You Misunderstand the Russian Nuclear Threat
Many believe Putin is simply sabre rattling and intimidating us. They see no threat of nuclear war. We can send NATO troops into Ukraine without risking a nuclear war.
I keep reading that Putin is just using nuclear blackmail and that a strong leader will call the bluff. That, in my opinion, misunderstands the danger of sending NATO into Ukraine.
It assumes that once NATO moves in, Putin can either push the red nuclear button or not.
Sure, Putin won't go nuclear if NATO invades Ukraine. So we're safe? Can't we just move NATO?
No, because history has taught us that wars often escalate far beyond our initial expectations. One domino falls, knocking down another. That's why having clear boundaries is vital. Crossing a seemingly harmless line can set off a chain of events that are unstoppable once started.
One example is WWI. The assassin of Archduke Franz Ferdinand could not have known that his actions would kill millions. They couldn't have known that invading Serbia to punish them for not handing over the accomplices would start a world war. Every action triggered a counter-action, plunging Europe into a brutal and bloody war. Each leader saw their actions as limited, not realizing how they kept the dominos falling.
Nobody can predict the future, but it's easy to imagine how NATO intervention could trigger a chain of events leading to a total war. Let me suggest some outcomes.
NATO creates a no-fly-zone. In retaliation, Russia bombs NATO airfields. Russia may see this as a limited counter-move that shouldn't cause further NATO escalation. They think it's a reasonable response to force NATO out of Ukraine. Nobody has yet thought to use the nuke.
Will NATO act? Polish airfields bombed, will they be stuck? Is this an article 5 event? If so, what should be done?
It could happen. Maybe NATO sends troops into Ukraine to punish Russia. Maybe NATO will bomb Russian airfields.
Putin's response Is bombing Russian airfields an invasion or an attack? Remember that Russia has always used nuclear weapons for defense, not offense. But let's not panic, let's assume Russia doesn't go nuclear.
Maybe Russia retaliates by attacking NATO military bases with planes. Maybe they use ships to attack military targets. How does NATO respond? Will they fight Russia in Ukraine or escalate? Will they invade Russia or attack more military installations there?
Seen the pattern? As each nation responds, smaller limited military operations can grow in scope.
So far, the Russian military has shown that they begin with less brutal methods. As losses and failures increase, brutal means are used. Syria had the same. Assad used chemical weapons and attacked hospitals, schools, residential areas, etc.
A NATO invasion of Ukraine would cost Russia dearly. “Oh, this isn't looking so good, better pull out and finish this war,” do you think? No way. Desperate, they will resort to more brutal tactics. If desperate, Russia has a huge arsenal of ugly weapons. They have nerve agents, chemical weapons, and other nasty stuff.
What happens if Russia uses chemical weapons? What if Russian nerve agents kill NATO soldiers horribly? West calls for retaliation will grow. Will we invade Russia? Will we bomb them?
We are angry and determined to punish war criminal Putin, so NATO tanks may be heading to Moscow. We want vengeance for his chemical attacks and bombing of our cities.
Do you think the distance between that red nuclear button and Putin's finger will be that far once NATO tanks are on their way to Moscow?
We might avoid a nuclear apocalypse. A NATO invasion force or even Western cities may be used by Putin. Not as destructive as ICBMs. Putin may think we won't respond to tactical nukes with a full nuclear counterattack. Why would we risk a nuclear Holocaust by launching ICBMs on Russia?
Maybe. My point is that at every stage of the escalation, one party may underestimate the other's response. This war is spiraling out of control and the chances of a nuclear exchange are increasing. Nobody really wants it.
Fear, anger, and resentment cause it. If Putin and his inner circle decide their time is up, they may no longer care about the rest of the world. We saw it with Hitler. Hitler, seeing the end of his empire, ordered the destruction of Germany. Nobody should win if he couldn't. He wanted to destroy everything, including Paris.
In other words, the danger isn't what happens after NATO intervenes The danger is the potential chain reaction. Gambling has a psychological equivalent. It's best to exit when you've lost less. We humans are willing to take small risks for big rewards. To avoid losses, we are willing to take high risks. Daniel Kahneman describes this behavior in his book Thinking, Fast and Slow.
And so bettors who have lost a lot begin taking bigger risks to make up for it. We get a snowball effect. NATO involvement in the Ukraine conflict is akin to entering a casino and placing a bet. We'll start taking bigger risks as we start losing to Russian retaliation. That's the game's psychology.
It's impossible to stop. So will politicians and citizens from both Russia and the West, until we risk the end of human civilization.
You can avoid spiraling into ever larger bets in the Casino by drawing a hard line and declaring “I will not enter that Casino.” We're doing it now. We supply Ukraine. We send money and intelligence but don't cross that crucial line.
It's difficult to watch what happened in Bucha without demanding NATO involvement. What should we do? Of course, I'm not in charge. I'm a writer. My hope is that people will think about the consequences of the actions we demand. My hope is that you think ahead not just one step but multiple dominos.
More and more, we are driven by our emotions. We cannot act solely on emotion in matters of life and death. If we make the wrong choice, more people will die.
Read the original post here.
More on Current Events
Bloomberg
3 years ago
Expulsion of ten million Ukrainians
According to recent data from two UN agencies, ten million Ukrainians have been displaced.
The International Organization for Migration (IOM) estimates nearly 6.5 million Ukrainians have relocated. Most have fled the war zones around Kyiv and eastern Ukraine, including Dnipro, Zhaporizhzhia, and Kharkiv. Most IDPs have fled to western and central Ukraine.
Since Russia invaded on Feb. 24, 3.6 million people have crossed the border to seek refuge in neighboring countries, according to the latest UN data. While most refugees have fled to Poland and Romania, many have entered Russia.
Internally displaced figures are IOM estimates as of March 19, based on 2,000 telephone interviews with Ukrainians aged 18 and older conducted between March 9-16. The UNHCR compiled the figures for refugees to neighboring countries on March 21 based on official border crossing data and its own estimates. The UNHCR's top-line total is lower than the country totals because Romania and Moldova totals include people crossing between the two countries.
Sources: IOM, UNHCR
According to IOM estimates based on telephone interviews with a representative sample of internally displaced Ukrainians, over 53% of those displaced are women, and over 60% of displaced households have children.
Jared A. Brock
3 years ago
Here is the actual reason why Russia invaded Ukraine
Democracy's demise
Our Ukrainian brothers and sisters are being attacked by a far superior force.
It's the biggest invasion since WWII.
43.3 million peaceful Ukrainians awoke this morning to tanks, mortars, and missiles. Russia is already 15 miles away.
America and the West will not deploy troops.
They're sanctioning. Except railways. And luxuries. And energy. Diamonds. Their dependence on Russian energy exports means they won't even cut Russia off from SWIFT.
Ukraine is desperate enough to hand out guns on the street.
France, Austria, Turkey, and the EU are considering military aid, but Ukraine will fall without America or NATO.
The Russian goal is likely to encircle Kyiv and topple Zelenskyy's government. A proxy power will be reinstated once Russia has total control.
“Western security services believe Putin intends to overthrow the government and install a puppet regime,” says Financial Times foreign affairs commentator Gideon Rachman. This “decapitation” strategy includes municipalities. Ukrainian officials are being targeted for arrest or death.”
Also, Putin has never lost a war.
Why is Russia attacking Ukraine?
Putin, like a snowflake college student, “feels unsafe.”
Why?
Because Ukraine is full of “Nazi ideas.”
Putin claims he has felt threatened by Ukraine since the country's pro-Putin leader was ousted and replaced by a popular Jewish comedian.
Hee hee
He fears a full-scale enemy on his doorstep if Ukraine joins NATO. But he refuses to see it both ways. NATO has never invaded Russia, but Russia has always stolen land from its neighbors. Can you blame them for joining a mutual defense alliance when a real threat exists?
Nations that feel threatened can join NATO. That doesn't justify an attack by Russia. It allows them to defend themselves. But NATO isn't attacking Moscow. They aren't.
Russian President Putin's "special operation" aims to de-Nazify the Jewish-led nation.
To keep Crimea and the other two regions he has already stolen, he wants Ukraine undefended by NATO.
(Warlords have fought for control of the strategically important Crimea for over 2,000 years.)
Putin wants to own all of Ukraine.
Why?
The Black Sea is his goal.
Ports bring money and power, and Ukraine pipelines transport Russian energy products.
Putin wants their wheat, too — with 70% crop coverage, Ukraine would be their southern breadbasket, and Russia has no qualms about starving millions of Ukrainians to death to feed its people.
In the end, it's all about greed and power.
Putin wants to own everything Russia has ever owned. This year he turns 70, and he wants to be remembered like his hero Peter the Great.
In order to get it, he's willing to kill thousands of Ukrainians
Art imitates life
This story began when a Jewish TV comedian portrayed a teacher elected President after ranting about corruption.
Servant of the People, the hit sitcom, is now the leading centrist political party.
Right, President Zelenskyy won the hearts and minds of Ukrainians by imagining a fairer world.
A fair fight is something dictators, corporatists, monopolists, and warlords despise.
Now Zelenskyy and his people will die, allowing one of history's most corrupt leaders to amass even more power.
The poor always lose
Meanwhile, the West will impose economic sanctions on Russia.
China is likely to step in to help Russia — or at least the wealthy.
The poor and working class in Russia will suffer greatly if there is a hard crash or long-term depression.
Putin's friends will continue to drink champagne and eat caviar.
Russia cutting off oil, gas, and fertilizer could cause more inflation and possibly a recession if it cuts off supplies to the West. This causes more suffering and hardship for the Western poor and working class.
Why? a billionaire sociopath gets his dirt.
Yes, Russia is simply copying America. Some of us think all war is morally wrong, regardless of who does it.
But let's not kid ourselves right now.
The markets rallied after the biggest invasion in Europe since WWII.
Investors hope Ukraine collapses and Russian oil flows.
Unbridled capitalists value lifeless.
What we can do about Ukraine
When the Russian army invaded eastern Finland, my wife's grandmother fled as a child. 80 years later, Russia still has Karelia.
Russia invaded Ukraine today to retake two eastern provinces.
History has taught us nothing.
Past mistakes won't fix the future.
Instead, we should try:
- Pray and/or meditate on our actions with our families.
- Stop buying Russian products (vodka, obviously, but also pay more for hydro/solar/geothermal/etc.)
- Stop wasting money on frivolous items and donate it to Ukrainian charities.
Here are 35+ places to donate.
- To protest, gather a few friends, contact the media, and shake signs in front of the Russian embassy.
- Prepare to welcome refugees.
More war won't save the planet or change hearts.
Only love can work.
Will Lockett
3 years ago
Russia's nukes may be useless
Russia's nuclear threat may be nullified by physics.
Putin seems nostalgic and wants to relive the Cold War. He's started a deadly war to reclaim the old Soviet state of Ukraine and is threatening the West with nuclear war. NATO can't risk starting a global nuclear war that could wipe out humanity to support Ukraine's independence as much as they want to. Fortunately, nuclear physics may have rendered Putin's nuclear weapons useless. However? How will Ukraine and NATO react?
To understand why Russia's nuclear weapons may be ineffective, we must first know what kind they are.
Russia has the world's largest nuclear arsenal, with 4,447 strategic and 1,912 tactical weapons (all of which are ready to be rolled out quickly). The difference between these two weapons is small, but it affects their use and logistics. Strategic nuclear weapons are ICBMs designed to destroy a city across the globe. Russia's ICBMs have many designs and a yield of 300–800 kilotonnes. 300 kilotonnes can destroy Washington. Tactical nuclear weapons are smaller and can be fired from artillery guns or small truck-mounted missile launchers, giving them a 1,500 km range. Instead of destroying a distant city, they are designed to eliminate specific positions, bases, or military infrastructure. They produce 1–50 kilotonnes.
These two nuclear weapons use different nuclear reactions. Pure fission bombs are compact enough to fit in a shell or small missile. All early nuclear weapons used this design for their fission bombs. This technology is inefficient for bombs over 50 kilotonnes. Larger bombs are thermonuclear. Thermonuclear weapons use a small fission bomb to compress and heat a hydrogen capsule, which undergoes fusion and releases far more energy than ignition fission reactions, allowing for effective giant bombs.
Here's Russia's issue.
A thermonuclear bomb needs deuterium (hydrogen with one neutron) and tritium (hydrogen with two neutrons). Because these two isotopes fuse at lower energies than others, the bomb works. One problem. Tritium is highly radioactive, with a half-life of only 12.5 years, and must be artificially made.
Tritium is made by irradiating lithium in nuclear reactors and extracting the gas. Tritium is one of the most expensive materials ever made, at $30,000 per gram.
Why does this affect Putin's nukes?
Thermonuclear weapons need tritium. Tritium decays quickly, so they must be regularly refilled at great cost, which Russia may struggle to do.
Russia has a smaller economy than New York, yet they are running an invasion, fending off international sanctions, and refining tritium for 4,447 thermonuclear weapons.
The Russian military is underfunded. Because the state can't afford it, Russian troops must buy their own body armor. Arguably, Putin cares more about the Ukraine conflict than maintaining his nuclear deterrent. Putin will likely lose power if he loses the Ukraine war.
It's possible that Putin halted tritium production and refueling to save money for Ukraine. His threats of nuclear attacks and escalating nuclear war may be a bluff.
This doesn't help Ukraine, sadly. Russia's tactical nuclear weapons don't need expensive refueling and will help with the invasion. So Ukraine still risks a nuclear attack. The bomb that destroyed Hiroshima was 15 kilotonnes, and Russia's tactical Iskander-K nuclear missile has a 50-kiloton yield. Even "little" bombs are deadly.
We can't guarantee it's happening in Russia. Putin may prioritize tritium. He knows the power of nuclear deterrence. Russia may have enough tritium for this conflict. Stockpiling a material with a short shelf life is unlikely, though.
This means that Russia's most powerful weapons may be nearly useless, but they may still be deadly. If true, this could allow NATO to offer full support to Ukraine and push the Russian tyrant back where he belongs. If Putin withholds funds from his crumbling military to maintain his nuclear deterrent, he may be willing to sink the ship with him. Let's hope the former.
You might also like
Tomas Pueyo
2 years ago
Soon, a Starship Will Transform Humanity
SpaceX's Starship.
Launched last week.
Four minutes in:
SpaceX will succeed. When it does, its massiveness will matter.
Its payload will revolutionize space economics.
Civilization will shift.
We don't yet understand how this will affect space and Earth culture. Grab it.
The Cost of Space Transportation Has Decreased Exponentially
Space launches have increased dramatically in recent years.
We mostly send items to LEO, the green area below:
SpaceX's reusable rockets can send these things to LEO. Each may launch dozens of payloads into space.
With all these launches, we're sending more than simply things to space. Volume and mass. Since the 1980s, launching a kilogram of payload to LEO has become cheaper:
One kilogram in a large rocket cost over $75,000 in the 1980s. Carrying one astronaut cost nearly $5M! Falcon Heavy's $1,500/kg price is 50 times lower. SpaceX's larger, reusable rockets are amazing.
SpaceX's Starship rocket will continue. It can carry over 100 tons to LEO, 50% more than the current Falcon heavy. Thousands of launches per year. Elon Musk predicts Falcon Heavy's $1,500/kg cost will plummet to $100 in 23 years.
In context:
People underestimate this.
2. The Benefits of Affordable Transportation
Compare Earth's transportation costs:
It's no surprise that the US and Northern Europe are the wealthiest and have the most navigable interior waterways.
So what? since sea transportation is cheaper than land. Inland waterways are even better than sea transportation since weather is less of an issue, currents can be controlled, and rivers serve two banks instead of one for coastal transportation.
In France, because population density follows river systems, rivers are valuable. Cheap transportation brought people and money to rivers, especially their confluences.
How come? Why were humans surrounding rivers?
Imagine selling meat for $10 per kilogram. Transporting one kg one kilometer costs $1. Your margin decreases $1 each kilometer. You can only ship 10 kilometers. For example, you can only trade with four cities:
If instead, your cost of transportation is half, what happens? It costs you $0.5 per km. You now have higher margins with each city you traded with. More importantly, you can reach 20-km markets.
However, 2x distance 4x surface! You can now trade with sixteen cities instead of four! Metcalfe's law states that a network's value increases with its nodes squared. Since now sixteen cities can connect to yours. Each city now has sixteen connections! They get affluent and can afford more meat.
Rivers lower travel costs, connecting many cities, which can trade more, get wealthy, and buy more.
The right network is worth at least an order of magnitude more than the left! The cheaper the transport, the more trade at a lower cost, the more income generated, the more that wealth can be reinvested in better canals, bridges, and roads, and the wealth grows even more.
Throughout history. Rome was established around cheap Mediterranean transit and preoccupied with cutting overland transportation costs with their famous roadways. Communications restricted their empire.
The Egyptians lived around the Nile, the Vikings around the North Sea, early Japan around the Seto Inland Sea, and China started canals in the 5th century BC.
Transportation costs shaped empires.Starship is lowering new-world transit expenses. What's possible?
3. Change Organizations, Change Companies, Change the World
Starship is a conveyor belt to LEO. A new world of opportunity opens up as transportation prices drop 100x in a decade.
Satellite engineers have spent decades shedding milligrams. Weight influenced every decision: pricing structure, volumes to be sent, material selections, power sources, thermal protection, guiding, navigation, and control software. Weight was everything in the mission. To pack as much science into every millimeter, NASA missions had to be miniaturized. Engineers were indoctrinated against mass.
No way.
Starship is not constrained by any space mission, robotic or crewed.
Starship obliterates the mass constraint and every last vestige of cultural baggage it has gouged into the minds of spacecraft designers. A dollar spent on mass optimization no longer buys a dollar saved on launch cost. It buys nothing. It is time to raise the scope of our ambition and think much bigger. — Casey Handmer, Starship is still not understood
A Tesla Roadster in space makes more sense.
It went beyond bad PR. It told the industry: Did you care about every microgram? No more. My rockets are big enough to send a Tesla without noticing. Industry watchers should have noticed.
Most didn’t. Artemis is a global mission to send astronauts to the Moon and build a base. Artemis uses disposable Space Launch System rockets. Instead of sending two or three dinky 10-ton crew habitats over the next decade, Starship might deliver 100x as much cargo and create a base for 1,000 astronauts in a year or two. Why not? Because Artemis remains in a pre-Starship paradigm where each kilogram costs a million dollars and we must aggressively descope our objective.
Space agencies can deliver 100x more payload to space for the same budget with 100x lower costs and 100x higher transportation volumes. How can space economy saturate this new supply?
Before Starship, NASA supplied heavy equipment for Moon base construction. After Starship, Caterpillar and Deere may space-qualify their products with little alterations. Instead than waiting decades for NASA engineers to catch up, we could send people to build a space outpost with John Deere equipment in a few years.
History is littered with the wreckage of former industrial titans that underestimated the impact of new technology and overestimated their ability to adapt: Blockbuster, Motorola, Kodak, Nokia, RIM, Xerox, Yahoo, IBM, Atari, Sears, Hitachi, Polaroid, Toshiba, HP, Palm, Sony, PanAm, Sega, Netscape, Compaq, GM… — Casey Handmer, Starship is still not understood
Everyone saw it coming, but senior management failed to realize that adaption would involve moving beyond their established business practice. Others will if they don't.
4. The Starship Possibilities
It's Starlink.
SpaceX invented affordable cargo space and grasped its implications first. How can we use all this inexpensive cargo nobody knows how to use?
Satellite communications seemed like the best way to capitalize on it. They tried. Starlink, designed by SpaceX, provides fast, dependable Internet worldwide. Beaming information down is often cheaper than cable. Already profitable.
Starlink is one use for all this cheap cargo space. Many more. The longer firms ignore the opportunity, the more SpaceX will acquire.
What are these chances?
Satellite imagery is outdated and lacks detail. We can improve greatly. Synthetic aperture radar can take beautiful shots like this:
Have you ever used Google Maps and thought, "I want to see this in more detail"? What if I could view Earth live? What if we could livestream an infrared image of Earth?
We could launch hundreds of satellites with such mind-blowing visual precision of the Earth that we would dramatically improve the accuracy of our meteorological models; our agriculture; where crime is happening; where poachers are operating in the savannah; climate change; and who is moving military personnel where. Is that useful?
What if we could see Earth in real time? That affects businesses? That changes society?
Katharine Valentino
3 years ago
A Gun-toting Teacher Is Like a Cook With Rat Poison
Pink or blue AR-15s?
A teacher teaches; a gun kills. Killing isn't teaching. Killing is opposite of teaching.
Without 27 school shootings this year, we wouldn't be talking about arming teachers. Gun makers, distributors, and the NRA cause most school shootings. Gun makers, distributors, and the NRA wouldn't be huge business if weapons weren't profitable.
Guns, ammo, body armor, holsters, concealed carriers, bore sights, cleaner kits, spare magazines and speed loaders, gun safes, and ear protection are sold. And more guns.
And lots more profit.
Guns aren't bread. You eat a loaf of bread in a week or so and then must buy more. Bread makers will make money. Winchester 94.30–30 1899 Lever Action Rifle from 1894 still kills. (For safety, I won't link to the ad.) Gun makers don't object if you collect antique weapons, but they need you to buy the latest, in-style killing machine. The youngster who killed 19 students and 2 teachers at Robb Elementary School in Uvalde, Texas, used an AR-15. Better yet, two.
Salvador Ramos, the Robb Elementary shooter, is a "killing influencer" He pushes consumers to buy items, which benefits manufacturers and distributors. Like every previous AR-15 influencer, he profits Colt, the rifle's manufacturer, and 52,779 gun dealers in the U.S. Ramos and other AR-15 influences make us fear for our safety and our children's. Fearing for our safety, we acquire 20 million firearms a year and live in a gun culture.
So now at school, we want to arm teachers.
Consider. Which of your teachers would you have preferred in body armor with a gun drawn?
Miss Summers? Remember her bringing daisies from her yard to second grade? She handed each student a beautiful flower. Miss Summers loved everyone, even those with AR-15s. She can't shoot.
Frasier? Mr. Frasier turned a youngster over down to explain "invert." Mr. Frasier's hands shook when he wasn't flipping fifth-graders and fractions. He may have shot wrong.
Mrs. Barkley barked in high school English class when anyone started an essay with "But." Mrs. Barkley dubbed Abie a "Jewboy" and gave him terrible grades. Arming Miss Barkley is like poisoning the chef.
Think back. Do you remember a teacher with a gun? No. Arming teachers so the gun industry can make more money is the craziest idea ever.
Or maybe you agree with Ted Cruz, the gun lobby-bought senator, that more guns reduce gun violence. After the next school shooting, you'll undoubtedly talk about arming teachers and pupils. Colt will likely develop a backpack-sized, lighter version of its popular killing machine in pink and blue for kids and boys. The MAR-15? (M for mini).
This post is a summary. Read the full one here.
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.