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.

He’s not the President. Stop treating him like one.

Elon Musk tweeted from Qatar, where he was watching the World Cup Final with Jared Kushner.

Musk's subsequent Tweets were as normal, basic, and bland as anyone's from a World Cup Final: It's depressing to see the world's richest man looking at his phone during a grand ceremony. Rich guy goes to rich guy event didn't seem important.

Before Musk posted his should-I-step-down-at-Twitter poll, CNN ran a long segment asking if it was hypocritical for him to reveal his real-time location after defending his (very dumb) suspension of several journalists for (supposedly) revealing his assassination coordinates by linking to a site that tracks Musks private jet. It was hard to ignore CNN's hypocrisy: It covered Musk as Twitter CEO like President Trump. EVERY TRUMP STORY WAS BASED ON HIM SAYING X, THEN DOING Y. Trump would do something horrific, lie about it, then pretend it was fine, then condemn a political rival who did the same thing, be called hypocritical, and so on. It lasted four years. Exhausting.

It made sense because Trump was the President of the United States. The press's main purpose is to relentlessly cover and question the president.

It's strange to say this out. Twitter isn't America. Elon Musk isn't a president. He maintains a money-losing social media service to harass and mock people he doesn't like. Treating Musk like Trump, as if he should be held accountable like Trump, shows a startling lack of perspective. Some journalists treat Twitter like a country.

The compulsive, desperate way many journalists utilize the site suggests as much. Twitter isn't the town square, despite popular belief. It's a place for obsessives to meet and converse. Journalists say they're breaking news. Their careers depend on it. They can argue it's a public service. Nope. It's a place lonely people go to speak all day. Twitter. So do journalists, Trump, and Musk. Acting as if it has a greater purpose, as if it's impossible to break news without it, or as if the republic is in peril is ludicrous. Only 23% of Americans are on Twitter, while 25% account for 97% of Tweets. I'd think a large portion of that 25% are journalists (or attention addicts) chatting to other journalists. Their loudness makes Twitter seem more important than it is. Nope. It's another stupid website. They were there before Twitter; they will be there after Twitter. It’s just a website. We can all get off it if we want. Most of us aren’t even on it in the first place.

Musk is a website-owner. No world leader. He's not as accountable as Trump was. Musk is cable news's primary character now that Trump isn't (at least for now). Becoming a TV news anchor isn't as significant as being president. Elon Musk isn't as important as we all pretend, and Twitter isn't even close. Twitter is a dumb website, Elon Musk is a rich guy going through a midlife crisis, and cable news is lazy because its leaders thought the entire world was on Twitter and are now freaking out that their playground is being disturbed.

I’ve said before that you need to leave Twitter, now. But even if you’re still on it, we need to stop pretending it matters more than it does. It’s a site for lonely attention addicts, from the man who runs it to the journalists who can’t let go of it. It’s not a town square. It’s not a country. It’s not even a successful website. Let’s stop pretending any of it’s real. It’s not.

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

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

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

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

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

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

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

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

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

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

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

“Poor distribution, not poor goods, is the main reason for failure” — Peter Thiel.

Here's an easy way to conceptualize "go-to-market" for your distribution plan.

One equation captures the concept:

Distribution = Ecosystem Participants + Incentives

Draw your customers' ecosystem. Set aside your goods and consider your consumer's environment. Who do they deal with daily? 

1. First, list each participant. You want an exhaustive list, but here are some broad categories.

• In-person media services

• Websites

• Events\Networks

• Financial education and banking

• Shops

• Staff

• Advertisers

• Twitter influencers

1. Draw influence arrows. Who's affected? I'm not just talking about Instagram selfie-posters. Who has access to your consumer and could promote your product if motivated?

The thicker the arrow, the stronger the relationship. Include more "influencers" if needed. Customer ecosystems are complex.

3. Incentivize ecosystem players. “Show me the incentive and I will show you the result.“, says Warren Buffet's business partner Charlie Munger.

Strong distribution strategies encourage others to promote your product to your target market by incentivizing the most prominent players. Incentives can be financial or non-financial.

Financial rewards

Usually, there's money. If you pay Facebook, they'll run your ad. Salespeople close deals for commission. Giving customers bonus credits will encourage referrals.

Most businesses underuse non-financial incentives.

Non-cash incentives

Motivate key influencers without spending money to expand quickly and cheaply. What can you give a client-connector for free?

Here are some ideas:

Are there any other features or services available?

Titles or status? Tinder paid college "ambassadors" for parties to promote its dating service.

Can I get early/free access? Facebook gave a select group of developers "exclusive" early access to their AR platform.

Are you a good host? Pharell performed at YPlan's New York launch party.

Distribution? Apple's iPod earphones are white so others can see them.

Have an interesting story? PR rewards journalists by giving them a compelling story to boost page views.

Prioritize distribution.

More time spent on distribution means more room in your product design and business plan. Once you've identified the key players in your customer's ecosystem, talk to them.

Money isn't your only resource. Creative non-monetary incentives may be more effective and scalable. Give people something useful and easy to deliver.

I use a conceptual and practical system I developed decades ago as an example.

Since childhood, I've been interested in the brain-mind connection, so I developed a system using scientific breakthroughs, experiments, and the experiences of successful people in my circles.

This story provides a high-level overview of a custom system to inform and inspire readers. Creating a mind gym was one of my best personal and professional investments.

Such a complex system may not be possible for everyone or appear luxurious at first. However, the process and approach may help you find more accessible and viable solutions.

Visualizing the brain as a muscle, I learned to stimulate it with physical and mental exercises, applying a new mindset and behavioral changes.

My methods and practices may not work for others because we're all different. I focus on the approach's principles and highlights so you can create your own program.

Some create a conceptual and practical system intuitively, and others intellectually. Both worked. I see intellect and intuition as higher selves.

The mental tools I introduce are based on lifestyle changes and can be personalized by anyone, barring physical constraints or underlying health conditions.

Some people can't meditate despite wanting to due to mental constraints. This story lacks exceptions.

People's systems may vary. Many have used my tools successfully. All have scientific backing because their benefits attracted scientists. None are unethical or controversial.

My focus is cognition, which is the neocortex's ability. These practices and tools can affect the limbic and reptilian brain regions.

A previous article discussed brain health's biological aspects. This article focuses on psychology.

Thinking, learning, and remembering are cognitive abilities. Cognitive abilities determine our health and performance.

Cognitive health is the ability to think, concentrate, learn, and remember. Cognitive performance boosting involves various tools and processes. My system and protocols address cognitive health and performance.

As a biological organ, the brain's abilities decline with age, especially if not used regularly. Older people have more neurodegenerative disorders like dementia.

As aging is inevitable, I focus on creating cognitive reserves to remain mentally functional as we age and face mental decline or cognitive impairment.

My protocols focus on neurogenesis, or brain growth and maintenance. Neurons and connections can grow at any age.

Metacognition refers to knowing our cognitive abilities, like thinking about thinking and learning how to learn.

In the following sections, I provide an overview of my system, mental tools, and protocols.

This system summarizes my 50-year career. Some may find it too abstract, so I give examples.

First, explain the system. Section 2 introduces activities. Third, how to measure and maintain mental growth.

1 — Developed a practical mental gym.

The mental gym is a metaphor for the physical fitness gym to improve our mental muscles.

This concept covers brain and mind functionality. Integrated biological and psychological components.

I'll describe my mental gym so my other points make sense. My mental gym has physical and mental tools.

Mindfulness, meditation, visualization, self-conversations, breathing exercises, expressive writing, working in a flow state, reading, music, dance, isometric training, barefoot walking, cold/heat exposure, CBT, and social engagements are regular tools.

Dancing, walking, and thermogenesis are body-related tools. As the brain is part of the body and houses the mind, these tools can affect mental abilities such as attention, focus, memory, task switching, and problem-solving.

Different people may like different tools. I chose these tools based on my needs, goals, and lifestyle. They're just examples. You can choose tools that fit your goals and personality.

2 — Performed tasks regularly.

These tools gave me clarity. They became daily hobbies. Some I did alone, others with others.

Some examples: I meditate daily. Even though my overactive mind made daily meditation difficult at first, I now enjoy it. Meditation three times a day sharpens my mind.

Self-talk is used for self-therapy and creativity. Self-talk was initially difficult, but neurogenesis rewired my brain to make it a habit.

Cold showers, warm baths with Epsom salts, fasting, barefoot walks on the beach or grass, dancing, calisthenics, trampoline hopping, and breathing exercises increase my mental clarity, creativity, and productivity.

These exercises can increase BDNF, which promotes nervous system growth. They improve mental capacity and performance by increasing blood flow and brain oxygenation.

I use weekly and occasional activities like dry saunas, talking with others, and community activities.

These activities stimulate the brain and mind, improving performance and cognitive capacity.

3 — Measured progress, set growth goals.

Measuring progress helps us stay on track. Without data, it's hard to stay motivated. When we face inevitable setbacks, we may abandon our dreams.

I created a daily checklist for a spreadsheet with macros. I tracked how often and long I did each activity.

I measured my progress objectively and subjectively. In the progress spreadsheet, I noted my meditation hours and subjective feelings.

In another column, I used good, moderate, and excellent to get qualitative data. It took time and effort. Later, I started benefiting from this automated structure.

Creating a page for each activity, such as meditation, self-talk, cold showers, walking, expressive writing, personal interactions, etc., gave me empirical data I could analyze, modify, and graph to show progress.

Colored charts showed each area's strengths and weaknesses.

Strengths motivate me to continue them. Identifying weaknesses helped me improve them.

As the system matured, data recording became a habit and took less time. I saw the result immediately because I automated the charts when I entered daily data. Early time investment paid off later.

Mind Gym Benefits, Effective Use, and Progress Measuring

This concept helped me move from comfort to risk. I accept things as they are.

Turnarounds were made. I stopped feeling "Fight-Flight-Freeze" and maintained self-control.

I tamed my overactive amygdala by strengthening my brain. Stress and anxiety decreased. With these shifts, I accepted criticism and turned envy into admiration. Clarity improved.

When the cognitive part of the brain became stronger and the primitive part was tamed, managing thoughts and emotions became easier. My AQ increased. I learned to tolerate people, physical, mental, and emotional obstacles.

Accessing vast information sources in my subconscious mind through an improved RAS allowed me to easily tap into my higher self and recognize flaws in my lower self.

Summary

The brain loves patterns and routines, so habits help. Observing, developing, and monitoring habits mindfully can be beneficial. Mindfulness helps us achieve this goal systematically.

As body and mind are connected, we must consider both when building habits. Consistent and joyful practices can strengthen neurons and neural connections.

Habits help us accomplish more with less effort. Regularly using mental tools and processes can improve our cognitive health and performance as we age.

Creating daily habits to improve cognitive abilities can sharpen our minds and boost our well-being.

Some apps monitor our activities and behavior to help build habits. If you can't replicate my system, try these apps. Some smartwatches and fitness devices include them.

Set aside time each day for mental activities you enjoy. Regular scheduling and practice can strengthen brain regions and form habits. Once you form habits, tasks become easy.

Improving our minds is a lifelong journey. It's easier and more sustainable to increase our efforts daily, weekly, monthly, or annually.

Despite life's ups and downs, many want to remain calm and cheerful.

This valuable skill is unrelated to wealth or fame. It's about our mindset, fueled by our biological and psychological needs.

Here are some lessons I've learned about staying calm and composed despite challenges and setbacks.

1 — Tranquillity starts with observing thoughts and feelings.

2 — Clear the mental clutter and emotional entanglements with conscious breathing and gentle movements.

3 — Accept situations and events as they are with no resistance.

4 — Self-love can lead to loving others and increasing compassion.

5 — Count your blessings and cultivate gratitude.

Clear thinking can bring joy and satisfaction. It's a privilege to wake up with a healthy body and clear mind, ready to connect with others and serve them.

Thank you for reading my perspectives. I wish you a healthy and happy life.

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.