The United States of Amazon: Same day treatment only for Prime members
July 22, 2022 12:43 PM Subscribe
Amazon said it had reached a $3.9 billion deal to acquire One Medical, a network of primary care clinics. As monopoly capitalism grows unchecked, Amazon's seriously dystopian forays into healthcare make the prospect of Medicare for All basically impossible. With access to incredible amounts of consumer data, the privacy implications are grim.
OneMedical's been a godsend for me as someone who travels frequently for work and doesn't have much of a home base. Goodbye to all that, I guess. Anybody know of alternatives that accomplish the same thing?
posted by fast ein Maedchen at 12:53 PM on July 22, 2022 [2 favorites]
posted by fast ein Maedchen at 12:53 PM on July 22, 2022 [2 favorites]
What
posted by Melismata at 12:54 PM on July 22, 2022 [1 favorite]
posted by Melismata at 12:54 PM on July 22, 2022 [1 favorite]
Oh good, another thing to run into the ground prop up with the endless fountain of money that is AWS.
posted by rockindata at 1:00 PM on July 22, 2022 [9 favorites]
posted by rockindata at 1:00 PM on July 22, 2022 [9 favorites]
What the ever-loving shit, y'all??
(And he also needs to be hunted for sport)
posted by Kitteh at 1:03 PM on July 22, 2022 [5 favorites]
(And he also needs to be hunted for sport)
posted by Kitteh at 1:03 PM on July 22, 2022 [5 favorites]
Ugh. Yesterday, I saw an ad on Instagram that was promoting Amazon Pets, and that scared me. This sounds so much worse.
posted by hydra77 at 1:03 PM on July 22, 2022 [2 favorites]
posted by hydra77 at 1:03 PM on July 22, 2022 [2 favorites]
GUILLOTINE. Guillotine guillotine guillotine.
posted by Silvery Fish at 1:07 PM on July 22, 2022 [16 favorites]
posted by Silvery Fish at 1:07 PM on July 22, 2022 [16 favorites]
SARCASM DETECTED. SILENCE PRIMECITIZENS. YOU ARE IN DIRECT VIOLATION OF THE TERMS OF SERVICE. PLEASE RETURN TO YOUR PRIMECUBICAL IMMEDIATELY OR YOU WILL FACE TERMINATION OF YOUR SERVICE CONTRACT WITHOUT ARBITRATION.
posted by loquacious at 1:08 PM on July 22, 2022 [15 favorites]
posted by loquacious at 1:08 PM on July 22, 2022 [15 favorites]
Isn’t this just one huge HIPPA violation?
posted by GenjiandProust at 1:12 PM on July 22, 2022 [8 favorites]
posted by GenjiandProust at 1:12 PM on July 22, 2022 [8 favorites]
Does someone at Amazon think "GE in the 1980s" was a good, sustainable goal to aim for?
posted by AzraelBrown at 1:15 PM on July 22, 2022 [16 favorites]
posted by AzraelBrown at 1:15 PM on July 22, 2022 [16 favorites]
I dunno, It's not ideal by a long way, profit motive should have no intersection with medical care at all, but... I can think of few more deserving targets of Amazon's relentless customer focus and "your profit margin is my margin of opportunity" ethos than American health insurance companies.
"Amazon prime delivers inexpensive insulin" would be a tectonic quality of life improvement for a lot of people.
posted by mhoye at 1:16 PM on July 22, 2022 [34 favorites]
"Amazon prime delivers inexpensive insulin" would be a tectonic quality of life improvement for a lot of people.
posted by mhoye at 1:16 PM on July 22, 2022 [34 favorites]
this tweet shows you how to cancel your One Medical membership.
i'll get back to making my appointments via zocdoc, which is more comprehensive anyway. i will definitely miss my doctor and all of the cloth accoutrements, but you know Amazon is not gonna keep these amenities and they will efficieancy their staff right to death.
when i wrote into them expressing my disappointment their reply was that the deal
Has not gone through yet so for now nothing is changing. I encourage other customers to write in & register their discontent, and reach out to
their electeds, as some lawmakers are scrutinizing this deal, and more pressure there will help. I also i encouraged the person at the One Medical end of the correspondence
that they should consider unionizing their workplace while they can.
I wasn't aware of this but over half of onemedical's revenue comes from medicare via a subsidiary, which this article calls a back door effort at the privatization of medicare (which i definitely do not want).
posted by wowenthusiast at 1:17 PM on July 22, 2022 [10 favorites]
i'll get back to making my appointments via zocdoc, which is more comprehensive anyway. i will definitely miss my doctor and all of the cloth accoutrements, but you know Amazon is not gonna keep these amenities and they will efficieancy their staff right to death.
when i wrote into them expressing my disappointment their reply was that the deal
Has not gone through yet so for now nothing is changing. I encourage other customers to write in & register their discontent, and reach out to
their electeds, as some lawmakers are scrutinizing this deal, and more pressure there will help. I also i encouraged the person at the One Medical end of the correspondence
that they should consider unionizing their workplace while they can.
I wasn't aware of this but over half of onemedical's revenue comes from medicare via a subsidiary, which this article calls a back door effort at the privatization of medicare (which i definitely do not want).
posted by wowenthusiast at 1:17 PM on July 22, 2022 [10 favorites]
I can think of few more deserving targets of Amazon's relentless customer focus and "your profit margin is my margin of opportunity" ethos than American health insurance companies.
Er. I think we may have different experiences with being an Amazon customer, because in the past three to five years I've noticed a vastly decreased level of customer service, which generally seems to be mediated by staff being badly overworked and burnt out/not given supports.
I also note that when health insurance companies and providers war, the people who usually bear the brunt of all costs are.... patients....
posted by sciatrix at 1:46 PM on July 22, 2022 [17 favorites]
Er. I think we may have different experiences with being an Amazon customer, because in the past three to five years I've noticed a vastly decreased level of customer service, which generally seems to be mediated by staff being badly overworked and burnt out/not given supports.
I also note that when health insurance companies and providers war, the people who usually bear the brunt of all costs are.... patients....
posted by sciatrix at 1:46 PM on July 22, 2022 [17 favorites]
Isn’t this just one huge HIPPA violation?
In what way?
Is One Medical a not for profit? The company always seemed to have a big silicon valley vibe.
posted by 2N2222 at 1:46 PM on July 22, 2022 [2 favorites]
After the last Mark Cuban Cost Plus Drugs thread, I did some price comparisons for prescriptions and found out that Amazon Pharmacy was, in some cases, actually cheaper than MCCPDC, GoodRx, and Costco (and always cheaper than my medical insurance).
However, the complexities of actual medical care and not just shipping packages make me considerably less excited about this acquisition, especially after Amazon just closed all their four-star stores.
posted by meowzilla at 1:48 PM on July 22, 2022
However, the complexities of actual medical care and not just shipping packages make me considerably less excited about this acquisition, especially after Amazon just closed all their four-star stores.
posted by meowzilla at 1:48 PM on July 22, 2022
I had just found a new PCP that I liked, after my last one lost his medical license for being a horrible creep.
I reached out and said I'm sure she couldn't tell me if she's considering leaving, but I'd happily follow her if she did.
posted by gurple at 1:56 PM on July 22, 2022 [3 favorites]
I reached out and said I'm sure she couldn't tell me if she's considering leaving, but I'd happily follow her if she did.
posted by gurple at 1:56 PM on July 22, 2022 [3 favorites]
I hate to see all the reflexive handwringing; this isn't necessarily a bad thing. Amazon has done a good job with its acquisition of PillPack, the mail order pharmacy, and the resulting Amazon Pharmacy works pretty well. I do hate to see all this business consolidation though. Shades of Ross Perot and EDS.
I'm a One Medical patient and appreciate their service but it's not like it's some smiley happy company. Their main shtick is charging a small gatekeeping fee for access to medical services, which I suspect is mostly done to turn away patients who are likely to be unable to pay healthcare bills. Also One Medical cheated on Covid vaccine access, letting some of its paying members jump the line. The consequence was being denied access to further vaccine. Rather than fess up and inform their patients they should look elsewhere they obfuscated and acted like there was a general shortage, not a punishment for their malfeasance.
posted by Nelson at 2:08 PM on July 22, 2022 [14 favorites]
I'm a One Medical patient and appreciate their service but it's not like it's some smiley happy company. Their main shtick is charging a small gatekeeping fee for access to medical services, which I suspect is mostly done to turn away patients who are likely to be unable to pay healthcare bills. Also One Medical cheated on Covid vaccine access, letting some of its paying members jump the line. The consequence was being denied access to further vaccine. Rather than fess up and inform their patients they should look elsewhere they obfuscated and acted like there was a general shortage, not a punishment for their malfeasance.
posted by Nelson at 2:08 PM on July 22, 2022 [14 favorites]
Isn’t this just one huge HIPPA violation?
I think the frequency with which these questions will arrive, we just need a big DOES NOT MATTER
the regulatory framework DOES NOT MATTER when money can capture that framework, when a percentage of a country's own law-makers habitually flaunt their contempt for the framework, conventions, any measure of propriety really
I don't see how any of this matters anymore. Sorry.
posted by elkevelvet at 2:09 PM on July 22, 2022 [7 favorites]
I think the frequency with which these questions will arrive, we just need a big DOES NOT MATTER
the regulatory framework DOES NOT MATTER when money can capture that framework, when a percentage of a country's own law-makers habitually flaunt their contempt for the framework, conventions, any measure of propriety really
I don't see how any of this matters anymore. Sorry.
posted by elkevelvet at 2:09 PM on July 22, 2022 [7 favorites]
the prospect of Medicare for All basically impossible
Why?
posted by Going To Maine at 2:22 PM on July 22, 2022 [8 favorites]
Why?
posted by Going To Maine at 2:22 PM on July 22, 2022 [8 favorites]
Their main shtick is charging a small gatekeeping fee for access to medical services, which I suspect is mostly done to turn away patients who are likely to be unable to pay healthcare bills
I have public insurance and I signed up with them as a kind of fill-in for convenience, and my insurance would cover emergencies. This seemed to be working out well for a year or two, but I found out recently that they were going to have to cancel my next appt because they don't "take" MediCal or I'd have to pay a few hundred dollars for the visit.
The ensuing conversation revealed that they subsidize your $200/year with charges to your insurance. They didn't have any explanation for why it had worked until then, but rules are rules I guess. Anyway, my account there is a dead man walking thereby.
posted by rhizome at 2:25 PM on July 22, 2022 [3 favorites]
I have public insurance and I signed up with them as a kind of fill-in for convenience, and my insurance would cover emergencies. This seemed to be working out well for a year or two, but I found out recently that they were going to have to cancel my next appt because they don't "take" MediCal or I'd have to pay a few hundred dollars for the visit.
The ensuing conversation revealed that they subsidize your $200/year with charges to your insurance. They didn't have any explanation for why it had worked until then, but rules are rules I guess. Anyway, my account there is a dead man walking thereby.
posted by rhizome at 2:25 PM on July 22, 2022 [3 favorites]
Because protecting the current American health care system from Amazon is something we should do.
Jesus Christ.
posted by Galvanic at 2:45 PM on July 22, 2022 [6 favorites]
Jesus Christ.
posted by Galvanic at 2:45 PM on July 22, 2022 [6 favorites]
I know a few pretty rich people, including some you will have heard of, and the ones I've met have mostly been nice people. They've made enough money that they don't have to worry about it ever again, and are happy to do the odd ridiculous thing (including one who rented a Ferrari at a wedding and drove it around a hockey rink), but appreciate the freedom it gives them to work on stuff they're interested in and look after their families.
The super-rich seem totally different - they don't want contentment, they want world domination. So far, Jeff Bezos has done his best to own bookstores, video streaming, music streaming, remote hosting (cloud), package delivery, cargo air, groceries, space flight, and now healthcare. It makes the Gilded Age look quaint.
posted by kersplunk at 2:57 PM on July 22, 2022 [8 favorites]
The super-rich seem totally different - they don't want contentment, they want world domination. So far, Jeff Bezos has done his best to own bookstores, video streaming, music streaming, remote hosting (cloud), package delivery, cargo air, groceries, space flight, and now healthcare. It makes the Gilded Age look quaint.
posted by kersplunk at 2:57 PM on July 22, 2022 [8 favorites]
Yeah, I'm with mhoye here. Amazon as a business is deeply unpleasant to interact with in any way, because they're so big that you as a single customer don't matter even a tiny bit to them, and they'd happily grind you and your family into fertilizer if it meant Jeff Bezos would become $12 richer. So the idea of you as a person having to interact with them as a health insurance provider is godawful and dystopian, but the idea of them (in their new role as healthcare providers) interacting with health insurance providers is a kind of neat unstoppable-force-meets-immovable-object hypothetical. Pitting Bezos against bottom-feeding profiteers in human misery (AKA health insurance execs) is the sort of fight where you hope both sides fight viciously and are killed outright, and then we swoop in and scavenge their remains.
posted by Mayor West at 3:58 PM on July 22, 2022 [20 favorites]
posted by Mayor West at 3:58 PM on July 22, 2022 [20 favorites]
First they came for Whole Foods, and I didn't speak up because I wasn't a vegan.
posted by pwnguin at 4:15 PM on July 22, 2022 [12 favorites]
posted by pwnguin at 4:15 PM on July 22, 2022 [12 favorites]
Because protecting the current American health care system from Amazon is something we should do.
Why?
So far, Jeff Bezos has done his best to own bookstores, video streaming, music streaming, remote hosting (cloud), package delivery, cargo air, groceries, space flight
All the things listed here haven't been hurt as a result. If anything, they've been enhanced. Some significantly. I don't really think the case against Bezos/Amazon is anywhere near convincing.
posted by 2N2222 at 4:23 PM on July 22, 2022 [2 favorites]
Why?
So far, Jeff Bezos has done his best to own bookstores, video streaming, music streaming, remote hosting (cloud), package delivery, cargo air, groceries, space flight
All the things listed here haven't been hurt as a result. If anything, they've been enhanced. Some significantly. I don't really think the case against Bezos/Amazon is anywhere near convincing.
posted by 2N2222 at 4:23 PM on July 22, 2022 [2 favorites]
All the things listed here haven't been hurt as a result. If anything, they've been enhanced. Some significantly. I don't really think the case against Bezos/Amazon is anywhere near convincing
Uhhhm, what? I'm honestly not sure how you can say this or not see how much Amazon has negatively impacted so many parts of our lives.
First off they treat workers like garbage and have been union busters and have engaged in some incredibly abusive labor practices, and not just for their retail, warehouse or delivery workers. I mean there's so many horrible stories about their labor abuses and treating humans like dirt that I don't even know where to start and my brain starts short circuiting.
For fuck's sake. Pee bottles on delivery trucks. Shoot, they just had a bunch of warehouse workers die because the management refused and ignored a tornado watch and didn't permit employees to seek shelter.
Bookstores are basically gone due to Amazon. There have been many incidents on record of authors being directly hurt by Amazon's bookseller policies.
Amazon has also hurt many consumers and producers of other products with allowing counterfeiters to run rampant in their distribution system. I mean not just in the wallet or pocket book, but by permitting unsafe counterfeit goods that actually injured them.
Many consumers have been hurt by less choices or venues for their needs due to closing stores. Many small towns and big cities alike have lost independent retailers due to the double whammy of Walmart's anti-competitive pricing and practices followed up by Amazon's knockout right hooks trying to eat Walmart's lunch.
Shoot, not too long ago Blue Origin was trying to legislate their way into the ISS and trying to sue Space-X and NASA or whatever that kerfluffle was because they couldn't openly compete with Boeing, Space-X and others.
I'm honestly super confused at how you can make the statement that "All the things listed here haven't been hurt" unless you either haven't been paying attention or you're living in some really nice parallel universe where Bezos isn't basically the living caricature of Lex Luthor.
posted by loquacious at 4:48 PM on July 22, 2022 [45 favorites]
Uhhhm, what? I'm honestly not sure how you can say this or not see how much Amazon has negatively impacted so many parts of our lives.
First off they treat workers like garbage and have been union busters and have engaged in some incredibly abusive labor practices, and not just for their retail, warehouse or delivery workers. I mean there's so many horrible stories about their labor abuses and treating humans like dirt that I don't even know where to start and my brain starts short circuiting.
For fuck's sake. Pee bottles on delivery trucks. Shoot, they just had a bunch of warehouse workers die because the management refused and ignored a tornado watch and didn't permit employees to seek shelter.
Bookstores are basically gone due to Amazon. There have been many incidents on record of authors being directly hurt by Amazon's bookseller policies.
Amazon has also hurt many consumers and producers of other products with allowing counterfeiters to run rampant in their distribution system. I mean not just in the wallet or pocket book, but by permitting unsafe counterfeit goods that actually injured them.
Many consumers have been hurt by less choices or venues for their needs due to closing stores. Many small towns and big cities alike have lost independent retailers due to the double whammy of Walmart's anti-competitive pricing and practices followed up by Amazon's knockout right hooks trying to eat Walmart's lunch.
Shoot, not too long ago Blue Origin was trying to legislate their way into the ISS and trying to sue Space-X and NASA or whatever that kerfluffle was because they couldn't openly compete with Boeing, Space-X and others.
I'm honestly super confused at how you can make the statement that "All the things listed here haven't been hurt" unless you either haven't been paying attention or you're living in some really nice parallel universe where Bezos isn't basically the living caricature of Lex Luthor.
posted by loquacious at 4:48 PM on July 22, 2022 [45 favorites]
I'm of mixed feelings about this, because this is just repeating history. There was once an enormous shipbuilding company called Kaiser. Around 1945, they wanted a better way of providing healthcare to its workers, so they created Kaiser Permanente.
It still exists today as a large health insurer in western US states. Amazingly, it operates more like public healthcare. They own their own hospitals, doctor's offices, and pharmacies, and the doctors work for Kaiser. They don't play the game of "You (the hospital) charge enormous amounts of money, we'll (insurance) pay it, and we all get big bonuses".
I can give an example of the result: I had a huge heart attack. The ambulance, emergency, lots of doctors, x-rays, tests, lots of stents, and follow-up care including a stress test. My total bill: $20.
Yes, there is really a lot of doubt that Amazon will be as rational as Kaiser was, but it is in their own self-interest to do so.
posted by eye of newt at 4:52 PM on July 22, 2022 [12 favorites]
It still exists today as a large health insurer in western US states. Amazingly, it operates more like public healthcare. They own their own hospitals, doctor's offices, and pharmacies, and the doctors work for Kaiser. They don't play the game of "You (the hospital) charge enormous amounts of money, we'll (insurance) pay it, and we all get big bonuses".
I can give an example of the result: I had a huge heart attack. The ambulance, emergency, lots of doctors, x-rays, tests, lots of stents, and follow-up care including a stress test. My total bill: $20.
Yes, there is really a lot of doubt that Amazon will be as rational as Kaiser was, but it is in their own self-interest to do so.
posted by eye of newt at 4:52 PM on July 22, 2022 [12 favorites]
Well, great. I have plenty of mixed feelings about OneMedical, but have found them actually competent when it comes to treating trans people, which is a minor miracle. You have to assume that's not going to last--OneMedical already can get a bit dodgy if you're "hard" in a variety of ways (a major failing of Kaiser, as well, by the way), but for some reason they actually backed up their talk about trans stuff.
posted by hoyland at 5:02 PM on July 22, 2022
posted by hoyland at 5:02 PM on July 22, 2022
It would actually make a lot of sense for Amazon to create their own health care company. They employ over a million people in the United States. That's a lot of additional money that Amazon could be making, instead of giving it to the insurers. They actually have more employees than all of One Medical's members. Just like AWS, it could be rolled out internally, "productized", then rolled out to the general public.
But the article doesn't mention any of this, and I'm assuming that it's going to operate as a separate business unit.
posted by meowzilla at 5:33 PM on July 22, 2022 [1 favorite]
But the article doesn't mention any of this, and I'm assuming that it's going to operate as a separate business unit.
posted by meowzilla at 5:33 PM on July 22, 2022 [1 favorite]
First off they treat workers like garbage
If that actually mattered to anyone in any significant way, there would be effective laws against it. That there are not such laws means the average American does not give a single shit about warehouse workers, including those same warehouse workers.
Look at where the warehouses are located. Observe their historical voting patterns. Realize that the people therein wish to be brutalized, because they vote specifically in favor of people who promise to brutalize them, and the fact that they are being brutalized has not changed their voting patterns. They may occasionally complain about being brutalized, but somehow that never translates into changing their worldview. Indeed, if anything it cements their us-vs-them worldview!
Go ahead, campaign on the basis of enhanced worker rights and unions. See how far that gets you anywhere that isn't deep deep deep blue (and, while you're at it, you'll probably want to upgrade your personal security). People, on the whole, aren't stupid -- I don't subscribe to the idea that my political opponents are morons (despite my using such words frequently). Instead, they have clearly decided that they should be brutalized, and that I should receive great services that are subsidized by their suffering.
If someone wants to ensure their own continued oppression, I don't see why I should care anymore. You wanna be ground into a fine paste, and you're prepared to threaten violence against anyone who tries to stop it? Well, OK then, enjoy being ground into a fine paste I guess, thanks for the free shipping my dude.
posted by aramaic at 6:02 PM on July 22, 2022 [3 favorites]
If that actually mattered to anyone in any significant way, there would be effective laws against it. That there are not such laws means the average American does not give a single shit about warehouse workers, including those same warehouse workers.
Look at where the warehouses are located. Observe their historical voting patterns. Realize that the people therein wish to be brutalized, because they vote specifically in favor of people who promise to brutalize them, and the fact that they are being brutalized has not changed their voting patterns. They may occasionally complain about being brutalized, but somehow that never translates into changing their worldview. Indeed, if anything it cements their us-vs-them worldview!
Go ahead, campaign on the basis of enhanced worker rights and unions. See how far that gets you anywhere that isn't deep deep deep blue (and, while you're at it, you'll probably want to upgrade your personal security). People, on the whole, aren't stupid -- I don't subscribe to the idea that my political opponents are morons (despite my using such words frequently). Instead, they have clearly decided that they should be brutalized, and that I should receive great services that are subsidized by their suffering.
If someone wants to ensure their own continued oppression, I don't see why I should care anymore. You wanna be ground into a fine paste, and you're prepared to threaten violence against anyone who tries to stop it? Well, OK then, enjoy being ground into a fine paste I guess, thanks for the free shipping my dude.
posted by aramaic at 6:02 PM on July 22, 2022 [3 favorites]
Because protecting the current American health care system from Amazon is something we should do.
Why?
Whoosh.
posted by Galvanic at 6:32 PM on July 22, 2022 [1 favorite]
Why?
Whoosh.
posted by Galvanic at 6:32 PM on July 22, 2022 [1 favorite]
Mod note: One comment deleted. Please avoid personal attacks.
posted by loup (staff) at 6:52 PM on July 22, 2022 [3 favorites]
posted by loup (staff) at 6:52 PM on July 22, 2022 [3 favorites]
Look at where the warehouses are located.
There are a lot of Amazon fulfillment centers, including a good number in blue states. There are also active unionization efforts happening in them that Amazon is working hard to suppress.
posted by ryanshepard at 8:07 PM on July 22, 2022 [12 favorites]
There are a lot of Amazon fulfillment centers, including a good number in blue states. There are also active unionization efforts happening in them that Amazon is working hard to suppress.
posted by ryanshepard at 8:07 PM on July 22, 2022 [12 favorites]
Look at where the warehouses are located. Observe their historical voting patterns. Realize that the people therein wish to be brutalized
...what?
Is this diatribe based on anything citable? Where are we getting the idea that Amazon warehouses are filled members of one political party?
A quick comparison between this map of Amazon warehouses, a map of the 2020 election , and a population density map appears to indicate that Amazon warehouses are mostly based near major population centers, which tend to vote blue. It's not one-to-one but it was consistent enough that I stopped checking after several cities. Seattle, Denver, Chicago, Detroit, Dallas, Atlanta... Note also the string of warehouses from DC to NYC that corresponds with high population density and the line of blue on the election map.
It may also be worth noting that white folks make up less than a third of Amazon warehouse and call center employees.
Or am I completely misunderstanding?
posted by rustybullrake at 8:10 PM on July 22, 2022 [8 favorites]
...what?
Is this diatribe based on anything citable? Where are we getting the idea that Amazon warehouses are filled members of one political party?
A quick comparison between this map of Amazon warehouses, a map of the 2020 election , and a population density map appears to indicate that Amazon warehouses are mostly based near major population centers, which tend to vote blue. It's not one-to-one but it was consistent enough that I stopped checking after several cities. Seattle, Denver, Chicago, Detroit, Dallas, Atlanta... Note also the string of warehouses from DC to NYC that corresponds with high population density and the line of blue on the election map.
It may also be worth noting that white folks make up less than a third of Amazon warehouse and call center employees.
Or am I completely misunderstanding?
posted by rustybullrake at 8:10 PM on July 22, 2022 [8 favorites]
Kaiser patients are generally forced to arbitrate all malpractice claims. HMOs aren’t some magic bullet.
posted by snuffleupagus at 8:13 PM on July 22, 2022 [4 favorites]
posted by snuffleupagus at 8:13 PM on July 22, 2022 [4 favorites]
I came to the conclusion recently that I can no longer morally support shopping on amazon, and I wish to god I'd done that years ago, but I kept making excuses.
I made this happen. Me. I vote left, but I've funneled more and more of my spending into amazon. I am one of the bad guys. Three weeks ago I decided not to be anymore and I stopped.
The excuses I've made are myriad. Evilamazon is cheap, and I live on an income that is so low it's shocking. Evilamazon is fast, and given the chaos of my life sometimes I've convinced myself it was the best option. Evilamazon has been the fastest way to get something the times when I'm trapped in rural areas for stretches of time. Evilamazon is easy when my joints are swollen and I hurt so much I don't want to leave the house, or when my gut is so messed up I'm spending $50 a month on anti-diarrheals and afraid to leave the house because bathrooms.
And you know what? I'm stronger than I thought I was. These three weeks have been bloody illuminating. I don't spend a lot, but every couple of days I find myself just wanting it, knowing I can't have it. The urge has seriously been worse than any chemical desire I've ever had, more persistent, and knowing that scares the shit out of me. I had no idea I was emotionally dependent on amazon. Amazon was where I kept my wishlists, it's where I still price-check things (even though I no longer buy there).
I helped make amazon what it is today and I've decided that if I want to not hate myself and actively help them become the ultimate supervillain I have to do the hard things, the things I was lying to myself about not being about to do. People survived before amazon. Being poor and disabled is not an excuse to help them shit all over everyone forever.
If anyone else wants to quit them and is struggling emotionally or practically, feel free to memail me. If you have trouble locating a product, I'm also a good researcher and one thing I have is time. I mean that. It doesn't matter if we like each other or we disagree on other things, my virtual door is always open on common causes.
posted by liminal_shadows at 8:30 PM on July 22, 2022 [29 favorites]
I made this happen. Me. I vote left, but I've funneled more and more of my spending into amazon. I am one of the bad guys. Three weeks ago I decided not to be anymore and I stopped.
The excuses I've made are myriad. Evilamazon is cheap, and I live on an income that is so low it's shocking. Evilamazon is fast, and given the chaos of my life sometimes I've convinced myself it was the best option. Evilamazon has been the fastest way to get something the times when I'm trapped in rural areas for stretches of time. Evilamazon is easy when my joints are swollen and I hurt so much I don't want to leave the house, or when my gut is so messed up I'm spending $50 a month on anti-diarrheals and afraid to leave the house because bathrooms.
And you know what? I'm stronger than I thought I was. These three weeks have been bloody illuminating. I don't spend a lot, but every couple of days I find myself just wanting it, knowing I can't have it. The urge has seriously been worse than any chemical desire I've ever had, more persistent, and knowing that scares the shit out of me. I had no idea I was emotionally dependent on amazon. Amazon was where I kept my wishlists, it's where I still price-check things (even though I no longer buy there).
I helped make amazon what it is today and I've decided that if I want to not hate myself and actively help them become the ultimate supervillain I have to do the hard things, the things I was lying to myself about not being about to do. People survived before amazon. Being poor and disabled is not an excuse to help them shit all over everyone forever.
If anyone else wants to quit them and is struggling emotionally or practically, feel free to memail me. If you have trouble locating a product, I'm also a good researcher and one thing I have is time. I mean that. It doesn't matter if we like each other or we disagree on other things, my virtual door is always open on common causes.
posted by liminal_shadows at 8:30 PM on July 22, 2022 [29 favorites]
If that actually mattered to anyone in any significant way, there would be effective laws against it.
Yeah, because the American government is so fucking responsive to the wishes of its citizenry.
posted by Ickster at 9:03 PM on July 22, 2022 [16 favorites]
Yeah, because the American government is so fucking responsive to the wishes of its citizenry.
posted by Ickster at 9:03 PM on July 22, 2022 [16 favorites]
Realize that the people therein wish to be brutalized,
I don't see why I should care anymore. You wanna be ground into a fine paste
In nearly 20 years of reading metafilter, this is one of the most astonishing things I've read. It's quite rare to see the Just World fallacy trotted out with such bare-faced contempt; usually it has a veneer of compassion. In its more childlike iterations, this fallacy leads to thoughts like: these sufferers may not like their lot, it may not seem fair, but they must be there for a reason. People who leave this orderly belief behind often spend time in a painful crisis of cynicism; some remain cynics, some move off to other beliefs. Remarkably, the point of view expressed here appears to have ventured through the usual crisis of cynicism, then lapped itself and come right back out of the starting gate with the Nihilist Just World: not only do the downtrodden like their lot, they are suffering because they all want to be destroyed and I'm happy to help that happen.
posted by cubeb at 9:33 PM on July 22, 2022 [39 favorites]
I don't see why I should care anymore. You wanna be ground into a fine paste
In nearly 20 years of reading metafilter, this is one of the most astonishing things I've read. It's quite rare to see the Just World fallacy trotted out with such bare-faced contempt; usually it has a veneer of compassion. In its more childlike iterations, this fallacy leads to thoughts like: these sufferers may not like their lot, it may not seem fair, but they must be there for a reason. People who leave this orderly belief behind often spend time in a painful crisis of cynicism; some remain cynics, some move off to other beliefs. Remarkably, the point of view expressed here appears to have ventured through the usual crisis of cynicism, then lapped itself and come right back out of the starting gate with the Nihilist Just World: not only do the downtrodden like their lot, they are suffering because they all want to be destroyed and I'm happy to help that happen.
posted by cubeb at 9:33 PM on July 22, 2022 [39 favorites]
some really nice parallel universe where Bezos isn't basically the living caricature of Lex Luthor
/me waves to loquacious from the parallel universe where Bezos is the living caricature of Dr Evil
posted by flabdablet at 10:17 PM on July 22, 2022 [3 favorites]
/me waves to loquacious from the parallel universe where Bezos is the living caricature of Dr Evil
posted by flabdablet at 10:17 PM on July 22, 2022 [3 favorites]
For everyone considering cancelling their subscription, remember that the headline is "Amazon to acquire", not "Amazon closes on". Big deals take time, especially if they invite regulatory scrutiny (which this one probably will).
If you're cancelling today out of principle, more power to you, but if you want to keep your doctor for now this will likely take months, if not a year plus.
posted by redct at 11:00 PM on July 22, 2022 [2 favorites]
If you're cancelling today out of principle, more power to you, but if you want to keep your doctor for now this will likely take months, if not a year plus.
posted by redct at 11:00 PM on July 22, 2022 [2 favorites]
Kaiser patients are generally forced to arbitrate all malpractice claims. HMOs aren’t some magic bullet.
No health plan, even state run health plans, are magic bullets. They all have pluses and minus. But just calling Kaiser another HMO is missing the point I was making. There is no concept of 'in network' and 'out of network'. There's no chance of the nightmare, but very real possibility in American healthcare, PPO and HMO alike, of an uncovered doctor or treatment, where you end up having to owe 10s to 100s of thousands. Every person in the Kaiser system is an employee of Kaiser The doctors like it because there's little to no insurance paperwork to deal with. No plan is perfect, but most US plans have a very real possibility of the patient going broke. At Kaiser, the risk is that you'll pay $20.
Combining the insurance company with the doctors/hospitals removes the incentives to overcharge and overtreat because they are also the ones paying.
posted by eye of newt at 12:08 AM on July 23, 2022
No health plan, even state run health plans, are magic bullets. They all have pluses and minus. But just calling Kaiser another HMO is missing the point I was making. There is no concept of 'in network' and 'out of network'. There's no chance of the nightmare, but very real possibility in American healthcare, PPO and HMO alike, of an uncovered doctor or treatment, where you end up having to owe 10s to 100s of thousands. Every person in the Kaiser system is an employee of Kaiser The doctors like it because there's little to no insurance paperwork to deal with. No plan is perfect, but most US plans have a very real possibility of the patient going broke. At Kaiser, the risk is that you'll pay $20.
Combining the insurance company with the doctors/hospitals removes the incentives to overcharge and overtreat because they are also the ones paying.
posted by eye of newt at 12:08 AM on July 23, 2022
Meh. The current US healthcare system is so unerringly shitty, I think it's probably created a legitimate opportunity for basically anybody to improve on it. Even Amazon. The bar is just that fucking low.
The interests of the healthcare incumbents are so far misaligned from the average person's, that anything that's truly bad for them is likely to be good for us. So let's go: fuck them up, Amazon. "Disrupt" that industry. Run them down like they're a mom-n-pop bookstore. I want health insurance executives throwing themselves out of 20th-floor windows. I want claims adjusters so squeezed, they're pissing in Gatorade bottles. Grab the whole sector by the balls and wring until there's no profit margin left. Drink. their. milkshake. and route it all to... shareholders. Whatever. Put it in a pile and burn it, I don't really care, just anything to degrade and disempower the current industry, which is actively blocking the creation of anything better.
I'd rather fight one Amazon than thousands of parasitic healthcare firms, all flying slightly under the radar, all working to make things just a little bit shittier, all nudging the political system just a bit in an advantageous direction, all working together but never quite rising to the level of a proper conspiracy.
We have a reasonable track record in the US of breaking up single companies when they become too big; we have a much poorer record of regulating industries.
posted by Kadin2048 at 12:23 AM on July 23, 2022 [8 favorites]
The interests of the healthcare incumbents are so far misaligned from the average person's, that anything that's truly bad for them is likely to be good for us. So let's go: fuck them up, Amazon. "Disrupt" that industry. Run them down like they're a mom-n-pop bookstore. I want health insurance executives throwing themselves out of 20th-floor windows. I want claims adjusters so squeezed, they're pissing in Gatorade bottles. Grab the whole sector by the balls and wring until there's no profit margin left. Drink. their. milkshake. and route it all to... shareholders. Whatever. Put it in a pile and burn it, I don't really care, just anything to degrade and disempower the current industry, which is actively blocking the creation of anything better.
I'd rather fight one Amazon than thousands of parasitic healthcare firms, all flying slightly under the radar, all working to make things just a little bit shittier, all nudging the political system just a bit in an advantageous direction, all working together but never quite rising to the level of a proper conspiracy.
We have a reasonable track record in the US of breaking up single companies when they become too big; we have a much poorer record of regulating industries.
posted by Kadin2048 at 12:23 AM on July 23, 2022 [8 favorites]
Pee bottles on delivery trucks.
If you think piss bottles are an Amazon invention, I have bad news: unionized UPS drivers have dealt with this for years. The tornado thing is fucked up tho.
posted by pwnguin at 12:54 AM on July 23, 2022 [5 favorites]
If you think piss bottles are an Amazon invention, I have bad news: unionized UPS drivers have dealt with this for years. The tornado thing is fucked up tho.
posted by pwnguin at 12:54 AM on July 23, 2022 [5 favorites]
You can still go broke at Kaiser . . . Or at least go broke-adjacent for the many Americans who can't afford a $400 emergency. . . They sell high deductible health plans with large out of pocket maxes, just like Aetna and the rest. But yeah, Kaiser is definitely as close to the NHS as the average person's gonna get in America, but their mental health is atrocious (Despite Henry J Kaiser supposedly believing that ongoing mental health care for the severely mentally ill was the cheapest of all other options including whatever the hell it is Kaiser is doing today to their mental health patients) and at the end of the day they are still a private insurance company looking to make a buck off illness (cynical?, Yes).
Also, lately my experience returning to them after being gone for a decade or so, is that their whole model is even more like this giant system where you're thrown in and all the right things/appointments are done for you but in the most impersonal stomping-out-widgets-like way . . I feel more like a car door on assembly line in a GM factory than a human patient receiving medical care. Maybe that's ok though? I guess I'll see in 30 years (If I'm lucky, knock on wood) when things start to fall apart. But then again maybe it'll all be run by Amazon algorithms... Fun!
posted by flamk at 12:54 AM on July 23, 2022 [1 favorite]
Also, lately my experience returning to them after being gone for a decade or so, is that their whole model is even more like this giant system where you're thrown in and all the right things/appointments are done for you but in the most impersonal stomping-out-widgets-like way . . I feel more like a car door on assembly line in a GM factory than a human patient receiving medical care. Maybe that's ok though? I guess I'll see in 30 years (If I'm lucky, knock on wood) when things start to fall apart. But then again maybe it'll all be run by Amazon algorithms... Fun!
posted by flamk at 12:54 AM on July 23, 2022 [1 favorite]
To me, what Amazon has done repeatedly is create systems that are initially so amazingly great that they are unsustainable. Or the only way they can be sustained at a certain level is for an initially nice service to become filled with more and more garbage all the time, to the point where people can hardly parse through it anymore, just so it can keep delivering. At the same time, people now expect the kind of fast and contactless service Amazon offers and demand that sort of service from any other company that tries to attract their online business.
So yeah, the idea of Amazon "getting into healthcare" doesn't inspire confidence from me, especially when we don't seem to nearly have enough doctors and nurses to begin with - and you can't just deliver those from a warehouse.
posted by wondermouse at 5:59 AM on July 23, 2022 [2 favorites]
So yeah, the idea of Amazon "getting into healthcare" doesn't inspire confidence from me, especially when we don't seem to nearly have enough doctors and nurses to begin with - and you can't just deliver those from a warehouse.
posted by wondermouse at 5:59 AM on July 23, 2022 [2 favorites]
...we don't seem to nearly have enough doctors and nurses to begin with - and you can't just deliver those from a warehouse.
Not unless you consider the world outside the US as a warehouse. With them entering the healthcare arena, it’s not hard to envision Amazon becoming a gateway for health practitioners from outside the US to become certified to practice in the US.
Anyone wishing to practice in the US usually has to take additional med school courses in order to gain parity in education with US practitioners. It wouldn’t be hard to imagine Amazon/One Medical setting up a system in which they help with the cost of the education in exchange for the doctors working for One Medical, or some other such arrangement.
posted by Thorzdad at 6:17 AM on July 23, 2022 [2 favorites]
Not unless you consider the world outside the US as a warehouse. With them entering the healthcare arena, it’s not hard to envision Amazon becoming a gateway for health practitioners from outside the US to become certified to practice in the US.
Anyone wishing to practice in the US usually has to take additional med school courses in order to gain parity in education with US practitioners. It wouldn’t be hard to imagine Amazon/One Medical setting up a system in which they help with the cost of the education in exchange for the doctors working for One Medical, or some other such arrangement.
posted by Thorzdad at 6:17 AM on July 23, 2022 [2 favorites]
What One Medical excels at is communication and ease of use. I joined over 10 years ago, and its astonishing to me that other medical practices are *still* not online, at all! The $200 I pay per year for a membership is absolutely worth the ability to schedule online, reliable access to my records online, timely test results online, ease of getting labs done, ability to access urgent care on the app or in person. No other medical practice I have ever gone to even comes close. And to top it all off, I have been seeing the same doctor for over 8 years and he’s probably the best doctor I’ve ever had.
So yeah, I am petrified Amazon will ruin this! But given that the signature benefit of One Medical is its platform and consumer convenience, I don’t really find the acquisition all that out of place. I hope the business model doesn’t interfere with the quality of care, but given that One Medical was already a profit-driven company, I’m not sure this is really a sea change.
posted by haptic_avenger at 6:20 AM on July 23, 2022
So yeah, I am petrified Amazon will ruin this! But given that the signature benefit of One Medical is its platform and consumer convenience, I don’t really find the acquisition all that out of place. I hope the business model doesn’t interfere with the quality of care, but given that One Medical was already a profit-driven company, I’m not sure this is really a sea change.
posted by haptic_avenger at 6:20 AM on July 23, 2022
HIPAA
Straight up purchasing a health care entity is the cleanest way to get around restrictions on disclosing patient information. HIPAA allows several businesses uses of patient data, so that the covered entity can bill, do quality review, and generally make their organization work. I work in the health-ai space, and it will be much easier for a researcher at Amazon to get and use completely identified information than academics or previous health-industrial partners.
posted by a robot made out of meat at 7:16 AM on July 23, 2022 [8 favorites]
Straight up purchasing a health care entity is the cleanest way to get around restrictions on disclosing patient information. HIPAA allows several businesses uses of patient data, so that the covered entity can bill, do quality review, and generally make their organization work. I work in the health-ai space, and it will be much easier for a researcher at Amazon to get and use completely identified information than academics or previous health-industrial partners.
posted by a robot made out of meat at 7:16 AM on July 23, 2022 [8 favorites]
WashPo: Why Amazon is buying a little-known medical provider for $3.9 billion. Not a great article, it basically just says "they want to try doing healthcare". But does discuss the HIPAA issues
posted by Nelson at 7:46 AM on July 23, 2022 [1 favorite]
What does this mean for patient data?I'm not particularly sanguine about the value of HIPAA; I feel like I've signed the rights to my data away many more times than it's meaningfully protected me. I don't understand the niceties though and it seems inevitable that this acquisition will enable more data sharing to Amazon.
[Amazon spokesperson] Quennell said the acquisition doesn’t change the fact that both companies “have stringent policies protecting customer privacy in accordance with HIPAA and all other applicable privacy laws and regulations.” ...
Others raised privacy concerns, pointing out that monetizing consumer data is an important part of Amazon’s other operations.
posted by Nelson at 7:46 AM on July 23, 2022 [1 favorite]
Amazon to get and use completely identified information than academics or previous health-industrial partners
I’m not a HIPPA expert but I find it hard to believe that Amazon would transfer non-anonymized health data between subsidiaries or even to researchers within the same organization.
posted by haptic_avenger at 8:15 AM on July 23, 2022 [1 favorite]
I’m not a HIPPA expert but I find it hard to believe that Amazon would transfer non-anonymized health data between subsidiaries or even to researchers within the same organization.
posted by haptic_avenger at 8:15 AM on July 23, 2022 [1 favorite]
Hey. DeID’ed data can be reID’ed later on. Re: this remark
posted by apathy at 9:06 AM on July 23, 2022
posted by apathy at 9:06 AM on July 23, 2022
I'm not a HIPAA expert either but if the law allows it, I believe Amazon will do it.
The question is if the law allows it. I work for a hospital and we don't even have to transfer health information internally, we all just log into the same electronic medical record system. If Amazon were working on an academic hospital model, I think they would just need the researchers to satisfy IRB requirements, which is more of an FDA thing than HIPAA. But that exhausts my knowledge of how it might work.
posted by joannemerriam at 9:14 AM on July 23, 2022
The question is if the law allows it. I work for a hospital and we don't even have to transfer health information internally, we all just log into the same electronic medical record system. If Amazon were working on an academic hospital model, I think they would just need the researchers to satisfy IRB requirements, which is more of an FDA thing than HIPAA. But that exhausts my knowledge of how it might work.
posted by joannemerriam at 9:14 AM on July 23, 2022
Bookstores are basically gone due to Amazon.
If Amazon didn't kill them, eBay or Overstock would have. Heck, maybe even Walmart would have stepped up their eCommerce game. As soon as the internet let you meet or exceed Barns&Nobles inventory, bookstores' days were numbered.
Standard retail practice is to sell books for twice what you paid for them. They'll couch it as a "50 percent discount" to feel less rapacious, but this is just a mirror universe accounting trick. In fact, pretty much all specialty retailing works this way. Retailers buy from wholesale (a warehouse) at half of MSRP, and attempt to sell at MSRP. Clay Christiansen has an entire chapter in Innovator's Dilemma on how retailer markup has eroded over the 20th century for the curious, but internet based front ends to wholesalers are a logical next step in a long history declining margins.
The industry has a number of defenses against this that border on cartel behavior, starting with printing MSRP on the book itself. The more annoying one is Minimum Advertised Price (MAP). Which basically is an agreement that retailers will not sell below MSRP, and if they get caught, the publisher will stop selling to them. This was expected to be a violation of anti-trust law until a 2007 SCOTUS decision ruled otherwise. Now they're far more common.
None of this should valorize Amazon; the list of misdeeds Amazon needs to answer for is quite long, and I'm a bit wary of Amazon buying their way into a new market and new data. I just want to point out that the bookstores were a victim of time and pressure more than Amazon in particular.
posted by pwnguin at 11:25 AM on July 23, 2022 [3 favorites]
If Amazon didn't kill them, eBay or Overstock would have. Heck, maybe even Walmart would have stepped up their eCommerce game. As soon as the internet let you meet or exceed Barns&Nobles inventory, bookstores' days were numbered.
Standard retail practice is to sell books for twice what you paid for them. They'll couch it as a "50 percent discount" to feel less rapacious, but this is just a mirror universe accounting trick. In fact, pretty much all specialty retailing works this way. Retailers buy from wholesale (a warehouse) at half of MSRP, and attempt to sell at MSRP. Clay Christiansen has an entire chapter in Innovator's Dilemma on how retailer markup has eroded over the 20th century for the curious, but internet based front ends to wholesalers are a logical next step in a long history declining margins.
The industry has a number of defenses against this that border on cartel behavior, starting with printing MSRP on the book itself. The more annoying one is Minimum Advertised Price (MAP). Which basically is an agreement that retailers will not sell below MSRP, and if they get caught, the publisher will stop selling to them. This was expected to be a violation of anti-trust law until a 2007 SCOTUS decision ruled otherwise. Now they're far more common.
None of this should valorize Amazon; the list of misdeeds Amazon needs to answer for is quite long, and I'm a bit wary of Amazon buying their way into a new market and new data. I just want to point out that the bookstores were a victim of time and pressure more than Amazon in particular.
posted by pwnguin at 11:25 AM on July 23, 2022 [3 favorites]
Bookstores are basically gone due to Amazon
Amazon is just the end stage of the process -- growing up, there were lots of little bookstores around my town. They were all driven out of business by the giant chain bookstores (B&N, Borders, etc) at malls on the edge of town. The chains helped to destroy American downtowns and paid their workers near minimum wage, all to the enrichment of big corporations.
Borders & B&N et al deserved to be burned in fire -- that they were by an even more rapacious corporation makes it hard to celebrate, but I do sometimes allow myself a moment of glee.
(We can hope there is renewed space for small, locally-focused bookstores again with the demise of the warehouse bookstores)
posted by Galvanic at 1:23 PM on July 23, 2022
Amazon is just the end stage of the process -- growing up, there were lots of little bookstores around my town. They were all driven out of business by the giant chain bookstores (B&N, Borders, etc) at malls on the edge of town. The chains helped to destroy American downtowns and paid their workers near minimum wage, all to the enrichment of big corporations.
Borders & B&N et al deserved to be burned in fire -- that they were by an even more rapacious corporation makes it hard to celebrate, but I do sometimes allow myself a moment of glee.
(We can hope there is renewed space for small, locally-focused bookstores again with the demise of the warehouse bookstores)
posted by Galvanic at 1:23 PM on July 23, 2022
It still exists today as a large health insurer in western US states. Amazingly, it operates more like public healthcare. They own their own hospitals, doctor's offices, and pharmacies, and the doctors work for Kaiser. They don't play the game of "You (the hospital) charge enormous amounts of money, we'll (insurance) pay it, and we all get big bonuses".
I live in Ireland, but have lived in the US, and used Anthem Blue Shield and then Kaiser. It's messed up that Kaiser had to go "I'll build my own health service, with blackjack, and hookers". When I lived in Berkeley, I had to go to Oakland to get even routine prescriptions dispensed.
Healthcare and housing are the two reasons why the government are going to lose the next election, but even the HSE (basically the Irish NHS), incompetent as they are, can supply me with a drug for €80 a month that costs $8,000 a month in America, and having insurance means that I pay nothing.
Amazon aren't doing this out of the goodness of their own hearts - they're doing this to make money by locking you in. I've seen it first-hand - they gave the company I worked for six AWS consultants for a year for free, knowing that once they had us hooked on Lambda, Athena, Redshift, etc., we were addicts in hock to dealers.
posted by kersplunk at 3:36 PM on July 23, 2022 [2 favorites]
I live in Ireland, but have lived in the US, and used Anthem Blue Shield and then Kaiser. It's messed up that Kaiser had to go "I'll build my own health service, with blackjack, and hookers". When I lived in Berkeley, I had to go to Oakland to get even routine prescriptions dispensed.
Healthcare and housing are the two reasons why the government are going to lose the next election, but even the HSE (basically the Irish NHS), incompetent as they are, can supply me with a drug for €80 a month that costs $8,000 a month in America, and having insurance means that I pay nothing.
Amazon aren't doing this out of the goodness of their own hearts - they're doing this to make money by locking you in. I've seen it first-hand - they gave the company I worked for six AWS consultants for a year for free, knowing that once they had us hooked on Lambda, Athena, Redshift, etc., we were addicts in hock to dealers.
posted by kersplunk at 3:36 PM on July 23, 2022 [2 favorites]
Well, I’ve been meaning to move my health care over to The Friedman Center, and this is gonna be the push I need to make that happen, but I’m not sure what I’ll do for the few months every year that I’m on tour. Just not get sick, I guess.
posted by mollymayhem at 3:39 PM on July 23, 2022
posted by mollymayhem at 3:39 PM on July 23, 2022
There is no concept of 'in network' and 'out of network'.
That's because you can't go anywhere else, and you effectively have no recourse if they disagree with you about what treatment you're entitled to.
posted by snuffleupagus at 4:05 PM on July 23, 2022
That's because you can't go anywhere else, and you effectively have no recourse if they disagree with you about what treatment you're entitled to.
posted by snuffleupagus at 4:05 PM on July 23, 2022
this thread is so bizarre. the opening statement about how this means the end of medicare for all is particularly weird. it's not so much a critique of amazon getting into the healthcare industry, or a thoughtful weighing of the pros and cons, so much as a generalized rant about how we deserve unlimited, world class, public, nonprofit, completely free, sensitive and loving medical care with individualized attention for all, with no waits, charges, or deductibles. and anything less than that is a capitalist hellscape.
no healthcare system in the world is perfect, and the american system sucks extra hard in particular. but without an understanding of compromises and cost/benefit of different options, the discussion devolves into catastrophizing.
posted by wibari at 6:44 PM on July 23, 2022 [6 favorites]
no healthcare system in the world is perfect, and the american system sucks extra hard in particular. but without an understanding of compromises and cost/benefit of different options, the discussion devolves into catastrophizing.
posted by wibari at 6:44 PM on July 23, 2022 [6 favorites]
how we deserve unlimited, world class, public, nonprofit, completely free, sensitive and loving medical care with individualized attention for all, with no waits, charges, or deductibles
Can we settle for free, unlimited, and world class? Because at the very least it should be free (and free shouldn't mean shitty).
posted by tiny frying pan at 6:47 AM on July 24, 2022 [2 favorites]
Can we settle for free, unlimited, and world class? Because at the very least it should be free (and free shouldn't mean shitty).
posted by tiny frying pan at 6:47 AM on July 24, 2022 [2 favorites]
we deserve unlimited, world class, public, nonprofit, completely free, sensitive and loving medical care with individualized attention for all, with no waits, charges, or deductibles.
I don't really see people demanding that. I mean, sure, basically any conversation about the US healthcare system is going to turn into a series of complaints, because that's really all there is to say about the US healthcare system. Unless you're an insurance-company, hospital-management-company, or pharmaceutical-company executive, the system is there to fuck you out of as much money as possible until you die. (At which point it will also try to fuck your estate for a bit more.) It's a system that literally profits, quite handsomely, on human suffering. What do you expect people to say about it?
And there is, of course, no such thing as "free" healthcare, or any other service; it's taxpayer-funded. It's worth being clear about that point. Basic healthcare should be something you get as a participant in the whole "industrialized civilization" package, because it's something everyone needs sooner or later, and it shouldn't be subject to profit-seeking.
That doesn't really seem like a huge goddamn ask.
We should, as the richest country on the planet, have unlimited and world-class healthcare, but realistically that's never going to happen; I'd be satisfied with some sort of Medicare-for-all that covers at least basic preventative, emergency, and chronic-disease healthcare, that gives us outcomes at least on par with other major industrialized countries. Again, doesn't really seem like a huge ask, given the astonishing percentage of GDP we spend on healthcare.
Amazon is pretty famous for crushing the profit margins of pretty much every industry it goes into, and it's those profit margins that are the problem. Right now there's too many people invested in keeping the gravy train moving the way it has been, moving money from working stiffs through our insane system of middlemen, each participant taking a cut along the way, until eventually whatever's left goes to pay for actual services rendered. Our political system allows any highly-motivated and well-funded group of individuals to block progress through legislation, so this can't be fixed until we either break their motivation, or their funding. (I'd be happy to work on breaking their motivation, perhaps by breaking some of their shit and/or limbs, but Americans are historically very hesitant to do stuff like that.) I'm cautiously optimistic about Amazon getting into healthcare because if Amazon were to start wringing the margins out of the industry, it's that much less money (and that many fewer employed people) that we have to fight against to achieve systemic change. It's a lot easier to fight, and our legal and political system is much more effective at fighting, a single large corporation than a thousand smaller ones.
posted by Kadin2048 at 7:43 AM on July 24, 2022 [2 favorites]
I don't really see people demanding that. I mean, sure, basically any conversation about the US healthcare system is going to turn into a series of complaints, because that's really all there is to say about the US healthcare system. Unless you're an insurance-company, hospital-management-company, or pharmaceutical-company executive, the system is there to fuck you out of as much money as possible until you die. (At which point it will also try to fuck your estate for a bit more.) It's a system that literally profits, quite handsomely, on human suffering. What do you expect people to say about it?
And there is, of course, no such thing as "free" healthcare, or any other service; it's taxpayer-funded. It's worth being clear about that point. Basic healthcare should be something you get as a participant in the whole "industrialized civilization" package, because it's something everyone needs sooner or later, and it shouldn't be subject to profit-seeking.
That doesn't really seem like a huge goddamn ask.
We should, as the richest country on the planet, have unlimited and world-class healthcare, but realistically that's never going to happen; I'd be satisfied with some sort of Medicare-for-all that covers at least basic preventative, emergency, and chronic-disease healthcare, that gives us outcomes at least on par with other major industrialized countries. Again, doesn't really seem like a huge ask, given the astonishing percentage of GDP we spend on healthcare.
Amazon is pretty famous for crushing the profit margins of pretty much every industry it goes into, and it's those profit margins that are the problem. Right now there's too many people invested in keeping the gravy train moving the way it has been, moving money from working stiffs through our insane system of middlemen, each participant taking a cut along the way, until eventually whatever's left goes to pay for actual services rendered. Our political system allows any highly-motivated and well-funded group of individuals to block progress through legislation, so this can't be fixed until we either break their motivation, or their funding. (I'd be happy to work on breaking their motivation, perhaps by breaking some of their shit and/or limbs, but Americans are historically very hesitant to do stuff like that.) I'm cautiously optimistic about Amazon getting into healthcare because if Amazon were to start wringing the margins out of the industry, it's that much less money (and that many fewer employed people) that we have to fight against to achieve systemic change. It's a lot easier to fight, and our legal and political system is much more effective at fighting, a single large corporation than a thousand smaller ones.
posted by Kadin2048 at 7:43 AM on July 24, 2022 [2 favorites]
Amazon is also good at making processes streamlined and efficient and very easy for the consumer. That's part of what One Medical is about, so the acquisition makes some sense to me. (One Medical also seems to be about maximalist insurance billing and serving relatively wealthy customers, I suspect they tend to actually increase the cost of care).
Amazon Pharmacy is really pretty good. Their web store works more or less like the main Amazon store. That doesn't sound like it's saying a lot but CVS Caremark (Blue Shield's choice) has literally never been able to make a website that works right.
Amazon Pharmacy also is good at showing you the drug prices. CVS Caremark was never able to show me what I'd pay for a prescription until after it shipped. Despite being my insurer's partner pharmacy. Amazon shows me the price both with insurance and without. The without-insurance price is often cheaper which is a shitty thing but not Amazon's fault. Sometimes they don't know the insurance price in which case there's a note "come back in 24 hours" and usually they have the price by then.
The American pharmacy and insurance market is just as fucked as the rest of our health care. But Amazon Pharmacy is doing a fairly good job cutting through that garbage and presenting a more reasonable buying experience.
posted by Nelson at 7:59 AM on July 24, 2022 [2 favorites]
Amazon Pharmacy is really pretty good. Their web store works more or less like the main Amazon store. That doesn't sound like it's saying a lot but CVS Caremark (Blue Shield's choice) has literally never been able to make a website that works right.
Amazon Pharmacy also is good at showing you the drug prices. CVS Caremark was never able to show me what I'd pay for a prescription until after it shipped. Despite being my insurer's partner pharmacy. Amazon shows me the price both with insurance and without. The without-insurance price is often cheaper which is a shitty thing but not Amazon's fault. Sometimes they don't know the insurance price in which case there's a note "come back in 24 hours" and usually they have the price by then.
The American pharmacy and insurance market is just as fucked as the rest of our health care. But Amazon Pharmacy is doing a fairly good job cutting through that garbage and presenting a more reasonable buying experience.
posted by Nelson at 7:59 AM on July 24, 2022 [2 favorites]
Let me explain what good healthcare looks like to many people who have never experienced it and cannot even begin to imagine it.
On arriving in Denmark, where I spent one fucking celestial year, I was asked what doctor I wanted. Staring at the lady responsible for getting me my identity card I said I didn't know. She prompted, "Would you like young or old? Man or woman?" I said I didn't care, and she said "Oh well, it doesn't matter anyway, you can choose another one if you don't like this one," and she tapped at the computer, explaining the small administrative fee should I ever want to change my doctor. "And here, just come see us or call if you want to change."
When I made my first appointment I discovered that the doctor was a five minute walk from my apartment, and there was a pharmacy on the way. When I called it rang straight through, with no wait and no hold music and the secretary asked when I wanted to come in. I said as soon as possible and she made an appointment for ten the following morning. I began to feel myself falling into bizarro world, a feeling that thickened and solidified the next day when I walked into a small office with empty chairs and one lady behind the desk.
Walking right up I said I was new and probably needed to fill out papers. She said "Oh no, of course not. We have your identity card information." I sat down, wondering why they weren't at least asking all the typical pre-existing condition questions.
Less than five minutes later the doctor, in regular clothes, ushered me back to the exam room, and here I discovered they didn't ask you to write everything down because they asked you that in person. It was the most personal, sane service I've ever gotten in a medical office. Because I have a serious chronic condition, she referred me a specialist at the hospital, and said I would be receiving a call and a letter with the date.
I walked out in less than 15 minutes total, the whole affair having taken something like half an hour, visit and travel by foot. On the way home I stopped at a pharmacy (where codeine with tylenol is available over-the-counter) and waited maybe ten minutes.
I received a call a couple of days later informing me of an appointment with a rheumatologist for two weeks in the future. Keep in mind my appointment was not for an urgent situation.
In Michigan I just called my rheumatologist and she is booking SIX MONTHS OUT and my current condition is incredibly urgent because I'm having severe side effects from medication and it's not working. I literally shit myself twice in the past month and I've lost ten pounds in the last two weeks, unintentionally. 1/3 of my hair has fallen out in the last month. The colonoscopy I requested with gastro can't happen for another three months. I've lived in TN, TX, and WA with a chronic condition and the situation is just as bad if not worse in those places. Of course I do have medicare, and most places won't take it, or only accept a certain number of medicare patients and that, of course, affects the time.
Medical care for me in Denmark was free, even though I wasn't paying any taxes as a student. Here in the US not only do I pay a monthly fee for medicare, every doctor is allowed to charge me personally 30 percent more on top of what they scrape out of medicare, the medicare I pay for again, even after paying into it with taxes for years.
Good healthcare for all is possible in the U.S. We don't have to live like animals, with people in the middle and on top trampling the ones below them, either intentionally or out of a sense of helplessness or malaise.
I've heard all the arguments that we can't have it here and they're all bullshit, an outrageous pack of lies designed to keep us subservient, weak, and fearful. We're pitted against each other on one hand and distracted by Amazon Prime on the other.
If there's ever a civil war here, I'll volunteer to be in that first row, the one that inevitably gets shot down, because my life isn't worth anything at all here. I realize that's a pipe dream, because with the weapons we have we can and would destroy entire cities. But if enough good people start to have these feelings, then surely to fuck we can start to change things, if only we can step away from the distraction and ease of easy commerce and entertainment.
People in the US don't believe it's possible because they haven't lived it. Even I bought the lie that healthcare for all would inevitably be a little worse (though I still wanted it and fought for it), until I lived it. They're lying to you. You are being sold down the river and asked to worship it, under the auspices of being the greatest country on earth, the most free.
I have to keep believing that even the smallest consistent changes can help. I have to keep believing that if enough people tell amazon to go fuck themselves, at least we start thinking about what capitalism is doing and how it completely destroys a sector of humanity.
posted by liminal_shadows at 8:39 AM on July 24, 2022 [19 favorites]
On arriving in Denmark, where I spent one fucking celestial year, I was asked what doctor I wanted. Staring at the lady responsible for getting me my identity card I said I didn't know. She prompted, "Would you like young or old? Man or woman?" I said I didn't care, and she said "Oh well, it doesn't matter anyway, you can choose another one if you don't like this one," and she tapped at the computer, explaining the small administrative fee should I ever want to change my doctor. "And here, just come see us or call if you want to change."
When I made my first appointment I discovered that the doctor was a five minute walk from my apartment, and there was a pharmacy on the way. When I called it rang straight through, with no wait and no hold music and the secretary asked when I wanted to come in. I said as soon as possible and she made an appointment for ten the following morning. I began to feel myself falling into bizarro world, a feeling that thickened and solidified the next day when I walked into a small office with empty chairs and one lady behind the desk.
Walking right up I said I was new and probably needed to fill out papers. She said "Oh no, of course not. We have your identity card information." I sat down, wondering why they weren't at least asking all the typical pre-existing condition questions.
Less than five minutes later the doctor, in regular clothes, ushered me back to the exam room, and here I discovered they didn't ask you to write everything down because they asked you that in person. It was the most personal, sane service I've ever gotten in a medical office. Because I have a serious chronic condition, she referred me a specialist at the hospital, and said I would be receiving a call and a letter with the date.
I walked out in less than 15 minutes total, the whole affair having taken something like half an hour, visit and travel by foot. On the way home I stopped at a pharmacy (where codeine with tylenol is available over-the-counter) and waited maybe ten minutes.
I received a call a couple of days later informing me of an appointment with a rheumatologist for two weeks in the future. Keep in mind my appointment was not for an urgent situation.
In Michigan I just called my rheumatologist and she is booking SIX MONTHS OUT and my current condition is incredibly urgent because I'm having severe side effects from medication and it's not working. I literally shit myself twice in the past month and I've lost ten pounds in the last two weeks, unintentionally. 1/3 of my hair has fallen out in the last month. The colonoscopy I requested with gastro can't happen for another three months. I've lived in TN, TX, and WA with a chronic condition and the situation is just as bad if not worse in those places. Of course I do have medicare, and most places won't take it, or only accept a certain number of medicare patients and that, of course, affects the time.
Medical care for me in Denmark was free, even though I wasn't paying any taxes as a student. Here in the US not only do I pay a monthly fee for medicare, every doctor is allowed to charge me personally 30 percent more on top of what they scrape out of medicare, the medicare I pay for again, even after paying into it with taxes for years.
Good healthcare for all is possible in the U.S. We don't have to live like animals, with people in the middle and on top trampling the ones below them, either intentionally or out of a sense of helplessness or malaise.
I've heard all the arguments that we can't have it here and they're all bullshit, an outrageous pack of lies designed to keep us subservient, weak, and fearful. We're pitted against each other on one hand and distracted by Amazon Prime on the other.
If there's ever a civil war here, I'll volunteer to be in that first row, the one that inevitably gets shot down, because my life isn't worth anything at all here. I realize that's a pipe dream, because with the weapons we have we can and would destroy entire cities. But if enough good people start to have these feelings, then surely to fuck we can start to change things, if only we can step away from the distraction and ease of easy commerce and entertainment.
People in the US don't believe it's possible because they haven't lived it. Even I bought the lie that healthcare for all would inevitably be a little worse (though I still wanted it and fought for it), until I lived it. They're lying to you. You are being sold down the river and asked to worship it, under the auspices of being the greatest country on earth, the most free.
I have to keep believing that even the smallest consistent changes can help. I have to keep believing that if enough people tell amazon to go fuck themselves, at least we start thinking about what capitalism is doing and how it completely destroys a sector of humanity.
posted by liminal_shadows at 8:39 AM on July 24, 2022 [19 favorites]
I don't really see people demanding that
People should be demanding that. For the price Americans in aggregate pay for medical services, it should be easy to fund health care as good as that for everybody.
posted by flabdablet at 8:51 AM on July 24, 2022 [3 favorites]
People should be demanding that. For the price Americans in aggregate pay for medical services, it should be easy to fund health care as good as that for everybody.
posted by flabdablet at 8:51 AM on July 24, 2022 [3 favorites]
Why oh why do we in the US settle for less? Why do we keep insisting it's impossible to have what the rest of the world has?
Is there any potential Presidential candidate that's under 70 years old and willing to use the words "single payer"?
posted by bink at 10:54 PM on July 24, 2022 [1 favorite]
Is there any potential Presidential candidate that's under 70 years old and willing to use the words "single payer"?
posted by bink at 10:54 PM on July 24, 2022 [1 favorite]
Why oh why do we in the US settle for less?
The only explanation that makes any sense to me is the effect of the consistently and heavily propagandized position that the US is by definition the best country in the world, from which it clearly follows that the US has nothing of value to learn from anywhere else and that any claim that things could be better, especially if backed by evidence from elsewhere that specific things are better there, must perforce be a lie.
The US has been living under Catch-22 for such a long time that there's now a deeply and widely inculcated belief that there must always and everywhere be a catch.
I think this is why any attempt to suggest that a health system almost completely monopolized by a huge publicly-accountable funds pool works better is always met with almost always furious and almost always spurious counter-points about people having to wait years for surgery - as if that, let alone being entirely denied any opportunity for surgery, couldn't possibly also be happening in the US.
posted by flabdablet at 3:42 AM on July 25, 2022 [1 favorite]
The only explanation that makes any sense to me is the effect of the consistently and heavily propagandized position that the US is by definition the best country in the world, from which it clearly follows that the US has nothing of value to learn from anywhere else and that any claim that things could be better, especially if backed by evidence from elsewhere that specific things are better there, must perforce be a lie.
The US has been living under Catch-22 for such a long time that there's now a deeply and widely inculcated belief that there must always and everywhere be a catch.
I think this is why any attempt to suggest that a health system almost completely monopolized by a huge publicly-accountable funds pool works better is always met with almost always furious and almost always spurious counter-points about people having to wait years for surgery - as if that, let alone being entirely denied any opportunity for surgery, couldn't possibly also be happening in the US.
posted by flabdablet at 3:42 AM on July 25, 2022 [1 favorite]
Why oh why do we in the US settle for less?
I don't think the explanation is that complex: we have a political system that you can basically steer via money. In the other thread someone linked this article about the failure of universal healthcare in California:
People said "we want universal healthcare", and industry said "lol no". And a whole bunch of politicians said, essentially, "oh, okay, nevermind then".
It didn't help that AB 1400 was pretty vague on the issue of how this universal healthcare would get paid for, which is, uh, not an unfair question for people to ask? There's an element of "if you come at the king, you best not miss"—and proposing single-payer in the US is definitely lèse-majesté, if not actual regicide. Not sure how they expected that to go.
posted by Kadin2048 at 9:01 AM on July 25, 2022 [1 favorite]
I don't think the explanation is that complex: we have a political system that you can basically steer via money. In the other thread someone linked this article about the failure of universal healthcare in California:
California Democrats on Monday failed to gather enough support to advance a government-funded universal health care system, succumbing to intense pressure from business groups and the insurance industry in an election year.That's it. That's the game.
People said "we want universal healthcare", and industry said "lol no". And a whole bunch of politicians said, essentially, "oh, okay, nevermind then".
It didn't help that AB 1400 was pretty vague on the issue of how this universal healthcare would get paid for, which is, uh, not an unfair question for people to ask? There's an element of "if you come at the king, you best not miss"—and proposing single-payer in the US is definitely lèse-majesté, if not actual regicide. Not sure how they expected that to go.
posted by Kadin2048 at 9:01 AM on July 25, 2022 [1 favorite]
It didn't help that AB 1400 was pretty vague on the issue of how this universal healthcare would get paid for, which is, uh, not an unfair question for people to ask?
One of those phenomena that can be seen but never again unseen is just how infrequently the exact same question is asked when it comes to funding military spending or massive tax cuts.
The present-day US is the wealthiest country that has ever existed on this planet, and the idea that it could somehow not afford to fund universal health care if that was something it actually chose to do is ludicrous on its face.
posted by flabdablet at 11:23 AM on July 25, 2022 [1 favorite]
One of those phenomena that can be seen but never again unseen is just how infrequently the exact same question is asked when it comes to funding military spending or massive tax cuts.
The present-day US is the wealthiest country that has ever existed on this planet, and the idea that it could somehow not afford to fund universal health care if that was something it actually chose to do is ludicrous on its face.
posted by flabdablet at 11:23 AM on July 25, 2022 [1 favorite]
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Time to say goodbye to all the great things i get as a OneMed patient, and get a new Dr. somewhere else.
posted by armoir from antproof case at 12:49 PM on July 22, 2022 [10 favorites]