I work in public mental health and earlier today got my weekly Becker Hospital Review email, which contained info about the Federal Trade Commission issuing a statement expressing privacy concerns about the merger.
Not sure whether these FTC statements are routine whenever global megacorps gobble up smaller companies, or whether they're issued based on past performance of the companies in question.
"The Federal Trade Commission issued a statement Feb. 27 warning Amazon and One Medical that it must keep healthcare data safe and is prohibited from using it for advertising or marketing purposes.
Amazon said it would not share One Medical patients' personal health information to sell other Amazon products, and the FTC said the company must uphold that statement.
'Companies that fail to abide by the commitments and representations they have made to consumers can violate Section 5 of the FTC Act,' the FTC wrote.
The FTC also said both companies must make it clear on how they will use protected health information as defined by HIPAA, as well as how Amazon will use One Medical patient data for purposes 'beyond the provision of healthcare.'
Amazon completed its $3.9 billion acquisition of virtual and in-person primary care company One Medical on Feb. 22."
> Companies that fail to abide [...] can violate Section 5 of the FTC Act
I'm sure the fine will be a real deterrent. Just like the fines have deterred Amazon to stop their anti-union practices. I wonder if we will ever see some antitrust measures ever again, or if it is just going to be a free for all from now on.
> GoodRx will be prohibited from sharing user health data with applicable third parties for advertising purposes, and has agreed to pay a $1.5 million civil penalty for violating the rule.
Meanwhile, GoodRx's revenue in 2021 was $745 million.
Interesting. So that's like, 0.2% of their gross revenue, about? Meanwhile, if my cursory math isn't screwed up, if your gross annual income is $100,000, 0.2% of your salary is $200.
So basically, they got something roughly akin to a speeding ticket.
But consider that when you get a speeding ticket your car insurance goes up and you often end-up paying far more than just the initial infraction fine. And you can be automatically disqualified from driving entirely once you get enough points on your license.
So if the fine were even remotely as impactful as a speeding-ticket is to a normal person then GoodRX would have just earned 3 penalty points on their business-license, have substantially higher business indemnity insurance costs, and once they hit enough points and caught doing-business-while-impetuous (DWI) again then the state would seize their business and crush it under a tank[1] and those at the wheel would be behind bars.
Somehow I doubt anything remotely close to that will happen to GoodRX and its management when this inevitably happens again.
It would be nice if black marks could be easily seen by consumers. For example by forcing the use of a "BM" (black mark) text next to the "TM" symbol in a company's logo.
The part about sharing the data will hurt them though. A part of their income comes from advertising to their users. If they can't do effective targeting anymore, their ad business will lose way more than $1m
I doubt we'll ever know when they use this data inappropriately since there's no way for consumers to know when it's happened and whistleblowers are very rare.
In this case, it's a bit different. Pretty much all of that information is protected by HIPAA.
I'm not sure the FTC will be Amazon's primary regulatory concern in this instance. And HIPAA is just the start. The FTC really is the least of your concerns once you start playing in healthcare on a diagnostic level.
Full disclosure, I've exited a diagnostic medical imaging software company and have been through the regulatory proctology exams that are 510(k) and HIPAA.
> In this case, it's a bit different. Pretty much all of that information is protected by HIPAA.
>
> I'm not sure the FTC will be Amazon's primary regulatory concern in this instance. And HIPAA is just the start. The FTC really is the least of your concerns once you start playing in healthcare on a diagnostic level.
A day or two ago, an HN thread had the founder of a company that worked with medical information, explain that HIPAA is actually a bit of a “paper tiger.”
It applies in very specific situations, and it can be surprising where it can be circumvented.
> One key issue facing Haven was that while the firm came up with ideas, each of the three founding companies executed their own projects separately with their own employees, obviating the need for the joint venture to begin with, according to the people, who declined to be identified speaking about the matter
I was thinking along the lines of whatever benefits team or HR had no interest in the actual venture and just hijacked it for their own purpose and thus sank the venture.
Managed care organizations (health insurance companies) earn 2% to 5% profit margins. Not sure what was in it for JPMorgan, Amazon, and Berkshire, who already earn better profit margins.
If they want to go vertical the whole way, then retail pharmacies are also not a money maker (see Walgreens’ figures, and CVS pre Caremark and Aetna merger). Then there is getting into the provider side, such as employing doctors and owning and operating hospitals. This side has more margin, but is very liability heavy and very risky to get into.
And Kaiser Permanente already does the entire healthcare vertical, but even they are not able to offer measurably lower premiums.
The biggest margins are in pharmaceuticals, but that requires billions of dollars in investment and many years to develop, all for what? At the end, you might as well sell your own medicines at a high margin.
I feel like a lot of the costs in medicine have to do with liability, and without tort reform, there is not much any business can do about costs.
Their notion was to reduce costs, not (necessarily) to earn more profit.
They wanted to reduce medical costs, and therefore their insurance costs, basically. I worked in a health tech company when this news broke years ago and was skeptical then. Health care is a hard industry with tons of perverse incentives and opposing interests. Any solution for our health care costs will include government regulations and laws. The private sector cannot, on its own, do it.
The existing profit margins are a rough measure of how much you can expect them to reduce costs, absent any technological advancements that lead to more efficiency.
If there’s multiple huge companies operating with similar, small profit margins over the course of 10+ years, it probably means they have optimized as much as possible within the constraints of the existing system. Hence, I would conclude that any further optimizations would have to come from changing the constraints.
There is a large administrative load for all healthcare which seems to serve no one except the hospitals (to avoid paying any local taxes their non-profit status does not get them out of), and the insurers (who justify their margins by negotiating through the bureaucracy).
The three companies all self fund their employees insurance, so the goal was to cut out some of this bloat by providing services directly to employees.
The Amazon Care implementation was amazing, it's unclear why it failed. I would speculate its because costs are dominated by services they didn't provide (emergency rooms etc).
Sure, but if it was as easy as cutting out the bloat, then wouldn’t Kaiser Permanente (KP) be the healthcare insurer/provider of choice where it exists?
Yet other plans are able to compete on the west coast.
KP has always been about the cheapest option for me. The Google/Stanford health plan was marginally cheaper when it launched while I worked at Stanford and then later at a Google subsidiary but living in SF they had very few local doctors (most of their network was down in Silicon Valley.)
People are certainly willing to pay more for PPO plans which give them more options but personally I’ve never run into problems with KP. And the California rule which means hospital charges for HMO patients are capped at the deductible for an out of network ER visit is hugely important. Otherwise you get nickel and dime’d by all sorts of charges for each professional who sees you in the ER and some hospitals even went after patients for $1000s when they charges more than the insurance company would pay. https://www.sfchronicle.com/bayarea/heatherknight/article/In...
> Otherwise you get nickel and dime’d by all sorts of charges for each professional who sees you in the ER and some hospitals even went after patients for $1000s when they charges more than the insurance company would pay.
The No Surprises Act took care of these issues nationwide as of Jan 1, 2022:
Well, that is some nonsense that is ridiculous to have been left out of No Surprises Act. Although, at least in this case, it still seems the state government says the loophole is not valid.
> The office told KHN that the "participating provider" contract does not override the laws barring out-of-network charges in emergency situations. "Danielle had an emergency and Regence acknowledges it was an emergency, so she cannot be balance-billed," said Stephanie Marquis, public affairs director for the Washington state Office of the Insurance Commissioner.
> I feel like a lot of the costs in medicine have to do with liability, and without tort reform, there is not much any business can do about costs.
Medicine is life-or-death. It would make sense that carelessness and dangerous products would cause serious damages including to the point where certain providers and drugs are not commercially viable because they literally do more harm than good.
Sure, but that doesn't mean that the liability costs does a good job at gauging that tradeoff. Cost may not be proportional to harm, and may not include to cost of inaction.
Just speculating but maybe the Amazon advantage is in b2b rather than b2c. In terms of AWS or Marketplace they have huge experience in selling managed resources to other companies. Maybe that approach could be applied to real world resources. Wrap everything in an API and offer everything on the same single vendor platform.
Personally I picked KP purely because I had no interest in playing middleman between my doctor and insurance company.
The US healthcare market is a complete clusterfuck. Other countries get comparable outcomes from universal healthcare for about the same outlay as we already spend on public healthcare.
I’d be wary of this decision since now you’ve elected to just work with the insurance salesperson, whose goal is to spend as little as possible on you. Providers at KP regularly tell you to “advocate for yourself” because now the doctors are beholden to the insurers. The regulatory agencies allow KP to self-police their quality metrics, so oversight is limited. As a KP member you waive your right to sue them for malpractice and have to engage in a KP designed arbitration process. If you’re in California there’s a limit on malpractice damages ($350k no death / $500k death) so chances are no lawyer will take a case against them unless it’s extremely clear cut and won’t require any domain experts ($$$).
KP may officially be a non-profit, but their CEO rakes in millions and their physician group is a separate for-profit entity.
There are some providers that make heroic efforts to provide quality care, but the overall culture seems to be very bureaucratic and big-co checkbox exercises.
I've wondered about this. KP and Geisinger are the closest things I've seen in the US to European-style private healthcare, albeit more vertically integrated, yet why isn't it so popular in the US?
> KP and Geisinger are the closest things I've seen in the US to European-style private healthcare, albeit more vertically integrated, yet why isn't it so popular in the US?
Kaiser has a reputation for being incredibly inflexible and rationing care to a degree that makes it a non-starter for anyone who has any healthcare needs beyond routine care (assuming they have an alternative to choose from). They have incredibly restrictive network rules, and they make it much harder to access non-routine care (additional hoops to jump through, etc). It's a very frustrating experience unless your care needs happen to align exactly with what their actuaries have determined is optimal.
This is not really surprising - it's exactly what you'd expect would happen when an insurer is directly responsible for clinical care (as much as integrated capitated healthcare systems pretend otherwise by using different terms to describe themselves, at the end of the day, that's exactly what they are: medical practices run by health insurance companies).
KP has a reputation for rationing care and more bureaucracy when seeking specialists compared to other insurance.
It is a good value, and works well for those who 1) aren't particularly involved in directing their own care or 2) are extremely aggressive in asserting themselves. People in the middle get frustrated.
I know when I was interviewing there they were talking about working with gov funded programs like for older or poorer people or something, as well as mobile clinics that would go visit people who had a hard time accessing care.
Don't know if that's still all true tho, that was 1-1.5 years ago.
Q: I don't have insurance, can I still use Galileo?
A: Yes! Your monthly or yearly membership fee will cover all the care you receive within the Galileo app.
You’re in good company: dang himself once forgot that link was there.
There’s also a “past” link in the top bar that allows you to look through the most popular stories from previous dates, so I’d suspect it’s all a bit confusing to most users.
The news 8 months ago was that it was agreed that this acquisition would happen, subject to the usual approvals and closing conditions. The news in late February was that the acquisition had finally been completed. Those two stories are not the same but of news.
However, today’s link is truly a re-submission of the late February item.
Amazon is laser focused on becoming the worlds first science fiction mega-corp.
Was thinking earlier today that with Blue Origin and Space-X and Artemis the US has a legitimate space industry. The future is right next door now.
life imitating art in this case would not be a good thing is the meaning.
in scifi the megacorp is typically a villain, so having a real life megacorp being a villain is not something i'm looking forward to, and yet the OP was equating Amazon as a scifi like megacorp. are you really unable to make the connection of why i'm asking why the comparison could be more ominous than good?
Has anyone have experience with One Medical? For example, if you have health insurance through your job, what does it provide that your insurance does not?
A previous employer paid for it, now I pay for it out of pocket. The convenience of scheduling routine things or setting up a video visit with a provider is more than worth it. There are many things where you might have considered going to an ER or making an appointment with your PCP, but instead you can have a quick video call which can help triage/understand what you're dealing with.
A few months ago I got a stomach bug traveling, and was able to do a quick video visit and get a script for antibiotics sent to a local pharmacy even though I was out of my home state. The ease of that one event is well worth the annual fee. There was no additional charge for the video visit.
During the height of covid, I got some other respiratory thing that I thought might be covid and I was extremely stressed. I did a video visit with a provider who was working (from home) while sick with covid. I thanked her for her service and started to cry.
Define "this"? It looks like they are specific to northern California, in which case they can't really serve the common use case of using One Medical as a pseudo-urgent care (the ability to have medication prescribed in any state when traveling, or to see a provider in any large city on short notice when traveling).
One medical is just a medical group like any other. They aren't insurance, they bill your insurance. They also charge a subscription fee which is not covered by insurance for membership. Out of membership you get access to their convenience services like mobile consultation. Most of these conveniences have been incorporated into big insurance players platforms by now, because they save money. They do so by trying to preempt you going to the clinic and starting to rack up charges when a video nurse could have told you to just take a chill pill. They also claim to offload much of the administrative and annoying health insurance work so you don't have to worry about it. I found this to be mostly true, but again becoming replicated by improved UX on the insurance providers sites. The other nice thing about them being a group is they have multiple clinics scattered around bigger metro areas. You can go to any site kinda like you would an urgent care.
I don't use One Medical any more because I no longer live in an area where they exist. They were a good customer experience for the basics. I will note that they are really just a triage replacement and the people you see are often less experienced. And they don't do specialists, really. If you get into anything complicated you're dealing with the general medical system as normal (annoying trips to random floors in big research hospitals to do weird tests that don't really tell you anything other than you already know type of vibe, not really knowing if you're in network or not because nobody can tell you a straight answer type of vibe, not knowing up front what classifies as a co-pay and what's a covered benefit, why is "hospital" lab work billed more than clinic lab work and why does that mean my insurance covers less of it and I have to pay extra more type of vibe). They're not vertically integrated like a Kaiser.
I'll echo some of the other responses. I'm a One Medical customer - started with my previous company, then when I left my employer I decided to still pay the annual subscription fee (was basically $100 with a promo for folks who just left an employer).
So far I've been a huge fan. Things like scheduling appointments, getting labs done, having an easy back-and-forth with a provider when you just have a question and nothing major, is way, way, way better with One Medical than with any of my previous doctors. I will challenge a bit another commenter's statement that "Most of these conveniences have been incorporated into big insurance players platforms by now" - while that's true, other insurance corp apps have generally been absolutely abysmal. One Medical's app is generally excellent IMO.
Of course, the big question has to do with quality of the practitioners. I've found that I really like my doctor at One Medical, but he is only recently out of training, so not sure how long he'll stick around
I would not have understood the benefits until I moved to DC from a smaller town.
In my home town, it was relatively trivial to find a competent GP who took my insurance. In the much larger market of DC, totally the opposite! Which led me to using OneMedical for a while.
The main advantages they had a few years ago were:
- Multiple locations (including near my apt and work place)
- easy to schedule appointments on short notice with either my PCP (if available) or anyone else on their staff (if not)
- Very easy to communicate with doctors/etc online, generally their portal was "not shitty"
- Appointments always started on time
The downside was the extra cost (trivial compared to the hassle it was to deal with other services) and the staff being a bit more impersonal -- they really hurried you out of there, which is the flip side of always starting on time. :)
I've actually kept up my account even though I see a different PCP these days, since it felt like it could be useful as a fallback on short notice. I'm thinking about cancelling now that Amazon has bought them, though.
My employer has a relationship with them. They have multiple locations at our various offices. I have on in my building. The convenience is unbeatable, both the on site services and convenience of the app. I always can get an appointment.
That being said over the last five years the quality of care has gone down. The good practitioners have left, and now there is quite a bit of turnover. I’ve had to change PCPs 4x in the last three years.
I've been a customer of theirs for at least 12 years, I think (I have an entry in my password manager from about that long ago, and I might have had an account before that). It's been fantastic, in general: I can get a phone consult anytime I've wanted one, and can get in to see a doc with pretty short notice. They are good at giving me the referrals I ask for, even if they are weird (eg., after listening to Chamath Palihapitiya talk about Coronarary Arterial Calcium scans, I got curious and wanted one, and 1med got me the referral I wanted/dealt with insurance, etc.). About the only downside is that it's a bit harder to keep a very consistent GP, in that 1med seems to have a fair amount of turnover. I don't know if it's hard to keep a consistent GP in other contexts, as I pretty much didn't go to doctors between the time I left high school and when I started using 1medical.
It's paying $100-200 a year to be able to get labs done pretty much immediately, schedule appointments easily, sit in waiting rooms that aren't depressing, and have a PCP and office workers that are nice to you and treat you like a human. Oh, and the video appointments are amazing. One time I had a really terrible UTI and got antibiotics within the hour from my phone.
It's very convenient to be able to book visits next day from an app. If you don't have any significant illnesses, maybe the convenience is worth it, but the medical care I got there was atrocious. I went in with a serious complaint and was just told "there's not much you can do about that" (turned out to be completely untrue). My provider repeatedly wrote prescriptions wrong. Over and over and over. And she would often forget what I told five minutes after I said it. Even though she was supposed to be my PCP, she seemed completely clueless about my conditions on every visit. My impression was that the providers are overworked and not able to really give patients the time and consideration needed.
The video visits are especially useful. Generally if you click "emergency video appointment" in the app you'll be in a video chat with a nurse practitioner in less than five minutes - often faster - no matter what time of day or night it is.
One thing I've used that for is emergency prescriptions: say I'm traveling and I forgot to bring a medication, I usually find that a five minute video chat will result in the medication I need being made available at a pharmacy in whatever town I'm visiting.
If it's anything like BetterHelp, you'll just be scheduled to the first available, lowest cost provider who get paid half or less the market rate for professional care. And knowing Amazon, they'll innovate newer ways to make it a dystopian dehumanizing process that leaves all parties with less care, less money, except for the shareholders.
One Medical is a primary care clinic, not a replacement for insurance. They will accept your insurance same as any other doctor. They have a bunch of locations and a decent sized staff. Their selling point is quick (sometimes same day) appointments and quick/cheap lab services.
I signed up after learning that a simple visit takes weeks to get an appt if you’re a new patient. At the time one medical offered same day appt and it was a big deal. Some of this has now been matched by insurance providers providing video visits for free, medical providers (like Kaiser/Shutter) and urgent care centres providing quicker appts. I now stay with them because it’s still easier to get all the usual stuff done through them, their offices are nicer and cleaner and having a reachable PCP really helps navigating the American system for me when I need a specialist consult or a prescription filled. During the early days of Covid it was super easy to get tested at their offices as well.
This is the big reason I originally signed up with them.
Being able to reliably schedule same/next-day appointments is such a breath of fresh air. You might not see your specific primary doctor if it's short notice, but I've always been able to see someone, and they'll have access to all your records.
Also, having my health record available regardless of which doctor, office, or city (within their network) I'm visiting is nice.
> if you have health insurance through your job, what does it provide that your insurance does not
I have no idea, but it worked. I went to the One Medical office nearby, and the doctor fixed my problem. All communication after was through the One Medical iPhone app, which was pretty good for medical software but was still complicated for no reason. The relatively few things the doctor wanted to tell me were scattered around different menus, and I missed some. He could've just given me a piece of paper, and it would've been way easier.
My employer pays for my membership. I use them for primary care and for getting blood labs drawn.
They're just like any other in-network clinic, except they try to provide an above-average experience. They bill your insurance, and you're still on the hook for copays. I suspect that they're more likely to write off stuff that insurance rejects rather than bill you, but all I know is I've directly paid them maybe $40 over the last 3 years.
Their clinics are comfortable and pleasantly decorated. Their front desk workers are all friendly and happily tackle clerical issues like tracking down external lab orders in other networks' systems.
Their app is about as meh as any other, but their scheduling system is actually usable with plenty of available appointments. For labs in particular, I can just drop in without an appointment and be done in 15 minutes. All the phlebotomists I've had have been skilled and empathic. I was able to get a 12-lead ECG there, too.
Their video sessions are very easy and convenient, and I've never had to wait more than 10 minutes or so. They aren't really going to solve any problems unless you just need an obvious prescription filled, but it's very comforting to be able to get a quick opinion from a random nurse practitioner. It's a nice way to help decide whether or not a problem is worth a trip to urgent care.
Echoing other comments here, I use One Medical and am an extremely happy customer — I pay the yearly subscription out of pocket. Online scheduling + video calls at any time with their staff make it well worth it, and they have offices in many cities and states so I've even seen doctors and gotten bloodwork + vaccinations done while traveling (domestically in the US). My experience with their doctors has generally been top notch as well, including one doctor visually and immediately diagnosing a family hereditary condition that had taken my sister years to get diagnosed through other doctors. And since they have so many offices, I can pretty much always get a next-day appointment in the Bay Area. I've never had to wait a memorable amount of time once I show up, and they can do a lot of labwork immediately onsite if you need or want it without additional scheduling or needing a return trip.
I've traveled and lived abroad, and IMO One Medical clears even the relatively high European-style medical system quality bar.
Happy for them that they got acquired by Amazon, since the scheduling + online stuff is a big part of what makes One Medical great and Amazon is quite good at that.
Interesting that you mention the European system in a positive light, since I didn't have that perception before moving here. But now that I am in France I see it. Doctolib is amazing. I used to have One Medical and it was nice although I didn't use it to its full potential. But Doctolib, by dent of being adopted by virtually every doctor and facility here, is on another level.
I had access to--and used--OneMedical through my employer-provided health insurance for a couple years. The way to understand it isn't as an alternative to your health insurance, but as a care-provider network with a nice app and a bunch of offices (at least in the Bay Area, where I lived at the time) that you pay a subscription to.
Overall, my experience was pretty good (with the caveat that this is all in the context of the US healthcare system, so the bar is rather low): I was happy with my PCP[0] and the overall level of care provided, and scheduling appointments (with my PCP or otherwise) was always really easy and straightforward[1]. I also never personally ran into any weird/scammy billing issues, something which I have encountered with some frequency at other healthcare providers[2].
That all being said, my work provided access to OneMedical as a perk, and I'm not sure if I'd pay the membership fee out of my own pocket if I ever move back to a city where they offer coverage (even setting aside concerns about its acquisition by Amazon).
[0] n=1, and I'm a white dude without any serious chronic illnesses or ailments, so take with the obvious grains of salt
[1] I was basically always able to schedule appointments within a week, and usually same- or next-day, which IME is unheard of in the American medical system in general. As a contrasting example, when I tried to find a PCP about a year prior to enrolling in OneMedical, but still living in the same metro area, most scheduling offices told me that there would be a 3-6 month waiting period for scheduling a routine physical, assuming they were taking new patients in the first place.
[2] Again, n=1, so I doubt this is really a generalizeable data point.
They were great with one major problem though, they don’t filter for science based medicine. They have all kinds of woo services they try to push like chiro, crystals, aroma, etc.
If you can get through the scammy stuff they’re pretty good though for the convenience
I have one medical. Basically the value proposition for me is that its easier interface to the whole medical system. Finding a primary care physicians can be done in like 5 minutes. Stuff like scheduling appointments, virtual visits, vaccines, tests and what not through the app is super easy. IDK if it will get mainstream adoption but to me it takes the edge off seeking medical care. Also their clinics are nice and in convenient places.
I paid for it out of pocket, the experience is pretty great in theory, but it doesn't make up for the apparent doctor shortage in SF. It's very difficult to get appointments with an actual doctor without waiting months.
I had BetterHelp through my old job, and used their telemedicine feature...until they realized that I didn't live in a state that they had an "official" location in, so, they cancelled my membership (ironically enough, when I used their telemed offering, I was in a state that they had offices in, just not near me!)
...only to reactivate it again when my employer questioned why, and have them cancel it again two weeks later.
I haven't even tried to use them or look at their offerings after being de-platformed on repeat for the longest part of a year until my employer dropped them.
I’m not sure how much of it was luck, but my provider at One Medical tested for Lyme disease and caught it in me. My provider seemed to be extra cautious based on very limited clues and I think that is somewhat related to it being a premium product.
Lyme can be super awful in some cases, especially when you’ve had it for a while without knowing. Given my experiences in other care systems, I don’t have a lot of faith they would have tested for it with any rigor.
I use one medical even though my insurance doesn't cover anything through them, as they're vastly more convenient for scheduling, telehealth, Rx renewals, etc., and the doctors I've seen are all good. They also have locations in "good" cities in the US, and thus if I'm traveling there, I have a decent local option. Completely happy with it.
One Medical would write adderall scripts for people during the pandemic. I think they stopped, but idk I went back to using a regular psychiatrist. Pretty wild to think that nurse practicioners were prescribing schedule IIs.
source: I got all of my adderall through them for nearly two years
I used it, but will transition away. They kept ratcheting down the time a doctor can see with the patient and increasingly make each visit "special" so they can charge $250 for a 25 minute session.
I already didn't like it, I like it even less now.
Yep. It's $200 to join. My insurance doesn't cover it but I can see an MD anytime. I can telehealth or visit my PCP through them usually next day. They have labs onsite. The wait is minimal, maybe 5 minutes.
Eh.. I'm open to see what happens. I'm currently being ground to a bloody pulp through the US medical machine. It has been one of the most stressful experiences of my life. It can't possibly get worse if Amazon gets its fingers into a small part. If they can squeeze even a few percentage points of improvement out of the process it'd be a huge win in my book. The current system makes one want to give up.
The reason it's so bad is because dentists, doctors offices, hospitals and health insurance companies have also gone through this same massive consolidation.
CVS Health Corporation owns almost 10,000 drug stores and fills more than 20% of all US prescriptions. It also owns Aetna, the largest health insurance company in the US. It's the fourth largest US company by revenue. Another health insurance company is number five.
The largest health care operator in the US is HCA Healthcare which runs 187 hospitals, and has $60 billion in revenue.
I think it's better to look at what works well in countries other than America - A solid public health system and more regulation on private industry. The improvisation of human health has a long history of negative consequences and it's very hard to go back on.
The best option is open enrollment for Medicare or state equivalent and tax funded subsidies for low-income individuals. Unfortunately this option is unattractive to either the left or right
Why is this unattractive to the left? The left wants any change. Obviously universal health care is preferred, but only the right and some centrists wants to restrict the things you mentioned.
On the left I think it is a case of the perfect being the enemy of the good.
One possible explanation for why we got the ACA instead of open Medicare when Democrats had the power under Obama is open Medicare enrollment has a greater chance of preventing Universal single pair down the road.
Open Medicare enrollment is also in some ways close to the status quo of Medicaid.
Lastly, it is a risky option because it pits Medicare directly against private insurance- what if it isn't cheaper or people don't like it
While I agree, it seems like the probability of this happening in the US any time soon is almost nil. Where as the probability of One Medical making at least some improvement is non zero.
I don't know. I don't see any good reason to think that on the whole, One Medical will have a positive effect on the health care system. I guess we shall see.
Not like they are the only player in town. If they don’t make things easier people just don’t use them, no harm done. So they are either good for consumers or not relevant. What’s the downside?
I could see them leading a march to the worsening of health care overall in a number of ways. I don't think it's as simple as "if they're not good, nobody will use them". Health care in the US doesn't really work that way, which is part of the problem with US health care.
I’m not a fan of US health care, but in the case of private healthcare providers isn’t that exactly how it works? Insurance etc maybe not do much, but what kinds of disproportionate power does something like One Medical have?
The problem is how 'health' is defined (or lackthereof) and overprescription of drugs.
It doesn't really seem like the medical industry is going in any particular direction other than developing more subscription drugs (whos primary sure sign that theyre doing anything is the side effects) and marketing them after using regulatory capture to approve them. One time cures barely get any funding or marketing or regulatory acceleration because they're simply not as profitable.
It's a really deeply cynical industry that I don't foresee fixing itself without near-total or total collapse.
> If they can squeeze even a few percentage points of improvement out of the process it'd be a huge win in my book.
That would be s/improvement/profit though, right? I bet they absolutely can manage that squeeze, and I bet it won't register as "improvement" from your perspective.
Lol why do you think these moves are about improvement of the process? Like its said they have a fiduciary duty to squeeze profit out of their moves. Improvement of the experience for the customer is at least orthogonal to that.
What moral or economic principle determines why one company shouldn't be allowed to buy another, as long as it's not reducing competition (e.g. Amazon buying Barnes and Noble, or Amazon buying Wal-Mart)?
If Amazon simply built its own One Medical that grew to the same size, should that similarly be prohibited? And how are you going to determine the dollar value valuation of a company where it's not allowed to buy companies anymore?
Because conglomerates -- corporations that have products in lots of different industries -- have been around for a long time. They grow when they think they can generate economies of scale and synergies, which is good for consumers.
Socialism, communism, anarchism, some Democratic Socialism, and some progressivism all believe there’s moral and economic principles to not let an Amazon or CVS keep buying up companies.
There’s lots of anti-capitalist resources available online. It’s sometimes hard to find them because of the Red Scare and capitalist’s wildly violent suppression winning the Cold War. Cheers!
Also, lots of neoliberal and other broadly pro-corporate-capitalist viewpoints outside of the Austrian/Chicago camp; unrestrained corporate monopoly is only seen as not a problem in a very small slice of the economic ideological space.
I agree. I think there should be a size and value threshold where it is determined that your company can reasonably just spend to build using your own R&D for literally anything, and that performing an acquisition at all (whether or not it makes you a monopoly) is harmful for the overall market.
Take Apple for example. It bought most of Intel's modem business to build its own product.
Does anyone seriously believe that Apple couldn't have built that kind of technology from scratch? How many modem businesses could they build before running out of cash? Wouldn't it have been better for Intel's modem business to go to someone else who might make the product available outside of Apple's closed product ecosystem?
I'm pretty sure Apple would have no problem bootstrapping an oil company or an industrial container ship manufacturing business, that's just how much money they have.
What exactly about "big" is it that makes you say this? Is it the amount of money they can throw around? Is it the ability to integrate these bought companies in with the rest of their companies? Is it that there aren't enough people at the top of the company?
They capture markets by loss leading, killing competition, at the same time hamstringing their suppliers/sellers with demands that are unreasonable. Only to either raise prices later or default to selling counterfeit goods, or change agreements but the market has been decimated so there is largely only a single place to source or sell goods. Then they take their war chest and do it to another industry. American medical is both extremely profitable and also extremely not profitable depending on where you sit. I do not see Amazon being a good faith participant in this field given their other business lines.
i mean i support you saying that about almost any company to promote more precise discussion but amazon literally employs like 1.5 million people and dominates both internet commerce and cloud computing, there are easier targets to argue that they aren’t “big”
And I'm wondering what aspect of their bigness is causing the badness. Is it profits? revenues? Is it the number of employees? Is it percent of the market share in the business that they are active in? Or is it some measure of their political power?
Companies go out of business for a number of reasons including but not limited to -) The inability to compete with or defend against mega-corps such as Amazon, Google, Facebook etc..., -) Being poorly managed, -) Having a product that people don't want/need. It's actually quite rare that smaller companies go out of business competing with their peers.
At the end of the day - what matters more - the success and profits of private companies - or the health and happiness of humans? They're not always diametrically opposed - but they're often not conducive to one another.
It’s not a straw man. I understand we’ve have been in low interest rate environments for a long time, but access to capital is no longer free and likely won’t be for a while.
Companies now do (and will continue) to go under due to lack of access to capital markets.
One Medical is actually probably one of the top examples of that kind of company. It would be very hard for them to issue new shares or raise debt to fund their operations.
And to the health and happiness of humans point, a bunch of people losing their primary care doctors is again, one of the top examples of bad social outcomes from a company going out of business.
Mmh no, a company isn't the same thing as a physical person (seen as a human being, not as a single person business), for example. As such, they are threated differently.
"We hold these truths to be self-evident, that all companies are created equal, that they are endowed by their Creator with certain unalienable Rights"
Strongly agreed. There have been plenty of people banned for life for returning too many items, or sometimes just one large item. Fine, no more shopping at Amazon. Now, there goes your healthcare provider(s) too.
Google was scary enough with so many digital properties tied together, but now a bohemoth expanding into the 'real' world should give everyone pause.
Also better keep your AWS accounts current so you can access your doctor and your pharmacy!
Also need to make sure your startup employers AWS bill is always current in case your work AWS account is linked to your personal Amazon Prime account behind the scenes somehow.
Not sure whether these FTC statements are routine whenever global megacorps gobble up smaller companies, or whether they're issued based on past performance of the companies in question.
"The Federal Trade Commission issued a statement Feb. 27 warning Amazon and One Medical that it must keep healthcare data safe and is prohibited from using it for advertising or marketing purposes.
Amazon said it would not share One Medical patients' personal health information to sell other Amazon products, and the FTC said the company must uphold that statement.
'Companies that fail to abide by the commitments and representations they have made to consumers can violate Section 5 of the FTC Act,' the FTC wrote.
The FTC also said both companies must make it clear on how they will use protected health information as defined by HIPAA, as well as how Amazon will use One Medical patient data for purposes 'beyond the provision of healthcare.'
Amazon completed its $3.9 billion acquisition of virtual and in-person primary care company One Medical on Feb. 22."
Becker - https://www.beckershospitalreview.com/disruptors/ftc-warns-a...
FTC Statement in full - https://www.ftc.gov/system/files/ftc_gov/pdf/2210191amazonon...