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.

You have to use it.

Chat-GPT is a revolution.

All social media outlets are discussing it. How it will impact the future and different things.

True.

I've been using Chat-GPT for a few days, and it's a rare revolution. It's amazing and will only improve.

I asked Chat-GPT about the best non-fiction books. It advised this, albeit results rely on interests.

The Immortal Life of Henrietta Lacks

by Rebecca Skloot

Science, Biography

A impoverished tobacco farmer dies of cervical cancer in The Immortal Life of Henrietta Lacks. Her cell strand helped scientists treat polio and other ailments.

Rebecca Skloot discovers about Henrietta, her family, how the medical business exploited black Americans, and how her cells can live forever in a fascinating and surprising research.

You ought to read it.

1. if you want to discover more about the past of medicine.

2. if you want to discover more about American history.

Bad Blood: Secrets and Lies in a Silicon Valley Startup

by John Carreyrou

Tech, Bio

Bad Blood tells the terrifying story of how a Silicon Valley tech startup's blood-testing device placed millions of lives at risk.

John Carreyrou, a Pulitzer Prize-winning journalist, wrote this book.

Theranos and its wunderkind CEO, Elizabeth Holmes, climbed to popularity swiftly and then plummeted.

You ought to read it.

1. if you are a start-up employee.

2. specialists in medicine.

The Power of Now: A Guide to Spiritual Enlightenment

by Eckhart Tolle

Self-improvement, Spirituality

The Power of Now shows how to stop suffering and attain inner peace by focusing on the now and ignoring your mind.

The book also helps you get rid of your ego, which tries to control your ideas and actions.

If you do this, you may embrace the present, reduce discomfort, strengthen relationships, and live a better life.

You ought to read it.

1. if you're looking for serenity and illumination.

2. If you believe that you are ruining your life, stop.

3. if you're not happy.

The 7 Habits of Highly Effective People

by Stephen R. Covey

Profession, Success

The 7 Habits of Highly Effective People is an iconic self-help book.

This vital book offers practical guidance for personal and professional success.

This non-fiction book is one of the most popular ever.

You ought to read it.

1. if you want to reach your full potential.

2. if you want to discover how to achieve all your objectives.

3. if you are just beginning your journey toward personal improvement.

Sapiens: A Brief History of Humankind

by Yuval Noah Harari

Science, History

Sapiens explains how our species has evolved from our earliest ancestors to the technology age.

How did we, a species of hairless apes without tails, come to control the whole planet?

It describes the shifts that propelled Homo sapiens to the top.

You ought to read it.

1. if you're interested in discovering our species' past.

2. if you want to discover more about the origins of human society and culture.

Trigger warning — Andrew Tate is running a genius marketing campaign

Andrew Tate is a 2022 internet celebrity.

Kickboxing world champion became rich playboy with controversial views on gender roles.

Andrew's get-rich-quick scheme isn't new. His social media popularity is impressive.

He’s currently running one of the most genius marketing campaigns in history.

He pulls society's pendulum away from diversity and inclusion and toward diversion and exclusion. He's unstoppable.

Here’s everything you need to know about Andrew Tate. And how he’s playing chess while the world plays checkers.

Cobra Tate is the name he goes by.

American-born, English-raised entrepreneur Andrew Tate lives in Romania.

Romania? Says Andrew,

“I prefer a country in which corruption is available to everyone.”

Andrew was a professional kickboxer with the ring moniker Cobra before starting Hustlers University.

Before that, he liked chess and worshipped his father.

Emory Andrew Tate III is named after his grandmaster chess player father.

Emory was the first black-American chess champion. He was military, martial arts-trained, and multilingual. A superhuman.

He lived in his car to make ends meet.

Andrew and Tristan relocated to England with their mother when their parents split.

It was there that Andrew began his climb toward becoming one of the internet’s greatest villains.

Andrew fell in love with kickboxing.

Andrew spent his 20s as a professional kickboxer and reality TV star, featuring on Big Brother UK and The Ultimate Traveller.

These 3 incidents, along with a chip on his shoulder, foreshadowed Andrews' social media breakthrough.

• Chess

• Combat sports

• Reality television

A dangerous trio.

Andrew started making money online after quitting kickboxing in 2017 due to an eye issue.

Andrew didn't suddenly become popular.

Andrew's web work started going viral in 2022.

Due to his contentious views on patriarchy and gender norms, he's labeled the King of Toxic Masculinity. His most contentious views (trigger warning):

• “Women are intrinsically lazy.”

• “Female promiscuity is disgusting.”

• “Women shouldn’t drive cars or fly planes.”

• “A lot of the world’s problems would be solved if women had their body count tattooed on their foreheads.”

Andrew's two main beliefs are:

1. “These are my personal opinions based on my experiences.”

2. “I believe men are better at some things and women are better at some things. We are not equal.”

Andrew intentionally offends.

Andrew's thoughts began circulating online in 2022.

In July 2022, he was one of the most Googled humans, surpassing:

• Joe Biden

• Donald Trump

• Kim Kardashian

Andrews' rise is a mystery since no one can censure or suppress him. This is largely because Andrew nor his team post his clips.

But more on that later.

Andrew's path to wealth.

Andrew Tate is a self-made millionaire. His morality is uncertain.

Andrew and Tristan needed money soon after retiring from kickboxing.

“I owed some money to some dangerous people. I had $70K and needed $100K to stay alive.”

Andrews lost $20K on roulette at a local casino.

Andrew had one week to make $50,000, so he started planning. Andrew locked himself in a chamber like Thomas Edison to solve an energy dilemma.

He listed his assets.

• Physical strength (but couldn’t fight)

• a BMW (worth around $20K)

• Intelligence (but no outlet)

A lightbulb.

He had an epiphany after viewing a webcam ad. He sought aid from women, ironically. His 5 international girlfriends are assets.

Then, a lightbulb.

Andrew and Tristan messaged and flew 7 women to a posh restaurant. Selling desperation masked as opportunity, Andrew pitched his master plan:

A webcam business — with a 50/50 revenue split.

5 women left.

2 stayed.

Andrew Tate, a broke kickboxer, became Top G, Cobra Tate.

The business model was simple — yet sad.

Andrew's girlfriends moved in with him and spoke online for 15+ hours a day. Andrew handled ads and equipment as the women posed.

Andrew eventually took over their keyboards, believing he knew what men wanted more than women.

Andrew detailed on the Full Send Podcast how he emotionally manipulated men for millions. They sold houses, automobiles, and life savings to fuel their companionship addiction.

When asked if he felt bad, Andrew said,

“F*ck no.“

Andrew and Tristan wiped off debts, hired workers, and diversified.

Tristan supervised OnlyFans models.

Andrew bought Romanian casinos and MMA league RXF (Real Xtreme Fighting).

Pandemic struck suddenly.

Andrew couldn't run his 2 businesses without a plan. Another easy moneymaker.

He banked on Hustlers University.

The actual cause of Andrew's ubiquity.

On a Your Mom’s House episode Andrew's 4 main revenue sources:

1. Hustler’s University

2. Owning casinos in Romania

3. Owning 10% of the Romanian MMA league “RXF”

4. “The War Room” — a society of rich and powerful men

When the pandemic hit, 3/4 became inoperable.

So he expanded Hustlers University.

But what is Hustler’s University?

Andrew says Hustlers University teaches 18 wealth-building tactics online. Examples:

• Real estate

• Copywriting

• Amazon FBA

• Dropshipping

• Flipping Cryptos

How to swiftly become wealthy.

Lessons are imprecise, rudimentary, and macro-focused, say reviews. Invest wisely, etc. Everything is free online.

You pay for community. One unique income stream.

The only money-making mechanism that keeps the course from being a scam.

The truth is, many of Andrew’s students are actually making money. Maybe not from the free YouTube knowledge Andrew and his professors teach in the course, but through Hustler’s University’s affiliate program.

Affiliates earn 10% commission for each new student = $5.

Students can earn $10 for each new referral in the first two months.

Andrew earns $50 per membership per month.

This affiliate program isn’t anything special — in fact, it’s on the lower end of affiliate payouts. Normally, it wouldn’t be very lucrative.

But it has one secret weapon— Andrew and his viral opinions.

Andrew is viral. Andrew went on a media tour in January 2022 after appearing on Your Mom's House.

• The Full Send Podcast

• The Fresh & Fit Podcast

• “BFFs” by Barstool Sports

And many, many more…

He chatted with Twitch streamers. Hustlers University wanted more controversy (and clips).

Here’s the strategy behind Hustler’s University that has (allegedly) earned students upwards of $10K per month:

1. Make a social media profile with Andrew Tates' name and photo.

2. Post any of the online videos of Andrews that have gone viral.

3. Include a referral link in your bio.

Effectively simple.

Andrew's controversy attracts additional students. More student clips circulate as more join. Andrew's students earn more and promote the product as he goes viral.

A brilliant plan that's functioning.

At the beginning of his media tour, Hustler’s University had 5,000 students. 6 months in, and he now has over 100,000.

One income stream generates $5 million every month.

Andrew's approach is not new.

But it is different.

In the early 2010s, Tai Lopez dominated the internet.

His viral video showed his house.

“Here in my garage. Just bought this new Lamborghini.”

Tais' marketing focused on intellect, not strength, power, and wealth to attract women.

How reading quicker leads to financial freedom in 67 steps.

Years later, it was revealed that Tai Lopez rented the mansion and Lamborghini as a marketing ploy to build social proof. Meanwhile, he was living in his friend’s trailer.

Faked success is an old tactic.

Andrew is doing something similar. But with one major distinction.

Andrew outsources his virality — making him nearly impossible to cancel.

In 2022, authorities searched Andrews' estate over human trafficking suspicions. Investigation continues despite withdrawn charges.

Andrew's divisive nature would normally get him fired. Andrew's enterprises and celebrity don't rely on social media.

He doesn't promote or pay for ads. Instead, he encourages his students and anyone wishing to get rich quick to advertise his work.

Because everything goes through his affiliate program. Old saying:

“All publicity is good publicity.”

Final thoughts: it’s ok to feel triggered.

Tate is divisive.

His emotionally charged words are human nature. Andrews created the controversy.

It's non-personal.

His opinions are those of one person. Not world nor generational opinion.

Briefly:

• It's easy to understand why Andrews' face is ubiquitous. Money.

• The world wide web is a chessboard. Misdirection is part of it.

• It’s not personal, it’s business.

• Controversy sells

Sometimes understanding the ‘why’, can help you deal with the ‘what.’

This report from Mark Gurman has stuck with me:

In the News and Stocks apps, the display ads are no different than what you might get on an ad-supported website. In the App Store, the ads are for actual apps, which are probably more useful for Apple users than mortgage rates. Some people may resent Apple putting ads in the News and Stocks apps. After all, the iPhone is supposed to be a premium device. Let’s say you shelled out $1,000 or more to buy one, do you want to feel like Apple is squeezing more money out of you just to use its standard features? Now, a portion of ad revenue from the News app’s Today tab goes to publishers, but it’s not clear how much. Apple also lets publishers advertise within their stories and keep the vast majority of that money. Surprisingly, Today ads also appear if you subscribe to News+ for $10 per month (though it’s a smaller number).

I use Apple News often. It's a good general news catch-up tool, like Twitter without the BS. Customized notifications are helpful. Fast and lovely. Except for advertisements. I have Apple One, which includes News+, and while I understand why the magazines still have brand ads, it's ridiculous to me that Apple enables web publishers to introduce awful ads into this experience. Apple's junky commercials are ridiculous.

We know publishers want and probably requested this. Let's keep Apple News ad-free for the much smaller percentage of paid users, and here's your portion. (Same with Stocks, which is more sillier.)

Paid app placement in the App Store is a wonderful approach for developers to find new users (though far too many of those ads are trying to trick users, in my opinion).

Apple is also planning to increase ads in its Maps app. This sounds like Google Maps, and I don't like it. I never find these relevant, and they clutter up the user experience. Apple Maps now has a UI advantage (though not a data/search one, which matters more).

Apple is nickel-and-diming its customers. We spend thousands for their products and premium services like Apple One. We all know why: income must rise, and new firms are needed to scale. This will eventually backfire.

Market fraud

Due to its decentralized and fragmented character, the crypto market has integrity difficulties.

Cryptocurrencies are an immature sector, therefore market manipulation becomes a bigger issue. Many research have attempted to uncover these abuses. CryptoCompare's newest one highlights some of the industry's most typical scams.

Why are these concerns so common in the crypto market? First, even the largest centralized exchanges remain unregulated due to industry immaturity. A low-liquidity market segment makes an attack more harmful. Finally, market surveillance solutions not implemented reduce transparency.

In CryptoCompare's latest exchange benchmark, 62.4% of assessed exchanges had a market surveillance system, although only 18.1% utilised an external solution. To address market integrity, this measure must improve dramatically. Before discussing the report's malpractices, note that this is not a full list of attacks and hacks.

Clean Trading

An investor buys and sells concurrently to increase the asset's price. Centralized and decentralized exchanges show this misconduct. 23 exchanges have a volume-volatility correlation < 0.1 during the previous 100 days, according to CryptoCompares. In August 2022, Exchange A reported $2.5 trillion in artificial and/or erroneous volume, up from $33.8 billion the month before.

Spoofing

Criminals create and cancel fake orders before they can be filled. Since manipulators can hide in larger trading volumes, larger exchanges have more spoofing. A trader placed a 20.8 BTC ask order at $19,036 when BTC was trading at $19,043. BTC declined 0.13% to $19,018 in a minute. At 18:48, the trader canceled the ask order without filling it.

Front-Running

Most cryptocurrency front-running involves inside trading. Traditional stock markets forbid this. Since most digital asset information is public, this is harder. Retailers could utilize bots to front-run.

CryptoCompare found digital wallets of people who traded like insiders on exchange listings. The figure below shows excess cumulative anomalous returns (CAR) before a coin listing on an exchange.

Finally, LAYERING is a sequence of spoofs in which successive orders are put along a ladder of greater (layering offers) or lower (layering bids) values. The paper concludes with recommendations to mitigate market manipulation. Exchange data transparency, market surveillance, and regulatory oversight could reduce manipulative tactics.