Borikén’s Chronicle: A Story of Healthcare in the 2037 Scenario
Key Points
- The central premise of this “story” is set in the future of Puerto Rico (P.R.) in 2037, driven by Demis Hassabis, a Nobel Prize winner in Chemistry in 2024, who predicted that AI would eradicate diseases within a decade. The scenario: Medical science has achieved a monumental breakthrough by eliminating the major diseases that have historically burdened humanity. P.R. has emerged as a cornerstone of the re-evolution of AI-driven healthcare.
- In this transformed health landscape, the primary concerns of the healthcare system will shift almost entirely to managing acute trauma and addressing unprecedented changes to the healthcare structure, including its economics.
- The rural-urban divide, already pronounced in 2024, deepened, leading to disparities in healthcare access, economic opportunities, and quality of life.
- It is essential to recognize that the story's scenario represents a notable departure from the typical gradual progress often observed in medicine. Eradicating such a wide array of complex and diverse diseases implies breakthroughs in prevention, cure, or both on a scale that would fundamentally change human existence.
- As a story, it features a fictional narrative along with baseline facts that serve as the foundation for projections. Certain fictional stories have inspired technological innovations over time, as found in the literature.
Borikén’s Chronicle: A Story of Healthcare in the 2037 Scenario
In the spring of 2037, San Juan's skyline was illuminated by the Caribbean sun and the serenity of the Atlantic Ocean, showcasing a harmonious mix of modern, AI-driven medical complexes and historic fortresses such as El Morro. Nobel Prize in Chemistry winner, 2024, Demis Hassabis' prediction—that AI would eradicate all diseases within a decade—had reshaped Puerto Rico’s healthcare landscape, transforming the island into a hub of trauma care and medical tourism. With its Level I trauma center now acting as the cornerstone of a streamlined health system, the Puerto Rico Medical Center (Centro Médico) in Río Piedras stood as the beating heart of the island. The economic ripples of this revolution, driven by AlphaNet’s successors to AlphaFold, redefined Puerto Rico’s economy, workforce, and societal fabric.
Healthcare Sector Re-evolution
By 2037, Puerto Rico’s healthcare system had pivoted entirely to acute care. Centro Médico, once strained by a $500 million budget burdened with uncompensated chronic disease cases in 2024, now thrived on a leaner $400 million budget. With cancer, diabetes complications, and infectious diseases eradicated by AI-designed therapies, the hospitals’ beds turned over rapidly, serving trauma victims from car crashes, industrial accidents, and hurricane injuries. ICU beds, freed from septic patients, are now dedicated to post-surgical recoveries, reducing average patient stays from 14 days to 4. This efficiency slashed operating costs by 30%, stabilizing Centro Médico’s finances and allowing a $50 million investment in state-of-the-art trauma equipment, including AI-guided robotic surgery suites.
Private hospitals, like Hospital Auxilio Mutuo and the Metro Pavía Health System, faced a reckoning. The oncology and cardiology wings, once their revenue drivers, were closed by 2035 as AlphaNet eliminated chronic diseases. Consolidation, already underway in the 2020s, culminated in a single, coordinated hospital network by 2037, with Pavía absorbing smaller facilities, such as the former HIMA hospitals. Auxilio Mutuo, a nonprofit, pivoted to medical tourism, capitalizing on underutilized surgical suites to attract Latin American patients for elective procedures like cosmetic surgeries and joint replacements. This sector generates $1 billion annually, employing 5,000 workers (with an average salary of $60,000) and contributing 5% to San Juan’s GDP. However, for-profit hospitals struggled; trauma care, while critical, was less lucrative than elective procedures, leading to the closure of smaller facilities in Caguas and Ponce, which resulted in the loss of 2,000 jobs.
Public Health and Fiscal Relief
The eradication of infectious diseases like dengue, chikungunya, and leptospirosis, which once cost Puerto Rico $100 million annually in response to outbreaks, freed up public health resources. The Department of Health redirected $200 million from chronic disease programs to injury prevention, launching campaigns for hurricane-proof housing and workplace safety. Life expectancy has soared to 88 years, up from 79 in 2024, resulting in a healthier elderly population. Unlike the dementia crisis projected to cost Puerto Rico $2 billion annually by 2025, AI-driven therapies eliminated Alzheimer’s, saving $1.5 billion in Medicaid funds. These savings alleviated the island’s Medicaid funding cliff, allowing a $300 million investment in rural clinic upgrades and telehealth networks.
Healthcare spending per person dropped from $5,200 in 2019 to $3,500 by 2037, as chronic care costs vanished. Federal Medicare and Medicaid grants, previously stretched thin, now fund infrastructure projects, like a $500 million renovation of Centro Médico’s aging facilities. This fiscal relief boosted Puerto Rico’s GDP growth to 3% annually, a stark contrast to the stagnation of the 2020s, with healthcare’s share of the economy shrinking from 15% to 8%.
Biotech and AI Innovation
Puerto Rico leveraged its pharmaceutical manufacturing legacy to become a regional hub for AI-driven biotech. In 2037, new biotech parks in Manatí and Barceloneta, built on former Pfizer sites, housed startups such as BioCaribeAI, which utilized AlphaNet to develop trauma-specific nanotherapies. These parks have attracted $2 billion in venture capital, creating 10,000 jobs for data scientists, bioengineers, and roboticists, with average salaries ranging from $80,000 to $150,000 per year. The University of Puerto Rico’s Medical Sciences Campus, in partnership with the Mayagüez campus, launched an AI Health Institute, training 1,000 students annually in bioinformatics, with graduates earning $100,000 starting salaries. This sector added $3 billion to the economy, rivaling tourism’s contribution.
Employment Shifts and Workforce Challenges
The healthcare workforce contracted as chronic disease specialists became obsolete. Oncologists, cardiologists, and endocrinologists, like Dr. Carmen Rivera, a 48-year-old former diabetologist in San Juan, retrained as emergency physicians or rehabilitation specialists. Carmen’s income dropped from $250,000 in 2028 to $150,000 by 2037, but she found stability at Centro Médico’s trauma unit, overseeing AI-guided fracture repairs. Total healthcare employment fell 20%, from 50,000 in 2024 to 40,000, with losses in nursing and administrative roles. However, demand surged for trauma surgeons, orthopedic specialists, and AI health technicians, resulting in the creation of 5,000 new jobs, with an average salary of $120,000.
Retention remained a challenge. In 2024, 30% of medical graduates left for the mainland; by 2037, improved hospital finances and quality of life kept 70% on the island. Dr. Javier Torres, a 35-year-old trauma surgeon in Bayamón, stayed due to Centro Médico’s cutting-edge facilities, earning $200,000 annually. Yet, rural areas like Utuado struggled, with clinics understaffed due to limited access to AI infrastructure, forcing professionals to relocate to urban centers.
Regional Disparities and Social Effects
The economic boom was uneven. San Juan and Mayagüez flourished, with GDP per capita rising to $40,000, driven by biotech and medical tourism. Hotels in Condado thrived, hosting international patients, and added 3,000 hospitality jobs. In contrast, rural municipalities lagged, with outdated clinics unable to fully utilize AI's capabilities. Healthcare spending in rural areas remained at $2,000 per capita, half of the urban levels, and 10% of rural hospitals closed, resulting in the loss of 1,000 jobs.
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In Lares, a mountainous coffee-growing region, the local diagnostic center, Centro de Salud Familiar, struggled with outdated infrastructure. In 2024, it served approximately 5,000 patients annually, many of whom had diabetes or cancer. By 2037, with chronic diseases eradicated, its case load had dropped to 2,000 trauma and injury cases; however, limited broadband access hindered the integration of AlphaNet. Patients waited weeks for AI-designed therapies, unlike San Juan’s same-day delivery. The center’s budget, cut from $10 million to $6 million, couldn’t afford upgrades, and its staff of 50 dwindled to 30, with nurses earning $40,000 compared to $80,000 in urban clinics. Rural GDP per capita stagnated at $20,000, half of San Juan’s, and 15% of residents migrated to urban centers or the mainland searching for better opportunities.
Utuado, another rural municipality, faced similar challenges. The Hospital Metropolitano closed in 2035 after losing revenue from chronic diseases, forcing residents to travel 40 miles to Centro Médico for trauma care. A hurricane in 2036 exposed the gap: 50 injuries overwhelmed local first responders, and delayed access to AlphaNet led to complications in 10% of cases. A viral X post from a Utuado nurse, María Vargas, decried the “urban bias” of AI healthcare, gaining 10,000 reposts and prompting a $100 million federal grant for rural telehealth. By 2037, only 20% of Utuado’s clinics had full AlphaNet access, and unemployment among former healthcare workers reached 12%.
Adjuntas, renowned for its lush forests, experienced an economic decline as young professionals left the area. The local clinic, serving 18,000 residents, relied on a single AI terminal that was often offline due to power grid issues—a legacy of Hurricane María in 2017. Dr. Luis Delgado, a 42-year-old general practitioner, earned $90,000, down from $120,000 in 2028, and spent hours coordinating patient transfers to Mayagüez. While rural elderly residents were healthier without chronic diseases, they faced mobility issues and relied on underfunded home care services. Local businesses, such as pharmacies, closed as AI-driven telehealth services reduced demand, resulting in the loss of 200 jobs.
In general, the healthier population on the island spurred growth in wellness and tourism. Puerto Rico’s elderly, now free of chronic diseases, fueled demand for active aging services, like yoga retreats in Rincón, adding $500 million to the economy. Tourism revenue hit $10 billion, as Puerto Rico marketed itself as a “health haven.” However, income inequality widened; biotech professionals and trauma specialists earned 10 times more than service workers, whose wages stagnated at $25,000.
Unintended Consequences and Ethical Concerns
The shift to trauma care strained emergency services during hurricanes, a frequent threat. A 2035 storm exposed gaps in rural preparedness, resulting in 200 injuries that overwhelmed local clinics. A 2037 X thread criticized AlphaNet’s focus on urban hospitals, accusing it of neglecting rural needs. Ethical debates emerged over medical tourism, as wealthy foreigners accessed elective surgeries while some rural Puerto Ricans waited for basic care. The government responded with a $50 million equity fund to subsidize rural access to AI, but progress was slow.
A Healthcare Professional's Perspective
Dr. Elena Morales, a 40-year-old emergency physician at Centro Médico, felt the economic shift personally. In 2024, she juggled chronic disease cases and burnout, earning $180,000. By 2037, her focus on trauma care was less stressful, but her salary dropped to $140,000, reflecting shorter patient interactions. She retrained in AI diagnostics, enhancing her skills, and moonlighted at a medical tourism clinic, which added $30,000 to her income. Elena marveled at Puerto Rico’s transformation—dengue-free summers, cancer-free families—but worried about rural patients like her cousin in Yauco, who faced a two-hour drive for care. At a 2037 conference in Old San Juan, she heard a virtual keynote from Hassabis, now a global health icon, urging vigilance against AI’s biases. Elena nodded, knowing Puerto Rico’s economic gains depended on ensuring no one was left behind.
Dr. Luis Delgado in Adjuntas faced a different reality. His clinic’s single AI terminal, installed in 2036, crashed during power outages, forcing manual diagnoses. Luis retrained in trauma care but considered relocating to Mayagüez, where salaries were 50% higher. His patients, like 70-year-old farmer José Rivera, benefited from disease eradication but struggled with injury follow-ups, traveling 30 miles for physical therapy. Luis joined a 2037 X campaign, #SaludParaTodos, which demanded rural broadband upgrades and gained 5,000 supporters but received little government action.
María Vargas, the Utuado nurse, became a rural advocate. After her hospital closed, she took a $35,000 telehealth job, coordinating AlphaNet consultations from home. Her X post highlighted the two-hour drives rural patients face to Centro Médico, sparking urban sympathy but slow policy change. María’s teenage son, Miguel, enrolled in UPR’s AI Health Institute, hoping to design rural-friendly AI tools, but she worried he’d leave for San Juan’s higher wages.
Economic and Social Implications
The rural-urban divide reshaped Puerto Rico’s economy. Urban areas captured 80% of the island’s $4 billion healthcare investment, with San Juan and Mayagüez gaining 15,000 biotech and trauma jobs. Rural areas, which contribute only 10% to the GDP, lost 3,000 healthcare jobs as clinics closed. The Department of Health’s $200 million reallocation to trauma equipment favored urban hospitals, with only $30 million reaching rural areas. Medical tourism boosted urban tax revenues by $200 million, funding San Juan’s infrastructure, while rural municipalities faced budget cuts, reducing school and road maintenance.
Socially, urban residents enjoyed seamless healthcare, with telehealth kiosks and wearable sensors ensuring instant access to AlphaNet. Rural communities, however, relied on sporadic mobile clinics, and 20% of the elderly lacked home care. Migration to urban centers increased rural depopulation by 10%, leaving communities like Lares hollowed out, as coffee farms struggled to find workers. A 2037 X thread by a rural mayor accused urban-centric policies of “abandoning El Campo, but urban leaders argued that economies of scale favored centralized AI hubs.
Bridging the Gap
By late 2037, grassroots efforts gained traction. The $100 million federal telehealth grant installed 50 AI terminals in rural clinics, serving 100,000 residents. UPR’s AI Health Institute launched a rural outreach program, training 200 students to maintain AlphaNet systems in municipalities like Adjuntas. Biotech startups, pressured by public outcry, piloted mobile AI labs in Utuado, reducing therapy wait times to one day. Still, full equity remained elusive—rural broadband coverage reached only 60% of households, and power outages persisted.
A Glimpse of Hope
At a 2037 festival in Lares, Dr. Luis and María watched Miguel present a prototype for a solar-powered AI diagnostic device, designed for rural clinics. Urban doctors, like Elena, who visited via teleconference, pledged their support. As salsa music filled the plaza, José Rivera, now healed, danced with his granddaughter. The divide was stark, but Puerto Rico’s spirit—resilient and communal—hinted at a future where AI could heal not just bodies but the island’s fractured landscape.
References
Galíndez LLC and Estudios Técnicos Puerto Rico Hospital Industry and financial situation study published in February 2024
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