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.

Trigger warning — Andrew Tate is running a genius marketing campaign

Andrew Tate is a 2022 internet celebrity.

Kickboxing world champion became rich playboy with controversial views on gender roles.

Andrew's get-rich-quick scheme isn't new. His social media popularity is impressive.

He’s currently running one of the most genius marketing campaigns in history.

He pulls society's pendulum away from diversity and inclusion and toward diversion and exclusion. He's unstoppable.

Here’s everything you need to know about Andrew Tate. And how he’s playing chess while the world plays checkers.

Cobra Tate is the name he goes by.

American-born, English-raised entrepreneur Andrew Tate lives in Romania.

Romania? Says Andrew,

“I prefer a country in which corruption is available to everyone.”

Andrew was a professional kickboxer with the ring moniker Cobra before starting Hustlers University.

Before that, he liked chess and worshipped his father.

Emory Andrew Tate III is named after his grandmaster chess player father.

Emory was the first black-American chess champion. He was military, martial arts-trained, and multilingual. A superhuman.

He lived in his car to make ends meet.

Andrew and Tristan relocated to England with their mother when their parents split.

It was there that Andrew began his climb toward becoming one of the internet’s greatest villains.

Andrew fell in love with kickboxing.

Andrew spent his 20s as a professional kickboxer and reality TV star, featuring on Big Brother UK and The Ultimate Traveller.

These 3 incidents, along with a chip on his shoulder, foreshadowed Andrews' social media breakthrough.

• Chess

• Combat sports

• Reality television

A dangerous trio.

Andrew started making money online after quitting kickboxing in 2017 due to an eye issue.

Andrew didn't suddenly become popular.

Andrew's web work started going viral in 2022.

Due to his contentious views on patriarchy and gender norms, he's labeled the King of Toxic Masculinity. His most contentious views (trigger warning):

• “Women are intrinsically lazy.”

• “Female promiscuity is disgusting.”

• “Women shouldn’t drive cars or fly planes.”

• “A lot of the world’s problems would be solved if women had their body count tattooed on their foreheads.”

Andrew's two main beliefs are:

1. “These are my personal opinions based on my experiences.”

2. “I believe men are better at some things and women are better at some things. We are not equal.”

Andrew intentionally offends.

Andrew's thoughts began circulating online in 2022.

In July 2022, he was one of the most Googled humans, surpassing:

• Joe Biden

• Donald Trump

• Kim Kardashian

Andrews' rise is a mystery since no one can censure or suppress him. This is largely because Andrew nor his team post his clips.

But more on that later.

Andrew's path to wealth.

Andrew Tate is a self-made millionaire. His morality is uncertain.

Andrew and Tristan needed money soon after retiring from kickboxing.

“I owed some money to some dangerous people. I had $70K and needed $100K to stay alive.”

Andrews lost $20K on roulette at a local casino.

Andrew had one week to make $50,000, so he started planning. Andrew locked himself in a chamber like Thomas Edison to solve an energy dilemma.

He listed his assets.

• Physical strength (but couldn’t fight)

• a BMW (worth around $20K)

• Intelligence (but no outlet)

A lightbulb.

He had an epiphany after viewing a webcam ad. He sought aid from women, ironically. His 5 international girlfriends are assets.

Then, a lightbulb.

Andrew and Tristan messaged and flew 7 women to a posh restaurant. Selling desperation masked as opportunity, Andrew pitched his master plan:

A webcam business — with a 50/50 revenue split.

5 women left.

2 stayed.

Andrew Tate, a broke kickboxer, became Top G, Cobra Tate.

The business model was simple — yet sad.

Andrew's girlfriends moved in with him and spoke online for 15+ hours a day. Andrew handled ads and equipment as the women posed.

Andrew eventually took over their keyboards, believing he knew what men wanted more than women.

Andrew detailed on the Full Send Podcast how he emotionally manipulated men for millions. They sold houses, automobiles, and life savings to fuel their companionship addiction.

When asked if he felt bad, Andrew said,

“F*ck no.“

Andrew and Tristan wiped off debts, hired workers, and diversified.

Tristan supervised OnlyFans models.

Andrew bought Romanian casinos and MMA league RXF (Real Xtreme Fighting).

Pandemic struck suddenly.

Andrew couldn't run his 2 businesses without a plan. Another easy moneymaker.

He banked on Hustlers University.

The actual cause of Andrew's ubiquity.

On a Your Mom’s House episode Andrew's 4 main revenue sources:

1. Hustler’s University

2. Owning casinos in Romania

3. Owning 10% of the Romanian MMA league “RXF”

4. “The War Room” — a society of rich and powerful men

When the pandemic hit, 3/4 became inoperable.

So he expanded Hustlers University.

But what is Hustler’s University?

Andrew says Hustlers University teaches 18 wealth-building tactics online. Examples:

• Real estate

• Copywriting

• Amazon FBA

• Dropshipping

• Flipping Cryptos

How to swiftly become wealthy.

Lessons are imprecise, rudimentary, and macro-focused, say reviews. Invest wisely, etc. Everything is free online.

You pay for community. One unique income stream.

The only money-making mechanism that keeps the course from being a scam.

The truth is, many of Andrew’s students are actually making money. Maybe not from the free YouTube knowledge Andrew and his professors teach in the course, but through Hustler’s University’s affiliate program.

Affiliates earn 10% commission for each new student = $5.

Students can earn $10 for each new referral in the first two months.

Andrew earns $50 per membership per month.

This affiliate program isn’t anything special — in fact, it’s on the lower end of affiliate payouts. Normally, it wouldn’t be very lucrative.

But it has one secret weapon— Andrew and his viral opinions.

Andrew is viral. Andrew went on a media tour in January 2022 after appearing on Your Mom's House.

• The Full Send Podcast

• The Fresh & Fit Podcast

• “BFFs” by Barstool Sports

And many, many more…

He chatted with Twitch streamers. Hustlers University wanted more controversy (and clips).

Here’s the strategy behind Hustler’s University that has (allegedly) earned students upwards of $10K per month:

1. Make a social media profile with Andrew Tates' name and photo.

2. Post any of the online videos of Andrews that have gone viral.

3. Include a referral link in your bio.

Effectively simple.

Andrew's controversy attracts additional students. More student clips circulate as more join. Andrew's students earn more and promote the product as he goes viral.

A brilliant plan that's functioning.

At the beginning of his media tour, Hustler’s University had 5,000 students. 6 months in, and he now has over 100,000.

One income stream generates $5 million every month.

Andrew's approach is not new.

But it is different.

In the early 2010s, Tai Lopez dominated the internet.

His viral video showed his house.

“Here in my garage. Just bought this new Lamborghini.”

Tais' marketing focused on intellect, not strength, power, and wealth to attract women.

How reading quicker leads to financial freedom in 67 steps.

Years later, it was revealed that Tai Lopez rented the mansion and Lamborghini as a marketing ploy to build social proof. Meanwhile, he was living in his friend’s trailer.

Faked success is an old tactic.

Andrew is doing something similar. But with one major distinction.

Andrew outsources his virality — making him nearly impossible to cancel.

In 2022, authorities searched Andrews' estate over human trafficking suspicions. Investigation continues despite withdrawn charges.

Andrew's divisive nature would normally get him fired. Andrew's enterprises and celebrity don't rely on social media.

He doesn't promote or pay for ads. Instead, he encourages his students and anyone wishing to get rich quick to advertise his work.

Because everything goes through his affiliate program. Old saying:

“All publicity is good publicity.”

Final thoughts: it’s ok to feel triggered.

Tate is divisive.

His emotionally charged words are human nature. Andrews created the controversy.

It's non-personal.

His opinions are those of one person. Not world nor generational opinion.

Briefly:

• It's easy to understand why Andrews' face is ubiquitous. Money.

• The world wide web is a chessboard. Misdirection is part of it.

• It’s not personal, it’s business.

• Controversy sells

Sometimes understanding the ‘why’, can help you deal with the ‘what.’

Many of us have struggled for years to master a second language (in my case, English). Because (at least in my situation) we've always used an input-based system or method.

I'll explain in detail, but briefly: We can understand some conversations or sentences (since we've trained), but we can't give sophisticated answers or speak fluently (because we have NOT trained at all).

What exactly is input-based learning?

Reading, listening, writing, and speaking are key language abilities (if you look closely at that list, it seems that people tend to order them in this way: inadvertently giving more priority to the first ones than to the last ones).

These talents fall under two learning styles:

• Reading and listening are input-based activities (sometimes referred to as receptive skills or passive learning).

• Writing and speaking are output-based tasks (also known as the productive skills and/or active learning).

What's the best learning style? To learn a language, we must master four interconnected skills. The difficulty is how much time and effort we give each.

According to Shion Kabasawa's books The Power of Input: How to Maximize Learning and The Power of Output: How to Change Learning to Outcome (available only in Japanese), we spend 7:3 more time on Input Based skills than Output Based skills when we should be doing the opposite, leaning more towards Output (Input: Output->3:7).

I can't tell you how he got those numbers, but I think he's not far off because, for example, think of how many people say they're learning a second language and are satisfied bragging about it by only watching TV, series, or movies in VO (and/or reading a book or whatever) their Input is: 7:0 output!

You can't be good at a sport by watching TikTok videos about it; you must play.

“being pushed to produce language puts learners in a better position to notice the ‘gaps’ in their language knowledge”, encouraging them to ‘upgrade’ their existing interlanguage system. And, as they are pushed to produce language in real time and thereby forced to automate low-level operations by incorporating them into higher-level routines, it may also contribute to the development of fluency. — Scott Thornbury (P is for Push)

How may I practice output-based learning more?

I know that listening or reading is easy and convenient because we can do it on our own in a wide range of situations, even during another activity (although, as you know, it's not ideal), writing can be tedious/boring (it's funny that we almost always excuse ourselves in the lack of ideas), and speaking requires an interlocutor. But we must leave our comfort zone and modify our thinking to go from 3:7 to 7:3. (or at least balance it better to something closer). Gradually.

“You don’t have to do a lot every day, but you have to do something. Something. Every day.” — Callie Oettinger (Do this every day)

We can practice speaking like boxers shadow box.

Speaking out loud strengthens the mind-mouth link (otherwise, you will still speak fluently in your mind but you will choke when speaking out loud). This doesn't mean we should talk to ourselves on the way to work, while strolling, or on public transportation. We should try to do it without disturbing others, such as explaining what we've heard, read, or seen (the list is endless: you can TALK about what happened yesterday, your bedtime book, stories you heard at the office, that new kitten video you saw on Instagram, an experience you had, some new fact, that new boring episode you watched on Netflix, what you ate, what you're going to do next, your upcoming vacation, what’s trending, the news of the day)

Who will correct my grammar, vocabulary, or pronunciation with an imagined friend? We can't have everything, but tools and services can help [1].

Lack of bravery

Fear of speaking a language different than one's mother tongue in front of native speakers is global. It's easier said than done, because strangers, not your friends, will always make fun of your accent or faults. Accept it and try again. Karma will prevail.

Perfectionism is a trap. Stop self-sabotaging. Communication is key (and for that you have to practice the Output too ).

“Don’t forget to have fun and enjoy the process.” — Ruri Ohama

[1] Grammarly, Deepl, Google Translate, etc.

If I could tell my younger self a few rules, they would boost my career.

1. Treat design like medicine; don't get attached.

If it doesn't help, you won't be angry, but you'll try to improve it. Designers blame others if they don't like the design, but the rule is the same: we solve users' problems. You're not your design, and neither are they. Be humble with your work because your assumptions will often be wrong and users will behave differently.

2. Consider your design flawed.

Disagree with yourself, then defend your ideas. Most designers forget to dig deeper into a pattern, screen, button, or copywriting. If someone asked, "Have you considered alternatives? How does this design stack up? Here's a functional UX checklist to help you make design decisions.

3. Codeable solutions.

If your design requires more developer time, consider whether it's worth spending more money to code something with a small UX impact. Overthinking problems and designing abstract patterns is easy. Sometimes you see something on dribbble or bechance and try to recreate it, but it's not worth it. Here's my article on it.

4. Communication changes careers

Designers often talk with users, clients, companies, developers, and other designers. How you talk and present yourself can land you a job. Like driving or swimming, practice it. Success requires being outgoing and friendly. If I hadn't said "hello" to a few people, I wouldn't be where I am now.

5. Ignorance of the law is not an excuse.

Copyright, taxation How often have you used an icon without checking its license? If you use someone else's work in your project, the owner can cause you a lot of problems — paying a lot of money isn't worth it. Spend a few hours reading about copyrights, client agreements, and taxes.

6. Always test your design

If nobody has seen or used my design, it's not finished. Ask friends about prototypes. Testing reveals how wrong your assumptions were. Steve Krug, one of the authorities on this topic will tell you more about how to do testing.

7. Run workshops

A UX designer's job involves talking to people and figuring out what they need, which is difficult because they usually don't know. Organizing teamwork sessions is a powerful skill, but you must also be a good listener. Your job is to help a quiet, introverted developer express his solution and control the group. AJ Smart has more on workshops here.

And tips for anyone trying.

We see the same story every few years.

BREAKING NEWS: [Platform X] launched a social network. With Facebook's reputation down, the new startup bets millions will switch.

Despite the excitement surrounding each new platform (Diaspora, Ello, Path, MeWe, Minds, Vero, etc.), no major exodus occurred.

Snapchat and TikTok attracted teens with fresh experiences (ephemeral messaging and rapid-fire videos). These features aren't Facebook, even if Facebook replicated them.

Facebook's core is simple: you publish items (typically text/images) and your friends (generally people you know IRL) can discuss them.

It's cool. Sometimes I don't want to, but sh*t. I like it.

Because, well, I like many folks I've met. I enjoy keeping in touch with them and their banter.

I dislike Facebook's corporation. I've been cautiously optimistic whenever a Facebook-killer surfaced.

None succeeded.

Why? Two causes, I think:

People couldn't switch quickly enough, which is reason #1

Your buddies make a social network social.

Facebook started in self-contained communities (college campuses) then grew outward. But a new platform can't.

If we're expected to leave Facebook, we want to know that most of our friends will too.

Most Facebook-killers had bottlenecks. You have to waitlist or jump through hoops (e.g. setting up a server).

Same outcome. Upload. Chirp.

After a week or two of silence, individuals returned to Facebook.

Reason #2: The fundamental experience was different.

Even when many of our friends joined in the first few weeks, it wasn't the same.

There were missing features or a different UX.

Want to reply with a meme? No photos in comments yet. (Trying!)

Want to tag a friend? Nope, sorry. 2019!

Want your friends to see your post? You must post to all your friends' servers. Good luck!

It's difficult to introduce a platform with 100% of the same features as one that's been there for 20 years, yet customers want a core experience.

If you can't, they'll depart.

The causes that led to the causes

Having worked on software teams for 14+ years, I'm not surprised by these challenges. They are a natural development of a few tech sector meta-problems:

Lean startup methodology

Silicon Valley worships lean startup. It's a way of developing software that involves testing a stripped-down version with a limited number of people before selecting what to build.

Billion people use Facebook's functions. They aren't tested. It must work right away*

*This may seem weird to software people, but it's how non-software works! You can't sell a car without wheels.

2. Creativity

Startup entrepreneurs build new things, not copies. I understand. Reinventing the wheel is boring.

We know what works. Different experiences raise adoption friction. Once millions have transferred, more features (and a friendlier UX) can be implemented.

3. Cost scaling

True. Building a product that can sustain hundreds of millions of users in weeks is expensive and complex.

Your lifeboats must have the same capacity as the ship you're evacuating. It's required.

4. Pure ideologies

People who work on Facebook-alternatives are (understandably) critical of Facebook.

They build an open-source, fully-distributed, data-portable, interface-customizable, offline-capable, censorship-proof platform.

Prioritizing these aims can prevent replicating the straightforward experience users expect. Github, not Facebook, is for techies only.

What about the business plan, though?

Facebook-killer attempts have followed three models.

1. Utilize VC funding to increase your user base, then monetize them later. (If you do this, you won't kill Facebook; instead, Facebook will become you.)

2. Users must pay to utilize it. (This causes a huge bottleneck and slows the required quick expansion, preventing it from seeming like a true social network.)

3. Make it a volunteer-run, open-source endeavor that is free. (This typically denotes that something is cumbersome, difficult to operate, and is only for techies.)

Wikipedia is a fourth way.

Wikipedia is one of the most popular websites and a charity. No ads. Donations support them.

A Facebook-killer managed by a good team may gather millions (from affluent contributors and the crowd) for their initial phase of development. Then it might sustain on regular donations, ethical transactions (e.g. fees on commerce, business sites, etc.), and government grants/subsidies (since it would essentially be a public utility).

When you're not aiming to make investors rich, it's remarkable how little money you need.

If you want to build a Facebook competitor, follow these tips:

1. Drop the lean startup philosophy. Wait until you have a finished product before launching. Build it, thoroughly test it for bugs, and then release it.

2. Delay innovating. Wait till millions of people have switched before introducing your great new features. Make it nearly identical for now.

3. Spend money climbing. Make sure that guests can arrive as soon as they are invited. Never keep them waiting. Make things easy for them.

4. Make it accessible to all. Even if doing so renders it less philosophically pure, it shouldn't require technical expertise to utilize.

5. Constitute a nonprofit. Additionally, develop community ownership structures. Profit maximization is not the only strategy for preserving valued assets.

Last thoughts

Nobody has killed Facebook, but Facebook is killing itself.

The startup is burying the newsfeed to become a TikTok clone. Meta itself seems to be ditching the platform for the metaverse.

I wish I was happy, but I'm not. I miss (understandably) removed friends' postings and remarks. It could be a ghost town in a few years. My dance moves aren't TikTok-worthy.

Who will lead? It's time to develop a social network for the people.

Greetings if you're working on it. I'm not a company founder, but I like to help hard-working folks.