Senator Marshall: AI Will Not Replace Us—It Will Assist Us

Senator Marshall At Semafor's World of Work Event with Burgess Everett

Washington - U.S. Senator Roger Marshall, M.D. (R-Kansas), joined Burgess Everett at Semafor'sWorld of Work event to discuss his Patients Deserve Price Tags Act and lowering the cost of health care for Americans, AI use in health care, how AI will affect the workforce, the federal government's place in AI and data center legislation, and more.

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On current Senate priorities and the Patients Deserve Price Tags Act:

"You know, I think number one, the election is starting to wear heavy on our shoulders. Like I feel like I should be back - I'm up this year so I feel like I should be back in Kansas. And at the same time, I'm already focused on: can we keep the government open? That would probably be the big long-term goal here - September 30th. But then today we have our price tags bill. Patients deserve price tags, not surprise billing; it forces transparency and competition into healthcare. This is why I came to D.C., was to do this bill. This is a concept I had 15 years ago, I've been in Congress now nine years, and this is one of the big three reasons I came. And we're going to get it through committee today."

"Oh, I think it's going to pass the committee, or we wouldn't be on it. We've got lots of co-sponsors on both sides of the aisle; it is a bipartisan issue. This will bring down the cost of healthcare by $1,000 a month, is what we're expecting for an average family. There's no other bill out there, there's nothing out there that would bring down the cost of living more than this bill would. The President's very motivated, I think that we're all in Congress motivated, so I think it has a real chance of getting to the finish line."

"That MRI, you know, it might be $600 here, and it might be $3,000 here for the same quality. You know, I ran a hospital along with my doctor's practice, oversaw health departments - I've seen healthcare inside and out, and this is the great boogeyman. Why do you have to wait? You still won't know what the price is till three months from now."

On AI use in health care:

"Right. So, I think the big picture to me - my theme - would be 'human in the loop.' You want to be the human in the loop of AI. Even today, I use AI two or three hours a day and on Saturdays, I'll spend four or six hours researching something. You know, preparing for this meeting. So, what does AI mean to other people besides me? So, the fact-finding part of this - usually we had leg staff working on the fact-finding. So, I'm constantly working ahead and trying to get that fact-finding part out of this, and once I find the facts, then I can jump to the future. So, for the doctor, I think it's going to help us with the medical records; it's going to help the data entry portion of this - interpreting the data, making sure we're not missing something. Really, for the most part in medicine, AI is really machine learning. So, reading Pap smears, reading mammograms. If you show AI what we're looking for in a mammogram - so pull out all the ones that look like this, this, and this. But you still need a human in the loop to say, 'Okay, of these 10, this is the one that needs biopsied.'"

"So, speaking of legislation - our prior authorization bill, which we think will get across the finish line this year as well. Again, something I've worked eight years on to streamline prior authorization. So, AI will be used, but I think it can be used to an advantage. I think that if AI looks at…let's say that I need to replace someone's hip. If Medicare Advantage needs to say, 'Here's the boxes the doctor needs to check.' The nurses do that for us of course; we send it to the company, AI looks at that, and then great. And if one of the boxes is missed, AI kicks it out and then automatically emails my nurse and says, 'Why didn't you do physical therapy for three months?' or whatever it is. So, I think it can expedite it. Just like nuclear physics - it can be used for good, it can be used for bad."

On AI's effect on the workforce:

"Oh, absolutely, and I think we're already seeing it. Thousands of jobs at Meta, Amazon - it's already happening as well. But I'm not fearful of it. When my grandfather was born, 30% of Americans worked in agriculture: 30%. When my dad was born, 10% of Americans worked in ag, and today 1%. So those jobs - people went to the city. Now they're building airplanes or electricians, all those other types of things that require a human to do them. Now we're building airplanes in Boeing and Textron in Wichita, but they're using AI for quality assurance. So, they're able to scan all the rivets on this plane's wing at one moment, and then AI identifies - and again, it's machine learning, really - and says, 'This is the abnormal rivets. Now go back and look at it.' The human in the loop says, 'Yeah, we circle this, this, and this one,' and they go back and redo those as well. So, I'm fearful of it - not fearful, that's the wrong word - I'm cognizant of it; we need to embrace it. And I think as a Senator, who's going to solve the riddle here? I'm a big community college, technical college fan. I don't know how to solve the riddle - the federal government will throw money at it, but I really have faith in people back home in solving this riddle. Community colleges, technical colleges can quickly flex to the needs of the day. My wife and I are both community college graduates, first-generation college students as well - huge fans of it. So, I think if you're a data entry person right now, and even if you're a legal aide, all those types of things like that, you better be figuring out what Plan B is. And I think our community colleges and technical colleges are the players. The interesting thought I had yesterday - we were discussing this amongst ourselves at lunch, and I said, 'Certainly the early-entry accountants and lawyers, those jobs will be taken over by AI. But how do we get seasoned lawyers and seasoned accountants if they don't start here?' So, if you're an accountant that's graduating, you've got to figure out how you're going to get in that loop. Interpreting that data, I guess, and then giving it to your senior partners - you better be able to understand, once the data is assimilated, and be able to contribute to what this data means."

On AI data centers and whether Senator Marshall would support a statewide moratorium:

"Yeah, people in Kansas are on fire against them, and several dozen counties have placed moratoriums on them. Certainly, it is a state issue- it's a county issue, really, a zoning issue. But I certainly support their moratoriums - I think they need to figure out the water issue and the electricity issue. I don't know why we would give them any tax breaks because they really don't bring a lot of jobs after they're built. I mean, once they're built, there's some maintenance to them as well. But I certainly don't want it to drive up other people's electricity costs, and I see that over and over. Panasonic came to Kansas, built this huge plant, and they had huge electricity needs, and guess what? Everyone around in that area has got increased rates because of the increased demand as well. So, we need to solve the energy problem. The closed-loop systems are going to make up for a lot of it as well. But Kansans are really upset about it, and I've learned that we better listen and figure out. I wonder if, in the backdrop of this, they're really worried about the job issue, but we'll see how that plays out."

"Oh, I think certainly that's not a Senate decision to make. I don't think if I were a governor I would push for that; I'd rather try to keep the decisions local."

On federal AI legislation:

"Preemption is just impossible right now. I feel like Goldilocks - not too hot, not too cold, let's get it just right. You know, the big part of AI I'm probably most concerned about is pornography, going after children, some of those types of things. I am ready to pass some type of legislation that would impact it from that standpoint, but that would probably be part of a bigger social media legislation. The quick thing I would say about AI is the national security side of this. And I really think that's what's going to drive Congress's decisions up here more than the job issue- I think we're going to quickly respond to this. When quantum computing becomes a real thing combined with AI, I think that foreign countries, terrorists, and our own government will be able to break down blockchain technology and encryption as well. So, I think that's my big fear- what terrorists could do to assault all the cyber issues as well. So, quantum- keep your eye on quantum computing; I think it's real. And again, the good part though is we're going to be able to do precision medicine, precision agriculture, all those types of things by using this quantum computing. Looking at your DNA- let's say you have hypertension- if I got a menu of medicines I can use for hypertension now, which one of those is the best one for your DNA? You have type 2 diabetes, which one of the GLP-1s will be best for you? Rather than traditionally, it's kind of like, 'Well, here's the recipe we start with,' and it might take us six months or a year to get it right."

On a possible HELP Committee chairmanship:

"So, Lisa Murkowski would be in front of me as well- so they would have to give up their committee assignments. It would be a great honor, but certainly respect what Lisa and what Rand are going to do. But I think I have my experiences in the real world."

"So, it's not just health- it's health, education, labor, and pensions. And more than being a doctor- I mentioned I ran a hospital; I've overseen health departments. But the labor part of this- I was raised in a union town, I've worked at refineries, so I think I understand a little bit more about the labor part of this. Education- I think being a first-generation college student, I have a special appreciation for education as well, and want to make sure that our public schools and our public universities and colleges survive through all these transitions as well. They need to become more efficient, but I think that those experiences in life have prepared me for this moment. And if I have the opportunity, again, why did I come here? I think you can impact the priorities on that committee, of all the priorities out there. My leadership skills, what I've done, running a hospital, military experience, I think leadership is just so important right now. Picking up on all these things we're talking about today: where can government make a difference without overreaching?"

On Senator Marshall's reelection and whether Republicans have done enough on the economy:

"I think just to be frank here, the Democrats have money to burn. They're able to raise money at the candidate level way beyond what we're able to for a whole lot of reasons, so I think they've got the money to burn. They'll have a solid candidate as well. I'm confident, but not cocky. But we'll run this to the finish line. We're assuming it'll be a tight race, and we're taking it for real."

"So, I think we have, but the real issue is the price of gas. I've never seen anything like this- that my numbers just go up or down with the price of gas. We could talk about the Working Family Tax Cuts- manufacturing is booming back home because of it, best cattle prices in my entire lifetime, really good jobs back home as well. It's one of the best economies I've lived through. At the same time, there's a group of folks out there that's struggling. It's people my children's age, folks under the age of 40, the folks that graduated with large college debt; they didn't buy a house yet. And gas and groceries and living credit card to credit card is where they are right now. So, we need to continue to focus on the cost of living- which we did with our housing bill, and we're going to do today with our price tags bill as well. And then we got to get the price of gas down. And it's totally: can we get Iran wrapped up sooner than later, and get that price of gas down? Because we're energy independent, the price will come tumbling down if we just get this situation in Iran wrapped up."

On ending the war in Iran:

"Yeah, you know, I think every day's a new day. I stay true to my goals from the beginning: Iran cannot have a nuclear weapon; next, no boots on the ground. I hate war. My dad served, my brother served, I served, my son is serving now. We've lost 18 soldiers now, and that's why President Eisenhower said, 'I hate war, as only a soldier who lived it can, with all its brutality, futility, and stupidity.' I'm supporting our Commander-in-Chief; I'm supporting our troops. If we're going to be there, we need to rip the band-aid off and get this done sooner than later. When will Iran finally capitulate? You're dealing with religious, irrational theocrats, so I just don't think Americans have an appreciation for how hard it is to deal with people that have no value for human life- especially women's lives, children's lives; they're murdering tens of thousands of Christians, and on and on. So, it's really day to day, and I just hope and pray. I just left a bipartisan prayer breakfast; there are about 24 of us that get together once a week like this, and of course one of our prayers is that these wars would end. But we cannot let Iran have nuclear weapons. And right now, the doctor in me says the benefits outweigh the risk. But I sure mourn the loss of those 18 soldiers who made the ultimate sacrifice."

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