“…Amazon approaches health care as another market, like books or groceries, focusing our attention on corporate engineering rather than the structural barriers that keep people from getting care.”
In late January, Jeff Bezos, Warren Buffett, and Jamie Dimon announced that Amazon, Berkshire Hathaway, and JPMorgan would be collaborating on a new “health care venture.” More recently we learned that Atul Gawande, the celebrated endocrine surgeon and writer for The New Yorker, will be its CEO, starting on July 9.
We don’t know much about what the project actually seeks to accomplish. Other than Gawande’s comment that “the system is broken, and better is possible,” the venture has not clearly named the health care problems it is attempting to solve or even offered a mission statement.
How might a new team of billionaires, led by a prominent surgeon and storyteller, approach our health care system? To get a better idea, it may be useful to look at Amazon and its chief executive officer, Jeff Bezos.
This month, Amazon helped fund a ballot challenge to repeal a tax that would have raised $48 million to combat homelessness in Seattle. This affront to the poor is unsurprising, because for most of its existence Amazon has been avoiding taxes as it seeks to more efficiently accrue new market shares.
In 2017, the European Union ordered Amazon to pay €250 million in back taxes it had evaded through an elaborate series of shell companies created around its Luxembourg headquarters in 2003. Amazon also has a track record of eliminating retail jobs, paying minimal or no property taxes, and abusing its workers. Despite this, poor cities with crumbling infrastructure like Philadelphia, my home, are courting Amazon with the help of state-level tax breaks, hoping to be chosen as the site of its new headquarters.
Outside the realm of private joint ventures, there is widespread agreement that our current health care system is in crisis. Leaders in the struggle for better care are emerging from the new Poor People’s Campaign, a continuation of the project launched by the Reverend Martin Luther King Jr. in 1968, and other advocates of Medicare For All.
The United States still has nearly 30 million uninsured people, while as many as 41 million remain underinsured. The rising costs created by health care profiteers are continually shifted onto poor and working class people.
As a member of Put People First! PA, a human rights organization led by poor and working class people, I understand Amazon’s exploits as a story about poverty and dispossession, not innovation. Our economy stratifies us by markers including income, race, nationality, gender, age, and ability, justified by a narrative about poverty which qualifies all of us as either “deserving” or “undeserving.”
The poor are widely denied health care and other fundamental needs on these bases. It is in this context that Amazon approaches health care as another market, like books or groceries, focusing our attention on corporate engineering rather than the structural barriers that keep people from getting care.
I’m disheartened to see that one of medicine’s moral voices is joining their team. Gawande, perhaps best known for his writing on the end of life in Being Mortal, has implemented quality improvement projects in diverse settings to make surgery safer. But I have no illusions that any amount of positive influence from one good person can change what Amazon stands for.
As Dr. Steffie Woolhandler of Physicians for a National Health Program commented about the project, Amazon and its partners have only one interest in health care: saving money. This project is only worthwhile if it gives them a unique competitive advantage.
As JPMorgan CEO Jamie Dimon reassured his clients, the new venture is invested only in its own employees and its own bottomline. It has no interest in guaranteeing health care access to everyone. And while the venture is nominally “nonprofit,” that distinction is not meaningful in a health care environment in which so-called nonprofits like Independence Blue Cross are shifting costs on to people across Pennsylvania.
More than 2,500 people have been arrested so far in Poor People’s Campaign demonstrations across the country, demanding policies to address rampant poverty and racism, including Medicare For All. U.S. Representative Keith Ellison, Democrat of Minnesota, was the keynote speaker at a recent Single Payer Strategy Conference in Minneapolis.
Health care inequity is a moral crisis that only the moral leadership of social movements can address. The fantasy of a magical fix handed down from a team of billionaires is at best a distraction. Knowing Amazon’s track record of exploiting its own workers, it could likely turn into something dangerous to health care workers and patients.
In the documentary Being Mortal, based on Atul Gawande’s book, there is a scene in which an older man dies peacefully on his own terms, surrounded by his family. The scene made me think of Isabella (Bella) Oliveras, a member of Put People First! PA who died in early 2017, from complications of a treatable disease. She was in her thirties.
At the time of Bella’s death, the group was helping her raise money for a motorized scooter, which her insurance would not cover although she was wheelchair-bound. The absence of stories like hers from our conversations about the end of life reflects our nation’s general failure to identify poverty as the central driver of health care outcomes.
Amazon and its business partners will not seriously engage this. They will likely not get us closer to universal, public insurance financing or meaningful checks on the profiteers that drive costs. We should look instead to the vision that Martin Luther King Jr. had at the end of his life. As he expressed it:
“There are millions of poor people in this country who have very little, or even nothing, to lose. If they can be helped to take action together, they will do so with a freedom and a power that will be a new and unsettling force in our complacent national life.”
Karim Sariahmed is a medical student at the Lewis Katz School of Medicine at Temple University. In addition to supporting the growth of Temple Med’s SNaHP chapter, he is a member of Put People First! PA. This is the community in Philadelphia that teaches him how to organize alongside many other developing organizers from various healthcare professions and healing traditions. You can read his other work at in-Training and the PPF-PA blog. He tweets @sariahmed.