Research on preventing disease, extending life, and caring for your body from the inside out

Grapefruit and pomegranates aren't on the list, so ignore that. Mostly, I enjoyed the visual, but those fruits are healthful, too.

15 (or 17 if you consider the photo) different foods a day sounds like a lot. If you're not used to it  — it is.

These lists don't aim for perfection. Instead, use this article and the science below to eat more of these foods. If you can eat 5 foods one day and 5 the next, you're doing well. This list should be customized to your requirements and preferences.

“Every time you eat or drink, you are either feeding disease or fighting it” -Heather Morgan.

The 15 Foods That You Should Consume Daily and Why:

1. Dark/Red Berries

(blueberries, blackberries, acai, goji, cherries, strawberries, raspberries)

The 2010 Global Burden of Disease Study is the greatest definitive analysis of death and disease risk factors in history. They found the primary cause of both death, disability, and disease inside the United States was diet.

Not eating enough fruit, and specifically berries, was one of the best predictors of disease (1).

What's special about berries? It's their color! Berries have the most antioxidants of any fruit, second only to spices. The American Cancer Society found that those who ate the most berries were less likely to die of cardiovascular disease.

2. Beans

Soybeans, black beans, kidney beans, lentils, split peas, chickpeas.

Beans are one of the most important predictors of survival in older people, according to global research (2).

For every 20 grams (2 tablespoons) of beans consumed daily, the risk of death is reduced by 8%.

Soybeans and soy foods are high in phytoestrogen, which reduces breast and prostate cancer risks. Phytoestrogen blocks the receptors' access to true estrogen, mitigating the effects of weight gain, dairy (high in estrogen), and hormonal fluctuations (3).

3. Nuts

(almonds, walnuts, pecans, pistachios, Brazil nuts, cashews, hazelnuts, macadamia nuts)

Eating a handful of nuts every day reduces the risk of chronic diseases like heart disease and diabetes. Nuts also reduce oxidation, blood sugar, and LDL (bad) cholesterol, improving arterial function (4).

Despite their high-fat content, studies have linked daily nut consumption to a slimmer waistline and a lower risk of obesity (5).

4. Flaxseed

(milled flaxseed)

2013 research found that ground flaxseed had one of the strongest anti-hypertensive effects of any food. A few tablespoons (added to a smoothie or baked goods) lowered blood pressure and stroke risk 23 times more than daily aerobic exercise (6).

Flax shouldn't replace exercise, but its nutritional punch is worth adding to your diet.

5. Other seeds

(chia seeds, hemp seeds, pumpkin seeds, sesame seeds, fennel seeds)

Seeds are high in fiber and omega-3 fats and can be added to most dishes without being noticed.

When eaten with or after a meal, chia seeds moderate blood sugar and reduce inflammatory chemicals in the blood (7). Overall, a great daily addition.

6. Dates

Dates are one of the world's highest sugar foods, with 80% sugar by weight. Pure cake frosting is 60%, maple syrup is 66%, and cotton-candy jelly beans are 70%.

Despite their high sugar content, dates have a low glycemic index, meaning they don't affect blood sugar levels dramatically. They also improve triglyceride and antioxidant stress levels (8).

Dates are a great source of energy and contain high levels of dietary fiber and polyphenols, making 3-10 dates a great way to fight disease, support gut health with prebiotics, and satisfy a sweet tooth (9).

7. Cruciferous Veggies

(broccoli, Brussel sprouts, horseradish, kale, cauliflower, cabbage, boy choy, arugula, radishes, turnip greens)

Cruciferous vegetables contain an active ingredient that makes them disease-fighting powerhouses. Sulforaphane protects our brain, eyesight, against free radicals and environmental hazards, and treats and prevents cancer (10).

Unless you eat raw cruciferous vegetables daily, you won't get enough sulforaphane (and thus, its protective nutritional benefits). Cooking destroys the enzyme needed to create this super-compound.

If you chop broccoli, cauliflower, or turnip greens and let them sit for 45 minutes before cooking them, the enzyme will have had enough time to work its sulforaphane magic, allowing the vegetables to retain the same nutritional value as if eaten raw. Crazy, right? For more on this, see What Chopping Your Vegetables Has to Do with Fighting Cancer.

8. Whole grains

(barley, brown rice, quinoa, oats, millet, popcorn, whole-wheat pasta, wild rice)

Whole-grains are one of the healthiest ways to consume your daily carbs and help maintain healthy gut flora.

This happens when fibre is broken down in the colon and starts a chain reaction, releasing beneficial substances into the bloodstream and reducing the risk of Type 2 Diabetes and inflammation (11).

9. Spices

(turmeric, cumin, cinnamon, ginger, saffron, cloves, cardamom, chili powder, nutmeg, coriander)

7% of a person's cells will have DNA damage. This damage is caused by tiny breaks in our DNA caused by factors like free-radical exposure.

Free radicals cause mutations that damage lipids, proteins, and DNA, increasing the risk of disease and cancer. Free radicals are unavoidable because they result from cellular metabolism, but they can be avoided by consuming anti-oxidant and detoxifying foods.

Including spices and herbs like rosemary or ginger in our diet may cut DNA damage by 25%. Yes, this damage can be improved through diet. Turmeric worked better at a lower dose (just a pinch, daily). For maximum free-radical fighting (and anti-inflammatory) effectiveness, use 1.5 tablespoons of similar spices (12).

10. Leafy greens

(spinach, collard greens, lettuce, other salad greens, swiss chard)

Studies show that people who eat more leafy greens perform better on cognitive tests and slow brain aging by a year or two (13).

As we age, blood flow to the brain drops due to a decrease in nitric oxide, which prevents blood vessels from dilatation. Daily consumption of nitrate-rich vegetables like spinach and swiss chard may prevent dementia and Alzheimer's.

11. Fermented foods

(sauerkraut, tempeh, kombucha, plant-based kefir)

Miso, kimchi, and sauerkraut contain probiotics that support gut microbiome.

Probiotics balance the good and bad bacteria in our bodies and offer other benefits. Fermenting fruits and vegetables increases their antioxidant and vitamin content, preventing disease in multiple ways (14).

12. Sea vegetables

(seaweed, nori, dulse flakes)

A population study found that eating one sheet of nori seaweed per day may cut breast cancer risk by more than half (15).

Seaweed and sea vegetables may help moderate estrogen levels in the metabolism, reducing cancer and disease risk.

Sea vegetables make up 30% of the world's edible plants and contain unique phytonutrients. A teaspoon of these super sea-foods on your dinner will help fight disease from the inside out.

13. Water

I'm less concerned about whether you consider water food than whether you drink enough. If this list were ranked by what single item led to the best health outcomes, water would be first.

Research shows that people who drink 5 or more glasses of water per day have a 50% lower risk of dying from heart disease than those who drink 2 or less (16).

Drinking enough water boosts energy, improves skin, mental health, and digestion, and reduces the risk of various health issues, including obesity.

14. Tea

All tea consumption is linked to a lower risk of stroke, heart disease, and early death, with green tea leading for antioxidant content and immediate health benefits.

Green tea leaves may also be able to interfere with each stage of cancer formation, from the growth of the first mutated cell to the spread and progression of cancer in the body. Green tea is a quick and easy way to support your long-term and short-term health (17).

15. Supplemental B12 vitamin

B12, or cobalamin, is a vitamin responsible for cell metabolism. Not getting enough B12 can have serious consequences.

Historically, eating vegetables from untreated soil helped humans maintain their vitamin B12 levels. Due to modern sanitization, our farming soil lacks B12.

B12 is often cited as a problem only for vegetarians and vegans (as animals we eat are given B12 supplements before slaughter), but recent studies have found that plant-based eaters have lower B12 deficiency rates than any other diet (18).

Article Sources:

1. The Global Burden of Disease Study 2010 (GBD 2010)

2. I. Darmadi-Blackberry, M. Wahlqvist, A. Kouris-Blazos, et al. Legumes: the most important dietary predictor of survival in older people of different ethnicities. Asia Pac J Clin Nutr. 2004;13(2):217–20.

3. Guha N, Kwan ML, Quesenberry CP Jr, Weltzien EK, Castillo AL, Caan BJ. Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors: the Life After Cancer Epidemiology study. Breast Cancer Res Treat. 2009 Nov;118(2):395–405.

4. Y. Bao, J. Han, F. B. Hu, E. L. Giovannucci, M. J. Stampfer, W. C. Willett, C. S. Fuchs. Association of nut consumption with total and cause-specific mortality. N. Engl. J. Med. 2013 369(21):2001–2011.

5. V. Vadivel, C. N. Kunyanga, H. K. Biesalski. Health benefits of nut consumption with special reference to body weight control. Nutrition 2012 28(11–12):1089–1097.

6. D Rodriguez-Leyva, W Weighell, A L Edel,R LaVallee, E Dibrov,R Pinneker, T G Maddaford, B Ramjiawan, M Aliani, R Guzman R, G N Pierce. Potent antihypertensive action of dietary flaxseed in hypertensive patients. Hypertension. 2013 Dec;62(6):1081–9. doi: 10.1161/HYPERTENSIONAHA.113.02094.

7. Vuksan V, Jenkins AL, Dias AG, Lee AS, Jovanovski E, Rogovik AL, Hanna A. Reduction in postprandial glucose excursion and prolongation of satiety: possible explanation of the long-term effects of whole grain Salba (Salvia Hispanica L.). Eur J Clin Nutr. 2010 Apr;64(4):436–8. doi: 10.1038/ejcn.2009.159. Epub 2010 Jan 20. PMID: 20087375.

8. W. Rock, M. Rosenblat, H. Borochov-Neori, N. Volkova, S. Judeinstein, M. Elias, and M. Aviram. Effects of date (Phoenix dactylifera L., Medjool or Hallawi Variety) consumption by healthy subjects on serum glucose and lipid levels and on serum oxidative status: a pilot study. J. Agric. Food. Chem., 57(17):8010{8017, 2009.

9. Eid N, Enani S, Walton G, et al. The impact of date palm fruits and their component polyphenols, on gut microbial ecology, bacterial metabolites and colon cancer cell proliferation. J Nutr Sci. 2014;3:e46.

10. Li Y, Zhang T, Korkaya H, Liu S, Lee HF, Newman B, Yu Y, Clouthier SG, Schwartz SJ, Wicha MS, Sun D. Sulforaphane, a Dietary Component of Broccoli/Broccoli Sprouts, Inhibits Breast Cancer Stem Cells. Clin Cancer Res. 2010 May 1;16(9):2580–90.

11. Lappi J, Kolehmainen M, Mykkänen H, Poutanen K. Do large intestinal events explain the protective effects of whole grain foods against type 2 diabetes? Crit Rev Food Sci Nutr. 2013;53(6):631–40.

12. S. S. Percival, J. P. V. Heuvel, C. J. Nieves, C. Montero, A. J. Migliaccio, J. Meadors. Bioavailability of Herbs and Spices in Humans as Determined by ex vivo Inflammatory Suppression and DNA Strand Breaks. J Am Coll Nutr. 2012 31(4):288–294.

13. Nurk E, Refsum H, Drevon CA, et al. Cognitive performance among the elderly in relation to the intake of plant foods. The Hordaland Health Study. Br J Nutr. 2010;104(8):1190–201.

14. Melini, F.; Melini, V.; Luziatelli, F.; Ficca, A.G.; Ruzzi, M. Health-Promoting Components in Fermented Foods: An Up-to-Date Systematic Review. Nutrients2019, 11, 1189.

15. H. Funahashi, T. Imai, T. Mase, M. Sekiya, K. Yokoi, H. Hayashi, A. Shibata, T. Hayashi, M. Nishikawa, N. Suda, Y. Hibi, Y. Mizuno, K. Tsukamura, A. Hayakawa, S. Tanuma. Seaweed prevents breast cancer? Jpn. J. Cancer Res. 2001 92(5):483–487.

16. Chan J, Knutsen SF, Blix GG, Lee JW, Fraser GE. Water, other fluids, and fatal coronary heart disease: the Adventist Health Study. Am J Epidemiol. 2002 May 1;155(9):827–33. doi: 10.1093/aje/155.9.827. PMID: 11978586.

17. Fujiki H, Imai K, Nakachi K, Shimizu M, Moriwaki H, Suganuma M. Challenging the effectiveness of green tea in primary and tertiary cancer prevention. J Cancer Res Clin Oncol. 2012 Aug;138(8):1259–70.

18. Damayanti, D., Jaceldo-Siegl, K., Beeson, W. L., Fraser, G., Oda, K., & Haddad, E. H. (2018). Foods and Supplements Associated with Vitamin B12Biomarkers among Vegetarian and Non-Vegetarian Participants of the Adventist Health Study-2 (AHS-2) Calibration Study. Nutrients, 10(6), 722. doi:10.3390/nu10060722

I’m a permaculture farmer. I want to create food-producing ecosystems. My hope is a world with easy access to a cuisine that nourishes consumers, supports producers, and leaves the Earth joyously habitable.

Permaculturists, natural farmers, plantsmen, and foodies share this ambition. I believe this group of green thumbs, stock-folk, and food champions is falling to tribalism, forgetting that rescuing the globe requires saving all of its inhabitants, even those who adore cheap burgers and Coke. We're digging foxholes and turning folks who disagree with us or don't understand into monsters.

Take Dr. Daphne Miller's comments at the end of her Slow Money Journal interview:

“Americans are going to fall into two camps when all is said and done: People who buy cheap goods, regardless of quality, versus people who are willing and able to pay for things that are made with integrity. We are seeing the limits of the “buying cheap crap” approach.”

This is one of the most judgmental things I've read outside the Bible. Consequences:

• People who purchase inexpensive things (food) are ignorant buffoons who prefer to choose fair trade coffee over fuel as long as the price is correct.

• It all depends on your WILL to buy quality or cheaply. Both those who are WILLING and those who ARE NOT exist. And able, too.

• People who are unwilling and unable are purchasing garbage. You're giving your kids bad food. Both the Earth and you are being destroyed by your actions. Your camp is the wrong one. You’re garbage! Disgrace to you.

Dr. Miller didn't say it, but words are worthless until interpreted. This interpretation depends on the interpreter's economic, racial, political, religious, family, and personal history. Complementary language insults another. Imagine how that Brown/Harvard M.D.'s comment sounds to a low-income household with no savings.

Dr. Miller's comment reflects the echo chamber into which nearly all clean food advocates speak. It asks easy questions and accepts non-solutions like raising food prices and eating less meat. People like me have cultivated an insular world unencumbered by challenges beyond the margins. We may disagree about technical details in rotationally-grazing livestock, but we short circuit when asked how our system could supply half the global beef demand. Most people have never seriously considered this question. We're so loved and affirmed that challenging ourselves doesn't seem necessary. Were generals insisting we don't need to study the terrain because God is on our side?

“Yes, the $8/lb ground beef is produced the way it should be. Yes, it’s good for my body. Yes it’s good for the Earth. But it’s eight freaking dollars, and my kid needs braces and protein. Bye Felicia, we’re going to McDonald’s.”

-Bobby Q. Homemaker

Funny clean foodies. People don't pay enough for food; they should value it more. Turn the concept of buying food with integrity into a wedge and drive it into the heart of America, dividing the willing and unwilling.

We go apeshit if you call our products high-end.

I've heard all sorts of gaslighting to defend a $10/lb pork chop as accessible (things I’ve definitely said in the past):

• At Whole Foods, it costs more.

• The steak at the supermarket is overly affordable.

• Pay me immediately or the doctor gets paid later.

I spoke with Timbercreek Market and Local Food Hub in front of 60 people. We were asked about local food availability.

They came to me last, after my co-panelists gave the same responses I would have given two years before.

I grumbled, "Our food is inaccessible." Nope. It's beyond the wallets of nearly everyone, and it's the biggest problem with sustainable food systems. We're criminally unserious about being leaders in sustainability until we propose solutions beyond economic relativism, wishful thinking, and insisting that vulnerable, distracted people do all the heavy lifting of finding a way to afford our food. And until we talk about solutions, all this preserve the world? False.

The room fell silent as if I'd revealed a terrible secret. Long, thunderous applause followed my other remarks. But I’m probably not getting invited back to any VNRLI events.

I make pricey cuisine. It’s high-end. I have customers who really have to stretch to get it, and they let me know it. They're forgoing other creature comforts to help me make a living and keep the Earth of my grandmothers alive, and they're doing it as an act of love. They believe in us and our work.

I remember it when I'm up to my shoulders in frigid water, when my vehicle stinks of four types of shit, when I come home covered in blood and mud, when I'm hauling water in 100-degree heat, when I'm herding pigs in a rainstorm and dodging lightning bolts to close the chickens. I'm reminded I'm not alone. Their enthusiasm is worth more than money; it helps me make a life and a living. I won't label that gift less than it is to make my meal seem more accessible.

Not everyone can sacrifice.

Let's not pretend we want to go back to peasant fare, despite our nostalgia. Industrial food has leveled what rich and poor eat. How food is cooked will be the largest difference between what you and a billionaire eat. Rich and poor have access to chicken, pork, and beef. You might be shocked how recently that wasn't the case. This abundance, particularly of animal protein, has helped vulnerable individuals.

Industrial food causes environmental damage, chronic disease, and distribution inequities. Clean food promotes non-industrial, artisan farming. This creates a higher-quality, more expensive product than the competition; we respond with aggressive marketing and the "people need to value food more" shtick geared at consumers who can spend the extra money.

The guy who is NOT able is rendered invisible by clean food's elitist marketing, which is bizarre given a.) clean food insists it's trying to save the world, yet b.) MOST PEOPLE IN THE WORLD ARE THAT GUY. No one can help him except feel-good charities. That's crazy.

Also wrong: a foodie telling a kid he can't eat a 99-cent fast food hamburger because it lacks integrity. Telling him how easy it is to save his ducketts and maybe have a grass-fed house burger at the end of the month as a reward, but in the meantime get your protein from canned beans you can't bake because you don't have a stove and, even if you did, your mom works two jobs and moonlights as an Uber driver so she doesn't have time to heat that shitup anyway.

A wealthy person's attitude toward the poor is indecent. It's 18th-century Versailles.

Human rights include access to nutritious food without social or environmental costs. As a food-forest-loving permaculture farmer, I no longer balk at the concept of cultured beef and hydroponics. My food is out of reach for many people, but access to decent food shouldn't be. Cultures and hydroponics could scale to meet the clean food affordability gap without externalities. If technology can deliver great, affordable beef without environmental negative effects, I can't reject it because it's new, unusual, or might endanger my business.

Why is your farm needed if cultured beef and hydroponics can feed the world? Permaculture food forests with trees, perennial plants, and animals are crucial to economically successful environmental protection. No matter how advanced technology gets, we still need clean air, water, soil, greenspace, and food.

Clean Food cultivated in/on live soil, minimally processed, and eaten close to harvest is part of the answer, not THE solution. Clean food advocates must recognize the conflicts at the intersection of environmental, social, and economic sustainability, the disproportionate effects of those conflicts on the poor and lower-middle classes, and the immorality and impracticality of insisting vulnerable people address those conflicts on their own and judging them if they don't.

Our clients, relatives, friends, and communities need an honest assessment of our role in a sustainable future. If we're serious about preserving the world, we owe honesty to non-customers. We owe our goal and sanity to honesty. Future health and happiness of the world left to the average person's pocketbook and long-term moral considerations is a dismal proposition with few parallels.

Let's make soil and grow food. Let the lab folks do their thing. We're all interdependent.

My wallpape

Elon's rides start rough, but then...

Elon Musk has never been so hated.

They don’t get Elon.

• He began using PayPal in this manner.

• He began with SpaceX in a similar manner.

• He began with Tesla in this manner.

Disruptive.

Elon had rocky starts. His creativity requires it. Just like writing a first draft.

His fastest way to find the way is to avoid it.

PayPal's pricey launch

PayPal was a 1999 business flop.

They were considered insane.

Elon and his co-founders had big plans for PayPal. They adopted the popular philosophy of the time, exchanging short-term profit for growth, and pulled off a miracle just before the bubble burst.

PayPal was created as a dollar alternative. Original PayPal software allowed PalmPilot money transfers. Unfortunately, there weren't enough PalmPilot users.

Since everyone had email, the company emailed payments. Costs rose faster than sales.

The startup wanted to get a million subscribers by paying $10 to sign up and $10 for each referral. Elon thought the price was fair because PayPal made money by charging transaction fees. They needed to make money quickly.

A Wall Street Journal article valuing PayPal at $500 million attracted investors. The dot-com bubble burst soon after they rushed to get financing.

Musk and his partners sold PayPal to eBay for $1.5 billion in 2002. Musk's most successful company was PayPal.

SpaceX's start-up error

Elon and his friends bought a reconditioned ICBM in Russia in 2002.

He planned to invest much of his wealth in a stunt to promote NASA and space travel.

Many called Elon crazy.

The goal was to buy a cheap Russian rocket to launch mice or plants to Mars and return them. He thought SpaceX would revive global space interest. After a bad meeting in Moscow, Elon decided to build his own rockets to undercut launch contracts.

Then SpaceX was founded.

Elon’s plan was harder than expected.

Explosions followed explosions.

• Millions lost on cargo.

• Millions lost on the rockets.

Investors thought Elon was crazy, but he wasn't.

NASA's biggest competitor became SpaceX. NASA hired SpaceX to handle many of its missions.

Tesla's shaky beginning

Tesla began shakily.

• Clients detested their roadster.

• They continued to miss deadlines.

Lotus would handle the car while Tesla focused on the EV component, easing Tesla's entry. The business experienced elegance creep. Modifying specific parts kept the car from getting worse.

Cost overruns, delays, and other factors changed the Elise-like car's appearance. Only 7% of the Tesla Roadster's parts matched its Lotus twin.

Tesla was about to die.

Elon saved the mess as CEO.

He fired 25% of the workforce to reduce costs.

Elon Musk transformed Tesla into the world's most valuable automaker by running it like a startup.

Tesla hasn't spent a dime on advertising. They let the media do the talking by investing in innovation.

Elon sheds. Elon tries. Elon learns. Elon refines.

Twitter doesn't worry me.

The media is shocked. I’m not.

This is just Elon being Elon.

• Elon makes lean.

• Elon tries new things.

• Elon listens to feedback.

• Elon refines.

Besides Twitter will always be Twitter.

I've summarized each.

Anne Lamott said books are important. Books help us understand ourselves and our behavior. They teach us about community, friendship, and death.

I read. One of my few life-changing habits. 100+ books a year improve my life. I'll list life-changing books you can read in a day. I hope you like them too.

Let's get started!

1) Seneca's Letters from a Stoic

One of my favorite philosophy books. Ryan Holiday, Naval Ravikant, and other prolific readers recommend it.

Seneca wrote 124 letters at the end of his life after working for Nero. Death, friendship, and virtue are discussed.

It's worth rereading. When I'm in trouble, I consult Seneca.

It's brief. The book could be read in one day. However, use it for guidance during difficult times.

My favorite book quotes:

• Many men find that becoming wealthy only alters their problems rather than solving them.

• You will never be poor if you live in harmony with nature; you will never be wealthy if you live according to what other people think.

• We suffer more frequently in our imagination than in reality; there are more things that are likely to frighten us than to crush us.

2) Steven Pressfield's book The War of Art

I’ve read this book twice. I'll likely reread it before 2022 is over.

The War Of Art is the best productivity book. Steven offers procrastination-fighting tips.

Writers, musicians, and creative types will love The War of Art. Workplace procrastinators should also read this book.

My favorite book quotes:

• The act of creation is what matters most in art. Other than sitting down and making an effort every day, nothing else matters.

• Working creatively is not a selfish endeavor or an attempt by the actor to gain attention. It serves as a gift for all living things in the world. Don't steal your contribution from us. Give us everything you have.

• Fear is healthy. Fear is a signal, just like self-doubt. Fear instructs us on what to do. The more terrified we are of a task or calling, the more certain we can be that we must complete it.

3) Darren Hardy's The Compound Effect

The Compound Effect offers practical tips to boost productivity by 10x.

The author believes each choice shapes your future. Pizza may seem harmless. However, daily use increases heart disease risk.

Positive outcomes too. Daily gym visits improve fitness. Reading an hour each night can help you learn. Writing 1,000 words per day would allow you to write a novel in under a year.

Your daily choices affect compound interest and your future. Thus, better habits can improve your life.

My favorite book quotes:

• Until you alter a daily habit, you cannot change your life. The key to your success can be found in the actions you take each day.

• The hundreds, thousands, or millions of little things are what distinguish the ordinary from the extraordinary; it is not the big things that add up in the end.

• Don't worry about willpower. Time to use why-power. Only when you relate your decisions to your aspirations and dreams will they have any real meaning. The decisions that are in line with what you define as your purpose, your core self, and your highest values are the wisest and most inspiring ones. To avoid giving up too easily, you must want something and understand why you want it.

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.