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.

My colleague Ilana Ovental and I examined pandemic media coverage of education at the end of last year. That analysis examined coverage changes. We tracked K-12 topic attention over the previous two decades using Lexis Nexis. See the results here.

I was struck by how cleanly the past two decades can be divided up into three (or three and a half) eras of school reform—a framing that can help us comprehend where we are and how we got here. In a time when epidemic, political unrest, frenetic news cycles, and culture war can make six months seem like a lifetime, it's worth pausing for context.

If you look at the peaks in the above graph, the 21st century looks to be divided into periods. The decade-long rise and fall of No Child Left Behind began during the Bush administration. In a few years, NCLB became the dominant K-12 framework. Advocates and financiers discussed achievement gaps and measured success with AYP.

NCLB collapsed under the weight of rigorous testing, high-stakes accountability, and a race to the bottom by the Obama years. Obama's Race to the Top garnered attention, but its most controversial component, the Common Core State Standards, rose quickly.

Academic standards replaced assessment and accountability. New math, fiction, and standards were hotly debated. Reformers and funders chanted worldwide benchmarking and systems interoperability.

We went from federally driven testing and accountability to government encouraged/subsidized/mandated (pick your verb) reading and math standardization. Last year, Checker Finn and I wrote The End of School Reform? The 2010s populist wave thwarted these objectives. The Tea Party, Occupy Wall Street, Black Lives Matter, and Trump/MAGA all attacked established institutions.

Consequently, once the Common Core fell, no alternative program emerged. Instead, school choice—the policy most aligned with populist suspicion of institutional power—reached a half-peak. This was less a case of choice erupting to prominence than of continuous growth in a vacuum. Even with Betsy DeVos' determined, controversial efforts, school choice received only half the media attention that NCLB and Common Core did at their heights.

Recently, culture clash-fueled attention to race-based curriculum and pedagogy has exploded (all playing out under the banner of critical race theory). This third, culture war-driven wave may not last as long as the other waves.

Even though I don't understand it, the move from slow-building policy debate to fast cultural confrontation over two decades is notable. I don't know if it's cyclical or permanent, or if it's about schooling, media, public discourse, or all three.

One final thought: After doing this work for decades, I've noticed how smoothly advocacy groups, associations, and other activists adapt to the zeitgeist. In 2007, mission statements focused on accomplishment disparities. Five years later, they promoted standardization. Language has changed again.

Part of this is unavoidable and healthy. Chasing currents can also make companies look unprincipled, promote scepticism, and keep them spinning the wheel. Bearing in mind that these tides ebb and flow may give educators, leaders, and activists more confidence to hold onto their values and pause when they feel compelled to follow the crowd.

Looking back into the past can help you understand what's happening today and why.

"Creator economy" conjures up images of originality, sincerity, and passion. Where do Michelangelos and da Vincis push advancement with their gifts without battling for bread and proving themselves posthumously? 

Creativity has been as long as humanity, but it's just recently become a new economic paradigm. We even talk about Web3 now.

Let's examine the creative economy's history to better comprehend it. What brought us here? Looking back can help you understand what's happening now.

No yawning, I promise 😉.

Creator Economy's history

Long, uneven transition to creator economy. Let's examine the economic and societal changes that led us there.

1. Agriculture to industry

Mid-18th-century Industrial Revolution led to shift from agriculture to manufacturing. The industrial economy lasted until World War II.

The industrial economy's principal goal was to provide more affordable, accessible commodities.

Unlike today, products were scarce and inaccessible.

To fulfill its goals, industrialization triggered enormous economic changes, moving power from agrarians to manufacturers. Industrialization brought hard work, rivalry, and new ideas connected to production and automation. Creative thinkers focused on that then.

It doesn't mean music, poetry, or painting had no place back then. They weren't top priority. Artists were independent. The creative field wasn't considered a different economic subdivision.

2. The consumer economy

Manufacturers produced more things than consumers desired after World War II. Stuff was no longer scarce.

The economy must make customers want to buy what the market offers.

The consumer economic paradigm supplanted the industrial one. Customers (or consumers) replaced producers as the new economic center.

Salesmen, marketing, and journalists also played key roles (TV, radio, newspapers, etc.). Mass media greatly boosted demand for goods, defined trends, and changed views regarding nearly everything.

Mass media also gave rise to pop culture, which focuses on mass-market creative products. Design, printing, publishing, multi-media, audio-visual, cinematographic productions, etc. supported pop culture.

The consumer paradigm generated creative occupations and activities, unlike the industrial economy. Creativity was limited by the need for wide appeal.

Most creators were corporate employees.

Creating a following and making a living from it were difficult.

Paul Saffo said that only journalists and TV workers were known. Creators who wished to be known relied on producers, publishers, and other gatekeepers. To win their favor was crucial. Luck was the best tactic.

3. The creative economy

Consumer economy was digitized in the 1990s. IT solutions transformed several economic segments. This new digital economy demanded innovative, digital creativity.

Later, states declared innovation a "valuable asset that creates money and jobs." They also introduced the "creative industries" and the "creative economy" (not creator!) and tasked themselves with supporting them. Australia and the UK were early adopters.

Individual skill, innovation, and intellectual property fueled the creative economy. Its span covered design, writing, audio, video material, etc. The creative economy required IT-powered activity.

The new challenge was to introduce innovations to most economic segments and meet demand for digital products and services.

Despite what the title "creative economy" may imply, it was primarily oriented at meeting consumer needs. It didn't provide inventors any new options to become entrepreneurs. Instead of encouraging innovators to flourish on their own, the creative economy emphasized "employment-based creativity."

4. The creator economy

Next, huge IT platforms like Google, Facebook, YouTube, and others competed with traditional mainstream media.

During the 2008 global financial crisis, these mediums surpassed traditional media. People relied on them for information, knowledge, and networking. That was a digital media revolution. The creator economy started there.

The new economic paradigm aimed to engage and convert clients. The creator economy allowed customers to engage, interact, and provide value, unlike the consumer economy. It gave them instruments to promote themselves as "products" and make money.

Writers, singers, painters, and other creators have a great way to reach fans. Instead of appeasing old-fashioned gatekeepers (producers, casting managers, publishers, etc.), they can use the platforms to express their talent and gain admirers. Barriers fell.

It's not only for pros. Everyone with a laptop and internet can now create.

2022 creator economy:

Since there is no academic description for the current creator economy, we can freestyle.

The current (or Web2) creator economy is fueled by interactive digital platforms, marketplaces, and tools that allow users to access, produce, and monetize content.

No entry hurdles or casting in the creative economy. Sign up and follow platforms' rules. Trick: A platform's algorithm aggregates your data and tracks you. This is the payment for participation.

The platforms offer content creation, design, and ad distribution options. This is platforms' main revenue source.

The creator economy opens many avenues for creators to monetize their work. Artists can now earn money through advertising, tipping, brand sponsorship, affiliate links, streaming, and other digital marketing activities.

Even if your content isn't digital, you can utilize platforms to promote it, interact and convert your audience, and more. No limits. However, some of your income always goes to a platform (well, a huge one).

The creator economy aims to empower online entrepreneurship by offering digital marketing tools and reducing impediments.

Barriers remain. They are just different. Next articles will examine these.

Why update the creator economy for Web3?

I could address this question by listing the present creator economy's difficulties that led us to contemplate a Web3 upgrade.

I don't think these difficulties are the main cause. The mentality shift made us see these challenges and understand there was a better reality without them.

Crypto drove this thinking shift. It promoted disintermediation, independence from third-party service providers, 100% data ownership, and self-sovereignty. Crypto has changed the way we view everyday things.

Crypto's disruptive mission has migrated to other economic segments. It's now called Web3. Web3's creator economy is unique.

Here's the essence of the Web3 economy:

• Eliminating middlemen between creators and fans.

• 100% of creators' data, brand, and effort.

• Business and money-making transparency.

• Authentic originality above ad-driven content.

In the next several articles, I'll explain. We'll also discuss the creator economy and Web3's remedies.

Final thoughts

The creator economy is the organic developmental stage we've reached after all these social and economic transformations.

The Web3 paradigm of the creator economy intends to allow creators to construct their own independent "open economy" and directly monetize it without a third party.

If this approach succeeds, we may enter a new era of wealth creation where producers aren't only the products. New economies will emerge.

This article is a summary. To read the full post, click here.

We've fought for humanity's sake. We need equilibrium.

We live in a world of opposites (black/white, up/down, love/hate), thus life is a game of achieving equilibrium. We have a universe of paradoxes within ourselves, not just in physics.

Individually, you balance your intellect and heart, but as a species, we're full of polarities. They might be gentle and compassionate, then ruthless and unsympathetic.

We desire for connection so much that we personify non-human beings and objects while turning to violence and hatred toward others. These contrasts baffle me. Will we find balance?

Anthropomorphization

Assigning human-like features or bonding with objects is common throughout childhood. Cartoons often give non-humans human traits. Adults still anthropomorphize this trait. Researchers agree we start doing it as infants and continue throughout life.

Humans of all ages are good at humanizing stuff. We build emotional attachments to weather events, inanimate objects, animals, plants, and locales. Gods, goddesses, and fictitious figures are anthropomorphized.

Cast Away, starring Tom Hanks, features anthropization. Hanks is left on an island, where he builds an emotional bond with a volleyball he calls Wilson.

We became emotionally invested in Wilson, including myself.

Why do we do it, though?

Our instincts and traits helped us survive and thrive. Our brain is alert to other people's thoughts, feelings, and intentions to assist us to determine who is safe or hazardous. We can think about others and our own mental states, or about thinking. This is the Theory of Mind.

Neurologically, specialists believe the Theory of Mind has to do with our mirror neurons, which exhibit the same activity while executing or witnessing an action.

Mirror neurons may contribute to anthropization, but they're not the only ones. In 2021, Harvard Medical School researchers at MGH and MIT colleagues published a study on the brain's notion of mind.

“Our study provides evidence to support theory of mind by individual neurons. Until now, it wasn’t clear whether or how neurons were able to perform these social cognitive computations.”

Neurons have particular functions, researchers found. Others encode information that differentiates one person's beliefs from another's. Some neurons reflect tale pieces, whereas others aren't directly involved in social reasoning but may multitask contributing factors.

Combining neuronal data gives a precise portrait of another's beliefs and comprehension. The theory of mind describes how we judge and understand each other in our species, and it likely led to anthropomorphism. Neuroscience indicates identical brain regions react to human or non-human behavior, like mirror neurons.

Some academics believe we're wired for connection, which explains why we anthropomorphize. When we're alone, we may anthropomorphize non-humans.

Humanizing non-human entities may make them deserving of moral care, according to another theory. Animamorphizing something makes it responsible for its actions and deserves punishments or rewards. This mental shift is typically apparent in our connections with pets and leads to deanthropomorphization.

Dehumanization

Dehumanizing involves denying someone or anything ethical regard, the opposite of anthropomorphizing.

Dehumanization occurs throughout history. We do it to everything in nature, including ourselves. We experiment on and torture animals. We enslave, hate, and harm other groups of people.

Race, immigrant status, dress choices, sexual orientation, social class, religion, gender, politics, need I go on? Our degrading behavior is promoting fascism and division everywhere.

Dehumanizing someone or anything reduces their agency and value. Many assume they're immune to this feature, but tests disagree.

It's inevitable. Humans are wired to have knee-jerk reactions to differences. We are programmed to dehumanize others, and it's easier than we'd like to admit.

Why do we do it, though?

Dehumanizing others is simpler than humanizing things for several reasons. First, we consider everything unusual as harmful, which has helped our species survive for hundreds of millions of years. Our propensity to be distrustful of others, like our fear of the unknown, promotes an us-vs.-them mentality.

Since WWII, various studies have been done to explain how or why the holocaust happened. How did so many individuals become radicalized to commit such awful actions and feel morally justified? Researchers quickly showed how easily the mind can turn gloomy.

Stanley Milgram's 1960s electroshock experiment highlighted how quickly people bow to authority to injure others. Philip Zimbardo's 1971 Stanford Prison Experiment revealed how power may be abused.

The us-versus-them attitude is natural and even young toddlers act on it. Without a relationship, empathy is more difficult.

It's terrifying how quickly dehumanizing behavior becomes commonplace. The current pandemic is an example. Most countries no longer count deaths. Long Covid is a major issue, with predictions of a handicapped tsunami in the future years. Mostly, we shrug.

In 2020, we panicked. Remember everyone's caution? Now Long Covid is ruining more lives, threatening to disable an insane amount of our population for months or their entire lives.

There's little research. Experts can't even classify or cure it. The people should be outraged, but most have ceased caring. They're over covid.

We're encouraged to find a method to live with a terrible pandemic that will cause years of damage. People aren't worried about infection anymore. They shrug and say, "We'll all get it eventually," then hope they're not one of the 30% who develops Long Covid.

We can correct course before further damage. Because we can recognize our urges and biases, we're not captives to them. We can think critically about our thoughts and behaviors, then attempt to improve. We can recognize our deficiencies and work to attain balance.

Changing perspectives

We're currently attempting to find equilibrium between opposites. It's superficial to defend extremes by stating we're only human or wired this way because both imply we have no control.

Being human involves having self-awareness, and by being careful of our thoughts and acts, we can find balance and recognize opposites' purpose.

Extreme anthropomorphizing and dehumanizing isolate and imperil us. We anthropomorphize because we desire connection and dehumanize because we're terrified, frequently of the connection we crave. Will we find balance?

Katrina Paulson ponders humanity, unanswered questions, and discoveries. Please check out her newsletters, Curious Adventure and Curious Life.

No, it’s not smartphones, overeating, or sugar.

Everyday practices affect brain health. Good brain practices increase memory and cognition.

Bad behaviors increase stress, which destroys brain cells.

Bad behaviors can reverse evolution and diminish the brain. So, avoid these practices for brain health.

1. The silent assassin

Introverts appreciated quarantine.

Before the pandemic, they needed excuses to remain home; thereafter, they had enough.

I am an introvert, and I didn’t hate quarantine. There are billions of people like me who avoid people.

Social relationships are important for brain health. Social anxiety harms your brain.

Antisocial behavior changes brains. It lowers IQ and increases drug abuse risk.

What you can do is as follows:

• Make a daily commitment to engage in conversation with a stranger. Who knows, you might turn out to be your lone mate.

• Get outside for at least 30 minutes each day.

• Shop for food locally rather than online.

• Make a call to a friend you haven't spoken to in a while.

2. Try not to rush things.

People love hustle culture. This economy requires a side gig to save money.

Long hours reduce brain health. A side gig is great until you burn out.

Work ages your wallet and intellect. Overworked brains age faster and lose cognitive function.

Working longer hours can help you make extra money, but it can harm your brain.

Side hustle but don't overwork.

What you can do is as follows:

• Decide what hour you are not permitted to work after.

• Three hours prior to night, turn off your laptop.

• Put down your phone and work.

• Assign due dates to each task.

3. Location is everything!

The environment may cause brain fog. High pollution can cause brain damage.

Air pollution raises Alzheimer's risk. Air pollution causes cognitive and behavioral abnormalities.

Polluted air can trigger early development of incurable brain illnesses, not simply lung harm.

Your city's air quality is uncontrollable. You may take steps to improve air quality.

In Delhi, schools and colleges are closed to protect pupils from polluted air. So I've adapted.

What you can do is as follows:

• To keep your mind healthy and young, make an investment in a high-quality air purifier.

• Enclose your windows during the day.

• Use a N95 mask every day.

4. Don't skip this meal.

Fasting intermittently is trendy. Delaying breakfast to finish fasting is frequent.

Some skip breakfast and have a hefty lunch instead.

Skipping breakfast might affect memory and focus. Skipping breakfast causes low cognition, delayed responsiveness, and irritation.

Breakfast affects mood and productivity.

Intermittent fasting doesn't prevent healthy breakfasts.

What you can do is as follows:

• Try to fast for 14 hours, then break it with a nutritious breakfast.

• So that you can have breakfast in the morning, eat dinner early.

• Make sure your breakfast is heavy in fiber and protein.

5. The quickest way to damage the health of your brain

Brain health requires water. 1% dehydration can reduce cognitive ability by 5%.

Cerebral fog and mental clarity might result from 2% brain dehydration. Dehydration shrinks brain cells.

Dehydration causes midday slumps and unproductivity. Water improves work performance.

Dehydration can harm your brain, so drink water throughout the day.

What you can do is as follows:

• Always keep a water bottle at your desk.

• Enjoy some tasty herbal teas.

• With a big glass of water, begin your day.

• Bring your own water bottle when you travel.

Conclusion

Bad habits can harm brain health. Low cognition reduces focus and productivity.

Unproductive work leads to procrastination, failure, and low self-esteem.

Avoid these harmful habits to optimize brain health and function.