In HBO’s new documentary on Theranos—the blood-testing startup valued at billions of dollars that turned out to be a massive scam—one of the creepiest scenes isn’t footage shot by a journalist but an ad from the now-defunct company itself.
“Mom, you really are an important part of our family,” a woman says in the clip, which appears about halfway through The Inventor: Out for Blood in Silicon Valley. She clears her throat meaningfully as she looks at an older woman. “Your health is really important to us. The kids adore you.” She hands the woman a square, blue-green card. A child stands by, a giant, single tear running down her cheek.
“Theranos gift cards,” a voice-over says. “Because nothing is more important than the health of those you love.” (It’s unclear if the commercial ever aired on TV.)
Theranos might be toast, its demise a cautionary tale of Silicon Valley’s fake-it-till-you-make-it ethos. But medical gift cards are still around. They’re not all that new, either: Ten years ago, an insurance company in Florida had a program that sold $59 gift cards at Florida Winn-Dixies and CVS drugstores, according to an AP report, which could be used toward insurance premiums.* That article mentioned a handful of other examples including a Michigan-based home health care service, Complete Compassionate Care, that offered gift cards; one woman used a gift card that she won as a raffle prize to pay for a few hours of caregiving for her husband, who had Alzheimer’s. A 2009 episode of This American Life described a savings card for acne medication that allowed patients to skip the copay (the card was free, and insurance was stuck with the rest of the hefty bill).
Today, Talkspace, a company that offers (scientifically questionable) text-based therapy, sells gift cards for one month or three months of treatment. The marketing language is similar to the pitch in the Theranos ad: “Offering someone a path to a happier life is more valuable than any material gift.”
Yes, that sounds like a pretty awkward gift to receive, and Talkspace knows it. “You need to be tactful, though,” the company notes in a blog post on how to properly send a text-therapy gift card. Some language they suggest: “It seems like you needed help. You should use this gift card.” (This is, to be clear, still an overstep!)
Health care—especially nonemergency stuff like therapy, home care, and proactive blood tests—has become such an expensive privilege that gift cards may seem like they make a kind of sad sense. But if you want to help someone pay for care, a gift card is definitely not the best way to go about it. For one thing, they sway where people get their health care if they choose a provider based on what’s stashed in their junk drawer rather than what’s medically ideal. So do coupons, another emerging weapon of health care capitalism, like a Cyber Monday $10 off deal I received for telehealth company Doctor on Demand last fall, or a Betterhelp therapy deal sold on Groupon.
These gift cards and coupons are emblematic of a future of direct-to-consumer health care where consumers are given power in a way that, while sometimes satisfying, isn’t necessarily healthy. Theranos allowed patients to order blood tests for themselves off a menu—an appealing proposition when it’s costly to visit a doctor, though not exactly a helpful one if you don’t have the knowledge to interpret complicated lab results. Talkspace and Betterhelp offer a mental health service that’s appealingly simple (texting!). But it’s not backed by the same research that in-person or even video therapy is, a fact that the companies don’t adequately explain. The startup Hers, which offers birth-control subscriptions at an alluring rate of $5 for the first month, has ads that are so styled like a clothing or makeup companies’, and a setup that is so akin to shopping (you pick out a birth control, and then consult a doctor), that I half-expect it to suggest I treat myself to some pills. Health care should involve options and second opinions, but it shouldn’t mimic the marketing tactics of retail stores or e-commerce. Yet it increasingly does. In at least that way, Theranos was prescient.
Even sweetened with a gift card, a test at Theranos almost definitely wasn’t a wise choice, in hindsight, because its proprietary blood-testing method turned out to be faulty. Former employee Tyler Shultz characterized the company’s abysmal accuracy rates in the documentary like this: “If people are testing themselves for syphilis using Theranos, there’s going to be a lot more syphilis in this world.”
Correction, March 19, 2019: This post originally misspelled Winn-Dixie.