Python Heatmap Technical Indicator

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

The Market System

Market regime:

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

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

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

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

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

Indicator of Relative Strength

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

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

• Distinguish between the positive and negative net changes.

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

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

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

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

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

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

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

Using the Heatmap to Find the Trend

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

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

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

Zooming out yields a basic heatmap, as shown below.

Plot code:

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

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

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

Contrarian indicator RSI. The following rules apply:

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

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

Zooming out yields a basic heatmap, as shown below.

Plot code:

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

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

Summary

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

Technical analysis will lose its reputation as subjective and unscientific.

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

• Put emotions aside and adopt a critical mindset.

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

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

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

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

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

More retail traders means faster, more sophisticated, and more successful methods.

Tech specifications

Only requires a laptop and an internet connection.

We'll use OpenBB's research platform for data/analysis.

Pricing and execution on Options-Quant

Background

You don't need to know the arithmetic details to use this method.

Black-Scholes is a popular option pricing model. It's best for pricing European options. European options are only exercisable at expiration, unlike American options. American options are always exercisable.

American options carry a premium to cover for the risk of early exercise. The Black-Scholes model doesn't account for this premium, hence it can't price genuine, traded American options.

Barone-Adesi-Whaley (BAW) model. BAW modifies Black-Scholes. It accounts for exercise risk premium and stock dividends. It adds the option's early exercise value to the Black-Scholes value.

The trader need not know the formulaic derivations of this model.

https://ir.nctu.edu.tw/bitstream/11536/14182/1/000264318900005.pdf

Strategy

This strategy targets implied volatility. First, we'll locate liquid options that expire within 30 days and have minimal implied volatility.

After selecting the option that meets the requirements, we price it to get the BAW implied volatility (we choose BAW because it's a more accurate Black-Scholes model). If estimated implied volatility is larger than market volatility, we'll capture the spread.

(Calculated IV — Market IV) = (Profit)

Some approaches to target implied volatility are pricey and inaccessible to individual investors. The best and most cost-effective alternative is to acquire a straddle and delta hedge. This may sound terrifying and pricey, but as shown below, it's much less so.

The Trade

First, we want to find our ideal option, so we use OpenBB terminal to screen for options that:

• Have an IV at least 5% lower than the 20-day historical IV

• Are no more than 5% out-of-the-money

• Expire in less than 30 days

We query:

stocks/options/screen/set low_IV/scr --export Output.csv

This uses the screener function to screen for options that satisfy the above criteria, which we specify in the low IV preset (more on custom presets here). It then saves the matching results to a csv(Excel) file for viewing and analysis.

Stick to liquid names like SPY, AAPL, and QQQ since getting out of a position is just as crucial as getting in. Smaller, illiquid names have higher inefficiencies, which could restrict total profits.

We calculate IV using the BAWbisection model (the bisection is a method of calculating IV, more can be found here.) We price the IV first.

According to the BAW model, implied volatility at this level should be priced at 26.90%. When re-pricing the put, IV is 24.34%, up 3%.

Now it's evident. We must purchase the straddle (long the call and long the put) assuming the computed implied volatility is more appropriate and efficient than the market's. We just want to speculate on volatility, not price fluctuations, thus we delta hedge.

The Fun Starts

We buy both options for $7.65. (x100 multiplier). Initial delta is 2. For every dollar the stock price swings up or down, our position value moves $2.

We want delta to be 0 to avoid price vulnerability. A delta of 0 suggests our position's value won't change from underlying price changes. Being delta-hedged allows us to profit/lose from implied volatility. Shorting 2 shares makes us delta-neutral.

That's delta hedging. (Share price * shares traded) = $330.7 to become delta-neutral. You may have noted that delta is not truly 0.00. This is common since delta-hedging means getting as near to 0 as feasible, since it is rare for deltas to align at 0.00.

Now we're vulnerable to changes in Vega (and Gamma, but given we're dynamically hedging, it's not a big risk), or implied volatility. We wanted to gamble that the position's IV would climb by at least 2%, so we'll maintain it delta-hedged and watch IV.

Because the underlying moves continually, the option's delta moves continuously. A trader can short/long 5 AAPL shares at most. Paper trading lets you practice delta-hedging. Being quick-footed will help with this tactic.

Profit-Closing

As expected, implied volatility rose. By 10 minutes before market closure, the call's implied vol rose to 27% and the put's to 24%. This allowed us to sell the call for $4.95 and the put for $4.35, creating a profit of $165.

You may pull historical data to see how this trade performed. Note the implied volatility and pricing in the final options chain for August 5, 2022 (the position date).

Final Thoughts

Congratulations, that was a doozy. To reiterate, we identified tickers prone to increased implied volatility by screening OpenBB's low IV setting. We double-checked the IV by plugging the price into Options-BAW Quant's model. When volatility was off, we bought a straddle and delta-hedged it. Finally, implied volatility returned to a normal level, and we profited on the spread.

The retail trading space is very quickly catching up to that of institutions.  Commissions and fees used to kill this method, but now they cost less than $5. Watching momentum, technical analysis, and now quantitative strategies evolve is intriguing.

I'm not linked with these sites and receive no financial benefit from my writing.

Tell me how your experience goes and how I helped; I love success tales.

DATA MINING WITH SUPERALGORES

Old pots produce the best soup.

Science has always inspired indicator design. From physics to signal processing, many indicators use concepts from mechanical engineering, electronics, and probability. In Superalgos' Data Mining section, we've explored using thermodynamics and information theory to construct indicators and using statistical and probabilistic techniques like reduced normal law to take advantage of low probability events.

An asset's price is like a mechanical object revolving around its moving average. Using this approach, we could design an indicator using the oscillator's Total Energy. An oscillator's energy is finite and constant. Since we don't expect the price to follow the harmonic oscillator, this energy should deviate from the perfect situation, and the maximum of divergence may provide us valuable information on the price's moving average.

Definition of the Harmonic Oscillator in Few Words

Sinusoidal function describes a harmonic oscillator. The time-constant energy equation for a harmonic oscillator is:

With

Time saves energy.

In a mechanical harmonic oscillator, total energy equals kinetic energy plus potential energy. The formula for energy is the same for every kind of harmonic oscillator; only the terms of total energy must be adapted to fit the relevant units. Each oscillator has a velocity component (kinetic energy) and a position to equilibrium component (potential energy).

The Price Oscillator and the Energy Formula

Considering the harmonic oscillator definition, we must specify kinetic and potential components for our price oscillator. We define oscillator velocity as the rate of change and equilibrium position as the price's distance from its moving average.

Price kinetic energy:

It's like:

With

and

L is the number of periods for the rate of change calculation and P for the close price EMA calculation.

Total price oscillator energy =

Given that an asset's price can theoretically vary at a limitless speed and be endlessly far from its moving average, we don't expect this formula's outcome to be constrained. We'll normalize it using Z-Score for convenience of usage and readability, which also allows probabilistic interpretation.

Over 20 periods, we'll calculate E's moving average and standard deviation.

We calculated Z on BTC/USDT with L = 10 and P = 21 using Knime Analytics.

The graph is detrended. We added two horizontal lines at +/- 1.6 to construct a 94.5% probability zone based on reduced normal law tables. Price cycles to its moving average oscillate clearly. Red and green arrows illustrate where the oscillator crosses the top and lower limits, corresponding to the maximum/minimum price oscillation. Since the results seem noisy, we may apply a non-lagging low-pass or multipole filter like Butterworth or Laguerre filters and employ dynamic bands at a multiple of Z's standard deviation instead of fixed levels.

Kinetic Detrender Implementation in Superalgos

The Superalgos Kinetic detrender features fixed upper and lower levels and dynamic volatility bands.

The code is pretty basic and does not require a huge amount of code lines.

It starts with the standard definitions of the candle pointer and the constant declaration :

let candle = record.current
let len = 10
let P = 21
let T = 20
let up = 1.6
let low = 1.6

Upper and lower dynamic volatility band constants are up and low.

We proceed to the initialization of the previous value for EMA :

if (variable.prevEMA === undefined) {
    variable.prevEMA = candle.close
}

And the calculation of EMA with a function (it is worth noticing the function is declared at the end of the code snippet in Superalgos) :

variable.ema = calculateEMA(P, candle.close, variable.prevEMA)
//EMA calculation
function calculateEMA(periods, price, previousEMA) {
    let k = 2 / (periods + 1)
    return price * k + previousEMA * (1 - k)
}

The rate of change is calculated by first storing the right amount of close price values and proceeding to the calculation by dividing the current close price by the first member of the close price array:

variable.allClose.push(candle.close)
if (variable.allClose.length > len) {
    variable.allClose.splice(0, 1)
}
if (variable.allClose.length === len) {
    variable.roc = candle.close / variable.allClose[0]
} else {
    variable.roc = 1
}

Finally, we get energy with a single line:

variable.E = 1 / 2 * len * variable.roc + 1 / 2 * P * candle.close / variable.ema

The Z calculation reuses code from Z-Normalization-based indicators:

variable.allE.push(variable.E)
if (variable.allE.length > T) {
    variable.allE.splice(0, 1)
}
variable.sum = 0
variable.SQ = 0
if (variable.allE.length === T) {
    for (var i = 0; i < T; i++) {
        variable.sum += variable.allE[i]
    }
    variable.MA = variable.sum / T
for (var i = 0; i < T; i++) {
        variable.SQ += Math.pow(variable.allE[i] - variable.MA, 2)
    }
    variable.sigma = Math.sqrt(variable.SQ / T)
variable.Z = (variable.E - variable.MA) / variable.sigma
} else {
    variable.Z = 0
}
variable.allZ.push(variable.Z)
if (variable.allZ.length > T) {
    variable.allZ.splice(0, 1)
}
variable.sum = 0
variable.SQ = 0
if (variable.allZ.length === T) {
    for (var i = 0; i < T; i++) {
        variable.sum += variable.allZ[i]
    }
    variable.MAZ = variable.sum / T
for (var i = 0; i < T; i++) {
        variable.SQ += Math.pow(variable.allZ[i] - variable.MAZ, 2)
    }
    variable.sigZ = Math.sqrt(variable.SQ / T)
} else {
    variable.MAZ = variable.Z
    variable.sigZ = variable.MAZ * 0.02
}
variable.upper = variable.MAZ + up * variable.sigZ
variable.lower = variable.MAZ - low * variable.sigZ

We also update the EMA value.

variable.prevEMA = variable.EMA

Conclusion

We showed how to build a detrended oscillator using simple harmonic oscillator theory. Kinetic detrender's main line oscillates between 2 fixed levels framing 95% of the values and 2 dynamic levels, leading to auto-adaptive mean reversion zones.

Superalgos' Normalized Momentum data mine has the Kinetic detrender indication.

All the material here can be reused and integrated freely by linking to this article and Superalgos.

This post is informative and not financial advice. Seek expert counsel before trading. Risk using this material.

Consider yourself lucky if your last FAANG interview was rejected.

FAANG—Facebook, Apple, Amazon, Netflix, Google

(I know its manga now, but watch me not care)

These big companies offer many benefits.

1. large salaries and benefits

2. Prestige

3. high expectations for both you and your coworkers.

However, these jobs may have major drawbacks that only become apparent when you're thrown to the wolves, so it's up to you whether you see them as drawbacks or opportunities.

I know most college graduates start working at big tech companies because of their perceived coolness.

I've worked in these companies for years and can tell you what to expect if you get a job here.

Little fish in a vast ocean

The most obvious. Most billion/trillion-dollar companies employ thousands.

You may work on a small, unnoticed product part.

Directors and higher will sometimes make you redo projects they didn't communicate well without respecting your time, talent, or will to work on trivial stuff that doesn't move company needles.

Peers will only say, "Someone has to take out the trash," even though you know company resources are being wasted.

The power imbalance is frustrating.

What you can do about it

Know your WHY. Consider long-term priorities. Though riskier, I stayed in customer-facing teams because I loved building user-facing products.

This increased my impact. However, if you enjoy helping coworkers build products, you may be better suited for an internal team.

I told the Directors and Vice Presidents that their actions could waste Engineering time, even though it was unpopular. Some were receptive, some not.

I kept having tough conversations because they were good for me and the company.

However, some of my coworkers praised my candor but said they'd rather follow the boss.

An outdated piece of technology can take years to update.

Apple introduced Swift for iOS development in 2014. Most large tech companies adopted the new language after five years.

This is frustrating if you want to learn new skills and increase your market value.

Knowing that my lack of Swift practice could hurt me if I changed jobs made writing verbose Objective C painful.

What you can do about it

1. Work on the new technology in side projects; one engineer rewrote the Lyft app in Swift over the course of a weekend and promoted its adoption throughout the entire organization.

2. To integrate new technologies and determine how to combine legacy and modern code, suggest minor changes to the existing codebase.

Most managers spend their entire day in consecutive meetings.

After their last meeting, the last thing they want is another meeting to discuss your career goals.

Sometimes a manager has 15-20 reports, making it hard to communicate your impact.

Misunderstandings and stress can result.

Especially when the manager should focus on selfish parts of the team. Success won't concern them.

What you can do about it

1. Tell your manager that you are a self-starter and that you will pro-actively update them on your progress, especially if they aren't present at the meetings you regularly attend.

2. Keep being proactive and look for mentorship elsewhere if you believe your boss doesn't have enough time to work on your career goals.

3. Alternately, look for a team where the manager has more authority to assist you in making career decisions.

After a certain point, company loyalty can become quite harmful.

Because big tech companies create brand loyalty, too many colleagues stayed in unhealthy environments.

When you work for a well-known company and strangers compliment you, it's fun to tell your friends.

Work defines you. This can make you stay too long even though your career isn't progressing and you're unhappy.

Google may become your surname.

Workplaces are not families.

If you're unhappy, don't stay just because they gave you the paycheck to buy your first home and make you feel like you owe your life to them.

Many employees stayed too long. Though depressed and suicidal.

What you can do about it

1. Your life is not worth a company.

2. Do you want your job title and workplace to be listed on your gravestone? If not, leave if conditions deteriorate.

3. Recognize that change can be challenging. It's difficult to leave a job you've held for a number of years.

4. Ask those who have experienced this change how they handled it.

You still have a bright future if you were rejected from FAANG interviews.

Rejections only lead to amazing opportunities. If you're young and childless, work for a startup.

Companies may pay more than FAANGs. Do your research.

Ask recruiters and hiring managers tough questions about how the company and teams prioritize respectful working hours and boundaries for workers.

I know many 15-year-olds who have a lifelong dream of working at Google, and it saddens me that they're chasing a name on their resume instead of excellence.

This article is not meant to discourage you from working at these companies, but to share my experience about what HR/managers will never mention in interviews.

Read both sides before signing the big offer letter.

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.