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.

He’s not the President. Stop treating him like one.

Elon Musk tweeted from Qatar, where he was watching the World Cup Final with Jared Kushner.

Musk's subsequent Tweets were as normal, basic, and bland as anyone's from a World Cup Final: It's depressing to see the world's richest man looking at his phone during a grand ceremony. Rich guy goes to rich guy event didn't seem important.

Before Musk posted his should-I-step-down-at-Twitter poll, CNN ran a long segment asking if it was hypocritical for him to reveal his real-time location after defending his (very dumb) suspension of several journalists for (supposedly) revealing his assassination coordinates by linking to a site that tracks Musks private jet. It was hard to ignore CNN's hypocrisy: It covered Musk as Twitter CEO like President Trump. EVERY TRUMP STORY WAS BASED ON HIM SAYING X, THEN DOING Y. Trump would do something horrific, lie about it, then pretend it was fine, then condemn a political rival who did the same thing, be called hypocritical, and so on. It lasted four years. Exhausting.

It made sense because Trump was the President of the United States. The press's main purpose is to relentlessly cover and question the president.

It's strange to say this out. Twitter isn't America. Elon Musk isn't a president. He maintains a money-losing social media service to harass and mock people he doesn't like. Treating Musk like Trump, as if he should be held accountable like Trump, shows a startling lack of perspective. Some journalists treat Twitter like a country.

The compulsive, desperate way many journalists utilize the site suggests as much. Twitter isn't the town square, despite popular belief. It's a place for obsessives to meet and converse. Journalists say they're breaking news. Their careers depend on it. They can argue it's a public service. Nope. It's a place lonely people go to speak all day. Twitter. So do journalists, Trump, and Musk. Acting as if it has a greater purpose, as if it's impossible to break news without it, or as if the republic is in peril is ludicrous. Only 23% of Americans are on Twitter, while 25% account for 97% of Tweets. I'd think a large portion of that 25% are journalists (or attention addicts) chatting to other journalists. Their loudness makes Twitter seem more important than it is. Nope. It's another stupid website. They were there before Twitter; they will be there after Twitter. It’s just a website. We can all get off it if we want. Most of us aren’t even on it in the first place.

Musk is a website-owner. No world leader. He's not as accountable as Trump was. Musk is cable news's primary character now that Trump isn't (at least for now). Becoming a TV news anchor isn't as significant as being president. Elon Musk isn't as important as we all pretend, and Twitter isn't even close. Twitter is a dumb website, Elon Musk is a rich guy going through a midlife crisis, and cable news is lazy because its leaders thought the entire world was on Twitter and are now freaking out that their playground is being disturbed.

I’ve said before that you need to leave Twitter, now. But even if you’re still on it, we need to stop pretending it matters more than it does. It’s a site for lonely attention addicts, from the man who runs it to the journalists who can’t let go of it. It’s not a town square. It’s not a country. It’s not even a successful website. Let’s stop pretending any of it’s real. It’s not.

His story will inspire you.

“Google search went down for a few hours in 2002; Jeff Dean handled all the queries by hand and checked quality doubled.”- Jeff Dean Facts.

One of many Jeff Dean jokes, but you get the idea.

Google's top six engineers met in a war room in mid-2000. Google's crawling system, which indexed the Web, stopped working. Users could still enter queries, but results were five months old.

Google just signed a deal with Yahoo to power a ten-times-larger search engine. Tension rose. It was crucial. If they failed, the Yahoo agreement would likely fall through, risking bankruptcy for the firm. Their efforts could be lost.

A rangy, tall, energetic thirty-one-year-old man named Jeff dean was among those six brilliant engineers in the makeshift room. He had just left D. E. C. a couple of months ago and started his career in a relatively new firm Google, which was about to change the world. He rolled his chair over his colleague Sanjay and sat right next to him, cajoling his code like a movie director. The history started from there.

When you think of people who shaped the World Wide Web, you probably picture founders and CEOs like Larry Page and Sergey Brin, Marc Andreesen, Tim Berners-Lee, Bill Gates, and Mark Zuckerberg. They’re undoubtedly the brightest people on earth.

Under these giants, legions of anonymous coders work at keyboards to create the systems and products we use. These computer workers are irreplaceable.

Let's get to know him better.

It's possible you've never heard of Jeff Dean. He's American. Dean created many behind-the-scenes Google products. Jeff, co-founder and head of Google's deep learning research engineering team, is a popular technology, innovation, and AI keynote speaker.

While earning an MS and Ph.D. in computer science at the University of Washington, he was a teaching assistant, instructor, and research assistant. Dean joined the Compaq Computer Corporation Western Research Laboratory research team after graduating.

Jeff co-created ProfileMe and the Continuous Profiling Infrastructure for Digital at Compaq. He co-designed and implemented Swift, one of the fastest Java implementations. He was a senior technical staff member at mySimon Inc., retrieving and caching electronic commerce content.

Dean, a top young computer scientist, joined Google in mid-1999. He was always trying to maximize a computer's potential as a child.

An expert

His high school program for processing massive epidemiological data was 26 times faster than professionals'. Epi Info, in 13 languages, is used by the CDC. He worked on compilers as a computer science Ph.D. These apps make source code computer-readable.

Dean never wanted to work on compilers forever. He left Academia for Google, which had less than 20 employees. Dean helped found Google News and AdSense, which transformed the internet economy. He then addressed Google's biggest issue, scaling.

Growing Google faced a huge computing challenge. They developed PageRank in the late 1990s to return the most relevant search results. Google's popularity slowed machine deployment.

Dean solved problems, his specialty. He and fellow great programmer Sanjay Ghemawat created the Google File System, which distributed large data over thousands of cheap machines.

These two also created MapReduce, which let programmers handle massive data quantities on parallel machines. They could also add calculations to the search algorithm. A 2004 research article explained MapReduce, which became an industry sensation.

Several revolutionary inventions

Dean's other initiatives were also game-changers. BigTable, a petabyte-capable distributed data storage system, was based on Google File. The first global database, Spanner, stores data on millions of servers in dozens of data centers worldwide.

It underpins Gmail and AdWords. Google Translate co-founder Jeff Dean is surprising. He contributes heavily to Google News. Dean is Senior Fellow of Google Research and Health and leads Google AI.

Recognitions

The National Academy of Engineering elected Dean in 2009. He received the 2009 Association for Computing Machinery fellowship and the 2016 American Academy of Arts and Science fellowship. He received the 2007 ACM-SIGOPS Mark Weiser Award and the 2012 ACM-Infosys Foundation Award. Lists could continue.

A sneaky question may arrive in your mind: How much does this big brain earn? Well, most believe he is one of the highest-paid employees at Google. According to a survey, he is paid $3 million a year.

He makes espresso and chats with a small group of Googlers most mornings. Dean steams milk, another grinds, and another brews espresso. They discuss families and technology while making coffee. He thinks this little collaboration and idea-sharing keeps Google going.

“Some of us have been working together for more than 15 years,” Dean said. “We estimate that we’ve collectively made more than 20,000 cappuccinos together.”

We all know great developers and software engineers. It may inspire many.

In this article, I'll describe a weekend project I started to make something. It was Product Hunt's #1 of the Day, #2 Weekly, and #4 Monthly product.

How did I make Landing Page Checklist so simple? Building and launching took 3 weeks. I worked 3 hours a day max. Weekends were busy.

It's sort of a long story, so scroll to the bottom of the page to see what tools I utilized to create Landing Page Checklist :x ‍

As a matter of fact, it all started with the startups-investments blog; Startup Bulletin, that I started writing in 2018. No, don’t worry, I won’t be going that far behind. The twitter account where I shared the blog posts of this newsletter was inactive for a looong time. I was holding this Twitter account since 2009, I couldn’t bear to destroy it. At the same time, I was thinking how to evaluate this account.

So I looked for a weekend assignment.

Weekend undertaking: Generate business names

Barash and I established a weekend effort to stay current. Building things helped us learn faster.

Simple. Startup Name Generator The utility generated random startup names. After market research for SEO purposes, we dubbed it Business Name Generator.

Backend developer Barash dislikes frontend work. He told me to write frontend code. Chakra UI and Tailwind CSS were recommended.

It was the first time I have heard about Tailwind CSS.

Before this project, I made mobile-web app designs in Sketch and shared them via Zeplin. I can read HTML-CSS or React code, but not write it. I didn't believe myself but followed Barash's advice.

My home page wasn't responsive when I started. Here it was:)

And then... Product Hunt had something I needed. Me-only! A website builder that gives you clean Tailwind CSS code and pre-made web components (like Elementor). Incredible.

I bought it right away because it was so easy to use. Best part: It's not just index.html. It includes all needed files. Like

• postcss.config.js

• README.md

• package.json

• among other things, tailwind.config.js

This is for non-techies.

Tailwind.build; which is Shuffle now, allows you to create and export projects for free (with limited features). You can try it by visiting their website.

After downloading the project, you can edit the text and graphics in Visual Studio (or another text editor). This HTML file can be hosted whenever.

Github is an easy way to host a landing page.

1. your project via Shuffle for export

2. your website's content, edit

3. Create a Gitlab, Github, or Bitbucket account.

4. to Github, upload your project folder.

5. Integrate Vercel with your Github account (or another platform below)

6. Allow them to guide you in steps.

Finally. If you push your code to Github using Github Desktop, you'll do it quickly and easily.

Speaking of; here are some hosting and serverless backend services for web applications and static websites for you host your landing pages for FREE!

I host landingpage.fyi on Vercel but all is fine. You can choose any platform below with peace in mind.

• Vercel

• Render

• Netlify

After connecting your project/repo to Vercel, you don’t have to do anything on Vercel. Vercel updates your live website when you update Github Desktop. Wow!

Tails came out while I was using tailwind.build. Although it's prettier, tailwind.build is more mobile-friendly. I couldn't resist their lovely parts. Tails :)

Tails have several well-designed parts. Some components looked awful on mobile, but this bug helped me understand Tailwind CSS.

Unlike Shuffle, Tails does not include files when you export such as config.js, main.js, README.md. It just gives you the HTML code. Suffle.dev is a bit ahead in this regard and with mobile-friendly blocks if you ask me. Of course, I took advantage of both.

creativebusinessnames.co is inactive, but I'll leave a deployment link :)

Adam Wathan's YouTube videos and Tailwind's official literature helped me, but I couldn't have done it without Tails and Shuffle. These tools helped me make landing pages. I shouldn't have started over.

So began my Tailwind CSS adventure. I didn't build landingpage. I didn't plan it to be this long; sorry.

I learnt a lot while I was playing around with Shuffle and Tails Builders.

Long story short I built landingpage.fyi with the help of these tools;

Learning, building, and distribution

• tailwindcss.com/docs

• Shuffle (Started with a Shuffle Template)

• Tails (Used components from here)

• Sketch (to handle icons, logos, and .svg’s)

• metatags.io (Auto Generator Meta Tags)

• Vercel (Hosting)

• Github Desktop (Pushing code to Github -super easy-)

• Visual Studio Code (Edit my code)

• Mailerlite (Capture Emails)

• Google Analytics

• Jarvis / Conversion.ai (%90 of the text on website written by AI 😇 )

• CookieHub (Consent Management)

That's all. A few things:

The Outcome

.fyi Domain: Why?

I'm often asked this.

I don't know, but I wanted to include the landing page term. Popular TLDs are gone. I saw my alternatives. brief and catchy.

CSS Tailwind Resources

I'll share project resources like Tails and Shuffle.

• Wicked Templates

• TailwindCSS Buttons

• Blocks | Wicked Templates

• nine4

• TUK — Tailwind UI KIT

• HyperUI

• Lofi UI

• Beginner Tailwind (I lately enrolled in this course but haven’t completed it yet.)

Thanks for reading my blog's first post. Please share if you like it.

OpenAI's ChatGPT is an amazing AI-powered chatbot. It can write poetry, fiction, and marketing ideas. I was impressed how well ChatGPT followed the interview, albeit there were a few classics “I’m afraid I can’t do that”.

Full interview below.

Me: I'm your interviewer. We'll discuss crypto. Thanks for being interviewed. What do you think about cryptocurrency?

CGPT: Cryptocurrency is an innovative technology that could transform money and financial activities. It might boost the efficiency and security of financial institutions and let consumers deal directly without banks. Cryptocurrency is still a new and untested technology with many unknowns and hurdles before it can be broadly accepted.

Me: Over 22,000 cryptocurrencies exist, and many have little use. We need how much cryptocurrencies?

CGPT: The appropriate quantity will rely on a multitude of factors, including each cryptocurrency's use cases, adoption rate, and market rivalry. Only a few cryptocurrencies will likely receive widespread adoption and be successful. Many existing cryptocurrencies may not survive since they can't deliver new or valued solutions or compete with more established cryptocurrencies.

Me: Will cryptocurrencies grow? What's next for worldwide adoption?

CGPT: It's hard to forecast the future of cryptocurrencies because the acceptance of new technologies is unpredictable. I believe cryptocurrencies will expand and acquire popularity in the future years. Regulatory ambiguity, security concerns, and scalability issues must be overcome for this to happen. Cryptocurrency companies and organizations must engage together with governments and authorities to address these obstacles and establish a growth-friendly climate. Continued innovation and improvement of the technology, including public education and awareness, will drive acceptance.

Me: Do bear markets affect bitcoin adoption?

CGPT: On the one hand, a bear market might induce uncertainty and hesitation among potential consumers. Bear markets can present opportunities for long-term investors who can acquire cryptocurrencies at cheaper prices and are more likely to hang onto their assets. A bear market can also test the tenacity and power of the underlying technology and community, which can boost long-term confidence and adoption. A bear market might have profound and nuanced effects on bitcoin adoption.

Me: What are some likely outcomes if Bitcoin reaches $100,000 by next year?

CGPT: If Bitcoin saw rapid growth, it would undoubtedly have repercussions for the cryptocurrency market and economy. Possible scenarios include increased public interest and awareness of cryptocurrency, a surge in demand for Bitcoin and other cryptocurrencies, and a growth in the cryptocurrency industry's market value. By shifting their focus and cash to the cryptocurrency market, investors and traders may also affect other asset classes, such as traditional equities and commodities. Governments and financial organizations may focus more on the cryptocurrency sector as they try to grasp Bitcoin's rapid rise.

Me: Will other countries accept crypto as currency?

CGPT: It's hard to say if additional governments will adopt cryptocurrencies as legal tender. Some countries have recognized the promise of bitcoin and are exploring its use, while others are cautious. Adoption of bitcoin as legal cash may vary by country, based on financial infrastructure, rules, and political atmosphere. As cryptocurrency technology evolves and becomes more accepted, more governments may embrace it as legal tender.

Me: Final question: will the recent cryptocurrency hacks affect long term adoption?

CGPT: Hacks might tarnish cryptocurrency's reputation and public faith in its security, the technology underpinning it is continually improving. Many cryptocurrency projects have developed strong security mechanisms to prevent hacks and other dangers, and these safeguards will undoubtedly improve over time. The decentralized nature of cryptocurrency makes it more resistant to attacks. Hacks and other security breaches are a concern, but they may not affect cryptocurrency adoption.

Ethereum is the second-largest cryptocurrency. The Merge, a mid-September event that will convert Ethereum's consensus process from proof-of-work to proof-of-stake if all goes according to plan, will be a game changer.

Why is Ethereum ditching proof-of-work? Because it can. We're talking about a fully functioning, open-source ecosystem with a capacity for evolution that other cryptocurrencies lack, a change that would allow it to scale up its performance from 15 transactions per second to 100,000 as its blockchain is used for more and more things. It would reduce its energy consumption by 99.95%. Vitalik Buterin, the system's founder, would play a less active role due to decentralization, and miners, who validated transactions through proof of work, would be far less important.

Why has this conversion taken so long and been so cautious? Because it involves modifying a core process while it's running to boost its performance. It requires running the new mechanism in test chains on an ever-increasing scale, assessing participant reactions, and checking for issues or restrictions. The last big test was in early June and was successful. All that's left is to converge the mechanism with the Ethereum blockchain to conclude the switch.

What's stopping Bitcoin, the leader in market capitalization and the cryptocurrency that began blockchain's appeal, from doing the same? Satoshi Nakamoto, whoever he or she is, departed from public life long ago, therefore there's no community leadership. Changing it takes a level of consensus that is impossible to achieve without strong leadership, which is why Bitcoin's evolution has been sluggish and conservative, with few modifications.

Secondly, The Merge will balance the consensus mechanism (proof-of-work or proof-of-stake) and the system decentralization or centralization. Proof-of-work prevents double-spending, thus validators must buy hardware. The system works, but it requires a lot of electricity and, as it scales up, tends to re-centralize as validators acquire more hardware and the entire network activity gets focused in a few nodes. Larger operations save more money, which increases profitability and market share. This evolution runs opposed to the concept of decentralization, and some anticipate that any system that uses proof of work as a consensus mechanism will evolve towards centralization, with fewer large firms able to invest in efficient network nodes.

Yet radical bitcoin enthusiasts share an opposite argument. In proof-of-stake, transaction validators put their funds at stake to attest that transactions are valid. The algorithm chooses who validates each transaction, giving more possibilities to nodes that put more coins at stake, which could open the door to centralization and government control.

In both cases, we're talking about long-term changes, but Bitcoin's proof-of-work has been evolving longer and seems to confirm those fears, while proof-of-stake is only employed in coins with a minuscule volume compared to Ethereum and has no predictive value.

As of mid-September, we will have two significant cryptocurrencies, each with a different consensus mechanisms and equally different characteristics: one is intrinsically conservative and used only for economic transactions, while the other has been evolving in open source mode, and can be used for other types of assets, smart contracts, or decentralized finance systems. Some even see it as the foundation of Web3.

Many things could change before September 15, but The Merge is likely to be a turning point. We'll have to follow this closely.