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

Wish you more bang for your buck

By ‘Cost a Bomb’ I didn’t mean to exaggerate. It’s an idiom that means ‘To be very expensive’. In fact, no app on the planet costs a bomb lol.

So, to the point.

Chronicle

(Freemium. For Pro, $24.99 | Available on Setapp)

You probably have trouble keeping track of dozens of bills and subscriptions each month.

Try Chronicle.

Easy-to-use app

• Add payment due dates and receive reminders,

• Save payment documentation,

• Analyze your spending by season, year, and month.

• Observe expenditure trends and create new budgets.

Best of all, Chronicle features an integrated browser for fast payment and logging.

iOS and macOS sync.

SoundSource

($39 for lifetime)

Background Music, a free macOS program, was featured in #6 of this post last month.

It controls per-app volume, stereo balance, and audio over its max level.

Background Music is fully supported. Additionally,

• Connect various speakers to various apps (Wow! ),

• change the audio sample rate for each app,

• To facilitate access, add a floating SoundSource window.

• Use its blocks in Shortcuts app,

• On the menu bar, include meters for output/input devices and running programs.

PixelSnap

($39 for lifetime | Available on Setapp)

This software is heaven for UI designers.

It aids you.

• quickly calculate screen distances (in pixels) ,

• Drag an area around an object to determine its borders,

• Measure the distances between the additional guides,

• screenshots should be pixel-perfect.

What’s more.

You can

• Adapt your tolerance for items with poor contrast and shadows.

• Use your Touch Bar to perform important tasks, if you have one.

Mate Translation

($3.99 a month / $29.99 a year | Available on Setapp)

Mate Translate resembles a roided-up version of BarTranslate, which I wrote about in #1 of this piece last month.

If you translate often, utilize Mate Translate on macOS and Safari.

I'm really vocal about it.

It stays on the menu bar, and is accessible with a click or ⌥+shift+T hotkey.

It lets you

• Translate in 103 different languages,

• To translate text, double-click or right-click on it.

• Totally translate websites. Additionally, Netflix subtitles,

• Listen to their pronunciation to see how close it is to human.

iPhone and Mac sync Mate-ing history.

Swish

($16 for lifetime | Available on Setapp)

Swish is awesome!

Swipe, squeeze, tap, and hold movements organize chaotic desktop windows. Swish operates with mouse and trackpad.

Some gestures:

• Pinch Once: Close an app
• Pinch Twice: Quit an app
• Swipe down once: Minimise an app
• Pinch Out: Enter fullscreen mode
• Tap, Hold, & Swipe: Arrange apps in grids
and many more...

After getting acquainted to the movements, your multitasking will improve.

Unite

($24.99 for lifetime | Available on Setapp)

It turns webapps into macOS apps. The end.

Unite's functionality is a million times better.

• Provide extensive customization (incl. its icon, light and dark modes)

• make menu bar applications,

• Get badges for web notifications and automatically refresh websites,

• Replace any dock icon in the window with it (Wow!) by selecting that portion of the window.

• Use PiP (Picture-in-Picture) on video sites that support it.

• Delete advertising,

• Throughout macOS, use floating windows

and many more…

I feel $24.99 one-off for this tool is a great deal, considering all these features. What do you think?

https://www.bzgapps.com/unite

CleanShot X

(Basic: $29 one-off. Pro: $8/month | Available on Setapp)

CleanShot X can achieve things the macOS screenshot tool cannot. Complete screenshot toolkit.

CleanShot X, like Pixel Snap 2 (#3), is fantastic.

Allows

• Scroll to capture a long page,

• screen recording,

  With webcam on,
• With mic and system audio,
• Highlighting mouse clicks and hotkeys.

• Maintain floating screenshots for reference

• While capturing, conceal desktop icons and notifications.

• Recognize text in screenshots (OCR),

• You may upload and share screenshots using the built-in cloud.

These are just 6 in 50+ features, and you’re already saying Wow!

Starting a passive income stream with data science and programming

My website is fresh. But how do I monetize it?

Creating a passive-income website is difficult. Advertise first. But what useful are ads without traffic?

Let’s Generate Traffic And Put Our Programming Skills To Use

SEO boosts traffic (Search Engine Optimisation). Traffic generation is complex. Keywords matter more than text, URL, photos, etc.

My Python skills helped here. I wanted to find relevant, Google-trending keywords (tags) for my topic.

First The Code

I wrote the script below here.

import re
from string import punctuation

import nltk
from nltk import TreebankWordTokenizer, sent_tokenize
from nltk.corpus import stopwords


class KeywordsGenerator:
    def __init__(self, pytrends):
        self._pytrends = pytrends

    def generate_tags(self, file_path, top_words=30):
        file_text = self._get_file_contents(file_path)
        clean_text = self._remove_noise(file_text)
        top_words = self._get_top_words(clean_text, top_words)
        suggestions = []
        for top_word in top_words:
            suggestions.extend(self.get_suggestions(top_word))
        suggestions.extend(top_words)
        tags = self._clean_tokens(suggestions)
        return ",".join(list(set(tags)))

    def _remove_noise(self, text):
        #1. Convert Text To Lowercase and remove numbers
        lower_case_text = str.lower(text)
        just_text = re.sub(r'\d+', '', lower_case_text)
        #2. Tokenise Paragraphs To words
        list = sent_tokenize(just_text)
        tokenizer = TreebankWordTokenizer()
        tokens = tokenizer.tokenize(just_text)
        #3. Clean text
        clean = self._clean_tokens(tokens)
        return clean

    def _clean_tokens(self, tokens):
        clean_words = [w for w in tokens if w not in punctuation]
        stopwords_to_remove = stopwords.words('english')
        clean = [w for w in clean_words if w not in stopwords_to_remove and not w.isnumeric()]
        return clean

    def get_suggestions(self, keyword):
        print(f'Searching pytrends for {keyword}')
        result = []
        self._pytrends.build_payload([keyword], cat=0, timeframe='today 12-m')
        data = self._pytrends.related_queries()[keyword]['top']
        if data is None or data.values is None:
            return result
        result.extend([x[0] for x in data.values.tolist()][:2])
        return result

    def _get_file_contents(self, file_path):
        return open(file_path, "r", encoding='utf-8',errors='ignore').read()

    def _get_top_words(self, words, top):
        counts = dict()

        for word in words:
            if word in counts:
                counts[word] += 1
            else:
                counts[word] = 1

        return list({k: v for k, v in sorted(counts.items(), key=lambda item: item[1])}.keys())[:top]


if __name__ == "1__main__":
    from pytrends.request import TrendReq

    nltk.download('punkt')
    nltk.download('stopwords')
    pytrends = TrendReq(hl='en-GB', tz=360)
    tags = KeywordsGenerator(pytrends)\
              .generate_tags('text_file.txt')
    print(tags)

Then The Dependencies

This script requires:

nltk==3.7
pytrends==4.8.0

Analysis of the Script

I copy and paste my article into text file.txt, and the code returns the keywords as a comma-separated string.

To achieve this:

1. A class I made is called KeywordsGenerator.

2. This class has a function: generate_tags

3. The function generate_tags performs the following tasks:

• retrieves text file contents

• uses NLP to clean the text by tokenizing sentences into words, removing punctuation, and other elements.

• identifies the most frequent words that are relevant.

• The pytrends API is then used to retrieve related phrases that are trending for each word from Google.

• finally adds a comma to the end of the word list.

4. I then use the keywords and paste them into the SEO area of my website.

These terms are trending on Google and relevant to my topic. My site's rankings and traffic have improved since I added new keywords. This little script puts our knowledge to work. I shared the script in case anyone faces similar issues.

I hope it helps readers sell their work.

From 1984 until 2011, he ran Apple using the same template.

What is a founder CEO's most crucial skill?

Presentation, communication, and sales

As a Business Angel Investor, I saw many pitch presentations and met with investors one-on-one to promote my companies.

There is always the conception of “Investors have to invest,” so there is no need to care about the presentation.

It's false. Nobody must invest. Many investors believe that entrepreneurs must convince them to invest in their business.

Sometimes — like in 2018–2022 — too much money enters the market, and everyone makes good money.

Do you recall the Buy Now, Pay Later Movement? This amazing narrative had no return potential. Only buyers who couldn't acquire financing elsewhere shopped at these companies.

Klarna's failing business concept led to high valuations.

Investors become more cautious when the economy falters. 2022 sees rising inflation, interest rates, wars, and civil instability. It's like the apocalypse's four horsemen have arrived.

Storytelling is important in rough economies.

When investors draw back, how can entrepreneurs stand out?

In Q2/2022, every study I've read said:

Investors cease investing

Deals are down in almost all IT industries from previous quarters.

What do founders need to do?

Differentiate yourself.

Storytelling talents help.

The Steve Jobs Way

Every time I watch a Steve Jobs presentation, I'm enthralled.

I'm a techie. Everything technical interests me. But, I skim most presentations.

What's Steve Jobs's secret?

Steve Jobs created Apple in 1976 and made it a profitable software and hardware firm in the 1980s. Macintosh goods couldn't beat IBM's. This mistake sacked him in 1985.

Before rejoining Apple in 1997, Steve Jobs founded Next Inc. and Pixar.

From then on, Apple became America's most valuable firm.

Steve Jobs understood people's needs. He said:

“People don’t know what they want until you show it to them. That’s why I never rely on market research. Our task is to read things that are not yet on the page.”

In his opinion, people talk about problems. A lot. Entrepreneurs must learn what the population's pressing problems are and create a solution.

Steve Jobs showed people what they needed before they realized it.

I'll explain:

Present a Big Vision

Steve Jobs starts every presentation by describing his long-term goals for Apple.

1984's Macintosh presentation set up David vs. Goliath. In a George Orwell-style dystopia, IBM computers were bad. It was 1984.

Apple will save the world, like Jedis.

Why do customers and investors like Big Vision?

People want a wider perspective, I think. Humans love improving the planet.

Apple users often cite emotional reasons for buying the brand.

Revolutionizing several industries with breakthrough inventions

Establish Authority

Everyone knows Apple in 2022. It's hard to find folks who confuse Apple with an apple around the world.

Apple wasn't as famous as it is today until Steve Jobs left in 2011.

Most entrepreneurs lack experience. They may market their company or items to folks who haven't heard of it.

Steve Jobs presented the company's historical accomplishments to overcome opposition.

In his presentation of the first iPhone, he talked about the Apple Macintosh, which altered the computing sector, and the iPod, which changed the music industry.

People who have never heard of Apple feel like they're seeing a winner. It raises expectations that the new product will be game-changing and must-have.

The Big Reveal

A pitch or product presentation always has something new.

Steve Jobs doesn't only demonstrate the product. I don't think he'd skip the major point of a company presentation.

He consistently discusses present market solutions, their faults, and a better consumer solution.

No solution exists yet.

It's a multi-faceted play:

• It's comparing the new product to something familiar. This makes novelty and the product more relatable.

• Describe a desirable solution.

• He's funny. He demonstrated an iPod with an 80s phone dial in his iPhone presentation.

Then he reveals the new product. Macintosh presented itself.

Show the benefits

He outlines what Apple is doing differently after demonstrating the product.

How do you distinguish from others? The Big Breakthrough Presentation.

A few hundred slides might list all benefits.

Everyone would fall asleep. Have you ever had similar presentations?

When the brain is overloaded with knowledge, the limbic system changes to other duties, like lunch planning.

What should a speaker do? There's a classic proverb:

“Tell me and I forget, teach me and I may remember, involve me and I learn” (— Not Benjamin Franklin).

Steve Jobs showcased the product live.

Again, using ordinary scenarios to highlight the product's benefits makes it relatable.

The 2010 iPad Presentation uses this technique.

Invite the Team and Let Them Run the Presentation

CEOs spend most time outside the organization. Many companies elect to have only one presenter.

It sends the incorrect message to investors. Product presentations should always include the whole team.

Let me explain why.

Companies needing investment money frequently have shaky business strategies or no product-market fit or robust corporate structure.

Investors solely bet on a team's ability to implement ideas and make a profit.

Early team involvement helps investors understand the company's drivers. Travel costs are worthwhile.

But why for product presentations?

Presenters of varied ages, genders, social backgrounds, and skillsets are relatable. CEOs want relatable products.

Some customers may not believe a white man's message. A black woman's message may be more accepted.

Make the story relatable when you have the best product that solves people's concerns.

Best example: 1984 Macintosh presentation with development team panel.

What is the largest error people make when companies fail?

Saving money on the corporate and product presentation.

Invite your team to five partner meetings when five investors are shortlisted.

Rehearse the presentation till it's natural. Let the team speak.

Successful presentations require structure, rehearsal, and a team. Steve Jobs nailed it.

4 Pricey Tools That Are Valuable

I pay based on ROI (return on investment).

If a $20/month tool or $500 online course doubles my return, I'm in.

Investing helps me build wealth.

Canva Pro

I initially refused to pay.

My course content needed updating a few months ago. My Google Docs text looked cleaner and more professional in Canva.

I've used it to:

• product cover pages

• eBook covers

• Product page infographics

See my Google Sheets vs. Canva product page graph.

Google Sheets vs Canva

Yesterday, I used it to make a LinkedIn video thumbnail. It took less than 5 minutes and improved my video.

In 30 hours, the video had 39,000 views.

Here's more.

HypeFury

Hypefury rocks!

It builds my brand as I sleep. What else?

Because I'm traveling this weekend, I planned tweets for 10 days. It took me 80 minutes.

So while I travel or am absent, my content mill keeps producing.

Also I like:

• I can reach hundreds of people thanks to auto-DMs. I utilize it to advertise freebies; for instance, leave an emoji remark to receive my checklist. And they automatically receive a message in their DM.

• Scheduled Retweets: By appearing in a different time zone, they give my tweet a second chance.

It helps me save time and expand my following, so that's my favorite part.

It’s also super neat:

Zoom Pro

My course involves weekly and monthly calls for alumni.

Google Meet isn't great for group calls. The interface isn't great.

Zoom Pro is expensive, and the monthly payments suck, but it's necessary.

It gives my students a smooth experience.

Previously, we'd do 40-minute meetings and then reconvene.

Zoom's free edition limits group calls to 40 minutes.

This wouldn't be a good online course if I paid hundreds of dollars.

So I felt obligated to help.

YouTube Premium

My laptop has an ad blocker.

I bought an iPad recently.

When you're self-employed and work from home, the line between the two blurs. My bed is only 5 steps away!

When I read or watched videos on my laptop, I'd slide into work mode. Only option was to view on phone, which is awkward.

YouTube premium handles it. No more advertisements and I can listen on the move.

3 Expensive Tools That Aren't Valuable

Marketing strategies are sometimes aimed to make you feel you need 38474 cool features when you don’t.

Certain tools are useless.

I found it useless.

Depending on your needs. As a writer and creator, I get no return.

They could for other jobs.

Shield Analytics

It tracks LinkedIn stats, like:

• follower growth

• trend chart for impressions

• Engagement, views, and comment stats for posts

• and much more.

Middle-tier creator costs $12/month.

I got a 25% off coupon but canceled my free trial before writing this. It's not worth the discount.

Why?

LinkedIn provides free analytics. See:

Not thorough and won't show top posts.

I don't need to see my top posts because I love experimenting with writing.

Slack Premium

Slack was my classroom. Slack provided me a premium trial during the prior cohort.

I skipped it.

Sure, voice notes are better than a big paragraph. I didn't require pro features.

Marketing methods sometimes make you think you need 38474 amazing features. Don’t fall for it.

Calendly Pro

This may be worth it if you get many calls.

I avoid calls. During my 9-5, I had too many pointless calls.

I don't need:

• ability to schedule calls for 15, 30, or 60 minutes: I just distribute each link separately.

• I have a Gumroad consultation page with a payment option.

• follow-up emails: I hardly ever make calls, so

• I just use one calendar, therefore I link to various calendars.

I'll admit, the integrations are cool. Not for me.

If you're a coach or consultant, the features may be helpful. Or book meetings.

Conclusion

Investing is spending to make money.

Use my technique — put money in tools that help you make money. This separates it from being an investment instead of an expense.

Try free versions of these tools before buying them since everyone else is.

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.