Can Amazon and big tech make American health care less painful?
The health care system in America is broken. Can big tech fix it? That’s what many of us hope to find out with Amazon’s pending acquisition of boutique primary care practice One Medical.
There’s little doubt among most people you talk with today – something’s gotta give when it comes to medical care in America. An estimated 100 million of us feel like we pay way too much for way too little when it comes to our health.
For example, my monthly bill for health insurance is $825 (I’m self-employed), yet I just had my first checkup in three years. That math works out to nearly $30,000 for that ten-minute appointment.
Insurance exists for the “just in case” scenario, but there was $88 billion worth of medical debt on Americans' credit reports as of June 2021, according to the Consumer Finance Protection Bureau. How many of us are just one bad diagnosis or accident away from bankruptcy ourselves?
What is One Medical? Why is it worth nearly $4 billion to Amazon?
One Medical is a membership-based primary care practice with nearly 200 locations across the United States. It also offers virtual services. The company reported having around 767,000 member patients as of May.
I was one of those patients when One Medical opened its first clinic in downtown San Francisco in 2007. I had excellent health insurance through my employer at the time, and it covered visits to One Medical’s swanky modern offices, minus the $199 annual membership fee. That annual fee paid for care is well worth ten times that amount.
I could always get an appointment within a day or two, and doctors spent as much time with me as I needed. Just walking through the front door felt like arriving at a new era of health care. Remember the "Grey's Anatomy" spinoff "Private Practice" and its one-stop-shop medical practice? It was a lot like that, minus the drama. It was everything I needed from a doctor’s office and then some.
Sound a bit familiar – a sort of Amazon Prime for health care? It was.
“We think health care is high on the list of experiences that need reinvention,” said Neil Lindsay, senior vice president of Amazon Health Services, in a press release announcing the One Medical deal. “We love inventing to make what should be easy easier, and we want to be one of the companies that helps dramatically improve the health care experience over the next several years,” he added.
Can big tech fix something this broken?
In stark contrast to the days when I was a One Medical patient, my current provider often feels like the mafia, charging exorbitant prices and making me wait months for appointments in far-away locations, only to have that appointment canceled the day I'm supposed to see them.
The U.S. spends $4 trillion on health care – more than any other country. Still, our outcomes are among the most dismal across several categories, including life expectancy, obesity, and chronic disease. Is this an industry that big tech can revive in a sustainable way that’s good for all of us?
Here’s a look at some of the biggest pros and cons of the potential “Amazon-ification” of primary care.
Pros: Speed and savings
Speed: Big tech – and Amazon especially – values speed and efficiency, something our doctor visit could use more of.
“Booking an appointment, waiting weeks or even months to be seen, taking time off work, driving to a clinic, finding a parking spot, waiting in the waiting room then the exam room for what is too often a rushed few minutes with a doctor, then making another trip to a pharmacy – we see lots of opportunity to both improve the quality of the experience and give people back valuable time in their days,” Amazon’s Lindsay said.
Convenience: Even if you don’t use any Amazon products, it's hard to deny the company's innovated technology in multiple areas, including streaming media, voice recognition, and artificial intelligence.
“With Amazon being a tech-forward company, there’s the possibility of offering more tech solutions to deliver care to a larger group of people,” said Ling Wong, senior advisor at Lightspeed Venture Partners, via email.
Using such considerable technological might to improve our health care could be a serious step up from what many of us deal with today.
“Care navigation needs to be patient-centric and clickable,” Steve Cashman, president and CEO of Caption Health, told me via email. “Imagine an experience void of duplicated forms, phone calls, numerous facilities, dirty waiting rooms, and waiting 30 days for multiple bills from entities you have never heard of.”
Cost: Even with insurance, clinic visits can get pricey. And if you don’t have insurance, you could get hit with medical bills that take a lifetime to pay off.
Amazon may be in a position to change that, as it already owns the online pharmacy PillPack, which it acquired in 2018 and launched a telehealth service a year later. In other words, this isn’t their first rodeo.
“Amazon’s already helping their employees have a voice in health care by applying technology and access to care expectations to a broad set of health care services,” Cashman says. “Large corporations have significant leverage and buying power for their millions of employees, and building a better system means everyone has an opportunity to benefit from aligned cost and quality of care incentives.”
With over 1.6 million employees worldwide, Amazon’s staff is more than twice the size of One Medical’s current membership. Does Amazon have the power to reduce costs across the board? If it does and passes that savings on to the patients, it could be a big win for people between jobs or otherwise unable to pay for health insurance.
Cons: More loss of privacy and the potential for data monopolies
Privacy: I know several people who still won’t use an Alexa-connected device in their homes for fear of Amazon's eavesdropping. Do we want to allow the same company that suggests what we buy, listen to, and watch on TV to access our most sensitive medical data? Privacy and tech watchdog groups are saying, "Oh hell no."
Amazon, along with several other consumer tech companies, has a history of asking for forgiveness later versus permission now, especially regarding our privacy. Examples include sharing Ring doorbell footage with law enforcement without a warrant, listening in on private conversations, and even using our personal internet connections without permission.
Privacy: Could your data be used to determine if you are seeking an abortion?
One Medical receives health information about children, families, the elderly, and the vulnerable. That includes information about substance abuse, mental health issues, and other intimate conditions. We cannot be confident that Amazon will treat this new data any better than it has treated its existing data hoard.
And privacy advocates aren't sure HIPAA laws are enough to stop potential abuse.
“HIPAA only protects individuals information as it is passed from patient to the health provider, covered entities, and business associates who have a direct role in patient care,” Debbie Reynolds, a global data privacy and data protection expert, said in an email.“
More worryingly, she added, "Other information about the location of an individual, perhaps health-related purchases, data about someone tracking their movement like accelerometers in mobile phones, is data that has either low consumer protections or no data privacy protections. With enough tangential data points, it’s easy to infer things about individuals that they would expect to remain private.”
This last part is especially alarming, especially when there are battles brewing over women crossing state lines to access abortion care and their data – such as that found in period trackers – being used to extrapolate they intend to do so.
Period tracker apps: How much info can companies or other parties access?
Are interstate travel bans next? Possible fallout as more company health insurance plans cover abortion travel
Data monopolies: Several people have also raised concerns about anti-trust issues and the notion that we are speeding toward a future where two or three companies control every aspect of our lives. It’s already possible to buy pretty much anything you need for daily life from Amazon – from a smartphone to groceries and even prescription medication – but do you want your doctor to also be on Jeff Bezos’ payroll, too?
“With this merger, Amazon’s creating a first-party data relationship with consumers, many of whom already provide Amazon with data about what they purchase from Amazon online, what content they watch on Prime Video, what food they purchase at Whole Foods, and now what primarily health care they use with One Medical. All those data points together create a kind of ‘data monopoly’ for Amazon,” Reynolds added.
Critics of the deal say that Amazon’s cross-industry tendrils require more regulation and oversight, especially regarding health care.
As Stacy Mitchell, co-executive director of the Institute for Local Self-Reliance, told The Washington Post, “This is another opportunity to gather up a huge cache of personal data to use that data and those relationships to further cement Amazon’s dominance as an online intermediary for lots of good and services.”