Public Citizen Advises US Decision-Makers Investigate Amazon-One Medical Merger

Article updated Aug. 4 with comment from an Amazon spokesperson.

Public Citizen advised Amazon's proposed acquisition of healthcare provider, One Medical, should be rejected in a letter sent the Centers for Medicare and Medicaid Services, the Federal Trade Commission, the U.S. Department of Justice, and leaders in Congress.

The non-profit consumer advocacy group that defends democracy and works to ensure government works for the people, wrote today that the merger should be investigated or "rejecteted unless Amazon commits to robust, legally binding safeguards that protect consumers, competition, and the integrity of the health care system."

Public Citizen raised the following concerns:

1. Amazon may gain an unfair competitive advantage in the healthcare market.
   There is good reason to fear that Amazon will leverage its dominant role in the online retail market to gain unfair advantage in healthcare delivery, for example, through bundling Amazon Prime and One Medical memberships, according to a release from Public Citizen.
2. Amazon may misuse patients’ health data.
   The personal medical data that One Medical routinely accumulates would be of enormous value to a marketing company such as Amazon, which will have an undeniable and inherent interest in trying to gain access to that most personal of data.
3. The merger may exacerbate healthcare inequalities.
   According to Public Citizen, Amazon-One Medical is likely to disproportionately serve healthier and wealthier patients. This will leave other healthcare providers with sicker and less profitable patients – raising overall costs, and worsening healthcare disparities already experienced by vulnerable populations.
4. The merger could worsen Medicare overbilling.
   Amazon, through its acquisition of One Medical, would likely build out a primary care network across the country that inflates Medicare payments as part of its business model.
5. The merger may undermine the quality of healthcare.
   Amazon’s online business model could deeply harm the quality of primary healthcare – including preventative, acute, and chronic disease management care. While some virtual visits can enhance consumer access, overly aggressive substitution of in-person medical encounters with virtual visits can work directly against the proper provision for needed in-person care. Relatedly, Amazon’s demand for robot-like efficiency among its employees may well conflict with the imperatives of providing quality healthcare.
6. The merger may undermine worker rights at One Medical.
   Amazon has a well-documented history of hostility to workers exercising their right to form unions, the release said. Similarly, One Medical workers have reported being rushed, pressured, stretched out, and unable to deliver the quality of care they believe patients require. Amazon seems likely to worsen these issues.

According to a statement by Robert Weissman, president of Public Citizen, in the release, the American healthcare system is broken, but Amazon’s entry as a major healthcare provider could make it worse.

“We may get marketing instead of medicine, data harvesting instead of privacy protections, robotic care instead of bedside manner, and more healthcare disparity instead of more quality," Weissman said. "The problem of American healthcare can be summed up as too much greed and not enough patient care. The Amazon acquisition of One Medical will only deepen that problem.”

An Amazon spokesperson commented on the statement regarding the safety of One Medical's member information.

“As required by law, Amazon will never share One Medical customers’ personal health information outside of One Medical for advertising or marketing purposes of other Amazon products and services without clear permission from the customer," wrote the spokesperson. “Should the deal close, One Medical customers' HIPAA Protected Health Information will be handled separately from all other Amazon businesses, as required by law.”