In Praise of the Six Page Narrative

Jeff Bezos is famous for being customer-centric, so much so that Amazon’s annual letters proudly say, “We seek to be Earth’s most customer-centric company.” Shipping, easy returns, streaming, and Kindle are proof. “Free” 2-day shipping for Prime membership is a big part for me. So far this year I’ve ordered 54 packages, 1.4 per week.

Another cultural strength is its lack of flashy presentations. Amazon doesn’t do PowerPoint or other slide shows. They prefer memos of up to six pages, reviewed in silence for 30 minutes at the start of a meeting, understanding it could take a week of deep thinking and analysis, and require many revisions and feedback from others. A six-pager is approximately 3,000 words or 5x longer than this post.

Why do we like (tolerate) PowerPoint? Partly because we like visual cotton candy, and because it’s easier and requires less thinking. Another reason is the aesthetics and macro view fit us well when we’re meeting-saturated. They give us visceral information that is usually taken at face value. Slides will always have a place for presenting (even Amazon presents its earnings with slides). But they should not take the place of the deeper thought that comes only through writing out your ideas.

Healthcare as a whole will never be as consumer-centric as Amazon. It’s emotional, episodic, has huge regulatory burdens and distortions, and 85% of the cost is not born directly by the patient (indirectly, yes, it does impact us through lower wages).  Shopping in healthcare, or consumerism, has limits, and is hard to compare to car shopping.

What do consumers want in healthcare and what can they realistically expect? One thing is choice. Another is low costs and what I call good-enough quality (for the basic things). In the individual Obamacare marketplace, consumers choose very high deductible coverage. According to eHealth, of the 2M non-subsidy1 enrollees in the Affordable Care Act (ACA) marketplace, the average individual deductible was $4,358.2. Many use it as if applied to the 150M+ world of employer-sponsored insurance, where the average single deductible is $1,500, and plan menus are smaller and selected by the employer3.

Consumer perception and results matter too. “Am I getting my money’s worth?” In the context of the Amazon-Berkshire-JPMorgan initiative, Jamie Dimon of JPMorgan talks about “better satisfaction for employees.” Warren Buffett mentions change “where people feel they’re getting better care.…preferably with lower costs.” Using scale is fine to reduce administrative burdens and negotiate discounts, but disruption to the employees, risks of balance billing, or drastic cuts will be noticed.

A longer narrative where numbers are defended is needed, at least in the strategy building stage. Many healthcare companies are “business model first” and not consumer-leaning. Charging everyone the same price for an all-you-can-eat healthcare buffet is one area, and then pretending that’s what everyone wants. Forcing or bribing people to do wellness is another. Companies reach for any statistic, or unsubstantiated graphics to justify fees and services, even when less is more. There are few short-cuts, and the long path to increasing our healthcare and financial IQs takes regular doses of learning and new information, and it ultimately rests on us as consumers.


Photo by Andrew Buchanan on Unsplash

  1. Subsidies for an individual end with an income of $24/hr; in 2017, 83% of enrollees qualified for subsidies
  2. As a side note, this figure is on the short-list of the most misquoted statistics in healthcare
  3. 4th party insurance
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