Economics

One of my biggest frustrations with private practice isn’t the practice of medicine—it’s trying to be entrepreneurial in healthcare without violating Stark or Anti-Kickback. These laws don’t just discourage abuse—they discourage innovation. For physicians, the current interpretation makes any new service, tool, or care model legally hazardous unless you partner with a hospital or hand it over to a corporate middleman. The rules are vague, the penalties are severe, and the process is so convoluted that even compliance requires legal teams most physicians can’t afford. Meanwhile, large institutions carve out exceptions, restructure arrangements, and walk right through loopholes that would trigger enforcement for any independent doctor. The result? Fewer physician-owned ventures. More consolidation. Higher costs. Less choice. And a system where the people actually delivering care are the least empowered to improve it. We can’t fix healthcare until we stop tying down the very people who are most capable of building a better version. #deltadocs Jon Kimball, MD David Yam

After years of tension over the corporate practice of medicine, the American College of Emergency Physicians and American Academy of Emergency Medicine (AAEM) now have the same position on CPOM. ACEP's new policy opposes non-physician ownership of emergency medicine practices. It also opposes the "friendly physician" model, where a physician "owns" an LLC on paper, while a large company actually runs the EM practice. "Ownership of medical practices, operating structures, and models should be physician-led and free of corporate influence that impacts the physician-patient relationship. The following types of medical practice ownership and operating structures would likewise constitute the prohibited corporate practice of medicine: ● Ownership of an emergency medicine practice or group by non-physician owners or by physicians who do not have responsibility for the management, leadership, and clinical care of the practice. ● Restricting access of emergency physicians to information and accountings of billings and collections in their name as described in ACEP’s policy statement “Compensation Arrangements for Emergency Physicians." The question is whether (and how) ACEP & AAEM will enforce this policy - possibly via censures of "friendly physicians". #emergencymedicine

The $24 Trillion Question: Is the US-DRC Deal Exploitation or Opportunity? The proposed minerals-for-security pact between the DRC and US raises urgent questions about Africa’s resource sovereignty. While the deal’s details remain opaque, history warns us: 1. The Exploitation Risk Raw cobalt/coltan exports = colonial patterns repeating. Congo’s $24 trillion reserves have fueled 60+ years of conflict, while 73% of its people live in poverty. Will this deal break or extend that cycle? 2. The Strategic Dilemma China controls 70% of DRC mines; the US now wants in. Africa must ask: Are we swapping one master for another, or playing the great powers against each other? 3. The Path Forward - Mandate Local Processing: Namibia banned raw lithium exports—why can’t DRC? - Transparency Triggers: Tie deals to auditable jobs/royalty metrics (e.g., Botswana’s diamond model). - Security ≠ Surrender: Military aid shouldn’t mean resource giveaways. The Bottom Line If this deal doesn’t build Congolese smelters, train engineers, spur enterprise development or fund schools, it’s just theft with nicer paperwork. #NoMoreRawDeals #ResourceJustice

The headline that caught my eye this week was "Life expectancy for Californians still lower than before COVID — here's why." Here's my take: The early evidence from California suggests a stubborn persistence of pandemic effects long after most people have "moved on." California's life expectancy in 2024 was 80.54 years, still 0.86 years shorter than it was in 2019. The drivers of mortality have shifted during this period, though, making the potential effects of the pandemic more subtle. For the first time since the pandemic began, drug overdoses and cardiovascular disease now account for a larger share of life expectancy decline than COVID itself. Drug overdoses represented 20 percent of the decline, cardiovascular disease 16 percent, and COVID just 13 percent. The question, however, is whether the cardiovascular disease and even drug overdose effects are somehow also tied to the pandemic. Some researchers, for example, attribute the cardiovascular changes to delayed care during the early pandemic, as people avoided hospitals even during heart attacks out of virus fears. Others point to rising obesity rates or long COVID's inflammatory effects on the heart. Three points here.   1️⃣ I had said at the time that the "skipped" care during the pandemic could prove to be an important test of value in healthcare — if we could skip a bunch of healthcare during the pandemic and do not suffer any subsequent health consequences, it would suggest the skipped care wasn't useful. The opposite, though, can highlight the most important types of healthcare delivered. 2️⃣ Robin Brooks, William Murdock, and I had shown that the effects of the pandemic on prices were remarkably persistent. It will be interesting to see if this same type of "long tail" to the pandemic applies to health outcomes also, as this early evidence suggests. 3️⃣ All these life expectancy measures are "period" rather than "cohort" measures — which means they don't actually measure how long a person born today is expected to live. Instead, they construct a hypothetical person with the survival experience of people at each age alive last year.  That's a convenient way to do the calculation but it generally doesn't line up with how most people think about their own mortality. https://lnkd.in/eeydG2Kd

34% of SMBs have only a month or less of cash reserves. How do we address this critical issue? Here are 10 essential cash management rules: 1. Understanding Cash Metrics: Focus on operating and free cash flow, not just profits. 2. Building Cash Reserves: Maintain enough cash to cover 3-6 months of payroll, slow months, and unexpected equipment costs. Be cautious in volatile industries. 3. Analyzing Beyond the Bank Balance: Use weekly financial reports instead of just checking the bank balance to better understand cash obligations. 4. Efficient Invoicing: Invoice immediately and manage accounts receivable proactively to ensure quicker payments. 5. Strategic Payment Scheduling: Don’t rush to pay bills; optimize payables for better cash flow and maintain good vendor communication. 6. Inventory Management: Treat inventory as an investment and balance stock levels to avoid cash tie-ups. 7. Growth and Cash Flow: Manage growth carefully by securing credit in advance and understanding the cash conversion cycle to prevent cash shortages. 8. Tax Planning: Treat taxes as a critical expense and work with a knowledgeable CPA to plan for tax implications. 9. Prudent Use of Debt: Use debt strategically to support growth and investment, and maintain diverse banking relationships. 10. Maintaining Flexibility: Develop a flexible business strategy that includes multiple suppliers and cross-trained staff. These strategies can help SMBs manage their cash flow more effectively and safeguard against financial crises. If you want to go deeper, I wrote about this in my newsletter. Please read and subscribe: https://lnkd.in/gP4KXvDU

For many small and medium enterprises (SMEs), managing account receivables is a persistent challenge. In a recent conversation with Harshal Banker, we explored common mistakes businesses make when it comes to pending payments and actionable strategies to overcome them. Here are the key insights: 1. Specify Due Dates, Not Just Credit Days One of the biggest oversights is mentioning credit terms (e.g., “45 days”) on invoices instead of a specific due date. Harshal highlighted how this ambiguity leads to delays, as customers rarely calculate deadlines themselves. A clearly stated due date removes guesswork and sets expectations upfront. 2. Send Reminders Before the Due Date There’s a misconception in SMEs that they can’t approach customers about payments until the credit period has lapsed. This leads to unnecessary delays. Harshal compared this to credit card companies, which send soft reminders a few days before payments are due. Proactively reminding customers ensures they’re aware without feeling pressured. 3. Implement Flexible Pricing for Credit Terms Harshal shared a game-changing practice: differentiated pricing based on credit periods. For one of his clients, invoices were revised to reflect a higher price if payments weren’t made on time. This incentivized timely payments while creating accountability. 4. Don’t Be Afraid to Ask for Your Dues Many SME owners hesitate to request payments, fearing it may strain relationships or lead to lost business. Harshal offered a refreshing perspective: if a customer refuses to pay and threatens to stop future business, they’re not worth keeping. True partnerships are built on mutual respect, including honoring payment agreements. The Takeaway Managing receivables isn’t just about chasing payments—it’s about creating a system that prioritizes transparency, accountability, and mutual trust. By adopting clear due dates, proactive reminders, flexible pricing, and a confident mindset, SMEs can overcome payment hurdles and maintain healthier cash flows. What’s your approach to managing account receivables? I’d love to hear your experiences and tips in the comments!

Are You Spending Too Much to Acquire a Customer, Or Not Enough? E-commerce brands often focus on lowering their customer acquisition costs (CAC). But what if cutting CAC is actually hurting growth? The real question isn’t just how much does it cost to acquire a customer? It’s how much should you be spending? If you knew with certainty that a customer would generate $500 in long-term profit, would you hesitate to spend $100 to acquire them? Probably not. But many brands take a one-size-fits-all approach, capping CAC at an arbitrary percentage of their first purchase revenue. This can lead to underinvestment in acquiring high-value customers and overinvestment in customers who won’t stick around. A better approach is to align CAC with long-term customer equity, not just at a blended level, but dynamically across customer segments. Some customers have significantly greater revenue potential than others. The challenge is identifying which customers will create sustainable profitability over time. The chart illustrates that customer acquisition cost (CAC) and lifetime value (LTV) are not linear, spending more on acquisition can lead to higher-value customers, but only up to a certain point. Key Insights: There is an optimal CAC range. - Spending too little on CAC (left side of the chart) may result in acquiring lower-value customers, limiting long-term profitability. - Spending too much (right side of the chart) can lead to diminishing returns, where LTV does not justify the extra spend.   The breakeven threshold matters. - The red dashed line represents where CAC = LTV, meaning any spend above this line is unprofitable unless justified by strategic goals (e.g., market share growth). Smarter spending, not just lower spending, drives profitability. - Many brands mistakenly focus only on reducing CAC, but the real goal is to align CAC with future LTV dynamically across customer segments. What This Means for Retailers Instead of asking, “How much does it cost to acquire a customer?”, the real question is: - How much should we spend to acquire the right customers? - How long will it take to break even on acquisition costs? - Which acquisition channels and products lead to the highest-value customers? Retailers who leverage AI-driven insights to align CAC with future Customer Equity, not just at a blended level but dynamically across customer segments, can spend smarter, scale faster, and drive long-term profitability. If you want to go deeper on this topic, Professor Peter Fader has done extensive research on customer-centric growth strategies. Check out this fascinating podcast with Nick Hague on how businesses can take a more data-driven approach to optimizing CAC. https://lnkd.in/eGu5EM5g #CustomerAcquisition #EcommerceGrowth #MarketingStrategy #CustomerEquity #GrowthMarketing #CACvsLTV #RetailStrategy #Profitability #WGBTpodcast

Stars are aligned, winds are favourable; it's time to sail... Since the beginning of this year, I have been sensing a global shift, that's now clearly in motion and the good news is that, India is at the centre. Recent reports from Moody’s and S&P confirm that global supply chains are clearly tilting towards India. And with supportive government initiatives, ground realities are changing fast: 1. PLI schemes are driving back interest in manufacturing. 2.Highways, new ports & freight corridors are reducing logistics time and cost. 3. Transshipment hubs are on the rise to boost export capabilities. Besides this, availability of young skilled workforce is our biggest advantage. So, my clear message for SMEs in manufacturing or trading is, "Don’t anchor in hesitation when conditions favor a leap." Augment capabilities, tie-up with global companies and start exploring export opportunities. It's equally a huge emerging opportunity for young talent, not only for jobs but more as entrepreneurs to venture into manufacturing, logistics, supply chain management. And for Indian IT companies, it's is a wake-up call to pivot. Move from legacy service models to products, platforms and smart infrastructure to; A) Build solutions in Industry 4.0, IoT, robotics & automation. B) Become enablers of productivity, efficiency & intelligence at the shop floor. C) Use AI as a performance multiplier, decision enabler. Now is the time. For founders, for business leaders and entrepreneurs, it's time to invest in strategies, develop capabilities and build execution momentum for the future. Those who will move swiftly with clarity and courage are going to shape the next decade of prosperity. #strategy #leadership #manufacturing #IT #growth

Gender equality and disability inclusion are essential to creating societies where everyone has equal opportunities and access to resources. This document presents a structured approach to addressing the unique challenges faced by women and girls with disabilities, shedding light on systemic barriers such as discrimination, economic exclusion, and restricted access to education and healthcare. By focusing on participatory approaches, it ensures that those directly affected are involved in shaping solutions, fostering a more inclusive and representative decision-making process. Beyond identifying obstacles, the document provides concrete strategies for making development efforts more inclusive. It explores ways to dismantle harmful social norms, enhance service accessibility, and create economic opportunities that empower women with disabilities. Through real-world examples and evidence-based recommendations, it illustrates how inclusive policies and programs can lead to lasting improvements. The guide also highlights the role of strong legal frameworks and institutional accountability in sustaining progress. For those working to advance gender equality and disability rights, this resource serves as a practical tool for integrating inclusive principles into programs and initiatives. It offers step-by-step guidance on embedding accessibility, participation, and equity into various sectors. By prioritizing lived experiences and collaborative approaches, it reinforces the importance of ensuring that solutions are not only well-designed but also driven by the voices of those most affected.