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Medicine Businesses United States

Is 'Amazon Care' a True Benefit Or Industrial Era-Style Healthcare? (computerworld.com) 155

Lucas123 writes: Like Apple and Intel, Amazon is piloting an in-house program for employees that in addition to healthcare insurance affords workers access to telemedicine and at-home visits from a contracted provider. While growing in popularity, in-house healthcare programs, which even include corporate clinics, are seen by some as an example of the growth in fragmented care or mimicking corporate care during the industrial era when factories had worksite clinics to get employees back to work faster. "[Corporate-based virtual healthcare programs, like Amazon's] is yet one more example of fragmented care," says Cynthia Burghard, a research director with IDC's Health Insights. "Back in the day, manufacturers had worksite clinics to take care of workers injured on the job mostly so they could get back to work sooner. The difference with what Amazon is doing compared to what the [Deloitte] survey shows is that the Amazon offering is disconnected to other care providers rather than under the supervision of an employee's providers." [The Deloitte survey found that 66% of physicians said telemedicine improved patient care access and 52% said it boosted patient satisfaction.]

Vik Panda, lead of operations for French sleep company Dreem, had this to say: "The news is that Jeff Bezos' company, and others like it, don't need anyone's permission to start building and paying for their own parallel healthcare systems, little by little. If Amazon replaces the existing health care system bit by bit, and employees of self-insured companies migrate to this new digital health system, do we all get to come along?" Amazon Care, Panda said, represents a wake-up call for providers, payers and employers because telehealth is not just about video chats with a doctor or wearable fitness trackers. "...It's a new operating system for health, and big technology companies are not going to wait for everyone else to figure it out."
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Is 'Amazon Care' a True Benefit Or Industrial Era-Style Healthcare?

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  • by weilawei ( 897823 ) on Tuesday October 01, 2019 @06:05AM (#59255922)

    Because insurance will charge $900 for a course of bloody freaking doxycycline that you can buy at the pet store for $10.

    True story.

    • They hardly make the prices.
      They don't even choose the medicine, unless you're lucky.
      (Remember Elsevier peddling several magazines targeted at doctors, containing nothing but fake studies from Merck?)

      Or is it analogous to you hating the government because lobbyists write the laws and regulations to give themselves advantages and then tell you to hate the government when it was not them doing it?

    • by PolygamousRanchKid ( 1290638 ) on Tuesday October 01, 2019 @06:49AM (#59255992)

      Because insurance will charge $900 for a course of bloody freaking doxycycline that you can buy at the pet store for $10.

      My sister did this trick once. Our mother was visiting her and our mother ran out of some medication she takes for her bones or hips or something like that.

      My sister, a chemical engineer, looked at the list of contents on the empty bottle, googled the medicine, and discovered that it was EXACTLY the same thing that she gives to her dog.

      So for a couple of days, my mother got doggie drugs and there were no problems.

      Oh, and the doggie drugs cost a fraction of the human stuff.

      • by Anonymous Coward on Tuesday October 01, 2019 @08:19AM (#59256164)
        It's not always that simple. I've taken generics that were supposed to be identical. Same ingredients and all that. But the generics gave me side effects that the the name-brand did not. Turns out there was a difference with the design of the delivery mechanism. The generic was just dumping strait into my system, which was spiking the drug, leading to the side effects. The name-brand had some sort of slow release. Of course, none of these differences were noted anywhere. Even after the facts, my doctor was not able to find anything stating these differences, other than doing some digging into why some people get the side-effects.
        • There are also higher quality controls on human-grade medicine. Occasionally things work the opposite way and you can get over teh counter human medicine for your pets that would otherwise be a Rx at a pet pharmacy.
          • Yep, but not just over the counter. For certain meds my vet would write me a script and send me to the CVS next door because he knew it was way cheaper than he could sell it to me for.
      • I did a similar trick, I got a small skin infection whilst visiting the US. I'd had this kind of infection a few times before so I knew what I needed for it. I went to a pharmacy and found out the treatment cream was over US$50 and requires me to go to a doctor to get a prescription. I didn't even ask about the oral anti-fungals I also take for it.

        So I waited until I got back to UK, made a bee line for the nearest Boots (pharmacy) and got the same brand cream + the pills over the counter for less than
        • People get fooled because there are cases where excessive regulation can be a problem, so every industry where things are overpriced points to that as the problem because they want fewer regulations.

          There is such a thing as over-regulation, but the US pharmaceutical industry is not experiencing it.
      • I'd only go for that in a real pinch. Two main reasons: one, a lot of people misjudge their ability to accurately figure these things out and are likely to poison themselves trying to do this. Two, quality controls are much stricter on medicine intended for humans. If you are physically unable to get the human variant and will suffer severe consequences otherwise, or if the cost of the drug will literally deprive you of the ability to eat for the next week, maybe this could work, but I wouldn't do it in any
      • Pets are property. If you're pet gets sick and dies from bad meds or food then the pet food company is only liable for the cost of the pet.

        John Oliver has a great video on poorly regulated compounding pharmacies [youtube.com]. It's scary to watch.

        Go watch it. Now if you think that's bad try to imagine how well regulated pet medication is.
    • Well, that's stupid of you. That's not the doctor's fault.

      I hate doctors because they are assholes. They are trained to depersonalize you, treat you like a piece of meat, and ignore you. If you have researched something more than they have (say, mold exposure, which both the CDC and the Mayo clinic say is becoming an epidemic) then they will not listen to you even a little bit because you have injured their professional pride.

      Prescription drug prices are the result of the efforts of big pharma, and the fact

      • by dbrueck ( 1872018 ) on Tuesday October 01, 2019 @08:33AM (#59256200)

        Well, that's stupid of you. That's not the doctor's fault. I hate doctors because they are assholes. They are trained to depersonalize you, treat you like a piece of meat, and ignore you.

        To each his own. I don't go to the doctor looking for someone to be chummy with me and much prefer someone with the mindset of a mechanic fixing a machine. :)

        If you have researched something more than they have (say, mold exposure, which both the CDC and the Mayo clinic say is becoming an epidemic) then they will not listen to you even a little bit because you have injured their professional pride.

        Maybe. Or maybe it's because (a) they constantly have to deal with people who spent some time on a couple of minutes googling and now think they know more than the doc and it's too much work to differentiate between them and the one-in-a-hundred who might actually be on to something and (b) they know that they carry the responsibility (and liability) so even if you're right, they still have to do pretty much the same work to arrive at the same conclusion. In the U.S. at least, if you were to mis-self-diagnose and get them to agree with you and prescribe the wrong treatment, you could turn around and sue them (and have a good shot of prevailing) even though it was your doing.

        • You bring up something they haven't researched and from a reputable source and their response isn't to look it up, it's to patronize and ignore. Fuck that. They can't be replaced by an expert system fast enough. And since computers are actually better at diagnosis than doctors, it will be a massive win for everyone. Well, everyone but the doctors, anyway. Maybe the smart ones can go into research. Someone has to train the system, after all.

        • Comment removed based on user account deletion
      • by thomst ( 1640045 ) on Tuesday October 01, 2019 @10:48AM (#59256710) Homepage

        drinkypoo raged:

        I hate doctors because they are assholes. They are trained to depersonalize you, treat you like a piece of meat, and ignore you. If you have researched something more than they have (say, mold exposure, which both the CDC and the Mayo clinic say is becoming an epidemic) then they will not listen to you even a little bit because you have injured their professional pride.

        You have to train them to recognize and respect your diagnostic skills, Martin. It isn't easy, I know, but it is possible. Eventually.

        My personal physician is an internist - a doctor who specializes in diagnosis. He blew me off when I asked for a referral to a dermatologist because a white nevus had grown on my forehead, and I felt it was important to have it checked out by a specialist. (I'm at particularly high risk for skin cancer, both because I'm very fair-skinned and have an unusually-large number of moles - none of which are white - and because I've had several severe sunburns, including one that caused third-degree burns on my forehead and nose.) I was only able to afford to see him every 6 months, so, at my next visit, I told him that the mole in question had begun to bleed about 4 months earlier, then had stopped bleeding about 2 months later.

        He immediately referred me to a dermatologist. With the 3-month wait for that appointment, it had been a full year since the nevus had first appeared and 9 months since I initially requested the referral. The dermatologist took one look at it, scrutinized it under an eyepiece lens, and announced, "Yep. It's cancer, all right. Oh, we'll biopsy it and send it to Pathology to confirm that - but I've seen enough of these to recognize a cancerous one when I see it, so I'm sure I'm right about it."

        And, of course, she was correct. It was a basal cell carcinoma - the most common (and least lethal) form of skin cancer. Two months later, I underwent surgery to have it removed. That involved the surgeon cutting a 1-inch by .5-inch "football-shaped" chunk of flesh out of my forehead. He cut all the way to the bone (because cancer), and scraped the bone clean. Prior to the operation, my dermatologist had assured me that "he's an excellent plastic surgeon." He was, indeed. You have to know the scar is there to see it.

        But it hurt like fucking blazes for months afterward - and I made it a point to mention that to my regular physician at our next appointment. A year or so later, I developed an umbilical hernia while foolishly carrying a full electronic drum kit down to my basement studio by myself. I made an appointment with my physician, and told him what had happened, and explained my self-diagnosis. He palpated the hernia, and responded, "I agree with your diagnosis. I'll refer you for a CAT scan, because they'll require one before they'll schedule you for surgery, but you're obviously correct about this being an umbilical hernia."

        The thing is, when they scanned my CAT, the images not only confirmed my diagnosis, they also revealed a roughly-globular mass in the upper-left quadrant of my abdomen. "That's a gallstone," the imaging specialist told me. "It's a pretty big one, but it's not cancer, if that's what you're concerned about.

        It wasn't. What I was concerned about was what that incidental image told me about a devastating chronic digestive condition from which I've been suffering for the past 5 years. I'd been referred to a couple of different gastroenterologists, and been treated with everything from industrial-strength antacids, to Elavil (to calm the muscles of my small intestine), to multiple courses of broad-spectrum antibiotics (to treat what turned out to have been an incorrect diagnosis of microbial overgrowth of the small intestine). None of that had worked. None of it even helped. But seeing that golf-ball-sized gallstone instantly revealed to me what had been causing my problem - a condition so disruptive that it causes me chronic, severe sleep deprivation to th

        • because I've had several severe sunburns, including one that caused third-degree burns on my forehead and nose

          Do you have a citation on how this is even possible? Everything I could find from health professionals says that you can't get third degree sunburns. For example, here's what Seattle Children's Hospital [seattlechildrens.org] says:

          Sunburn never causes a third-degree burn or scarring

          That stands to reason, since third-degree burns involve charring of the skin and sunlight isn't powerful enough to do that unless concentrated. If you fail on the simple diagnosis of the severity of a burn then I would say your internist would be cor

    • If that was any time in the last decade**, you really should look for a new pharmacy. doxycycline is a common enough generic that most pharmacies will sell you a 30 day supply for $4 or $5, or a 90 day supply for $10. Because it's an antibiotic, some pharmacies like meijer will give it to you completely free.

      **Except apparently in 2014...wikipedia notes that thee was a supply shortage that year and the price skyrocketed
    • by havana9 ( 101033 )
      Now, with single payer system medicine the price of Pfizer made doxycicline is like 4 Euro for ten pills, but because the generic costs 2 Euro, I have to pay the difference.
      You need a recipe anyway, but the one from your GP or from hospital and ER will suffice. Sometimes you could get pills without prescriprion at full price [tellerreport.com] but it's actually forbidden and had consequence for the pharmacist.
    • Insurance didn't charge it. Regional hospitals and drug companies dictate prices.
    • by guruevi ( 827432 )

      You can also go to the pet store and get your doxycycline, if you're smart enough. Not sure if it's clean enough and tested on humans though. There is a reason for the charge, humans are expensive, research is expensive and if a single nation is carrying the majority of the world's medical research, that nation will have expensive medical systems.

      Also, doxycycline specifically costs $15 from CVS and many other pharmacies.

  • by BAReFO0t ( 6240524 ) on Tuesday October 01, 2019 @06:16AM (#59255936)

    With the morals you know from Amazon.

    Everything else follows from that.

    • If you have the means and the scale to set up your own clinics, I can well imagine that you'll be able to provide the same level of care or better for less money. Especially in the US system where there is very little incentive anywhere to drive down prices. Don't worry about me bashing that system; while our health care is partly socialized, in terms of costs we are much in the same boat, and for the same reason. One word: insurers.

      So Amazon saves money and increases profits. Nothing wrong with that
      • by gtall ( 79522 )

        Hi there Amazon Employee #104897, this is your friendly Amazon Cyber-Doctor here to assist you. I see you have the heartbreak of Psoriasis. Maybe you'd be interested in our valuable offer of 1 + One Free Pseudo-Hyperoxaline for your condition with free delivery. Rope some family members into this valuable offer and we'll deliver using our Fly-Bots, they know where you live.

    • Comment removed based on user account deletion
  • Victorian comeback (Score:5, Insightful)

    by stealth_finger ( 1809752 ) on Tuesday October 01, 2019 @06:17AM (#59255940)
    They aren't going to happy til they have their own amazon towns where children are born into warehouse jobs and taught in schools, amazon schools obviously, about how amazon's profits are the only thing that matters, the world is out to get them and bezos is elevated to the position of dear leader.
    • Amazon wants to be the only retailer left standing. Then you will have to sell your soul to the company store. They'll own you lock stock and broom handle.

      • Amazon wants to be the only retailer left standing.

        Since they're still considerably smaller than Walmart, looks like they're not succeeding too well, if that's their goal.

        • Amazon is considerably bigger then Walmat when you consider the rest of the world. Total world domination of sales and IT Operations (AWS) in their aim.
          With no one else to go to they will be the 'company store'. I fully expect them to follow FaceBook and issue their own crypto currency. Then it will be the only currency they'll accept.
          Bezos is going to rival Zuckerberg for world dictator of the 2030's.

  • by Opportunist ( 166417 ) on Tuesday October 01, 2019 @06:37AM (#59255970)

    Would you really want your doctor to put your employer's interest before yours?

    Because with some injuries it's quite possible to get you patched up in little time but ruin you in the long run (when you get thrown away and replaced with a new part, sorry, worker) rather than doing a full recovery which would take longer but allows you to actually stay healthy for longer, too.

    • Would you really want your doctor to put your employer's interest before yours?

      Because with some injuries it's quite possible to get you patched up in little time but ruin you in the long run (when you get thrown away and replaced with a new part, sorry, worker) rather than doing a full recovery which would take longer but allows you to actually stay healthy for longer, too.

      Imagine if this kind of system was in place when all the nasty about asbestos was comeing out. We'd still be telling them to shut up you've only got a little cough, now drink 2 tea spoons of this and get back to work.

  • No and No (Score:2, Insightful)

    by thegarbz ( 1787294 )

    It's a stupid American quirk due to your instance that sick people should just go off and die if they aren't wealthy. Corporations as healthcare providers is the dumbest "feature" of any developed country, and fortunately there are very few such developed countries.

    • These problems in health care are a result of government regulation: https://www.youtube.com/watch?... [youtube.com]
      • No, they are a result of government mis-regulation. Regulation isn't bad. The way you regulate in the USA is.

    • It's a stupid American quirk due to your instance that sick people should just go off and die if they aren't wealthy

      Hello ignorant European! You may not be aware, but emergency rooms are required to treat anyone who comes in, even if they cannot pay.

      Now you are somewhat less ignorant, you are welcome!

      • Hello ignorant European! You may not be aware, but emergency rooms are required to treat anyone who comes in, even if they cannot pay.

        I didn't say emergency. I guess you may be ignorant of the things which go on in your own country, where people choose not to get treatment to prevent being a financial burden on their next of kin, or where the reason you end up in the emergency ward is because actually seeing the doctor for a minor ailment becomes a financial decision, or how some people with allergies don't carry epipens because fuck they are expensive for no reason over there.

        Before calling people ignorant maybe ask if you understood the

      • Not to mention the fact that if you're (say) over 75 the likelyhood you'll get cancer treatment is almost zero.
  • "[Corporate-based virtual healthcare programs, like Amazon's] is yet one more example of fragmented care," says Cynthia Burghard,

    Um, what? How is it more "fragmented" than anything else?

    People like convenient health care options. And there no reason amazon doctors can't communicate with other doctors, like everybody else. Urgent care sends a report to your PCP, Amazon doctor sends a report to your PCP, what's the difference?

    • Take a look at what Amazon did with local law-enforcement to circumvent the need to get a warrant in order to gain access to your own cameras. Do you really think theyâ(TM)re going to honor patient Dr. confidentiality?

    • "[Corporate-based virtual healthcare programs, like Amazon's] is yet one more example of fragmented care," says Cynthia Burghard,

      Um, what? How is it more "fragmented" than anything else?

      Because here's just another fragment. And I wouldn't expect amazon doctors to talk to other doctors without either a)it being beneficial to them, or b) the other side pays up. Probably both.

    • Um, what? How is it more "fragmented" than anything else?

      I think, and feel free to correct me if I'm wrong here, is that it isn't a question of quantity of fragmentation but of who is being fragmented. So, I'm guessing the argument someone might make is, imagine Amazon Fire Department and let's say Amazon pours a ton of money into it and is able to write it off taxes. Fire breaks out in an Amazon warehouse, Amazon's high tech FD puts out the blaze everything is great. Now let's say a fire breaks out in the town but poses no risk to the warehouse. Amazon FD si

      • by kenh ( 9056 )

        imagine Amazon Fire Department and let's say Amazon pours a ton of money into it and is able to write it off taxes. Fire breaks out in an Amazon warehouse, Amazon's high tech FD puts out the blaze everything is great. Now let's say a fire breaks out in the town but poses no risk to the warehouse. Amazon FD sits there and watches local FD put out a three alarm fire with whatever tax payer's money can muster.

        A very similar scenario played out about 8 years ago when one town in TN I believe decided it didn't need a fire department, it was too expensive for their small town, so they collected no fire Dept taxes and had no coverage. A neighboring town offered to extend fire department coverage, but homeowners had to pay a small fee in lieu of collecting local taxes to fund the fire department. When a fire occurred in the town without a fire department the neighboring town FD would roll to the scene and monitor the

  • People mark those down because they didn't get an antibiotic when they had a virus and thought the doctor wasn't doing their job.

  • not me, i would never go to work for him, i read about the horrific conditions in hot un-air-conditioned warehouses with long hours and no overtime pay
    • not me, i would never go to work for him, i read about the horrific conditions in hot un-air-conditioned warehouses with long hours and no overtime pay

      Excellent, and I'm serious about that. The most powerful lever you have is personal choice. Exercise it. I guarantee Bezos cares a lot more about hiring people and selling product than any rant in any magazine.

      I'd never take an Amazon warehouse job but only because I have much better options. I know people for which an Amazon job would look pretty good.

  • Considering the firsthand stories that were relayed to me from people that have worked in the warehouses, I am surprised they are giving home visit healthcare. Based on the stories, as to how much they are overworked, I am rather surprised that they did not set up a clinic at the warehouses. I suspect that the employees will be afraid to use the service for fear of it costing them their jobs. At the same time I also suspect that Amazon is not being benevolent. They most likely suspect malingering. They prob

    • by tsqr ( 808554 )

      I would not even be surprised if you called in sick if they did not send a medical expert out there to confirm you're actually really sick.

      Uh huh. Because it's definitely cheaper to have a "medical expert" make a house call, than to have a low-paid employee take a day off.

      • They bill the insurance that comes out of the employees pay. You think amazon is gonna pay? They probably are getting more refunded than the cost of the medical employee. Its probably profitable.

      • Because it's definitely cheaper to have a "medical expert" make a house call, than to have a low-paid [hourly] employee take [an unpaid] day off.

        FTFY.

        The over-reaction is amazing. Amazon employs tens of thousands of people, many performing manual warehouse labor, where minor injuries a likely to occur. The company puts medical professionals on the staff to improve care and cut costs (eventually), and all people can see is a dystopian end where employees are permanently disabled by "company first" healthcare practices that only exist in their minds?

        Explain to me how it's better to NOT have a nurse's office at an Amazon warehouse? How it's better for

  • In practice, there is no way from preventing your employer with this having any and all data about your health. Health data is privileged and to be kept secret for good reasons.

    • Explain how my employer gets all my medical information - and please be sure to explain how our current HIPPA regulations (which prevent my doctor from telling my wife my medical condition) simply rolls over and provides employers your complete medical history.

      • by gweihir ( 88907 )

        If you go to the in-house clinic of your employer, or get health-care pretty much directly provided by your employer, please explain to me how you realistically want to keep that data isolated and that includes data in people's minds. No fantasies please, actual reality.

      • If you're employer is self insured, the employer no doubt has access to your health data.
  • by kenh ( 9056 )

    Vik Panda, lead of operations for French sleep company Dreem, had this to say: "The news is that Jeff Bezos' company, and others like it, don't need anyone's permission to start building and paying for their own parallel healthcare systems, little by little. If Amazon replaces the existing health care system bit by bit, and employees of self-insured companies migrate to this new digital health system, do we all get to come along?"

    This fellow is expecting that as Amazon's "parallel healthcare system" for Amazon employees grows, he wants access to it for non-Amazon employees? Why? Is there some fundamental problem in the French healthcare system that something like this would address?

    This is really nothing new, I've worked in several companies with on-site medical offices, typically staffed with nurses, similar to school nurses in the past.

  • I've extremely wary of these kinds of services being conglomerated under one roof, a big corporation. How is this driving freedom of choice?

    • I've extremely wary of these kinds of services being conglomerated under one roof, a big corporation. How is this driving freedom of choice?

      At the risk of sounding pedantic, it enhances choice because you now have a new choice: work at Amazon and get their in-house care or work somewhere else and get more traditional care. That first choice did not exist a week ago.

      What's odd is my company (which is not Amazon) also makes available all sorts of on-line consulting services. I don't know if they're doing it to contain costs or as a perk to spice up the benefit plan. I guarantee Benefits is looking at how popular the service is and if it's not, it

  • Healthcare costs at least $1k per employee per month. Amazon probably has about 100k employees in the Seattle area. That means they spend about $100 million dollars a month on premiums - just for the Seattle crowd alone. Amazon is so big they probably self-insure, but they're still going to be spending a literal ton of money a month on employee health.

    Doctors and nurses on-site makes sense. It's convenient, and for people who don't really have "a relationship" with their doctor it doesn't matter.

    Don't want

  • by MobyDisk ( 75490 ) on Tuesday October 01, 2019 @01:35PM (#59257588) Homepage

    We are falling down a slippery slope of benefits that will slowly crush small or even medium businesses. If a big company offers me health insurance, life insurance, a 24/7 on-site doctor, car insurance, a discount on cars purchased from some vendor, a discount at AT&T, discount cable TV, identity theft prevention, and a gym discount -- eventually people will lose their ability to switch jobs, which deflates salaries and slows the economy. Small businesses can't provide all of this, which means small businesses won't start and self employment will become financially nonviable. Plus, it skews the market: Maybe I prefer Verizon, but my employer only gives me a discount if I use AT&T. That happens today with health insurance, I don't want it to happen with other services.

    THOUGHT-EXPERIMENT TIME: Suppose we made it illegal for employers to offer any benefits. Employers may only offer salaries. Anything the employer paid on your behalf, or that was paid pre-tax, becomes a tax deduction instead.

    There would be more incentives to start a business, become self-employed, or to switch jobs. Your existing health insurance, life insurance, AD&D, etc would not change. It would be easier to compare one job to another. You could choose your insurance instead of being tied to the employer's selection and your employer would not be able to require you to change insurances, thus they couldn't make you change doctors. The private insurance markets would be on the same level playing field as the corporate-backed ones. Individuals would get to see the actual cost of their insurance coverage.

    Salaries would have to increase proportionally, but the total expenditures by the company would be the same. We might have to deal with whatever tax incentives they lost by providing it.

    It would also make it harder to game the system by paying the VP a salary of $1/year and providing them with $400 million in benefits per year. Maybe we would make some exemptions for stock options or profit sharing or something like that.

    There is a historical reason that the US started tying health insurance benefits to employment, and it wasn't a very good reason really, and it doesn't make sense any longer.... I gotta search for what that was...

  • Practicing Workers Comp attorney here, many of my clients work for Amazon (public record) and some of them have been treated at AmCare. My personal review of the medical records shows that they are sloppy, poorly made, and at least when they involve a claim of injury, were altered after the fact to provide the best possible coverage for Amazon.

    Even if Amazon isn't pushing them to falsify documents, there is an intrinsic bias in company employees to do something favorable to the company and to be critical

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