A Learning a Day

I love Morgan Housel’s writing. I was thinking about a story he shared in a post earlier in the year. It’s a great post, one I thought I’d share in full.

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I broke my back skiing when I was a teenager. It’s still screwed up and I occasionally tweak it, leaving me in agony for a few days. When I’m in pain I’ve noticed: I’m irritable, short-tempered, and impatient. I try hard to not be, but pain can override the best intentions.

One lesson I’ve tried to learn is that whenever I see someone being a jerk, my knee-jerk reaction is to think, “What an asshole.” My second reaction is: maybe his back hurts.

It’s not an excuse, but a reminder that all behavior makes sense with enough information. You can always see people’s actions, but rarely (if ever) what’s happening in their head.

Here’s a related point: Most harm done to others is unintentional. I think the vast majority of people are good and well-meaning, but in a competitive and stressful world it’s easy to ignore how your actions affect others.

Roy Baumeister writes in his book Evil:

Evil usually enters the world unrecognized by the people who open the door and let it in. Most people who perpetrate evil do not see what they are doing as evil. Evil exists primarily in the eye of the beholder, especially in the eye of the victim.

One consequence of this is that it’s easy to underestimate bad things happening in the world. If I ask myself, “How many people want to cause harm?” I’d answer “very few.” If I ask, “How many people can do mental gymnastics to convince themselves that their actions are either not harmful or justified?” I’d answer … almost everybody.

An iron rule of math is that 50% of the population has to be below average. It’s true for income, intelligence, health, wealth, everything. And it’s a brutal reality in a world where social media stuffs the top 1% of moments of the top 1% of people in your face.

You can raise the quality of life for those below average, or set a floor on how low they can go. But when a majority of people expect a top 5% outcome the result is guaranteed mass disappointment.

I think the majority of society problems are all downstream of housing affordability. The median age of first-time homebuyers went from 29 in 1981 to 40 today. But the shock this causes is so much deeper than housing. When young people are shut out of the life-defining step of having their own place, they’re less likely to get married, less likely to have kids, have worse mental health, and – my theory – more likely to have extreme political views, because when you don’t feel financially invested in your community you’re less likely to care about the consequences of bad policy.

Every economic issue is complex, but this one seems pretty straight forward: we should build more homes. Millions of them, as fast as we can. It’s the biggest opportunity to make the biggest positive impact on society.

I heard someone say recently that the reason so many people are skeptical AI will improve society – or are terrified it will do the opposite – is because it’s not clear the internet (and phones) made their life better.

That’s a subjective point, but it got me thinking: Imagine if you asked people 25 years after these things were invented whether life was better or worse because of their existence: Electricity, radio, airplane, refrigeration, air conditioning, antibiotics, etc.

I think nearly everyone would say “better.” It wouldn’t even be a question.

The internet is unique in the history of technology because there’s a list of things it improved (communication, access to information) but another list of things it likely made worse for almost everybody (political polarization, dopamine addiction from social media, less in-person interaction, lower attention spans, the spread of misinformation.)

There aren’t many examples throughout history of technology so universal with so many obvious downsides relative to what existed before it. But the wounds are so fresh that it’s not surprising many look at AI with the same fear.

This is more hope than prediction, but I wouldn’t be surprised if in 20 years we look back at this era of political nastiness as a generational bottom we grew out of.

There’s a long history of Americans cycling through how they feel about government and how politicians treat each other.

The 1930s were unbelievably vicious. There was a well organized plot to overthrow Franklin Roosevelt and replace him with a Marine general named Smedley Butler, who would effectively become dictator. The Great Depression made Americans lose so much faith in government that the prevailing view was, “hey, might as well give this a shot.”

It would have sounded preposterous if someone told you in the 1930s that by the 1950s more than 70% of Americans said they trusted the government to do the right thing almost all the time. But that’s what happened.

And it would have sounded preposterous in the 1950s if you told Americans within 20 years trust would collapse amid the Vietnam War and Watergate.

It would have sounded preposterous if you told Americans in the 1970s that within 20 years trust and faith in government would have surged amid 1990s prosperity and balanced budgets.

And equally absurd if you told Americans in the 1990s that we’d be where we are today.

Cycles are so hard to predict, because it’s easier to forecast in straight lines. What’s almost impossible to detect in real time is the same forces fueling public opinion plant the seeds of their own demise. When times are good, people get complacent and stop caring about good governance. When times are bad they get fed up and say, “Enough of this.” And I think we’re not far from that today.

I have a theory about nostalgia: It happens because the best survival strategy in an uncertain world is to overworry. When you look back, you forget about all the things you worried about that never came true. So life appears better in the past because in hindsight there wasn’t as much to worry about as you were actually worrying about at the time.

Every few months, I replace my phone’s screen protector. The replacement ships over from whichever company I bought it from, and then I head to an AT&T store to request help from a representative put it on. There’s real art and science to doing it without bubbles.

Every time, I walk out feeling like I’ve been handed a new phone. That brief window before I inevitably drop it and scratch the whole thing up at any rate.

But the bigger thing I walk away with is gratitude. These representatives take a few minutes out of their day to do something like this for free, and I’ve never been met with anything other than generosity.

It’s one of those small moments that reminds me how many good humans are out there.

I’m grateful for them.

When it comes to eating healthy, exercising, and everything else that’s good for us — we can approach every day looking for excuses not to do it, or looking for reasons to do it.

Our choice.

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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Henry Kaiser was a construction magnate who had invested in shipyards as the demand for ships rose with World War II.

By 1942, his shipyards in Richmond, California were running around the clock. Workers poured in from across the country — 80,000 by the end of that year, over 200,000 at peak. Kaiser built housing for them, schools for their children, a credit union, and even a dedicated electric commuter train between the housing areas and the yards.

Between his Richmond and Portland shipyards alone, his teams built 1,490 ships during the war. When he noticed too many workers missing shifts due to illness, he decided it was time to build a better healthcare system for his employees.

He called Sidney Garfield — the desert doctor whose prepaid model had so captivated him at Grand Coulee — and asked him to scale it. Garfield built out a tiered system: first aid stations in the shipyards for minor injuries, a field hospital in Richmond for more serious cases, and a fully renovated hospital in Oakland for severe illness. Workers paid 7 cents a day for comprehensive coverage.

By August 1944, 92.2% of the Richmond workforce had voluntarily enrolled — the highest voluntary enrollment rate of any health plan in the country.

Kaiser didn’t stop at healthcare. In 1942 he bypassed the unions and integrated his shipyards directly, hiring Black workers and women through the US Employment Service. His hospitals followed. At a time when racial segregation in medicine was standard practice, Kaiser’s facilities treated workers of all races and genders equally.

The American Medical Association was watching all of this with alarm. Their opposition was fierce and coordinated. The prepaid model threatened everything the medical establishment had built — the traditional fee-for-service relationship, the physician as independent entrepreneur, the idea that medicine was a private transaction between doctor and patient. County and state medical societies even barred Kaiser’s doctors from existing hospital facilities.

Kaiser’s response was to build his own hospitals. If the establishment wouldn’t share their facilities, he would create his own self-contained system — with full-time doctors, nurses, and staff who believed in the same thing he did: that keeping people healthy was better medicine than treating them when sick.

Ironically, the AMA attacked it by calling this socialized medicine. Kaiser was a private sector industrialist who had chosen to build a market-based solution — employers paying for worker coverage, competition driving quality — and was now getting attacked as a socialist for it.

When the war ended and the shipyards closed, membership collapsed almost overnight — from 200,000 to 11,000. So, in July 1945, Kaiserand Garfield announced it was open to the public. The San Francisco Chronicle reported the news matter-of-factly: Kaiser’s Permanente Foundation Hospital in Oakland, built for shipyard workers, was now available to anyone who walked through the door.

Writers at the time called it “a Mayo Clinic for the common man.” Kaiser simultaneously drafted a proposal for Congress to establish a nationwide voluntary prepaid care system. While Congress ignored it, unions didn’t.

Between 1952 and 1955, membership grew to 500,000 as Kaiser partnered with labor leaders to extend coverage to unionized workers across California. The model that the AMA had tried to kill quietly became the template for a new kind of healthcare organization — one that would eventually be called a “Health Maintenance Organization”, codified into federal law by the HMO Act of 1973.

Henry Kaiser built the Hoover Dam, the Grand Coulee Dam, and the Liberty Ships that helped win the Second World War. He started an aluminum company, a steel company, and an automobile company. He was one of the most prolific industrialists in American history. But he said Kaiser Permanente was the achievement he was most proud of.

Fittingly, the shipyards are long gone and Kaiser Industries no longer exists. But the health plan he built for his workers survives — 13.1 million members, 40 hospitals, $127 billion in annual revenue, the largest nonprofit health system in America.

Change is hard. It doesn’t matter if you know you need it. It’s still hard.

The reason is simple: periods of change are periods of learning. You learn about the situation, the people involved, and yourself. And learning, real learning, is hard.

Because to learn and not to do is not to learn.

Which means learning requires changing how you operate. And changing how you operate means rewiring your brain — replacing old muscle memory with a new pattern. Literally.

That process is… hard. There’s nothing in life I’ve found to be so consistently, reliably hard.

So when change feels difficult, that’s not a sign something is wrong. It’s a sign that the real work is getting done – typically within ourselves.

Whenever you’re debating how a product or user experience should work and find yourself spinning, it’s worth going back to two questions.

Are we clear about what problem we’re solving?

Are we clear what the solution looks like from the user’s perspective?

Most confusion traces back to one of two failure modes — either we’re solving the wrong problem, or we’ve gotten so attached to what we want to build that we’ve lost sight of what the user actually needs.

For years, the Microsoft OneNote app on iPhone was solid. It wasn’t flashy. But it was a reliable hub for organizing things that worked well on desktop and mobile alike.

Over the past couple of years, it has languished. And what’s interesting is that neglected software doesn’t just stay where it was. It gets worse.

Not because the code degrades. But because the ecosystem around it changes. Apple updates its operating system. The way apps interact with the OS shifts. And the little things you took for granted in a previous version quietly stop working as well. Glitches accumulate. App switching breaks. The experience slowly erodes.

It’s a useful reminder about maintenance. It’s never heroic work. It doesn’t show up in a launch announcement or generate immediate ROI. But there’s a real cost to keeping something even as good as it used to be — and if the product matters, it’s probably worth paying that cost.

Applicable to other things in life too.

In any organization, you can play two kinds of games. Games about doing good. And games about feeling good.

Games about doing good have one currency: impact. That impact shows up as a better experience for the people you serve — and eventually, in some form, better outcomes for everyone.

Games about feeling good are games of status. Being invited to the right meetings. Having your worth recognized by the seat you have at the table. Getting the acknowledgment that soothes whatever insecurity is loudest that day.

It’s natural to want some of that. But the pull toward status games is worth watching — because I’ve seen these dynamics play out just as much in three-person organizations as in ten-thousand-person ones. The scale changes, but the game doesn’t.

The key is the ability to consistently prioritize impact over status. It’s not just that impact games drive better outcomes — though they do that. It’s that they contribute more to our happiness in the long run too.

Because status games are often stupid games.

And as the saying goes, when you play stupid games, you win stupid prizes.

After being dismantled in the playoffs by the Oklahoma Thunder, LeBron James was asked whether it was time to retire. He gave a beautiful answer.

“I think for me it’s about the process. If I can commit to still being in love with the process of showing up to the arena five and a half hours before a game to start preparing… showing up to 11 o’clock practice, I’m there at 8 o’clock preparing my body, preparing my mind. So I think for me, I’ve always been in love with the process.”

I love that one of the greatest players in the history of the game still talks about getting to work 3 hours earlier than he needs to.

His talent has always been extraordinary, but it’s this love of the process, compounded over decades, that explains the longevity.

As in basketball, so in life.

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 1933, a 27-year-old doctor named Sidney Garfield borrowed money from his father, drove out to the Mojave Desert, and built a 12-bed hospital in the sand.

He had signed a contract to provide medical care for 5,000 construction workers building the Colorado River Aqueduct — the most ambitious water project in California’s history. The nearest hospital was hours away. The work was dangerous and the desert heat was unforgiving.

Garfield’s radical belief was that a doctor’s job was to keep people healthy, not just treat them when they broke down. So, he introduced safety education, hydration protocols, annual checkups. Injury rates among his workers dropped from 27 per 100 in 1934 to 3 per 100 by 1937.

The medicine was working. But the business was not.

Insurance companies paid slowly, or didn’t pay at all. Garfield kept treating workers regardless — you couldn’t turn someone away in the middle of the desert. But the hospital was quietly going broke. He was weeks from shutting the whole thing down when an insurance executive named Harold Hatch came to see him with an idea.

Hatch proposed flipping the payment model entirely. Instead of billing after treatment, the insurance company would prepay Garfield a fixed amount per worker per day in exchange for a guarantee of care. The rate: a nickel a day per worker for work-related injuries.

The revenue stabilized immediately. With predictable income, Garfield could plan ahead, hire properly, and invest heavily in prevention. And prevention was now in his direct financial interest. A healthy worker cost him nothing. A sick one cost him everything. For the first time, a doctor’s incentives were perfectly aligned with his patients’ wellbeing.

Garfield extended the offer directly to the workers: pay an extra nickel a day from your own pocket and I’ll cover everything — work injuries, illness, your whole family. About 95% of workers signed up. The hospital thrived. And Garfield quietly proved something that would take American healthcare decades to fully absorb: keeping people well was better medicine, and better economics, than waiting for them to get sick.

When the aqueduct project ended in 1938, Garfield was preparing to go into private practice when a colleague mentioned his work to a man named Henry Kaiser — the builder behind the Hoover Dam, the Grand Coulee Dam, and soon the Liberty ships that would help supply the Allied war effort. Kaiser’s Grand Coulee workers had almost no access to medical care. He invited Garfield to come north.

When Kaiser visited Garfield’s hospital, the two men spent the whole day together talking. At the end of it Kaiser told him: “If your plan achieves even half of what you claim, it should be available to every person in this country.”

Kaiser was a builder who thought in scale. In Garfield’s prepaid model he saw something that could work far beyond a desert construction site. He was right — but neither of them could have imagined just how far it would go.

Next week: Kaiser takes Garfield’s idea to his WWII shipyards and scales it to 200,000 workers. It is a fascinating story of how a wartime health plan became the largest nonprofit health system in America.