On April 10, Mark Zuckerberg testified in front of Congress on how Facebook manages user data, defending his company against accusations of privacy violations. In light of this scandal, Facebook quietly dropped a plan with hospitals and health organizations to receive anonymized patient hospital records in a data sharing program that included Stanford’s own medical school. The data would be anonymized before being shared to avoid privacy violations, but Facebook planned to deanonymize the data, ostensibly to look out for users’ health. This planned invasion of privacy exemplifies the dangers of Silicon Valley’s move into the healthcare industry. If Silicon Valley tech giants become omnipresent forces in the healthcare industry, like Facebook is for social media or Amazon for e-commerce, they would be able to manipulate the decisions we make regarding our bodies, or even eliminate the possibility of freely making those choices. This is a violation of our human right to bodily autonomy, which demands that we be able to freely make choices about our bodies and that no one else make such choices without our consent.
Although Facebook claims it was acting in the best interests of their users’ health, we can’t forget that at the end of the day it’s just another company looking to make a profit. A CNN report revealed that Facebook was wining and dining pharmaceutical marketing representatives at conferences in order to make deals for targeted pharmaceutical advertisements. Facebook claims to have only their users’ health in mind, but it seems more likely that Facebook’s hospital data-sharing scheme was looking to make a profit from users’ health issues. Apologists would respond that people are still making their own choices about their bodies, and that advertisements just tell them what options they have. However, as the 2016 Presidential Election shows, advertisement easily runs into the territory of large-scale social manipulation, and we are completely justified in holding Facebook responsible for that.
To be clear, these problems are already present in the United States healthcare system. Predatory pharma advertising existed before Facebook. Unabashed price-hiking of medicine is par for the course. Insurance companies regularly avoid paying people’s bills by retroactively cancelling healthcare policies, a practice called “rescission.” Everyone on the political spectrum seems to agree that the United States healthcare system is broken, and only disagree on how to fix it. But allowing free-market agents from Silicon Valley into the system is not the answer.
As Silicon Valley continues to operate in healthcare unchecked, we can expect the contradiction between free-market economics and healthcare to become even more pronounced, with negative impacts for all of us. Most startups in the healthcare industry currently operate in a fee-for-service model, where a one-off service is rendered for a one-off payment. A startup called Heal, for instance, allows users to book a house call from their phones just like they would book an Uber. Although a fee for service model is nothing new in the healthcare industry, its reinforcement can have frightful consequences for accessibility and quality. A 2013 article in The New England Journal of Medicine, found that fee-for-service mechanisms in U.S. healthcare incentivizes “increasing the volume and cost of services (whether appropriate or not), encourages duplication, discourages care coordination, and promotes inefficiency in the delivery of medical services.”
The spread of Silicon Valley’s profit-seeking logic will have deadly (literally) consequences for the healthcare industry. Medicine is a human endeavor. Doctors should not be forced into an incentive structure that forces them to think of patients as items on an assembly line to be cycled through as quickly as possible. If a patient’s slow recovery is a financial burden for their doctor rather than a cause for increased empathy, medicine has failed.
Moreover, Silicon Valley is now making a leap by entering public health, which leads to a separate set of issues, including some pertaining to the basic human right of bodily autonomy. Public health organizations are concerned with health beyond the treatment of existing conditions. Typically they make decisions about people’s health on their behalf, or influence the framework in which people make those decisions. If a company like Facebook, which does not ask for users’ permission before accessing confidential medical data, controlled that framework, people would be unknowingly manipulated in their choices about their bodies.
Facebook is not the only tech giant entering the health game. Amazon is teaming up with JPMorgan Chase and Berkshire Hathaway to form a healthcare company to cover Amazon employees. Essentially, this would place Amazon employees’ health in the hands of the company. A Harvard Business Review article argues that this is also an example of Amazon turning internal logistical solutions into external products. This one, if successful, would give Amazon a sizable influence in the health insurance industry. As a health insurance company, Amazon would have financial control over people’s health decisions, tempered only by how far the market allows Amazon to go without losing customers.
However, we can’t trust the free market to protect our choices about our bodies from outside influence. For free choice to exist in the healthcare industry people must have a variety of options, and tech giants make a habit of removing all competition. There are currently no true competitors for the likes of Facebook or Amazon. A competitor would have to start from the bottom as a start-up. But as the tech giants optimize their market presence and improve their strategies, the survival of startups becomes unlikely. Startups have little chance of survival against these companies that have already mastered the Silicon Valley game. This means that If the tech giants give healthcare the same treatment they’ve given information technology, we will be forced to accept whatever choices they make about our bodies — there will be no alternative.
Currently, we have a voice in state decisions regarding our bodies through democratic mechanisms. We even have some minimal agency in choosing which health insurance companies will decide whether our hospital visits get funded or not. But if Silicon Valley’s tech giants are allowed to become unchecked, omnipresent agents in the healthcare industry, they will have a monopoly on decisions about our bodies. The very fact that tech giants have the audacity to move in this direction indicates that Silicon Valley is beginning to see itself as our society’s proper paternalist superego for the 21st century. For the past several hundred years, citizens of democratic countries have enjoyed the ability to, at the very least, have some voice in the processes that affect and control our bodies. In this future we would be denied even that. We must demand the right to have a say in the processes that affect our bodies and our health before these systems are cemented along undemocratic lines.
Elijah Spiegel
Photo: Mark Zuckerberg at South by Southwest in 2008. Credit: Jason McELweenie
Stanford Sphere 