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Thanks for this post Sharif. I never knew surgery could be performed remotely!

Agree that MSF is a perfect application of telemedicine = where the alternative is no care at all. This also completely transforms the model of one looking to volunteer with MSF; instead of travelling to the country, volunteers can provide services remotely, which greatly increases efficiency.

I also wrote my post on telemedicine, and I’m curious as to your perspective on this: for what types of ailments does LI work best?

On November 20, 2016, RYR commented on Education: One size no longer has to fit all :

Thanks Gorick, this is a really interesting article. I’m a big fan of the idea of more personalized learning experiences. Even in the most communal of learning environments, the HBS classroom, I’d argue there’s a huge variety of learning trajectories. Each of us learn in different ways, and embracing this is a step in the right direction.

I think the socioeconomic divide is a real issue – curriculum can’t be fully online if all kids don’t have access at home. But also, school districts with less access to funding probably can’t afford the upfront investment in laptops for each student to get a program like this off the ground.

The anecdote of the girl pressing keys randomly doesn’t bother me so much for two reasons: One, you’d have to compare the amount of “zoning out” for the computerized system vs. the status quo classroom experience to make a meaningful statement. Second, this can be easily programmed into the education software to alert the teacher when a student is exhibiting behavior that is unlikely to be productive.

On November 20, 2016, RYR commented on From physical to digital – Magic: the Gathering :

Interesting article Brandon, thanks! What’s fascinating to me in the shift of MTG to online is 2 things:

1) How this affects the revenue model – I would think pre-digital, most MTG revenue was selling cards to players. Once you go digital, could you then have a subscriber model where everyone gets dealt random new cards each week or month?

2) How the social experience changes. You mentioned that you formed a lot of close friends playing MTG with them growing up. To what extent did the in-person social aspect impact your love of the game? Is digital only possible for those who have been exposed to the strong in-person social experience? Would a first time MTG player in digital be as loyal?

On November 20, 2016, RYR commented on RubiconMD: Treating Referrals :

Thanks for the article Ryan – seems like an interesting problem to tackle. My biggest question would be how an asynchronous interaction compares with the curbside consult in terms of efficiency and efficacy. Realize that the curbside consult has the obvious drawback of access, but isn’t it much easier to communicate in person vs. over email, especially in time-sensitive and complex situations?

On November 20, 2016, RYR commented on Athenahealth: The Quest to Unbreak Healthcare :

Thanks for this article! Agree that revenue cycle management for small/medium sized providers has a ton of value in today’s healthcare system, but what does athena do that differentiates themselves from other players in the market?

Agree with TCG that the recent trend of provider consolidation is bad for athena, especially hospitals acquiring smaller physician practices, as hospitals typically have much more sophisticated billing departments vs. smaller practices.

Interesting post – it’s great to see the company re-positioning itself in the coal space for what’s needed in the market today (new boiler technology, retrofitted parts, etc.). Too often I think we cast black and white distinctions around which companies are “evil” vs. “good”; this is a great example of a company that has adapted its operating model to shifting customer preferences over time (cheap reliable energy in the 1900s, clean energy today). Kind of reminds me of the Trump “I’m what’s wrong with the system therefore I’m the only one who can fix it” argument, which makes a lot of sense for mitigating the environmental impact of coal plants in the short-term, given coal still comprises a significant portion of U.S. generation capacity today.

Brandon – completely agree that climate change will endanger wildlife as well as the ecosystem. Any kind of organization dedicated to wildlife preservation hopes for as much stability as possible in the world, and any large deviations from the status quo are bad.

I do see a silver lining though in terms of the third prong of the Federation’s mission: the development of future conservationists. As climate change becomes more relevant in our day-to-day lives, more resources and airtime will be dedicated to the issue in society. This will likely lead to a younger generation that is more enthused than ours to protect the planet. Whether or not we will have reached the point of no return is irrelevant – there’s no way to know this until well after the fact. So in a world where climate change worsens considerably, we’ll start to see increased relevance of organizations devoted to preserving the planet, which could make it a very exciting time to be part of the National Wildlife Federation.

On November 7, 2016, RYR commented on Munich Re – mitigating risk in an uncertain climate :

JM – I like the points you bring up that (i) climate change adds risk to the world and (ii) makes underwriting more difficult because of increased tail risk specifically. Tail risks are tougher to robustly price, and given the regulatory requirements for VaR, this could make the business model tougher going forward.

I actually see a few tailwinds for reinsurers here, given my own post was about an insurer (Allstate):
1) Insurers are facing the same problem, so they are more likely to buy reinsurance. To the extent reinsuers get more comfortable with pricing the increased tail risks associated with climate change, this is an opportunity
2) In general, more risk is good for the insurance industry in a world of risk-averse individuals. More risk = more value able to be provided to the end consumer

It’s a positive sign that Munich Re has invested in a climate change research center. Climate change is a risk that is difficult to underwrite, so building this capability could be a strong differentiator for the business.

On November 7, 2016, RYR commented on Always Coca Cola? :

It’s an interesting issue whether or not a global water supply shortage is good or bad for Coca-Cola. You could make the argument that it may be good:

1) Global water shortages will not restrict Coca-Cola’s access to water; rather, it will cause an increase in water needed to manufacture its products (so increase in raw materials cost)

2) All other beverage manufacturers will feel the same raw materials cost pressure –> beverage prices will increase across the board

3) Yes, consumers may reduce beverage consumption because of higher prices, but prices of almost everything edible will increase as water becomes costlier. For simplicity, let’s assume total beverage consumption is unchanged

4) Change in consumption of Coca-Cola products will then be determined by the relative price increase of Coca-Cola products vs. other beverage manufacturers, which would depend on the portion of total raw materials cost coming from water for Coca-Cola compared to other beverage manufacturers. This is not publicly available information, so it is unclear how Coca-Cola would stack up

5) Coca-Cola has relatively high margins (from their 10-K, Coca-Cola has ~20% operating margins vs. Pepsi at ~13-14%). Assuming similar business mix, this would support that Coca-Cola is better positioned to absorb higher input costs, given more margin cushion

Coke 10-K: https://www.sec.gov/Archives/edgar/data/21344/000002134416000050/a2015123110-k.htm
Pepsi 10-K: https://www.sec.gov/Archives/edgar/data/77476/000007747616000066/pepsico201510-k.htm

On November 7, 2016, RYR commented on Taiwan Semiconductor Manufacturing Co’s Water Woes :

Michael 1 – this is really interesting stuff. Never knew that semiconductor manufacturing was so dependent on access to highly purified water.

My understanding of your argument is that semiconductor manufacturing is a water-intensive process, and that Taiwan’s supply of water will be affected disproportionately by the onset of climate change. The cost of semiconductor manufacturing in Taiwan will rise, and therefore TSMC will be less competitive in the global semiconductor market.

But to what extent are other semiconductor manufacturers going through similar issues? Given China is TSMC’s largest market, is there another semiconductor manufacturer that will be less affected by climate change that can step in and take share from TSMC? If so, are there other methods by which TSMC can secure access to water for the medium to long term (do fresh water futures exist)?