High Context Companies

One of the more interesting insights in The Nvidia Way, the book on Nvidia’s rise under CEO Jensen Huang, is his use of the weekly Top 5 Things emails (T5Ts). In these emails, employees across the company send him their top five updates about their work, observations, and priorities, providing Huang with an unfiltered view of what’s happening. The book notes that he pours a glass of scotch every Sunday night and reads hundreds of them. 

A while back, a mentor explained to me that one of the most important attributes of a leader is their ability to see the company through the eyes of the people who aren’t in the room. If you can’t do this well, you’ll lose the trust of your team, and their engagement will fall. And you’ll probably make a lot of bad decisions. Tools like the T5T and things like skip-level meetings, mini town halls with Q&A, engagement surveys, and insisting on a culture of transparency and openness where people feel comfortable telling hard truths can help leaders get their arms around the problems and opportunities on the ground and ensure they’re seeing the world accurately.

This goes the other way as well. I’ve written before about how important it is for employees to understand the context around decisions made at high levels. I once had a job where I wasn’t on the senior management team, but I had a lot of access to the senior management team. I’d often hear employees at lower levels being very critical of decisions being made at the top. I remember thinking, “These people just don’t have the context; I wish they could somehow get it...” It’s crucial that leaders take the time to give their teams the context around their decisions. The aspiration should be that the lowest-level employee would make the same decision as the highest-level employee because they’re operating with the same information and context.

The key to all of this is that for anyone to make good decisions, they must operate with a strong understanding of the truth — of what’s actually happening. You could probably directly measure an executive's success by how capable they are at this because it’s literally the only way they can make good decisions. This obviously scales to the company, too. I’d bet you could tightly correlate the quality of shared context across an organization directly with its financial success.

It sure is working for Nvidia.

Five Productivity Apps

It occurred to me recently that despite all of the downfalls of being attached to our phones, for me personally, there are a bunch of apps I use that actually make me more productive. I’ve started to use widgets on my iPhone for a few of the apps I use most frequently, which is great because it puts the app right in front of you every time you open your phone as a reminder to do the thing it wants you to do. Here are five that I’m really enjoying. 

Monarch for personal finance

I used Mint.com to track my finances for at least a decade before it shut down. Recently, I started using Monarch, which is just exceptional. One of the big issues with these apps is categorizing your expenses, which can be really time-consuming. Monarch makes this really easy and quick. I’m also using it for budgeting and it makes that really easy as well. The interface and usability of both the web app and iPhone app are amazing. 

Duolingo for learning a language

I’m learning Mandarin right now, and the Duolingo app is an incredible tutor. The app is really well done, and it does a good job of helping you create a daily habit. It harasses you until you complete a lesson. I just hit 50 days in a row and don’t see myself slowing down anytime soon. 

Calm for meditation

There are a ton of medication apps, but I really enjoy Calm, and they have a pretty low-cost lifetime membership. It’s great for meditation but also for playing music for focused work. I wish they did more around habit creation. 

Google Tasks for to-dos

I’ve tried lots of to-do systems over the years but I finally think Google Tasks is the one. If you use the widget it will display your top 3 things to do that day right on your home screen so you see them front and center every time you open your phone. 

Whoop for habit tracking

I’ve had a Whoop for many years to track sleep and activity. They have a journal feature that tracks your habits, which I started using a few months ago. It’s really slick and easy to quickly update your tracker each morning.

Return on Capital Vs. Cost Of Capital

A company's value is equal to the present value of the cash investors can take out of it over time. Investors want to put their money into things that will provide them with lots of future cash flows. Technically speaking, they want to put money in companies whose return on capital exceeds their cost of capital. For an equity investment, the cost of capital for a company is the return that the investor expects; for a debt investment, the cost of capital is the interest rate the company has to pay.

Early-stage technology companies aren’t yet generating cash for investors. They typically lose money as they build up a set of products that can deliver cash back to shareholders at some point in the future. In the context of a new technology company and how an investor thinks about these financial returns, you could see two phases:

Phase 1: Building something that can deliver cash. Once a new venture has found product/market fit, it starts growing quickly. If you generate $1,000 in revenue in your first year, it's not that difficult to 10x that growth and get to $10,000 the next year. In this phase, companies aren't thinking about delivering cash back to investors; they're using all of their capital to invest in the company to grow their revenue and market share so that someday they have something that can deliver cash returns. In this phase, the cost of capital (the return the investor expects) exceeds the return on capital because there aren’t any returns yet. Investors are ok with this because they’re betting on big returns that will happen in the future.

This is why SaaS companies experiencing high growth don’t really worry too much about profits. They worry about growth so that they know they’re building something big, and they worry about unit economics (the profitability of providing a single unit of their product to a customer versus the cost of providing that unit). So, the high-growth SaaS company is happy to be unprofitable and burning through investor capital as long as it knows that it’s acquiring customers that will generate profits in the long term. So when the company has saturated the market and growth has slowed, they can pull back on sales & marketing expenses and R&D investments, and the unit economics then show up in the actual profitability of the company through previously acquired customers. So, this type of company isn’t yet delivering cash; it’s building something that will someday be able to deliver cash.

Phase 2: Delivering cash. Eventually, growth slows as the market saturates, and it gets harder to grow quickly on a larger base of revenue. Companies then find that continuing to invest investor capital and operating profits back into the business is no longer a good idea. That is, they can’t generate a return on capital that is higher than the cost of that capital. That’s when companies slow down their investments and start returning some cash to shareholders through dividends, share buybacks, or paying down debt, such that the investor can go invest in things that are more likely to exceed their expectations for an investment return.

The reason I’m going through all of this context is that one of the hardest things for a company to do, especially a technology company, is to identify the moment when it’s better to start returning cash to shareholders than it is to keep investing in new growth. There’s a saying that “profitable companies that have lots of cash have run out of ideas.” Leaders in companies don’t want to appear like they don’t have new ideas or that they can’t successfully execute them. And not investing in new stuff and just trying to get more profitable to pay out dividends isn’t nearly as fun as deciding to build a self-driving car or placing some other type of big bet. It’s even harder in today’s environment, where so many companies raised capital when growth multiples were super high. Case in point: ServiceTitan, which went public a few weeks ago, priced its IPO share price well below its last round of venture capital financing in 2021. Telling your investors that you think you’ve saturated growth when the company is likely valued less than it was when they invested is a really hard thing to do.

So, hundreds of companies have found themselves between a rock and a hard place. Growth has stalled as they've saturated their core market. But they’re a long way from getting above their last valuation (or “mark” in VC parlance), so they’re continuing to try to grow back into that valuation and, in some cases, destroying shareholder value in the process, where the investments they’re making will not exceed their cost of capital — especially because their cost of capital is now higher as their valuation has dropped. Some companies are betting too aggressively on their ability to produce high growth and are also speculating that if they do deliver on that high growth, the market will value it as it did in previous years. The median public SaaS company is now valued at 6x revenue, a long way from the 20x to 30x multiples of 2021. Getting a company’s valuation above its last mark is a a great thing to try to do, but destructive if done unprofitably.

I’ve simplified this issue a bit, as there are other options besides growing and returning cash. Companies can also invest in efficiency, reposition themselves strategically, and make profitable acquisitions. But all of this comes back to this super important topic of knowing who you are, knowing what’s best for your company right now, and having the courage to pursue that direction. A dollar is a dollar, whether invested in new growth or given back to shareholders as a dividend or share buyback. One approach is not inherently better than the other. As a responsible capital allocator, the key is knowing which one is better for you.

2024 Annual Review

It's that time of year when everyone sets their New Year resolutions and goals for 2025. I don't really do resolutions and besides setting a couple big goals for the year, I prefer to focus on standards and habits. It's also a time to reflect back on 2024. I came across a great approach to this in this post from Sahil Bloom that pushes you to reflect by asking yourself 7 key questions to reflect on the year. I went through it and typed out my own answers and found it really valuable. You might too.

The Best Books I Read In 2024

Here are the 10 best books I read in 2024. Hope you enjoy some of these. Past lists: 2023, 2021, 2020, 2019, 2018, 2017.

 
 

1/ Same as Ever: A Guide to What Never Changes by Morgan Housel. Really cool sort of social sciences book about timeless principles in life and finance that remain the same over time.

2/ World on the Brink: How America Can Beat China in the Race for the Twenty-First Century by Dmitri Alperovitch. Just a tremendous overview of the tensions between the US and China and what might come next. This book really helped me clarify how to think about foreign affairs. You have the western hemisphere and the eastern hemisphere. The US is the clear leader of the West. The East doesn’t have a clear leader, and that’s very much in the US’s interests. The East has ~70% of the world’s population. If China were to become dominant, many of our allies would be forced to tip toward China and away from the US (South Korea, Australia, Japan, etc.). The primary objective of US foreign policy is to avoid that outcome.

3/ Crash Course: The American Automobile Industry's Road to Bankruptcy and Bailout and Beyond by Paul Ingrassia. An excellent overview of the twists and turns of the US auto industry since its inception. An incredibly interesting story.

4/ Hidden Potential: The Science of Achieving Greater Things by Adam Grant. Sort of a Moneyball-like book. It talks about identifying hidden talent, which is an invaluable skill when building a startup.

5/ The Most Important Thing: Uncommon Sense for the Thoughtful Investor by Howard S. Marks. Great insights from Howard Marks on managing risk and your patience as an investor.

6/ How To Get Rich: (without getting lucky) by Naval Ravikant. Brilliant framework for creating wealth using long-term thinking, entrepreneurship, and leveraging technology. I’d make this mandatory reading for high school students.

“The purpose of wealth is freedom. It’s nothing more than that. It’s not to buy fur coats, or drive Ferraris, or sail yachts, or jet around the world in your Gulfstream. That stuff gets really boring and really stupid, really fast. It’s really so that you are your own sovereign individual.”

7/ Revenge of the Tipping Point: Overstories, Superspreaders, and the Rise of Social Engineering by Malcolm Gladwell. I’m a sucker for Gladwell’s books. A really fun read on social change and how key people can make a major impact.

8/ Scarcity Brain: Fix Your Craving Mindset and Rewire Your Habits to Thrive with Enough by Michael Easter. Really good book on how to crave less. Sort of the opposite of Atomic Habits in some ways.

9/ Naked Economics: Undressing the Dismal Science by Charles Wheelan. Another book that should be required reading for high school students. An extremely easy read and really strong overview of fundamental economic concepts that everyone should understand.

10/ How to Invest: Masters on the Craft by David Rubenstein. A series of interviews with some of the world’s most successful investors that lay out their strategies and advice on successful investing.

Greatest Strength = Greatest Weakness

Early in my career, managers were traditionally expected to tell their employees their weaknesses and how to improve them. Then, they would check in every few months to discuss their progress. It took me a long time to realize that this was a mistake. Over and over, in my career, I've found that a high-performing person's weaknesses are what actually make them great at what they're great at. Identifying how an individual’s weaknesses actually support their strength can you give a lot of insight into how to best interact with and manage that person.

  • People who are perfectionists and demand extremely high work quality spend too much time on unimportant things and have trouble prioritizing.

  • People who are great strategic thinkers struggle with on-the-ground execution plans. 

  • People who are extremely adaptable and can respond quickly to challenges struggle with focus and stability. 

  • People who are really optimistic ignore potential obstacles and can be unprepared for setbacks. 

  • People who are highly competitive can create friction in their team and struggle with collaboration.

Hire people who are the best in the world at what they do and let them run after that thing. Spending time having them focus on improving something that they don't do well and probably don't enjoy doing is a low ROI effort. Of course, they should know their weaknesses and how they might impact others and should develop the flexibility and self-awareness to know when to dial them back or complement them with other traits. But doubling down on a high performer’s strengths will lead to much better outcomes and a much happier team.

Reading Lists

After taking a step back from a full-time operating role in health tech, I’m spending some time diving deep into the history of some of the most successful businesses that have operated in some of the most impactful industries in the US, as well as deepening my understanding of healthcare, and specifically the economics of healthcare. I’ve come up with a reading list that I’m going to work through over the coming weeks — 10 books on business history and 10 books on the economics of healthcare. Sharing it here. Feel free to send any recommendations!

Business History

Private Empire: ExxonMobil and American Power by Steve Coll

The Box: How the Shipping Container Made the World Smaller and the World Economy Bigger by Marc Levinson

Tough Calls: AT&T and the Hard Lessons Learned from the Telecom Wars by Dick Martin

Citizen Coke: The Making of Coca-Cola Capitalism by Bartow J. Elmore

Capitalism in America: A History by Alan Greenspan and Adrian Wooldridge

Disney War by James B. Stewart

The Fish That Ate the Whale: The Life and Times of America’s Banana King by Rich Cohen

Factory Man: How One Furniture Maker Battled Offshoring, Stayed Local – and Helped Save an American Town by Beth Macy

Empire of Cotton: A Global History by Sven Beckert

Brick by Brick: How LEGO Rewrote the Rules of Innovation and Conquered the Global Toy Industry by David C. Robertson

Business of Healthcare 

Pricing Life: Why It's Time for Health Care Rationing by Peter A. Ubel

Catastrophic Care: Why Everything We Think We Know about Health Care Is Wrong by David Goldhill

Moneyball Medicine: Thriving in the New Data-Driven Healthcare Market by Harry Glorikian and Malorye Allison Branca

Redefining Health Care: Creating Value-Based Competition on Results by Michael E. Porter and Elizabeth Olmsted Teisberg

An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal

The Innovator's Prescription: A Disruptive Solution for Health Care by Clayton M. Christensen, Jerome H. Grossman, and Jason Hwang

The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care by Eric Topol

Medicare Meltdown: How Wall Street and Washington are Ruining Medicare and How to Fix It by Rosemary Gibson and Janardan Prasad Singh

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer by Shannon Brownlee

The Price We Pay: What Broke American Health Care—and How to Fix It by Marty Makary

Healthcare's Incentive Misalignment

Just under 15 years ago, I sat down in a conference room with one of my clients, the SVP of Benefits of a self-insured, Fortune 100 company. Like most large companies (his had about 300,000+ employees at the time), they were focused on reducing their health insurance costs as it had become an enormous line item for them that had the attention of their CEO. My company recently launched a product that helped large employers drive enrollment and engagement in voluntary benefit programs (things like smoking cessation, health risk assessments, fitness contests, nutrition counseling, etc.). Like many companies, my client had very low usage of these programs. I spent a few minutes telling him about our product, thinking that if we could increase usage of these programs, his employees would be healthier, bringing down their insurance costs.

Once I was done talking, he looked at me and told me the thing that large self-insured employers and health plans aren't supposed to say:

"Brian, the average employee's tenure at our company is 22 months. I don't want to spend time investing in driving usage in things that will make my employees healthy only to have them leave and have some other employer benefit from that investment."

And in those two sentences, he articulated the #1 structural problem with healthcare in the United States: incentive misalignment.

Misaligned Incentives

There are three major players in US healthcare: the patient, the provider, and the payer. And none of their incentives are aligned.

Patient: The patient's incentive is to live a long, healthy life.

Provider: The provider's incentive is to have lots of sick patients who need billable treatments.

Payer: The payer's incentive (or self-insured employer) is to cover lots of healthy patients who don’t get sick and don’t need treatment. But only for a short period. They only care if the patient is healthy while they're a member of their health plan. Members typically stick with the same plan for 2 to 3 years. Health plans have extremely high churn rates as employees change jobs, patients fall on and off Medicaid, move to lower-cost Medicare plans, etc. Payers don’t have a financial incentive to invest in the long-term health of the patient. They have no incentive to help the patient live a long, healthy life. In fact, they have a disincentive to invest in the long-term health of the patient if that payoff comes after the patient is no longer a member. This dynamic applies to the provider as well in a value-based care model where the provider is taking financial risk. 

To be clear, when I’m talking about incentives, I’m not talking about ethical incentives. Everyone wants people to be healthy. I’m talking about financial incentives. They are not aligned. And that’s a real problem, as payers and providers are businesses that need to make responsible financial decisions. 

For business models and systems to work well, they need incentive alignment. Take the iPhone ecosystem as a simple example. The user wants a great phone at a reasonable price with an unlimited number of functions. Apple wants to sell a lot of high-margin phones and high-margin apps. And the app makers want a huge audience to build apps for. It’s not perfect, but financial incentives are generally aligned, so this ecosystem thrives.

In a system full of problems, this lack of aligned incentives is the core problem in healthcare.

We need to get to a system where the entity caring for the patient and the entity paying for the care of the patient is financially aligned with the patient’s incentive to live a long, healthy life.

Solutions

Ideally, the government could help with some top-down structural changes such as incentivizing longer-term health investments through tax incentives, allowing plans to benefit from long-term preventative investments, or possibly universal coverage of some sort and changing the way care is paid for. However, a big change from the government will be difficult and come with its own complex set of sensitive tradeoffs. That said, It seems the use of HSAs, which allow employees to carry tax-free dollars that can be used for health expenses across employers, has expanded. I’m also very encouraged by the Individual Coverage Health Reimbursement Arrangement (ICHRA) that was launched in 2019, set up through a partnership between HHS, the Department of Labor, and the Department of Treasury, which allows employees to pick their plan outside of their employer and get reimbursed by their employer, allowing them to stick with the same plan as they change jobs. We need more of that. 

The private sector has a huge opportunity to address the incentive problem through real business model disruption. The word “disruption” gets thrown around a lot, especially in health tech. But disruption doesn’t just happen through new technologies. It happens through fundamental business model transformation that changes the way business is done. The hotel industry wasn’t disrupted by the Internet or even by early Internet companies like Orbitz, Expedia, and Kayak. Those services just changed the way consumers book hotels and the way hotels do marketing. AirBnB was actually disruptive by transforming a gigantic B2C business into a peer-to-peer business. That’s disruption.

Of course, these business model transformations take time, and they almost always start by focusing on a very niche part of the market and scaling up from there. We’re seeing some signs of this in healthcare:

Longevity-focused solutions such as Function Health and Neko Health give the patient more control and take a longer-term, consumer-focused focus perspective on health. 

Direct primary care models like Taro Health, where patients pay a flat fee for access to primary care services incentivizing providers to focus on preventative care for the long term.

In 2013, I wrote a post titled 15 Reasons Why Healthcare Has A Business Model Problem. Rereading it today, all of those problems still stand. Healthcare is a uniquely challenging problem for all of the reasons I listed in that post. And one thing I’ve learned over the years is that you can complain about it all you want, but when you have to turn your attention to solutions, you realize there simply are not great answers. It’s just a set of very complex, nuanced, and thorny tradeoffs.

As Charlie Munger said, “Show me the incentive, and I’ll show you the outcome.” The negative outcomes have been evident for years. While many of these approaches are early, and it’ll take time to get real traction, it’s exciting to see entrepreneurs focused on root cause incentive alignment to drive long-term and sustainable transformation. We need it now more than ever.

Assets > Wages

Aside from a short period of turmoil during COVID and the inflation that followed the economic stimulus, the US economy has been pretty strong over the last ~15 years. The stock market is at all-time highs. Unemployment is near all-time lows. Inflation is now mostly back in check. The dollar is strong.

But there is a somewhat troubling trend that people — particularly people early in their careers — should be aware of. And that is the expanding gap between the high growth in asset values versus the relatively low growth in wages. 

Since the Great Financial Crisis in 2008, stock prices have increased 540%, home prices have grown 114%, inflation has increased 50%, while wages have only grown 43%. Unfortunately, this trend contributes greatly to the wealth gap in the US. Generally, lower-income people are less likely to own assets and make most or all of their income from their jobs. People with higher incomes own most of the assets. The rich get richer. Literally.

It wasn't always this way. From 1945 to 1973, wages grew nearly twice as fast as home prices. But this new trend of assets growing faster than wages has accelerated significantly, driven by a variety of factors that are unlikely to change:

1/ Home price inflation. Over the last several decades, zoning and other types of laws have made it almost impossible to build large numbers of new homes in areas where people want to live. While there's plenty of land to build on in the US, bureaucracy gets in the way. Meanwhile, to fuel growth, we need more people to come into the country (through immigration or births). That means more and more demand for homes, which means higher prices. 

2/ Stock prices continue to rise rapidly. The US stock market has really stood out lately compared to virtually any other country. Given our democratic system, the rule of law, and our embrace of innovation, we're really outpacing the rest of the world. And while things might be a bit overvalued due to AI and low interest rates, it seems like there's no end to the scale of the large tech companies that are leading the market. When I was a kid, the largest US companies were companies like General Electric and General Motors. Companies that were selling high marginal cost hard goods, mostly in the United States. Now, we have these tech companies with very low marginal costs selling their product to nearly everyone on Earth. These companies are huge. Facebook has something like 6 billion users. And it costs a lot for General Motors to build a car; it costs Facebook next to nothing to display an ad. 

3/ Wage stagnation. While wages will continue to increase, they won't grow nearly as fast as assets. Offshoring and technological innovation (particularly AI) will put downward pressure on wage increases. Again, as I've mentioned in the past, there will be plenty of jobs, and wages will increase, but people who only generate wealth through their time and effort will continue to fall behind. 

Owners of assets have benefited disproportionality over the last couple of decades. And outside of some earth-shattering change, there's little reason to believe that will stop. 

It’s important to understand these trends and act accordingly. The message to younger people is to start getting their money into assets as much as possible sooner rather than later. Trying to get rich on your time and effort is an uphill battle. Be frugal, start saving and investing as early as possible.

Benchmarks & Storytelling

The other day, a founder asked me about financial benchmarks for a company at his stage. He asked about the optimal CAC/LTV, gross margin, and revenue per employee. 

Benchmarks are important. Investors, particularly investors who don't have intimate knowledge of your company, will use them as a guide for how to value your company. There's a temptation for founders to optimize against top-tier benchmarks. But I think that's unwise. Optimizing against benchmarks is actually relatively easy. What's really difficult is knowing what your company needs right now and optimizing against that. That's a lot harder.

‘Revenue per employee’ provides a very simple example of this concept. Top-tier SaaS companies have a revenue per employee of around $300k. It's tempting to chase that number. The problem is that the easiest way to grow your current revenue per employee is to stop innovating. Get rid of all the employees working on stuff that won't impact revenue this quarter or this year. But that's likely not at all what your company needs right now for a variety of reasons.

So, in many cases, you actually don't want to optimize revenue per employee. That might not be what your company needs right now.

The best approach to this problem is to know your metrics and be aware of top-tier benchmarks but to intelligently apply those benchmarks to your business and be able to explain to an investor and your team why that's the right thing for you right now. A great story around why your revenue per employee is lower than a top-tier company because you are thinking about growth 3 to 5 years from now or why your gross margin is low right now because you're overly investing in your early customers, or why your CAC is high because your testing new marketing channels is a lot more impressive than a simple point in time comparison to benchmarks of companies that might need to optimize around something completely different.

AI In Sales & The Jevons Paradox

A month or so ago, I wrote about the emerging AI business model and its potential impact on white-collar employment. As I said in the post, I'm skeptical that AI will reduce the number of white-collar workers, particularly salespeople. With that in mind, I came across a concept called the Jevons Paradox

The Jevons Paradox says that when technological improvements increase the efficiency of a resource, that leads to higher consumption of that resource, not less.

A couple of examples:

Technologies like home insulation, in theory, would reduce the need for heating and cooling energy consumption. But the effect was that people invested in larger homes resulting in more overall energy consumption.

Electric/hybrid cars bring down energy costs, leading to more frequent driving and longer trips, and more overall energy consumption.

This concept also applies to work.

Flexible work tools like Zoom have added convenience but also made it possible to work more, increasing the number of hours worked. 

Communication tools like Slack and email make communication more efficient but have also led to far more communications and increased workloads. 

I think we'll see the Jevons Paradox at work with AI in sales. As AI takes on more of the job of a salesperson and does things like lead scoring, opportunity prioritization, CRM automation, communication personalization, sentiment analysis, etc., it will bring down the cost of sales. That means that each salesperson costs less per dollar in sales than they did prior to the adoption of AI. That will cause companies to want to do more sales and hire more salespeople to do the work.

The myth is that automation makes the worker superfluous. In reality, the opposite is true because it’s an opportunity for the ambitious to do more. Marketing automation is a great example. Facebook Ads can effectively run highly targeted, comprehensive marketing campaigns, in theory reducing the need for digital marketers. When, in fact, those platforms made marketing cheaper, which led to major increases in the need for more digital marketers to manage these programs and to do more marketing. The same will be true with AI in sales.

When something gets cheaper, we tend to do more of it.

DOGE, Startups & Political Party Paradoxes

Elon Musk and Vivek Ramaswamy outlined the rationale behind their Department of Government Efficiency project (DOGE) in the Wall Street Journal last week. DOGE is intended to serve as an advisory board to streamline the U.S. federal government and reduce inefficiencies, particularly within three-letter agencies like HHS, EPA, FTC, DOD, etc. While the idea is controversial, it’s also hard not to like. No doubt government isn’t as efficient as it could be, and with the exploding federal deficit, cost reduction sounds like a nice idea. However, it’s worth noting that several presidents have tried similar initiatives in the past with limited success.

What makes this particular effort interesting, though, is its focus on reducing the thousands of regulations federal agencies have implemented over the years. The idea is that fewer regulations would mean reduced headcount to enforce those regulations and taxpayer savings. Many Americans may not realize that unelected federal agency staff write thousands of rules annually governing how businesses across the country operate.

These rules, while rooted in laws passed by Congress, are written and enforced by the agencies themselves. For example, Congress might pass a law like the Safe Drinking Water Act, and the EPA would then draft and enforce specific rules regarding contaminants, pollutant limits, and reporting requirements. This structure makes sense because Congress doesn’t have the bandwidth to dive into the details of implementing every law.

Critics argue that these agencies have amassed too much power, often acting on their own priorities rather than staying accountable to the public.

Musk and Ramaswamy wrote in their piece:

“Our nation was founded on the basic idea that the people we elect run the government. That isn’t how America functions today. Most legal edicts aren’t laws enacted by Congress but “rules and regulations” promulgated by unelected bureaucrats—tens of thousands of them each year. Most government enforcement decisions and discretionary expenditures aren’t made by the democratically elected president or even his political appointees but by millions of unelected, unappointed civil servants within government agencies who view themselves as immune from firing thanks to civil-service protections.

This is antidemocratic and antithetical to the Founders’ vision. It imposes massive direct and indirect costs on taxpayers. Thankfully, we have a historic opportunity to solve the problem.”

Government agencies, like most organizations, grow in size and scope over time. It’s human nature to want to do more with more influence, more budget, and more people. Rarely do people within these organizations prioritize limiting their scope or shrinking their footprint. It’s just not in our nature.

As a result, millions of pages of regulations now govern nearly every aspect of American business. While many of these rules are undoubtedly necessary, it’s reasonable to assume there’s significant overreach.

All of this reminds me of a talk Bill Gurley gave a while back on regulatory capture. Regulatory capture occurs when agencies tasked with regulating an industry become overly influenced by the interests of the organizations they regulate.

Gurley talked about a classic example of this in healthcare. Epic Systems, the healthcare software giant, benefited enormously from the Affordable Care Act (ACA). The ACA’s HITECH Act incentivized healthcare providers to adopt electronic medical records (EMR) software. A new agency, the Office of the National Coordinator for Health Information Technology (ONC), now renamed to the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology (ASTP/ONC), was established to administer this program.

ONC mandated payments of $44,000 per doctor to purchase EMR software and an additional $17,000 for demonstrating "Meaningful Use" — proof they were actively using it. Epic’s CEO played a pivotal role in designing the requirements for Meaningful Use, which aligned closely with Epic’s existing products. This created high barriers to entry, forcing smaller competitors out of the market or to incur major penalties for being out of compliance with the new regulations.

ONC has gone on to write more and more rules on top of the EHR standards for things like health IT certification, interoperability standards, and information blocking. If you work at a health tech startup, it’s more likely than not that these rules impact your company in some way.

Perhaps the best examples of regulatory capture came out of the Great Financial Crisis in 2008. Financial regulations, like Dodd-Frank, reinforced the dominance of the large incumbent banks. These rules imposed strict capital and compliance requirements, which big banks could absorb but smaller ones could not.

The result was that large institutions like JPMorgan Chase and Goldman Sachs emerged stronger than ever, making it difficult for smaller banks and new entrants to thrive.

Again, while many of these rules are valuable, many are not. And the overarching structure of the system generally favors large incumbents. This is true for two reasons:

1/ Lobbying Power: Large companies have the resources to influence Congress and federal agencies through lobbying and campaign donations. Many of them house large government affairs and public policy staffs in Washington.

2/ Established precedents: Policymakers often are reluctant to implement big changes to the way businesses operate and as a result design their programs and rules around the existing establishments.

If DOGE succeeds in reducing federal agency regulations, it would inherently challenge rules designed to protect the country’s largest companies that have benefited from the regulatory capture dynamic — ExxonMobil, Microsoft, Boeing, UnitedHealth, Walmart, etc. 

This is a rather surprising effort to come out of a Republican administration that has typically supported big business, but it makes sense in the context of some of Trump’s other non-traditional decisions since winning the election. Take some of the comments he made when nominating RFK for Secretary of HHS:

“For too long, Americans have been crushed by the industrial food complex and drug companies who have engaged in deception, misinformation, and disinformation. HHS will play a big role in helping ensure that everybody will be protected from harmful chemicals, pollutants, pesticides, pharmaceutical products, and food additives.”

This statement sounds more like left-wing activism than traditional Republican rhetoric.

Back to the DOGE effort. No doubt the purpose of this effort is to reduce the cost of the federal government, but by unraveling many of the regulations that protect incumbents, this also starts to shift the balance of power back towards startups. Multiple VCs have talked about how these regulations have paralyzed the work of many startups, particularly in fintech, crypto, and AI. While Musk and Ramaswamy have run big businesses that have undoubtedly benefited from these regulations, they’re both founders and entrepreneurs as opposed to traditional, big company managers. Much of this effort feels like an indirect backlash against the “managerial revolution” where professional managers hold the primary power in organizations and economies as opposed to inventors, entrepreneurs, and founders. So, in some ways, DOGE isn’t just an effort to reduce the size of government; it’s also very much an effort to support a thriving and innovative startup ecosystem. 

This won’t be easy. In fact, it might be impossible. There will be endless lawsuits, and large, powerful businesses with enormous lobbying budgets will scramble to protect the status quo.

But if it’s successful, DOGE has the potential to reduce the size of government and weaken the big established incumbents, creating more opportunities for startups to drive innovation. And it may realign some aspects of the American political party system. If it doesn’t succeed, it may simply underscore and reinforce how entrenched the existing system and structure have become.