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Google’s search monopoly complicates a mental health crisis
- changoplatanero 6y agoNot clear to me how breaking up the google search monopoly would lead to a lower cost per click for valuable keywords.
- tyingq 6y agoYes, this just seems to be more providers bidding on "online therapy" keywords, since the in-person kind isn't so practical right now.
- stingraycharles 6y agoAnd if I’m not mistaken, the audience is now also a lot bigger, right? Would this not imply that this evens each other out? The therapist of the article could just maintain her bid price, not?
- tyingq 6y agoIt's a weird market since there's only so many room for ads. Normally, you would add shelf space, Google doesn't do that.
- CydeWeys 6y agoYeah but clearly the ads being bid up are worth it to someone, no? Is the issue that the limited supply is now being taken up by therapists charging more than her, i.e. those who can bear higher costs of advertising? And if so ... what exactly is the workable alternative? This is all just market forces. The cost of advertising and acquiring new business has been around for much longer than Google.
- tssva 6y agoThey aren't even being taken up by therapists charging more than her. They are being taken up by corporations providing online access to therapists for substantially less than she charges. The consumer is actually benefiting. She charges $250 a session. Lets say she sees 6 patients per day generating $1500 gross revenue a day. She spends $20 a day in ads which works out to around 1.3% of gross revenues spent on advertising. That is an extremely low amount spent on advertising. The US Small Business Administration recommendation for businesses with revenues less than $5 million per year is to spend 7-8% of gross revenues on marketing.
- CydeWeys 6y agoThat's a good point and thanks for doing the numbers. Maybe she just has unrealistic expectations of how much is normal to spend on advertising? It sounds like it. She should definitely be able to afford to spend more than a platform like BetterHelp, which is making a lot less per consultation than she is.
- bryanrasmussen 6y agoisn't adding shelf space analogous to adding more ads? I mean I haven't really kept track but I am always seeing complaints on HN about how many more ads there on google nowadays so they must add some shelf space.
- gowld 6y agoGoogle Search and Maps has unlimited shelf space, and it is free.
- stingraycharles 6y agoAren’t “extra shelves” in case of Google second and third page of search results? Or is it an illusion that people actually view those pages?
- tyingq 6y agoMy understanding is that very few people go past the first page.
- pradn 6y agoIt sorta does add shelf space. The number of ads show per keyword varies. A large proportion of searches get no ads, and some get a whole pageful.
- gowld 6y agoNo, because the demand is same (or slightly modified by Covid), but supply is much larger because geography is not a constraint.
- MattGaiser 6y agoI don't see how either. The total number of searches would remain the same. The total payment from customers for therapy services would remain the same. It would be worth it for therapy companies to spend the same amount of money chasing those customers.
- goodside 6y agoSpending on therapy advertisement would go up during a nation-wide transition to online therapy because far more people are switching therapists — people who previously chose a therapist based on convenience of the office location suddenly no longer have to. There’s also likely more consumption of therapy overall because of unemployment and other COVID-related hardships.
- MattGaiser 6y agoYes, but neither of those are impacted by whether there is one major search engine or five.
- tigerbelt 6y agoGoal isn’t to lower cpc Goal is to offer breathing room for innovation where predatory ad approach doesn’t serve as the arbiter of information on webs
- treis 6y agoPart of the problem is that since Google is a monopoly they have little incentive to produce good organic search results. It's much better for them if you end up clicking an ad than a search result. And with a dominant position there's not much alternative for businesses or consumers. A competitive search market might force them to come up with better organic results since those are (theoretically) better than ad links. This problem is amplified by VC funded start ups. They're willing to lose billions in order to gain a dominant market share. How can little ole therapy service compete with VC funded therapy market when they don't care about making money? Eventually little ole therapy service folds and the therapists have to go work for VC funded therapy market. The long term outlook is that we get one (or a handful) of therapy platforms that are just middle men extracting value.
- deleted 6y ago[deleted]
- Proven 6y agoGoogle is not a monopoly and free market capitalism is the last system in which a monopoly could exist. Monopolies exist in socialism (and fascism, or statism). Google has no monopoly on anything - anyone can hire its product teams and buy, rent or build the kind of infrastructure they have. I don't know what exactly is the Bloomberg writer whining about. Bloomberg Inc is like Google in the area of access to professional financial news and info services.
- MattGaiser 6y ago> he didn’t even check to see how they did. “I mean, it’s Bing, right?” he says. Bing and Yahoo are still about 20% of the American market. It is not inconsequential. I suspect that prices have soared there as well though, simply because the pandemic severely disrupts therapists. In a world of video calls, there is no local market. There are as many places seeking to sell you therapy as sell you gasoline now.
- hn_throwaway_99 6y agoI don't know where you get 20%, this shows Bing+Yahoo at barely over 10% total. https://gs.statcounter.com/search-engine-market-share/all/united-states-of-america https://gs.statcounter.com/search-engine-market-share/all/un...
- MattGaiser 6y agoFrom Google fetching this one for its info box: https://gs.statcounter.com/search-engine-market-share/desktop/united-states-of-america https://gs.statcounter.com/search-engine-market-share/deskto... So I found only the desktop market share.
- learc83 6y agoI'm sure when you factor in mobile, Bing and Yahoo are nowhere near that high.
- hn_throwaway_99 6y agoThese days desktop market share is less than mobile, it's not really useful to only talk about desktop.
- rietta 6y ago> pandemic severely disrupts therapists. In a world of video calls, there is no local market. This is absolutely not true in the United States. Therapists are licensed in each state and it can cause severe professional problems and ethics situation. A counselor cannot technically even see a client telehealth if they are on vacation out of state that week unless the counselor is also licensed in the State the client is vacationing in. Source: My wife is a licensed practical counselor and regularly studies for her mandatory continuing education credits in the evening. I hear her watching the lectures and answering questions on those exams.
- thatfrenchguy 6y agoIn France, they fixed this by not allowing doctors or drugs to advertise. One of the best decisions ever, for a lot of reasons: you cut care cost, and you avoid that kind of third party profiteering.
- techntoke 6y agoThis sounds like a great idea for many sectors.
- luckylion 6y agoThat moves the money to be spent on SEO instead of going directly to Google, doesn't it? It's less predictable, but unless you do it, you won't be seen, ever, anywhere, by anyone.
- anoncake 6y agoI don't know about France, but in Germany, the vast majority of doctors don't even have a website to SEO. People manage to find them just fine anyway.
- luckylion 6y agoI'm in Germany, every doctor I know has a website. Maybe it varies by region? Some have simple sites, most have marketing-sites, plenty with keyword domains.
- stingraycharles 6y agoOver here in The Netherlands as well. It’s almost as if people forgot that there are directories of medical professionals you can consult!
- chrisseaton 6y ago> That moves the money to be spent on SEO instead of going directly to Google, doesn't it? No. In most countries doctors and drugs don't need any SEO, because the doctor is provided by the health service, and the doctor picks the drugs based on clinical indication.
- gowld 6y agoIsn't Google Maps search free for users and providers? Doesn't high ad pricing mean there is a glut of supply for the service in question? The article subject seems upset that someone else gets the customers, but that's not a problem for anyone. If the subject got the customers, that wouldn't be "fair" to their competitors.
- ss2003 6y agoA higher priced ad means that the provider is charging extra for the service. Those charges are passed directly to the consumer. If you have a business that is small niche of larger area you will be priced out of ads by larger, higher charging competitors. This squeezes out small and creative organizations and leaves the overall market with a few cookie cutter services that charge much more than the value of the product or service. Consumers without a lot of discretionary income can't find a service to use. Small businesses cease to exist.
- cease2exist 6y ago> 'cease to exist' Game-Theory anyone: A balancing act for um the chance to dominate ?
- pradn 6y agoCompetition for a limited resource (ad space, land, wireless spectrum) selects for companies with higher margin. In one understanding, higher profits mean the business is providing higher value. In another, it means the business is sucking up excess value that could be had by upstream consumers. Ad space can be seen as land rented out a user request at a time. Having more competitors to Google will help only a little bit. There's only so many user request x ad space x keyword units to be split among the companies. So the total amount of "land" advertisers bid for remains constant, so prices will be roughly similar. The only difference will be that Google will command a smaller cut of the auctioned price. I doubt that will make as much of a difference as an influx of entrants to the bidding market. Some Google keywords are 10s or 100s of dollars; the Google cut isn't driving hat, but the value of a new customer acquisition. Disclaimer: I work at Google but not on ads.
- techntoke 6y agoAnytime I see a service that pays for ranking then I intentionally avoid them.
- Isinlor 6y agoThe article completely failed to convince me on it's main point. No regulation will fix the fact that people have limited attention, besides banning ads altogether. Google does a lot of bad stuff, but auctioning ads is not one of them. Also somebody dares to bill people ONLY 50$ per hour! How dare they to not bill 250$?! ...
- faangFar 6y agoSide note on billing. My wife's practice is finally hitting it's celing. She needs to either charge more or hire more doctors + get a bigger space. She is her brand, so we probably won't get more doctors. But we have slowly raised prices from 50$ to 75$ per hour. Next we are going to stop accepting some government health insurance because they only pay $60/hr. Long term I can see 125$-200$/hr private pay only. The alternative to her 1 on 1 care is a hospital/clinic where you get 37 minute visits shared with multiple other clients, and have a new doctor every few weeks due to high turnover. Word of mouth is more powerful than ads.
- gen220 6y agoThis is kind of a deep question, and not meant to cast aspersions on what you're doing, because it's perfectly rational. The world of private doctors who don't accept patients paying with insurance (government or otherwise) is very interesting to me. Do you think there's a major difference in expected outcome for the average patient, between your wife's practice and a hospital/clinic? I can totally grok how a patient would find her services valuable enough to pay a much higher rate, out of pocket; but I'm trying to figure out if the payer's arbitrary cut-offs are rational. Maybe 60/hr is close to the price-point of exponentially-diminishing returns, from the risk-carrier's perspective? Obviously, institutional payers are way more conservative with risk than financially-well-off individuals, so maybe they're making mistakes on the margin. Anyways, hope I'm making sense. It's a fascinating topic.
- faangFar 6y agoThere seems to be a lot to unpack, so sorry if this is jumping around but I tried to provide lots of details. My wife has worked at those places and the difference in patient outcomes is night and day. Sure some people will get better regardless, but there's something special about people saying a 3 year old injury has 0/10 pain. At a big name company, they get people "good enough". She's one of those people that would prefer to be a Physical Therapist rather than a business owner. As a side note, many of her patients came from that 60$/hr insurance because most places don't accept it. It seems like it's a stepping stone. Knowing her, they will be grandfathered in. Something I didn't mention is how often she does free work/eat the cost because insurance will deny payment for services that were approved but later deemed "not necessary". (Despite the person being unable to work) It's complicated because a phone call, or Physician, or patient can sometimes fix this.
- drivebycomment 6y agoIt looks like the main reason the ads price for therapy went up is the extra competition - that COVID making the therapy market from in-person to virtual creates the supply to be not constrained by distance, which means suppliers have to compete across greater pool of suppliers, including therapists from cheaper cost of living areas. This naturally creates a downward pressure for the average price, and of course firms like BetterHelp show up to take advantage of this price differential - i.e. they are doing an arbitrage. So this comes down to therapists living in expensive areas complaining about competition from therapists from cheaper areas. Given there are still people who need/want local therapy, there will be a new price equilibrium but most likely it will be lower than before. No amount of complaining about Google or ads or arbitrage like BetterHelp will make the price stay as before. Nothing much to see here - this looks mostly like a market adapting to a new changed market condition.
- Ensorceled 6y agoAd prices going up means that more money is being siphoned off by Google from the mental health care service industry. It's unclear that this is ACTUALLY competition for the service or just competition for the ads. I personally would not do therapy remote unless I had to so any therapist I would be looking for would be local even if I have to do therapy remote in the short term.
- Spivak 6y agoThe bit about ad prices is a little silly. If the price of chaise lounges went up it would also be siphoning money from mental health providers.
- Ensorceled 6y agoI have no idea what point you are making.
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- munificent 6y agoAs I understand it, the problem here has little to do with Google. The problem is that the transition to telehealth means that therapists are now competing directly with large national mental healthare providers like BetterHealth and Talkspace mentioned in the article. Those big companies have deeper advertising pockets. If you want to break up companies to make it easier for independent therapists, those are the ones to break up. Google is just the marketplace. This is like blaming the sidewalk or the interstate highway system when Wal-Mart causes your local mom and pop store to shut down. Google isn't driving her prices up, competition is.
- shuntress 6y agoIt is a little bit like that. It would probably be considered a problem if Wal-Mart paid the state/highway department to ensure that major town roads "flow naturally" to Wal-Mart and are better maintained than roads that lead elsewhere. This is definitely similar to major companies in a specific domain buying the top search result from google for any query within that domain.
- jacobush 6y agoBeing America, I’d be stunned if Walmart didn’t grease the road bureaucracy in their favour.
- root_axis 6y agoDoesn't seem like a good analogy in either case. The highways are a shared public resource, the 1st page of google is just an ideal place to show an ad.
- shuntress 6y agoGoogle is the closest thing to a "shared public resource" for indexing/searching the Internet that we have. I agree with you that there are inherent properties of physical transit pathways that make them difficult to compare "one to one" with digital index searches. But I do not think these differences make the two completely incomparable. I completely disagree that the 1st page of google is "just" an ideal place to show an ad. While it definitely is an ideal place to show an ad it is also much more than that. That is like saying a supermarket that can give cash-back at the register is just an ATM.
- ineedasername 6y agoI don't see the direct connection to out mental health crisis in this issue. None of this addresses the mental health care crisis in terms of patient outcomes and patient well being. Instead, the article talks about how individual therapists are losing out as ad prices rise and newer tech-mediated therapy platforms are gaining attention & market share. (and working for those platforms doesn't pay nearly as well) Also google has a near-monopoly for online advertising, so these therapists have few options if they aren't born natural marketers, and Google customer support is bad. In short, it's bad for therapists. Nothing much said about this being bad for patients though. It's possible patients have greater access to care with these new platforms.
- WarOnPrivacy 6y agoA question from the millions of folks who don't have $50-250/hr (x hr/mo) - could this possibly lead to a genuine chance at therapy? [a] Five therapists offering 2/hrs per week to the community isn't nothing - it is a drop in an ocean of need, however. [b] No. Trying to launch an insurance debate won't help answer this question in a helpful way. Thanks for asking tho.
- Sangama34 6y agoThe article is so wrong. This is part of the reason why I do not take main stream journalists very seriously. I wish same issue was taken up by some hard core economist. What is wrong with the article : - So one small Psychiatrist is losing business to other Psychiatrists. It is perfectly possible that Ross is an inefficient Psychiatrist here and patients are better served by other Psychiatrists. This is a loss for Ross but barely a "complication". Also it is not clear to me if the market was divided 50-50 between say Google and Bing why would it be any difference. From over 10 years of experience in ad industry I have realized that it is a ruthlessly free market system where the inefficient player will get punished very quickly. What Google has done here is that opened up a lager pool of customers for the suppliers and that has resulted into fierce competition among suppliers. The customers invariably will benefit here as they have more options. - The rant about smart campaigns This is one of the real bad arguments. A couple's councilor is upset that Google is unable to differentiate between a PTSD councilor and couple's Councillor. Will the world be better served if a couple's councilor has to compete with a florist or a nanny ? [That it what yellow pages were]. The article laments that customers have more choice and it is not easy for the suppliers to rely on information asymmetry to make profit. They take some fictional futuristic scenario and compare google against it and blame those problems on Google. But in reality it is a good problem to have. PS. This is by no means to claim that Google's ad algorithms are perfect, but it is without dispute that they are better than all available alternatives.
- reaperducer 6y ago- So one small Psychiatrist is losing business to other Psychiatrists. Perhaps you're approaching this from a technical standpoint because you're a computer person. He's not supposed to represent the entirety of the problem. He's there to illustrate the problem. Journalists do this to "humanize" the story, to make it more understandable by the audience. This is done all the time. If there's space available, several people are added. Or there may have been several examples in the reporter's original writing, but they were cut for various reasons like lack of space. As an HN reader, you're probably not the audience.
- fhsm 6y ago> possible that Ross is an inefficient Psychiatrist I share your uncertainty about the relevance of Google’s market share. It was however clear to me that Ross is a psychologist, not a psychiatrist, working as a psychotherapist. > Ellen Ross ... a psychotherapist ... her practice, True North Psychology ... “I’m a fairly good psychologist,” she says. The exact service on offer is central to the more relevant issue of competition among suppliers. The psychotherapy market is increasingly competitive. Hopefully she’s an efficient psychotherapist as the flood of money into that space is likely to require some adaptation.