I've written a lot about Y Combinator's success, but as any startup founder or investor knows, many startups fail.

Rebel Fund invests in the top 5-10% of new Y Combinator startups each year, so we focus on identifying and supporting the most promising technology startups in our ecosystem. Given the power law dynamic and asymmetric risk/return profile of venture capital, we worry more about our successes than our failures. Since the latter still counts, this essay will focus on the proportion of YC startups that fail.

Since YC's launch in 2005, the figure below shows the percentage of active, inactive, and public/acquired YC startups by batch.

As more startups finish, the blue bars (active) decrease significantly. By 12 years, 88% of startups have closed or exited. Only 7% of startups reach resolution each year.

YC startups by status after 12 years:

Half the startups have failed, over one-third have exited, and the rest are still operating.

In venture investing, it's said that failed investments show up before successful ones. This is true for YC startups, but only in their early years.

Below, we only present resolved companies from the first chart. Some companies fail soon after establishment, but after a few years, the inactive vs. public/acquired ratio stabilizes around 55:45. After a few years, a YC firm is roughly as likely to quit as fail, which is better than I imagined.

I prepared this post because Rebel investors regularly question me about YC startup failure rates and how long it takes for them to exit or shut down.

Early-stage venture investors can overlook it because 100x investments matter more than 0x investments.

YC founders can ignore it because it shouldn't matter if many of their peers succeed or fail ;)

New ventures are exciting. It's fun to imagine yourself rich, successful, and famous (if that's your thing). How you'll help others and make your family proud. This excitement can pull you forward for years, even when you intuitively realize that the path you're on may not lead to your desired success.

Know when to change course. Switching course can mean pivoting or changing direction.

In this not-so-short blog, I'll describe the journey of building your dream. And how the journey might look when you think you're building your dream, but fall short of that vision. Both can feel similar in the beginning, but there are subtle differences.

Let’s dive in.

How an exciting journey to a dead end looks and feels.

You want to help many people. You're business-minded, creative, and ambitious. You jump into entrepreneurship. You're excited, free, and in control.

I'll use tech as an example because that's what I know best, but this applies to any entrepreneurial endeavor.

So you start learning the basics of your field, say coding/software development. You read books, take courses, and may even join a bootcamp. You start practicing, and the journey begins. Once you reach a certain level of skill (which can take months, usually 12-24), you gain the confidence to speak with others in the field and find common ground. You might attract a co-founder this way with time. You and this person embark on a journey (Tip: the idea you start with is rarely the idea you end with).

Amateur mistake #1: You spend months building a product before speaking to customers.

Building something pulls you forward blindly. You make mistakes, avoid customers, and build with your co-founder or small team in the dark for months, usually 6-12 months.

You're excited when the product launches. We'll be billionaires! The market won't believe it. This excites you and the team. Launch.

….

Nothing happens.

Some people may sign up out of pity, only to never use the product or service again.

You and the team are confused, discouraged and in denial. They don't get what we've built yet. We need to market it better, we need to talk to more investors, someone will understand our vision.

This is a hopeless path, and your denial could last another 6 months. If you're lucky, while talking to consumers and investors (which you should have done from the start), someone who has been there before would pity you and give you an idea to pivot into that can create income.

Suppose you get this idea and pivot your business. Again, you've just pivoted into something limited by what you've already built. It may be a revenue-generating idea, but it's rarely new. Now you're playing catch-up, doing something others are doing but you can do better. (Tip #2: Don't be late.) Your chances of winning are slim, and you'll likely never catch up.

You're finally seeing revenue and feel successful. You can compete, but if you're not a first mover, you won't earn enough over time. You'll get by or work harder than ever to earn what a skilled trade could provide. You didn't go into business to stress out and make $100,000 or $200,000 a year. When you can make the same amount by becoming a great software developer, electrician, etc.

You become stuck. Either your firm continues this way for years until you realize there isn't enough growth to recruit a strong team and remove yourself from day-to-day operations due to competition. Or a catastrophic economic event forces you to admit that what you were building wasn't new and unique and wouldn't get you where you wanted to be.

This realization could take 6-10 years. No kidding.

The good news is, you’ve learned a lot along the way and this information can be used towards your next venture (if you have the energy).

Key Lesson: Don’t build something if you aren’t one of the first in the space building it just for the sake of building something.

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Let's discuss what it's like to build something that can make your dream come true.

Case 2: Building something the market loves is difficult but rewarding.

It starts with a problem that hasn't been adequately solved for a long time but is now solvable due to technology. Or a new problem due to a change in how things are done.

Let's examine each example.

Example #1: Mass communication. The problem is now solvable due to some technological breakthrough.

Twitter — One of the first web 2 companies that became successful with the rise of smart mobile computing.

People can share their real-time activities via mobile device with friends, family, and strangers. Web 2 and smartphones made it easy and fun.

Example #2: A new problem has emerged due to some change in the way things are conducted.

Zoom- A web-conferencing company that reached massive success due to the movement towards “work from home”, remote/hybrid work forces.

Online web conferencing allows for face-to-face communication.

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These two examples show how to build a unicorn-type company. It's a mix of solving the right problem at the right time, either through a technological breakthrough that opens up new opportunities or by fundamentally changing how people do things.

Let's find these opportunities.

Start by examining problems, such as how the world has changed and how we can help it adapt. It can also be both. Start team brainstorming. Research technologies, current world-trends, use common sense, and make a list. Then, choose the top 3 that you're most excited about and seem most workable based on your skillsets, values, and passion.

Once you have this list, create the simplest MVP you can and test it with customers. The prototype can be as simple as a picture or diagram of user flow and end-user value. No coding required. Market-test. Twitter's version 1 was simple. It was a web form that asked, "What are you doing?" Then publish it from your phone. A global status update, wherever you are. Currently, this company has a $50 billion market cap.

Here's their MVP screenshot.

Small things grow. Tiny. Simplify.

Remember Frequency and Value when brainstorming. Your product is high frequency (Twitter, Instagram, Snapchat, TikTok) or high value (Airbnb for renting travel accommodations), or both (Gmail).

Once you've identified product ideas that meet the above criteria, they're simple, have a high frequency of use, or provide deep value. You then bring it to market in the simplest, most cost-effective way. You can sell a half-working prototype with imagination and sales skills. You need just enough of a prototype to convey your vision to a user or customer.

With this, you can approach real people. This will do one of three things: give you a green light to continue on your vision as is, show you that there is no opportunity and people won't use it, or point you in a direction that is a blend of what you've come up with and what the customer / user really wants, and you update the prototype and go back to the maze. Repeat until you have enough yeses and conviction to build an MVP.

Follower count, earnings, and more

I created my 7th TikTok account six months ago. TikTok's great. I've developed accounts for Amazon products, content creators/brand deals education, website flipping, and more.

Introverted or shy people use faceless TikTok accounts.

Maybe they don't want millions of people to see their face online, or they want to remain anonymous so relatives and friends can't locate them.

Going faceless on TikTok can help you grow a following, communicate your message, and make money online.

Here are 6 steps I took to turn my Tik Tok account into a $60,000/year side gig.

From nothing to $60K in 6 months

It's clickbait, but it’s true. Here’s what I did to get here.

Quick context:

I've used social media before. I've spent years as a social creator and brand.

I've built Instagram, TikTok, and YouTube accounts to nearly 100K.

How I did it

First, select a niche.

If you can focus on one genre on TikTok, you'll have a better chance of success, however lifestyle creators do well too.

Niching down is easier, in my opinion.

Examples:

• Travel

• Food

• Kids

• Earning cash

• Finance

You can narrow these niches if you like.

During the pandemic, a travel blogger focused on Texas-only tourism and gained 1 million subscribers.

Couponing might be a finance specialization.

One of my finance TikTok accounts gives credit tips and grants and has 23K followers.

Tons of ways you can get more specific.

Consider how you'll monetize your TikTok account. I saw many enormous TikTok accounts that lose money.

Why?

They can't monetize their niche. Not impossible to commercialize, but tough enough to inhibit action.

First, determine your goal.

In this first step, consider what your end goal is.

Are you trying to promote your digital products or social media management services?

You want brand deals or e-commerce sales.

This will affect your TikTok specialty.

This is the first step to a TikTok side gig.

Step 2: Pick a content style

Next, you want to decide on your content style.

Do you do voiceover and screenshots?

You'll demonstrate a product?

Will you faceless vlog?

Step 3: Look at the competition

Find anonymous accounts and analyze what content works, where they thrive, what their audience wants, etc.

This can help you make better content.

Like the skyscraper method for TikTok.

Step 4: Create a content strategy.

Your content plan is where you sit down and decide:

• How many videos will you produce each day or each week?

• Which links will you highlight in your biography?

• What amount of time can you commit to this project?

You may schedule when to post videos on a calendar. Make videos.

5. Create videos.

No video gear needed.

Using a phone is OK, and I think it's preferable than posting drafts from a computer or phone.

TikTok prefers genuine material.

Use their app, tools, filters, and music to make videos.

And imperfection is preferable. Tik okers like to see videos made in a bedroom, not a film studio.

Make sense?

When making videos, remember this.

I personally use my phone and tablet.

Step 6: Monetize

Lastly, it’s time to monetize How will you make money? You decided this in step 1.

Time to act!

For brand agreements

• Include your email in the bio.

• Share several sites and use a beacons link in your bio.

• Make cold calls to your favorite companies to get them to join you in a TikTok campaign.

For e-commerce

• Include a link to your store's or a product's page in your bio.

For client work

• Include your email in the bio.

• Use a beacons link to showcase your personal website, portfolio, and other resources.

For affiliate marketing

• Include affiliate product links in your bio.

• Join the Amazon Influencer program and provide a link to your storefront in your bio.

$60,000 per year from Tik Tok?

Yes, and some creators make much more.

Tori Dunlap (herfirst100K) makes $100,000/month on TikTok.

My TikTok adventure took 6 months, but by month 2 I was making $1,000/month (or $12K/year).

By year's end, I want this account to earn $100K/year.

Imagine if my 7 TikTok accounts made $100K/year.

7 Tik Tok accounts X $100K/yr = $700,000/year

On January 1, "Public Domain Day," thousands of creative works immediately join the public domain. The original creator or copyright holder loses exclusive rights to reproduce, adapt, or publish the work, and anybody can use it. It happens with movies, poems, music, artworks, books (where creative rights endure 70 years beyond the author's death), and sometimes source code.

Public domain creative works open the door to new uses. 400,000 sound recordings from before 1923, including Winnie-the-Pooh, were released this year.  With most of A.A. Milne's 1926 Winnie-the-Pooh characters now available, we're seeing innovative interpretations Milne likely never planned. The ancient hyphenated version of the honey-loving bear is being adapted for a horror movie: "Winnie-the-Pooh: Blood and Honey"... with Pooh and Piglet as the baddies.

Counterintuitively, experimenting and recombination can occasionally increase IP value. Open source movements allow the public to build on (or fork and duplicate) existing technologies. Permissionless innovation helps Android, Linux, and other open source software projects compete. Crypto's success at attracting public development is also due to its support of open source and "remix culture," notably in NFT forums.

Production memes

NFT projects use several IP strategies to establish brands, communities, and content. Some preserve regular IP protections; others offer NFT owners the opportunity to innovate on connected IP; yet others have removed copyright and other IP safeguards.

By using the "Creative Commons Zero" (cc0) license, artists can intentionally select for "no rights reserved." This option permits anyone to benefit from derivative works without legal repercussions. There's still a lot of confusion between copyrights and NFTs, so nothing here should be considered legal, financial, tax, or investment advice. Check out this post for an overview of copyright vulnerabilities with NFTs and how authors can protect owners' rights. This article focuses on cc0.

Nouns, a 2021 project, popularized cc0 for NFTs. Others followed, including: A Common Place, Anonymice, Blitmap, Chain Runners, Cryptoadz, CryptoTeddies, Goblintown, Gradis, Loot, mfers, Mirakai, Shields, and Terrarium Club are cc0 projects.

Popular crypto artist XCOPY licensed their 1-of-1 NFT artwork "Right-click and Save As Guy" under cc0 in January, exactly one month after selling it. cc0 has spawned many derivatives.

"Right-click Save As Guy" by XCOPY (1)/derivative works (2)

XCOPY said Monday he would apply cc0 to "all his existing art." "We haven't seen a cc0 summer yet, but I think it's approaching," said the artist. - predicting a "DeFi summer" in 2020, when decentralized finance gained popularity.

Why do so many NFT authors choose "no rights"?

Promoting expansions of the original project to create a more lively and active community is one rationale. This makes sense in crypto, where many value open sharing and establishing community.

Creativity depends on cultural significance. NFTs may allow verifiable ownership of any digital asset, regardless of license, but cc0 jumpstarts "meme-ability" by actively, not passively, inviting derivative works. As new derivatives are made and shared, attention might flow back to the original, boosting its reputation. This may inspire new interpretations, leading in a flywheel effect where each derivative adds to the original's worth - similar to platform network effects, where platforms become more valuable as more users join them.

cc0 licence allows creators "seize production memes."

"SEASON 1 MEME CARD 2"

Physical items are also using cc0 NFT assets, thus it's not just a digital phenomenon. The Nouns Vision initiative turned the square-framed spectacles shown on each new NounsDAO NFT ("one per day, forever") into luxury sunglasses. Blitmap's pixel-art has been used on shoes, apparel, and caps. In traditional IP regimes, a single owner controls creation, licensing, and production.

The physical "blitcap" (3rd level) is a descendant of the trait in the cc0 Chain Runners collection (2nd), which uses the "logo" from cc0 Blitmap (1st)! The Logo is Blitmap token #84 and has been used as a trait in various collections. The "Dom Rose" is another popular token. These homages reference Blitmap's influence as a cc0 leader, as one of the earliest NFT projects to proclaim public domain intents. A new collection, Citizens of Tajigen, emerged last week with a Blitcap characteristic.

These derivatives can be a win-win for everyone, not just the original inventors, especially when using NFT assets to establish unique brands. As people learn about the derivative, they may become interested in the original. If you see someone wearing Nouns glasses on the street (or in a Super Bowl ad), you may desire a pair, but you may also be interested in buying an original NounsDAO NFT or related derivative.

Blitmap Logo Hat (1), Chain Runners #780 ft. Hat (2), and Blitmap Original "Logo #87" (3)

Co-creating open source

NFTs' power comes from smart contract technology's intrinsic composability. Many smart contracts can be integrated or stacked to generate richer applications.

"Money Legos" describes how decentralized finance ("DeFi") smart contracts interconnect to generate new financial use cases. Yearn communicates with MakerDAO's stablecoin $DAI and exchange liquidity provider Curve by calling public smart contract methods. NFTs and their underlying smart contracts can operate as the base-layer framework for recombining and interconnecting culture and creativity.

cc0 gives an NFT's enthusiast community authority to develop new value layers whenever, wherever, and however they wish.

Multiple cc0 projects are playable characters in HyperLoot, a Loot Project knockoff.

Open source and Linux's rise are parallels. When the internet was young, Microsoft dominated the OS market with Windows. Linux (and its developer Linus Torvalds) championed a community-first mentality, freely available the source code without restrictions. This led to developers worldwide producing new software for Linux, from web servers to databases. As people (and organizations) created world-class open source software, Linux's value proposition grew, leading to explosive development and industry innovation. According to Truelist, Linux powers 96.3% of the top 1 million web servers and 85% of smartphones.

With cc0 licensing empowering NFT community builders, one might hope for long-term innovation. Combining cc0 with NFTs "turns an antagonistic game into a co-operative one," says NounsDAO cofounder punk4156. It's important on several levels. First, decentralized systems from open source to crypto are about trust and coordination, therefore facilitating cooperation is crucial. Second, the dynamics of this cooperation work well in the context of NFTs because giving people ownership over their digital assets allows them to internalize the results of co-creation through the value that accrues to their assets and contributions, which incentivizes them to participate in co-creation in the first place.

Licensed to create

If cc0 projects are open source "applications" or "platforms," then NFT artwork, metadata, and smart contracts provide the "user interface" and the underlying blockchain (e.g., Ethereum) is the "operating system." For these apps to attain Linux-like potential, more infrastructure services must be established and made available so people may take advantage of cc0's remixing capabilities.

These services are developing. Zora protocol and OpenSea's open source Seaport protocol enable open, permissionless NFT marketplaces. A pixel-art-rendering engine was just published on-chain to the Ethereum blockchain and integrated into OKPC and ICE64. Each application improves blockchain's "out-of-the-box" capabilities, leading to new apps created from the improved building blocks.

Web3 developer growth is at an all-time high, yet it's still a small fraction of active software developers globally. As additional developers enter the field, prospective NFT projects may find more creative and infrastructure Legos for cc0 and beyond.

Electric Capital Developer Report (2021), p. 122

Growth requires composability. Users can easily integrate digital assets developed on public standards and compatible infrastructure into other platforms. The Loot Project is one of the first to illustrate decentralized co-creation, worldbuilding, and more in NFTs. This example was low-fi or "incomplete" aesthetically, providing room for imagination and community co-creation.

Loot began with a series of Loot bag NFTs, each listing eight "adventure things" in white writing on a black backdrop (such as Loot Bag #5726's "Katana, Divine Robe, Great Helm, Wool Sash, Divine Slippers, Chain Gloves, Amulet, Gold Ring"). Dom Hofmann's free Loot bags served as a foundation for the community.

Several projects have begun metaphorical (lore) and practical (game development) world-building in a short time, with artists contributing many variations to the collective "Lootverse." They've produced games (Realms & The Crypt), characters (Genesis Project, Hyperloot, Loot Explorers), storytelling initiatives (Banners, OpenQuill), and even infrastructure (The Rift).

Why cc0 and composability? Because consumers own and control Loot bags, they may use them wherever they choose by connecting their crypto wallets. This allows users to participate in multiple derivative projects, such as  Genesis Adventurers, whose characters appear in many others — creating a decentralized franchise not owned by any one corporation.

Genesis Project's Genesis Adventurer (1) with HyperLoot (2) and Loot Explorer (3) versions

When to go cc0

There are several IP development strategies NFT projects can use. When it comes to cc0, it’s important to be realistic. The public domain won't make a project a runaway success just by implementing the license. cc0 works well for NFT initiatives that can develop a rich, enlarged ecosystem.

Many of the most successful cc0 projects have introduced flexible intellectual property. The Nouns brand is as obvious for a beer ad as for real glasses; Loot bags are simple primitives that make sense in all adventure settings; and the Goblintown visual style looks good on dwarfs, zombies, and cranky owls as it does on Val Kilmer.

The ideal cc0 NFT project gives builders the opportunity to add value:

• vertically, by stacking new content and features directly on top of the original cc0 assets (for instance, as with games built on the Loot ecosystem, among others), and

• horizontally, by introducing distinct but related intellectual property that helps propagate the original cc0 project’s brand (as with various Goblintown derivatives, among others).

These actions can assist cc0 NFT business models. Because cc0 NFT projects receive royalties from secondary sales, third-party extensions and derivatives can boost demand for the original assets.

Using cc0 license lowers friction that could hinder brand-reinforcing extensions or lead to them bypassing the original. Robbie Broome recently argued (in the context of his cc0 project A Common Place) that giving away his IP to cc0 avoids bad rehashes down the line. If UrbanOutfitters wanted to put my design on a tee, they could use the actual work instead of hiring a designer. CC0 can turn competition into cooperation.

Community agreement about core assets' value and contribution can help cc0 projects. Cohesion and engagement are key. Using the above examples: Developers can design adventure games around whatever themes and item concepts they desire, but many choose Loot bags because of the Lootverse's community togetherness. Flipmap shared half of its money with the original Blitmap artists in acknowledgment of that project's core role in the community. This can build a healthy culture within a cc0 project ecosystem. Commentator NiftyPins said it was smart to acknowledge the people that constructed their universe. Many OG Blitmap artists have popped into the Flipmap discord to share information.

cc0 isn't a one-size-fits-all answer; NFTs formed around well-established brands may prefer more restrictive licenses to preserve their intellectual property and reinforce exclusivity. cc0 has some superficial similarities to permitting NFT owners to market the IP connected with their NFTs (à la Bored Ape Yacht Club), but there is a significant difference: cc0 holders can't exclude others from utilizing the same IP. This can make it tougher for holders to develop commercial brands on cc0 assets or offer specific rights to partners. Holders can still introduce enlarged intellectual property (such as backstories or derivatives) that they control.

Blockchain technologies and the crypto ethos are decentralized and open-source. This makes it logical for crypto initiatives to build around cc0 content models, which build on the work of the Creative Commons foundation and numerous open source pioneers.

NFT creators that choose cc0 must select how involved they want to be in building the ecosystem. Some cc0 project leaders, like Chain Runners' developers, have kept building on top of the initial cc0 assets, creating an environment derivative projects can plug into. Dom Hofmann stood back from Loot, letting the community lead. (Dom is also working on additional cc0 NFT projects for the company he formed to build Blitmap.) Other authors have chosen out totally, like sartoshi, who announced his exit from the cc0 project he founded, mfers, and from the NFT area by publishing a final edition suitably named "end of sartoshi" and then deactivating his Twitter account. A multi-signature wallet of seven mfers controls the project's smart contract. 

cc0 licensing allows a robust community to co-create in ways that benefit all members, regardless of original creators' continuous commitment. We foresee more organized infrastructure and design patterns as NFT matures. Like open source software, value capture frameworks may see innovation. (We could imagine a variant of the "Sleepycat license," which requires commercial software to pay licensing fees when embedding open source components.) As creators progress the space, we expect them to build unique rights and licensing strategies. cc0 allows NFT producers to bootstrap ideas that may take off.

Are you one of these Zoom dogs?

The Person Who Is Apparently Always on Mute

Waffles thinks he can overpower the mute button by shouting loudly.

The person who believed their camera to be off

Barkley's used to remote work, but he hasn't mastered the "Stop Video" button. Everyone is affected.

Who is driving for some reason, exactly?

Why is Pumpkin always late? Who knows? Shouldn't she be driving? If you could hear her over the freeway, she'd answer these questions.

The Person With the Amazing Bookcase

Cicero likes to use SAT-words like "leverage" and "robust" in Zoom sessions, presumably from all the books he wants you to see behind him.

The Individual Who Is Unnecessarily Dressed

We hope Bandit is going somewhere beautiful after this meeting, or else he neglected the quarterly earnings report and is overcompensating to distract us.

The person who works through lunch in between zoom calls

Barksworth has back-to-back meetings all day, so you can watch her eat while she talks.

The Person Who Is A Little Too Comfy

Hercules thinks Zoom meetings happen between sleeps. He'd appreciate everyone speaking more quietly.

The Person Who Answered the Phone Outside

Frisbee has a gorgeous backyard and lives in a place with great weather year-round, and she wants you to think about that during the daily team huddle.

Who Wants You to Pay Attention to Their Pet

Snickers hasn't listened to you in 20 minutes unless you tell her how cute her kitten is.

One who is, for some reason, positioned incorrectly on the screen

Nelson's meetings consist primarily of attempting to figure out how he positioned his laptop so absurdly.

The person who says too many goodbyes

Zeus waves farewell like it's your first day of school while everyone else searches for the "Leave Meeting" button. It's nice.

He who has a poor internet connection

Ziggy's connectivity problems continue... She gives a long speech as everyone waits awkwardly to inform her they missed it.

The Clearly Multitasking Person

Tinkerbell can play fetch during the monthly staff meeting if she works from home, but that's not a good idea.

The Person Using Zoom as a Makeup and Hair Mirror

If Gail and Bob knew Zoom had a "hide self view" option, they'd be distraught.

The person who feels at ease with simply leaving

Rusty bails when a Zoom conference is over. Rusty's concept is decent.

ZERO GRACE/ZERO MALICE

Amazon's purchase of One Medical could speed up American healthcare

The U.S. healthcare industry is a 7-ton seal bleeding at sea. Predators are circling. Unearned margin: price increases relative to inflation without quality improvements. Amazon is the 11-foot megalodon with 7-inch teeth. Amazon is no longer circling... but attacking.

In 2020 dollars, per capita U.S. healthcare spending increased from $2,968 in 1980 to $12,531. The result is a massive industry with 13% of the nation's workers and a fifth of GDP.

Doctor No

In 40 years, healthcare has made progress. From 73.7 in 1980 to 78.8 in 2019, life expectancy rose (before Covid knocked it back down a bit). Pharmacological therapies have revolutionized, and genetic research is paying off. The financial return, improvement split by cost increases, is terrible. No country has expense rises like the U.S., and no one spends as much per capita as we do. Developed countries have longer life expectancies, healthier populations, and less economic hardship.

Two-thirds of U.S. personal bankruptcies are due to medical expenses and/or missed work. Mom or Dad getting cancer could bankrupt many middle-class American families. 40% of American adults delayed or skipped needed care due to cost. Every healthcare improvement seems to have a downside. Same pharmacological revolution that helped millions caused opioid epidemic. Our results are poor in many areas: The U.S. has a high infant mortality rate.

Healthcare is the second-worst retail industry in the country. Gas stations are #1. Imagine walking into a Best Buy to buy a TV and a Blue Shirt associate requests you fill out the same 14 pages of paperwork you filled out yesterday. Then you wait in a crowded room until they call you, 20 minutes after the scheduled appointment you were asked to arrive early for, to see the one person in the store who can talk to you about TVs, who has 10 minutes for you. The average emergency room wait time in New York is 6 hours and 10 minutes.

If it's bad for the customer, it's worse for the business. Physicians spend 27% of their time helping patients; 49% on EHRs. Documentation, order entry, billing, and inbox management. Spend a decade getting an M.D., then become a bureaucrat.

No industry better illustrates scale diseconomies. If we got the same return on healthcare spending as other countries, we'd all live to 100. We could spend less, live longer and healthier, and pay off the national debt in 15 years. U.S. healthcare is the worst ever.

What now? Competition is at the heart of capitalism, the worst system of its kind.

Priority Time

Amazon is buying One Medical for $3.9 billion. I think this deal will liberate society. Two years in, I think One Medical is great. When I got Covid, I pressed the One Medical symbol on my phone; a nurse practitioner prescribed Paxlovid and told me which pharmacies had it in stock.

Amazon enables the company's vision. One Medical's stock is down to $10 from $40 at the start of 2021. Last year, it lost $250 million and needs cash (Amazon has $60 billion). ONEM must grow. The service has 736,000 members. Half of U.S. households have Amazon Prime. Finally, delivery. One Medical is a digital health/physical office hybrid, but you must pick up medication at the pharmacy. Upgrade your Paxlovid delivery time after a remote consultation. Amazon's core competency means it'll happen. Healthcare speed and convenience will feel alien.

It's been a long, winding road to disruption. Amazon, JPMorgan, and Berkshire Hathaway formed Haven four years ago to provide better healthcare for their 1.5 million employees. It rocked healthcare stocks the morning of the press release, but folded in 2021.

Amazon Care is an employee-focused service. Home-delivered virtual health services and nurses. It's doing well, expanding nationwide, and providing healthcare for other companies. Hilton is Amazon Care's biggest customer. The acquisition of One Medical will bring 66 million Prime households capital, domain expertise, and billing infrastructure. Imagine:

"Alexa, I'm hot and my back hurts."

"Connecting you to a Prime doctor now."

Want to vs. Have to

I predicted Amazon entering healthcare years ago. Why? For the same reason Apple is getting into auto. Amazon's P/E is 56, double Walmart's. The corporation must add $250 billion in revenue over the next five years to retain its share price. White-label clothes or smart home products won't generate as much revenue. It must enter a huge market without scale, operational competence, and data skills.

Current Situation

Healthcare reform benefits both consumers and investors. In 2015, healthcare services had S&P 500-average multiples. The market is losing faith in public healthcare businesses' growth. Healthcare services have lower EV/EBITDA multiples than the S&P 500.

Amazon isn't the only prey-hunter. Walmart and Alibaba are starting pharmacies. Uber is developing medical transportation. Private markets invested $29 billion in telehealth last year, up 95% from 2020.

The pandemic accelerated telehealth, the immediate unlock. After the first positive Covid case in the U.S., services that had to be delivered in person shifted to Zoom... We lived. We grew. Video house calls continued after in-person visits were allowed. McKinsey estimates telehealth visits are 38 times pre-pandemic levels. Doctors adopted the technology, regulators loosened restrictions, and patients saved time. We're far from remote surgery, but many patient visits are unnecessary. A study of 40 million patients during lockdown found that for chronic disease patients, online visits didn't affect outcomes. This method of care will only improve.

Amazon's disruption will be significant and will inspire a flood of capital, startups, and consumer brands. Mark Cuban launched a pharmacy that eliminates middlemen in January. Outcome? A 90-day supply of acid-reflux medication costs $17. Medicare could have saved $3.6 billion by buying generic drugs from Cuban's pharmacy. Other apex predators will look at different limbs of the carcass for food. Nike could enter healthcare via orthopedics, acupuncture, and chiropractic. LVMH, L'Oréal, and Estée Lauder may launch global plastic surgery brands. Hilton and Four Seasons may open hospitals. Lennar and Pulte could build "Active Living" communities that Nana would leave feet first, avoiding the expense and tragedy of dying among strangers.

Risks

Privacy matters: HIV status is different from credit card and billing address. Most customers (60%) feel fine sharing personal health data via virtual technologies, though. Unavoidable. 85% of doctors believe data-sharing and interoperability will become the norm. Amazon is the most trusted tech company for handling personal data. Not Meta: Amazon.

What about antitrust, then?

Amazon should be required to spin off AWS and/or Amazon Fulfillment and banned from promoting its own products. It should be allowed to acquire hospitals. One Medical's $3.9 billion acquisition is a drop in the bucket compared to UnitedHealth's $498 billion market valuation.

Antitrust enforcement shouldn't assume some people/firms are good/bad. It should recognize that competition is good and focus on making markets more competitive in each deal. The FTC should force asset divestitures in e-commerce, digital marketing, and social media. These companies can also promote competition in a social ill.

U.S. healthcare makes us fat, depressed, and broke. Competition has produced massive value and prosperity across most of our economy.

Dear Amazon … bring it.