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.

Old power paradigm blocks new planetary paradigm

The difference between our reality and the media's reality is like a tale of two worlds. The greatest and worst of times, really.

Expanding information demands complex skills and understanding to separate important information from ignorance and crap. And that's just the start of determining the source's aim.

Trust who? We see people trust liars in public and then be destroyed by their decisions. Mistakes may be devastating.

Many give up and don't trust anyone. Reality is a choice, though. Same risks.

We must separate our needs and wants from reality. Needs and wants have rules. Greed and selfishness create an unlivable planet.

Culturally, we know this, but we ignore it as foolish. Selfish and greedy people obtain what they want, while others suffer.

We invade, plunder, rape, and burn. We establish civilizations by institutionalizing an exploitable underclass and denying its existence. These cultural lies promote greed and selfishness despite their destructiveness.

Controlling parts of society institutionalize these lies as fact. Many of each age are willing to gamble on greed because they were taught to see greed and selfishness as principles justified by prosperity.

Our cultural understanding recognizes the long-term benefits of collaboration and sharing. This older understanding generates an increasing tension between greedy people and those who see its planetary effects.

Survival requires distinguishing between global and regional realities. Simple, yet many can't do it. This is the first time human greed has had a global impact.

In the past, conflict stories focused on regional winners and losers. Losers lose, winners win, etc. Powerful people see potential decades of nuclear devastation as local, overblown, and not personally dangerous.

Mutually Assured Destruction (MAD) was a human choice that required people to acquiesce to irrational devastation. This prevented nuclear destruction. Most would refuse.

A dangerous “solution” relies on nuclear trigger-pullers not acting irrationally. Since then, we've collected case studies of sane people performing crazy things in experiments. We've been lucky, but the climate apocalypse could be different.

Climate disaster requires only continuing current behavior. These actions already cause global harm, but that's not a threat. These activities must be viewed differently.

Once grasped, denying planetary facts is hard to accept. Deniers can't think beyond regional power. Seeing planet-scale is unusual.

Decades of indoctrination defining any planetary perspective as un-American implies communal planetary assets are for plundering. The old paradigm limits any other view.

In the same way, the new paradigm sees the old regional power paradigm as a threat to planetary civilization and lifeforms. Insane!

While MAD relied on leaders not acting stupidly to trigger a nuclear holocaust, the delayed climatic holocaust needs correcting centuries of lunacy. We must stop allowing craziness in global leadership.

Nothing in our acknowledged past provides a paradigm for such. Only primitive people have failed to reach our level of sophistication.

Before European colonization, certain North American cultures built sophisticated regional nations but abandoned them owing to authoritarian cruelty and destruction. They were overrun by societies that saw no wrong in perpetual exploitation. David Graeber's The Dawn of Everything is an example of historical rediscovery, which is now crucial.

From the new paradigm's perspective, the old paradigm is irrational, yet it's too easy to see those in it as ignorant or malicious, if not both. These people are both, but the collapsing paradigm they promote is older or more ingrained than we think.

We can't shift that paradigm's view of a dead world. We must eliminate this mindset from our nations' leadership. No other way will preserve the earth.

Change is occurring. As always with tremendous transition, younger people are building the new paradigm.

The old paradigm's disintegration is insane. The ability to detect errors and abandon their sources is more important than age. This is gaining recognition.

The breakdown of the previous paradigm is not due to senile leadership, but to systemic problems that the current, conservative leadership cannot recognize.

Stop following the old paradigm.

I apologize if this sounds basic, but throughout my career, I've always been clear that a company's activities are shaped by its founder(s)' morality.

I consider Palantir, owned by PayPal founder Peter Thiel, evil. He got $5 billion tax-free by hacking a statute to help middle-class savings. That may appear clever, but I think it demonstrates a shocking lack of solidarity with society. As a result of this and other things he has said and done, I early on dismissed Peter Thiel as someone who could contribute anything positive to society, and events soon proved me right: we are talking about someone who clearly considers himself above everyone else and who does not hesitate to set up a company, Palantir, to exploit the data of the little people and sell it to the highest bidder, whoever that is and whatever the consequences.

The German courts have confirmed my warnings concerning Palantir. The problem is that politicians love its surveillance tools because they think knowing more about their constituents gives them power. These are ideal for dictatorships who want to snoop on their populace. Hence, Silicon Valley's triumphalist dialectic has seduced many governments at many levels and collected massive volumes of data to hold forever.

Dangerous company. There are many more. My analysis of the moral principles that disclose company management changed my opinion of Facebook, now Meta, and anyone with a modicum of interest might deduce when that happened, a discovery that leaves you dumbfounded. TikTok was easy because its lack of morality was revealed early when I saw the videos it encouraged minors to post and the repercussions of sharing them through its content recommendation algorithm. When you see something like this, nothing can convince you that the firm can change its morals and become good. Nothing. You know the company is awful and will fail. Speak it, announce it, and change it. It's like a fingerprint—unchangeable.

Some of you who read me frequently make its Facebook today jokes when I write about these firms, and that's fine: they're my moral standards, those of an elderly professor with thirty-five years of experience studying corporations and discussing their cases in class, but you don't have to share them. Since I'm writing this and don't have to submit to any editorial review, that's what it is: when you continuously read a person, you have to assume that they have moral standards and that sometimes you'll agree with them and sometimes you won't. Morality accepts hierarchies, nuances, and even obsessions. I know not everyone shares my opinions, but at least I can voice them. One day, one of those firms may sue me (as record companies did some years ago).

Palantir is incredibly harmful. Limit its operations. Like Meta and TikTok, its business strategy is shaped by its founders' immorality. Such a procedure can never be beneficial.

Most productive people are habitual.

Early in the day, do important tasks.

In his best-selling book Eat That Frog, Brian Tracy advised starting the day with your hardest, most important activity.

Most individuals work best in the morning. Energy and willpower peak then.

Mornings are also ideal for memory, focus, and problem-solving.

Thus, the morning is ideal for your hardest chores.

It makes sense to do these things during your peak performance hours.

Additionally, your morning sets the tone for the day. According to Brian Tracy, the first hour of the workday steers the remainder.

After doing your most critical chores, you may feel accomplished, confident, and motivated for the remainder of the day, which boosts productivity.

Develop Your Essentialism

In Essentialism, Greg McKeown claims that trying to be everything to everyone leads to mediocrity and tiredness.

You'll either burn out, be spread too thin, or compromise your ideals.

Greg McKeown advises Essentialism:

Clarify what’s truly important in your life and eliminate the rest.

Eliminating non-essential duties, activities, and commitments frees up time and energy for what matters most.

According to Greg McKeown, Essentialists live by design, not default.

You'll be happier and more productive if you follow your essentials.

Follow these three steps to live more essentialist.

Prioritize Your Tasks First

What matters most clarifies what matters less. List your most significant aims and values.

The clearer your priorities, the more you can focus on them.

On Essentialism, McKeown wrote, The ultimate form of effectiveness is the ability to deliberately invest our time and energy in the few things that matter most.

#2: Set Your Priorities in Order

Prioritize your priorities, not simply know them.

“If you don’t prioritize your life, someone else will.” — Greg McKeown

Planning each day and allocating enough time for your priorities is the best method to become more purposeful.

#3: Practice saying "no"

If a request or demand conflicts with your aims or principles, you must learn to say no.

Saying no frees up space for our priorities.

Place Sleep Above All Else

Many believe they must forego sleep to be more productive. This is false.

A productive day starts with a good night's sleep.

Matthew Walker (Why We Sleep) says:

“Getting a good night’s sleep can improve cognitive performance, creativity, and overall productivity.”

Sleep helps us learn, remember, and repair.

Unfortunately, 35% of people don't receive the recommended 79 hours of sleep per night.

Sleep deprivation can cause:

• increased risk of diabetes, heart disease, stroke, and obesity

• Depression, stress, and anxiety risk are all on the rise.

• decrease in general contentment

• decline in cognitive function

To live an ideal, productive, and healthy life, you must prioritize sleep.

Follow these six sleep optimization strategies to obtain enough sleep:

• Establish a nightly ritual to relax and prepare for sleep.

• Avoid using screens an hour before bed because the blue light they emit disrupts the generation of melatonin, a necessary hormone for sleep.

• Maintain a regular sleep schedule to control your body's biological clock (and optimizes melatonin production)

• Create a peaceful, dark, and cool sleeping environment.

• Limit your intake of sweets and caffeine (especially in the hours leading up to bedtime)

• Regular exercise (but not right before you go to bed, because your body temperature will be too high)

Sleep is one of the best ways to boost productivity.

Sleep is crucial, says Matthew Walker. It's the key to good health and longevity.

You do not want to miss these

Stop! Stop it! Two things to avoid when starting a YouTube channel. Critical. Possible channel-killers Its future revenue.

I'll tell you now, so don't say "I wish I knew."

The Notorious Copyright Allegation

My YouTube channel received a copyright claim before I sold it. This claim was on a one-minute video I thought I'd changed enough to make mine, but the original owner disagreed.

It cost me thousands in ad revenue. Original owner got the profits.

Well, it wasn't your video, you say.

Touché.

I've learned. Sorta

I couldn't stop looking at the video's views. The video got 1,000,000 views without any revenue. I made 4 more similar videos.

If they didn't get copyrighted, I'd be rolling in dough.

You've spent a week editing and are uploading to YouTube. You're thrilled as you stand and stretch your back. You see the video just before publishing.

No way!

The red exclamation point on checks.

Copyright claim!

YouTube lets you publish, but you won't make money.

Sounds fair? Well, it is.

Copyright claims mean you stole someone's work. Song, image, or video clip.

We wouldn't want our content used for money.

The only problem with this is that almost everything belongs to someone else. I doubt some of the biggest creators are sitting down and making their music for their videos. That just seems really excessive when you could make a quick search on YouTube and download a song (I definitely don’t do this because that would be stealing).

So how do you defeat a copyright defense?

Even copyright-free songs on YouTube aren't guaranteed. Some copyrighted songs claim to be free.

Use YouTube's free music library or pay for a subscription to adobe stock, epidemic sound, or artlist.io.

Most of my videos have Nintendo music. Almost all game soundtracks are copyright-free and offer a variety of songs.

Restriction on age

Age restrictions are a must-avoid. A channel dies.

YouTube never suggests age-restricted videos.

Shadow banning means YouTube hides your content from subscribers and non-subscribers.

Keeping your channel family-friendly can help.

I hear you complaining that your channel isn't for kids. I agree. Not everyone has a clean mouth or creates content for minors.

YouTube has changed rapidly in recent years. Focusing on kids. Fewer big creators are using profanity or explicit content in videos. Not YouTube-worthy.

Youtube wants to be family-friendly. A family-friendly movie. It won't promote illegal content. Yes, it allows profanity.

Do I recommend avoiding no-no words in videos? Never. Okay. YouTube's policies are shaky. YouTube uses video content to determine ad suitability.

No joke. If you're serious about becoming a content creator, avoid profanity and inappropriate topics.

If your channel covers 18+ topics, like crime or commentary, censor as much as possible.

YouTube can be like walking on eggshells. You never know what is gonna upset the boss. So play it safe and try to avoid getting on their bad side.

Mr. Beast, Dream, Markplier, Faze Rug, and PewDewPie are popular creators. They maintain it family-friendly while entertaining fans.

You got this.