Medicine has a well-established model for distributing liability across physicians and tools: whoever caused the failure bears the liability. AI vendors have quietly opted out of it — and the contracts they're asking health systems to sign reflect that.

In the first week of January 2026, Utah, and OpenAI each drew a different line around health AI—and liability. Utah’s Doctronic pilot treats AI like a clinician, with malpractice coverage and preserved remedies. OpenAI adds medical-record syncing under unchanged disclaimers and a $100 cap.

Blue Cross Blue Shield of Massachusetts just posted a $400 million loss—the worst in their history. The culprit? GLP-1 medications that could eventually save insurers billions. The costs hit today, the savings arrive years later, and health systems are caught in the middle.

Lawmakers are moving to ban AI-only insurance denials, requiring human sign-off for every case. It sounds compassionate, but it locks us into the same slow, opaque, costly system. The smarter move is AI with guardrails — transparency, audits, and contestable rationales — for faster, clearer, more accountable decisions.