Everyone wants a scalable startup.

Innovation helps launch a startup. The secret to a scalable business is growth trials (from 1 to 100).

Growth marketing combines marketing and product development for long-term growth.

Today, I'll explain growth hacking strategies popular startups used to scale.

1/ A Facebook user's social value is proportional to their friends.

Facebook built its user base using content marketing and paid ads. Mark and his investors feared in 2007 when Facebook's growth stalled at 90 million users.

Chamath Palihapitiya was brought in by Mark.

The team tested SEO keywords and MAU chasing. The growth team introduced “people you may know”

This feature reunited long-lost friends and family. Casual users became power users as the retention curve flattened.

Growth Hack Insights: With social network effect the value of your product or platform increases exponentially if you have users you know or can relate with.

2/ Airbnb - Focus on your value propositions

Airbnb nearly failed in 2009. The company's weekly revenue was $200 and they had less than 2 months of runway.

Enter Paul Graham. The team noticed a pattern in 40 listings. Their website's property photos sucked.

Why?

Because these photos were taken with regular smartphones. Users didn't like the first impression.

Graham suggested traveling to New York to rent a camera, meet with property owners, and replace amateur photos with high-resolution ones.

A week later, the team's weekly revenue doubled to $400, indicating they were on track.

Growth Hack Insights: When selling an “online experience” ensure that your value proposition is aesthetic enough for users to enjoy being associated with them.

3/ Zomato - A company's smartphone push ensured growth.

Zomato delivers food. User retention was a challenge for the founders. Indian food customers are notorious for switching brands at the drop of a hat.

Zomato wanted users to order food online and repeat orders throughout the week.

Zomato created an attractive website with “near me” keywords for SEO indexing.

Zomato gambled to increase repeat orders. They only allowed mobile app food orders.

Zomato thought mobile apps were stickier. Product innovations in search/discovery/ordering or marketing campaigns like discounts/in-app notifications/nudges can improve user experience.

Zomato went public in 2021 after users kept ordering food online.

Growth Hack Insights: To improve user retention try to build platforms that build user stickiness. Your product and marketing team will do the rest for them.

4/ Hotmail - Signaling helps build premium users.

Ever sent or received an email or tweet with a sign — sent from iPhone?

Hotmail did it first! One investor suggested Hotmail add a signature to every email.

Overnight, thousands joined the company. Six months later, the company had 1 million users.

When serving an existing customer, improve their social standing. Signaling keeps the top 1%.

5/ Dropbox - Respect loyal customers

Dropbox is a company that puts people over profits. The company prioritized existing users.

Dropbox rewarded loyal users by offering 250 MB of free storage to anyone who referred a friend. The referral hack helped Dropbox get millions of downloads in its first few months.

Growth Hack Insights: Think of ways to improve the social positioning of your end-user when you are serving an existing customer. Signaling goes a long way in attracting the top 1% to stay.

These experiments weren’t hacks. Hundreds of failed experiments and user research drove these experiments. Scaling up experiments is difficult.

Contact me if you want to grow your startup's user base.

Inspired by someone I never met

Inspiration is good and bad.

Paul Jarvis inspires me. He's a web person and writer who created his own category by being himself.

Paul said no thank you when everyone else was developing, building, and assuming greater responsibilities. This isn't success. He rewrote the rules. Working for himself, expanding at his own speed, and doing what he loves were his definitions of success.

Play with a problem that you have

The biggest problem can be not recognizing a problem.

Acceptance without question is deception. When you don't push limits, you forget how. You start thinking everything must be as it is.

For example: working. Paul worked a 9-5 agency work with little autonomy. He questioned whether the 9-5 was a way to live, not the way.

Another option existed. So he chipped away at how to live in this new environment.

Don't simply jump

Internet writers tell people considering quitting 9-5 to just quit. To throw in the towel. To do what you like.

The advice is harmful, despite the good intentions. People think quitting is hard. Like courage is the issue. Like handing your boss a resignation letter.

Nope. The tough part comes after. It’s easy to jump. Landing is difficult.

The landing

Paul didn't quit. Intelligent individuals don't. Smart folks focus on landing. They imagine life after 9-5.

Paul had been a web developer for a long time, had solid clients, and was respected. Hence if he pushed the limits and discovered another route, he had the potential to execute.

Working on the side

Society loves polarization. It’s left or right. Either way. Or chaos. It's 9-5 or entrepreneurship.

But like Paul, you can stretch polarization's limits. In-between exists.

You can work a 9-5 and side jobs (as I do). A mix of your favorites. The 9-5's stability and creativity. Fire and routine.

Remember you can't have everything but anything. You can create and work part-time.

My hybrid lifestyle

Not selling books doesn't destroy my world. My globe keeps spinning if my new business fails or if people don't like my Tweets. Unhappy algorithm? Cool. I'm not bothered (okay maybe a little).

The mix gives me the best of both worlds. To create, hone my skill, and grasp big-business basics. I like routine, but I also appreciate spending 4 hours on Saturdays writing.

Some days I adore leaving work at 5 pm and disconnecting. Other days, I adore having a place to write if inspiration strikes during a run or a discussion.

I’m a part-time creator

I’m a part-time creator. No, I'm not trying to quit. I don't work 5 pm - 2 am on the side. No, I'm not at $10,000 MRR.

I work part-time but enjoy my 9-5. My 9-5 has goodies. My side job as well.

It combines both to meet my lifestyle. I'm satisfied.

Join the Part-time Creators Club for free here. I’ll send you tips to enhance your creative game.

Many people find the internet's various business models bewildering.

This article summarizes 31 startup e-books.

1. Using the freemium business model (free plus premium),

The freemium business model offers basic software, games, or services for free and charges for enhancements.

Examples include Slack, iCloud, and Google Drive

Provide a rudimentary, free version of your product or service to users.

Google Drive and Dropbox offer 15GB and 2GB of free space but charge for more.

Freemium business model details (Click here)

2. The Business Model of Subscription

Subscription business models sell a product or service for recurring monthly or yearly revenue.

Examples: Tinder, Netflix, Shopify, etc

It's the next step to Freemium if a customer wants to pay monthly for premium features.

Subscription Business Model (Click here)

3. A market-based business strategy

It's an e-commerce site or app where third-party sellers sell products or services.

Examples are Amazon and Fiverr.

• On Amazon's marketplace, a third-party vendor sells a product.

• Freelancers on Fiverr offer specialized skills like graphic design.

Marketplace's business concept is explained.

4. Business plans using aggregates

In the aggregator business model, the service is branded.

Uber, Airbnb, and other examples

Marketplace and Aggregator business models differ.

Amazon and Fiverr link merchants and customers and take a 10-20% revenue split.

Uber and Airbnb-style aggregator Join these businesses and provide their products.

5. The pay-as-you-go concept of business

This is a consumption-based pricing system. Cloud companies use it.

Example: Amazon Web Service and Google Cloud Platform (GCP) (AWS)

AWS, an Amazon subsidiary, offers over 200 pay-as-you-go cloud services.

“In short, the more you use the more you pay”

When it's difficult to divide clients into pricing levels, pay-as-you is employed.

6. The business model known as fee-for-service (FFS)

FFS charges fixed and variable fees for each successful payment.

For instance, PayU, Paypal, and Stripe

Stripe charges 2.9% + 30 per payment.

These firms offer a payment gateway to take consumer payments and deposit them to a business account.

Fintech business model

7. EdTech business strategy

In edtech, you generate money by selling material or teaching as a service.

edtech business models

Freemium When course content is free but certification isn't, e.g. Coursera

FREE TRIAL SkillShare offers free trials followed by monthly or annual subscriptions.

Self-serving marketplace approach where you pick what to learn.

Ad-revenue model The company makes money by showing adverts to its huge user base.

Lock-in business strategy

Lock in prevents customers from switching to a competitor's brand or offering.

It uses switching costs or effort to transmit (soft lock-in), improved brand experience, or incentives.

Apple, SAP, and other examples

Apple offers an iPhone and then locks you in with extra hardware (Watch, Airpod) and platform services (Apple Store, Apple Music, cloud, etc.).

9. Business Model for API Licensing

APIs let third-party apps communicate with your service.

Uber and Airbnb use Google Maps APIs for app navigation.

Examples are Google Map APIs (Map), Sendgrid (Email), and Twilio (SMS).

Business models for APIs

1. Free: The simplest API-driven business model that enables unrestricted API access for app developers. Google Translate and Facebook are two examples.

2. Developer Pays: Under this arrangement, service providers such as AWS, Twilio, Github, Stripe, and others must be paid by application developers.

3. The developer receives payment: These are the compensated content producers or developers who distribute the APIs utilizing their work. For example, Amazon affiliate programs

10. Open-source enterprise

Open-source software can be inspected, modified, and improved by anybody.

For instance, use Firefox, Java, or Android.

Google paid Mozilla $435,702 million to be their primary search engine in 2018.

Open-source software profits in six ways.

1. Paid assistance The Project Manager can charge for customization because he is quite knowledgeable about the codebase.

2. A full database solution is available as a Software as a Service (MongoDB Atlas), but there is a fee for the monitoring tool.

3. Open-core design R studio is a better GUI substitute for open-source applications.

4. sponsors of GitHub Sponsorships benefit the developers in full.

5. demands for paid features Earn Money By Developing Open Source Add-Ons for Current Products

Open-source business model

11. The business model for data

If the software or algorithm collects client data to improve or monetize the system.

Open AI GPT3 gets smarter with use.

Foursquare allows users to exchange check-in locations.

Later, they compiled large datasets to enable retailers like Starbucks launch new outlets.

12. Business Model Using Blockchain

Blockchain is a distributed ledger technology that allows firms to deploy smart contracts without a central authority.

Examples include Alchemy, Solana, and Ethereum.

Business models using blockchain

1. Economy of tokens or utility When a business uses a token business model, it issues some kind of token as one of the ways to compensate token holders or miners. For instance, Solana and Ethereum

2. Bitcoin Cash P2P Business Model Peer-to-peer (P2P) blockchain technology permits direct communication between end users. as in IPFS

3. Enterprise Blockchain as a Service (Baas) BaaS focuses on offering ecosystem services similar to those offered by Amazon (AWS) and Microsoft (Azure) in the web 3 sector. Example: Ethereum Blockchain as a Service with Bitcoin (EBaaS).

4. Blockchain-Based Aggregators With AWS for blockchain, you can use that service by making an API call to your preferred blockchain. As an illustration, Alchemy offers nodes for many blockchains.

13. The free-enterprise model

In the freeterprise business model, free professional accounts are led into the funnel by the free product and later become B2B/enterprise accounts.

For instance, Slack and Zoom

Freeterprise companies flourish through collaboration.

Start with a free professional account to build an enterprise.

14. Business plan for razor blades

It's employed in hardware where one piece is sold at a loss and profits are made through refills or add-ons.

Gillet razor & blades, coffee machine & beans, HP printer & cartridge, etc.

Sony sells the Playstation console at a loss but makes up for it by selling games and charging for online services.

Advantages of the Razor-Razorblade Method

1. lowers the risk a customer will try a product. enables buyers to test the goods and services without having to pay a high initial investment.

2. The product's ongoing revenue stream has the potential to generate sales that much outweigh the original investments.

Razor blade business model

15. The business model of direct-to-consumer (D2C)

In D2C, the company sells directly to the end consumer through its website using a third-party logistic partner.

Examples include GymShark and Kylie Cosmetics.

D2C brands can only expand via websites, marketplaces (Amazon, eBay), etc.

D2C benefits

• Lower reliance on middlemen = greater profitability

• You now have access to more precise demographic and geographic customer data.

• Additional space for product testing

• Increased customisation throughout your entire product line-Inventory Less

16. Business model: White Label vs. Private Label

Private label/White label products are made by a contract or third-party manufacturer.

Most amazon electronics are made in china and white-labeled.

Amazon supplements and electronics.

Contract manufacturers handle everything after brands select product quantities on design labels.

17. The franchise model

The franchisee uses the franchisor's trademark, branding, and business strategy (company).

For instance, KFC, Domino's, etc.

Subway, Domino, Burger King, etc. use this business strategy.

Many people pick a franchise because opening a restaurant is risky.

18. Ad-based business model

Social media and search engine giants exploit search and interest data to deliver adverts.

Google, Meta, TikTok, and Snapchat are some examples.

Users don't pay for the service or product given, e.g. Google users don't pay for searches.

In exchange, they collected data and hyper-personalized adverts to maximize revenue.

19. Business plan for octopuses

Each business unit functions separately but is connected to the main body.

Instance: Oyo

OYO is Asia's Airbnb, operating hotels, co-working, co-living, and vacation houses.

20, Transactional business model, number

Sales to customers produce revenue.

E-commerce sites and online purchases employ SSL.

Goli is an ex-GymShark.

21. The peer-to-peer (P2P) business model

In P2P, two people buy and sell goods and services without a third party or platform.

Consider OLX.

22. P2P lending as a manner of operation

In P2P lending, one private individual (P2P Lender) lends/invests or borrows money from another (P2P Borrower).

Instance: Kabbage

Social lending lets people lend and borrow money directly from each other without an intermediary financial institution.

23. A business model for brokers

Brokerages charge a commission or fee for their services.

Examples include eBay, Coinbase, and Robinhood.

Brokerage businesses are common in Real estate, finance, and online and operate on this model.

1. Buy/sell similar models Examples include financial brokers, insurance brokers, and others who match purchase and sell transactions and charge a commission.

2. These brokers charge an advertiser a fee based on the date, place, size, or type of an advertisement. This is known as the classified-advertiser model. For instance, Craiglist

24. Drop shipping as an industry

Dropshipping allows stores to sell things without holding physical inventories.

When a customer orders, use a third-party supplier and logistic partners.

Retailer product portfolio and customer experience Fulfiller The consumer places the order.

Dropshipping advantages

• Less money is needed (Low overhead-No Inventory or warehousing)

• Simple to start (costs under $100)

• flexible work environment

• New product testing is simpler

25. Business Model for Space as a Service

It's centered on a shared economy that lets millennials live or work in communal areas without ownership or lease.

Consider WeWork and Airbnb.

WeWork helps businesses with real estate, legal compliance, maintenance, and repair.

26. The business model for third-party logistics (3PL)

In 3PL, a business outsources product delivery, warehousing, and fulfillment to an external logistics company.

Examples include Ship Bob, Amazon Fulfillment, and more.

3PL partners warehouse, fulfill, and return inbound and outbound items for a charge.

Inbound logistics involves bringing products from suppliers to your warehouse.

Outbound logistics refers to a company's production line, warehouse, and customer.

27. The last-mile delivery paradigm as a commercial strategy

Last-mile delivery is the collection of supply chain actions that reach the end client.

Examples include Rappi, Gojek, and Postmates.

Last-mile is tied to on-demand and has a nighttime peak.

28. The use of affiliate marketing

Affiliate marketing involves promoting other companies' products and charging commissions.

Examples include Hubspot, Amazon, and Skillshare.

Your favorite youtube channel probably uses these short amazon links to get 5% of sales.

Affiliate marketing's benefits

• In exchange for a success fee or commission, it enables numerous independent marketers to promote on its behalf.

• Ensure system transparency by giving the influencers a specific tracking link and an online dashboard to view their profits.

• Learn about the newest bargains and have access to promotional materials.

29. The business model for virtual goods

This is an in-app purchase for an intangible product.

Examples include PubG, Roblox, Candy Crush, etc.

Consumables are like gaming cash that runs out. Non-consumable products provide a permanent advantage without repeated purchases.

30. Business Models for Cloud Kitchens

Ghost, Dark, Black Box, etc.

Delivery-only restaurant.

These restaurants don't provide dine-in, only delivery.

For instance, NextBite and Faasos

31. Crowdsourcing as a Business Model

Crowdsourcing = Using the crowd as a platform's source.

In crowdsourcing, you get support from people around the world without hiring them.

Crowdsourcing sites

1. Open-Source Software gives access to the software's source code so that developers can edit or enhance it. Examples include Firefox browsers and Linux operating systems.

2. Crowdfunding The oculus headgear would be an example of crowdfunding in essence, with no expectations.

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.

Ethereum is the second-largest cryptocurrency. The Merge, a mid-September event that will convert Ethereum's consensus process from proof-of-work to proof-of-stake if all goes according to plan, will be a game changer.

Why is Ethereum ditching proof-of-work? Because it can. We're talking about a fully functioning, open-source ecosystem with a capacity for evolution that other cryptocurrencies lack, a change that would allow it to scale up its performance from 15 transactions per second to 100,000 as its blockchain is used for more and more things. It would reduce its energy consumption by 99.95%. Vitalik Buterin, the system's founder, would play a less active role due to decentralization, and miners, who validated transactions through proof of work, would be far less important.

Why has this conversion taken so long and been so cautious? Because it involves modifying a core process while it's running to boost its performance. It requires running the new mechanism in test chains on an ever-increasing scale, assessing participant reactions, and checking for issues or restrictions. The last big test was in early June and was successful. All that's left is to converge the mechanism with the Ethereum blockchain to conclude the switch.

What's stopping Bitcoin, the leader in market capitalization and the cryptocurrency that began blockchain's appeal, from doing the same? Satoshi Nakamoto, whoever he or she is, departed from public life long ago, therefore there's no community leadership. Changing it takes a level of consensus that is impossible to achieve without strong leadership, which is why Bitcoin's evolution has been sluggish and conservative, with few modifications.

Secondly, The Merge will balance the consensus mechanism (proof-of-work or proof-of-stake) and the system decentralization or centralization. Proof-of-work prevents double-spending, thus validators must buy hardware. The system works, but it requires a lot of electricity and, as it scales up, tends to re-centralize as validators acquire more hardware and the entire network activity gets focused in a few nodes. Larger operations save more money, which increases profitability and market share. This evolution runs opposed to the concept of decentralization, and some anticipate that any system that uses proof of work as a consensus mechanism will evolve towards centralization, with fewer large firms able to invest in efficient network nodes.

Yet radical bitcoin enthusiasts share an opposite argument. In proof-of-stake, transaction validators put their funds at stake to attest that transactions are valid. The algorithm chooses who validates each transaction, giving more possibilities to nodes that put more coins at stake, which could open the door to centralization and government control.

In both cases, we're talking about long-term changes, but Bitcoin's proof-of-work has been evolving longer and seems to confirm those fears, while proof-of-stake is only employed in coins with a minuscule volume compared to Ethereum and has no predictive value.

As of mid-September, we will have two significant cryptocurrencies, each with a different consensus mechanisms and equally different characteristics: one is intrinsically conservative and used only for economic transactions, while the other has been evolving in open source mode, and can be used for other types of assets, smart contracts, or decentralized finance systems. Some even see it as the foundation of Web3.

Many things could change before September 15, but The Merge is likely to be a turning point. We'll have to follow this closely.

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.