After moving to New York last year, I went looking for a primary-care doctor. If I wanted to see someone near my home soon, the choice was a physician a year or two out of residency—or no one. Experienced physicians with open calendars were in concierge practices, I learned. One practice said its membership fee was $12,000 a year. Another said $24,000.
Those are the going rates for what used to be ordinary care: someone who knows you, sees you
After moving to New York last year, I went looking for a primary-care doctor. If I wanted to see someone near my home soon, the choice was a physician a year or two out of residency—or no one. Experienced physicians with open calendars were in concierge practices, I learned. One practice said its membership fee was $12,000 a year. Another said $24,000.
Those are the going rates for what used to be ordinary care: someone who knows you, sees you promptly and has time to think about your test results. My situation wasn’t extraordinary. More than 100 million Americans lack a regular primary-care provider. Attentive care has become a luxury.
That situation results from the economics of medicine. Primary care pays less than almost any other specialty, often by six figures a year. Most medical students finish school owing more than $200,000. Primary care is a slow way to repay it, so fewer doctors choose the field. More than a quarter of Americans went to an urgent-care clinic in 2024. But urgent care addresses acute illness or injury and doesn’t usually detect the gradual changes that can become disease.
Our country is sick. Only 7% of American adults have healthy blood pressure, blood sugar, cholesterol and weight. The rest of us live on a slope from early risk to established disease even though we know what keeps people healthy. Researchers broadly agree that staying healthy longer comes down to four habits: exercise most days, eat mostly unprocessed food, sleep enough and stay socially connected. For early prediabetes and mild hypertension, those habits can rival a prescription.
But doctors no longer have time to tailor advice on living well for each patient. When was the last time a physician talked with you not about what is wrong today but about staying healthy over the next 20 years? For most people the answer is never.
Prevention happens when doctors notice and act on trend lines. Today’s medical system waits for red lines. A 10-minute visit isn’t long enough to spot and act on the trend. For a typical patient roster, recommended preventive care alone would take a primary care doctor more than 14 hours a day.
What fills the gap? Artificial intelligence. About 1 in 3 American adults have turned to a chatbot for health advice in the past year. Bots can sound like a concierge doctor. What AI does best is the underlying work: reading a patient’s health history, weighing symptoms and suggesting a treatment plan.
Sometimes sensible and sometimes wrong, the chatbot’s counsel is delivered with confidence. Americans consult AI for their health whether or not the advice is trustworthy. The questions: What will it take for AI to dispense reliable medical counsel? Can medical practices be paid to act on it?
Here is what it would take. Begin with patient records. A chatbot working from one lab result can only make a guess. The same chatbot, shown years of labs, imaging and diagnoses, can catch glucose, blood pressure and weight drifting up together, years before any one measure crosses a line. But if you ask a hospital today to send your records to a new doctor, you can wait months. The records should follow the patient automatically, and the patient should decide who sees them, a new doctor or an AI.
Next, prove that the advice AI offers is accurate. In a recent study of real clinical cases, some AI models gave safer advice than generalist physicians, but other models made a serious mistake in more than 1 in 5 cases. Today most health AI escapes federal review by calling itself a wellness product. Washington solved this problem for cars decades ago. The government crash-tests popular models and publishes the ratings. Health AI needs its own crash test: a rotating set of real clinical cases, kept confidential, presented to any AI that Americans consult for medical advice. The results should be published where patients can see them.
Finally, pay medical practices to act on what the AI finds. Most practices are still paid by the visit, not for whether patients stay healthy, so a risk flagged years early is a warning nobody is paid to heed. Medicare’s new Advancing Chronic Care with Effective, Scalable Solutions model, or Access, which began July 5, pays for improvement. Medical practices collect their payments in full only when their patients’ blood pressure or blood sugar actually improves. Paying for outcomes instead of visits is the missing incentive that turns what the AI flags into care someone is paid to deliver. But most of Medicare’s payment experiments have failed, so private insurers and employers should test outcome-based models of their own. What has changed is the economics: A doctor’s time is scarce and expensive, and an AI’s is nearly free.
AI is already in almost every pocket. It can transform healthcare with the record, the proof and the payment. Build them, and the forward-looking concierge care some have today could become available to anyone with a phone.
Mr. Rosenblatt is founder of Being, a health-longevity company, and a member of the HCPLAN Tech-Enabled Health Care Workgroup, a federal advisory panel convened by the Centers for Medicare and Medicaid Services.
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