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.

It's kids' digital crack

TikTok is a destructive social media platform.

• The interface shortens attention spans and dopamine receptors.

• TikTok shares more data than other apps.

• Seeing an endless stream of dancing teens on my glowing box makes me feel like a Blade Runner extra.

TikTok did in one year what MTV, Hollywood, and Warner Music tried to do in 20 years. TikTok has psychotized the two-thirds of society Aldous Huxley said were hypnotizable.

Millions of people, mostly kids, are addicted to learning a new dance, lip-sync, or prank, and those who best dramatize this collective improvisation get likes, comments, and shares.

TikTok is a great app. So what?

The Commercial Magnifying Glass TikTok made me realize my generation's time was up and the teenage Zoomers were the target.

I told my 14-year-old sister, "Enjoy your time under the commercial magnifying glass."

TikTok sells your every move, gesture, and thought. Data is the new oil. If you tell someone, they'll say, "Yeah, they collect data, but who cares? I have nothing to hide."

It's a George Orwell novel's beginning. Look up Big Brother Award winners to see if TikTok won.

TikTok shares your data more than any other social media app, and where it goes is unclear. TikTok uses third-party trackers to monitor your activity after you leave the app.

Consumers can't see what data is shared or how it will be used. — Genius URL

32.5 percent of Tiktok's users are 10 to 19 and 29.5% are 20 to 29.

TikTok is the greatest digital marketing opportunity in history, and they'll use it to sell you things, track you, and control your thoughts. Any of its users will tell you, "I don't care, I just want to be famous."

TikTok manufactures mental illness

TikTok's effect on dopamine and the brain is absurd. Dopamine controls the brain's pleasure and reward centers. It's like a switch that tells your brain "this feels good, repeat."

Dr. Julie Albright, a digital culture and communication sociologist, said TikTok users are "carried away by dopamine." It's hypnotic, you'll keep watching."

TikTok constantly releases dopamine. A guy on TikTok recently said he didn't like books because they were slow and boring.

The US didn't ban Tiktok.

Biden and Trump agree on bad things. Both agree that TikTok threatens national security and children's mental health.

The Chinese Communist Party owns and operates TikTok, but that's not its only problem.

• There’s borderline child porn on TikTok

• It's unsafe for children and violated COPPA.

• It's also Chinese spyware. I'm not a Trump supporter, but I was glad he wanted TikTok regulated and disappointed when he failed.

Full-on internet censorship is rare outside of China, so banning it may be excessive. US should regulate TikTok more.

We must reject a low-quality present for a high-quality future.

TikTok vs YouTube

People got mad when I wrote about YouTube's death.

They didn't like when I said TikTok was YouTube's first real challenger.

Indeed. TikTok is the fastest-growing social network. In three years, the Chinese social media app TikTok has gained over 1 billion active users. In the first quarter of 2020, it had the most downloads of any app in a single quarter.

TikTok is the perfect social media app in many ways. It's brief and direct.

Can you believe they had a YouTube vs TikTok boxing match? We are doomed as a species.

YouTube hosts my favorite videos. That’s why I use it. That’s why you use it. New users expect more. They want something quicker, more addictive.

TikTok's impact on other social media platforms frustrates me. YouTube copied TikTok to compete.

It's all about short, addictive content.

I'll admit I'm probably wrong about TikTok. My friend says his feed is full of videos about food, cute animals, book recommendations, and hot lesbians.

Whatever.

TikTok makes us bad

TikTok is the opposite of what the Ancient Greeks believed about wisdom.

It encourages people to be fake. It's like a never-ending costume party where everyone competes.

It does not mean that Gen Z is doomed.

They could be the saviors of the world for all I know.

TikTok feels like a step towards Mike Judge's "Idiocracy," where the average person is a pleasure-seeking moron.

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.

People don’t believe in influencers anymore; they need people like you.

Social media influencers have dominated for years. We've seen videos, images, and articles of *famous* individuals unwrapping, reviewing, and endorsing things.

This industry generates billions. This year, marketers spent $2.23 billion on Instagram, $1 million on Youtube, and $775 million on Tiktok. This marketing has helped start certain companies.

Influencers are dying, so ordinary people like us may take over this billion-dollar sector. Why?

Why influencers are perishing

Most influencers lie to their fans, especially on Instagram. Influencers' first purpose was to make their lives so flawless that others would want to buy their stuff.

In 2015, an Australian influencer with 600,000 followers went viral for revealing all her photos and everything she did to seem great before deleting her account.

“I dramatically edited the pictures, I manipulated the environements, and made my life look perfect in social media… I remember I obsessively checked the like count for a full week since uploading it, a selfie that now has close to 2,500 likes. It got 5 likes. This was when I was so hungry for social media validation … This was the reason why I quit social media: for me, personally, it consumed me. I wasn’t living in a 3D world.”

Influencers then lost credibility.

Influencers seem to live in a bubble, separate from us. Thanks to self-popularity love's and constant awareness campaigns, people find these people ridiculous.

Influencers are praised more for showing themselves as natural and common than for showing luxuries and lies.

Little by little, they are dying, making room for a new group to take advantage of this multi-million dollar business, which gives us (ordinary people) a big opportunity to grow on any content creation platform we want.

Why this is your chance to develop on any platform for creating content

In 2021, I wrote “Not everyone who talks about money is a Financial Advisor, be careful of who you take advice from,”. In it, I warned that not everyone with a large following is a reputable source of financial advice.

Other writers hated this post and said I was wrong.

People don't want Jeff Bezos or Elon Musk's counsel, they said. They prefer to hear about their neighbor's restroom problems or his closest friend's terrible business.

Real advice from regular folks.

And I found this was true when I returned to my independent YouTube channel and had more than 1000 followers after having abandoned it with fewer than 30 videos in 2021 since there were already many personal finance and travel channels and I thought mine wasn't special.

People appreciated my videos because I was a 20-something girl trying to make money online, and they believed my advice more than that of influencers with thousands of followers.

I think today is the greatest time to grow on any platform as an ordinary person. Normal individuals give honest recommendations about what works for them and look easier to make because they have the same options as us.

Nobody cares how a millionaire acquired a Lamborghini unless it's entertaining. Education works now. Real counsel from average people is replicable.

Many individuals don't appreciate how false influencers seem (unreal bodies and excessive surgery and retouching) since it makes them feel uneasy.

That's why body-positive advertisements have been so effective, but they've lost ground in places like Tiktok, where the audience wants more content from everyday people than influencers living amazing lives. More people will relate to your content if you appear genuine.

Last thoughts

Influencers are dwindling. People want more real people to give real advice and demonstrate an ordinary life.

People will enjoy anything you tell about your daily life as long as you provide value, and you can build a following rapidly if you're honest.

This is a millionaire industry that is getting more expensive and will go with what works, so stand out immediately.

Canonicalization and canonical URLs are essential for SEO, and improper implementation can negatively impact your site's performance.

Canonical tags were introduced in 2009 to help webmasters with duplicate or similar content on multiple URLs.

To use canonical tags properly, you must understand their purpose, operation, and implementation.

Canonical URLs and Tags

Canonical tags tell search engines that a certain URL is a page's master copy. They specify a page's canonical URL. Webmasters can avoid duplicate content by linking to the "canonical" or "preferred" version of a page.

How are canonical tags and URLs different? Can these be specified differently?

Tags

Canonical tags are found in an HTML page's head></head> section.

<link rel="canonical" href="https://www.website.com/page/" />

These can be self-referencing or reference another page's URL to consolidate signals.

Canonical tags and URLs are often used interchangeably, which is incorrect.

The rel="canonical" tag is the most common way to set canonical URLs, but it's not the only way.

Canonical URLs

What's a canonical link? Canonical link is the'master' URL for duplicate pages.

In Google's own words:

A canonical URL is the page Google thinks is most representative of duplicate pages on your site.

— Google Search Console Help

You can indicate your preferred canonical URL. For various reasons, Google may choose a different page than you.

When set correctly, the canonical URL is usually your specified URL.

Canonical URLs determine which page will be shown in search results (unless a duplicate is explicitly better for a user, like a mobile version).

Canonical URLs can be on different domains.

Other ways to specify canonical URLs

Canonical tags are the most common way to specify a canonical URL.

You can also set canonicals by:

• Setting the HTTP header rel=canonical.

• All pages listed in a sitemap are suggested as canonicals, but Google decides which pages are duplicates.

• Redirects 301.

Google recommends these methods, but they aren't all appropriate for every situation, as we'll see below. Each has its own recommended uses.

Setting canonical URLs isn't required; if you don't, Google will use other signals to determine the best page version.

To control how your site appears in search engines and to avoid duplicate content issues, you should use canonicalization effectively.

Why Duplicate Content Exists

Before we discuss why you should use canonical URLs and how to specify them in popular CMSs, we must first explain why duplicate content exists. Nobody intentionally duplicates website content.

Content management systems create multiple URLs when you launch a page, have indexable versions of your site, or use dynamic URLs.

Assume the following URLs display the same content to a user:

1. https://www.website.com/category/product-a/

2. https://www.website.com/product-a/

3. https://website.com/product-a/

4. http://www.website.com/product-a/

5. http://website.com/product-a/

6. https://m.website.com/product-a/

7. https://www.website.com/product-a

8. https://www.website.com/product-A/

A search engine sees eight duplicate pages, not one.

• URLs #1 and #2: the CMS saves product URLs with and without the category name.

• #3, #4, and #5 result from the site being accessible via HTTP, HTTPS, www, and non-www.

• #6 is a subdomain mobile-friendly URL.

• URL #7 lacks URL #2's trailing slash.

• URL #8 uses a capital "A" instead of a lowercase one.

Duplicate content may also exist in URLs like:

https://www.website.com
https://www.website.com/index.php

Duplicate content is easy to create.

Canonical URLs help search engines identify different page variations as a single URL on many sites.

SEO Canonical URLs

Canonical URLs help you manage duplicate content that could affect site performance.

Canonical URLs are a technical SEO focus area for many reasons.

Specify URL for search results

When you set a canonical URL, you tell Google which page version to display.

Which would you click?

https://www.domain.com/page-1/

https://www.domain.com/index.php?id=2

First, probably.

Canonicals tell search engines which URL to rank.

Consolidate link signals on similar pages

When you have duplicate or nearly identical pages on your site, the URLs may get external links.

Canonical URLs consolidate multiple pages' link signals into a single URL.

This helps your site rank because signals from multiple URLs are consolidated into one.

Syndication management

Content is often syndicated to reach new audiences.

Canonical URLs consolidate ranking signals to prevent duplicate pages from ranking and ensure the original content ranks.

Avoid Googlebot duplicate page crawling

Canonical URLs ensure that Googlebot crawls your new pages rather than duplicated versions of the same one across mobile and desktop versions, for example.

Crawl budgets aren't an issue for most sites unless they have 100,000+ pages.

How to Correctly Implement the rel=canonical Tag

Using the header tag rel="canonical" is the most common way to specify canonical URLs.

Adding tags and HTML code may seem daunting if you're not a developer, but most CMS platforms allow canonicals out-of-the-box.

These URLs each have one product.

How to Correctly Implement a rel="canonical" HTTP Header

A rel="canonical" HTTP header can replace canonical tags.

This is how to implement a canonical URL for PDFs or non-HTML documents.

You can specify a canonical URL in your site's.htaccess file using the code below.

<Files "file-to-canonicalize.pdf"> Header add Link "< http://www.website.com/canonical-page/>; rel=\"canonical\"" </Files>

301 redirects for canonical URLs

Google says 301 redirects can specify canonical URLs.

Only the canonical URL will exist if you use 301 redirects. This will redirect duplicates.

This is the best way to fix duplicate content across:

• HTTPS and HTTP

• Non-WWW and WWW

• Trailing-Slash and Non-Trailing Slash URLs

On a single page, you should use canonical tags unless you can confidently delete and redirect the page.

Sitemaps' canonical URLs

Google assumes sitemap URLs are canonical, so don't include non-canonical URLs.

This does not guarantee canonical URLs, but is a best practice for sitemaps.

Best-practice Canonical Tag

Once you understand a few simple best practices for canonical tags, spotting and cleaning up duplicate content becomes much easier.

Always include:

One canonical URL per page

If you specify multiple canonical URLs per page, they will likely be ignored.

Correct Domain Protocol

If your site uses HTTPS, use this as the canonical URL. It's easy to reference the wrong protocol, so check for it to catch it early.

Trailing slash or non-trailing slash URLs

Be sure to include trailing slashes in your canonical URL if your site uses them.

Specify URLs other than WWW

Search engines see non-WWW and WWW URLs as duplicate pages, so use the correct one.

Absolute URLs

To ensure proper interpretation, canonical tags should use absolute URLs.

So use:

<link rel="canonical" href="https://www.website.com/page-a/" />

And not:

<link rel="canonical" href="/page-a/" />

If not canonicalizing, use self-referential canonical URLs.

When a page isn't canonicalizing to another URL, use self-referencing canonical URLs.

Canonical tags refer to themselves here.

Common Canonical Tags Mistakes

Here are some common canonical tag mistakes.

301 Canonicalization

Set the canonical URL as the redirect target, not a redirected URL.

Incorrect Domain Canonicalization

If your site uses HTTPS, don't set canonical URLs to HTTP.

Irrelevant Canonicalization

Canonicalize URLs to duplicate or near-identical content only.

SEOs sometimes try to pass link signals via canonical tags from unrelated content to increase rank. This isn't how canonicalization should be used and should be avoided.

Multiple Canonical URLs

Only use one canonical tag or URL per page; otherwise, they may all be ignored.

When overriding defaults in some CMSs, you may accidentally include two canonical tags in your page's <head>.

Pagination vs. Canonicalization

Incorrect pagination can cause duplicate content. Canonicalizing URLs to the first page isn't always the best solution.

Canonicalize to a 'view all' page.

How to Audit Canonical Tags (and Fix Issues)

Audit your site's canonical tags to find canonicalization issues.

SEMrush Site Audit can help. You'll find canonical tag checks in your website's site audit report.

Let's examine these issues and their solutions.

No Canonical Tag on AMP

Site Audit will flag AMP pages without canonical tags.

Canonicalization between AMP and non-AMP pages is important.

Add a rel="canonical" tag to each AMP page's head>.

No HTTPS redirect or canonical from HTTP homepage

Duplicate content issues will be flagged in the Site Audit if your site is accessible via HTTPS and HTTP.

You can fix this by 301 redirecting or adding a canonical tag to HTTP pages that references HTTPS.

Broken canonical links

Broken canonical links won't be considered canonical URLs.

This error could mean your canonical links point to non-existent pages, complicating crawling and indexing.

Update broken canonical links to the correct URLs.

Multiple canonical URLs

This error occurs when a page has multiple canonical URLs.

Remove duplicate tags and leave one.

Canonicalization is a key SEO concept, and using it incorrectly can hurt your site's performance.

Once you understand how it works, what it does, and how to find and fix issues, you can use it effectively to remove duplicate content from your site.

Canonicalization SEO Myths