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As a One Medical customer, this makes me very unhappy: even if internal controls protect my data from the rest of Amazon’s business, I struggle to believe that

As a One Medical customer, this makes me very unhappy: even if internal controls protect my data from the rest of Amazon’s business, I struggle to believe that their interests are aligned with mine.

nostrebored 4y ago
Could I ask why?
- forevergreenyon 4y ago
  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'.
  - thunky 4y ago
    I hate to break it to you, but health care is already a for-profit industry.
    - woodruffw 4y ago
      Nobody said that it isn’t. There’s a world of difference between making a profit and driving a bottom line.
      - thunky 4y ago
        I don't understand. Are you saying that existing for-profit health care companies are not attempting to maximize their profits?
        GavinMcG 4y ago
        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.
        woodruffw 4y ago
        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.
    - Workaccount2 4y ago
      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".
    - forevergreenyon 4y ago
      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.
    - JohnFen 4y ago
      Right, which at heart is the primary reason why it's so utterly broken.
- woodruffw 4y ago
  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.
  - robertlagrant 4y ago
    > 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.
    - ellisv 4y ago
      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.
      - robertlagrant 4y ago
        In certain regulatory environments it won't be a penalty. It'll be a recall and shutdown.
        mrguyorama 4y ago
        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.
        robertlagrant 4y ago
        This isn't to do with antitrust.
jessriedel 4y ago
I have been using OneMedical since 2019, Amazon Pharmacy since 2021 (a few months after they began operating), and regular Amazon since forever. Happy customer in each case. Anything could happen with this acquisition, of course, but I'm pretty optimistic.
hellomyguys 4y ago
As a One Medical customer, the experience post IPO has been awful. Hard to get appointments and less and less MDs available with incredibly high turnover. I wouldn't say their interests are aligned with mine at all, but agree the customer data being in Amazon's hands isn't great.
- coredog64 4y ago
  Let's segregate customer data from medical data: The US has some (IMO) pretty strict laws about protecting PHI. One Medical isn't going to keep your data in an open public S3 bucket, and random Amazon employees aren't going to be snooping around your medical records on their intranet.
  - ejb999 4y ago
    Not to mention that there is already a better than decent chance that no matter who has your medical records, they are already being stored or backed up into one of the major cloud providers anyway.
  - NickC25 4y ago
    Strict yes, but a company with the lobbying budget of Amazon can easily get around those laws. 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."
    - chimeracoder 4y ago
      > Strict yes, but a company with the lobbying budget of Amazon can easily get around those laws. 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.
ctvo 4y ago
Amazon customer service isn't what it once was, but it's still better than 99% of the industry. 30 seconds to a call with a human, instant refund, etc.. They're still one of the few large companies you can get on the phone and speak to someone with for a 5 dollar order. Try that with anything Google, Meta, ... related. Heck even in ecommerce, try that with an order online from Walmart. 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.
- woodruffw 4y ago
  This is a technocratic framing: I’m not trying to get a $5 refund from my doctor, or to speak with customer service. I want to speak to my doctor on the phone, to have a years-long relationship with them (so that they understand my medical history beyond whatever a DB schema supports), and so forth. It is not remotely clear to me that Amazon is equipped to provide these things.
  - coredog64 4y ago
    ahem Have you seen the scale of their Enterprise Support organization? As an AWS customer, you can be on the phone with your TAM in minutes. Maybe Amazon consumer doesn't flex that way, but it's a very limited viewpoint to say that there's no corporate DNA at Amazon that's set up for customer service.
    - woodruffw 4y ago
      I didn't say they lack the "DNA" for customer service. I just don't think the kinds of customer service they've optimized for are compatible with reasonable (and beneficial, in terms of patient outcomes) expectations in the world of primary care medicine.
crazygringo 4y ago
They were already a publicly traded corporation. Their interests have never been aligned with yours fundamentally, they've been aligned with a fiduciary duty to make profit for shareholders. Literally nothing about the profit motive has changed. 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
- eli 4y ago
  Amazon has a reputation for ruthless efficiency. Seems speculative to assume that they bought One Medical because of its high level of care and that they are able to manage the company in a way that it continues. There are plenty of Amazon acquisitions where the service got worse post-acquisition, was relaunched as something else, or was simply shuttered.
  - crazygringo 4y ago
    But Amazon already did the same with Whole Foods. It continues to be premium. 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.
    - slantedview 4y ago
      Whole Foods workers were impacted by the acquisition. Since healthcare depends on high skill workers, any impact to them will harm customers.
    - j0hnyl 4y ago
      Whole Foods is absolute TRASH after Amazon bought it. The food used to be good and now it's absolute crap, less options, utter rubbish no better than keyfood. At least in NYC anyway. (multiple locations)
manv1 4y ago
You're assuming that One Medical's interests are different than Amazon's. You're probably wrong. 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.
- polygamous_bat 4y ago
  You know what's one case of a quantitative solution to a medical problem? Take a physically healthy but severely mentally ill person, and harvest their organs to transplant. It's surely gonna bring in profit and increase our GDP! 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.
burnte 4y ago
I'm in healthcare IT, there are incredibly strict regulations about what we can and can't do with your PHI. Amazon isn't big enough to fuck with the OIG.

nostrebored 4y ago

Could I ask why?

forevergreenyon 4y ago
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'.
- thunky 4y ago
  I hate to break it to you, but health care is already a for-profit industry.
  - woodruffw 4y ago
    Nobody said that it isn’t. There’s a world of difference between making a profit and driving a bottom line.
    - thunky 4y ago
      I don't understand. Are you saying that existing for-profit health care companies are not attempting to maximize their profits?
      - GavinMcG 4y ago
        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.
      - woodruffw 4y ago
        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.
  - Workaccount2 4y ago
    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".
  - forevergreenyon 4y ago
    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.
  - JohnFen 4y ago
    Right, which at heart is the primary reason why it's so utterly broken.
woodruffw 4y ago
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.
- robertlagrant 4y ago
  > 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.
  - ellisv 4y ago
    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.
    - robertlagrant 4y ago
      In certain regulatory environments it won't be a penalty. It'll be a recall and shutdown.
      - mrguyorama 4y ago
        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.
        robertlagrant 4y ago
        This isn't to do with antitrust.

jessriedel 4y ago

I have been using OneMedical since 2019, Amazon Pharmacy since 2021 (a few months after they began operating), and regular Amazon since forever. Happy customer in each case. Anything could happen with this acquisition, of course, but I'm pretty optimistic.

hellomyguys 4y ago

As a One Medical customer, the experience post IPO has been awful. Hard to get appointments and less and less MDs available with incredibly high turnover. I wouldn't say their interests are aligned with mine at all, but agree the customer data being in Amazon's hands isn't great.

coredog64 4y ago
Let's segregate customer data from medical data: The US has some (IMO) pretty strict laws about protecting PHI. One Medical isn't going to keep your data in an open public S3 bucket, and random Amazon employees aren't going to be snooping around your medical records on their intranet.
- ejb999 4y ago
  Not to mention that there is already a better than decent chance that no matter who has your medical records, they are already being stored or backed up into one of the major cloud providers anyway.
- NickC25 4y ago
  Strict yes, but a company with the lobbying budget of Amazon can easily get around those laws. 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."
  - chimeracoder 4y ago
    > Strict yes, but a company with the lobbying budget of Amazon can easily get around those laws. 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.

ctvo 4y ago

Amazon customer service isn't what it once was, but it's still better than 99% of the industry. 30 seconds to a call with a human, instant refund, etc.. They're still one of the few large companies you can get on the phone and speak to someone with for a 5 dollar order. Try that with anything Google, Meta, ... related. Heck even in ecommerce, try that with an order online from Walmart. 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.

woodruffw 4y ago
This is a technocratic framing: I’m not trying to get a $5 refund from my doctor, or to speak with customer service. I want to speak to my doctor on the phone, to have a years-long relationship with them (so that they understand my medical history beyond whatever a DB schema supports), and so forth. It is not remotely clear to me that Amazon is equipped to provide these things.
- coredog64 4y ago
  ahem Have you seen the scale of their Enterprise Support organization? As an AWS customer, you can be on the phone with your TAM in minutes. Maybe Amazon consumer doesn't flex that way, but it's a very limited viewpoint to say that there's no corporate DNA at Amazon that's set up for customer service.
  - woodruffw 4y ago
    I didn't say they lack the "DNA" for customer service. I just don't think the kinds of customer service they've optimized for are compatible with reasonable (and beneficial, in terms of patient outcomes) expectations in the world of primary care medicine.

crazygringo 4y ago

They were already a publicly traded corporation. Their interests have never been aligned with yours fundamentally, they've been aligned with a fiduciary duty to make profit for shareholders. Literally nothing about the profit motive has changed. 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

eli 4y ago
Amazon has a reputation for ruthless efficiency. Seems speculative to assume that they bought One Medical because of its high level of care and that they are able to manage the company in a way that it continues. There are plenty of Amazon acquisitions where the service got worse post-acquisition, was relaunched as something else, or was simply shuttered.
- crazygringo 4y ago
  But Amazon already did the same with Whole Foods. It continues to be premium. 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.
  - slantedview 4y ago
    Whole Foods workers were impacted by the acquisition. Since healthcare depends on high skill workers, any impact to them will harm customers.
  - j0hnyl 4y ago
    Whole Foods is absolute TRASH after Amazon bought it. The food used to be good and now it's absolute crap, less options, utter rubbish no better than keyfood. At least in NYC anyway. (multiple locations)

manv1 4y ago

You're assuming that One Medical's interests are different than Amazon's. You're probably wrong. 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.

polygamous_bat 4y ago
You know what's one case of a quantitative solution to a medical problem? Take a physically healthy but severely mentally ill person, and harvest their organs to transplant. It's surely gonna bring in profit and increase our GDP! 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.

burnte 4y ago

I'm in healthcare IT, there are incredibly strict regulations about what we can and can't do with your PHI. Amazon isn't big enough to fuck with the OIG.