Amazon has approval from FTC to acquire One Medical primary-care clinics
wsj.com
wsj.com
Fuck Amazon, though.
New doctors generally don't want to go into primary care anymore - it doesn't pay nearly as much as being a specialist does, and you are expected to be available to your patients 365 days a year, 24 hours a day (at least that is what many patients think).
It is a pretty miserable business to be in right now, and not sure what is going to make it better.
>New doctors generally don't want to go into primary care anymore
An amazingly high portion of Canadians don't have a family doctor <https://www.ctvnews.ca/health/despite-more-doctors-many-cana...>. In Atlantic Canada (the four easternmost provinces) it is impossible, repeat impossible, to get a family doctor if you don't have one <https://web.archive.org/web/20190226051406/https://www.thete...>. It's one thing to have shortages in rural areas—that happens in the US too—but Halifax?!? I've heard the same occurs in Vancouver too.
I am confused. Vancouver is on the West Coast of Canada while your statement is about "four eastermost provinces". Is it then a nation-wide problem?
Boy, I wish. I've never had a doctor with any kind of special availability. I can leave a message at their office but it's not like I'll get any kind of response until later the next business day, and that will just be from an assistant.
For 24/7 needs that's what urgent care is for, or the emergency room if it's more serious.
HIPAA provides far fewer protections than you probably think it does, and flagrant violations are frighteningly common.
Worse, HIPAA provides no private right to recourse, so even if your PHI is exposed, you're not entitled to a penny in compensation.
HHS may fine Amazon, but to Amazon, $1.5 million (the maximum cap for all violations of a provision due to negligence) might as well be the cost of doing business. And you won't receive one cent of that.
For starters, HIPAA doesn't actually prevent your doctor or health insurer from selling your data to a third party. It also doesn't prevent that third party from giving that data to a fourth party, who can give it to another, and so on.
What happens if one of those tertiary parties has a breach and ends up exposing your data? In theory they're supposed to report it back up the chain, but in practice it doesn't go more than one or two links, if that.
So in short:
- you have no way of enumerating the number of entities who have legal access to your health data
- you have no way of finding out when it's been illegally exposed by any of the parties who have legal access to it
- if by chance you happen to find out about an exposure[0] you have no recourse except to report it to HHS, who may apply a statutory fine, but the fine is typically minuscule compared to the size, revenue, and profit of the guilty party
- if by chance you find out about an exposure of your PHI, you are not entitled to receive any compensation
All things considered, it's easier to enumerate the very limited ways that HIPAA does actually protect you than to enumerate the protections that most people incorrectly think HIPAA provides.
[0] a real-life example is you Googling the name of your partner and stumbling upon a publicly visible Excel spreadsheet containing the name, SSN, addresses, and medical diagnoses of thousands of patients
[1] see above
https://www.ada.org/resources/practice/legal-and-regulatory/...
Eh, that's not exactly true. HIPAA isn't the only (or even primary) vehicle for safeguarding patients from research, and most research is conducted under the auspices of large (usually academic) institutions that have processes to ensure informed consent, which are in turn backed by other legal statutes or contracts. Those aren't perfect, but it's not correct to say that patients provide blanket consent when they begin at a new practice, or that HIPAA is responsible.
But it has some pretty huge holes in it. A lot of telemedicine services aren't covered by HIPAA, for instance.
I'm not worried about Amazon keeping my data in a public bucket, nor about Amazon employees snooping in it -- but I am 100% worried about Amazon pulling some "anonymization" BS and using my data for purposes other than providing health care to me.
I don't trust Amazon with my less sensitive data as it is -- I absolutely wouldn't want Amazon anywhere near my health data.
Some of my family works in medicine and there is nothing that scares the pants off of medical administration more than a HIPAA data breach. There are real penalties for it from the government and they have to be reported. People responsible get fired.
I'm imagining a utopia in which our medical data is as well protected as people think it is under HIPAA.
> Some of my family works in medicine and there is nothing that scares the pants off of medical administration more than a HIPAA data breach. There are real penalties for it from the government and they have to be reported. People responsible get fired.
The penalties are usually in the tens of thousands of dollars. That sounds like a lot, but it's really not when you consider that most breaches for which fines are levied usually affect many patients, not just one, and when you consider the annual revenue and margins of most of these responsible parties.
The fines are capped by statute at a value (about $1.5 million for all violations of a provision in a single year) that is laughably low.
Except your searching for medical conditions on google or amazon is not protected. They know.
The USA has demonstrated time and time again a pattern of fining corporations a minuscule amount in comparison to the damage done.
Besides, even before it comes to fines and it's in discussion in Congressional chambers, Amazon lobbyists can say to practically any senator or congressman/congresswoman: "you want to go against us for antitrust reaons? Oh well, guess we're going to have to close that Amazon warehouse in your district that creates so many jobs...and oh yeah looks like that Whole Foods in your district isn't profitable, we're going to have to close that one up too."
They don't even need to lobby. They can just pay the fines. The fines are capped by statute at an egregiously low value, which to Amazon is chump change.
Why is that even remotely acceptable in a democratic society?
Amazon isn't actually doing this, and it isn't actually acceptable.
HIPPA fines are public, if they did this even once everyone would know.
See the big banks collective responses to regulations placed on the financial industry in the aftermath of 2008 - if the fine is significantly smaller than the potential for profits, they will do those activities and pay the fine 100% of the time. This mentality is evident in many other sectors as well, especially with publicly traded companies.
Yes, I know HIPPA fines are public. However, Amazon has enough money to not care, and to never care. You know how many labor laws Amazon has blatantly violated and not cared? If they can capture an entirely new vertical (healthcare), their share price will increase despite looming lawsuits and pesky regulations. Amazon is a multi-trillion dollar company that focuses on growth at any and all costs.
You wrote a whole paragraph about something that never actually happened, and that shows no sign of happening.
And you wrote it as if it actually happened. It's quite astonishing to read.
The fact that the penalty for many serious violations consists of fines that represent a tiny fraction of the company's worth means that breaking the law is an easy economic decision for companies. Fines are just a cost of doing business, and not even a major one.
But fortunately their business model has been about providing a superior level of care for a small extra fee, and presumably Amazon is buying them for that strength. Otherwise it would be a pretty pointless acquisition.
But who knows, maybe now there'll be a discount if you have a Prime membership or something. :P
There are plenty of Amazon acquisitions where the service got worse post-acquisition, was relaunched as something else, or was simply shuttered.
There were some temporary hiccups at one point with a new backend system but that was all.
So I don't see why they wouldn't be doing the same they've done with Whole Foods, which is maintaining the high level of service, because that's the proven successful business model.
True in Wyoming and the Bay Area, too. Produce and fish aren’t as fresh as competitors. It’s cheaper. But not premium.
The food is the same. Nothing has changed that I can tell.
Same hot/cold bar. Same produce. Same meat and fish. Same in house brands. Same pizza. Same bakery.
Main differences are just a lot more self checkout and areas for Amazon returns. And Prime discounts of course.
What food do you think got worse?
The only store that has consistently better produce at scale than Whole Foods in NYC is Eataly, but it's more expensive and there are only two of them. Before that there was Dean & Deluca but they've long since gone out of business and their prices were astronomical -- but I swear their produce section was like a museum and the vegetables were almost works of art.
I find it funny that when you drill down, the only supposed quality decrease is in the "freshness" of produce and meat, the two things that are ultimately the most subjective. I've shopped at a lot of supermarkets for a long time, and I truly have to wonder if people are simply imagining a decrease in freshness simply because it fits a preconceived narrative that if Amazon bought it, it must have gotten worse.
Because with my own eyes and taste, I don't see it at all. And it's not like this is ancient history hard to remember -- Amazon only bought WF five and a half years ago.
The difference in quality has little to do with "freshness." I recently studied the difference between Whole Foods and Fresh Direct in some detail. Fresh Direct is generally 20% more expensive than Whole Foods. We were looking to cut our budget, so switching from Fresh Direct to Whole Foods was an easy choice. However, after a few weeks, it was clear that the quality just isn't as good.
Here are a few examples:
1. Fresh Direct has heritage raised chicken and pork. The chicken, in particular is amazing. It's much smaller than a typical chicken, way more flavorful, and the color of the meat is so interesting. The dark meat has a beautiful purple luster not found in the Whole Foods chicken.
2. The "Animal Wellfare Certified" meats at Whole Foods are all step 1 or step 2. Fresh Directly has many step 3 and step 4 options.
3. All of the Lancaster Co-op produce is really good. Can't find anything like it at Whole Foods.
4. We eat a lot of fruit during the summer. Certain produce at Whole Foods is just bad. Like I could not buy a good organic peach at Whole Foods. They always came rock hard and never softened.
I mean, these "subjective" things are basically the only thing Whole Foods has going for it. Every grocery store chain stocks "natural/organic/wellness" brands now, most at cheaper prices than Whole Foods. The quality of the produce is essentially the only reason to shop there.
The differentiators - usually reflected in motivated staff with the freedom to solve customer problems, but also in the case of WF a focus on quality fresh food, etc - will be relentlessly driven down.
WF continues to be "premium" but it's definitely not the same chain that it was a decade ago.
My reasonable hopes stemmed from what HEB has done with sub-brand Central Market. While CM isn't quite as awesome as its high point, more CM goodness has rolled into regular HEB than bean-counting into CM.
It does? Not in my area. I've never been a Whole Foods customer, but my friends who were have universally said that it has become much worse.
This is a trope that needs to stop. Public companies are not alike and the fiduciary duty is only a very high level one that can be used to justify both squeezing every customer as much as possible to losing money to support growth.
What the shareholders want matters and an acquisition changes that completely.
This is a fake rule that people love to repeat. It isn't true.
E.g., but feel free to google it yourself -- there are a multitude of articles on the subject: https://www.nytimes.com/roomfordebate/2015/04/16/what-are-co...
But yes, a board of a for-profit corporation must pursue profits to their full reasonable capability. If they neglect that duty, they will be sued and replaced. This is, for example, why Twitter had no choice but to sell to Elon. Because that was most profitable to shareholders. Otherwise the board would have been taken to court and lost. That is fiduciary duty to profits.
The idea that it's a "fake rule" is also something people love to repeat. But that isn't true. A publicly traded corporation simply cannot choose to forgo profits for all time and invest in customer service instead, for example. There absolutely is a fiduciary duty to make decisions that are ultimately profitable. (But that obviously goes along with flexibility to e.g. invest more to defer profits, invest in nice offices to attract better employees, etc.)
No this has been explicitly rejected by the court. The fiduciary duty a company has to it's board is to not screw them over. A company has the freedom to leave money on the table in order to do the right thing. Your shareholders have no grounds to sue you if you are doing something that doesn't produce 100% profit but still produces reasonable profit.
My guess is Amazon sees hospitals/practices starting to use more "cloud-y" services and wants to set themselves up to capture as much of that revenue as possible. The old hospital IT-fortress model leaves a lot of efficiency gains on the table and I'm sure AWS would love to be able to capture all of that.
source: I work at a "cloud-y" medical tech company
That all depends. There are serious limits to where HIPAA applies. Not everyone who who handles medical data is bound by it, for starters.
This is true, but not true of anyone working at One Medical, since health care providers are bound by HIPAA. If you tell your friend you have cancer, sure, they can legally share that info. If you tell your faith healer, or your employer, they can as well.
If you tell your PCP (or your PCPs app, or their secretary), and they share that with Andy Jassy without him being cleared to handle PHI, they're in for a mountain of fines.
As much as I like being cynical about surveillance capitalism, I don't think Amazon's primary motivation here is patient data, at least in the short-to-medium term. If they wanted the data, they'd buy, like, a vitamin company or something.
This is a very good point.
Nonetheless, I think that being cynical about anything Amazon is up to isn't unwarranted.
My primary personal problem with this deal is that I do my best to avoid doing business with Amazon at all, and the more tendrils they spread, the more difficult this will be.
100%. I still don’t think having the 21st century standard-bearer for anticompetitive practices move into healthcare is a good thing by any means.
On a more practical level: Amazon is gargantuan, and I don’t necessarily trust them to have the scoped vision necessary to run a good medical practice, rather than just a large one that fits their portfolio. This is true for any large company; Amazon is large even by large company standards.
They'll have to be a bit careful with regulation here if they do try it. Clinical trials are where you do that sort of thing.
For the human individual person, the interests (the goal) is to care for their health; but amazon is a corporation: for them the real goal is profit, not health.
I'm saying that for the human the incentives should be all about health. the money, the costs are the "obstacle".
On the other hand, for the corporation the incentives are the profit. The health is a cost (or "obstacle").
with this 'frame' in mind I'm saying the incentives are not aligned on their own because the priorities are in conflict.
What's truly the problem here, is how healthy patients aren't 'good' customers of health-services. Then again, this is not a problem unique to Amazon, but they're getting into this 'rodeo'.
throwing a capitalistic-optimizing 'machine' into health services has been a huge mistake which is seemingly impossible to fix... this is how systems collapse; when the system is so resistant to fixing its 'problems' that only changing the entirety (or a significantly larger chunk) of the system fixes the problems; but the problems have to be 'life or death' (or 'do-or-die') level for this to kick in.
the biggest issue is that for a level of the system there is no problem, people die anyways. but for another level of the system (the human individual perspective) this IS a problem. if/when the system ignores a level of itself it becomes unstable like it's happening now.
One Medical is there to make money. Amazon will make One Medical more efficient at making money, even if that means forcing you to be healthier.
How?
One nagging problem with healthcare is doctors believe that medicine isn't a cookie cutter problem when in fact it is. For the vast majority of conditions there are standard treatments that work. If that wasn't the case modern medicine wouldn't exist.
Every doctor can whip out some corner case and say "but what about this." Sure, that's great. But for condition A the standard treatments usually work. The trick is to know when the standard treatments aren't working and what to do.
Amazon, or any healthcare company with enough data, can look at the data and see what treatments actually work and what treatments don't. It's not a hard problem, really, but traditional health systems don't care, and to be frank, academic researchers are basically too lacking in imagination to understand how to do it or why it should be done.
Amazon at the very least will try to apply quantitative methods to the problem.
However morally abhorrent this practice may be, I do not trust Amazon to NOT do this if there aren't any laws against it, which is why I am against this acquisition. I know some people may find it debatable, but I believe healthcare should be run with a Kantian framework where every life is priceless rather than a utilitarian one.
I have some hope that they can do something that's better than the low, low bar that is the US healthcare system.
Edit: Thought about this some more, and I think consumers shouldn't be nearly as worried as doctors, nurses, pharma cos, and insurance companies.
Amazon is cutthroat in its dealings with stakeholders who aren't its direct customers. Amazon has no issues squeezing book publishers, vendors, and employees. They justify this as the means of getting the best price and experience for customers. Translate that to the healthcare industry and I'm not sure what to think. Some of the actors in the space could use a wake up call, but overworked nurses, GPs, etc. are not ideal.
- Standardize health records (detailed visit summaries, all tests and lab results, all visits to referrals or specialists)
- Fast appointment times (single digit days)
- A minimum standard of service. Doctors who won't immediately rush you out the door without solving the root cause, who won't prescribe you medication that they were sold over lunch, who'll listen to your symptoms, and because the outcome is measured by Amazon's uncaring data collection machinery, they're incentivized to actually solve the issue.
- Affordable health insurance plans and prescription drugs
The above is already leagues ahead of what my friends and family have access to or deal with. For those with the means, I'm sure there will be premium offerings that may check some of the boxes you're looking for. I think there's space for Amazon's uncaring, industrial approach to do good for people and improve quality of life.
> I think there's space for Amazon's uncaring, industrial approach to do good for people and improve quality of life.
> [I want a] minimum standard of service. Doctors who won't immediately rush you out the door without solving the root cause, who won't prescribe you medication that they were sold over lunch, who'll listen to your symptoms, and because the outcome is measured by Amazon's uncaring data collection machinery, they're incentivized to actually solve the issue.
Anyone who has actual clinical experience will tell you that an "uncaring data collection machinery" does not incentivize anyone to "actually solve the issue". Quite the opposite: the reason that the patient experience has gotten worse over the last few decades is because the industry has already been moving towards an "uncaring data collection machinery", while simultaneously squeezing providers and narrowing their already-small margins[0] and as it turns out, uncaring data collection machineries don't care about patients.
Amazon's entire modus operandi fits very well with the absolute worst[1] forces that already exist within the healthcare industry, so it's quite hard to imagine a world in which this actually works out to patients' benefit in the long run. They might sprinkle a few shiny bells and whistles on top to placate people's fear, but actual care delivery is going to suffer in pretty much every way that you list aspirationally.
[0] People sometimes treat this as a victory because they think that it'll lead to lower healthcare costs, but providers' pay actually makes up a very small fraction of healthcare spending in the US. Even if you could eliminate those costs entirely without impacting clinical care delivery or patients in any way (which is impossible), it would still translate to a 15% reduction (which wouldn't even be passed on to patients anyway, because the system incentivizes insurers to increase costs on the claims side to increase their own earnings)
[1] worst for everyone involved except shareholders
I'm not sure this is true. The current implementation -- maybe. But the incentives, from an outsider's perspective, seem to align?
1. Healthy patients cost less in the long term. Solving for long term issues (type 2 diabetes!) vs. the immediate issue and getting someone out the door is profit seeking.
2. Patients being alive continue to pay service fees is profit seeking.
Why would Amazon not aggressively track outcomes, measure every dimension of provider care, and ruthlessly fire / downgrade low performers to maintain the above goals?
This is an extremely common misconception. Luckily, you've picked a really easy example to illustrate.
"Solving" type 2 diabetes is an incredibly tricky problem. It's not something that can even be measured in the short-term, let alone solved. It's also quite individualized, more so than probably any other common diagnosis except cancer. There's no magic bullet intervention, and it takes a lot of active work to build the provider-patient relationship to a point where it can identify the appropriate interventions for that patient, identify problems with those interventions, and help the patient execute on them successfully.
Because it's so individualized, and because it's so long-term, any system designed to "streamline" that is ultimately going to fail, because the curse of dimensionality will inevitably collapse away the requisite information, and the pursuit of short-term profit will inevitably cause the system to prioritize short-term interventions over long-term ones which will actually address the issue.
"Healthy patients cost less in the long term" is technically true, but there's no way of turning unhealthy patients into healthy ones that doesn't, in aggregate, cost more than the theoretical savings.
> Why would Amazon not aggressively track outcomes, measure every dimension of provider care, and ruthlessly fire / downgrade low performers to maintain the above goals?
Again, this is an incredibly technocratic approach to a field (care delivery) that requires a different approach. It works if you assume that negative outcomes are the fault of individual providers ("low performers") and that individual providers have both the agency and resources to solve arbitrary cases. In practice, that's almost never the case: there are way too many confounding factors that impact clinical outcomes, and providers are quite limited in their power compared to other players: the insurance companies, the administration of the system they work within, and most importantly, the patients themselves.
Honestly, the only way you could meaningfully "fire low performers" is to identify patients who aren't performing well and then drop them. Which is, in a way, what the health insurance system does... but we tend to consider that an antipattern.
While digesting that unpleasant postulation, I will refer to a second order effect, and that is .. always on electronic ID with de-facto location tracking, entering into the commercial info fabric. Legislators be warned, this is going to change, and change, and change again the social fabric as real people fall into health problems and life changes, and no longer run their relationship with public information about their conditions, and that it is linked to a (profit-motive) law enforcement fines, court conditions and oversight, one at a time on a very large scale.
Your experience with Amazon's customer service and my experience with it are completely opposite.
This is one of the reasons that capital profits should be taxes way higher. Letting one company accumulate such power in such a short period of time makes society unstable.
I hope the best to the American citizens that will suffer thru this situation.
I very strongly disagree that Amazon will accomplish more good change than bad.
Maybe they can do better? Fee for service is kind of insane. Urgent care strep throat $250 + meds makes no sense. It should be $50 total or less.
1. You interact with a receptionist. They use commercial software to track your visit, find an appropriate medical professional for your condition, and fit you into a schedule/queue.
2. You see a medical professional, often a nurse, that checks your vitals and updates your chart. This professional will often take a swab of the infected area.
3. The swab is sent to a lab, where medical grade equipment and a trained technician analysis the sample.
4. You see a medical professional with the prescription pad. Usually an MD or NP. They are responsible for the diagnosis. Strep infection could be a symptom of a larger problem. People without a bacterial infection need to be treated, but shouldn't be given antibiotics. This professional needs to carefully listen to the patient and clearly explain their condition, and what to expect from treatment.
5. You see clerk at checkout. Your entire bill is reviewed by your insurance company.
6. You see a pharmacy tech, a pharmacist oversees your prescription being filled, a medical grade product is provided. Lots of liability at this step. Lots of security and shrinkage concerns for the business.
Keep in mind that throughout this entire process staff is held to higher education, background, and training standards than the general population, all software is built for HIPPA and costs more than standard enterprise software, all equipment is built to a very high standard, all offices are more sanitary than average businesses, and many of the trades are seeing long term labor shortages. Throughout the process you'll probably take an hour of professional time.
1. I signed in using an automated terminal. A tablet which scanned my ID and insurance card. I sit down in the waiting room. A few minutes later a nurse comes to get me.
2. The nurse takes my temperature and swabs my throat for a rapid test which is then done in front of me. The nurse leaves the room while the test is reacting. The interaction takes about five minutes.
3. A NP came in to look at the test and my throat. The only interaction I had with the NP was when they asked me if I thought I had strep to which I replied "yes". The NP diagnosed me with strep and wrote me a script for amoxicillin in less than five minutes.
4. I left the urgent care clinic without seeing the clerk at checkout. The entire visit including waiting to see a medical professional took less than 30 minutes.
5. Ten minutes later I pick up my course of antibiotics at a pharmacy four blocks away. The price of the medicine was free with insurance and $15 dollars without.
Strep tests cost $35 dollars retail. The price to visit the clinic was $200 dollars ($165 sans the price of test). The per hour cost of medical care was $990 dollars.
The sensitivity of rapid strep tests is already low (and the cost/risk of untreated strep quite high), to the point where standard-of-care already dictates that negative rapid results be followed up with a lab culture. Not everyone follows that in all circumstances, but it is considered standard of care.
The real-world accuracy of OTC rapid strep tests performed at home by untrained non-clinicians is even lower.
There are cases in which a strep diagnosis is warranted without all of the above, but the picture you're painting is overly optimistic in terms of cost, and measurably degrades quality of care for patients compared to the status quo.
https://afcurgentcareathenstn.com/are-rapid-strep-tests-accu...
98% is the specificity in the link you cited, not the sensitivity, which would be the relevant statistic. That's also a consumer-facing marketing page for an urgent care clinic that just cites "sources", so you should probably take anything you read there with a grain of salt. It's essentially an advertisement.
But furthermore, we're not talking about the tests performed in a clinic by a clinician. We're talking about OTC tests performed at home by an untrained non-clinician.
https://www.aafp.org/pubs/fpm/issues/2008/0200/p48.html#:~:t....
This is the danger of Googling around for information without any contextual domain knowledge.
- You're quoting a statistic from an op-ed (op-eds are not fact-checked, let alone peer-reviewed)
- You're misquoting the statistic as provided by the op-ed (that op-ed is written about a test with 95% specificity, as claimed by the author)
- You're quoting an op-ed written by a witness called to testify in the defense of a physician who was sued for not following the documented standard-of-care - hardly an impartial source
- You're quoting an op-ed written about a single case (n=1). Furthermore, it is chosen not even as a medical case study but rather because the legal case is of financial interest to the author
- The op-ed is nearly fifteen years old - and, as it turns out, the prevalence and risk of rheumatic fever is radically different in 2023 than it was in 2008, for the worse.
- Even if you discount all of the above, the op-ed as taken at face value is written about a case in which a patient didn't get a backup culture drawn and ended up requiring two heart valve replacements (!) after a false negative on the rapid strep test. Regardless of whether or not the doctor is legally liable, it's not a good argument that rapid tests are sufficient.
If you go about looking for information to support your argument, it's often likely that you'll be able to find something that on the surface seems to support your case. But if you don't have the necessary domain knowledge to evaluate the trustworthiness of the source, the accuracy of the claim, or even its relevance to the matter at hand, that can lead you astray.
That's doable. The thing I don't like about this approach is that I'm not sure how it works on the margins. A rapid covid test has a lower accuracy than a strep swap processed in a lab. What do the people with very sick throats but not strep do? How does it catch people that have a more fundamental health issue? Are there common pitfalls that the system might snag on, like individuals not carefully reading dialog boxes and quickly incorrectly clicking that they do not have a antibiotic allergy.
I'm privileged, but my personal bias is to pay more for higher quality health care instead of paying less for lower quality healthcare.
So yeah, maybe Amazon can do better at least on the administration side.
I'm pretty sick of this stuff. As if a multi-conglomerate will have no want to abuse the access to new data and push medical access in directions it shouldn't be going. Amazon just bought iRobot. So now they have microphones and cameras in your home, they know what you eat, buy, and watch, and now they get your medical information.
I honestly don't have any hopes anymore. The U.S.'s democratic process and regulation entities are corporate captured. We're owned and controlled by institutional corporate shareholders.
Government is still in charge.
It just chooses to be captured, even though its first job - which it gets paid for by extracting money by force - is to not be captured.
That’s … not how capture works.
I'm saying that people in government has to decide to be captured, when it extracts free money from its populace with the promise that it will remain impartial.
> That’s … not how capture works.
This is never a useful thing to say in terms of furthering the conversation. I appreciate it may have felt good, though.
Corporations have purchased our government and therefore the government is, in my opinion, not in charge. Sure they enact violence as all nation states do- often on behalf of those corporations.
Neither of those two actors are good for the people, for the working class.
Count your blessings
Blessings not from corporate kindness, by the way.
The only thing a corporation can do, especially at Amazon’s size, is evil for the worker and community. They are built to expand into infinity, consuming all for shareholder profit.
I mean if you're passionate about it.
> Why don't you start X to compete with a trillion dollar behemoth Y?
Because if they think they can make a profit, they have a trillion dollar that they will freely leverage to strangle the living air out of your company. Weak US anti-trust laws won't do anything until there is a "significant, provable harm to the consumer".
The general lesson here is more capitalism won't solve the issues of unchecked capitalism, you will have to get the legislative system to intervene to make sure you can have fair competition in the market.
Mike Judge literally wrote this story as a warning and we're just making sure it happens.
"Welcome to AmazonGo we love you"
That and, my experience at the doctor now feels quite similar. "Says here you're retarded"
It's gotten so bad that there is an actual sign that says "GPS IS WRONG THIS IS NOT THE WAY" at the end of the last paved part.
It was fixed within a couple days, and it stayed fixed.
Did you report this road?
I went back to good old Pandora and it's been so nice to have an algorithm that feeds me something I actually want.
Can't we for once have legislators who can say something to the effect of "stay in your lane" to a corporation and actually enforce it?
How does a bookstore go from being a bookstore that now controls the internet's infrastructure and now my healthcare?
Despite my sneering comment, Amazon was never supposed to be a "bookstore"
Bezos's goal was to be the largest intermediary for all commerce worldwide.
This was the quote: "To be Earth’s most customer-centric company, where customers can find and discover anything they might want to buy online, and endeavors to offer its customers the lowest possible prices"
I don't know but money isn't the answer. Back then, in 1980's Germany book wholesellers Koch, Neff & Oetinger and Lichtenbrink pioneered robotic storage, and for very much the same reasons as Amazon. They were logistics giants that would deliver your book overnight, but they did not go on do dominate the world.
NY, for example: https://regs.health.ny.gov/content/section-40510-medical-rec...
> Medical records shall be retained in their original or legally reproduced form for a period of at least six years from the date of discharge or three years after the patient's age of majority (18 years), whichever is longer, or at least six years after death.
Honestly would have expected Google to buy it before Amazon, halfway just for that reason.
I think that would add a lot to healthcare especially in the US.
Buying Whole Foods was a way to buy a freezer and small warehouse with the grocery budget of the top ~3% of US Households attached. OneMedical is a way to do the same. I expect they’ll try to roll up Summit or another group next.
I find this an odd but interesting approach, because I associate Amazon as being a bargain, low quality sort of brand. It's a good service, but it's definitely not premium. In some cases I'd say it borders on tacky and tasteless. This is not just about the product catalog too, it's site/app quality, Fire and Alexa devices, selling ads on Kindle lock screens, being completely shameless about service quality issues, AWS shipping services 2 years before they're actually any good, and so on.
Whole Foods probably isn't like this yet, although I haven't been in since pre-acquisition because there are only a few in the UK, and I don't know anything about OneMedical, but if Amazon's brand permeates into these, either visibly or invisibly, I can't imagine it going well.
"By taking a large portion of healthy, well-educated patients who require less-complex care out of the usual primary care system, tech companies such as Amazon will leave primary care, a specialty essential to the future of health in the U.S. that is already on life support, even more desolate."
https://www.statnews.com/2022/07/23/deal-between-amazon-and-...
You are not completely wrong, but it is not that simple - the problem most PCPs have is that 'doc in a box' places tend to soak up all the quick and easy visits, that pay just as much as the long and complicated ones that can takes hours for a typical PCP to resolve - but they often pay the same - so urgent care clinics see you, look at your throat, write you a prescription and send you on the way - "treat'em and street'em"
Meanwhile the 82 year old 400lb diabetic, pre-dementia patient on 12 different medicines with 7 different things they want to talk about during the visit, takes a doctor and team of nurses and medical assistants a hugely disproportionate amount of time to diagnose and treat - and they can't bill all that much more than the doc-in-the-box got for writing a script for a sore throat.
In other words, these places are skimming all the profitable and easy to resolve cases, and the PCP now only has complicated patients that proportionally pay less, further eroding the finances of most primary care facilities, which then means they can't pay as much, so then they have an even harder time attracting talent.
It is also difficult to ask a PCP to see 16-20 complicated cases in a typical day - they need a few easy ones thrown in that they can quickly resolve and move on. Nobody can go 100% all day long on hard problems.
I was referred to a “dermatologist” recently that turned out to be a PA with a background in nutrition. She had virtually no experience with actual dermatology. I was forced to wait over an hour after my appointment was set to begin, and my insurance was billed $500 for a 15-minute visit. She did not improve my situation one iota, so that was a complete waste of time and money.
Our health system is failing spectacularly at every level.
Heck, even regular nurses with a few years experience could probably look at your sore throat, check your blood sugars and adjust your meds.
Everybody thinks whatever they have wrong with them is something unique and special that requires a full blown MD - usually it is not.
If I need a transplant, I am going to want a full blown MD to do it - for most run of the mill things, I am happy to see a NP or PA.
And, as we know, if you have a passion for something, you deserve to get paid less for it. That is sarcasm.
1. The numbers on Amazon's quarterly reports are huge. They are playing in the big leagues.
2. Everyone with money remembers when they were just a book store and the dotcom bubble burst. The narrative that they can go into a market and dominate it in a few years is a strong one everyone has a lot of belief in.
3. They are one of the leaders in using technology to upgrade traditional business lines. Every industry still experiences Fear of Missing Out on the latest technology change. Imagine how great of a position Sears Catalog would have been in if they could have held their strength for another five or ten years. They had brand name recognition, supplier relationships, warehousing, distribution, and physical locations for returns.
4. When a tech company enters a market there is a higher level of risk accepted than private equity. The private equity firms usually pick more sure bets than this.