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Comment by kerkeslager | Hacker News Reader

The problem is that there's numerous conflicts of interests and a strong possibility for abuse.

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.

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What exactly changes for a person when they still have their medical insurance just like before? How can they be abused?

1. Some health insurance companies offer similar services, and Amazon has all the same perverse incentives to direct you toward cheaper treatments over more effective ones. When the entity providing healthcare is the same as the entity paying for it, there's a conflict of interest. I'm putting this first because it's already happening at health insurance companies, so it's practically guaranteed that it will happen at Amazon.

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.

Thank you for the detailed response!

Full Disclosure: I work at Amazon.

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.

1. They care because they're paying for it.

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.

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