Costing a leg

Day 54: Thursday

Morning, Tim!

Silly Josephine…

Tim as you well know I work in healthcare. Thinking about healthcare as a business feels kind of grimy at times — you are making money off of those who desperately need help, many times in order to live. That said, having worked with a lot of Catholic hospital systems, the usual saying goes “No margin no mission”. In order to operate, in order to help all of those people, they need to have the financial backing to do so. They certainly have a lot of write-offs each year, essentially donating care back to communities; but it’s no news that in the U.S., healthcare is expensive, and many people are paying all they can afford in medical bills.

I’m not sure how I’m supposed to think about making money off of others’ misfortune. In one hand, I’m helping them extend life; in the other, the cost of that extension is often a poor quality of life, constantly fretting about bills and work.

I recently came across some articles about financially backing legal cases. I asked a friend of mine with a law degree to explain in a bit more detail, but the gist is that there are many wrongs done to people – e.g. abuse, discrimination, etc. – done by a corporation that has quite a bit of money. If the individual were to sue, there are legal ways for the corporation to spend those dollars quickly prolonging and “drowning” the individual, making it effectively impossible to sue in many cases. There are some lawyers who will work on a contingency basis, not getting paid until the individual does — but they typically have caps far smaller than would be necessary to take on a corporation.

The linked article discusses financially backing some of these cases. Now I certainly don’t have enough money to bankroll anyone’s legal case, but the idea still intrigues me. If real harm was done, shouldn’t there be some recompense paid? The same problem we saw above begins to arise, though – in order to operate like this, the financial backer would need some form of compensation, thus taking a portion of what would go to the individual. There’s this feeling of doing good while simultaneously lessening the good done.

I’m not sure there’s any way around it within healthcare. Hopefully make it cheaper to deliver care, I suppose. It’s just unfortunate that there’s a cost to doing good.

Until tomorrow,


Suspected bibliophile

Day 44: Thursday

Morning, Tim!

Tim, It should be obvious to long standing Thily Fin readers that you are quite the avid reader. Not only do you regularly write and cite poetry, you also go into roots and philology. Hopefully you don’t (regularly, at least) fall prey to the Etymological Fallacy

What readers may not know is that I have (outside of Thily Fin) accused Tim of liking old books (note to readers: if you did know this…well I guess I don’t want to think about that scenario). Tim has adamantly denied that he likes old books simply for the sake that they are old – it is the content that matters. In other words, he wouldn’t judge a book by its old cover…

Now Tim, I came across this article and found it particularly intriguing. You see, a man checked out some library books throughout the year, similarly perhaps to how you and our readers might use libraries. He was a bit different, though. To paint a fuller picture, he checked out over 2300 books!! That’s quite remarkable. Importantly, his motive was a bit paradoxical. Because books infrequently checked out fall prey to algorithms (blast you, technology!) which help cull dated material to create room for the new, he was checking these books out to ensure they did not leave the shelves. However, he also wanted these books to be read by future patrons – to get taken off the shelves. I’m sure the authorities pointed out this wonderful logic “WHICH IS IT?! DO YOU WANT THEM ON THE SHELVES OR NOT?! Guess he couldn’t make up his mind…

That’s a silly little spew of consciousness. The other, perhaps more interesting take on the story, is a warning. Tim, when I first saw this story, I immediately thought the culprit might by you, secretly embarrassed by the voracity with which you bring to learning. Unwilling to confess your secret, you created this story to throw everyone off the scent, only to have it backfire with repercussions. Thankfully I realized it couldn’t possibly be you — 2300 books is way too few.

Until tomorrow,


Them’s fightin words (Happy Boxing Day)

Day 36: Monday

Morning, Tim!

I hope you had a wonderful Christmas! I saw you, so I anticipate it went pretty well. Re-reading that sentence seems narcissistic – you see I wasn’t meaning to imply it was good because you saw me, but because I saw you seemingly enjoying your day.

On that note, Happy Boxing Day. In case you aren’t familiar, Boxing Day is the day following Christmas. Notably, it’s the day everyone is returning all the stuff they don’t want from the previous day. Angry because of the long lines while return shopping, fights often break out, ending the holiday cheer – thus Boxing day.

I’ll be driving today – hopefully it isn’t raining so I can think a bit throughout the trip. I haven’t been able to think much through, but I have an interest in combining my recent writing on technology and automation with your ongoing musings on poetry, music, and art in general. More to come (an early morning, so keeping this brief…).


I defend your huffing and puffing with bricks. No blowing my base down. I lull your base into complacency with a sleepy kitten (not drawn, still counts. See rule #1)

Until tomorrow,


Defend your base (Drawing challenge; business models)

Day 33: Tuesday

Morning, Tim!

Thank  you for the beautiful imagery yesterday. I could be referencing either your poem, the star across Milan, or perhaps (and here’s the frontrunner…)

The choir members are hilarious.  They’re all adults, some of them quite elderly, but they act like little children […] This meant that yesterday, instead of just chatting during mass, they also told each other to be quiet in between conversations.

This is perfectly like children. It’s kind of a beautiful thing.

Tim have you ever ridden a Segway? I’m going to ride this one to now discuss business models…

So working with early stage companies I come across a variety of ways businesses provide value, ranging from “outsource the humans to other humans” to providing new datasets (e.g. by monitoring something previously not monitored [patients/staff/supplies/etc.]) to making existing datasets useful (e.g. predictive analytics; visual dashboards), among many, many others. It’s a great chance to think about where there are gaps in the market — where there are meaningful problems that there are no real solution for. It has also provided an interesting case study on business models.

Walking through some history, you had mom and pop stores selling things locally — groceries, shovels, bicycles, flowers. Enter Walmart, who truly displaced many of these locally owned stores and sold the same goods. So how did they succeed? They had more shelf space then anybody else, and became a one stop shop — the stores were much larger than what they were displacing and each sold “everything”, at least in that seemingly at that period in time. Having the convenience of going to one store for your cereal, orange juice, and kid’s Christmas present was only part of the story, though. Because Walmart had such scale, they were able to negotiate with suppliers to lower prices; not only could you get Cheerio’s and a rocking horse, but you could do so cheaper than you would be able to anywhere else. That’s part of why Amazon is so interesting current day – by putting your inventory online, you have effectively infinite shelf-space; and by having  (free) Prime 2-day (or 1-day/same-day/2-hour depending on location) delivery, you also begin to chip away at the immediacy constraints of traditional retail. Among many other reasons, it’s why Amazon has an interesting business model.

So that’s the kind of business model stuff that’s going through my head (except a lot more detailed and nerdy) when I’m at work talking with these companies. Take yesterday for example. Doctors are highly trained, and thus are “expensive” labor in total dollars. Wanting to keep tabs on patients and visits, when Doctors take notes about visits they are effectively acting as highly trained, very expensive scribes. To help alleviate this problem, there was dictation software — you could speak faster than you could write, and so notes could be gathered quickly. Alternatively, if you put an actual medical scribe in the room, you could have notes taken in real-time, saving the doctors time entirely but now paying another person. The business model continues to move forward — if you put the scribe remotely and simply have an audio and/or visual stream coming to them they could do some from a call center; you could put that call center in a labor market where it is cheaper and also gain the efficiencies in staffing to obviate the down-town it would take an in-person scribe to e.g. switch rooms. Finally, the direction that is exciting, is in the automation of the scribing all-together. To add color, this would be technology that takes the audio and/or visual stream, parses the audio, and then algorithmically places the necessary snippets of information into the relevant fields within the system. What is really exciting about this model is the lack of marginal cost (put too simply: the cost to serve the next customer). Because it is software (outside the very small tech investment to capture the audio stream), no human is being hired to do scribing, and so you no longer scale linearly with costs and revenues, but instead have a high fixed cost up front (to get the algorithm right and have servers to process the necessary information) and then distribute it over every new customer you have.

whew. That was a really large text wall. I doubt anyone has read this far, but I’m going to include a picture and a game as a reward if anyone has.

So Tim here’s how the game works:

  1.  I’m going to draw a base (See below).
  2. You then draw a base. Then draw something to attack my base.
  3. I then draw something to defend my base, and attack your base.
  4. You then draw something to defend your base, and attack my base.
  5. Repeat steps 3 & 4 (as reasonable)


  1. There are no rules (I kid. I just like it how it sounds intense when people say this…)
  2. Be creative

Zak’s Base


Until tomorrow,


p.s. the title of this post was supposed to somehow capture the fun nature of the game and also the very dry nature of my post about business models. I’m imagining someone shouting “Defend our base!” in each case…and in the case of someone shouting it in business in reference to protecting, for example, their customer base, that person would be…annoying.

First and best, for 100 years

Day 28: Wednesday

Morning, Tim!

I work with a lot of entrepreneurs. Most of the companies I interact with have been around for less than 5 years, many for only 1, and each are in ongoing development mode. They are passionate about the work they do and, being in healthcare, oftentimes have a personal story about why they do the work they do. It is wonderful work – entrepreneurs have said they want to make a difference, that the current way of doing things wasn’t good enough on it’s own, and that they want to contribute to making it better.

In thinking about what makes at least some of these companies successful as they scale, I’ve been primed to look at Amazon first, and recently received another example in Patagonia that is similar, yet with some key differences. I recognize the immediate thought may (should) be “But Zak…those aren’t startups”. Correct. But they are both led by entrepreneurs who have control and who have established what success looks like for their companies.

Taking Amazon first, Bezos saw Amazon wasn’t great at working internally when one team needed access to what another team was working on. Perhaps the means of getting there are a bit unsettling, but Bezos mandated that teams had to create interfaces to connect with one another, and that all communication must be through these interfaces. For context, Bezos was taking away any shortcuts – it was more work to create these interfaces (particularly backwards, in many cases). When your vision is to be around after 100 years, though, you build it right – no need for shortcuts, you build it to last and to scale. By forcing teams to create this infrastructure to support, they had also built it for the rest of the world – AWS allows for Amazon to build tech infrastructure that others would use, and they know others will use it because they use it. They are their first and best customer (and…it’s nice when your best customer is the largest online retail giant). Amazon has also done this with their distribution infrastructure, figuring out how to fulfill 2-day delivery all across the US. By building it to meet their own needs, they can just as easily meet others (because they intimately know the needs and challenges faced).

Turning to Patagonia, Yvon Chouinard founded the company because he didn’t like the equipment available to him for climbing. Wanting better gear, he made it – realizing others would want it, he made more and sold it. He did the same for clothing, finding that he couldn’t find elsewhere the clothes he himself would want to wear. The jackets not built to last, nor built for quickly changing weather. The shirts were too bland, the shorts not sturdy. As he created, he also brought on others who, like him, did the activities he wanted to create a company to support. Who better to know what the surfer needs than the guy who, rather than be in his job, mostly just wants to surf all day. While not a clean comparison (Patagonia employees aren’t themselves a best customer in the way that is for AWS, not supporting with nearly the same size/scale) and I’m over-simplifying, but the end-result is similar – Yvon created a company that values doing it “right”, as if they were going to be there in a 100 years, and made products that they themselves wanted in order that they might better do their passions/jobs.

I’m not sure what this looks like for healthcare. In advising health systems, it looks like first and foremost creating a system that the individuals themselves would want to go to. Perhaps that means there is more personalization – whether genomics or simply knowing I prefer Zak to Zakary when I come in. Perhaps it’s a focus on making things safer – perhaps by reducing unnecessary variation in supplies so people can become better experts, perhaps by enforcing hand-washing. Perhaps it’s building a workplace that supports its employees – a workplace that clinicians want to go to, even though the work they do every day is physically and emotionally taxing. I’m not exactly sure how to put this into practice for entrepreneurs within healthcare, but it’s something I think about. Perhaps making medical records more accessible, or innovating within chronic disease or mental health is relevant.

Anyway – I like the idea of creating things that will last, not because of “legacy” but because it’s inspiring to act in a way that is rewarding – to “do it right” and feel satisfied in the work done because it wasn’t for short-term gain or one that took shortcuts. It’s admirable to put in the work, having the discipline to do it right – even more so when empowering others to do that work in their daily lives with you.

Until tomorrow,


Ugh. I hate lines (but…what to do without them?)

Day 22: Tuesday

Morning, Tim!

If my recollection of English is correct, your use of ‘literal’ is mostly a  taunt, valiantly attempting to have me tirade about unusual incorrect usage and usages. I won’t take the bait – just know I’m watching you closely. That said, I’m watching you closely mostly because you got a haircut from a stylist not named Monique, not because of your taunts. Italy is really changing you…

A couple weeks ago I touched a bit on automation, attempting to detail some thoughts on the tech industry’s moral obligation to bring others along with them. Rather than simply displace workers from jobs, the industry as a whole should help think carefully about the society being created when these jobs are gone and how people can not only make a living but also live meaningful lives contributing to societal flourishing.

Amazon announced the soon to be public launch of their Amazon Go store concept. Watch the video below – it’s worth the couple of minutes.

Now to be clear, this is one store that isn’t yet open to the public. But the implications are glaring. There are 3.5 million people working in cashier jobs in the US alone. I’m not sure how it’s counted, but you also have people managing those cashiers and in the case of grocery stores those bagging the purchases. That’s a lot of people to displace.

And to be sure the technology will have some kinks to work out and some frustrations of it’s own. There will need to be a clear way to get assistance if something isn’t coming “off the cart” if you put it back (consumer frustration) or ensure everything is being charged (retailer frustration). But in the long run, if it really is using self-enforcing and learning tech as described, the thousands of data points gleaned every day add up and the experience improves, driving more people to use the service. Moreover, if their massive scale and logistical distribution advantages weren’t enough, the real advantage here comes when looking at costs – investing in the (essentially) fixed costs of running the tech allows Amazon to out-compete others who have to use labor. And as hinted at above, it’s not just grocery that gets impacted – there’s no reason to believe similar technology couldn’t be put into clothing retail, gas stations, convenience stores, etc.

I write this thoroughly torn about how to feel. From a tech innovation perspective, I’m all for it. People unproductively standing in lines is a real problem to be solved – time that could be spent building relationships over tea or writing comics about math (this is the kind of friendship we have, Tim!) or observing the beauty in nature. But there are other real-world implications, meaning people may not have jobs to work to pay their way through school or to support their families or to simply make a few extra bucks so they can go hang out with their friends on the weekends.

And I don’t have any answers. I don’t even have thoughts in the right direction, yet. But being attentive to what is happening and having it sit on the mind, discussing it with friends – that I can do. Let me know when you’ve figured it out, Tim…

Until tomorrow,


p.s. I really liked your pigeons rummaging.

p.p.s. If the Amazon Go thing comes to fruition, I have serious angst about having to travel back through stores to put groceries back rather than simply placing my unwanted rice bag on top of the canned soup section. And before you say “aww you’re that guy! Put it back yourself” I’ll pe-empt with a “Hey I’m giving someone a job!”…

Confirmation bias; sources of information

Day 12: Tuesday

Morning, Tim!

Cleverness has your way with words. I could mean no one has your way with words (which is likely taken as a compliment but, taken literally is just a truism) or I could mean a large bearded man, a legend, a king has a way with words that is similar to your way with words. I’ll let you decide, Tim.

I wanted to follow up a bit on my fake news letter, and not only because I just enjoyed a wonderful cup of Indian Nimbu tea (which isn’t really relevant, but I’ve started drinking tea again and have a strong desire to continue advertising that fact to you). Specifically, I wanted to bring into question how you get your information. Being historically loose, a while back information would come by word of mouth, written letters, and, if noteworthy enough, a newspaper. Because of the distribution costs, the ‘local’ paper tended toward a monopoly, which made sense for their business model; selling ads meant they wanted the most readers, and being a trustworthy source that got the paper on the doorstep in a timely manner, covering what needed to be known in the day ensured that. Fast forward, you have TV producers vying to be the source of truth through morning and nightly news casts. Then, in the age of the internet, company’s began to reproduce the content they had on paper in little bits so everyone could read. Now-a-days, a TON of people get their news by scrolling through a feed of paid placement, shared content, and created content (Facebook, in case you hadn’t guessed or clicked on my link, Tim…). But before there was Facebook, Google dominated (and still does) by being a different kind of source. Rather than being a push, where the user is passive in the receiving of information, Google requires the user to be an active participant, pulling the information (quick aside, that’s why their ads do so well; it’s why Amazon paid so much to become the place people ended up when they needed to buy something and why ultimately they have become the (trusted) starting place [even more so than search engines] for all things intended for purchase.)

How does this all relate to fake news, you ask? A few different ways. First, in today’s world, when distribution costs are 0 because of the internet, the newspaper monopolies of old suddenly are competing with everyone globally — a content creator in London, Hong Kong, a tiny little farm town, and you, Tim, are all competing for the eye-space of the same readers.

In a pull world, the incentives align to be the best source of truth, the source that someone can go to reliably time and time again. They’d bookmark you, or in the case of Amazon, this would bear itself out by how people start their shopping. In a push world, however, incentives are different; because the ads are being sold and pushed directly to you, it’s competing for eye-space not by being the best, but by drawing in your attention. It means you have click-bait headlines, and news which is polarizing in order to get a reaction. If you strongly agree, great! Share it as truth (whether it’s real news or fake news, confirmation bias often provides nice blinders). If you strongly disagree? Great! Share again, but this time with commentary about how wrong it is. For the content producer (and Facebook as a source where people go to get information pushed to them), the incentives are to gain the most attention, sustaining that for longer and longer periods of time. Facebook doesn’t have an opinion on what is “right” or on what “should” have that attention; so long as it’s on their platform, they are making money, be it a photo album from vacation to Italy, a link to some quotations, or some clickbait about this Awesome Blog That Writes About Crazy Topics You Won’t Believe!!! But while Facebook isn’t incentivized to have an opinion on what you focus attention on, it has created the platform which enables others to polarize, much of which is getting attention in recent news about filter bubbles and fake content.

One quick note before signing off an already lengthy letter. There is a bunch of talk about the bad that could and does come of this (people reading, believing, and sharing things that aren’t true but that shape their opinion; people reading only things they agree with because they are surrounded by people like them, and thus beginning to think another point of view unfathomable; etc.). On the bright side, living in a world where distribution costs are 0, it means theoretically all those people focusing their attention on Facebook could be reading articles about the New York Times and their wonderful journalism…or they could be reading some quickly written letter to my brother-in-law. And it also means that they could be reading about something that wouldn’t otherwise be covered — a niche like a post about quiche, or perhaps a deeper dive at social issues that wouldn’t otherwise be covered because  they are taboo, difficult to read about, or those covering them simply do not understand the issues.C4C4E4A9-363E-4112-97D0-11964D9AC29F.jpg

Until tomorrow,