Bear markets don't last forever, but that's hard to remember. Jamie Cullen's illustration

A bear market is a 20% decline from peak to trough in stock prices.

The S&P 500 was down 24% from its January highs at its low point this year. Bear market.

The U.S. stock market has had 13 bear markets since WWII (including the current one). Previous 12 bear markets averaged –32.7% losses. From peak to trough, the stock market averaged 12 months. The average time from bottom to peak was 21 months.

In the past seven decades, a bear market roundtrip to breakeven has averaged less than three years.

Long-term averages can vary widely, as with all historical market data. Investors can learn from past market crashes.

Historical bear markets offer lessons.

Bear market duration

A bear market can cost investors money and time. Most of the pain comes from stock market declines, but bear markets can be long.

Here are the longest U.S. stock bear markets since World war 2:

Stock market crashes can make it difficult to break even. After the 2008 financial crisis, the stock market took 4.5 years to recover. After the dotcom bubble burst, it took seven years to break even.

The longer you're underwater in the market, the more suffering you'll experience, according to research. Suffering can lead to selling at the wrong time.

Bear markets require patience because stocks can take a long time to recover.

Stock crash recovery

Bear markets can end quickly. The Corona Crash in early 2020 is an example.

The S&P 500 fell 34% in 23 trading sessions, the fastest bear market from a high in 90 years. The entire crash lasted one month. Stocks broke even six months after bottoming. Stocks rose 100% from those lows in 15 months.

Seven bear markets have lasted two years or less since 1945.

The 2020 recovery was an outlier, but four other bear markets have made investors whole within 18 months.

During a bear market, you don't know if it will end quickly or feel like death by a thousand cuts.

Recessions vs. bear markets

Many people believe the U.S. economy is in or heading for a recession.

I agree. Four-decade high inflation. Since 1945, inflation has exceeded 5% nine times. Each inflationary spike caused a recession. Only slowing economic demand seems to stop price spikes.

This could happen again. Stocks seem to be pricing in a recession.

Recessions almost always cause a bear market, but a bear market doesn't always equal a recession. In 1946, the stock market fell 27% without a recession in sight. Without an economic slowdown, the stock market fell 22% in 1966. Black Monday in 1987 was the most famous stock market crash without a recession. Stocks fell 30% in less than a week. Many believed the stock market signaled a depression. The crash caused no slowdown.

Economic cycles are hard to predict. Even Wall Street makes mistakes.

Bears vs. bulls

Bear markets for U.S. stocks always end. Every stock market crash in U.S. history has been followed by new all-time highs.

How should investors view the recession? Investing risk is subjective.

You don't have as long to wait out a bear market if you're retired or nearing retirement. Diversification and liquidity help investors with limited time or income. Cash and short-term bonds drag down long-term returns but can ensure short-term spending.

Young people with years or decades ahead of them should view this bear market as an opportunity. Stock market crashes are good for net savers in the future. They let you buy cheap stocks with high dividend yields.

You need discipline, patience, and planning to buy stocks when it doesn't feel right.

Bear markets aren't fun because no one likes seeing their portfolio fall. But stock market downturns are a feature, not a bug. If stocks never crashed, they wouldn't offer such great long-term returns.

Python Volatility-Based Catapult Indicator

As a catapult, this technical indicator uses three systems: Volatility (the fulcrum), Momentum (the propeller), and a Directional Filter (Acting as the support). The goal is to get a signal that predicts volatility acceleration and direction based on historical patterns. We want to know when the market will move. and where. This indicator outperforms standard indicators.

Knowledge must be accessible to everyone. This is why my new publications Contrarian Trading Strategies in Python and Trend Following Strategies in Python now include free PDF copies of my first three books (Therefore, purchasing one of the new books gets you 4 books in total). GitHub-hosted advanced indications and techniques are in the two new books above.

The Foundation: Volatility

The Catapult predicts significant changes with the 21-period Relative Volatility Index.

The Average True Range, Mean Absolute Deviation, and Standard Deviation all assess volatility. Standard Deviation will construct the Relative Volatility Index.

Standard Deviation is the most basic volatility. It underpins descriptive statistics and technical indicators like Bollinger Bands. Before calculating Standard Deviation, let's define Variance.

Variance is the squared deviations from the mean (a dispersion measure). We take the square deviations to compel the distance from the mean to be non-negative, then we take the square root to make the measure have the same units as the mean, comparing apples to apples (mean to standard deviation standard deviation). Variance formula:

As stated, standard deviation is:

# The function to add a number of columns inside an array
def adder(Data, times):
    
    for i in range(1, times + 1):
    
        new_col = np.zeros((len(Data), 1), dtype = float)
        Data = np.append(Data, new_col, axis = 1)
        
    return Data

# The function to delete a number of columns starting from an index
def deleter(Data, index, times):
    
    for i in range(1, times + 1):
    
        Data = np.delete(Data, index, axis = 1)
        
    return Data
    
# The function to delete a number of rows from the beginning
def jump(Data, jump):
    
    Data = Data[jump:, ]
    
    return Data

# Example of adding 3 empty columns to an array
my_ohlc_array = adder(my_ohlc_array, 3)

# Example of deleting the 2 columns after the column indexed at 3
my_ohlc_array = deleter(my_ohlc_array, 3, 2)

# Example of deleting the first 20 rows
my_ohlc_array = jump(my_ohlc_array, 20)

# Remember, OHLC is an abbreviation of Open, High, Low, and Close and it refers to the standard historical data file

def volatility(Data, lookback, what, where):
    
  for i in range(len(Data)):

     try:

        Data[i, where] = (Data[i - lookback + 1:i + 1, what].std())
     except IndexError:
        pass
        
  return Data

The RSI is the most popular momentum indicator, and for good reason—it excels in range markets. Its 0–100 range simplifies interpretation. Fame boosts its potential.

The more traders and portfolio managers look at the RSI, the more people will react to its signals, pushing market prices. Technical Analysis is self-fulfilling, therefore this theory is obvious yet unproven.

RSI is determined simply. Start with one-period pricing discrepancies. We must remove each closing price from the previous one. We then divide the smoothed average of positive differences by the smoothed average of negative differences. The RSI algorithm converts the Relative Strength from the last calculation into a value between 0 and 100.

def ma(Data, lookback, close, where): 
    
    Data = adder(Data, 1)
    
    for i in range(len(Data)):
           
            try:
                Data[i, where] = (Data[i - lookback + 1:i + 1, close].mean())
            
            except IndexError:
                pass
            
    # Cleaning
    Data = jump(Data, lookback)
    
    return Data
def ema(Data, alpha, lookback, what, where):
    
    alpha = alpha / (lookback + 1.0)
    beta  = 1 - alpha
    
    # First value is a simple SMA
    Data = ma(Data, lookback, what, where)
    
    # Calculating first EMA
    Data[lookback + 1, where] = (Data[lookback + 1, what] * alpha) + (Data[lookback, where] * beta)    
 
    # Calculating the rest of EMA
    for i in range(lookback + 2, len(Data)):
            try:
                Data[i, where] = (Data[i, what] * alpha) + (Data[i - 1, where] * beta)
        
            except IndexError:
                pass
            
    return Datadef rsi(Data, lookback, close, where, width = 1, genre = 'Smoothed'):
    
    # Adding a few columns
    Data = adder(Data, 7)
    
    # Calculating Differences
    for i in range(len(Data)):
        
        Data[i, where] = Data[i, close] - Data[i - width, close]
     
    # Calculating the Up and Down absolute values
    for i in range(len(Data)):
        
        if Data[i, where] > 0:
            
            Data[i, where + 1] = Data[i, where]
            
        elif Data[i, where] < 0:
            
            Data[i, where + 2] = abs(Data[i, where])
            
    # Calculating the Smoothed Moving Average on Up and Down
    absolute values        
                             
    lookback = (lookback * 2) - 1 # From exponential to smoothed
    Data = ema(Data, 2, lookback, where + 1, where + 3)
    Data = ema(Data, 2, lookback, where + 2, where + 4)
    
    # Calculating the Relative Strength
    Data[:, where + 5] = Data[:, where + 3] / Data[:, where + 4]
    
    # Calculate the Relative Strength Index
    Data[:, where + 6] = (100 - (100 / (1 + Data[:, where + 5])))  
    
    # Cleaning
    Data = deleter(Data, where, 6)
    Data = jump(Data, lookback)

    return Data

def relative_volatility_index(Data, lookback, close, where):

    # Calculating Volatility
    Data = volatility(Data, lookback, close, where)
    
    # Calculating the RSI on Volatility
    Data = rsi(Data, lookback, where, where + 1) 
    
    # Cleaning
    Data = deleter(Data, where, 1)
    
    return Data

The Arm Section: Speed

The Catapult predicts momentum direction using the 14-period Relative Strength Index.

As a reminder, the RSI ranges from 0 to 100. Two levels give contrarian signals:

• A positive response is anticipated when the market is deemed to have gone too far down at the oversold level 30, which is 30.

• When the market is deemed to have gone up too much, at overbought level 70, a bearish reaction is to be expected.

Comparing the RSI to 50 is another intriguing use. RSI above 50 indicates bullish momentum, while below 50 indicates negative momentum.

The direction-finding filter in the frame

The Catapult's directional filter uses the 200-period simple moving average to keep us trending. This keeps us sane and increases our odds.

Moving averages confirm and ride trends. Its simplicity and track record of delivering value to analysis make them the most popular technical indicator. They help us locate support and resistance, stops and targets, and the trend. Its versatility makes them essential trading tools.

This is the plain mean, employed in statistics and everywhere else in life. Simply divide the number of observations by their total values. Mathematically, it's:

We defined the moving average function above. Create the Catapult indication now.

Indicator of the Catapult

The indicator is a healthy mix of the three indicators:

• The first trigger will be provided by the 21-period Relative Volatility Index, which indicates that there will now be above average volatility and, as a result, it is possible for a directional shift.

• If the reading is above 50, the move is likely bullish, and if it is below 50, the move is likely bearish, according to the 14-period Relative Strength Index, which indicates the likelihood of the direction of the move.

• The likelihood of the move's direction will be strengthened by the 200-period simple moving average. When the market is above the 200-period moving average, we can infer that bullish pressure is there and that the upward trend will likely continue. Similar to this, if the market falls below the 200-period moving average, we recognize that there is negative pressure and that the downside is quite likely to continue.

lookback_rvi = 21
lookback_rsi = 14
lookback_ma  = 200
my_data = ma(my_data, lookback_ma, 3, 4)
my_data = rsi(my_data, lookback_rsi, 3, 5)
my_data = relative_volatility_index(my_data, lookback_rvi, 3, 6)

Two-handled overlay indicator Catapult. The first exhibits blue and green arrows for a buy signal, and the second shows blue and red for a sell signal.

The chart below shows recent EURUSD hourly values.

def signal(Data, rvi_col, signal):
    
    Data = adder(Data, 10)
        
    for i in range(len(Data)):
            
        if Data[i,     rvi_col] < 30 and \
           Data[i - 1, rvi_col] > 30 and \
           Data[i - 2, rvi_col] > 30 and \
           Data[i - 3, rvi_col] > 30 and \
           Data[i - 4, rvi_col] > 30 and \
           Data[i - 5, rvi_col] > 30:
               
               Data[i, signal] = 1
                           
    return Data

Signals are straightforward. The indicator can be utilized with other methods.

my_data = signal(my_data, 6, 7)

Lumiwealth shows how to develop all kinds of algorithms. I recommend their hands-on courses in algorithmic trading, blockchain, and machine learning.

Summary

To conclude, my goal is to contribute to objective technical analysis, which promotes more transparent methods and strategies that must be back-tested before implementation. Technical analysis will lose its reputation as subjective and unscientific.

After you find a trading method or approach, follow these steps:

• Put emotions aside and adopt an analytical perspective.

• Test it in the past in conditions and simulations taken from real life.

• Try improving it and performing a forward test if you notice any possibility.

• Transaction charges and any slippage simulation should always be included in your tests.

• Risk management and position sizing should always be included in your tests.

After checking the aforementioned, monitor the plan because market dynamics may change and render it unprofitable.

Python Heatmap Technical Indicator

Heatmaps provide an instant overview. They can be used with correlations or to predict reactions or confirm the trend in trading. This article covers RSI heatmap creation.

The Market System

Market regime:

• Bullish trend: The market tends to make higher highs, which indicates that the overall trend is upward.

• Sideways: The market tends to fluctuate while staying within predetermined zones.

• Bearish trend: The market has the propensity to make lower lows, indicating that the overall trend is downward.

Most tools detect the trend, but we cannot predict the next state. The best way to solve this problem is to assume the current state will continue and trade any reactions, preferably in the trend.

If the EURUSD is above its moving average and making higher highs, a trend-following strategy would be to wait for dips before buying and assuming the bullish trend will continue.

Indicator of Relative Strength

J. Welles Wilder Jr. introduced the RSI, a popular and versatile technical indicator. Used as a contrarian indicator to exploit extreme reactions. Calculating the default RSI usually involves these steps:

• Determine the difference between the closing prices from the prior ones.

• Distinguish between the positive and negative net changes.

• Create a smoothed moving average for both the absolute values of the positive net changes and the negative net changes.

• Take the difference between the smoothed positive and negative changes. The Relative Strength RS will be the name we use to describe this calculation.

• To obtain the RSI, use the normalization formula shown below for each time step.

The 13-period RSI and black GBPUSD hourly values are shown above. RSI bounces near 25 and pauses around 75. Python requires a four-column OHLC array for RSI coding.

import numpy as np
def add_column(data, times):
    
    for i in range(1, times + 1):
    
        new = np.zeros((len(data), 1), dtype = float)
        
        data = np.append(data, new, axis = 1)
    return data
def delete_column(data, index, times):
    
    for i in range(1, times + 1):
    
        data = np.delete(data, index, axis = 1)
    return data
def delete_row(data, number):
    
    data = data[number:, ]
    
    return data
def ma(data, lookback, close, position): 
    
    data = add_column(data, 1)
    
    for i in range(len(data)):
           
            try:
                
                data[i, position] = (data[i - lookback + 1:i + 1, close].mean())
            
            except IndexError:
                
                pass
            
    data = delete_row(data, lookback)
    
    return data
def smoothed_ma(data, alpha, lookback, close, position):
    
    lookback = (2 * lookback) - 1
    
    alpha = alpha / (lookback + 1.0)
    
    beta  = 1 - alpha
    
    data = ma(data, lookback, close, position)
    data[lookback + 1, position] = (data[lookback + 1, close] * alpha) + (data[lookback, position] * beta)
    for i in range(lookback + 2, len(data)):
        
            try:
                
                data[i, position] = (data[i, close] * alpha) + (data[i - 1, position] * beta)
        
            except IndexError:
                
                pass
            
    return data
def rsi(data, lookback, close, position):
    
    data = add_column(data, 5)
    
    for i in range(len(data)):
        
        data[i, position] = data[i, close] - data[i - 1, close]
     
    for i in range(len(data)):
        
        if data[i, position] > 0:
            
            data[i, position + 1] = data[i, position]
            
        elif data[i, position] < 0:
            
            data[i, position + 2] = abs(data[i, position])
            
    data = smoothed_ma(data, 2, lookback, position + 1, position + 3)
    data = smoothed_ma(data, 2, lookback, position + 2, position + 4)
    data[:, position + 5] = data[:, position + 3] / data[:, position + 4]
    
    data[:, position + 6] = (100 - (100 / (1 + data[:, position + 5])))
    data = delete_column(data, position, 6)
    data = delete_row(data, lookback)
    return data

Make sure to focus on the concepts and not the code. You can find the codes of most of my strategies in my books. The most important thing is to comprehend the techniques and strategies.

My weekly market sentiment report uses complex and simple models to understand the current positioning and predict the future direction of several major markets. Check out the report here:

Using the Heatmap to Find the Trend

RSI trend detection is easy but useless. Bullish and bearish regimes are in effect when the RSI is above or below 50, respectively. Tracing a vertical colored line creates the conditions below. How:

• When the RSI is higher than 50, a green vertical line is drawn.

• When the RSI is lower than 50, a red vertical line is drawn.

Zooming out yields a basic heatmap, as shown below.

Plot code:

def indicator_plot(data, second_panel, window = 250):
    fig, ax = plt.subplots(2, figsize = (10, 5))
    sample = data[-window:, ]
    for i in range(len(sample)):
        ax[0].vlines(x = i, ymin = sample[i, 2], ymax = sample[i, 1], color = 'black', linewidth = 1)  
        if sample[i, 3] > sample[i, 0]:
            ax[0].vlines(x = i, ymin = sample[i, 0], ymax = sample[i, 3], color = 'black', linewidth = 1.5)  
        if sample[i, 3] < sample[i, 0]:
            ax[0].vlines(x = i, ymin = sample[i, 3], ymax = sample[i, 0], color = 'black', linewidth = 1.5)  
        if sample[i, 3] == sample[i, 0]:
            ax[0].vlines(x = i, ymin = sample[i, 3], ymax = sample[i, 0], color = 'black', linewidth = 1.5)  
    ax[0].grid() 
    for i in range(len(sample)):
        if sample[i, second_panel] > 50:
            ax[1].vlines(x = i, ymin = 0, ymax = 100, color = 'green', linewidth = 1.5)  
        if sample[i, second_panel] < 50:
            ax[1].vlines(x = i, ymin = 0, ymax = 100, color = 'red', linewidth = 1.5)  
    ax[1].grid()
indicator_plot(my_data, 4, window = 500)

Call RSI on your OHLC array's fifth column. 4. Adjusting lookback parameters reduces lag and false signals. Other indicators and conditions are possible.

Another suggestion is to develop an RSI Heatmap for Extreme Conditions.

Contrarian indicator RSI. The following rules apply:

• Whenever the RSI is approaching the upper values, the color approaches red.

• The color tends toward green whenever the RSI is getting close to the lower values.

Zooming out yields a basic heatmap, as shown below.

Plot code:

import matplotlib.pyplot as plt
def indicator_plot(data, second_panel, window = 250):
    fig, ax = plt.subplots(2, figsize = (10, 5))
    sample = data[-window:, ]
    for i in range(len(sample)):
        ax[0].vlines(x = i, ymin = sample[i, 2], ymax = sample[i, 1], color = 'black', linewidth = 1)  
        if sample[i, 3] > sample[i, 0]:
            ax[0].vlines(x = i, ymin = sample[i, 0], ymax = sample[i, 3], color = 'black', linewidth = 1.5)  
        if sample[i, 3] < sample[i, 0]:
            ax[0].vlines(x = i, ymin = sample[i, 3], ymax = sample[i, 0], color = 'black', linewidth = 1.5)  
        if sample[i, 3] == sample[i, 0]:
            ax[0].vlines(x = i, ymin = sample[i, 3], ymax = sample[i, 0], color = 'black', linewidth = 1.5)  
    ax[0].grid() 
    for i in range(len(sample)):
        if sample[i, second_panel] > 90:
            ax[1].vlines(x = i, ymin = 0, ymax = 100, color = 'red', linewidth = 1.5)  
        if sample[i, second_panel] > 80 and sample[i, second_panel] < 90:
            ax[1].vlines(x = i, ymin = 0, ymax = 100, color = 'darkred', linewidth = 1.5)  
        if sample[i, second_panel] > 70 and sample[i, second_panel] < 80:
            ax[1].vlines(x = i, ymin = 0, ymax = 100, color = 'maroon', linewidth = 1.5)  
        if sample[i, second_panel] > 60 and sample[i, second_panel] < 70:
            ax[1].vlines(x = i, ymin = 0, ymax = 100, color = 'firebrick', linewidth = 1.5) 
        if sample[i, second_panel] > 50 and sample[i, second_panel] < 60:
            ax[1].vlines(x = i, ymin = 0, ymax = 100, color = 'grey', linewidth = 1.5) 
        if sample[i, second_panel] > 40 and sample[i, second_panel] < 50:
            ax[1].vlines(x = i, ymin = 0, ymax = 100, color = 'grey', linewidth = 1.5) 
        if sample[i, second_panel] > 30 and sample[i, second_panel] < 40:
            ax[1].vlines(x = i, ymin = 0, ymax = 100, color = 'lightgreen', linewidth = 1.5)
        if sample[i, second_panel] > 20 and sample[i, second_panel] < 30:
            ax[1].vlines(x = i, ymin = 0, ymax = 100, color = 'limegreen', linewidth = 1.5) 
        if sample[i, second_panel] > 10 and sample[i, second_panel] < 20:
            ax[1].vlines(x = i, ymin = 0, ymax = 100, color = 'seagreen', linewidth = 1.5)  
        if sample[i, second_panel] > 0 and sample[i, second_panel] < 10:
            ax[1].vlines(x = i, ymin = 0, ymax = 100, color = 'green', linewidth = 1.5)
    ax[1].grid()
indicator_plot(my_data, 4, window = 500)

Dark green and red areas indicate imminent bullish and bearish reactions, respectively. RSI around 50 is grey.

Summary

To conclude, my goal is to contribute to objective technical analysis, which promotes more transparent methods and strategies that must be back-tested before implementation.

Technical analysis will lose its reputation as subjective and unscientific.

When you find a trading strategy or technique, follow these steps:

• Put emotions aside and adopt a critical mindset.

• Test it in the past under conditions and simulations taken from real life.

• Try optimizing it and performing a forward test if you find any potential.

• Transaction costs and any slippage simulation should always be included in your tests.

• Risk management and position sizing should always be considered in your tests.

After checking the above, monitor the strategy because market dynamics may change and make it unprofitable.

Here's how to be clear.

“I have only made this letter longer because I have not had the time to make it shorter.” — French mathematician, physicist, inventor, philosopher, and writer Blaise Pascal

Concise.

People want this. We tend to repeat ourselves and use unnecessary words.

Being vague frustrates readers. It focuses their limited attention span on figuring out what you're saying rather than your message.

Edit carefully.

“Examine every word you put on paper. You’ll find a surprising number that don’t serve any purpose.” — American writer, editor, literary critic, and teacher William Zinsser

How do you write succinctly?

Here are three ways to polish your writing.

1. Delete

Your readers will appreciate it if you delete unnecessary words. If a word or phrase is essential, keep it. Don't force it.

Many readers dislike bloated sentences. Ask yourself if cutting a word or phrase will change the meaning or dilute your message.

For example, you could say, “It’s absolutely essential that I attend this meeting today, so I know the final outcome.” It’s better to say, “It’s critical I attend the meeting today, so I know the results.”

Key takeaway

Delete actually, completely, just, full, kind of, really, and totally. Keep the necessary words, cut the rest.

2. Just Do It

Don't tell readers your plans. Your readers don't need to know your plans. Who are you?

Don't say, "I want to highlight our marketing's problems." Our marketing issues are A, B, and C. This cuts 5–7 words per sentence.

Keep your reader's attention on the essentials, not the fluff. What are you doing? You won't lose readers because you get to the point quickly and don't build up.

Key takeaway

Delete words that don't add to your message. Do something, don't tell readers you will.

3. Cut Overlap

You probably repeat yourself unintentionally. You may add redundant sentences when brainstorming. Read aloud to detect overlap.

Remove repetition from your writing. It's important to edit our writing and thinking to avoid repetition.

Key Takeaway

If you're repeating yourself, combine sentences to avoid overlap.

4. Simplify

Write as you would to family or friends. Communicate clearly. Don't use jargon. These words confuse readers.

Readers want specifics, not jargon. Write simply. Done.

Most adults read at 8th-grade level. Jargon and buzzwords make speech fluffy. This confuses readers who want simple language.

Key takeaway

Ensure all audiences can understand you. USA Today's 5th-grade reading level is intentional. They want everyone to understand.

5. Active voice

Subjects perform actions in active voice. When you write in passive voice, the subject receives the action.

For example, “the board of directors decided to vote on the topic” is an active voice, while “a decision to vote on the topic was made by the board of directors” is a passive voice.

Key takeaway

Active voice clarifies sentences. Active voice is simple and concise.

Bringing It All Together

Five tips help you write clearly. Delete, just do it, cut overlap, use simple language, and write in an active voice.

Clear writing is effective. It's okay to occasionally use unnecessary words or phrases. Realizing it is key. Check your writing.

Adding words costs.

Write more concisely. People will appreciate it and read your future articles, emails, and messages. Spending extra time will increase trust and influence.

“Not that the story need be long, but it will take a long while to make it short.” — Naturalist, essayist, poet, and philosopher Henry David Thoreau

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.

Could this happen?

Medium isn't like other social media giants. It wasn't a dot-com startup that became a multi-trillion-dollar social media firm. It launched in 2012 but didn't gain popularity until later. Now, it's one of the largest sites by web traffic, but it's still little compared to most. Most of Medium's traffic is external, but they don't run advertisements, so it's all about memberships.

Medium isn't profitable, but they don't disclose how terrible the problem is. Most of the $163 million they raised has been spent or used for acquisitions. If the money turns off, Medium can't stop paying its writers since the site dies. Writers must be paid, but they can't substantially slash payment without hurting the platform. The existing model needs scale to be viable and has a low ceiling. Facebook and other free social media platforms are struggling to retain users. Here, you must pay to appreciate it, and it's bad for writers AND readers. If I had the same Medium stats on YouTube, I'd make thousands of dollars a month.

Then what? Medium has tried to monetize by offering writers a cut of new members, but that's unsustainable. People-based growth is limited. Imagine recruiting non-Facebook users and getting them to pay to join. Some may, but I'd rather write.

Alternatives:

• Donation buttons

• Tiered subscriptions ($5, $10, $25, etc.)

• Expanding content

and these may be short-term fixes, but they're not as profitable as allowing ads. Advertisements can pay several dollars per click and cents every view. If you get 40,000 views a month like me, that's several thousand instead of a few hundred. Also, Medium would have enough money to split ad revenue with writers, who would make more. I'm among the top 6% of Medium writers. Only 6% of Medium writers make more than $100, and I made $500 with 35,000 views last month. Compared to YouTube, the top 1% of Medium authors make a lot. Mr. Beast and PewDiePie make MILLIONS a month, yet top Medium writers make tens of thousands. Sure, paying 3 or 4 people a few grand, or perhaps tens of thousands, will keep them around. What if great authors leveraged their following to go huge on YouTube and abandoned Medium? If people use Medium to get successful on other platforms, Medium will be continuously cycling through authors and paying them to stay.

Ads might make writing on Medium more profitable than making videos on YouTube because they could preserve the present freemium model and pay users based on internal views. The $5 might be ad-free.

Consider: Would you accept Medium ads? A $5 ad-free version + pay-as-you-go, etc. What are your thoughts on this?

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