My colleague Ilana Ovental and I examined pandemic media coverage of education at the end of last year. That analysis examined coverage changes. We tracked K-12 topic attention over the previous two decades using Lexis Nexis. See the results here.

I was struck by how cleanly the past two decades can be divided up into three (or three and a half) eras of school reform—a framing that can help us comprehend where we are and how we got here. In a time when epidemic, political unrest, frenetic news cycles, and culture war can make six months seem like a lifetime, it's worth pausing for context.

If you look at the peaks in the above graph, the 21st century looks to be divided into periods. The decade-long rise and fall of No Child Left Behind began during the Bush administration. In a few years, NCLB became the dominant K-12 framework. Advocates and financiers discussed achievement gaps and measured success with AYP.

NCLB collapsed under the weight of rigorous testing, high-stakes accountability, and a race to the bottom by the Obama years. Obama's Race to the Top garnered attention, but its most controversial component, the Common Core State Standards, rose quickly.

Academic standards replaced assessment and accountability. New math, fiction, and standards were hotly debated. Reformers and funders chanted worldwide benchmarking and systems interoperability.

We went from federally driven testing and accountability to government encouraged/subsidized/mandated (pick your verb) reading and math standardization. Last year, Checker Finn and I wrote The End of School Reform? The 2010s populist wave thwarted these objectives. The Tea Party, Occupy Wall Street, Black Lives Matter, and Trump/MAGA all attacked established institutions.

Consequently, once the Common Core fell, no alternative program emerged. Instead, school choice—the policy most aligned with populist suspicion of institutional power—reached a half-peak. This was less a case of choice erupting to prominence than of continuous growth in a vacuum. Even with Betsy DeVos' determined, controversial efforts, school choice received only half the media attention that NCLB and Common Core did at their heights.

Recently, culture clash-fueled attention to race-based curriculum and pedagogy has exploded (all playing out under the banner of critical race theory). This third, culture war-driven wave may not last as long as the other waves.

Even though I don't understand it, the move from slow-building policy debate to fast cultural confrontation over two decades is notable. I don't know if it's cyclical or permanent, or if it's about schooling, media, public discourse, or all three.

One final thought: After doing this work for decades, I've noticed how smoothly advocacy groups, associations, and other activists adapt to the zeitgeist. In 2007, mission statements focused on accomplishment disparities. Five years later, they promoted standardization. Language has changed again.

Part of this is unavoidable and healthy. Chasing currents can also make companies look unprincipled, promote scepticism, and keep them spinning the wheel. Bearing in mind that these tides ebb and flow may give educators, leaders, and activists more confidence to hold onto their values and pause when they feel compelled to follow the crowd.

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.

A worldwide energy crisis might have hampered renewable energy and clean tech investment. Nope.

BNEF's 2023 Energy Transition Investment Trends study surprised and encouraged. Global energy transition investment reached $1 trillion for the first time ($1.11t), up 31% from 2021. From 2013, the clean energy transition has come and cannot be reversed.

BNEF Head of Global Analysis Albert Cheung said our findings ended the energy crisis's influence on renewable energy deployment. Energy transition investment has reached a record as countries and corporations implement transition strategies. Clean energy investments will soon surpass fossil fuel investments.

The table below indicates the tripping point, which means the energy shift is occuring today.

BNEF calls money invested on clean technology including electric vehicles, heat pumps, hydrogen, and carbon capture energy transition investment. In 2022, electrified heat received $64b and energy storage $15.7b.

Nonetheless, $495b in renewables (up 17%) and $466b in electrified transport (up 54%) account for most of the investment. Hydrogen and carbon capture are tiny despite the fanfare. Hydrogen received the least funding in 2022 at $1.1 billion (0.1%).

China dominates investment. China spends $546 billion on energy transition, half the global amount. Second, the US total of $141 billion in 2022 was up 11% from 2021. With $180 billion, the EU is unofficially second. China invested 91% in battery technologies.

The 2022 transition tipping point is encouraging, but the BNEF research shows how far we must go to get Net Zero. Energy transition investment must average $4.55 trillion between 2023 and 2030—three times the amount spent in 2022—to reach global Net Zero. Investment must be seven times today's record to reach Net Zero by 2050.

BNEF 2023 Energy Transition Investment Trends.

As shown in the graph above, BNEF experts have been using their crystal balls to determine where that investment should go. CCS and hydrogen are still modest components of the picture. Interestingly, they see nuclear almost fading. Active transport advocates like me may have something to say about the massive $4b in electrified transport. If we focus on walkable 15-minute cities, we may need fewer electric automobiles. Though we need more electric trains and buses.

Albert Cheung of BNEF emphasizes the challenge. This week's figures promise short-term job creation and medium-term energy security, but more investment is needed to reach net zero in the long run.

I expect the BNEF Energy Transition Investment Trends report to show clean tech investment outpacing fossil fuels investment every year. Finally saying that is amazing. It's insufficient. The planet must maintain its electric (not gas) pedal. In response to the research, Christina Karapataki, VC at Breakthrough Energy Ventures, a clean tech investment firm, tweeted: Clean energy investment needs to average more than 3x this level, for the remainder of this decade, to get on track for BNEFs Net Zero Scenario. Go!

Scaling your startup requires answering customer demands, not growth tricks.

I cofounded Freedo Rentals in 2019. I reached 50 lakh+ ARR in 6 months before quitting owing to the epidemic.

Freedo aimed to solve 2 customer pain points:

• Users lacked a reliable last-mile transportation option.

• The amount that Auto walas charge for unmetered services

Solution?

Effectively simple.

Build ports at high-demand spots (colleges, residential societies, metros). Electric ride-sharing can meet demand.

We had many problems scaling. I'll explain using the AARRR model.

• Brand unfamiliarity or a novel product offering were the problems with awareness. Nobody knew what Freedo was or what it did.

• Problem with awareness: Content and advertisements did a poor job of communicating the task at hand. The advertisements clashed with the white-collar part because they were too cheesy.

• Retention Issue: We encountered issues, indicating that the product was insufficient. Problems with keyless entry, creating bills, stealing helmets, etc.

• Retention/Revenue Issue: Costly compared to established rivals. Shared cars were 1/3 of our cost.

• Referral Issue: Missing the opportunity to seize the AHA moment. After the ride, nobody remembered us.

Once you know where you're struggling with AARRR, iterative solutions are usually best.

Once you have nailed the AARRR model, most startups use paid channels to scale. This dependence, on paid channels, increases with scale unless you crack your organic/inbound game.

Over-index growth loops. Growth loops increase inflow and customers as you scale.

When considering growth, ask yourself:

• Who is the solution's ICP (Ideal Customer Profile)? (To whom are you selling)

• What are the most important messages I should convey to customers? (This is an A/B test.)

• Which marketing channels ought I prioritize? (Conduct analysis based on the startup's maturity/stage.)

• Choose the important metrics to monitor for your AARRR funnel (not all metrics are equal)

• Identify the Flywheel effect's growth loops (inertia matters)

My biggest mistakes:

• not paying attention to consumer comments or satisfaction. It is the main cause of problems with referrals, retention, and acquisition for startups. Beyond your NPS, you should consider second-order consequences.

• The tasks at hand should be quite clear.

Here's my scaling equation:

Growth = A x B x C

A = Funnel top (Traffic)

B = Product Valuation (Solving a real pain point)

C = Aha! (Emotional response)

Freedo's A, B, and C created a unique offering.

Freedo’s ABC:

A — Working or Studying population in NCR

B — Electric Vehicles provide last-mile mobility as a clean and affordable solution

C — One click booking with a no-noise scooter

Final outcome:

FWe scaled Freedo to Rs. 50 lakh MRR and were growing 60% month on month till the pandemic ceased our growth story.

How we did it?

We tried ambassadors and coupons. WhatsApp was our most successful A/B test.

We grew widespread adoption through college and society WhatsApp groups. We requested users for referrals in community groups.

What worked for us won't work for others. This scale underwent many revisions.

Every firm is different, thus you must know your customers. Needs to determine which channel to prioritize and when.

Users desired a safe, time-bound means to get there.

This (not mine) growth framework helped me a lot. You should follow suit.

Or the “lie to me” method.

I can predict a startup's success in minutes.

Just interview its founder.

Ask "why?"

I question "why" till I sense him.

I need to feel the person I have in front of me. I need to know if he or she can deliver. Startups aren't easy. Without abilities, a brilliant idea will fail.

Good entrepreneurs have these qualities: He's a leader, determined, and resilient.

For me, they can be split in two categories.

The first entrepreneur aspires to live meaningfully. The second wants to get rich. The second is communicative. He wants to wow the crowd. He's motivated by the thought of one day sailing a boat past palm trees and sunny beaches.

What drives the first entrepreneur is evident in his speech, face, and voice. He will not speak about his product. He's (nearly) uninterested. He's not selling anything. He's not a salesman. He wants to succeed. The product is his fuel.

He'll explain his decision. He'll share his motivations. His desire. And he'll use meaningful words.

Paul Ekman has shown that face expressions aren't cultural. His study influenced the American TV series "lie to me" about body language and speech.

Passionate entrepreneurs are obvious. It's palpable. Faking passion is tough. Someone who wants your favor and money will expose his actual motives through his expressions and language.

The good liar will be able to fool you for a while, but not for long if you pay attention to his body language and how he expresses himself.

And also, if you look at his business plan.

His business plan reveals his goals. Read between the lines.

Entrepreneur 1 will focus on his "why", whereas Entrepreneur 2 will focus on the "how".

Entrepreneur 1 will develop a vision-driven culture.

The second, on the other hand, will focus on his EBITDA.

Why is the culture so critical? Because it will allow entrepreneur 1 to develop a solid team that can tackle his problems and trials. His team's "why" will keep them together in tough times.

"Give me a terrific start-up team with a mediocre idea over a weak one any day." Because a great team knows when to pivot and trusts each other. Weak teams fail.” — Bernhard Schroeder

Closings thoughts

Every VC must ask Why. Entrepreneur's motivations. This "why" will create the team's culture. This culture will help the team adjust to any setback.

Few sentences can have global significance.

Ethan Zuckerman invented the pop-up commercial in 1997.

He was working for Tripod.com, an online service that let people make little web pages for free. Tripod offered advertising to make money. Advertisers didn't enjoy seeing their advertising next to filthy content, like a user's anal sex website.

Zuckerman's boss wanted a solution. Wasn't there a way to move the ads away from user-generated content?

When you visited a Tripod page, a pop-up ad page appeared. So, the ad isn't officially tied to any user page. It'd float onscreen.

Here’s the thing, though: Zuckerman’s bit of Javascript, that created the popup ad? It was incredibly short — a single line of code:

window.open('http://tripod.com/navbar.html'
"width=200, height=400, toolbar=no, scrollbars=no, resizable=no, target=_top");

Javascript tells the browser to open a 200-by-400-pixel window on top of any other open web pages, without a scrollbar or toolbar.

Simple yet harmful! Soon, commercial websites mimicked Zuckerman's concept, infesting the Internet with pop-up advertising. In the early 2000s, a coder for a download site told me that most of their revenue came from porn pop-up ads.

Pop-up advertising are everywhere. You despise them. Hopefully, your browser blocks them.

Zuckerman wrote a single line of code that made the world worse.

I read Zuckerman's story in How 26 Lines of Code Changed the World. Torie Bosch compiled a humorous anthology of short writings about code that tipped the world.

Most of these samples are quite short. Pop-cultural preconceptions about coding say that important code is vast and expansive. Hollywood depicts programmers as blurs spouting out Niagaras of code. Google's success was formerly attributed to its 2 billion lines of code.

It's usually not true. Google's original breakthrough, the piece of code that propelled Google above its search-engine counterparts, was its PageRank algorithm, which determined a web page's value based on how many other pages connected to it and the quality of those connecting pages. People have written their own Python versions; it's only a few dozen lines.

Google's operations, like any large tech company's, comprise thousands of procedures. So their code base grows. The most impactful code can be brief.

The examples are fascinating and wide-ranging, so read the whole book (or give it to nerds as a present). Charlton McIlwain wrote a chapter on the police beat algorithm developed in the late 1960s to anticipate crime hotspots so law enforcement could dispatch more officers there. It created a racial feedback loop. Since poor Black neighborhoods were already overpoliced compared to white ones, the algorithm directed more policing there, resulting in more arrests, which convinced it to send more police; rinse and repeat.

Kelly Chudler's You Are Not Expected To Understand This depicts the police-beat algorithm.

Even shorter code changed the world: the tracking pixel.

Lily Hay Newman's chapter on monitoring pixels says you probably interact with this code every day. It's a snippet of HTML that embeds a single tiny pixel in an email. Getting an email with a tracking code spies on me. As follows: My browser requests the single-pixel image as soon as I open the mail. My email sender checks to see if Clives browser has requested that pixel. My email sender can tell when I open it.

Adding a tracking pixel to an email is easy:

<img src="URL LINKING TO THE PIXEL ONLINE" width="0" height="0">

An older example: Ellen R. Stofan and Nick Partridge wrote a chapter on Apollo 11's lunar module bailout code. This bailout code operated on the lunar module's tiny on-board computer and was designed to prioritize: If the computer grew overloaded, it would discard all but the most vital work.

When the lunar module approached the moon, the computer became overloaded. The bailout code shut down anything non-essential to landing the module. It shut down certain lunar module display systems, scaring the astronauts. Module landed safely.

22-line code

POODOO    INHINT
    CA  Q
    TS  ALMCADR

    TC  BANKCALL
    CADR  VAC5STOR  # STORE ERASABLES FOR DEBUGGING PURPOSES.

    INDEX  ALMCADR
    CAF  0
ABORT2    TC  BORTENT

OCT77770  OCT  77770    # DONT MOVE
    CA  V37FLBIT  # IS AVERAGE G ON
    MASK  FLAGWRD7
    CCS  A
    TC  WHIMPER -1  # YES.  DONT DO POODOO.  DO BAILOUT.

    TC  DOWNFLAG
    ADRES  STATEFLG

    TC  DOWNFLAG
    ADRES  REINTFLG

    TC  DOWNFLAG
    ADRES  NODOFLAG

    TC  BANKCALL
    CADR  MR.KLEAN
    TC  WHIMPER

This fun book is worth reading.

I'm a contributor to the New York Times Magazine, Wired, and Mother Jones. I've also written Coders: The Making of a New Tribe and the Remaking of the World and Smarter Than You Think: How Technology is Changing Our Minds. Twitter and Instagram: @pomeranian99; Mastodon: @clive@saturation.social.