An Abundant, Dynamic Future: Part 1

Welcome welcome

Quick introduction: I’m Mike 👋

I focus on the future of technology, business, and industry at a professional services firm. In my spare time, I like to explore how technology, culture, and entrepreneurship interplay with each other. bold:new is a newsletter focused on exploring exciting things within these domains and thinking about their impact on the future.

What should you expect & what will you get out of it?

Periodic (weekly-ish, tbd) quick-reads about tech, culture, startups, and futurism. A meme or two. Hopefully, you learn something new or think about something you already knew in a different way. Intended vibe:

The breakdown

Each newsletter will include:

• on set | Overview of what will be covered in the issue

• up & up | "Stock" cards about trending topics on the www, vc funding trends, etc.

• deep dive | Focused write-up about various trends, recent happenings, etc.

Some newsletters will include:

• odds & ends | Sharing something interesting or unique, even if not 100% on-topic

• snooze | Sharing a longer read for when you have some extra time

With this out of the way, let's get into the first issue ⬇️

• up & up | Tools & platforms powering the Creator Economy

• deep dive | Exploring American abundance & dynamism (Part 1: Healthcare)

• odds & ends | Our favorite frenemies, the Fed & the free markets, and the role of empathy

Creator Marketplaces 🤳: Creators continue to be important to brand strategy, and TikTok's Creator Marketplace enables brands to discover and connect with creators who can help them achieve their brand goals (e.g., drive awareness with Gen Z). Beyond the Tok, there's a litany of other marketplaces like GRIN, CreatorIQ, and #paid which span other socials. The best marketplaces will focus on authenticity and maximizing creator-brand fit. Rex Woodbury's piece Influencer Marketing 2.0 is worth a read on this topic.

AI-Generated Music 🎵: Everybody has been playing around with OpenAI's ChatGPT and DALL-E, from writing college essays to generating award-winning art (there is zero controversy about this). But OpenAI's Jukebox, Google's AudioLM, Stability AI's Harmonai, and startups like Musico are all making advances in generative music, raising questions about the impact on artists and commercial rights.

Beehiiv 🐝: Beehiiv is a newsletter platform (which this newsletter is conveniently written on) started by some of the original employees from Morning Brew and launched in 2022, raising its latest round in October. It and other publishing platforms like Substack, Mirror, and Every, provide individual creators and brands with custom tools to reach, engage, and even share content ownership with their readers.

An Abundant, Dynamic Future ⚛️

On January 12, 2022, Derek Thompson wrote an article that states "The U.S. doesn't have enough COVID tests - or houses, immigrants, physicians, or solar panels. We need an abundance agenda". The root cause? Thompson argues it's manufactured scarcity (think artificial scarcity at a macro level) caused by contrasting, often hypocritic elements of modern American life. Think NIMBY-ism, lobbying, excessive regulation, and the like which impede positive sum progress.

His proposed solution? An abundance agenda: a policy agenda focused on building an abundance of comfort (e.g., better healthcare), power (e.g., sustainable energy), and time (e.g., less work with higher productivity) in America. It's pro-growth and pro-innovation. The agenda focuses on 5 key areas - Healthcare, Education, Housing, Transportation, and Energy & Climate Change - which suffer from some form of scarcity but if solved could be transformative to our society.

Two days later, on January 14, 2022, Katherine Boyle released a16z's Building American Dynamism investment thesis focused on addressing American stagnation and institutional failure:

Both Thompson and Boyle are arguing for the same thing - a reinvigorated, future-fit America - but with different approaches: top-down policy (Thompson) versus bottom-up bootstrapping (Boyle). Thompson's approach blends ideologies from liberalism, progressivism, libertarianism, and conservatism to create policy at the intersection of human welfare, innovation, simplicity (reducing red tape), and national greatness (think "best places to live"). Meanwhile, Boyle's approach looks to the private sector and ambitious entrepreneurs to solve thorny issues which American institutions - the very same ones Thompson calls out - simply cannot, whether due to monolithic technology infrastructures, lack of talent, or regulatory capture.

A key element to both arguments is the importance of atoms in a bit-obsessed world. The 2010s saw an explosion in the FAANG/MATANAs of the world (although 2022 knocked them down a notch 🔻) while atoms-related innovation was less celebrated. That narrative is changing. The pandemic pushed this to the forefront when we all collectively realized the importance of modern manufacturing capabilities and more adaptive supply chains. And we're starting to see signals of a future where it is no longer atoms vs. bits, but rather atoms, powered by bits.

To quote Boyle again:

Boyle and her team at a16z have already done a great job of highlighting entrepreneurs building at the intersection of the physical and digital here. We're going to remix this and look at some of these companies through Thompson's lens: 5 critical areas suffering from scarcity that need bold founders to tackle them with modern, technology-enabled solutions. We'll start with Healthcare, and explore Education, Housing, Transportation, and Energy & Climate Change in the coming weeks. Let's get to it.

(Disclaimer: Approaching these areas from a generalist POV; not claiming to be an expert by any means)

Part 1: Healthcare 🏥

Within healthcare, Thompson focuses on America's physician shortage. He points out we have ~26 physicians per 10,000 citizens which is good for the 3rd lowest of the 38 OECD member countries (🥲). There are numerous reasons for this physician shortage, including time-intensive education, high student debt loads, an aging patient population, and greater demand for healthcare services with increased health insurance access. He also points out that some of this scarcity is by design: underfunded residency programs restrict the supply of physicians and successful lobbying efforts keep nurses and foreign-born doctors from practicing certain "physician-only" procedures or at all.

Beyond physicians, there is a broader shortage of nurses and healthcare providers (HCPs) in general. Solving these shortages will be hard, but not impossible. Policies providing additional funding for healthcare education programs, reducing the debt burden on healthcare workers, and expanding the use of technology can help. On this last point, we're starting to see a new generation of startups use technology to alleviate the strain on healthcare systems, specifically in the areas of Talent, Access, and Time.

Talent 🧑‍⚕️

Building infrastructure for healthcare systems and HCPs to quickly match and reduce time-to-hire can alleviate shortage pressure. Talent marketplaces focused on healthcare providers are trying to do just that:

• Incredible Health built a marketplace to match hospitals with pre-screened nurses and has reduced the hiring time from an average of 82 days to just 2 weeks (Series B, $80m, a16z, August 2022)

• Clipboard Health allows HCPs to pick up per diem shifts to fit their schedule (Series C, $80m, Sequoia, Feb 2022)

• IntelyCare helps hospital systems optimize their staffing mix and float pool, providing access to as-needed talent (Series C, $115m, Kaiser Permanente Ventures, April 2022)

• Trusted and Nomad Health helps travel nurses find short-term, on-demand opportunities (Trusted: Series C, $94m, Greenspring, Nov 2021) (Nomad: Late-stage, $105m, Adams Street, July 2022)

Access 🧑‍💻

Solutions that benefit both provider and patient are win-win. This next group of startups improves patient access to providers and helps providers see more patients in less time.

• Ro is a telehealth provider for sexual health, fertility, and weight loss and is working on at-home diagnostics and in-home care (Late-stage, $150m, ShawSpring, Feb 2022)

• Hims and Hers provide personalized telehealth care for men's and women's daily wellness (Late-stage, $100m, Redpoint, Jan 2019)

• Nurx provides telehealth services for sexual wellness, including contraception and HIV/PReP (Series C, $22.5m, Union Square, February 2020)

• Maven is the largest virtual clinic for women and family health (Series E, $90m, General Catalyst, Nov 2022)

Time ⏰

Freeing up HCPs to perform value-add work and spend more time with patients, instead of administrative tasks and paperwork, can be a huge unlock for healthcare system efficiencies. Startups are using AI/ML and robotic assistants to do just that:

• Qventus provide hospitals with automated, AI-powered platforms to manage and optimize the end-to-end patient lifecycle, reducing the admin burden on HCPs (Series C, $50m, THL, Feb 2022)

• AKASA provides AI-driven revenue cycle and operations cost management, including optimized HCP resource allocation (Series B, $60m, BOND, March 2021)

• DeepScribe uses natural language processing (NLP) to produce comprehensive clinical documentation for HCPs instead of manual solutions (Series A, $30m, Index, Jan 2022)

• Robotic surgery assistants like DaVinci have been helping surgeons perform complex surgeries in shorter times for 20+ years. New assistants are coming to market and will continue to leverage tech like AI/ML and IoT to enable intelligent surgery suites. Beyond the surgery suite, robotic assistants like Terapio can collect vitals and Aethon's TUG can deliver medicine from lab to bed, freeing up HCPs for more value-add work.

This is just the tip of the iceberg; so many other startups and technology applications are helping to reduce the strain on our existing healthcare workers and minimizing the impact of our current shortage. And remember: this is just the bottoms-up approach. For holistic, industry-wide solutions to our talent shortage, we need the private and public sectors to support innovative, transformative policies which eliminate scarcity-inducing practices and properly incentivize current and future generations of healthcare providers.

Next week: Education.

Kyla Scanlon's recent piece A Non-Zero-Interest Rate World talks about the weird relationship between the free markets and the Fed. She ends with the below quote which ties in nicely with Thompson's argument - when decisions are made that impact supply and demand (and therefore scarcity), it is often empathy for our fellow humans that is left on the chopping block.

Thanks for reading & happy 2023 😬