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Comment by nostrebored | Hacker News Reader

Could I ask why?

On a purely corporate level: Amazon’s business ethos seems in tension with the things I want from my PCP. I don’t want to be A/B tested for retention and mean time between visits in my doctor’s office.

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.

> I don’t want to be A/B tested for retention and mean time between visits in my doctor’s office.

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.

I'd agree but I think they'll view any penalties as the cost of doing business. If they can find a way to reduce costs or raise profits by more than the penalty amount then it they'll absolutely do it.

In certain regulatory environments it won't be a penalty. It'll be a recall and shutdown.

The US has largely not shown the level of anti-trust zeal that it needs to, even among party democrats. I have no faith they will stop or shut down a company violating things.

This isn't to do with antitrust.

Clinical trials are needed for medical interventions. But can't they A/B test e.g. communications or in-app experiences that try to get you to come in for insurance-covered stuff? This doesn't need to be evil -- maybe they search for messaging which gets more people in the door for vaccine boosters or regular physicals. Maybe after scheduling a kid's checkup, the app nags you to schedule your own, etc.

I'll venture a guess:

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'.

I hate to break it to you, but health care is already a for-profit industry.

Nobody said that it isn’t. There’s a world of difference between making a profit and driving a bottom line.

I don't understand. Are you saying that existing for-profit health care companies are not attempting to maximize their profits?

My doctor doesn’t sell scratch-offs and cigarettes in his waiting room. The profit motive doesn’t require companies to pursue every single avenue of profit; beyond that, medical ethics explicitly forbid some avenues.

Yes. Plenty of medical providers are focused on making a profit while still emphasizing other values, rather than sacrificing them in the name of maximizing profits.

Right, but there exists enough people in the healthcare space that want an outcome driven approach as opposed to a profit driven approach. You let the parasites in and it moves the needle towards (or more towards) "profit driven".

this is unnecessary, of course I know this. It's the reason Americans are now engaging in 'health tourism' a.k.a. going anywhere else in the world to get health care, specially when they know the specific procedure they need.

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.

Right, which at heart is the primary reason why it's so utterly broken.

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