Patient privacy has been inviolable since the time of Hippocrates, in 400 BC. That may be about to end. Last week Amazon announced it is going to acquire One Medical, a health care provider with over 700,000 patients.
Big Tech has flirted with health care for years. Amazon’s direct entry into primary health care is a turning point. It will increase the perils of surveillance capitalism, with implications for everyone.
Amazon knows our guilty pleasures, what we buy, what pills we buy, and what we watch and read and listen to. Its devices listen in our homes, and peep out of our (Amazon Ring) door bells. Amazon’s “Kuiper” satellites will soon connect our Internet.
Recent scandals revealed that Amazon uses the data collected for supposedly innocent reasons in ways that betray our trust. Amazon staff say there are no limits on how Amazon uses this data internally. According to Amazon’s former head of information security: “We have no idea where our fucking data is.”
One Medical receives health information about children, families, the elderly, and vulnerable. That includes information about substance abuse, mental health issues, and other intimate conditions. We cannot be confident that Amazon will treat this new data any better than it has treated its existing data hoard.
Our secrets are not safe inside Amazon. And it is not just consumers who are at risk. Other companies that compete with or sell through Amazon will almost certainly be harmed. Amazon uses data collected from one part of its business to help other parts. For example, it competes with retailers that sell on its platform by exploiting its insider data about their businesses. More data – especially intimate data – increases Amazon’s market power over consumers and competitors.
If we allow Amazon to run our medical clinics, will we also allow Amazon to operate health insurance services, too? We face a bleak future where an all-knowing behemoth exploits our intimate vulnerabilities not to provide care to us, but to capture revenue for itself.
This concern is not hypothetical. The business model employed by internet giants, surveillance capitalism, is defined by the extraction of data from all sources, the creation of models of collective and individual human behavior, and the use of global apps – like Facebook, Instagram, YouTube or Amazon – to steer users towards desired behaviors. We have already witnessed massive harms from surveillance capitalism, including the undermining of elections in the U.S. and other countries, the amplification of disinformation during a pandemic, and ethnic cleansing in Myanmar.
Like Amazon, Google, and Microsoft have sought and won major contracts with the federal government, notably the Department of Defense. Google has built a stronghold in public education. To date, policy makers have not acted on warnings about the threats to civil liberties that might result from surveillance capitalists managing government databases and educational systems.
What makes Amazon’s acquisition of One Medical especially troubling is that it would enable the extension of surveillance capitalism beyond advertising-driven platforms into the real world, and it would do so in health care, one of the most sensitive categories of data. Amazon is not alone.
Amazon’s acquisition of One Medical requires regulatory approval. This transaction gives the Federal Trade Commission an opportunity to exercise not only its duty under antitrust law, but also its new mandate to protect consumer privacy. Past efforts to safeguard consumer privacy under the Health Insurance Portability and Accountability Act (HIPAA), have proved to be inadequate, as data from medical tests, prescriptions, wellness applications, and the like are not protected. There is also ambiguity about how HIPAA applies to models created from protected data.
We do not know that Amazon will misuse data it gathers from One Medical, but there is no reason to take that risk. Consumers have little protection today from surveillance capitalism. The few initiatives in Congress barely scratch the surface of the problem. That leaves the FTC as the best hope for protecting consumers from potentially predatory behavior.
Consumer protection used to be a core function of government. It should be again. The harms from unregulated use of personal data are well known and understood. There is no excuse for further delay. Blocking Amazon’s proposed acquisition of One Medical will not solve the problem, but it will send an essential message that the government will finally use the tools at its disposal to protect Americans.