A Learning a Day

Coastal redwoods are the tallest tree species on earth. They exist only within a mile of the California coast, sustained by fog — drawing water directly from the air to feed themselves.

But the most intriguing thing about these majestic giants isn’t their height. A four-hundred-foot tall redwood has roots only eight to twelve feet deep. What keeps them standing is that those roots spread up to two hundred feet outward — intertwining with the roots of neighboring trees, connected through mycelium, sharing nutrients, holding each other steady, supporting the younger ones still growing.

Their survival isn’t a solo act. It takes a village.

For a species so rare and so majestic, it’s a beautiful reminder of what it actually takes to survive on this planet.

The easiest reward a company can give good talent is compensation.

The hard kind is creating an environment where they can actually thrive — where they have the tools and resources to get important things done without being hampered by bureaucracy and red tape.

Midway through Game 4 of the NBA Finals, the San Antonio Spurs had the biggest lead in NBA Finals history — twenty-nine points. They ended up losing by one.

One word explains most of it: momentum.

I think about it every time something disrupts my routine. A good run of exercising, eating well, staying on track — and then travel, or something else, gets in the way.

Momentum is so easy to lose. And yet so powerful when you have it, because every move builds on the previous one.

It’s an ally when you can use it. An archenemy when you lose it.

The helpful reframe for me is that when the odds feel difficult, you don’t have to worry about the end. You just have to shift the momentum. Focus on the next thing that builds it, then the next. Keep going.

Just like the Knicks did.

Yesterday, I shared Noah Smith’s observation that fifteen years ago, the internet was an escape from the real world — and now the real world is an escape from the internet.

Smith recently shared a study that puts hard numbers behind that idea.

Researchers at NBER used a clever natural experiment: the iPhone launched in 2007 exclusively on AT&T through early 2011. That carrier exclusivity created geographic variation — some areas had coverage, others didn’t — allowing them to isolate the smartphone’s effect on birth rates.

The results are striking. iPhone access reduced births by 4.5–8% among 15–19 year olds and 3.2–6.6% among 20–24 year olds. Overall, the diffusion of the iPhone explains 33–52% of the entire decline in the U.S. fertility rate since 2007 among women aged 15–44.

The mechanism the researchers point to: less in-person interaction, more pornography use, less sexual frequency.

Sadly, it all makes intuitive sense. And birth control is likely just the tip of the iceberg.

And while it is easy to point to everyone else, the first place to examine at is our own phone habits.

Noah Smith shared a note he’s shared about phones a few years ago – “15 years ago, the internet was an escape from the real world. Now, the real world is an escape from the internet.”

It hit hard.

Beware spending your time worrying about things — most of them will never happen.

Our time is best spent improving what is.

I recently started building products focused on healthcare affordability in the US. As I was ramping up on a new space, the biggest question that sparked my curiosity was: how did we get here? This question is the inspiration for this weekly series chronicling the decisions, accidents, and breakthroughs that built the US healthcare system.

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In November 1945, seven months into his presidency, Harry Truman sent a message to Congress that would define the next two decades of his life.He had identified a problem the employer-sponsored system couldn’t solve. That system worked well for people who were employed. But the elderly had retired. The very poor had never had employer coverage. And the middle class had no protection against the financial devastation of serious illness.

Truman proposed a solution: a national health insurance program, funded through payroll taxes, open to all Americans. A survey taken shortly after found 59% of Americans who knew about the plan supported it.

The American Medical Association saw it differently and launched one of the most aggressive lobbying campaigns in American political history. They hired a public relations firm, used the phrase “socialized medicine,” and distributed pamphlets to doctors’ waiting rooms across the country

. They even circulated a quote attributed to Soviet leader Lenin calling socialized medicine “the keystone to the arch of the Socialist State.” This was fabricated. But the campaign worked anyway. Public support collapsed from 59% to 24% in five years. Legislators across the aisle were moved by the same fears the AMA had carefully cultivated. Truman’s plan died in Congress.

He later wrote: “I have had some bitter disappointments as President, but one that has troubled me most has been the failure to defeat organized opposition to a national compulsory health insurance program.”

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Twenty years passed with the problem remaining unsolved.

By 1963, the gap was stark. While 75% of Americans under 65 had hospital insurance, only 56% of those over 65 did. One in three elderly Americans lived in poverty.

The employer-based system had a blind spot built in from the beginning. It worked for people who were working. The moment you retired, you were on your own.

The bill finally went through in1965 with support from members of both parties who had watched the gap go unfilled for two decades. But it required a critical compromise: physicians and insurers retained control over their own fees. No price controls. This was the concession that got the medical establishment to stand down.

And it quietly planted the seeds of the cost explosion that followed.

In a wonderful twist to the story, President Lyndon B Johnson chose to sign the bill at Independence, Missouri instead of the White House. He explained that he considered President Truman “the real daddy of Medicare” and handed him and his wife Bess the first two Medicare cards ever issued.

Truman was 81. His card number was 488-40-6969A. He called it “a profound personal experience.”

The impact was immediate. Before Medicare, roughly half of older Americans had no health insurance. After its launch, coverage became nearly universal. Nearly 20 million people enrolled in the first three years. Elderly poverty fell from 29% to 12% over the following two decades. Medicare’s rollout also helped enforce the Civil Rights Act, driving hospital desegregation across the country.

Medicaid, passed in the same bill, extended coverage to low-income Americans. Today it covers more than 71 million people.

Within a decade, Medicare had become one of the most fiercely defended programs in Washington — protected by legislators on both sides who had seen what it meant to the people in their districts.

But the compromise that got it passed — no price controls, physicians and insurers setting their own fees — meant the federal government had become a massive paying customer with no ability to negotiate. Medicare would pay whatever was charged.

The program that answered the question of “what happens when you leave your job?” had created a new one: What happens when costs have no ceiling?

I’m a heavy user of voice-to-text. It’s a key part of my workflow, and it improves my productivity — but only about sixty percent of the time. Lower than I expected when I first started using it.

Here’s what I’ve realized. Voice-to-text improves the efficiency with which I get an idea down. But that’s only a gain when the bottleneck is the speed of capture. A lot of the time, the bottleneck is actually the thinking itself — and the act of typing, with its slight slowness, gives me the time to process. In those moments, voice offers no efficiency gain.

This points to something broader about any system or tool. An improvement only counts if it’s an improvement to the actual constraint.

Optimize anything else and it doesn’t really matter.

Sometimes, all we have are bad and worse options.

The only way is through.

There’s a lot of talk right now about companies deploying AI tools and not seeing results that map to the spend. Many reasons get cited. But I suspect the simple one at the heart of it is constraints.

The analogy comes from Eli Goldratt’s famous book “The Goal”, a pre-read in most introductory operations management classes. If you’re manufacturing a car and you figure out how to produce doors more efficiently — great. But if doors aren’t your bottleneck, it doesn’t matter. The body still needs only four doors. Making more doesn’t move the car out the door faster.

AI tools work the same way. They can genuinely optimize many parts of a workflow. But if that workflow isn’t the constraint, optimizing it changes nothing at the outcome level.

Product teams shipping more features is only valuable if features were the bottleneck — if those features unlock new markets or make a step-change improvement to customer value. If they don’t, you’ve just made the wrong thing faster.

And that’s before you factor in the change management required to actually go after the right constraints in the first place.

The fundamental principles of operations and productivity haven’t gone away. It shouldn’t surprise anyone that ignoring them produces disappointing results.