside in court, according to the Kaiser Family Foundation.

Biden's Health and Human Services secretary would be able to unwind the approvals, but it is a complicated task, said Joan Alker, executive director of the Center for Children and Families at Georgetown University. The secretary would have to determine whether to withdraw permission for the entire waiver or just certain features.

Several of these waivers included other provisions that could make it harder for low-income Americans to retain Medicaid coverage, such as lockouts for non-payment of premiums.

One executive order Trump repeatedly points to is expanding short-term health plans, which typically have lower premiums, but provide less comprehensive coverage and don't have to adhere to the Affordable Care Act's protections for people with pre-existing conditions.

"The short-term plans have important symbolic significance because they restrict coverage to people with pre-existing conditions, which was a prominent political issue in the campaign," said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation.

In its first year in office, the Trump administration slashed funds to promote Obamacare open enrollment and to assist consumers with selecting plans by 90% and 84%, respectively.

The Biden administration is expected to reverse all these measures to curtail Obamacare.

Biden has promised to revoke the Trump administration rule barring federally funded health care providers in the Title X family planning program from referring patients for abortions.

Biden has vowed to reverse the so-called Mexico City Policy, a ban on funding for foreign nonprofits that perform or promote abortions, which Trump reinstated and expanded during his tenure.

The Trump administration reinstated the measure -- which had previously impacted only family planning assistance -- in 2017 by presidential memorandum and extended it to all applicable US global health funding under the "Protecting Life in Global Health Assistance."

The Biden administration is also expected to reinstitute a directive that states cannot bar Medicaid funds from going to qualified providers that separately provide abortions, such as Planned Parenthood.

Trump also signed a bill in 2017 allowing states to withhold federal money from organizations that provide abortion services, including Planned Parenthood.

The Trump administration has been particularly hostile toward transgender Americans. Among its most criticized moves was an effort earlier this year to rollback an Obama-era regulation prohibiting discrimination in health care against patients who are transgender.

Biden's LGBTQ policy plan also says he will work to expand funding for mental health services for LGBTQ Americans and that his administration plans to automatically enroll low-income LGBTQ people in the public option, once it's created, if they live in rural areas in states that didn't expand Medicaid.

agents will open up many more learning opportunities.

Already, AI can help you pick out a new TV and recommend movies, books, shows, and podcasts. Likewise, a company I’ve invested in, recently launched Pix, which lets you ask questions (“Which Robert Redford movies would I like and where can I watch them?”) and then makes recommendations based on what you’ve liked in the past

Productivity

copilots can do a lot—such as turn a written document into a slide deck, answer questions about a spreadsheet using natural language, and summarize email threads while representing each person’s point of view.

I don’t think any single company will dominate the agents business--there will be many different AI engines available.

Helping patients and healthcare workers will be especially beneficial for people in poor countries, where many never get to see a doctor at all.

To create a new app or service, you won’t need to know how to write code or do graphic design. You’ll just tell your agent what you want. It will be able to write the code, design the look and feel of the app, create a logo, and publish the app to an online store

Agents will do even more. Having one will be like having a person dedicated to helping you with various tasks and doing them independently if you want. If you have an idea for a business, an agent will help you write up a business plan, create a presentation for it, and even generate images of what your product might look like

For decades, I’ve been excited about all the ways that software would make teachers’ jobs easier and help students learn. It won’t replace teachers, but it will supplement their work—personalizing the work for students and liberating teachers from paperwork and other tasks so they can spend more time on the most important parts of the job.

Mental health care is another example of a service that agents will make available to virtually everyone. Today, weekly therapy sessions seem like a luxury. But there is a lot of unmet need, and many people who could benefit from therapy don’t have access to it.

Entertainment and shopping

The real shift will come when agents can help patients do basic triage, get advice about how to deal with health problems, and decide whether they need to seek treatment.

They’ll replace word processors, spreadsheets, and other productivity apps.

Education

For example, few families can pay for a tutor who works one-on-one with a student to supplement their classroom work. If agents can capture what makes a tutor effective, they’ll unlock this supplemental instruction for everyone who wants it. If a tutoring agent knows that a kid likes Minecraft and Taylor Swift, it will use Minecraft to teach them about calculating the volume and area of shapes, and Taylor’s lyrics to teach them about storytelling and rhyme schemes. The experience will be far richer—with graphics and sound, for example—and more personalized than today’s text-based tutors.

your agent will be able to help you in the same way that personal assistants support executives today. If your friend just had surgery, your agent will offer to send flowers and be able to order them for you. If you tell it you’d like to catch up with your old college roommate, it will work with their agent to find a time to get together, and just before you arrive, it will remind you that their oldest child just started college at the local university.

To see the dramatic change that agents will bring, let’s compare them to the AI tools available today. Most of these are bots. They’re limited to one app and generally only step in when you write a particular word or ask for help. Because they don’t remember how you use them from one time to the next, they don’t get better or learn any of your preferences.

The current state of the art is Khanmigo, a text-based bot created by Khan Academy. It can tutor students in math, science, and the humanities—for example, it can explain the quadratic formula and create math problems to practice on. It can also help teachers do things like write lesson plans.

Businesses that are separate today—search advertising, social networking with advertising, shopping, productivity software—will become one business.

other issues won’t be decided by companies and governments. For example, agents could affect how we interact with friends and family. Today, you can show someone that you care about them by remembering details about their life—say, their birthday. But when they know your agent likely reminded you about it and took care of sending flowers, will it be as meaningful for them?

In the computing industry, we talk about platforms—the technologies that apps and services are built on. Android, iOS, and Windows are all platforms. Agents will be the next platform.

A shock wave in the tech industry

Agents won’t simply make recommendations; they’ll help you act on them. If you want to buy a camera, you’ll have your agent read all the reviews for you, summarize them, make a recommendation, and place an order for it once you’ve made a decision.

Agents will affect how we use software as well as how it’s written. They’ll replace search sites because they’ll be better at finding information and summarizing it for you

they’ll be dramatically better. You’ll be able to have nuanced conversations with them. They will be much more personalized, and they won’t be limited to relatively simple tasks like writing a letter.

Companies will be able to make agents available for their employees to consult directly and be part of every meeting so they can answer questions.

AI agents that are well trained in mental health will make therapy much more affordable and easier to get. Wysa and Youper are two of the early chatbots here. But agents will go much deeper. If you choose to share enough information with a mental health agent, it will understand your life history and your relationships. It’ll be available when you need it, and it will never get impatient. It could even, with your permission, monitor your physical responses to therapy through your smart watch—like if your heart starts to race when you’re talking about a problem with your boss—and suggest when you should see a human therapist.

If the number of companies that have started working on AI just this year is any indication, there will be an exceptional amount of competition, which will make agents very inexpensive.

Agents are smarter. They’re proactive—capable of making suggestions before you ask for them. They accomplish tasks across applications. They improve over time because they remember your activities and recognize intent and patterns in your behavior. Based on this information, they offer to provide what they think you need, although you will always make the final decisions.

Agents are not only going to change how everyone interacts with computers. They’re also going to upend the software industry, bringing about the biggest revolution in computing since we went from typing commands to tapping on icons.

In the distant future, agents may even force humans to face profound questions about purpose. Imagine that agents become so good that everyone can have a high quality of life without working nearly as much. In a future like that, what would people do with their time? Would anyone still want to get an education when an agent has all the answers? Can you have a safe and thriving society when most people have a lot of free time on their hands?

The ramifications for the software business and for society will be profound.

In the next five years, this will change completely. You won’t have to use different apps for different tasks. You’ll simply tell your device, in everyday language, what you want to do. And depending on how much information you choose to share with it, the software will be able to respond personally because it will have a rich understanding of your life. In the near future, anyone who’s online will be able to have a personal assistant powered by artificial intelligence that’s far beyond today’s technology.

You’ll also be able to get news and entertainment that’s been tailored to your interests. CurioAI, which creates a custom podcast on any subject you ask about, is a glimpse of what’s coming.

An agent will be able to help you with all your activities if you want it to. With permission to follow your online interactions and real-world locations, it will develop a powerful understanding of the people, places, and activities you engage in. It will get your personal and work relationships, hobbies, preferences, and schedule. You’ll choose how and when it steps in to help with something or ask you to make a decision.

even the best sites have an incomplete understanding of your work, personal life, interests, and relationships and a limited ability to use this information to do things for you. That’s the kind of thing that is only possible today with another human being, like a close friend or personal assistant.

The most exciting impact of AI agents is the way they will democratize services that today are too expensive for most people

They’ll have an especially big influence in four areas: health care, education, productivity, and entertainment and shopping.

In the Netherlands, the PVV surged to become the largest party among 18- to 34-year-olds, winning 17% of their vote against 7% previously. In Sweden’s 2022 ballot, 22% of the 18-21 cohort voted for the far-right Sweden Democrats, against 12% in 2018.

“I am not a racist because I voted for Wilders. It frustrates me that migrants receive more help from the government than Dutch people – but I’m not against Islam; I don’t want mosques closed. I just think we need to control immigration better.”

Koen, 19, a student in Amsterdam, echoed that view. “I still live with my parents – I can’t afford a room in Amsterdam,” he said. “I have to commute every day. Wilders wants to give housing to people who are from here – I don’t think that’s strange.”

Far-right parties are not the preferred option – or even second choice – for younger voters everywhere in Europe, analysts caution. The trend appears strongest in countries such as Austria, Germany, the Netherlands, Sweden and Denmark

In Spain, the ultra-conservative Vox party’s share of the under-35 vote soared from 22% in April 2019 to a record 34% that November, echoing its rollercoaster performance with the electorate as a whole. It fell back in July this year but still stands at 27%.

Issues such as housing, overcrowded classes and struggling hospitals were key to the youth vote, De Vries said. “Wilders may want ‘Dutch people first’ but he promises to fix these things,” she said. “The government parties imposed austerity.”

Zerka also identified economic insecurity as the most significant factor. “Young voters haven’t moved rightwards on migration, abortion, minority rights,” he said. “Far-right parties have convinced them that they offer a credible economic alternative.”

Other factors include some far-right parties “managing to position themselves as a ‘cool’ electoral option”, Zerka said. “They are increasingly offering younger voters equally young, often charismatic politicians – people who speak their language.”

Zerka also cites far-right parties’ social media skills: Spain’s Vox has a particularly slick operation, and Sławomir Mentzen, the 37-year-old leader of Poland’s ultra-liberal far-right Konfederacja (Confederation) party, has 800,000 followers on TikTok.

Jacob Davey, the head of policy and research at the Institute for Strategic Dialogue thinktank, identified the influence of a far- and ultra-right youth counterculture, typified by the far-right pan-European Generation Identity group, as an additional factor.

Even if “economic grievances, insecurities around housing, jobs, futures” may account for much of the youth vote, he said, “we’re seeing the growth to fruition of a concerted far- and extreme-right effort to reach and radicalise young people”.

finally, said De Vries, there was “simply, normalisation. For many of these young voters, far-right parties have been part of the political landscape their whole lives. They’ve grown up with them. There’s not the stigmatisation there once was.”

“My mother’s a nurse, and healthcare is not coping. Wilders campaigned on investing in healthcare and old people’s homes. When it comes to migration, people from a war country deserve a better life here but it shouldn’t be at the expense of Dutch people.”

The low-income, middle-income and high-income health systems have extremely different problems. You know, in low-income countries, getting to a health post is hard. It’s very expensive. Whereas in rich countries, yes, you can get to your doctor. In low-income countries, the main problems you have is infectious diseases. We’re dealing with countries that in the worst case where kids have death rates of 20 percent and that’s all infectious disease. And nothing else. In the U.S., in terms of kids under 5, other than premature birth, you really don’t have big problems. Kids just don’t die of infectious disease.

in the U.S., what do people die of? From age 5 till age 50, you’ve got suicide, you’ve got traffic accidents. There’s very little cancer and heart disease before age 50.

what’s a year of life worth? They call it a disability-adjusted life year (DALY). When you’re running a poor country health-care system, you can’t treat a year of life as being worth more than, say, $200, $300 or else you’ll bankrupt your health system immediately. So, with very few exceptions, you do nothing for cancer. If you get cancer, you’re going to die. And so none of the stuff that’s going on in the U.S. about $300,000 a year chemotherapy drugs is relevant.

If you spend the less than 2 percent of what the rich countries spend, but you spend it on vaccinations and antibiotics, you get over half of all that healthcare does to extend life. So you spend 2 percent and you get 50 percent. If you spend another 80 percent you’re at over 90 percent.

in rich-world health, innovation is both your friend and your enemy. Innovation is inventing organ replacement, joint replacement. We’re inventing ways of doing new things that cost $300,000 and take people in their 70s and, on average, give them an extra, say, two or three years of life. And then you have to say, given finite resources, should we fire two or three teachers to do this operation? And with chemotherapies, we’ve got things where we’ll spend our dollars on treatments where you’re valuing a life here at over $10 to $20 million. Really big, big numbers, which if you were infinitely rich, of course that would be fine. So most innovations, unfortunately, actually increase the net costs of the healthcare system. There’s a few, particularly having to do with chronic diseases, that are an exception. If you could cure Alzheimer’s, if you could avoid diabetes — those are gigantic in terms of saving money. But the incentive regime doesn’t favor them.

We’re very uncomfortable putting a value on human life. The way I see our health system is we’ve chosen to pay a huge premium in order to avoid these questions. A prerequisite for the kind of cost-cutting innovations you’re talking about it is being willing to make judgments about what a human life is worth, or even what a few months of a human life are worth. Because if you can’t decide that, then of course you just pay for everything. But if you start trying to make those choices, or even get people to think about those choices, people cry “death panels!”

BG. Yes, someone in the society has to deal with the reality that there are finite resources and we’re making trade-offs, and be explicit about that. When the car companies were found to have a memo that actually said, “This safety feature costs X and saved Y lives,” the very existence of that memo was considered damning. It was “Oh, you think human life is only a bank account.” Or when you made it reimbursable for a doctor to ask, “Do you want heroic care at the end-of-life,” that was a death panel. No, it wasn’t a death panel! It was asking somebody to make a decision.