Amazon launches Amazon Care, a virtual medical clinic for employees
cnbc.com
cnbc.com
It’s just a remote care benefit. My current employer offers it, administered by a vendor, and it’s separate from your actual insurance. You can call or video chat, send pictures, and even get prescriptions filled off-hours. It comes in handy for a lot of common quick scenarios.
The only news is that Amazon is big enough to self administer it.
It’s pretty much inevitable that companies of that immense size save money by self-administering or self-insuring many benefits like this.
A lot of people on HN seem to have an "assume everything is okay until there is insurmountable evidence that it has been catastrophically wrong for a long time" approach to regulating corporations. Historically this approach has allowed corporations to abuse workers, customers, the environment, and whoever/whatever else is profitable to abuse.
Amazon isn't some ethical outlier of a corporation: they have plenty of ongoing history of worker abuses and leveraging their power in one sector to gain unfair advantage in another. So why would this be any different?
So no, I don't think people are misunderstanding this, I think they're approaching what Amazon is doing with an appropriate level of skepticism. It's incredibly naive to assume that Amazon is only going to use this in the positive ways outlined in their press releases.
2. Amazon can leverage this to guide healthcare providers and employees toward treatments which benefit Amazon rather than the patient. A simple example would be favoring outpatient treatments which allow the employee to keep working rather than inpatient treatments which don't, regardless of which is actually the appropriate treatment. They don't have to explicitly instruct doctors to do this, they merely have to fund outpatient more, make it more prominent in their internal documents, and create more paperwork hoops for people to jump through to get inpatient treatment. Similarly, they can try to steer women away from pregnancy (and therefore maternity leave) by overstating the dangers of pregnancy, and overfunding tests which are likely to create concerns.
3. Medical providers are legally unable to share most medical data with your employer. This becomes effectively unenforceable when your medical provider is your employer.
This information can be used in ways that harms workers, such as terminating employees with costly medical conditions, conditions which might cause them to miss work, mental health issues, or conditions with a social stigma such as AIDS or alcoholism.
Before you say, "they can just use their healthcare through their medical insurance like before for things they don't want their employer to know about", consider that people frequently don't understand privacy, and don't understand that this information could be used to harm them, so many people won't do this. People commonly make the mistake of assuming amoral corporations will behave ethically. Privacy, especially medical privacy, should be default-on.
Everything you've said here is effectively worst-case scenario and you are treating that pessimism as skepticism when they aren't the same thing.
So let's be clear on a few aspects of this that are bordering on absurd:
1. The actual incentive for Amazon is building a remote healthcare business. The idea that Amazon is going to somehow force providers to direct you toward "cheap" treatments is asinine. Why in the world would they care? This is entirely separate from Amazon's insurance, which it doesn't own.
2. No they can't. Twice now the premise of your argument is that Amazon is somehow able to dictate what healthcare providers do. They can force a nurse to overstate the dangers of pregnancy? Are you serious?
3. This is either the most naive statement you've made, or a bold-faced lie. I'll assume the former. The treatment itself is provided by Oasis Medical. They are not owned by Amazon. Amazon owns the technology. Oasis owns the care, including, patient records.
I'll agree with one thing you said: people don't understand privacy. This is no exception. While invasive invasions of privacy only require a visit to a website, medical privacy has been default on for decades.
Another thing people on HN don't seem to understand: There is an enormous different between skepticism and pessimism. The latter makes it incredibly easy to ignore the content of your messages as nothing more than a conspiracy theorist. There are probably a sea of valid complaints about this program, unfortunately they get buried under a sea of absurdity that the world outside of HN completely ignores.
It's unfortunate.
2. This is a straw man argument. I did not say what you are accusing me of saying. Anyone can read the post you are responding to and see that I'm correct.
I didn't say they would force a nurse to do anything. In fact, I explicitly said that they wouldn't instruct doctors to do this, and I'll say now that the same goes for nurses and all medical staff. Directing employees away from treatments doesn't have to be so heavy-handed as forcing medical staff to do anything: I explained how they could go about this more subtly in my post. I'm open to you criticizing my posts, but I do insist that you critique what I've actually said.
To expand a bit, this could be as simple as writing the informational materials on each of the services they provide, placing negative side effects more prominently for treatments they want to discourage. It's very hard to accuse anyone of wrongdoing if they put side effects for one treatment in red on the front of the pamphlet, and hide them for another treatment in 6pt font at the back of the pamphlet, but these sorts of strategies have real-world affects on people's lives.
3. I may be misunderstanding the article (and it's currently down for me, so I can't check my memory), but my impression is that this clinic is paid for by Amazon directly, so that employees won't have to go through their health insurance for basic treatments. Ostensibly this reduces the cost of health insurance. But it's highly unlikely that Oasis bills Amazon one opaque number and Amazon just writes them a check: Amazon (reasonably) would want to know what they're paying for. And once you know what you're paying for, that gives you a lot of information about your employees. For example, filling prescriptions is one service provided: if there is a line item for Rilpivirine the employee probably has HIV, if there's a line item for Disulfiram they probably are an alcoholic. They don't need full access to medical records--merely having access to medical billing gives them a lot of information which is inappropriate for an employer to have access to.
You're casting these possibilities as if they're conspiracy theories, but these are all things which health insurance companies already do, particularly the first one. The incentives are slightly different for Amazon, but it's not outlandish that when they start taking on some of the responsibilities of a health insurance company, they would also pick up some of the abuse behaviors of a health insurance company.
I think this just serve as another reason why employer-based healthcare insurance is a weird anomaly that should be done away with. If you work at a large company then your health plan will almost certainly be self-insured, and now not only are you a worker for said company you’re now this risk that is being watched and managed by your company that knows every healthcare interaction you have. It’s creepy.
if only i lived in appland, canada where the apps roamed free (aka some major city)
What’s old is new again, as they say.
That however makes sense. An industry complex with a tendency for grave, life-threatening injuries such as a shipyard is well advised to host an on-site clinic so that people injured get faster access to proper care instead of the basic stuff that EMTs can provide.
This is the root of the newsworthiness of Amazon's entries into new businesses.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383159/, https://www.bmj.com/content/324/7330/135.short, https://about.kaiserpermanente.org/our-story/news/accolades-..., https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.19.2.1...)
Want to see a therapist? Wait is two months but we can prescribe you some drugs within a week if you'd prefer that. Feeling a potential serious adverse reaction to those drugs? We'll call you back in a month, maybe, or enjoy your ER visit. First time patient needing some new medications? Here is a three month supply, see you again in three months, hope they work out and you don't need any adjustments.
But now there's no protective layer between the employee, their personal data trail and the employer. I would suspect that for some diseases / consitions this situation is going to discourage employees to seek care.
Isn't this the crux of the issue? there is a huge conflict of interest going on here.
I described very clearly that I needed a refill of a common non-scheduled medication. They took my credit card info and charged me $50, transferred me to the NP who immediately told me they could not prescribe it.
A waste of time and money. I went to the NP at the local CVS MinuteClinuc and had the bottle of pills in 30 minutes.
Maybe taking someone's money without providing a service is a one-in-a-million case. It is still encoded in workflows and software, and no easy way to get a refund. So, instutionalized.
I am not blaming Amazon for anything. I am pointing out that your health problems need to be followed up, with your general practitioner (GP), if you have to visit an urgent care, even if you are "healthy". In many cases, all you really need to do is have the urgent care medical records transferred to your GP--and confirm that the GP office got them.
Considering that the third leading cause of death in the US is preventable medical errors [1], complete and accurate health records are important. In fact, this was how I was properly diagnosed with a very rare disease. I am now in remission and I get a second chance to live my life.
[1] https://www.npr.org/sections/health-shots/2016/05/03/4766361...
a. the benefit is obviously superior (better care than you'd get from a PCP or national telemedicine brand like Teladoc)
and/or
b. the benefit is emulsified with covered perks like gym memberships, wellness programming, etc.
It's interesting that this is a story though. It's either a recruiting tactic or they're floating it as something they might sell outwardly later. It's also potentially a way to control coverage costs for employees.
Employer-provided health insurance is a total racket. I would love to see Medicare-for-all in the US, and support that. But we also need a plan B.
But how do you break a racket? You can’t just built a startup, because the market is fucked: everyone with money already gets care for free. Most of the people who need care are broke.
And there are so many layers of indirection: patient -> employer -> insurer -> provider.... that you’re not just dealing with a single racket, you have layers of protectorates that are milking people at every stage.
Plus there’s the scale issue, with a pool of 100 patient-customers, a few bad years can sink your startup. Yes you can buy specialty insurance, but it would need to be a very complex product and you need scale to make that appealing to an underwriter.
Which brings me to why I am excited about Amazon trying this:
A big employer seems like the only party other than the state who can break the racket.
Amazon is more or less bearing the full cost of their employees care, and they have the scale to act as their own insurer. They also have the software and data science teeth needed to build the backoffice.
Medicare for all is what we need, but I support Amazon because I believe in the diversity of tactics.
Have fun trying to get hold of an actual doctor. I understand that nurses are more than capable of handling lots of issues, but I doubt Amazon will publish a breakdown of the doctor:nurse ratio for this initiative.
This is crap. It's basically streamlined McMedicine. Any ailment which steps out of the ordinary will be deferred or ignored. This is vaporware. Its goal is to save Bezos money for employee health insurance and using it's gimmicks to advertise it as a 'benefit'
> Health care represents a $3.5 trillion sector for Amazon
This is the problem right here. As long as medical care is a business, it's gonna be run like a business and trust me, you don't want Amazon running anything medical for you.
Why would that be more true for this service than any other provider?
Healthcare is as toxic as Taxi industry pre Uber and if it takes Amazon or Apple similar what Uber/Lyft did to destroy the current state so be it. it will still be a net positive.
My solution is government-run single payer health insurance, separated from employers. It doesn't need 'disruption' or 'innovation' or any other Silicon Valley band-aid. It just needs to drop the cancerous insurers from the market completely and separate profits from healthcare.
Why should healthcare be provided by your employer, and not your government?
Needs a bit more blockchain and webscale. I mean, it's an implementation detail but I'd put the individual test results on some Kafka topics and then have a worker to commit these to a blockchain for durability. Solving the real problems here..