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.

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.

Are you one of these Zoom dogs?

The Person Who Is Apparently Always on Mute

Waffles thinks he can overpower the mute button by shouting loudly.

The person who believed their camera to be off

Barkley's used to remote work, but he hasn't mastered the "Stop Video" button. Everyone is affected.

Who is driving for some reason, exactly?

Why is Pumpkin always late? Who knows? Shouldn't she be driving? If you could hear her over the freeway, she'd answer these questions.

The Person With the Amazing Bookcase

Cicero likes to use SAT-words like "leverage" and "robust" in Zoom sessions, presumably from all the books he wants you to see behind him.

The Individual Who Is Unnecessarily Dressed

We hope Bandit is going somewhere beautiful after this meeting, or else he neglected the quarterly earnings report and is overcompensating to distract us.

The person who works through lunch in between zoom calls

Barksworth has back-to-back meetings all day, so you can watch her eat while she talks.

The Person Who Is A Little Too Comfy

Hercules thinks Zoom meetings happen between sleeps. He'd appreciate everyone speaking more quietly.

The Person Who Answered the Phone Outside

Frisbee has a gorgeous backyard and lives in a place with great weather year-round, and she wants you to think about that during the daily team huddle.

Who Wants You to Pay Attention to Their Pet

Snickers hasn't listened to you in 20 minutes unless you tell her how cute her kitten is.

One who is, for some reason, positioned incorrectly on the screen

Nelson's meetings consist primarily of attempting to figure out how he positioned his laptop so absurdly.

The person who says too many goodbyes

Zeus waves farewell like it's your first day of school while everyone else searches for the "Leave Meeting" button. It's nice.

He who has a poor internet connection

Ziggy's connectivity problems continue... She gives a long speech as everyone waits awkwardly to inform her they missed it.

The Clearly Multitasking Person

Tinkerbell can play fetch during the monthly staff meeting if she works from home, but that's not a good idea.

The Person Using Zoom as a Makeup and Hair Mirror

If Gail and Bob knew Zoom had a "hide self view" option, they'd be distraught.

The person who feels at ease with simply leaving

Rusty bails when a Zoom conference is over. Rusty's concept is decent.

VeeFriends is one NFT project I'm sure will last.

I believe in blockchain technology and JPEGs, aka NFTs. NFTs aren't JPEGs. It's not as it seems.

Gary Vaynerchuk is leading the pack with his new NFT project VeeFriends, I wrote a year ago. I was spot-on. It's the most innovative project I've seen.

Since its minting in May 2021, it has given its holders enormous value, most notably the first edition of VeeCon, a multi-day superconference featuring iconic and emerging leaders in NFTs and Popular Culture. First-of-its-kind NFT-ticketed Web3 conference to build friendships, share ideas, and learn together.

VeeFriends holders got free VeeCon NFT tickets. Attendees heard iconic keynote speeches, innovative talks, panels, and Q&A sessions.

It was a unique conference that most of us, including me, are looking forward to in 2023. The lineup was epic, and it allowed many to network in new ways. Really memorable learning. Here are a couple of gratitude posts from the attendees.

VeeFriends Series 2

This article explains VeeFriends if you're still confused.

GaryVee's hand-drawn doodles have evolved into wonderful characters. The characters' poses and backgrounds bring the VeeFriends IP to life.

Yes, this is the second edition of VeeFriends, and at current prices, it's one of the best NFT opportunities in years. If you have the funds and risk appetite to invest in NFTs, VeeFriends Series 2 is worth every penny. Even if you can't invest, learn from their journey.

1. Art Is the Start

Many critics say VeeFriends artwork is below average and not by GaryVee. Art is often the key to future success.

Let's look at one of the first Mickey Mouse drawings. No one would have guessed that this would become one of the most beloved animated short film characters. In Walt Before Mickey, Walt Disney's original mouse Mortimer was less refined.

First came a mouse...

These sketches evolved into Steamboat Willie, Disney's first animated short film.

Fred Moore redesigned the character artwork into what we saw in cartoons as kids. Mickey Mouse's history is here.

Looking at how different cartoon characters have evolved and gained popularity over decades, I believe Series 2 characters like Self-Aware Hare, Kind Kudu, and Patient Pig can do the same.

GaryVee captures this journey on the blockchain and lets early supporters become part of history. Time will tell if it rivals Disney, Pokemon, or Star Wars. Gary has been vocal about this vision.

2. VeeFriends is Intellectual Property for the Coming Generations

Most of us grew up watching cartoons, playing with toys, cards, and video games. Our interactions with fictional characters and the stories we hear shape us.

GaryVee is slowly curating an experience for the next generation with animated videos, card games, merchandise, toys, and more.

VeeFriends UNO, a collaboration with Mattel Creations, features 17 VeeFriends characters.

VeeFriends and Zerocool recently released Trading Cards featuring all 268 Series 1 characters and 15 new ones. Another way to build VeeFriends' collectibles brand.

At Veecon, all the characters were collectible toys. Something will soon emerge.

Kids and adults alike enjoy the YouTube channel's animated shorts and VeeFriends Tunes. Here's a song by the holder's Optimistic Otter-loving daughter.

This VeeFriends story is only the beginning. I'm looking forward to animated short film series, coloring books, streetwear, candy, toys, physical collectibles, and other forms of VeeFriends IP.

3. Veefriends will always provide utilities

Smart contracts can be updated at any time and authenticated on a ledger.

VeeFriends Series 2 gives no promise of any utility whatsoever. GaryVee released no project roadmap. In the first few months after launch, many owners of specific characters or scenes received utilities.

Every benefit or perk you receive helps promote the VeeFriends brand.

Recent partnerships are listed below.

• MaryRuth's Multivitamin Gummies

• Productive Puffin holders from VeeFriends x Primitive

• Pickleball Scene & Clown Holders Only

Pickleball & Competitive Clown Exclusive experience, anteater multivitamin gummies, and Puffin x Primitive merch

Considering the price of NFTs, it may not seem like much. It's just the beginning; you never know what the future holds. No other NFT project offers such diverse, ongoing benefits.

4. Garyvee's team is ready

Gary Vaynerchuk's team and record are undisputed. He's a serial entrepreneur and the Chairman & CEO of VaynerX, which includes VaynerMedia, VaynerCommerce, One37pm, and The Sasha Group.

Gary founded VaynerSports, Resy, and Empathy Wines. He's a Candy Digital Board Member, VCR Group Co-Founder, ArtOfficial Co-Founder, and VeeFriends Creator & CEO. Gary was recently named one of Fortune's Top 50 NFT Influencers.

Gary Vayenerchuk aka GaryVee

Gary documents his daily life as a CEO on social media, which has 34 million followers and 272 million monthly views. GaryVee Audio Experience is a top podcast. He's a five-time New York Times best-seller and sought-after speaker.

Gary can observe consumer behavior to predict trends. He understood these trends early and pioneered them.

• 1997 — Realized e-potential commerce's and started winelibrary.com. In five years, he grew his father's wine business from $3M to $60M.

• 2006 — Realized content marketing's potential and started Wine Library on YouTube. TV

• 2009 — Estimated social media's potential (Web2) and invested in Facebook, Twitter, and Tumblr.

• 2014: Ethereum and Bitcoin investments

• 2021 — Believed in NFTs and Web3 enough to launch VeeFriends

GaryVee isn't all of VeeFriends. Andy Krainak, Dave DeRosa, Adam Ripps, Tyler Dowdle, and others work tirelessly to make VeeFriends a success.

GaryVee has said he'll let other businesses fail but not VeeFriends. We're just beginning his 40-year vision.

I have more confidence than ever in a company with a strong foundation and team.

5. Humans die, but characters live forever

What if GaryVee dies or can't work?

A writer's books can immortalize them. As long as their books exist, their words are immortal. Socrates, Hemingway, Aristotle, Twain, Fitzgerald, and others have become immortal.

Everyone knows Vincent Van Gogh's The Starry Night.

We all love reading and watching Peter Parker, Thor, or Jessica Jones. Their behavior inspires us. Stan Lee's message and stories live on despite his death.

GaryVee represents VeeFriends. Creating characters to communicate ensures that the message reaches even those who don't listen.

Gary wants his values and messages to be omnipresent in 268 characters. Messengers die, but their messages live on.

Gary envisions VeeFriends creating timeless stories and experiences. Ten years from now, maybe every kid will sing Patient Pig.

6. I love the intent.

Gary planned to create Workplace Warriors three years ago when he began designing Patient Panda, Accountable Ant, and Empathy elephant. The project stalled. When NFTs came along, he knew.

Gary wanted to create characters with traits he values, such as accountability, empathy, patience, kindness, and self-awareness. He wants future generations to find these traits cool. He hopes one or more of his characters will become pop culture icons.

These emotional skills aren't taught in schools or colleges, but they're crucial for business and life success. I love that someone is teaching this at scale.

In the end, intent matters.

Humans Are Collectors

Buy and collect things to communicate. Since the 1700s. Medieval people formed communities around hidden metals and stones. Many people still collect stamps and coins, and luxury and fashion are multi-trillion dollar industries. We're collectors.

The early 2020s NFTs will be remembered in the future. VeeFriends will define a cultural and technological shift in this era. VeeFriends Series 1 is the original hand-drawn art, but it's expensive. VeeFriends Series 2 is a once-in-a-lifetime opportunity at $1,000.

If you are new to NFTs, check out How to Buy a Non Fungible Token (NFT) For Beginners

This is a non-commercial article. Not financial or legal advice. Information isn't always accurate. Before making important financial decisions, consult a pro or do your own research.

This post is a summary. Read the full article here

TOP APPS

Who survives spring cleaning?

Relax. Notion is off-limits. This topic is popular.

(I wrote about it 2 years ago, before everyone else did.) So).

These apps are probably new to you. I hope you find a new phone app after reading this.

Outdooractive

ViewRanger is Google Maps for outdoor enthusiasts.

This app has been so important to me as a freedom-loving long-distance walker and hiker.

This app shows nearby trails and right-of-ways on top of an Open Street Map.

Helpful detail and data. Any route's distance,

You can download and follow tons of routes planned by app users.

This has helped me find new routes and places a fellow explorer has tried.

Free with non-intrusive ads. Years passed before I subscribed. Pro costs £2.23/month.

This app is for outdoor lovers.

Google Files

New phones come with bloatware. These rushed apps are frustrating.

We must replace these apps. 2017 was Google's year.

Files is a file manager. It's quick, innovative, and clean. They've given people what they want.

It's easy to organize files, clear space, and clear cache.

I recommend Gallery by Google as a gallery app alternative. It's quick and easy.

Trainline

App for trains, buses, and coaches.

I've used this app for years. It did the basics well when I first used it.

Since then, it's improved. It's constantly adding features to make traveling easier and less stressful.

Split-ticketing helps me save hundreds a year on train fares. This app is only available in the UK and Europe.

This service doesn't link to a third-party site. Their app handles everything.

Not all train and coach companies use this app. All the big names are there, though.

Here's more on the app.

Battlefield: Mobile

Play Store has 478,000 games. Few can turn my phone into a console.

Call of Duty Mobile and Asphalt 8/9 are examples.

Asphalt's loot boxes and ads make it unplayable. Call of Duty opens with a few ads. Close them to play without hassle.

This game uses all your phone's features to provide a high-quality, seamless experience. If my internet connection is good, I never experience lag or glitches.

The gameplay is energizing and intense, just like on consoles. Sometimes I'm too involved. I've thrown my phone in anger. I'm totally absorbed.

Customizability is my favorite. Since phones have limited screen space, we should only have the buttons we need, placed conveniently.

Size, opacity, and position are modifiable. Adjust audio, graphics, and textures. It's customizable.

This game has been on my phone for three years. It began well and has gotten better. When I think the creators can't do more, they do.

If you play, read my tips for winning a Battle Royale.

Lightroom

As a photographer, I believe your best camera is on you. The phone.

2017 was a big year for this app. I've tried many photo-editing apps since then. This always wins.

The app is dull. I've never seen better photo editing on a phone.

Adjusting settings and sliders doesn't damage or compress photos. It's detailed.

This is important for phone photos, which are lower quality than professional ones.

Some tools are behind a £4.49/month paywall. Adobe must charge a subscription fee instead of selling licenses. (I'm still bitter about Creative Cloud's price)

Snapseed is my pick. Lightroom is where I do basic editing before moving to Snapseed. Snapseed review:

These apps are great. They cover basic and complex editing needs while traveling.

Final Reflections

I hope you downloaded one of these. Share your favorite apps. These apps are scarce.

Most don't understand the issue until it's too late.

My first startup was what entrepreneurs call the hardest. A two-sided marketplace.

Two-sided marketplaces are the hardest startups because founders must solve the chicken or the egg conundrum.

A two-sided marketplace needs suppliers and buyers. Without suppliers, buyers won't come. Without buyers, suppliers won't come. An empty marketplace and a founder striving to gain momentum result.

My first venture made me a struggling founder seeking to achieve traction for a two-sided marketplace. The company failed, and I vowed never to start another like it.

I didn’t. Unfortunately, my second venture was almost as hard. It failed like the second-hardest startup.

What kind of startup is the second-hardest?

The second-hardest startup, which is almost as hard to develop, is rarely discussed in the startup community. Because of this, I predict more founders fail each year trying to develop the second-toughest startup than the hardest.

Fairly, I have no proof. I see many startups, so I have enough of firsthand experience. From what I've seen, for every entrepreneur developing a two-sided marketplace, I'll meet at least 10 building this other challenging startup.

I'll describe a startup I just met with its two co-founders to explain the second hardest sort of startup and why it's so hard. They created a financial literacy software for parents of high schoolers.

The issue appears plausible. Children struggle with money. Parents must teach financial responsibility. Problems?

It's possible.

Buyers and users are different.

Buyer-user mismatch.

The financial literacy app I described above targets parents. The parent doesn't utilize the app. Child is end-user. That may not seem like much, but it makes customer and user acquisition and onboarding difficult for founders.

The difficulty of a buyer-user imbalance

The company developing a product faces a substantial operational burden when the buyer and end customer are different. Consider classic firms where the buyer is the end user to appreciate that responsibility.

Entrepreneurs selling directly to end users must educate them about the product's benefits and use. Each demands a lot of time, effort, and resources.

Imagine selling a financial literacy app where the buyer and user are different. To make the first sale, the entrepreneur must establish all the items I mentioned above. After selling, the entrepreneur must supply a fresh set of resources to teach, educate, or train end-users.

Thus, a startup with a buyer-user mismatch must market, sell, and train two organizations at once, requiring twice the work with the same resources.

The second hardest startup is hard for reasons other than the chicken-or-the-egg conundrum. It takes a lot of creativity and luck to solve the chicken-or-egg conundrum.

The buyer-user mismatch problem cannot be overcome by innovation or luck. Buyer-user mismatches must be solved by force. Simply said, when a product buyer is different from an end-user, founders have a lot more work. If they can't work extra, their companies fail.