War -- and Healthcare -- On the Cheap

Like many of you, I’m watching the war in Ukraine with great interest and much support. For all the fuss about expensive weapons -- like F-16 fighters, Abrams tanks, Stryker and Bradley armored fighting vehicles, Patriot missile defense systems, Javelin anti-tank missiles, Himars long range missiles, and various types of high tech drones -- what I’m most fascinated with is how Ukraine is using inexpensive, practically homemade drones as a key weapon.

Making your own (combat?) drone Credit: Bing

It's a new way of waging war.  And when I say “waging war,” I can’t help but also think “providing health care.” It’s not so much that I think drones are going to revamp health care, but if very expensive weapons may, in fact, not be the future of warfare, maybe very expensive treatments aren’t necessarily the future of healthcare either.

Just within the last two weeks, for example, The New York Times headlined Budget Drones Prove Their Value in a Billion-Dollar War, AP said Using duct tape and bombs, Ukraine’s drone pilots wage war with low-cost, improvised weapons, ABC News reports: Inside Ukraine’s efforts to bring an ‘army of drones’ to war against Russia, and Defense News describes how Cardboard drone vendor retools software based on Ukraine war hacks.

This is not the U.S. military-industrial complex’s “shock-and-awe” kind of warfare; this is the guy-in-his-garage-building-his-own-weapons kind of warfare.

Ukraine’s minister for digital transformation, Mykhailo Federov, says the government is committed to building a state-of-the-art “army of drones.”  He promises: “A new stage of the war will soon begin.”

NYT detailed:

Drones made of plastic foam or plastic are harder to find on radar, reconnaissance teams said. Ukraine buys them from commercial suppliers who also sell to aerial photographers or hobbyists around the world, along with parts such as radios, cameras, antennas and motors. The drone units mix and match parts until they find combinations that can fly past sophisticated Russian air defenses.

“The doctrine of war is changing,” one Ukrainian commander said.  “Drones that cost hundreds of dollars are destroying machines costing millions of dollars.”  The AP discusses how an elite drone unit – “a ragtag group of engineers, corporate managers and filmmakers” -- “assembled with just $700,000, has destroyed $80 million worth of enemy equipment.”

Dmytro Kovalchuk, CEO of drone manufacturer Warbird, told ABC News: “In Ukraine, not a single state enterprise is producing drones. It's all private enterprises, sometimes partnerships…It [the drone] costs $1,000 and can destroy a tank that costs $500,000.”

And it is not just attacking tanks or just from the air; Just last month, Ukraine used a sea drone to damage an expensive Russian warship. 

One of the many reasons the war in Ukraine is important is because China is watching closely to see what might happen if it were to invade Taiwan, and I’m hoping Taiwan and its allies, including the U.S., are paying close attention to the importance of drones. NYT is skeptical, charging: “A new generation of cheaper and more flexible vessels could be vital in any conflict with China, but the Navy remains lashed to big shipbuilding programs driven by tradition, political influence and jobs.”

“The U.S. Navy is arrogant,” said retired admiral Lorin Selby, who used to head the Office of Naval Research. “We have an arrogance about, we’ve got these aircraft carriers, we’ve got these amazing submarines. We don’t know anything else. And that is just wrong.”  Another former officer agreed: “Right now, they are still building a largely 20th-century Navy.”

“We are trying to improve Navy power, but we need to do more than that: We need to reimagine Navy power,” he also said. “We’re kind of at a pivotal point in history. It is vital that we throw off old conventions.”

It’s not that the Navy is unaware of the potential of drones; as NYT acknowledged, it has been testing integrating “drone boats, unmanned submersible vessels and aerial vehicles capable of monitoring and intercepting threats over hundreds of miles.” It’s more that it isn’t a priority; the budget devoted to it, one officer lamented, is “the dust particle on the pocket lint of the budget.”

The Wall Street Journal was more optimistic, reporting on details of a recent speech from Kathleen Hicks, the deputy secretary of defense. She vowed that DoD “plans to spend hundreds of millions of dollars to produce an array of thousands of air-, land- and sea-based artificial-intelligence systems that are intended to be ‘small, smart, cheap’”

Of course, when fighter planes now can cost $135 million each, aircraft carriers cost $13b apiece, and the overall DoD budget is closing in on $1 trillion annually, spending “hundreds of millions” on alternative weapons does kind of sound like pocket lint.  The Pentagon admits that China is “displaying growing numbers of autonomous and teaming systems,” including “a substantial amount of development displaying efforts to produce swarming capability for operational applications.” They’re taking this seriously.

“The hundreds of millions of dollars range, while a great start, would only provide hundreds of the truly capable ocean drones we need to establish true deterrence to China and other adversaries,” Kevin Decker, chief executive of Ocean Aero, told WSJ.  “They’ve got to start somewhere, and they’ve got to start now.”

“Quite frankly, industry is well ahead of us,” Marine Lt. Gen. Karsten Heckl, deputy commandant for combat admitted. “So we’re trying to catch up but [there is] a lot of promise.”

As the Ukrainian commander said, the doctrine of war is changing.  Weapons systems started in the 1990’s (F-35 fighter) or early 2000’s (the Gerald Ford aircraft carrier) are just going into service and are already outdated.  Admiral Selby has it right: “It is vital that we throw off old conventions.”

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So it is with healthcare.  Capital sinks like hospitals are healthcare’s aircraft carriers – once essential, but now vastly expensive and hugely vulnerable. Prescription drugs that can cost hundreds of thousands, if not millions, of dollars annually are 20^th century pricing in a world of AI drug development, CRISPR, and 3D printing, to name a few innovations.  Adding facility fees to even telehealth visits is (stupid) 20^th century thinking.  Health insurance premiums that are unaffordable even to middle class customers reflect 20^th approaches.

Similarly, I’m not worried that healthcare won’t find many uses for AI; rather, I’m worried that it will co-opt AI into making existing cost structures even higher, rather than using it to make healthcare become “small, smart, and cheap.”

The doctrine of healthcare must change.  Where is its ragtag team of engineers, computer scientists, physicians, and entrepreneurs making it faster, smaller, smarter, cheaper, more personal, and definitely more effective?