Restructuring and layoffs cause career reevaluation. Your career can benefit.

Once you become institutionalized, the corporate ladder is all you know.

You're bubbled. Extremists term it the corporate Matrix. I'm not so severe because the business world brainwashed me, too.

This boosted my corporate career.

Until I hit bottom.

15 months later, I view my corporate life differently. You may wish to advance professionally. Read this before you do.

Your happiness in the workplace may be deceptive.

I've been fortunate to spend time with corporate aces.

Working for 2.5 years in banking social media gave me some of these experiences. Earlier in my career, I recorded interviews with business leaders.

These people have titles like Chief General Manager and Head Of. New titles brought life-changing salaries.

They seemed happy.

I’d pass them in the hallway and they’d smile or shake my hand. I dreamt of having their life.

The ominous pattern

Unfiltered talks with some of them revealed a different world.

They acted well. They were skilled at smiling and saying the correct things. All had the same dark pattern, though.

Something felt off.

I found my conversations with them were generally for their benefit. They hoped my online antics as a writer/coach would shed light on their dilemma.

They'd tell me they wanted more. When you're one position away from CEO, it's hard not to wonder if this next move will matter.

What really displeased corporate ladder chasers

Before ascending further, consider these.

Zero autonomy

As you rise in a company, your days get busier.

Many people and initiatives need supervision. Everyone expects you to know business details. Weak when you don't. A poor leader is fired during the next restructuring and left to pursue their corporate ambition.

Full calendars leave no time for reflection. You can't have a coffee with a friend or waste a day.

You’re always on call. It’s a roll call kinda life.

Unable to express oneself freely

My 8 years of LinkedIn writing helped me meet these leaders.

I didn't think they'd care. Mistake.

Corporate leaders envied me because they wanted to talk freely again without corporate comms or a PR firm directing them what to say.

They couldn't share their flaws or inspiring experiences.

They wanted to.

Every day they were muzzled eroded by their business dream.

Limited family time

Top leaders had families.

They've climbed the corporate ladder. Nothing excellent happens overnight.

Corporate dreamers rarely saw their families.

Late meetings, customer functions, expos, training, leadership days, team days, town halls, and product demos regularly occurred after work.

Or they had to travel interstate or internationally for work events. They used bags and motel showers.

Initially, they said business class flights and hotels were nice. They'd get bored. 5-star hotels become monotonous.

No hotel beats home.

One leader said he hadn't seen his daughter much. They used to Facetime, but now that he's been gone so long, she rarely wants to talk to him.

So they iPad-parented.

You're miserable without your family.

Held captive by other job titles

Going up the business ladder seems like a battle.

Leaders compete for business gains and corporate advancement.

I saw shocking filthy tricks. Leaders would lie to seem nice.

Captives included top officials.

A different section every week. If they ran technology, the Head of Sales would argue their CRM cost millions. Or an Operations chief would battle a product team over support requests.

After one conflict, another began.

Corporate echelons are antagonistic. Huge pay and bonuses guarantee bad behavior.

Overly centered on revenue

As you rise, revenue becomes more prevalent. Most days, you'd believe revenue was everything. Here’s the problem…

Numbers drain us.

Unless you're a closet math nerd, contemplating and talking about numbers drains your creativity.

Revenue will never substitute impact.

Incapable of taking risks

Corporate success requires taking fewer risks.

Risks can cause dismissal. Risks can interrupt business. Keep things moving so you may keep getting paid your enormous salary and bonus.

Restructuring or layoffs are inevitable. All corporate climbers experience it.

On this fateful day, a small few realize the game they’ve been trapped in and escape. Most return to play for a new company, but it takes time.

Addiction keeps them trapped. You know nothing else. The rest is strange.

You start to think “I’m getting old” or “it’s nearly retirement.” So you settle yet again for the trappings of the corporate ladder game to nowhere.

Should you climb the corporate ladder?

Let me end on a surprising note.

Young people should ascend the corporate ladder. It teaches you business skills and helps support your side gig and (potential) online business.

Don't get trapped, shackled, or muzzled.

Your ideas and creativity become stifled after too much gaming play.

Corporate success won't bring happiness.

Find fulfilling employment that matters. That's it.

Ray Dalio's super-effective roadmap 

Ray Dalio's $22 billion net worth ranks him 36th globally. From 1975 to 2011, he built the world's most successful hedge fund, never losing more than 4% from 1991 to 2020. (and only doing so during 3 calendar years). 

Dalio describes a 5-step process in his best-selling book Principles. It's the playbook he's used to build his hedge fund, beat the markets, and face personal challenges. 

This 5-step system is so valuable and well-explained that I didn't edit or change anything; I only added my own insights in the parts I found most relevant and/or relatable as a young entrepreneur. The system's overview: 

1. Have clear goals 

2. Identify and don’t tolerate problems 

3. Diagnose problems to get at their root causes 

4. Design plans that will get you around those problems 

5. Do what is necessary to push through the plans to get results 

If you follow these 5 steps in a virtuous loop, you'll almost always see results. Repeat the process for each goal you have. 

1. Have clear goals 

a) Prioritize: You can have almost anything, but not everything. 

I started and never launched dozens of projects for 10 years because I was scattered. I opened a t-shirt store, traded algorithms, sold art on Instagram, painted skateboards, and tinkered with electronics. I decided to try blogging for 6 months to see where it took me. Still going after 3 years. 

b) Don’t confuse goals with desires. 

A goal inspires you to act. Unreasonable desires prevent you from achieving your goals. 

c) Reconcile your goals and desires to decide what you want. 

d) Don't confuse success with its trappings. 

e) Never dismiss a goal as unattainable. 

Always one path is best. Your perception of what's possible depends on what you know now. I never thought I'd make money writing online so quickly, and now I see a whole new horizon of business opportunities I didn't know about before. 

f) Expectations create abilities. 

Don't limit your abilities. More you strive, the more you'll achieve. 

g) Flexibility and self-accountability can almost guarantee success. 

Flexible people accept what reality or others teach them. Self-accountability is the ability to recognize your mistakes and be more creative, flexible, and determined. 

h) Handling setbacks well is as important as moving forward. 

Learn when to minimize losses and when to let go and move on. 

2. Don't ignore problems 

a) See painful problems as improvement opportunities. 

Every problem, painful situation, and challenge is an opportunity. Read The Art of Happiness for more. 

b) Don't avoid problems because of harsh realities. 

Recognizing your weaknesses isn't the same as giving in. It's the first step in overcoming them. 

c) Specify your issues. 

There is no "one-size-fits-all" solution. 

d) Don’t mistake a cause of a problem with the real problem. 

"I can't sleep" is a cause, not a problem. "I'm underperforming" could be a problem. 

e) Separate big from small problems. 

You have limited time and energy, so focus on the biggest problems. 

f) Don't ignore a problem. 

Identifying a problem and tolerating it is like not identifying it. 

3. Identify problems' root causes 

a) Decide "what to do" after assessing "what is." 

"A good diagnosis takes 15 to 60 minutes, depending on its accuracy and complexity. [...] Like principles, root causes recur in different situations. 

b) Separate proximate and root causes. 

"You can only solve problems by removing their root causes, and to do that, you must distinguish symptoms from disease." 

c) Knowing someone's (or your own) personality can help you predict their behavior. 

4. Design plans that will get you around the problems 

a) Retrace your steps. 

Analyze your past to determine your future. 

b) Consider your problem a machine's output. 

Consider how to improve your machine. It's a game then. 

c) There are many ways to reach your goals. 

Find a solution. 

d) Visualize who will do what in your plan like a movie script. 

Consider your movie's actors and script's turning points, then act accordingly. The game continues. 

e) Document your plan so others can judge your progress. 

Accountability boosts success. 

f) Know that a good plan doesn't take much time. 

The execution is usually the hardest part, but most people either don't have a plan or keep changing it. Don't drive while building the car. Build it first, because it'll be bumpy. 

5. Do what is necessary to push through the plans to get results 

a) Great planners without execution fail. 

Life is won with more than just planning. Similarly, practice without talent beats talent without practice. 

b) Work ethic is undervalued. 

Hyper-productivity is praised in corporate America, even if it leads nowhere. To get things done, use checklists, fewer emails, and more desk time. 

c) Set clear metrics to ensure plan adherence. 

I've written about the OKR strategy for organizations with multiple people here. If you're on your own, I recommend the Wheel of Life approach. Both systems start with goals and tasks to achieve them. Then start executing on a realistic timeline. 

If you find solutions, weaknesses don't matter. 

Everyone's weak. You, me, Gates, Dalio, even Musk. Nobody will be great at all 5 steps of the system because no one can think in all the ways required. Some are good at analyzing and diagnosing but bad at executing. Some are good planners but poor communicators. Others lack self-discipline. 

Stay humble and ask for help when needed. Nobody has ever succeeded 100% on their own, without anyone else's help. That's the paradox of individual success: teamwork is the only way to get there. 

Most people won't have the skills to execute even the best plan. You can get missing skills in two ways: 

1. Self-taught (time-consuming) 

2. Others' (requires humility) light

On knowing what to do with your life 

“Some people have good mental maps and know what to do on their own. Maybe they learned them or were blessed with common sense. They have more answers than others. Others are more humble and open-minded. […] Open-mindedness and mental maps are most powerful.” — Ray Dalio 

I've always known what I wanted to do, so I'm lucky. I'm almost 30 and have always had trouble executing. Good thing I never stopped experimenting, but I never committed to anything long-term. I jumped between projects. I decided 3 years ago to stick to one project for at least 6 months and haven't looked back. 

Maybe you're good at staying focused and executing, but you don't know what to do. Maybe you have none of these because you haven't found your purpose. Always try new projects and talk to as many people as possible. It will give you inspiration and ideas and set you up for success. 

There is almost always a way to achieve a crazy goal or idea. 

Enjoy the journey, whichever path you take.

Steve Jobs' initial mission at Apple in 1997 was to destroy. He killed the Newton PDA and Macintosh clones. Apple stopped trying to please everyone under Jobs.

Afterward, there were few highly targeted moves. First, the pink iMac. Modest success. The iPod, iPhone, and iPad made Apple the world's most valuable firm. Each maneuver changed the company's center of gravity and won.

That's the idea behind Schwerpunkt, a German military term meaning "focus." Jobs didn't need to win everywhere, just where it mattered, so he focused Apple's resources on a few key goods. Finding your Schwerpunkt is more important than charts and analysis for excellent strategy.

Comparison of Relative Strength and Relative Weakness

The iPod, Apple's first major hit after Jobs' return, didn't damage Microsoft and the PC, but instead focused Apple's emphasis on a fledgling, fragmented market that generated "sucky" products. Apple couldn't have taken on the computer titans at this stage, yet it beat them.

The move into music players used Apple's particular capabilities, especially its ability to build simple, easy-to-use interfaces. Jobs' charisma and stature, along his understanding of intellectual property rights from Pixar, helped him build up iTunes store, which was a quagmire at the time.

In Good Strategy | Bad Strategy, management researcher Richard Rumelt argues that good strategy uses relative strength to counter relative weakness. To discover your main point, determine your abilities and where to effectively use them.

Steve Jobs did that at Apple. Microsoft and Dell, who controlled the computer sector at the time, couldn't enter the music player business. Both sought to produce iPod competitors but failed. Apple's iPod was nobody else's focus.

Finding The Center of Attention

In a military engagement, leaders decide where to focus their efforts by assessing commanders intent, the situation on the ground, the topography, and the enemy's posture on that terrain. Officers spend their careers learning about schwerpunkt.

Business executives must assess internal strengths including personnel, technology, and information, market context, competitive environment, and external partner ecosystems. Steve Jobs was a master at analyzing forces when he returned to Apple.

He believed Apple could integrate technology and design for the iPod and that the digital music player industry sucked. By analyzing competitors' products, he was convinced he could produce a smash by putting 1000 tunes in my pocket.

The only difficulty was there wasn't the necessary technology. External ecosystems were needed. On a trip to Japan to meet with suppliers, a Toshiba engineer claimed the company had produced a tiny memory drive approximately the size of a silver dollar.

Jobs knew the memory drive was his focus. He wrote a $10 million cheque and acquired exclusive technical rights. For a time, none of his competitors would be able to recreate his iPod with the 1000 songs in my pocket.

How to Enter the OODA Loop

John Boyd invented the OODA loop as a pilot to better his own decision-making. First OBSERVE your surroundings, then ORIENT that information using previous knowledge and experiences. Then you DECIDE and ACT, which changes the circumstance you must observe, orient, decide, and act on.

Steve Jobs used the OODA loop to decide to give Toshiba $10 million for a technology it had no use for. He compared the new information with earlier observations about the digital music market.

Then something much more interesting happened. The iPod was an instant hit, changing competition. Other computer businesses that competed in laptops, desktops, and servers created digital music players. Microsoft's Zune came out in 2006, Dell's Digital Jukebox in 2004. Both flopped.

By then, Apple was poised to unveil the iPhone, which would cause its competitors to Observe, Orient, Decide, and Act. Boyd named this OODA Loop infiltration. They couldn't gain the initiative by constantly reacting to Apple.

Microsoft and Dell were titans back then, but it's hard to recall. Apple went from near bankruptcy to crushing its competition via Schwerpunkt.

Rather than a destination, it is a journey

Trying to win everywhere is a strategic blunder. Win significant fights, not trivial skirmishes. Identifying a focal point to direct resources and efforts is the essence of Schwerpunkt.

When Steve Jobs returned to Apple, PC firms were competing, but he focused on digital music players, and the iPod made Apple a player. He launched the iPhone when his competitors were still reacting. When Steve Jobs said, "One more thing," at the end of a product presentation, he had a new focus.

Schwerpunkt isn't static; it's dynamic. Jobs' ability to observe, refocus, and modify the competitive backdrop allowed Apple to innovate consistently. His strategy was tailored to Apple's capabilities, customers, and ecosystem. Microsoft or Dell, better suited for the enterprise sector, couldn't succeed with a comparable approach.

There is no optimal strategy, only ones suited to a given environment, when relative strength might be used against relative weakness. Discovering the center of gravity where you can break through is more of a journey than a destination; it will become evident after you reach.

Sundar Pichai unveiled Simplicity Sprint at Google's latest all-hands conference.

To boost employee efficiency.

Not surprising. Few envisioned Google declaring a productivity drive.

Sunder Pichai's speech:

“There are real concerns that our productivity as a whole is not where it needs to be for the head count we have. Help me create a culture that is more mission-focused, more focused on our products, more customer focused. We should think about how we can minimize distractions and really raise the bar on both product excellence and productivity.”

The primary driver driving Google's efficiency push is:

Google's efficiency push follows 13% quarterly revenue increase. Last year in the same quarter, it was 62%.

Market newcomers may argue that the previous year's figure was fuelled by post-Covid reopening and growing consumer spending. Investors aren't convinced. A promising company like Google can't afford to drop so quickly.

Google’s quarterly revenue growth stood at 13%, against 62% in last year same quarter.

Google isn't alone. In my recent essay regarding 2025 programmers, I warned about the economic downturn's effects on FAAMG's workforce. Facebook had suspended hiring, and Microsoft had promised hefty bonuses for loyal staff.

In the same article, I predicted Google's troubles. Online advertising, especially the way Google and Facebook sell it using user data, is over.

FAAMG and 2nd rung IT companies could be the first to fall without Post-COVID revival and uncertain global geopolitics.

Google has hardly ever discussed effectiveness:

Apparently openly.

Amazon treats its employees like robots, even in software positions. It has significant turnover and a terrible reputation as a result. Because of this, it rarely loses money due to staff productivity.

Amazon trumps Google. In reality, it treats its employees poorly.

Google was the founding father of the modern-day open culture.

Larry and Sergey Google founded the IT industry's Open Culture. Silicon Valley called Google's internal democracy and transparency near anarchy. Management rarely slammed decisions on employees. Surveys and internal polls ensured everyone knew the company's direction and had a vote.

20% project allotment (weekly free time to build own project) was Google's open-secret innovation component.

After Larry and Sergey's exit in 2019, this is Google's first profitability hurdle. Only Google insiders can answer these questions.

• Would Google's investors compel the company's management to adopt an Amazon-style culture where the developers are treated like circus performers?

• If so, would Google follow suit?

• If so, how does Google go about doing it?

Before discussing Google's likely plan, let's examine programming productivity.

What determines a programmer's productivity is simple:

How would we answer Google's questions?

As a programmer, I'm more concerned about Simplicity Sprint's aftermath than its economic catalysts.

Large organizations don't care much about quarterly and annual productivity metrics. They have 10-year product-launch plans. If something seems horrible today, it's likely due to someone's lousy judgment 5 years ago who is no longer in the blame game.

Deconstruct our main question.

• How exactly do you change the culture of the firm so that productivity increases?

• How can you accomplish that without affecting your capacity to profit? There are countless ways to increase output without decreasing profit.

• How can you accomplish this with little to no effect on employee motivation? (While not all employers care about it, in this case we are discussing the father of the open company culture.)

• How do you do it for a 10-developer IT firm that is losing money versus a 1,70,000-developer organization with a trillion-dollar valuation?

When implementing a large-scale organizational change, success must be carefully measured.

The fastest way to do something is to do it right, no matter how long it takes.

You require clearly-defined group/team/role segregation and solid pass/fail matrices to:

• You can give performers rewards.

• Ones that are average can be inspired to improve

• Underachievers may receive assistance or, in the worst-case scenario, rehabilitation

As a 20-year programmer, I associate productivity with greatness.

Doing something well, no matter how long it takes, is the fastest way to do it.

Let's discuss a programmer's productivity.

Why productivity is a strange term in programming:

Productivity is work per unit of time.

Money=time This is an economic proverb. More hours worked, more pay. Longer projects cost more.

As a buyer, you desire a quick supply. As a business owner, you want employees who perform at full capacity, creating more products to transport and boosting your profits.

All economic matrices encourage production because of our obsession with it. Productivity is the only organic way a nation may increase its GDP.

Time is money — is not just a proverb, but an economical fact.

Applying the same productivity theory to programming gets problematic. An automating computer. Its capacity depends on the software its master writes.

Today, a sophisticated program can process a billion records in a few hours. Creating one takes a competent coder and the necessary infrastructure. Learning, designing, coding, testing, and iterations take time.

Programming productivity isn't linear, unlike manufacturing and maintenance.

Average programmers produce code every day yet miss deadlines. Expert programmers go days without coding. End of sprint, they often surprise themselves by delivering fully working solutions.

Reversing the programming duties has no effect. Experts aren't needed for productivity.

These patterns remind me of an XKCD comic.

Programming productivity depends on two factors:

• The capacity of the programmer and his or her command of the principles of computer science

• His or her productive bursts, how often they occur, and how long they last as they engineer the answer

At some point, productivity measurement becomes Schrödinger’s cat.

Product companies measure productivity using use cases, classes, functions, or LOCs (lines of code). In days of data-rich source control systems, programmers' merge requests and/or commits are the most preferred yardstick. Companies assess productivity by tickets closed.

Every organization eventually has trouble measuring productivity. Finer measurements create more chaos. Every measure compares apples to oranges (or worse, apples with aircraft.) On top of the measuring overhead, the endeavor causes tremendous and unnecessary stress on teams, lowering their productivity and defeating its purpose.

Macro productivity measurements make sense. Amazon's factory-era management has done it, but at great cost.

Google can pull it off if it wants to.

What Google meant in reality when it said that employee productivity has decreased:

When Google considers its employees unproductive, it doesn't mean they don't complete enough work in the allotted period.

They can't multiply their work's influence over time.

• Programmers who produce excellent modules or products are unsure on how to use them.

• The best data scientists are unable to add the proper parameters in their models.

• Despite having a great product backlog, managers struggle to recruit resources with the necessary skills.

• Product designers who frequently develop and A/B test newer designs are unaware of why measures are inaccurate or whether they have already reached the saturation point.

• Most ignorant: All of the aforementioned positions are aware of what to do with their deliverables, but neither their supervisors nor Google itself have given them sufficient authority.

So, Google employees aren't productive.

How to fix it?

• Business analysis: White suits introducing novel items can interact with customers from all regions. Track analytics events proactively, especially the infrequent ones.

• SOLID, DRY, TEST, and AUTOMATION: Do less + reuse. Use boilerplate code creation. If something already exists, don't implement it yourself.

• Build features-building capabilities: N features are created by average programmers in N hours. An endless number of features can be built by average programmers thanks to the fact that expert programmers can produce 1 capability in N hours.

• Work on projects that will have a positive impact: Use the same algorithm to search for images on YouTube rather than the Mars surface.

• Avoid tasks that can only be measured in terms of time linearity at all costs (if a task can be completed in N minutes, then M copies of the same task would cost M*N minutes).

In conclusion:

Software development isn't linear. Why should the makers be measured?

Notation for The Big O

I'm discussing a new way to quantify programmer productivity. (It applies to other professions, but that's another subject)

The Big O notation expresses the paradigm (the algorithmic performance concept programmers rot to ace their Google interview)

Google (or any large corporation) can do this.

1. Sort organizational roles into categories and specify their impact vs. time objectives. A CXO role's time vs. effect function, for instance, has a complexity of O(log N), meaning that if a CEO raises his or her work time by 8x, the result only increases by 3x.

2. Plot the influence of each employee over time using the X and Y axes, respectively.

3. Add a multiplier for Y-axis values to the productivity equation to make business objectives matter. (Example values: Support = 5, Utility = 7, and Innovation = 10).

4. Compare employee scores in comparable categories (developers vs. devs, CXOs vs. CXOs, etc.) and reward or help employees based on whether they are ahead of or behind the pack.

After measuring every employee's inventiveness, it's straightforward to help underachievers and praise achievers.

Example of a Big(O) Category:

If I ran Google (God forbid, its worst days are far off), here's how I'd classify it. You can categorize Google employees whichever you choose.

The Google interview truth:

O(1) < O(log n) < O(n) < O(n log n) < O(n^x) where all logarithmic bases are < n.

O(1): Customer service workers' hours have no impact on firm profitability or customer pleasure.

CXOs Most of their time is spent on travel, strategic meetings, parties, and/or meetings with minimal floor-level influence. They're good at launching new products but bad at pivoting without disaster. Their directions are being followed.

Devops, UX designers, testers Agile projects revolve around deployment. DevOps controls the levers. Their automation secures results in subsequent cycles.

UX/UI Designers must still prototype UI elements despite improved design tools.

All test cases are proportional to use cases/functional units, hence testers' work is O(N).

Architects Their effort improves code quality. Their right/wrong interference affects product quality and rollout decisions even after the design is set.

Core Developers Only core developers can write code and own requirements. When people understand and own their labor, the output improves dramatically. A single character error can spread undetected throughout the SDLC and cost millions.

Core devs introduce/eliminate 1000x bugs, refactoring attempts, and regression. Following our earlier hypothesis.

The fastest way to do something is to do it right, no matter how long it takes.

Conclusion:

Google is at the liberal extreme of the employee-handling spectrum

Microsoft faced an existential crisis after 2000. It didn't choose Amazon's data-driven people management to revitalize itself.

Instead, it entrusted developers. It welcomed emerging technologies and opened up to open source, something it previously opposed.

Google is too lax in its employee-handling practices. With that foundation, it can only follow Amazon, no matter how carefully.

Any attempt to redefine people's measurements will affect the organization emotionally.

The more Google compares apples to apples, the higher its chances for future rebirth.

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.