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 friend told me of an incident she found particularly irritating: a retailer where she is a frequent client, with an account and loyalty card, asked for the item's receipt.

We all know that stores collect every bit of data they can on us, including our socio-demographic profile, address, shopping habits, and everything we've ever bought, so why would they need a fading receipt? Who knows? That their consumers try to pass off other goods? It's easy to verify past transactions to see when the item was purchased.

That's it. Why require receipts? Companies send us incentives, discounts, and other marketing, yet when we need something, we have to prove we're not cheating.

Why require us to preserve data and documents when our governments and governmental institutions already have them? Why do I need to carry documents like my driver's license if the authorities can check if I have one and what state it's in once I prove my identity?

We shouldn't be required to give someone data or documents they already have. The days of waiting up with our paperwork for a stern official to inform us something is missing are over.

How can retailers still ask if you have a receipt if we've made our slow, bureaucratic, and all-powerful government sensible? Then what? The shop may not accept your return (which has a two-year window, longer than most purchase tickets last) or they may just let you replace the item.

Isn't this an anachronism in the age of CRMs, customer files that know what we ate for breakfast, and loyalty programs? If government and bureaucracies have learnt to use its own files and make life easier for the consumer, why do retailers ask for a receipt?

They're adding friction to the system. They know we can obtain a refund, use our warranty, or get our money back. But if I ask for ludicrous criteria, like keeping the purchase receipt in your wallet (wallet? another anachronism, if I leave the house with only my smartphone! ), it will dissuade some individuals and tip the scales in their favor when it comes to limiting returns. Some manager will take credit for lowering returns and collect her annual bonus. Having the wrong metrics is common in management.

To slow things down, asking for a receipt is like asking us to perform a handstand and leap 20 times on one foot. You have my information, use it to send me everything, and know everything I've bought, yet when I need a two-way service, you refuse to utilize it and require that I keep it and prove it.

Refuse as customers. If retailers want our business, they should treat us well, not just when we spend money. If I come to return a product, claim its use or warranty, or be taught how to use it, I am the same person you treated wonderfully when I bought it. Remember that, and act accordingly.

A store should use my information for everything, not just what it wants. Keep my info, but don't sell me anything.

He explained everything.

A drinking buddy confessed. Alexander. He says he works at a startup based on a scam, which appears too clever to be a lie.

Alexander (assuming he developed the story) or the startup's creator must have been a genius.

This is the story of an Internet scam that targets older individuals and generates tens of millions of dollars annually.

The business sells authentic things at 10% of their market value. This firm cannot be lucrative, but the entrepreneur has a plan: monthly subscriptions to a worthless service.

The firm can then charge the customer's credit card to settle the gap. The buyer must subscribe without knowing it. What's their strategy?

How does the con operate?

Imagine a website with a split homepage. On one page, the site offers an attractive goods at a ridiculous price (from 1 euro to 10% of the product's market worth).

Same product, but with a stupid monthly subscription. Business is unsustainable. They buy overpriced products and resell them too cheaply, hoping customers will subscribe to a useless service.

No customer will want this service. So they create another illegal homepage that hides the monthly subscription offer. After an endless scroll, a box says Yes, I want to subscribe to a service that costs x dollars per month.

Unchecking the checkbox bugs. When a customer buys a product on this page, he's enrolled in a monthly subscription. Not everyone should see it because it's illegal. So what does the startup do?

A page that varies based on the sort of website visitor, a possible consumer or someone who might be watching the startup's business

Startup technicians make sure the legal page is displayed when the site is accessed normally. Typing the web address in the browser, using Google, etc. The page crashes when buying a goods, preventing the purchase.

This avoids the startup from selling a product at a loss because the buyer won't subscribe to the worthless service and charge their credit card each month.

The illegal page only appears if a customer clicks on a Google ad, indicating interest in the offer.

Alexander says that a banker, police officer, or anyone else who visits the site (maybe for control) will only see a valid and buggy site as purchases won't be possible.

The latter will go to the site in the regular method (by typing the address in the browser, using Google, etc.) and not via an online ad.

Those who visit from ads are likely already lured by the site's price. They'll be sent to an illegal page that requires a subscription.

Laziness is humanity's secret weapon. The ordinary person ignores tiny monthly credit card charges. The subscription lasts around a year before the customer sees an unexpected deduction.

After-sales service (ASS) is useful in this situation.

After-sales assistance begins when a customer notices slight changes on his credit card, usually a year later.

The customer will search Google for the direct debit reference. How he'll complain to after-sales service.

It's crucial that ASS appears in the top 4/5 Google search results. This site must be clear, and offer chat, phone, etc., he argues.

The pigeon must be comforted after waking up. The customer learns via after-sales service that he subscribed to a service while buying the product, which justifies the debits on his card.

The customer will then clarify that he didn't intend to make the direct debits. The after-sales care professional will pretend to listen to the customer's arguments and complaints, then offer to unsubscribe him for free because his predicament has affected him.

In 99% of cases, the consumer is satisfied since the after-sales support unsubscribed him for free, and he forgets the debited amounts.

The remaining 1% is split between 0.99% who are delighted to be reimbursed and 0.01%. We'll pay until they're done. The customer should be delighted, not object or complain, and keep us beneath the radar (their situation is resolved, the rest, they don’t care).

It works, so we expand our thinking.

Startup has considered industrialization. Since this fraud is working, try another. Automate! So they used a site generator (only for product modifications), underpaid phone operators for after-sales service, and interns for fresh product ideas.

The company employed a data scientist. This has allowed the startup to recognize that specific customer profiles can be re-registered in the database and that it will take X months before they realize they're subscribing to a worthless service. Customers are re-subscribed to another service, then unsubscribed before realizing it.

Alexander took months to realize the deception and leave. Lawyers and others apparently threatened him and former colleagues who tried to talk about it.

The startup would have earned prizes and competed in contests. He adds they can provide evidence to any consumer group, media, police/gendarmerie, or relevant body. When I submitted my information to the FBI, I was told, "We know, we can't do much.", he says.

Wish you more bang for your buck

By ‘Cost a Bomb’ I didn’t mean to exaggerate. It’s an idiom that means ‘To be very expensive’. In fact, no app on the planet costs a bomb lol.

So, to the point.

Chronicle

(Freemium. For Pro, $24.99 | Available on Setapp)

You probably have trouble keeping track of dozens of bills and subscriptions each month.

Try Chronicle.

Easy-to-use app

• Add payment due dates and receive reminders,

• Save payment documentation,

• Analyze your spending by season, year, and month.

• Observe expenditure trends and create new budgets.

Best of all, Chronicle features an integrated browser for fast payment and logging.

iOS and macOS sync.

SoundSource

($39 for lifetime)

Background Music, a free macOS program, was featured in #6 of this post last month.

It controls per-app volume, stereo balance, and audio over its max level.

Background Music is fully supported. Additionally,

• Connect various speakers to various apps (Wow! ),

• change the audio sample rate for each app,

• To facilitate access, add a floating SoundSource window.

• Use its blocks in Shortcuts app,

• On the menu bar, include meters for output/input devices and running programs.

PixelSnap

($39 for lifetime | Available on Setapp)

This software is heaven for UI designers.

It aids you.

• quickly calculate screen distances (in pixels) ,

• Drag an area around an object to determine its borders,

• Measure the distances between the additional guides,

• screenshots should be pixel-perfect.

What’s more.

You can

• Adapt your tolerance for items with poor contrast and shadows.

• Use your Touch Bar to perform important tasks, if you have one.

Mate Translation

($3.99 a month / $29.99 a year | Available on Setapp)

Mate Translate resembles a roided-up version of BarTranslate, which I wrote about in #1 of this piece last month.

If you translate often, utilize Mate Translate on macOS and Safari.

I'm really vocal about it.

It stays on the menu bar, and is accessible with a click or ⌥+shift+T hotkey.

It lets you

• Translate in 103 different languages,

• To translate text, double-click or right-click on it.

• Totally translate websites. Additionally, Netflix subtitles,

• Listen to their pronunciation to see how close it is to human.

iPhone and Mac sync Mate-ing history.

Swish

($16 for lifetime | Available on Setapp)

Swish is awesome!

Swipe, squeeze, tap, and hold movements organize chaotic desktop windows. Swish operates with mouse and trackpad.

Some gestures:

• Pinch Once: Close an app
• Pinch Twice: Quit an app
• Swipe down once: Minimise an app
• Pinch Out: Enter fullscreen mode
• Tap, Hold, & Swipe: Arrange apps in grids
and many more...

After getting acquainted to the movements, your multitasking will improve.

Unite

($24.99 for lifetime | Available on Setapp)

It turns webapps into macOS apps. The end.

Unite's functionality is a million times better.

• Provide extensive customization (incl. its icon, light and dark modes)

• make menu bar applications,

• Get badges for web notifications and automatically refresh websites,

• Replace any dock icon in the window with it (Wow!) by selecting that portion of the window.

• Use PiP (Picture-in-Picture) on video sites that support it.

• Delete advertising,

• Throughout macOS, use floating windows

and many more…

I feel $24.99 one-off for this tool is a great deal, considering all these features. What do you think?

https://www.bzgapps.com/unite

CleanShot X

(Basic: $29 one-off. Pro: $8/month | Available on Setapp)

CleanShot X can achieve things the macOS screenshot tool cannot. Complete screenshot toolkit.

CleanShot X, like Pixel Snap 2 (#3), is fantastic.

Allows

• Scroll to capture a long page,

• screen recording,

  With webcam on,
• With mic and system audio,
• Highlighting mouse clicks and hotkeys.

• Maintain floating screenshots for reference

• While capturing, conceal desktop icons and notifications.

• Recognize text in screenshots (OCR),

• You may upload and share screenshots using the built-in cloud.

These are just 6 in 50+ features, and you’re already saying Wow!

Let's see this once-dominant IT corporation crumble.

What's the capital of Kazakhstan? If you don't know the answer, you can probably find it by Googling. Google Search returned results for Nur-Sultan in 0.66 seconds.

Google is the best search engine I've ever used. Did you know another search engine ruled the Internet? I'm sure you guessed Yahoo!

Google's friendly UI and wide selection of services make it my top choice. Let's explore Yahoo's decline.

Yahoo!

YAHOO stands for Yet Another Hierarchically Organized Oracle. Jerry Yang and David Filo established Yahoo.

Yahoo is primarily a search engine and email provider. It offers News and an advertising platform. It was a popular website in 1995 that let people search the Internet directly. Yahoo began offering free email in 1997 by acquiring RocketMail.

According to a study, Yahoo used Google Search Engine technology until 2000 and then developed its own in 2004.

Yahoo! rejected buying Google for $1 billion

Larry Page and Sergey Brin, Google's founders, approached Yahoo in 1998 to sell Google for $1 billion so they could focus on their studies. Yahoo denied the offer, thinking it was overvalued at the time.

Yahoo realized its error and offered Google $3 billion in 2002, but Google demanded $5 billion since it was more valuable. Yahoo thought $5 billion was overpriced for the existing market.

In 2022, Google is worth $1.56 Trillion.

What happened to Yahoo!

Yahoo refused to buy Google, and Google's valuation rose, making a purchase unfeasible.

Yahoo started losing users when Google launched Gmail. Google's UI was far cleaner than Yahoo's.

Yahoo offered $1 billion to buy Facebook in July 2006, but Zuckerberg and the board sought $1.1 billion. Yahoo rejected, and Facebook's valuation rose, making it difficult to buy.

Yahoo was losing users daily while Google and Facebook gained many. Google and Facebook's popularity soared. Yahoo lost value daily.

Microsoft offered $45 billion to buy Yahoo in February 2008, but Yahoo declined. Microsoft increased its bid to $47 billion after Yahoo said it was too low, but Yahoo rejected it. Then Microsoft rejected Yahoo’s 10% bid increase in May 2008.

In 2015, Verizon bought Yahoo for $4.5 billion, and Apollo Global Management bought 90% of Yahoo's shares for $5 billion in May 2021. Verizon kept 10%.

Yahoo's opportunity to acquire Google and Facebook could have been a turning moment. It declined Microsoft's $45 billion deal in 2008 and was sold to Verizon for $4.5 billion in 2015. Poor decisions and lack of vision caused its downfall. Yahoo's aim wasn't obvious and it didn't stick to a single domain.

Hence, a corporation needs a clear vision and a leader who can see its future.

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