The Four: The Hidden DNA of Amazon, Apple, Facebook, and Google by Scott Galloway
Brief Summary
The Four is an eye-opening pathway into understanding just how influential and gargantuan Amazon, Apple, Facebook, and Google (Galloway calls these companies the Four Horsemen) are in our lives. He strangely connects each of these four to a primal / human urge (belly, sex drive, social drive, intel) as a mechanism to explore how the tech giants manipulate our behavior and have wiggled their way into the center of our lives. As much as we may express cynicism or distrust, the vast majority of Americans and a significant portion of the world give these companies access to our most private thoughts, our attention, our wallets, and our relationships.
The book is well-documented, cleverly told, and quite engaging, if not just alarming. Galloway expresses concern without seeming to speak down to us and seems driven by a purpose to shine a light on a phenomenon many of us are actively living.
Where Was Healthcare?
This book was dedicated to the changes in our economy and the unique role that these four tech giants have in understanding us and our thoughts. His interest is largely in tech, and in advertising, purchasing power, and the attention that we offer these companies. As healthcare is close to 20% of the GDP, I had hoped to see more direct links by Galloway to this sector. When I think of the millions of dollars payers and providers spend to get our attention, their efforts seem scoffable after absorbing Galloway’s portrayal of the reach had by the Four Horsemen. Healthcare is widely recognized as one of the few remaining sectors of the economy that hasn’t yet been transformed by the tech, information, and consumer revolutions.
When I think of the millions of dollars payers and providers spend to get our attention, their efforts seem scoffable after absorbing Galloway’s portrayal of the reach had by the Four Horsemen.
My takeaway
Reading this book from a healthcare perspective made me feel alarmed that the industry generally isn’t more concerned about the impact that big tech is likely to have on healthcare in upcoming years. Previously halted or failed attempts have led some to think that healthcare is immune from the type of disruption seen in other sectors. Healthcare is notoriously resistant to influence by outside forces. I have heard healthcare leaders brag about dealing with real issues vs. the perceived fluff of what Amazon could do in healthcare down the road. This makes me worry for the industry, and especially for smaller, community-based payers and providers.
These big tech companies are unlikely to compete directly, such as with incumbents by starting their own health insurance company (although, we do have Oscar) or hospital, but instead by shifting some of the fundamental building blocks along the delivery chain and with patient/consumer engagement. Following the activity of big tech in general and specifically in healthcare is rarely part of the competitive and market analysis conducted in many healthcare companies. However, this kind of focus can help to head off, and be prepared for, changes ahead. We’ve got thoughts on how to keep the lights on with day-to-day needs while keeping binoculars focused on the horizon, and would love to hear your thoughts, too.
Recommend? - Yes! It helps frame the world we see around us
This book is a quick read and it starts delivering insights and ahas from the start. You don’t have to agree with everything that Galloway posits to get tremendous value from the points he is trying to make. I challenge you to read this book and think the same way about healthcare, and about the use of your smart phone, in the same way again. If you do read it, reach out – I’d love to connect with you on the implications for healthcare.
My Ratings
Engaging/Interesting - 5 stars - Galloway has clever insights and an irreverent and sometimes funny author’s voice. He tells a compelling story of each of these companies, and I looked forward to the deep dive of each one.
Compelling Purpose - 4 stars - Galloway seems to want to expose the power of the Horsemen as a cautionary tale for the current state of the economy. My purpose in reading was healthcare-oriented, but also with a broader social view.
Relevance to Healthcare - 3/5 stars - The book isn’t immediately referential of healthcare (3) but the messages, played out to their potential, are extremely relevant (5).
Overall Recommendation - 5 stars - We can’t afford to keep saying change will never happen in healthcare just because it hasn’t happened yet. We simply can’t keep raising prices while offering inconsistent service quality and expect it to go on forever. This book jolts the reader into paying attention.
Nancy Wise, Managing Partner, Spring Street Exchange
Nancy founded Spring Street Exchange because she wanted to be wholly free to work with like-minded individuals in striving to make healthcare how it should be, rather than the way it has always been. Her work in the industry has ranged from tiny, community-based nonprofit service organizations to billion-dollar insurers, and most things in between. She specializes in the intersection between big ideas and practical planning, which she believes can only be accomplished through radical collaboration and using a new set of tools. Her secret sauce is in leading strategic planning and visioning initiatives.
Nancy has a master’s degree in Public Health and an MBA from the University of California at Berkeley and a BA in American Civilization from Brown University. She is from both Pittsburgh and Alameda, CA, but now lives in Lexington, MA, where the shot was fired that was heard around the world.