Apple and Google have generated much hope and controversy with their plan to create a Covid-19 tracking app. Too bad it won’t work.
Public debate has focused on how to balance the right to privacy with the potential to save lives. There’s ample reason for scepticism – for example,"anonymous” Bluetooth tracking can be deanonymised. But that’s not what I care about. What concerns me is that the whole concept of a tradeoff is false from the start, because no app can fix the thoroughly inequitable US health care system.
Before we go there, let’s talk about why people are so psyched about the app. They point to the breathlessly marketed story of Singapore, which used smartphone technology to combat Covid-19. Yet the country’s prime minister attributed its success to traditional detective work – that is, intensively interviewing the infected and tracking down contacts. Only one in six people in Singapore have downloaded the smartphone app, which is opt-in just like the Apple/Google offering. It wasn’t really that crucial.
Now consider the app in the US context. To be effective, it must help the most vulnerable – people who, due to characteristics such as race, income, age and occupation are disproportionately exposed and dying. Yet many of them simply don’t have smartphones. They’re homeless, in nursing homes, in prisons. It’s the same old access story, similar to how Verily, a division of Google’s parent company Alphabet, can help people find and arrange coronavirus testing – but only if they have a Google account. The people who need the service most are locked out.
That’s not all. Assume for a moment that all these people had phones, downloaded the app and would thus find out if they were exposed. What would they do? Many aren’t insured, so testing and treatment would be prohibitively expensive, even if it were available. Or suppose they have gig economy jobs, such as Instacart delivery. What good would it do them to be told they were exposed? They know they’re at high risk. They need the work, otherwise they would have quit already. And if they really were sick, why would they risk their livelihood by volunteering the information to an app?
President Trump has said hospitals will be compensated for treating uninsured Covid-19 patients, but it's unclear how that limited money will be distributed, and people might be wary of risking it. Even before the current crisis, nearly a quarter of Americans avoided medical care because of cost considerations. For that matter, millions of undocumented workers are likely not eligible for help. Even insured people are reasonably worried about getting hit with multi-thousand-dollar surprise out-of-network charges, even when their hospital is in-network.
It’s starting to look like the app will be helpful only to people who have money and good health insurance, not the people we should be worrying about.
So what would work? In addition to detective work, Singapore covered the cost of all treatments and tests – which were widespread and accessible – and provided sick pay for people who had to stay home. The United States has a long way to go to match that. Even the best smartphone app won’t solve systemic problems.
This column does not necessarily reflect the opinion of Bloomberg LP and its owners.
Cathy O’Neil is a Bloomberg Opinion columnist. She is a mathematician who has worked as a professor, hedge-fund analyst and data scientist. She founded ORCAA, an algorithmic auditing company, and is the author of Weapons Of Math Destruction. – Bloomberg
Did you find this article insightful?
67% readers found this article insightful