More on Marketing

Michael Salim
3 years ago
300 Signups, 1 Landing Page, 0 Products
I placed a link on HackerNews and got 300 signups in a week. This post explains what happened.
Product Concept
The product is DbSchemaLibrary. A library of Database Schema.
I'm not sure where this idea originated from. Very fast. Build fast, fail fast, test many ideas, and one will be a hit. I tried it. Let's try it anyway, even though it'll probably fail. I finished The Lean Startup book and wanted to use it.
Database job bores me. Important! I get drowsy working on it. Someone must do it. I remember this happening once. I needed examples at the time. Something similar to Recall (my other project) that I can copy — or at least use as a reference.
Frequently googled. Many tabs open. The results were useless. I raised my hand and agreed to construct the database myself.
It resurfaced. I decided to do something.
Due Diligence
Lean Startup emphasizes validated learning. Everything the startup does should result in learning. I may build something nobody wants otherwise. That's what happened to Recall.
So, I wrote a business plan document. This happens before I code. What am I solving? What is my proposed solution? What is the leap of faith between the problem and solution? Who would be my target audience?
My note:
In my previous project, I did the opposite!
I wrote my expectations after reading the book's advice.
“Failure is a prerequisite to learning. The problem with the notion of shipping a product and then seeing what happens is that you are guaranteed to succeed — at seeing what happens.” — The Lean Startup book
These are successful metrics. If I don't reach them, I'll drop the idea and try another. I didn't understand numbers then. Below are guesses. But it’s a start!
I then wrote the project's What and Why. I'll use this everywhere. Before, I wrote a different pitch each time. I thought certain words would be better. I felt the audience might want something unusual.
Occasionally, this works. I'm unsure if it's a good idea. No stats, just my writing-time opinion. Writing every time is time-consuming and sometimes hazardous. Having a copy saved me duplication.
I can measure and learn from performance.
Last, I identified communities that might demand the product. This became an exercise in creativity.
The MVP
So now it’s time to build.
A MVP can test my assumptions. Business may learn from it. Not low-quality. We should learn from the tiniest thing.
I like the example of how Dropbox did theirs. They assumed that if the product works, people will utilize it. How can this be tested without a quality product? They made a movie demonstrating the software's functionality. Who knows how much functionality existed?
So I tested my biggest assumption. Users want schema references. How can I test if users want to reference another schema? I'd love this. Recall taught me that wanting something doesn't mean others do.
I made an email-collection landing page. Describe it briefly. Reference library. Each email sender wants a reference. They're interested in the product. Few other reasons exist.
Header and footer were skipped. No name or logo. DbSchemaLibrary is a name I thought of after the fact. 5-minute logo. I expected a flop. Recall has no users after months of labor. What could happen to a 2-day project?
I didn't compromise learning validation. How many visitors sign up? To draw a conclusion, I must track these results.
Posting Time
Now that the job is done, gauge interest. The next morning, I posted on all my channels. I didn't want to be spammy, therefore it required more time.
I made sure each channel had at least one fan of this product. I also answer people's inquiries in the channel.
My list stinks. Several channels wouldn't work. The product's target market isn't there. Posting there would waste our time. This taught me to create marketing channels depending on my persona.
Statistics! What actually happened
My favorite part! 23 channels received the link.
I stopped posting to Discord despite its high conversion rate. I eliminated some channels because they didn't fit. According to the numbers, some users like it. Most users think it's spam.
I was skeptical. And 12 people viewed it.
I didn't expect much attention on a startup subreddit. I'll likely examine Reddit further in the future. As I have enough info, I didn't post much. Time for the next validated learning
No comment. The post had few views, therefore the numbers are low.
The targeted people come next.
I'm a Toptal freelancer. There's a member-only Slack channel. Most people can't use this marketing channel, but you should! It's not as spectacular as discord's 27% conversion rate. But I think the users here are better.
I don’t really have a following anywhere so this isn’t something I can leverage.
The best yet. 10% is converted. With more data, I expect to attain a 10% conversion rate from other channels. Stable number.
This number required some work. Did you know that people use many different clients to read HN?
Unknowns
Untrackable views and signups abound. 1136 views and 135 signups are untraceable. It's 11%. I bet much of that came from Hackernews.
Overall Statistics
The 7-day signup-to-visit ratio was 17%. (Hourly data points)
First-day percentages were lower, which is noteworthy. Initially, it was little above 10%. The HN post started getting views then.
When traffic drops, the number reaches just around 20%. More individuals are interested in the connection. hn.algolia.com sent 2 visitors. This means people are searching and finding my post.
Interesting discoveries
1. HN post struggled till the US woke up.
11am UTC. After an hour, it lost popularity. It seemed over. 7 signups converted 13%. Not amazing, but I would've thought ahead.
After 4pm UTC, traffic grew again. 4pm UTC is 9am PDT. US awakened. 10am PDT saw 512 views.
2. The product was highlighted in a newsletter.
I found Revue references when gathering data. Newsletter platform. Someone posted the newsletter link. 37 views and 3 registrations.
3. HN numbers are extremely reliable
I don't have a time-lapse graph (yet). The statistics were constant all day.
2717 views later 272 new users, or 10.1%
With 293 signups at 2856 views, 10.25%
At 306 signups at 2965 views, 10.32%
Learnings
1. My initial estimations were wildly inaccurate
I wrote 30% conversion. Reading some articles, looks like 10% is a good number to aim for.
2. Paying attention to what matters rather than vain metrics
The Lean Startup discourages vanity metrics. Feel-good metrics that don't measure growth or traction. Considering the proportion instead of the total visitors made me realize there was something here.
What’s next?
There are lots of work to do. Data aggregation, display, website development, marketing, legal issues. Fun! It's satisfying to solve an issue rather than investigate its cause.
In the meantime, I’ve already written the first project update in another post. Continue reading it if you’d like to know more about the project itself! Shifting from Quantity to Quality — DbSchemaLibrary

Jon Brosio
3 years ago
This Landing Page is a (Legal) Money-Printing Machine
and it’s easy to build.
A landing page with good copy is a money-maker.
Let's be honest, page-builder templates are garbage.
They can help you create a nice-looking landing page, but not persuasive writing.
Over the previous 90 days, I've examined 200+ landing pages.
What's crazy?
Top digital entrepreneurs use a 7-part strategy to bring in email subscribers, generate prospects, and (passively) sell their digital courses.
Steal this 7-part landing page architecture to maximize digital product sales.
The offer
Landing pages require offers.
Newsletter, cohort, or course offer.
Your reader should see this offer first. Includind:
Headline
Imagery
Call-to-action
Clear, persuasive, and simplicity are key. Example: the Linkedin OS course home page of digital entrepreneur Justin Welsh offers:
A distinctly defined problem
Everyone needs an enemy.
You need an opponent on your landing page. Problematic.
Next, employ psychology to create a struggle in your visitor's thoughts.
Don't be clever here; label your customer's problem. The more particular you are, the bigger the situation will seem.
When you build a clear monster, you invite defeat. I appreciate Theo Ohene's Growth Roadmaps landing page.
Exacerbation of the effects
Problem identification doesn't motivate action.
What would an unresolved problem mean?
This is landing page copy. When you describe the unsolved problem's repercussions, you accomplish several things:
You write a narrative (and stories are remembered better than stats)
You cause the reader to feel something.
You help the reader relate to the issue
Important!
My favorite script is:
"Sure, you can let [problem] go untreated. But what will happen if you do? Soon, you'll begin to notice [new problem 1] will start to arise. That might bring up [problem 2], etc."
Take the copywriting course, digital writer and entrepreneur Dickie Bush illustrates below when he labels the problem (see: "poor habit") and then illustrates the repercussions.
The tale of transformation
Every landing page needs that "ah-ha!" moment.
Transformation stories do this.
Did you find a solution? Someone else made the discovery? Have you tested your theory?
Next, describe your (or your subject's) metamorphosis.
Kieran Drew nails his narrative (and revelation) here. Right before the disclosure, he introduces his "ah-ha!" moment:
Testimonials
Social proof completes any landing page.
Social proof tells the reader, "If others do it, it must be worthwhile."
This is your argument.
Positive social proof helps (obviously).
Offer "free" training in exchange for a testimonial if you need social evidence. This builds social proof.
Most social proof is testimonies (recommended). Kurtis Hanni's creative take on social proof (using a screenshot of his colleague) is entertaining.
Bravo.
Reveal your offer
Now's the moment to act.
Describe the "bundle" that provides the transformation.
Here's:
Course
Cohort
Ebook
Whatever you're selling.
Include a product or service image, what the consumer is getting ("how it works"), the price, any "free" bonuses (preferred), and a CTA ("buy now").
Clarity is key. Don't make a cunning offer. Make sure your presentation emphasizes customer change (benefits). Dan Koe's Modern Mastery landing page makes an offer. Consider:
An ultimatum
Offering isn't enough.
You must give your prospect an ultimatum.
They can buy your merchandise from you.
They may exit the webpage.
That’s it.
It's crucial to show what happens if the reader does either. Stress the consequences of not buying (again, a little consequence amplification). Remind them of the benefits of buying.
I appreciate Charles Miller's product offer ending:
The top online creators use a 7-part landing page structure:
Offer the service
Describe the problem
Amplify the consequences
Tell the transformational story
Include testimonials and social proof.
Reveal the offer (with any bonuses if applicable)
Finally, give the reader a deadline to encourage them to take action.
Sequence these sections to develop a landing page that (essentially) prints money.

Dung Claire Tran
3 years ago
Is the future of brand marketing with virtual influencers?
Digital influences that mimic humans are rising.
Lil Miquela has 3M Instagram followers, 3.6M TikTok followers, and 30K Twitter followers. She's been on the covers of Prada, Dior, and Calvin Klein magazines. Miquela released Not Mine in 2017 and launched Hard Feelings at Lollapazoolas this year. This isn't surprising, given the rise of influencer marketing.
This may be unexpected. Miquela's fake. Brud, a Los Angeles startup, produced her in 2016.
Lil Miquela is one of many rising virtual influencers in the new era of social media marketing. She acts like a real person and performs the same tasks as sports stars and models.
The emergence of online influencers
Before 2018, computer-generated characters were rare. Since the virtual human industry boomed, they've appeared in marketing efforts worldwide.
In 2020, the WHO partnered up with Atlanta-based virtual influencer Knox Frost (@knoxfrost) to gather contributions for the COVID-19 Solidarity Response Fund.
Lu do Magalu (@magazineluiza) has been the virtual spokeswoman for Magalu since 2009, using social media to promote reviews, product recommendations, unboxing videos, and brand updates. Magalu's 10-year profit was $552M.
In 2020, PUMA partnered with Southeast Asia's first virtual model, Maya (@mayaaa.gram). She joined Singaporean actor Tosh Zhang in the PUMA campaign. Local virtual influencer Ava Lee-Graham (@avagram.ai) partnered with retail firm BHG to promote their in-house labels.
In Japan, Imma (@imma.gram) is the face of Nike, PUMA, Dior, Salvatore Ferragamo SpA, and Valentino. Imma's bubblegum pink bob and ultra-fine fashion landed her on the cover of Grazia magazine.
Lotte Home Shopping created Lucy (@here.me.lucy) in September 2020. She made her TV debut as a Christmas show host in 2021. Since then, she has 100K Instagram followers and 13K TikTok followers.
Liu Yiexi gained 3 million fans in five days on Douyin, China's TikTok, in 2021. Her two-minute video went viral overnight. She's posted 6 videos and has 830 million Douyin followers.
China's virtual human industry was worth $487 million in 2020, up 70% year over year, and is expected to reach $875.9 million in 2021.
Investors worldwide are interested. Immas creator Aww Inc. raised $1 million from Coral Capital in September 2020, according to Bloomberg. Superplastic Inc., the Vermont-based startup behind influencers Janky and Guggimon, raised $16 million by 2020. Craft Ventures, SV Angels, and Scooter Braun invested. Crunchbase shows the company has raised $47 million.
The industries they represent, including Augmented and Virtual reality, were worth $14.84 billion in 2020 and are projected to reach $454.73 billion by 2030, a CAGR of 40.7%, according to PR Newswire.
Advantages for brands
Forbes suggests brands embrace computer-generated influencers. Examples:
Unlimited creative opportunities: Because brands can personalize everything—from a person's look and activities to the style of their content—virtual influencers may be suited to a brand's needs and personalities.
100% brand control: Brand managers now have more influence over virtual influencers, so they no longer have to give up and rely on content creators to include brands into their storytelling and style. Virtual influencers can constantly produce social media content to promote a brand's identity and ideals because they are completely scandal-free.
Long-term cost savings: Because virtual influencers are made of pixels, they may be reused endlessly and never lose their beauty. Additionally, they can move anywhere around the world and even into space to fit a brand notion. They are also always available. Additionally, the expense of creating their content will not rise in step with their expanding fan base.
Introduction to the metaverse: Statista reports that 75% of American consumers between the ages of 18 and 25 follow at least one virtual influencer. As a result, marketers that support virtual celebrities may now interact with younger audiences that are more tech-savvy and accustomed to the digital world. Virtual influencers can be included into any digital space, including the metaverse, as they are entirely computer-generated 3D personas. Virtual influencers can provide brands with a smooth transition into this new digital universe to increase brand trust and develop emotional ties, in addition to the young generations' rapid adoption of the metaverse.
Better engagement than in-person influencers: A Hype Auditor study found that online influencers have roughly three times the engagement of their conventional counterparts. Virtual influencers should be used to boost brand engagement even though the data might not accurately reflect the entire sector.
Concerns about influencers created by computers
Virtual influencers could encourage excessive beauty standards in South Korea, which has a $10.7 billion plastic surgery industry.
A classic Korean beauty has a small face, huge eyes, and pale, immaculate skin. Virtual influencers like Lucy have these traits. According to Lee Eun-hee, a professor at Inha University's Department of Consumer Science, this could make national beauty standards more unrealistic, increasing demand for plastic surgery or cosmetic items.
Other parts of the world raise issues regarding selling items to consumers who don't recognize the models aren't human and the potential of cultural appropriation when generating influencers of other ethnicities, called digital blackface by some.
Meta, Facebook and Instagram's parent corporation, acknowledges this risk.
“Like any disruptive technology, synthetic media has the potential for both good and harm. Issues of representation, cultural appropriation and expressive liberty are already a growing concern,” the company stated in a blog post. “To help brands navigate the ethical quandaries of this emerging medium and avoid potential hazards, (Meta) is working with partners to develop an ethical framework to guide the use of (virtual influencers).”
Despite theoretical controversies, the industry will likely survive. Companies think virtual influencers are the next frontier in the digital world, which includes the metaverse, virtual reality, and digital currency.
In conclusion
Virtual influencers may garner millions of followers online and help marketers reach youthful audiences. According to a YouGov survey, the real impact of computer-generated influencers is yet unknown because people prefer genuine connections. Virtual characters can supplement brand marketing methods. When brands are metaverse-ready, the author predicts virtual influencer endorsement will continue to expand.
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Ajay Shrestha
2 years ago
Bitcoin's technical innovation: addressing the issue of the Byzantine generals
The 2008 Bitcoin white paper solves the classic computer science consensus problem.
Issue Statement
The Byzantine Generals Problem (BGP) is called after an allegory in which several generals must collaborate and attack a city at the same time to win (figure 1-left). Any general who retreats at the last minute loses the fight (figure 1-right). Thus, precise messengers and no rogue generals are essential. This is difficult without a trusted central authority.
In their 1982 publication, Leslie Lamport, Robert Shostak, and Marshall Please termed this topic the Byzantine Generals Problem to simplify distributed computer systems.
Consensus in a distributed computer network is the issue. Reaching a consensus on which systems work (and stay in the network) and which don't makes maintaining a network tough (i.e., needs to be removed from network). Challenges include unreliable communication routes between systems and mis-reporting systems.
Solving BGP can let us construct machine learning solutions without single points of failure or trusted central entities. One server hosts model parameters while numerous workers train the model. This study describes fault-tolerant Distributed Byzantine Machine Learning.
Bitcoin invented a mechanism for a distributed network of nodes to agree on which transactions should go into the distributed ledger (blockchain) without a trusted central body. It solved BGP implementation. Satoshi Nakamoto, the pseudonymous bitcoin creator, solved the challenge by cleverly combining cryptography and consensus mechanisms.
Disclaimer
This is not financial advice. It discusses a unique computer science solution.
Bitcoin
Bitcoin's white paper begins:
“A purely peer-to-peer version of electronic cash would allow online payments to be sent directly from one party to another without going through a financial institution.” Source: https://www.ussc.gov/sites/default/files/pdf/training/annual-national-training-seminar/2018/Emerging_Tech_Bitcoin_Crypto.pdf
Bitcoin's main parts:
The open-source and versioned bitcoin software that governs how nodes, miners, and the bitcoin token operate.
The native kind of token, known as a bitcoin token, may be created by mining (up to 21 million can be created), and it can be transferred between wallet addresses in the bitcoin network.
Distributed Ledger, which contains exact copies of the database (or "blockchain") containing each transaction since the first one in January 2009.
distributed network of nodes (computers) running the distributed ledger replica together with the bitcoin software. They broadcast the transactions to other peer nodes after validating and accepting them.
Proof of work (PoW) is a cryptographic requirement that must be met in order for a miner to be granted permission to add a new block of transactions to the blockchain of the cryptocurrency bitcoin. It takes the form of a valid hash digest. In order to produce new blocks on average every 10 minutes, Bitcoin features a built-in difficulty adjustment function that modifies the valid hash requirement (length of nonce). PoW requires a lot of energy since it must continually generate new hashes at random until it satisfies the criteria.
The competing parties known as miners carry out continuous computing processing to address recurrent cryptography issues. Transaction fees and some freshly minted (mined) bitcoin are the rewards they receive. The amount of hashes produced each second—or hash rate—is a measure of mining capacity.
Cryptography, decentralization, and the proof-of-work consensus method are Bitcoin's most unique features.
Bitcoin uses encryption
Bitcoin employs this established cryptography.
Hashing
digital signatures based on asymmetric encryption
Hashing (SHA-256) (SHA-256)
Hashing converts unique plaintext data into a digest. Creating the plaintext from the digest is impossible. Bitcoin miners generate new hashes using SHA-256 to win block rewards.
A new hash is created from the current block header and a variable value called nonce. To achieve the required hash, mining involves altering the nonce and re-hashing.
The block header contains the previous block hash and a Merkle root, which contains hashes of all transactions in the block. Thus, a chain of blocks with increasing hashes links back to the first block. Hashing protects new transactions and makes the bitcoin blockchain immutable. After a transaction block is mined, it becomes hard to fabricate even a little entry.
Asymmetric Cryptography Digital Signatures
Asymmetric cryptography (public-key encryption) requires each side to have a secret and public key. Public keys (wallet addresses) can be shared with the transaction party, but private keys should not. A message (e.g., bitcoin payment record) can only be signed by the owner (sender) with the private key, but any node or anybody with access to the public key (visible in the blockchain) can verify it. Alex will submit a digitally signed transaction with a desired amount of bitcoin addressed to Bob's wallet to a node to send bitcoin to Bob. Alex alone has the secret keys to authorize that amount. Alex's blockchain public key allows anyone to verify the transaction.
Solution
Now, apply bitcoin to BGP. BGP generals resemble bitcoin nodes. The generals' consensus is like bitcoin nodes' blockchain block selection. Bitcoin software on all nodes can:
Check transactions (i.e., validate digital signatures)
2. Accept and propagate just the first miner to receive the valid hash and verify it accomplished the task. The only way to guess the proper hash is to brute force it by repeatedly producing one with the fixed/current block header and a fresh nonce value.
Thus, PoW and a dispersed network of nodes that accept blocks from miners that solve the unfalsifiable cryptographic challenge solve consensus.
Suppose:
Unreliable nodes
Unreliable miners
Bitcoin accepts the longest chain if rogue nodes cause divergence in accepted blocks. Thus, rogue nodes must outnumber honest nodes in accepting/forming the longer chain for invalid transactions to reach the blockchain. As of November 2022, 7000 coordinated rogue nodes are needed to takeover the bitcoin network.
Dishonest miners could also try to insert blocks with falsified transactions (double spend, reverse, censor, etc.) into the chain. This requires over 50% (51% attack) of miners (total computational power) to outguess the hash and attack the network. Mining hash rate exceeds 200 million (source). Rewards and transaction fees encourage miners to cooperate rather than attack. Quantum computers may become a threat.
Visit my Quantum Computing post.
Quantum computers—what are they? Quantum computers will have a big influence. towardsdatascience.com
Nodes have more power than miners since they can validate transactions and reject fake blocks. Thus, the network is secure if honest nodes are the majority.
Summary
Table 1 compares three Byzantine Generals Problem implementations.
Bitcoin white paper and implementation solved the consensus challenge of distributed systems without central governance. It solved the illusive Byzantine Generals Problem.
Resources
Resources
Source-code for Bitcoin Core Software — https://github.com/bitcoin/bitcoin
Bitcoin white paper — https://bitcoin.org/bitcoin.pdf
https://www.microsoft.com/en-us/research/publication/byzantine-generals-problem/
https://www.microsoft.com/en-us/research/uploads/prod/2016/12/The-Byzantine-Generals-Problem.pdf
Genuinely Distributed Byzantine Machine Learning, El-Mahdi El-Mhamdi et al., 2020. ACM, New York, NY, https://doi.org/10.1145/3382734.3405695

Jerry Keszka
3 years ago
10 Crazy Useful Free Websites No One Told You About But You Needed
The internet is a massive information resource. With so much stuff, it's easy to forget about useful websites. Here are five essential websites you may not have known about.
1. Companies.tools
Companies.tools are what successful startups employ. This website offers a curated selection of design, research, coding, support, and feedback resources. Ct has the latest app development platform and greatest client feedback method.
2. Excel Formula Bot
Excel Formula Bot can help if you forget a formula. Formula Bot uses AI to convert text instructions into Excel formulas, so you don't have to remember them.
Just tell the Bot what to do, and it will do it. Excel Formula Bot can calculate sales tax and vacation days. When you're stuck, let the Bot help.
3.TypeLit
TypeLit helps you improve your typing abilities while reading great literature.
TypeLit.io lets you type any book or dozens of preset classics. TypeLit provides real-time feedback on accuracy and speed.
Goals and progress can be tracked. Why not improve your typing and learn great literature with TypeLit?
4. Calm Schedule
Finding a meeting time that works for everyone is difficult. Personal and business calendars might be difficult to coordinate.
Synchronize your two calendars to save time and avoid problems. You may avoid searching through many calendars for conflicts and keep your personal information secret. Having one source of truth for personal and work occasions will help you never miss another appointment.
https://calmcalendar.com/
5. myNoise
myNoise makes the outside world quieter. myNoise is the right noise for a noisy office or busy street.
If you can't locate the right noise, make it. MyNoise unlocks the world. Shut out distractions. Thank your ears.
6. Synthesia
Professional videos require directors, filmmakers, editors, and animators. Now, thanks to AI, you can generate high-quality videos without video editing experience.
AI avatars are crucial. You can design a personalized avatar using a web-based software like synthesia.io. Our avatars can lip-sync in over 60 languages, so you can make worldwide videos. There's an AI avatar for every video goal.
Not free. Amazing service, though.
7. Cleaning-up-images
Have you shot a wonderful photo just to notice something in the background? You may have a beautiful headshot but wish to erase an imperfection.
Cleanup.pictures removes undesirable objects from photos. Our algorithms will eliminate the selected object.
Cleanup.pictures can help you obtain the ideal shot every time. Next time you take images, let Cleanup.pictures fix any flaws.
8. PDF24 Tools
Editing a PDF can be a pain. Most of us don't know Adobe Acrobat's functionalities. Why buy something you'll rarely use? Better options exist.
PDF24 is an online PDF editor that's free and subscription-free. Rotate, merge, split, compress, and convert PDFs in your browser. PDF24 makes document signing easy.
Upload your document, sign it (or generate a digital signature), and download it. It's easy and free. PDF24 is a free alternative to pricey PDF editing software.
9. Class Central
Finding online classes is much easier. Class Central has classes from Harvard, Stanford, Coursera, Udemy, and Google, Amazon, etc. in one spot.
Whether you want to acquire a new skill or increase your knowledge, you'll find something. New courses bring variety.
10. Rome2rio
Foreign travel offers countless transport alternatives. How do you get from A to B? It’s easy!
Rome2rio will show you the best method to get there, including which mode of transport is ideal.
Plane
Car
Train
Bus
Ferry
Driving
Shared bikes
Walking
Do you know any free, useful websites?

Scott Galloway
3 years ago
First Health
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.
