iBCI, Quadriplegia, Jedi Knights, and the Transhumanist Consumer Business Model

I do not think CMS can be restructured any time soon.

However, if the community of physicians, scientists, regulators, and people living with these conditions can sculpt good legislation ideas, that they could hand it off to patient advocacy groups who would then press members of Congress (both Senate and House) to get a specific iBCI-coverage bill that ensured 

• coverage based on function and biomarker not disease etiology

• payment of entire care pathway, not just device-one-and-done, eg ensured that all the testing previous to implant and all the skilled rehab post-rehab was reimbursed better than current alternatives 

My understanding (which may or may not be accurate):

• CMS is legally structured in a way that it is obligated to ignore saving taxpayer money by getting patients and caregivers back to work. Only Congress can mandate this novel reimbursement approach. 

• All implantable medical devices are paid for as one-and-done: the person is admitted to the hospital with a specific DRG code that guarantees a certain $ amount. Most of that money is the facility fee that the hospital keeps, and the rest is a provider fee for the surgeon. The hospital then pays the vendor of the device. If a person needs MRIs, outpatient OT, PT, neuropsych testing etc before after during, they are all paid entirely separately from that one DRG payment. That is where the system falls apart for a technology like iBCI. 

EM has been transparent about the desire to make iBCI as a "wizard hat" to merge human brains with AGI as an existential salvation of "if you can't beat them, then join them." Does this blur the line between a medical device to help those with neurological disease and injury and a "cosmetic neurosurgery" for able-bodied people?

Will there be iBCI companies adopting a business model akin to charging ultra-wealthy able-bodied people for a ride on a suborbital flight?

If yes, then all one needs is a handful of adventerous billionaires

• who want the thrill of a being like a real-life Jedi where they can

  • simply think a thought and have the lights turn off and on

  • words appear mysteriously on a screen

  • speakers read out their thoughts like a hovering angel

  • communicate telepathically with other implanted billionaires

  • levitate objects by silently steering clouds of microscopic gnat-like drone-robots with their minds

• each pay several million per implant, and that is enough to sustain that niche Neuromancer/Matrix/cosmetic neurosurgery business model

This pay-to-play model requires a relatively small number of customers, and thus would be robust even in scenarios like global warming exceeding 2 degrees Celsius by 2040 to start collapsing the global food supply.

In terms of regulations, companies seeking to offer that type of consumer brain implant, would want to abide by FDA regulations, just like cosmetic surgery devices follow FDA regulations.

While there appears to be a libertarian strain among transhumanists- such that one would expect them to chafe at any type of regulation, they know that their billionaire customers will expect that FDA imprimatur, thinking if it is safe enough to put in the brain of person dying of ALS, then surely it will be safe enough to put in their brain. Implanting an iBCI into a healthy adult will obviously be off-label and would raise serious ethical concerns, and I don't see how CMS/private insurers would reimburse. Instead, I infer it would be to charge several $M per implant out of pocket.

To keep up good public relations, they may even subsidize the implants for the people with ALS, a kind of unusual neurotech Robin Hood model where the able-bodied billionaires pay for iBCI for people with severe motor disabilities. 

While the sensorimotor/Broca's interface will be enough to afford Jedi telepathy and telekinesis, ultimately to merge with the AGI, the transhumanists must move beyond iBCI as a narrow input/output pipe and towards expanding the substrate of neural processing itself.

This is why there are physicists excited about whole brain interfaces that can stimulate and record from every individual neuron, simultaneously, in the entire brain. I get the impression that there is an assumption that just like adding enough parameters to a transformer model suddenly yields a state-change-like jump in performance, that if the channel count on iBCI goes up enough that this will magically and automatically allow the human to connect to the AGI and become a godlike superintelligence, who will look upon other humans the way humans now look down to cows, dogs, ants, paramecia.

iBCI is the only medical device technology where these kinds of issues could come up. Physician-scientists working on novel cardiac devices, or bioprinting organs to transplant, etc, are not pulled in to these discussions about transhuman evolution and AGI merging.