Alexa, I’ve fallen and I can’t get up!

In this episode, we unpack Amazon’s efforts to “disrupt U.S. healthcare” (apologies for the new age business lingo!). And after their spectacular failure to disrupt anything, we talk about Amazon’s pivot from “disrupting” the healthcare industry to joining it. About a month ago, Amazon purchased One Medical, an in-person and virtual subscription-based healthcare service (the so-called “Netflix of healthcare”). What does Amazon’s move into the healthcare industry mean for patients, and how could it impact the social movement for Medicare for All? Are we moving toward a future where you have to ask Alexa to take a look at that potentially cancerous mole on your ass?

Show Notes

Amazon has been trying to break into the healthcare industry for some time now. What exactly are they trying to do and how successful have they been?

  • In 2018, Amazon forms Haven with JP Morgan and Berkshire Hathaway, claiming they will “disrupt” healthcare industry by lowering costs and improving outcomes. Had completely insufficient market power or leverage to do that effectively. 
  • So then in 2019 Amazon launches Amazon Care, a “concierge care” service for its employees, quickly expanding to other employers (like Whole Foods and Hilton) who could offer Amazon Care as part of their own business’s employee benefits package, and then eventually to the general public. (This is a common strategy at Amazon – they created Amazon Web Services to satisfy their own customer service needs then started selling it to other companies and now it’s one of their most valuable assets.) It was abruptly shut down in late August 2022 after the One Medical merger.
  • Most recently in July 2022, Amazon buys One Medical in an all-cash deal worth 3.9 billion 
    1. One Medical has had its own problems that sound eerily familiar to the issues doctors had with Amazon Care – a model that once again stresses profits over healthcare.
    2. Basically doing with healthcare what they did with groceries by buying out Whole Foods – when Amazon Fresh wasn’t catching on they simply bought out one of their biggest competitors
    3. You could sort of call One Medical the Whole Foods of health care rather than the “Netflix…” mostly rich people use it.

Why would Amazon WANT to move into the healthcare industry, where they have zero experience? Money and hubris of course! This is the only industry in the US that always growing and seems to be recession-proof, and Amazon really believes they are capable of doing anything, even when they are batting 0-for-2 in their healthcare projects. Study in White Male Privilege!

Amazon’s business model emphasizes speed, convenience, and efficiency for the consumer above all else, and they seem intent to carry this forward into their healthcare ventures. What are the potential problems of applying this approach to healthcare? How is it going to affect patients?

  • Amazon Care is a good first case study:
    • Even before it was shut down, there was some whistleblowing going on behind the scenes as medical staff complained that the company’s practices were putting profits over patients: From an August 2022 Washington Post Article: “While planning to expand Amazon Care beyond Seattle, Amazon managers wanted to avoid building a physical hub. Instead, they asked if nurses could store and dispose of medical supplies at home and stabilize patient blood samples using centrifuges in their personal cars, the two former nurses said. They said the staffers protested the ask.
  • One Medical seems to be a perfect fit for the Amazon model, even before they were bought out:
    • In 2021 Congress convened a special subcommittee to investigate companies like One Medical for using the pandemic to increase their revenue. In the final report, Rep James Clyburn said “Troublingly but unsurprisingly, in the chaos and confusion of the Trump Administration’s mismanaged early vaccine rollout, self-interested vaccine providers like One Medical and its executives sought to take advantage of their possession of scarce doses to advance company interests and pad the bottom line.  This unscrupulous conduct prevented these doses from protecting the health and lives of less privileged Americans at high risk from the coronavirus.”
    • In August 2021, employees of One Medical set out to unionize their workplace in part because of the lack of focus on patient care. They complained about shortened times for doctors visits and rushed schedules for call centers and lab workers.

In March 2021, Amazon Care helped to found a lobbying group called “Moving Health Home” to loosen restrictions on at-home healthcare and encourage CMS to cover home treatment at the same rate that it covers treatment in medical facilities, which could deliver huge profits to health and tech companies. We love home healthcare – it helps folks with chronic health conditions stay in their homes and avoid institutionalization. How could that be a bad thing?

Our allies at National Nurses Union are intensely critical of the “Hospital At Home” programs that Amazon is targeting for home-based care:
“These Home All Alone schemes were born of an unholy alliance between a profit-driven hospital industry, technology giants, and venture capitalists seeking to reap profits by replacing hands-on skilled hospital care with robots, gadgets, and less-skilled contract workers… While the hospital industry has for many years pushed to decentralize care away from the hospital and towards outpatient and telehealth programs, the pandemic provided an opening to promote, establish, and normalize these schemes on a much larger scale. In November 2020, as hospitals were overrun with Covid patients, the U.S. Centers for Medicare and Medicaid Services (CMS) waived significant regulations governing the provision of hospital care, making it feasible for hospitals to send acute-care patients to their own homes but still collect as much in CMS reimbursements as if they were housed at the hospital.”

The CMS waiver allowed “acute care” reimbursements for at-home care while SUSPENDING requirements for immediate availability of a registered nurse. Also “… the program allows a 30-minute response time for patient emergencies, which can be met by calling the local 911 system.” Needless to say, in a hospital setting the response time for patient emergencies will be seconds, so this is a major degradation of care.

All of this begs the question: What are the ramifications of a company with Amazon’s financial and political sway entering the healthcare sphere? What other pieces of legislation or regulations could become targets for Amazon lobbyists?

Clearly this has the potential to set up Amazon as an additional opponent of Medicare for All. But, just as some of the strongest leadership in the Medicare for All movement has come from providers (nurses, doctors, social workers, psychologists, etc.), this also creates a new constituency of Amazon workers who will have to see the failings of the healthcare system on a day-to-day basis, and form a natural new constituency for our movement. Time to get organizing, just like the Amazon Workers Union!

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