KFF's Business of Health with Chip Kahn

When health systems are stressed, Martin McKee has been there taking notes. He's spent four decades studying collapse and recovery — the post-Soviet transition, the 2008 financial crisis, the COVID-19 pandemic. Now, as professor of European public health at the London School of Hygiene and Tropical Medicine and research director of the European Observatory on Health Systems and Policies, he's turned that lens on AI. He arrives at a charged moment: America is locked in a debate over whether AI development should slow down or even pause. Europe made a different choice — binding AI with some of the world's strictest rules. After a run of episodes examining AI through a U.S. lens, Chip and McKee cross the Atlantic: What does the American debate look like from Europe — and does regulation offer an answer that a pause cannot?

In another concerning example of AI agents going rogue recently, an OpenAI agent hacked into an Australian government website containing health care data. While some industry CEOs are calling for a slowdown and demands for regulation grow, host Chip Kahn focuses on the implications for health care when these same kinds of AI systems are already at work in hospitals — in billing, in scheduling, and increasingly in decisions about patients. To consider how health care should respond, Chip talks with Stephen Klasko, a physician, former health system CEO, and now an industry leader who sits on both sides of the issues, working with the labs building the technology and focusing on patient care initiatives through his work at General Catalyst and as CEO of the Health Assurance Foundation. Klasko says there's time to act and the answer isn’t a “pause.” Among his recommendations are creating a 9/11-style commission for AI in health, adding AI safety to health system board agendas, a 30-minute rule for tackling rogue agents, and giving frontline staff the authority to pull the plug.

Across the tech industry, many of AI's own leaders are calling for oversight — self-imposed or from government. That debate is on, but where it will land is anyone's guess. Joe Grogan takes a different tack: the biggest threat in health care AI may not be too little regulation, but the wrong kind. And he has seen regulation from the seats where it gets made: the White House Domestic Policy Council, the federal health care budget at OMB, and before Washington, the industry side of bringing a cure for Hepatitis C to patients. Chip and Grogan discuss the federal government's proper role in regulating generative AI, the growing patchwork of state AI laws, why CMS reimbursement structures need to change, and how Europe's cautious approach is impeding the technology's growth. Grogan closes with his two biggest worries: fear-driven policy that bans innovation outright, and the risk to patients' most sensitive data as AI's appetite for it grows.

Dr. Brian Miller has seen medical technology regulation from every side — as a hospitalist, a former FDA official, and now an associate professor at Johns Hopkins University, where he leads a research group on market-driven approaches to FDA regulation and Medicare payment policy. In this episode, Chip talks with Miller about what happens when the FDA applies its 1976 medical device framework to AI — a technology that learns and changes.Miller's argument may surprise you: the manual system of medicine we have today is already less safe and less consistent than most people assume. What keeps him up at night isn't the speed of AI — it's the risk that fear-driven regulation will cost us the opportunities AI offers. The conversation was recorded shortly before the FDA released a discussion paper outlining possible regulatory approaches and inviting stakeholder feedback. Chip weighs in on the paper at the end of the episode. 

At the close of every episode, Chip asks his guests the same question: ‘What keeps you up at night?’ In this highlights episode, we share intriguing responses on AI’s role in health care. From deepfakes and misinformation to bias and the risk of losing the human connection at the heart of care, these highlights capture some of the top issues today.

***KFF's The Business of Health podcast is on a summer break and will return in September.***AI is racing into everyday medicine. The rules of the road are still being written. Dr. Michelle Mello of Stanford, professor at both the Law School and the School of Medicine, and co-leader of its Healthcare Ethical Assessment Lab for AI, joins Chip to address the questions that trail every advance this series has covered: who makes the rules, who ensures the technology gets it right — and who answers when it doesn't?