Should Labs impose Desperation Premiums?

Every so often it's useful to transpose a few practices from outside the laboratory into the laboratory, just to see how we would evaluate them.

The new Tech powers are gleefully implementing a system called "surveillance pricing", which they sell as a dynamic way to sell things to customers, except it turns out that they really only want the pricing to go in one direction: up. So if they know your income levels, they raise your prices. So if they know your need to travel on short notice, they raise your airplane ticket prices, etc. If you're an Uber Driver who regularly accepts all jobs, then Uber will reduce the payment they offer you, vs. an Uber driver who is less reliable. Rather than reward your loyalty, let's extract more profit from it.

https://doctorow.medium.com/https-pluralistic-net-2026-04-06-empiricism-washing-veena-dubal-d63fef485503

This sounds well and good, a great way to maximize revenues. Why don't we apply that to healthcare?

Are you feeling chest pains? You're probably willing to pay a bit more for that Troponin-I test now. Want a faster TAT?  Well, you're in luck: all you need to do is upgrade to premium testing level...

Are you a cancer patient? You're probably willing to pay more for your tumor marker tests. Has one round of chemotherapy failed? Then you're probably willing to pay even more for the slimmer hope offered by a second round. Our algorithm has determined your insurance is definitely willing to pay for it.

Do you have a family history of a genetic disease? Clearly, the test for that disease is worth more to you than an ordinary person.

It's obscene. Exploiting people for profit may be a national past-time, but our new data centers are maximizing the brutality:

"Combine monopoly, weak privacy law, weak competition law, and digitization, and you don't just make surveillance pricing possible — at that point, it's practically inevitable. This is what it means to create an enshittogenic policy environment: by arranging policy so that the most awful schemes of the worst people are the most profitable, you guarantee that those people will end up organizing commercial and labor markets."

Even our best efforts to regulate this are carving out massive loopholes:

https://doctorow.medium.com/https-pluralistic-net-2026-04-30-something-must-be-done-there-ive-done-something-9d64ad603bd2

Yes, AI has beneficial applications. But the worst applications seem to be driving the market, making the worst people also the wealthiest.

Healthcare pricing, particularly in the US, is already an atrocity, perhaps even AI can't figure out how to make it worse.