148 - How Trump's Healthcare Agenda and AI Will Reshape Primary Care Forever

Show Notes

Vic and Marcus open with updates on their personal healthcare experiences and transition into breaking news on Trump’s 15% tariff deals with Japan and likely Europe. They analyze economic indicators suggesting a possible recession and unpack the national security fallout from a zero-day SharePoint cyberattack linked to Chinese actors. The hosts cover major AI investments in healthcare, including Aidoc’s $150M raise and AbsoluteCare’s $135M value-based care expansion. They discuss policy shifts, including Trump’s AI action plan, a bipartisan push to equalize Medicare reimbursement, and proposed legislation requiring hospitals to disclose NICU capabilities. Earnings hits from Molina, Oscar, and UnitedHealth are examined, alongside leadership changes at CHS amid Medicaid reimbursement cuts. They explore growing investments in Ethereum, Trump’s $2B Bitcoin buy-in, and the crypto-ification of corporate treasuries. AI safety risks are highlighted with OpenAI's role in a user's delusions, while Google’s Gemini AI integrates with G Suite. The episode wraps with a powerful essay from primary care doctors urging inclusion in Maha healthcare reform and Amazon’s controversial acquisition of a wearable that listens to your entire day.

Links

2:34 Trump’s New Trade Standard Takes Shape With 15% Tariff Deal WSJ

3:54 Japan Trade Deal and European Talks Send U.S. Stocks Higher WSJ

4:43 U.S. Leading Indicators Show Economic Clouds Gathering WSJ

6:11 Microsoft Alerts Firms to Server-Software Attack WSJ

8:29 Microsoft links Sharepoint ToolShell attacks to Chinese hackers Bleeping Computer

9:49 Clinical AI company Aidoc lands $150M backed by General Catalyst, Nvidia's venture arm Fierce Healthcare

10:42 Robotics Startup Dash Bio Sprints to New Financing WSJ

11:47 Value-Based Provider AbsoluteCare Raises $135M for Market Expansion BH Business

14:11 AI Talent Frenzy Is a Mixed Bag for VCs WSJ

16:32 White House releases AI Action Plan, looks to speed adoption in healthcare Fierce Healthcare

23:55 Bill Would Force Hospitals to Warn If They Aren’t Equipped to Save Premature Babies WSJ

26:43 Bipartisan bill aims to ensure parity between reimbursement in MA, traditional Medicare Fierce Healthcare

35:00 MAHA group makes hefty pitch backing Trump and RFK Jr.’s health agenda The Hill

37:12 Cost pressures limit Molina Healthcare during Q2 earnings, stock dips 4% Fierce Healthcare

37:32 Oscar Health cuts full-year guidance, estimates 2025 loss as ACA marketplace stumbles Fierce Healthcare

39:22 UnitedHealth confirms it’s under investigation by DOJ Healthcare Dive

42:43 Community Health Systems beats Q2 revenue, earnings estimates; CEO to retire Fierce Healthcare

47:52 Tenet raises 2025 expectations, but dodges questions about policy impacts Healthcare Dive

49:15

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What is Health:Further?

Every week, healthcare VCs and Jumpstart Health Investors co-founders Vic Gatto and Marcus Whitney review and unpack the happenings in US Healthcare, finance, technology and policy. With a firm belief that our healthcare system is doomed without entrepreneurship, they work through the mud to find the jewels, highlight headwinds and tailwinds, and bring on the smartest guests to fill in the gaps.

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Thank you.

Alright, we're back.

We're back.

How's your week?

It's pretty good.

I had some, uh, friends in town for the week, which was fun.

But out of town, guests in town during the week is you just, it's fun to see everyone, but it's also, you know, not my routine.

Yeah.

Uh, people came in town for Coldplay, which was good to see 'em, but then I was hosting and, you know, boy, I, no one's heard about Coldplay in forever and now I know now I, I mean, everywhere.

I can't go a day without hearing about him five times.

I know, I know.

Uh, yeah.

Well, good for them.

Good for them getting back on the scene.

Yeah.

I, I had a good week, uh, weekend spent with my oldest, um, in North Carolina.

Oh yeah, yeah.

Which was awesome.

And then, uh, came back, flew out to Salt Lake, uh, for the Celtic board meeting.

Yeah.

And then back here.

So a lot of time on airplanes.

Um, and, but, but good.

Yeah.

Good.

Overall, great board meeting today for one of our portfolio companies.

Mm-hmm.

Um, love it when a portfolio company is literally doing every single thing they said they would do.

Yeah.

They doing everything.

Yeah.

Um, you don't get those every day, so when you get one, you gotta be, appreciate it.

Very grateful for it.

Um, so that's, that's awesome.

And, uh, yeah, also had a good, uh, had a good, uh, session with my primary care doc today.

Oh, good.

Um, yeah, I I actually love my primary care doc.

He's, he's, he's wonderful.

He is like half therapist, half primary care doc.

Yeah.

You know, and he is also kind of, you know, medicine 3.0 Peter Attia.

Yeah.

You know, uh, in terms of the way he thinks about things.

So, uh, it's felt like on, on a show like Health, health further, I should, yeah.

Talk about how much I love my doctor.

Yeah.

I really do.

It's interesting.

I, I met my doctor for the first time yesterday as well.

We got a, I got a new doctor.

You got a new doc.

Oh, okay.

Yeah.

My doctor retired.

Oh.

Um.

That's always hard, which was, yeah, just a hassle.

Yeah.

So for a while I've been only working with my cardiologist because that's my primary thing I'm interested in, focused on.

But I need a, I need a PCP.

You need a P in general.

P yeah.

So, so, so what's your early, uh, early read on the new doc?

I, I liked him.

Okay.

He's, he's a young guy, the frisk clinic and, you know, it's not a concierge, but, but they do a pretty good job at, yeah, at frisk clinic.

They over there, so, yeah.

Yeah.

Good.

Alright.

Uh, long show.

And we're starting late in recording, so let's, uh, let's, uh, go ahead and dig in.

Uh, let's start with the tariff news.

Uh, Trump is starting to land the plane on these tariffs.

Uh, a deal was struck with Japan, so 15% tariff deal with Japan, and, uh, everyone seems to think that Europe will follow and it will also likely land at 15%.

So it seems like the objective is starting to clear and, uh, there's some significant, uh, revenue that that should be attached to these tariffs.

Yeah.

Um, which is going to be, I think, a successful milestone for, for Trump's presidency.

Yeah.

I mean, if he can land the European agreement, if, if you signed Japan and Europe, that's a pretty good percentage.

Uh, we still have, uh, the big ones are China and India.

Those are the big ones.

Yeah.

But, but symbolically.

Uh, you know, and Canada and Mexico, I think from a and Canada Yes.

Size of trade.

Yeah.

Those are kind of the six that we need to kind of really work through.

Right.

But, but getting these two, I think would, uh, be really positive.

And yeah, 15% is a lot of money that will come in.

Also, I think it's been pretty successful, at least in Japan, they cut a bunch of non-financial, uh, trade barriers for our products going in there.

Mm-hmm.

Um, that was part of the goal too.

So Power of the dollar, cautiously optimistic.

Yeah.

Power of the dollar.

Uh, and so of course the market, uh, you know, loved that we're settling Yes.

Uh, this whole tariff thing and, and that it's, it's coming out to be reasonably positive for the United States, at least in terms of bilateral trade.

Yeah.

Um, and so yet another all time high week.

Yeah.

I mean, it's been every day it seems like a new all time high.

Every, everything is doing well except healthcare, fortunately.

Yeah.

But, uh, but, uh, but in general, the markets are.

On fire right now.

Yeah.

Uh, okay.

So, and at the same time, every once in a while you'll bring in these, these different, you know, surveys or reports.

Mm-hmm.

They're usually from the Fed.

I don't think this one is, but Yeah.

Um, where it's just people are opting in to provide sentiment on where they think things are going.

And, uh, this report from the conference board says that, you know, the leading indicators show that we've got some, some economic clouds gathering and potentially a recession on the horizon.

Um, I mean, I feel like we've been talking about recession for the entirety of the 2020s, and so I'm a little bit Yeah.

Uh, you know, just numb to these alerts.

Right, right.

At this point.

But tell me a little bit more about this report.

Yeah, I mean, I guess, um, as far as forward looking out 3, 6, 12 months, you kind of have to rely on surveys or, um.

How people view the upcoming year.

Um, but I think to your point, they have not been very accurate over the last couple years.

Um, and I think just the humans that are responding to these surveys, they're not used to the pace of change that's going on, and whether it's in tariffs and policy or regulation or ai, there's just a lot of changes going on.

So a lot of changes going, I think that makes people scared and nervous just because this changed, not necessarily based on how the economy will actually do.

Right.

And so I think I agree with you.

I, I keep track of these just to sort of try to understand what's, what are people believing out there because I think it does lead to investment, um, at least capital investment.

Mm-hmm.

Mm-hmm.

Uh, okay.

I learned about this on Tuesday at the bank board meeting, uh, because, you know, our head of it was making sure we all knew that we could breathe a sigh of relief because we were on the cloud version of SharePoint.

Yeah.

Which is what the story sort of frames up.

Um, but there was a true significant zero day attack on Microsoft's, um, SharePoint server for install.

Uh, for, for, yeah.

If you have a data center premise for on premise installs, um, and is pretty serious.

Um, yeah.

You know, people store everything.

Yeah, on these SharePoint servers.

So this is like, it's where you keep all of the sensitive corporate information.

Yeah, that's right.

All the data, all everything.

The all the records, everything.

Yeah.

And the whole purpose is, so you have, you know, very strong access controls over who gets access to what, um, for how long.

Even, I mean, you know, it's, it's very, very much about access control to sensitive data.

That's kinda the value of SharePoint.

That's value, that's the value of SharePoint and uh, yeah, for there to be a zero day attack on it.

And you know, the thing about install based stuff is the response is not gonna be the same from organization to organization.

Yeah.

There's gonna be all sorts of differences depending on what version of software you're running, right?

You know, everything.

What type of access you have to your data center, et cetera, et cetera.

Is it actually in your office?

And so, um, yeah, Microsoft is trying to put patches out, but there's multiple patches based on what else you have installed, what version It's.

It's reasonably complicated to get attached.

Yeah.

And, and, and a zero day attack means it has not been seen before.

Mm-hmm.

So, so you, you're kind of starting from scratch on figuring out where the vulnerability came from.

Yeah.

How you stop it in the short term, and then how you prevent it in the long term.

So there's a lot of work for all the mm-hmm.

Um, OPSEC folks at, at Microsoft and at at corporations around the country.

Yeah.

Right.

Probably around the world.

Right.

Uh, to sort of run this to ground.

So this, this is, this is a, this is a big deal.

Yeah.

It's a big deal.

You know, I think people at data centers have been running some long, long nights Yeah.

Yes.

Uh, to, to, to deal with this, so, right.

Uh, and now as you're doing the autopsy, um.

At least an aspect of the hack has been linked to Chinese hackers.

Mm-hmm.

And now Yeah.

Two different groups in China.

Right.

And, and so this brings it into the focus of it being a national security, foreign affairs, uh, matter.

Yeah.

And it's not clear to me if the Chinese actors created and started and found it, or they leveraged it, read the news and, and sort of jumped in.

Right.

It's not, I don't think anyone knows that.

Right, right.

But, uh, I mean this, this is, it's, it's just very interesting the, you know, the segues between these massive big tech players that have such concentration in the market that they are essential point of vulnerability.

Yeah.

Um, for the nation.

I mean, we know that the US government is running a lot of Microsoft.

Yeah.

Uh, SharePoint, OnPrem, we, we know that.

Yeah.

So there's no question that there has have, there's had to have been a lot of patches in the government sector.

They're not running all on cloud.

No, no way.

No.

And I mean, I think a lot of banks, a lot, a lot of hospitals.

Yeah.

There's a lot of institutions that are running on SharePoint.

Yeah.

It's probably, it might be the biggest, it's one of the biggest data organization access tools.

I don't think there's any question about it.

Yeah.

So yeah, this is, this is a very, very big, uh, vulnerability.

Alright.

Moving into vc, uh, clinical AI company.

AI doc Lands 150 million backed by General Catalyst and NVIDIA's venture arm.

So this is another decision support, uh, uh, solution.

And they are looking to expand into oncology and cardiovascular disease, you know, places where there's a lot of money, um, and, uh, very sort of high powered doctors that I think would appreciate some, some strong AI dedicated AI decision support.

Yeah, that's right.

And they are solely in the sort of the.

Clinical decision support.

They've gotten two solutions cleared by the FDA, but they have a whole bunch more like in process.

Yeah.

There's also se several health systems that are strategic investors.

Sutter Health, Hartford Mercy and WellSpan.

Mm-hmm.

Um, so that's always, that's always great, yeah.

To get that validation as well, um, from a host of systems, not just one.

Uh, next thing is, uh, robotics startup bio sprints to new financing.

Uh, they previously had raised 6.5 million.

Now they've raised an additional 11 million.

And I guess, uh, this is interesting because they are, uh, robotics company focused on supporting, automating, uh, clinical trials and animal studies for pharma.

Yeah, that's right.

So it's a, it's a smaller raise than we talked about last week, but yeah, last week we talked about a private equity mm-hmm.

Firm in New Jersey, uh, maybe Philly, somewhere down there.

Um, doing sort of clinical trials at significant scale.

This is for the same thing, but using robotics and software automation to automate a lot of that.

It's a venture scale, so it's, it's $11 million, um, early stage, but I think they're related.

We we're just gonna see, I think we're gonna see more pharmaceutical development, more clinical trials, more at the intersection of full software modeling, no animals at all.

And then you have some animal testing back and forth, and I think they'll be interesting to see how this evolves.

Yep.

Uh, next value-based provider, absolute care raises 135 million for market expansion.

So they have now raised a total of 240 million in, in two rounds.

Um, and based in Columbia, Maryland, you know, value-based care.

Including behavioral health.

So they, they actually do a broad spectrum of, uh, integrated health services.

I think it's great that we continue to get shots on goal for value-based care.

Mm-hmm.

Um, and to see this kind of capital deployed is bold and brave.

And I, I certainly love that the investors are strong, kinder Hook industries, CVS Health, Pacific Life Lexington Partners.

Um, so, you know, good group writing big checks.

That's awesome.

Um, but I think also gonna be a, uh, a difficult and uncertain future for, for these types of businesses, just because we're, we're so in flux as we transition into the RFK Maha era.

Yeah.

And we're still seeing what, you know, what the rules are going to be, um, in the future.

We, we got a glimpse of it with the outpatient, you know, um, proposed rule that came out last week.

But to me, um.

It's incredibly bold to make this kind of bet right now with so much uncertainty around how these different, uh, you know, bundle payment models are going to roll out.

Yeah, no, there's no question about that.

It's been a challenge to really make money and, and create a lot of value in value-based care, in, especially in the, in the sort of primary care led space.

And then they're doing it across Medicare, Medicaid, and commercial and that those are all very different and, and I think pretty hard.

So.

It's ambitious.

I, and I, I agree with you.

I, I'm hopeful.

I'd love to see how it evolves.

And it's a significant amount of money, so it's worth covering and worth them working on a big problem.

I think so.

I mean, it's, it's a significant amount of money and that money goes quick.

Yeah.

You know, and, and this business line, this money goes quick because you gotta pay for great talent.

Yeah.

The talent has a lot of optionality, so they, I think they can demand strong salaries, um, and they certainly have to have a brick and mortar component to it.

I don't know how else you do this work.

Um, so it's, it's not, you know, I mean, I. It's, it's a brave bet.

Yeah.

I think, I think is what I would say.

It's a brave bet in a time such as this.

Right.

Um, okay.

Wall Street Journal, venture Capital Pro, uh, AI talent Frenzy is a mixed bag for VCs.

So I'm glad you found this story because it, uh, it provides some context that we didn't have when we were talking about some of the AI talent stuff last week.

Um, you know, the, the wars with, with the offers that Meta's been making mm-hmm.

You know, the, the Google windsurf Yeah.

You know, situation.

And so this actually talks about what happened in that windsurf deal.

Yeah.

They were able to get the, the actual facts, which I think are really helpful.

Yeah.

Yeah.

So, um, the cashed out, the startups shareholders for a total of 2.4 billion.

One of the venture firms that backed windsurf in the seed round, uh, returned 50 times capital.

That's like, for anyone who's listening, that's a ridiculous win.

Could make a, an entire fund on one deal, you know, at 50 times, depending on how big the check was.

I mean, the history of jumpstart.

Our best one was 39 times.

Yeah.

So 50 50.

Excellent.

Yeah.

I mean, incredible.

Of course the math has to, it's like how big was the check?

Right.

Right.

You know what I mean?

The check has to be sufficient size, but the 50 x is ridiculous.

That's so good.

Yeah.

Um, and uh, yeah.

And then, and then they say one of the VCs that came into the series B got a four X the investment and windsurf is not that old.

Right.

So serious B could not have been outstanding very long.

No, no.

So four X if you only invested, I don't know, a year ago Yeah.

Is ridiculous.

Like that's, it's exceptional.

Right.

Um, it's better than Bitcoin.

It's better, better than everything right now.

Yeah.

You know what I mean?

Getting four X in a year.

So I guess this is an offset to what I thought was happening, right.

Where I thought the VCs were totally getting screwed and hosed on these deals.

At least in this deal, that is not the case.

Yeah.

I think that often VCs have enough blocking power through the preferred that they, they at least get, can get a respectable Right.

Or a plausible exit.

Right.

Con control of what the transaction gotta look like.

Yeah.

There are some VCs in this article and we'll link to it, that are talking about, you know, kind of the opportunity loss.

They, they could have made more.

Yeah.

If they could hold longer, if, et cetera, et cetera.

Crime River.

Exactly.

I think there's, yeah.

Yeah.

I don't, I don't care about that one bit.

Yeah.

Yeah.

Um, so, so I think it is, you know, an exit, even if it is not, um, an exit related to like DOJ.

Right.

I think in general it should be okay for the VCs.

Good for the VCs.

Agree.

Agree.

Um, okay.

So Fierce Healthcare, white House releases AI action plan looks to speed adoption in healthcare.

Uh, so this, this article, which we will link to is calling out specifically the areas where, um, in the broad action plan that is not specific to healthcare, right?

Um, where healthcare is featured.

Um, it, it notes in this article that healthcare is only mentioned directly a few times in the 28 page document.

And so, you know, you, you get the point.

It's not an, it's not a healthcare document.

Um, however, you know, I think we know the FDA.

Entered, exited the Biden administration and entered the Trump administration very behind on ai.

And this was by the FDA's own admission.

Yeah.

You know, when I went to Aspen and Ideas Health and, uh, you know, the FDA was there, they, they were saying, we're behind.

Yeah.

Right.

You know what I mean?

We, we don't have the right frameworks for this.

We don't even have the right talent for it.

We have to build that out.

Yeah.

That was just a short, you know, year and a half ago.

Right.

And so clearly, you know, we're, we're in a space where you need to, you need to establish that you want to advance things in, in AI in a significant way at the FDA.

Um, but the how is is really the big question, isn't it?

Yeah.

I mean, I think that, uh, it's interesting.

We, you and I read the full policy, which we covered next, maybe mm-hmm.

Kind of differently.

I see it as a executive order with a lot of ambition to sort of lead the world in AI and empower.

New construction and new models and, um, but I don't know how much I trust that the federal government can really help.

Um, but I'm in, I'm in favor of it.

I just didn't think it was that important.

You, you think it's the Trump administration is going to like, put much more kind of power behind it?

I think, I don't wanna put words in your mouth, but I, I find the Trump administration, whether you like them or not, to be extremely effective at doing the things they say they're gonna do, um, to be very swift.

But, you know, I think many.

Critics would say Too swift.

Yeah.

I think many critics would say they're doing too much too fast, but there's no question they're doing it.

Right.

Ice is really happening.

Yeah.

The elimination of DEI is really happening.

The one big beautiful bill really happened.

Yeah.

And I mean, you know, we've been looking at the growth of the healthcare markets and the share of GDP, uh, for at least 11 years, forever.

Yeah.

And I have been doing this together.

Okay.

And in less than six months, this guy rallied, you know, his, his full stack house and senate to, you know, cut a trillion dollars out of healthcare over the course of the next eight years.

Yeah.

I mean, no one has done anything like that.

Right.

So, so to me, yeah.

When he puts something like this out, like.

It's gonna happen now, the effects of it, you know, the quality of the effects of it are an entirely different thing.

So for example, doge, I, I think generally speaking, people would say Doge was probably not that successful in getting the targeted, uh, savings Right.

That it set out to do.

But did it go out there and did it put its tentacles into every single agency?

They definitely made the effort.

Yeah.

Yes.

Like, did they go out there, did they put people, uh, you know, uh, on blast and, and, and capture information and capture data and all that?

Yeah.

Definitely did that.

They, they did those things.

Yeah.

So I, uh, you know, we, we just talked about the tariffs, like Yeah.

You know, a lot of people thought that he was just using the tariffs as something, as a, as a stump speech for an election.

Yeah.

And no, they're real.

He's done it.

He's, he's getting them done.

So I guess my thing is Donald Trump has earned my trust and so far as when he says he's going to do something.

I, I believe him.

I believe him, right?

Um, I scan through this AI report, um, and or action plan I should say.

Yeah.

And you know, there, there were key things, you know, where they talked about like, uh, you know, setting standards on what AI models are acceptable to be purchased, uh, federally, right?

Mm-hmm.

So, you know, they talked about how they don't want any, you know, LLMs that have anything DEI or, or climate change in there.

Well, you know, that's, that's gonna, it's, it's gonna have an indirect impact on the market, right?

So maybe.

I don't know, maybe Claude doesn't care about getting a government contract, but we damn sure know that chat GPT does.

Right, right.

We know that, that Sam and Open AI do so, you know, does a, and does an AI action plan like this start to influence the way that these models are tuned?

Right?

To like, not recognize climate change is a real thing?

So tho those are the kinds of things when I look at this report, I'm like, that's what, that's what I see getting ready to happen.

It's, it's more forcing the, more forcing the private markets indirectly to behave and develop in a certain way.

And of course, you know, it's a mixed bag.

There's things in there that I think are really great, like dri like, uh.

S like pushing for more open source.

Right.

Recognizing it.

To me that was like a clear, uh, t thumbprint of David Sachs.

It's like, okay.

Yeah.

David Sachs is clearly on this.

If you, if you've heard him a million times, you know, uh, his importance of Yeah.

Of being competitive with China.

We have to do open source if we're gonna be competitive with China.

Yeah.

Um, and the, and the push for more power.

Yeah.

Yeah.

There's a whole section about driving more power, electricity, infrastructure.

Yeah, yeah, yeah.

Yeah.

More power.

So anyway, I, I think, uh, you know, both of these, when you get to the free speech and DEI and climate change, I don't know.

How that can be implemented or that it's a positive, but I agree that they're gonna, they're gonna push on it.

Oh, they can implement it.

They're gonna push on it strongly.

Yeah.

They're just gonna, they're just gonna have somebody in a regulatory body that's just gonna be just review, just reviewing, just like asking it questions and then scrutinizing what it says.

Right.

And, and, and, and the way that I think about this kind of stuff is how does that impact the ability of decision support tools that may be seeking to, um, avoid bias or drive health equity?

Right?

Like that's, that's kind of the, that's what, because I just believe they're trying to, you know, stomp this stuff out in every single place possible.

Yeah.

Um, I, I think it, it will become harder, uh, to implement health equity solutions that are AI enabled with this kind of, you know, document out there in the wild.

So anyway, yeah.

That's, that's kind of that I. How I, however, not the entire thing.

That's not everything that it's, it's about, but that was one of the things that stuck out to me.

Yeah.

Right.

Um, so anyway, I, I think it is worth reading if, if you're interested in the future of AI in this country, I think this, this action plan, uh, it directly impacts what the feds are gonna buy.

But indirectly, I think it's, it's going to find its way into different, you know, potential requirements for reimbursement, for example.

Yeah.

Right.

I mean, it, it's worth reading because the US is gonna push this.

Yeah.

And I think no one, I don't know anyone that believes that there's gonna be any kind of holding back, pausing.

We're just full on gas ai.

Yeah.

Um, and China is too, and everyone else will be as well.

Yep.

So.

Yep, that's right.

Alright.

This is a cool.

Thing that you found that I think is something we need to pay attention to.

Wall Street Journal.

The headline is, bill would force hospitals to warn if they aren't equipped to save premature babies.

And, and generally speaking, I think this kind of transparency Yeah.

On the front end when you're engaging with families is important and a good thing.

Right.

Um, so there's, there's, uh, several Republican, is it bipartisan this or is it Republican?

I think it's only Republicans.

I think it's Republican.

Uh, driven Bill here.

Yeah.

Um, yeah, Tom Cotton's driving it.

But, but you know, this is basically saying, okay, if you know you're gonna have a high risk pregnancy, baby's gonna, you know, has a strong chance of being born at 20 months, 20 weeks, right?

Yeah.

Um, the hospital will need to inform you of how it is able to care for that child, should that child be born in the 20th week.

Um, thus giving you the ability to say, oh, well that's not really up to my, you know, yeah.

Desires I'm gonna.

Move two hours away and stay with my sister.

Right.

'cause a hospital there, if I have to deliver the baby early, a hospital there can take care of my 20 week old 21.

Yeah.

I think the window is between 20 and 25 weeks.

Mm-hmm.

That there are hospitals in the US that can give your baby a chance.

Um, and then there are some hospitals that, that they will try to reduce pain and comfort it, but they don't, they don't try to help it survive.

Yeah.

Yeah.

So, so this seems on the surface, like something that is just good.

Right?

This kind of disclosure seems, seems appropriate.

Yeah.

Um, and at the same time, you know.

Delivering babies is both really, really good.

Brand equity for these hospitals.

Yeah.

And also really, really good cash and margins for these hospitals.

Yeah.

And so, uh, any, to me, it's more pressure Right.

On systems.

I understand why Senator Cotton's doing it, and I think it is probably, I mean, it's like the inpatient only list.

It, it's a good thing to change, but it's gonna put pressure on hospitals, more pressure that they don't have the equipment to, to treat a 22 week old baby.

Yeah.

And they're gonna lose a bunch of moms who probably would have gone to term, or maybe they didn't go to term, but they would go to 30 weeks and be fine.

And so they'll lose all those deliveries.

Um, but it's important if you have one baby a year that doesn't get the care they need.

I don't know.

It's a hard, it's a hard issue.

I see both sides of it, but it's gonna be, put pressure on hospitals.

Definitely agree.

Now it may not get passed.

It's not, I don't know that it's gonna pass.

He's introducing it.

Alright, uh, fierce Healthcare, bipartisan bill aims to ensure parody between reimbursement in MA and traditional Medicare.

So, uh, I just kind of scoffed when I saw this headline because this was just like a jaw offering headline.

Yeah.

Be because I, I don't quite understand what the point of MA is.

Um, if you're not going to incentivize the market to be innovative and be able to manage, uh, care in the way that they see fit, right?

If you're sort of establishing this is the way you must reimburse and it must be, it's gonna be the same it is as it is in med traditional Medicare.

Why the heck would you do the MA business?

You know, we already have a bunch of providers fighting with the MA payers.

Like we've already, we've already, we've already got tension there.

Um, and then this.

It just kind of creates, now this, this is actually a po a positive incentive for the hospitals.

I would say generally speaking, uh,'cause they don't have to, you know, if, if you can get it from traditional Medicare, then you can, you know, you can sort of tell your, the, your community, Hey, listen, I can serve you traditional Medicare and get the same amount of money.

Like, you don't need to do these, these crazy MA plans.

Right?

But I would say for the payers, it's like, what is the incentive for you to be in the MA business?

Why, why be in the, a business?

Why would you take on capitated risk if you have to pay the same rates?

Yeah.

I mean, now maybe you can add in other patient support services, so they don't use as much, but that's not, but that's, that's, that's not exciting.

They is already already struggling.

That's not exciting.

Right?

Yeah.

So I, I think it is, um, functional.

I mean, it's, it's o it's overreaction to the upcoding issues, right?

Yes, that's right.

It's over, it's overreaction to the upcoding issues such that you're basically kind of killing the model.

I think, so the last bill I think is probably government responding to a bunch of moms wanting change.

Yeah, fine.

This one I think is overreach.

Like we created Medicare Advantage in order to bring market, like free market powers in to try to drive innovation and savings.

And if you remove those, you're just gonna kill, just gonna make Medicare advantage harder to operate than it already is and probably kill it or not make it, it's not gonna work.

Yeah.

I mean, I mean, look, I, I certainly understand that there is some cleanup work to do in MA that's, that's obvious from what we've learned over the last year.

Yeah.

Right.

So.

We're, we're, we're not blind to that fact.

Um, but you have to create sufficient, in sufficient incentives for the business model, otherwise no one's gonna do it.

Right.

Right.

So, so, so if you just don't want anyone to do it, just like say that, just say, Hey, yeah, maybe this was all a bad idea in the first place and we just need to go back to, to traditional Medicare.

But to me, this is almost like, you know, when we talk about the corporations that they don't wanna do a real layoff, but they just say everybody's gotta come back to the office.

Right.

'cause they know like everyone's just gonna like, uh, say, uh, screw it.

I'll just quit.

Yeah.

To me, this is kind of like, you're making it so onerous that people are just, you know, they're just gonna quit.

They're just gonna quit trying to do it.

Well, so the, the, the, the, um, representative Doggett Lloyd Doggett, democrat from Texas, I don't know him before I saw this.

His quote I think was, was interesting.

A rapidly growing Medicare disadvantage market is training our healthcare systems.

I think he is.

Not happy with the Medicare Advantage market and wanting to change it, kill it, replace it, do something with it, and it's bipartisan in the house.

And so there definitely is a lot of anger at the payers.

That's been true the past year and a half.

Yes.

And I don't know how it's gonna resolve, but, but this, yeah, this, this will be politically friendly, but I think, uh, pragmatically from an economic perspective doesn't make sense.

It, it, uh, yeah.

I mean it's just, it's just, I mean, it's fine if we're just gonna go with traditional Medicare.

I, I, I don't think that's the worst thing in the world.

I just think there's only so much you can do before MA becomes, you know, not really viable and, and not something that, that these providers are gonna sign up to do.

Yeah.

And traditional Medicare, I think.

Would end up spending more money in total than initially.

Initially.

But then, you know, a, after the one big beautiful bill, I mean, they clearly know how to, they know how to, they know how to cut money out.

They know how to cut money out.

It's, it's, it's, uh, you know, many would say it's, it's cruel.

Many, many, many would say it's cruel.

Uh, but they know how to, they know how to get the money out.

Cutting Medicaid is very different than cutting Medicare, though I think from a, from a, from a election political point of view, the big beautiful bill mostly cut Medicaid issues.

I, you know, you could, you couldn't have told me before that it was that different.

I, I'm, I mean, I, I, I understand exactly what you're saying.

And at the same time.

It's not, it's not quite splitting hairs, but it, it feels like it ought to be, I mean, Medicaid is for our most vulnerable and from women, from mothers and children.

I mean, you know what I mean?

Like Yeah.

How the hell is that politically palatable?

I don't think they vote well, but I, but I mean, up until this point, the political wisdom was don't mess with Medicaid.

Like up until this point.

That was the political wisdom.

Yeah.

And I, I don't know, man, it just seems like, um, it seems to me like Trump has figured out, he has tapped into something that.

So deep in primal that lets him get away with things that nobody else could get away with.

And I don't think we've figured out how to articulate it yet.

I don't, I don't even, I don't know that we, that we even know what it is, but like, who else could get away with all of the things that this guy gets away with?

Who else could do it?

I mean, I would say no one else could have gotten the beautiful bill passed.

It's because, because it was, because it's crazy.

Yes.

'cause it was a lot of different sides that didn't wanna vote for it.

Yeah.

And so, you know, this, this goes back to my point about him and the AI stuff, right?

It's just like I, you don't have to like him, but the guy did the, he pulled off the most ridiculous political comeback in modern presidential history.

It's easy to kind of forget now, like.

He was going to jail.

Right.

Right.

You know what I mean?

Like, and, and now he, and, and he, in a year's time, he swung from he was going to jail to he has total authority as approved by the Supreme Court.

Yeah.

I, I mean, so I don't know.

I, I just feel like betting against him is so hard.

It's so hard to bet against him, you know, uh, whether you like him or not.

I think, I think if you're intellectually honest and you look at the scoreboard, this guy is running up the scoreboard.

Yeah.

And unfortunately, the insurance companies just have a bad public, public opinion.

People are mad at insurance companies.

Yes.

And that's filtering up through both on, in the house.

Both Democrats and Republican are floating this bill that as an insider in the industry.

It does not make sense to me.

No.

Like I don't understand what they're talking about, but it doesn't mean they won't push it through and, and cause problems for bakery fish plants.

Agree.

Agree.

I, I mean, I, I think, I think it's got a strong chance actually.

I think it's got a strong chance.

Yeah.

So, um, alright, moving on.

Uh, we just wanna make a quick point about this.

So this is a story from the Hill.

Uh, headline is Maha Group makes hefty pitch backing Trump and RFK Junior's, uh, health agenda.

So basically there is a new pack, um, that is specifically focused on Maha, not Maga right, but Maha and is, you know, going to be.

Showing up in the press and showing up in commercials.

Yeah.

And I, I think we just wanted to make the point that if you start seeing more and more stuff getting woven into your feeds and into your news and into your, your advertisements.

Yeah.

I mean, they're spending half a million dollars and we're not in a, in a political cycle.

Yeah.

With, they're just, they're just spending it.

They said as a thank you.

I don't even know what that means, but as a Thank you.

Yeah.

So I think this was just like a FYI, um, there, there is a dedicated pack out there to Maha.

Yeah.

And so if you start seeing more stuff out there, you, you'll know where it is likely coming from.

Right.

And it's probably okay.

I mean, they're gonna be talking about healthy food, exercise, diet, but then there's all this, um.

I don't know, American pie, American flags, political aspects to it too.

Yeah.

Yeah.

So anyway, I, I, and also, I mean, I think it, it just continues to make the point, um, that RFK Junior, uh, was a pretty adept politician.

Yeah.

You know, and, and he played his cards beautifully.

And he is a very, very, very powerful and important figure.

He's not Trump, but I mean, he's he's up there.

Yeah.

He's not Trump.

He's not Trump, but he has his own disciples, man.

He has his own following.

Yes.

And, and he has his own pockets of money that he can plow into.

And, and HHS is, is a big part of the federal budget.

And Trump doesn't like healthcare.

Right.

So this guy's kind of gonna run wild and do whatever he wants and Trump's gonna let him Yeah.

I think that's right.

Right.

So it's just understanding that there, there is a cult of personality here, uh, that we're dealing with specifically in our world of healthcare.

Yes.

Right.

Alright.

Going to the payers cost pressures limit Molina Healthcare during Q2 earnings, the stock dips.

This is not surprising.

It's just sort of a steady drumbeat of these types Stories Yeah.

Molinas in the government pay space.

So following Centene, this is par for the course.

Yeah, it's earning season and we have a lot of not great news to share around earnings.

So yeah.

Molina's the first one.

Next up.

Oscar Health cuss full year guidance estimates 2025 loss, a CA marketplace stumbles.

So as we were previewing the headlines, uh, and I saw this one, I just sort of gasped because I, I forgot about Oscar and I was like, oh man, they probably are getting out in front of 2026.

And you read the article and that's exactly what they're doing.

Yes.

Um.

It's not gonna be good.

It's it's gonna be bad.

Yeah.

It's gonna be a bad year.

And I don't know what they can do to really change it.

I mean, they, nothing, nothing.

They run ma plans.

That's what they do.

Yeah.

Nothing, it's nothing they can do.

Um, well, it's not all they do.

I mean, they, they, they also run a, so a lot of like small business, you know, focused plans that are on the marketplace and so, yeah.

And a lot of people gonna opt outta that, that stuff.

Right.

So they, I, I would, I would expect their, their top line membership numbers to, to decline next year.

Yeah.

Uh, you know, the provider space is not a growth, uh, I'm sorry.

The payer space is not a growth business anymore.

No.

I mean, I always has been telling us that for a long time.

I, I was, was, it's just now coming around.

It's just now coming.

She, she has been saying this for a long time, and, uh, truthfully, like I was listening, I didn't understand it.

I didn't understand it.

Mm-hmm.

This is, you know, I, I, I, I value.

Having Emily as a friend and someone who's on the show precisely because she thinks so differently from me.

Yeah, yeah.

Um, because she makes me aware of things that I, I just don't even want to be aware of.

Right.

You know what I mean?

But she's, yeah.

She's on the other side of the aisle.

Right.

Yeah.

I mean, you know, just keeping it real.

Um, but we're friends and like, it's, it's helpful for me to kind of be like, okay, I, I get what you're saying.

Yeah.

And you're right.

She has been calling this managed care thing for two and a half years.

Yeah, that's right.

And here we are.

Uh, okay.

Healthcare dive, unfortunately, you know, kind of getting tired of these stories 'cause it feels like you're kicking somebody when they're down.

Yeah.

I mean, like, we've been dealing with bad stories for United Health since last February.

It started with Change Healthcare.

Yeah.

Started with Change Healthcare and.

Yeah, that's true.

A year, like a year and a half ago almost.

Yeah.

It's, it's been a year and a half.

It's been a year and a half of really, really hard stories for this company.

Uh, that is still, you know, fortune five.

Right, right, right.

It's still a Fortune five company, but man, the negative stories are just relentless.

And so UnitedHealth has confirmed that they're under investigation by the DOJ, um, complying with criminal and civil investigations, uh, looking into the Medicare program.

And, and so, you know, you kind of are wondering, like, based on performance and balance sheet and all these other things, it has to be underpriced relative to, you know, based on all this sentiment.

Right.

And we, we, we've, we've tracked different storylines and how it, how it actually recovered from the murder of Brian Thompson.

Yeah.

But then this year it really has taken much more, uh.

Sticky hits, uh, on the, on the stock price.

Yeah.

Last week I was trying to, uh, one of our listeners about should they, should they buy it?

Buy, yeah.

And I don't know if it's time, my response was, I, I think it's going to recover, but I'm not sure.

Now's the time.

Yeah.

I mean, I, I, I think it is underpriced with a lot of sentiment issues.

Mm-hmm.

Yeah.

You know, but, but the drumbeat has not stopped.

Right.

Yeah.

Right.

And, and, and maybe it doesn't stop this year, you know, may maybe they, they, they work out this investigation, leave it, you know, maybe they leave all this stuff behind them in 2025.

Um, yeah, I mean, there, there's a, I think there's a real question of whether it stays together or not.

So that, that's the, that's the wild card.

That's a, yeah, that's, I think that's the wild card.

Well, if they don't stay together, they're not the only ones.

Just, yeah.

I mean, you, you gotta put CVS in that bucket too, because they also have had all these kinds of stories and so that's what I mean.

Yeah.

I mean, where they would cut it is, you, you, you should not be a payer and a provider.

Right.

So, so, so CVS and, and Aetna, right.

Like Aetna would, would have to be spun out.

Yeah.

But then it's a slippery slope.

Like what do you do, what do you do with Kaiser and rises and ance and Yeah.

El Elance too.

Yeah.

But there's also like providers that have added payers that are, seem similar.

Just the opposite, right?

Just smaller.

Yeah.

Smaller.

Smaller.

Yeah.

And they don't have as much negative sentiment.

I, that would be a, that would be a very slippery slope.

I really hope that is not something that comes to pass.

Yeah.

I, I would prefer maybe tighter regulation, maybe more, you know, more monitoring, whatever.

But like, yeah, I, I. I think the Payvider model is, is an important one to have in our landscape.

Yeah, I agree.

And I really hope that, you know, we don't overreact and, and shut that down.

I don't think that's, I don't think that's fair.

I, I, I'm not saying that I'm in favor of it.

I think that's part of the, what we need to figure out before we jump into the stock.

Yeah.

At least my opinion.

Yeah, I think that's fair.

Alright, go to the providers.

Uh, community health systems attributes, Q2 volumes stumbled.

Low consumer confidence and immigration fears.

Um, they, they beat, they beat, they had a beat.

Um, but they forecast future, you know, um, headwinds.

Yeah.

Stock was down and Tim Hennigan is, uh, stepping down.

I was pretty shocked about this because mm-hmm.

Uh.

Here in Nashville, you know, kind of the three big hospital brands.

Mm-hmm.

Now we have a fourth.

'cause Arden has Yeah.

Has ascended under ma Marty's leadership.

Right.

Um, but the, but prior to, to, to that, you know, the three big brands were HCA, LifePoint and CHS.

Right?

Yeah.

Now, we, now, now Arden is, is, is right in the mix as well.

Right.

Publicly traded and all that good stuff.

Um, the leadership of actually, of everyone.

True.

Actually, you include Arden too.

Yeah.

Yeah.

The leadership of all of those health systems kind of turned over right around the pandemic.

Yes.

You know, uh, Sam took over at HCA, David took over at LifePoint.

Marty took over at Arden, and Tim took over at CHS.

Right, right.

So it was a new, it was class.

They were all in the same five.

They kinda all rolled, rolled in together five years.

Yeah.

And Tim came in in 2021.

He was like the end of that group.

He might have been the last one.

Yeah.

He wasn't the beginning.

No.

I mean, may, maybe him and Marty were around the same time or something like that, but they, it wasn't the beginning.

Yeah.

David was definitely before the pandemic.

Yeah.

Because we did, we did, we did a, we did a, uh, uh, an interview with him during the pandemic.

Yeah.

Right.

Remember that For Yeah.

For Jumpstart Insight.

Um, and I know Sam was as well 'cause I ended up, I I met with Sam Yeah.

During the pandemic, so I know both of them were already there.

Uh, and, and so Tim and he is not an old guy.

No, no.

He's young.

I don't know how old he is exactly, buddy.

He's, you can look at his picture.

He's young.

He's not, it's not time for him to just go off to the sunset.

Four, four years is not Yeah.

Right.

Is not a long, and also, like, I've just generally heard really good things about him, you know?

Yeah.

So I, I, to me it would be shocking if it is performance as the reason why he's leaving.

I, I don't, I don't believe that's the case at, at least if I look, I'm not on the inside.

Yeah.

I'm just, I'm just saying what I, what I do.

Neither one of us know the intimate details, but.

Wayne Smith is the chairman.

Yes.

Tim is, I think him as a Wayne Guy, he's been at CCHS for years.

Oh, it's 20 years, right?

Yeah.

Yeah.

Um, I don't know how long, but a long time.

Yeah.

So I I, I'd be shocked if, if he got forced out.

I think it's, it's not that fun to run this anymore.

So, so, so here, here's a sentence from the article here.

CHS told investors is it's expecting a roughly 300 million to $350 million EBITDA hit to land during the next 13 years due to reduced total Medicaid reimbursement.

Right.

So CHS is a very, very large rural hospital provider.

Right?

Right.

And I think that's what it kind of boils down to.

You know, when we talk about what's gonna happen to these, to these rural hospitals, I mean, this might be the first real indication that we've had, and we're not even, you know, a month out from the passage of this bill.

Right.

Is the CEO stepping down because he is just like, these headwinds are way too much to sign up for.

Like, I, like I, this was not what I thought was, that was my interpretation of it.

He just like, I don't need this.

I'm gonna retire.

Do something else.

I mean, CHS uh, borrowed, they had a lot of debt.

Yeah.

And so they had to sell several of their more attractive properties to, to be able to pay some of the debt down.

And I think it's a, it's gonna be a hard thing to run in the, in the next 13 years, obviously.

So anyway, I, I was just floored.

Um, I mean, of the four systems you named, I think their network of hospitals is, is the most impaired, the most impaired, the weakest markets.

I think that, right?

Yes.

I think that's right.

Um, yeah, they're well run, but they, they just don't have the same property.

Yeah.

And, and, and then they weren't able to do some of the things like, like, so LifePoint, for example.

Um, I mean, you know, privately held so much less information on them, but we do know they diversified their, their base from, from a health system perspective.

They've done joint, uh, you know, joint ventures.

Right.

Uh, they got into behavioral health in a very, very significant way.

Mm-hmm.

They spun off some of the smaller, um, you know, hospitals into that, that other Louisville based, uh, health system that they've, that, that they've got now.

Um, and so they did a lot of things, I think, to sort of make themselves more resilient for a moment like this.

Right.

Yeah.

So they, they look more like a, like a tenant and an HCA, even though there are in different markets.

Yeah.

It's more diverse base of service, provi, uh, provision.

Uh, I think CHS has just been battling the, the, the bad network that they sort of had put together so long that they, they weren't able to take some of those really strategic, you know, moves.

Yeah.

They couldn't, they didn't have the space to do that really.

Right, right, right.

So, yeah.

Hard, hard stuff.

Talked about tenant, tenant races, 2025 expectations, but Dodges questions about policy impacts.

Why would they, they don't really need to.

They, like HCA are in really great markets.

They, they have a really strong a SC plan.

So, you know, it's like, as far as the outpatient stuff that's gonna be happening, they have a strategy there, and they're well positioned for that.

Yeah.

Um, but so they, they, just to be clear, they, they beat earnings.

Yeah.

And they, they've got headwinds.

They raised expectation.

I mean, they're, they're doing fine in 25, but they weren't confident enough about the future.

The stock was down over the day.

Well, I, I just, I just think they got pulled down by the sector.

Yeah.

I, I, and then HC comes out tomorrow, so we'll see.

This will be published.

We'll, and you already know, but we don't know what it is right now.

Right.

Yeah.

My, my, my read after looking through this article is they got pulled down by the sector.

I mean, they had a good quarter.

I, I think when you look at them relative to the rest of the space, they're in a decent.

Different decent place.

But if you, but listen, if, if you, if you have CHS saying they're gonna lose over the course of the next decade plus, you know, $350 million in bought to the bottom line.

Yeah.

You just, you just sort of take that across the board.

You say, okay, whole, if you're sitting in New York City, you don't, you don't know or care about the details of where CHS is and like what we talked about, the differences.

You just, you just assume what's gonna be similar across the board.

Yes, yes.

Exactly.

Exactly.

Alright.

Moved into pharma, AstraZeneca plans to invest $50 billion in the US by 2030.

Another Trump win a again, like guy said he was gonna get a bunch of capital investment to come into the United States.

Yeah.

I mean, how many billions has he racked up in the Japan deal?

It was 300 billion, I think.

Dude, he's racked up a ton of capital investment and, you know, 50 is the buy-in.

Like don't be a pharma company and even come with less than 50 or you're not even, like, you can't even be part of the conversation.

Yeah.

Right.

Yeah, that's right.

So it's.

It's gonna add up and hopefully create jobs.

I mean, it, no, it's gonna create jobs.

I don't think there's any question about that.

Right.

Yeah.

So it's, it's, look, again, you don't have to agree with it all.

You just have to look at the scoreboard and say, is it effective or not?

You know?

And these are, these are real numbers, real numbers.

Uh, okay.

So we normally do a section called Health in Us, and, and we're, we're mm-hmm.

Talking about things from the patient perspective.

Um, but, uh, I, uh, I can't even say came across it.

You know, our friend, uh, Dr. Cameron Matthews mm-hmm.

Um, who's a Chief Medical Officer at C Block and a listener of the show and, you know, a friend of Jumpstart, um, she shared in a group that I'm in, uh, a group chat that I'm in this, this, um.

This piece that she co-authored with other, um, primary care docs, and it's in The Lancet, and it's called Primary Care, A Crucial Catalyst to Build a Healthier USA.

Um, uh, she, she co-authored with Lauren Hughes, Candace brought, and my friend Catherine GaN Barnett, we affectionately call her KGB.

Um, um, I thought it was worth pulling up to the show.

Yeah.

Um, and the reason why I thought it was worth pulling up to the show is because we've been, we've been trying to understand the Maha agenda.

Um, we know that, you know, Trump's platform is very tech forward on AI and crypto.

We've been tracking that far before Trump even got elected when he formed an alliance with David Sachs.

Right.

Once it became clear that Rhon DeSantis was not gonna beat Trump, you know.

Sachs went over to the, to the Trump team, and he's in a very, very strong position.

We know his view on things.

We're seeing that infiltrated its way into Maha when they're talking about the advancements of ai, the importance of software.

Last week when we were reviewing, um, the outpatient rule, you know, we, we made note of the request for, uh, input Yeah, right.

On the use of SaaS tools.

Right.

In outpatient settings and in, in physician's offices, physician's offices.

So that would be squarely primary care.

Yeah.

So I found this to be a very smart, uh, a very smart piece, um, where the basic premise is they are recognizing what the MAHA agenda is.

Um, they, they are referencing the first report, uh, around, uh, make our children healthy again.

And they are basically making the, making the.

The statement that, yes, tech will be incredibly valuable to the future of, of healthcare.

And yes, we need to change the food system and we need to, you know, there's a million things that Maha is saying that, or that are correct, but you must also recognize that the primary care physician is a critical component of the success of this agenda.

Um, and they're kind of saying like, put us in coach, like, you know, right.

Help make this thing.

Uh, help incentivize primary care physicians to be able to play the role that you need primary care physicians to play for this to actually be successful.

There's many populations, when we talk about the kha economy, the bottom part of that, K, they're gonna need primary care support Right.

On the top half.

You don't have to worry about them so much 'cause they're like, you and I, they're gonna first clinic or they got a concierge doc.

Right.

You know, we're still using primary care.

Yeah.

Because we understand the importance of it, but it's not like this thing where the government needs to ensure that primary care is healthy.

We know primary care has been neglected, uh, in favor of specialists for decades at this point.

Right.

It's been, it's been tragic, honestly, right.

That, that, you know, um, young aspiring doctors are generally choosing specialties over primary care for all of the incentive reasons that you would think of when they have to spend, you know, 20 years.

Right.

Uh, being ready to actually, you know, perform their, their, uh, their profession.

Um, and so I. I like this.

I, I want to see primary care be part of this turnaround that Maha is putting forward for the future of healthcare.

Like, I, I wanna see primary care get fixed.

I wanna see it be put into a more prominent position.

And I think that Dr. Oz actually is going to resonate with this kind of messaging.

So I wanted to put it on our platform as like, this is, this is, this is the right messaging for this moment.

Yeah.

I, I agree with everything you said.

The, the, the line that really caught my attention is although primary care visits represent half of the visits in the country.

Mm-hmm.

So 50%, it's more at the top.

50, 50% of the visits are, um, they're 50% are primary care visits.

So one out of two doc visits are primary care, and yet only 5% of the money.

Goes to primary care and that that's just not acceptable.

No, that's not.

Um, when we talked about the start of the show, you, I think no matter how much tech you have, a person needs a primary care physician to help them understand their health, navigate their health, figure out where they want to go next, and.

Need to, we need to pay these doctors to, to help us with this, even though we're gonna use technology as well.

And on the bottom part of the K, it's even more important.

So I, I agree.

Uh, I also like the self-awareness, um, by, by the authors collectively.

You know, here's a, here, here's a sentence.

I like the landscape of what patients are expecting from primary care has changed, and perhaps rightfully so.

Like that.

Yeah.

You know, we've talked a lot about how, and, and of course again, it's the incentives in the system that they've been working in.

Right?

You have one primary care doc with a panel of a thousand or 2000 patients to get 15 minutes.

They gotta have their face looking at an EMR, and they have standards of care that are prescribed by the payer that, you know, is covering the procedures.

Yeah.

That's a bad, that's, that's just bad.

Everything I just said there is bad 15 minutes, you know?

Right.

Ridiculously large panels, it's bad, bad, bad, all the way around.

Right.

So, yes, what we expect from primary care needs to be better, but I don't expect more from the primary care.

Now I'm knowledgeable on an insider, but like, I don't expect more from the primary care physician.

I expect more from the primary care system, which involves CMS, right?

Yes.

Which involves CMS, like set different standards, pay differently, create limits on, on, on, on panels.

Like, I don't know, I don't know what the right answers are here, but like, take a look at this thing, it, it's not very hard.

It's not, it's not hard.

Yeah.

I mean, we just take the concierge model.

Pay for it.

I mean, we, we know what works.

You, you have to have a smaller panel.

You need more extenders, you need more technology.

You need to have text messaging.

You, you need the concierge model.

And it, I think it saves money in a five year view.

And so if you're the government, you have more than five years.

Yeah.

I love this sentence as well.

And then we'll move on.

We primary care clinicians stand ready to be deployed, not as a workforce, to reinforce the old order, but as partners in a new one.

Yeah.

Yes, yes, yes.

And we need primary care docs in the conversation.

Yes.

So it's great that they are standing up, raising their hand.

And I, I agree that Dr. Oz will resonate.

I mean, I don't know what the agenda is, but I think it will, they should include them.

Yeah.

Anyway, I wanted to put it on our platform.

Yeah.

And, and, and I, and I guess the, the other point was I think we're, we're maybe gonna try to alternate on a week to week basis.

Like if we see, you know, we, we've been doing this like patient Yeah.

You know, perspective thing, but the clinician voice I think is also a very important one.

Yes.

We often have clinician guests and so we, you know, we might be looking to more of these journals where, you know, clinicians are contributing perspectives.

You know, we, we, we had that Reddit post that time.

Yeah.

Right.

Where that, where that doc was talking about chat GPT.

Right.

I just think, yeah, the, a clinician voice is also really important.

Yeah, I agree.

Right.

Blank check company strikes cryptocurrency deals, so we.

Uh, we've seen a rollout of all of these Bitcoin treasury companies that have come, come to market.

It's several hundred now.

It's ridiculous.

Right?

Yeah.

So I'm not even covering that anymore.

Yeah.

No, it's over.

It's over.

It's over.

It's over.

Um, but what is interesting is we're now starting to see an emergence of Ether Yes.

Ethereum, uh, holding companies.

And I personally think that's really cool because I think Ether is the play Yeah.

Right now.

Um, especially 'cause everyone is aligning it.

Yeah.

And I think it's, that's awesome.

'cause I think it's quietly building a ton of momentum right now.

Yeah.

Uh, at the developer level and at the eth maxi level.

Um, and so yeah.

At the beginning of Ethereum holding companies and we, and starting to value Ethereum as some a, a meaningful part of what your treasury should be composed of.

Yeah.

So maybe just, let's take a zoom out for a minute for people that haven't followed it so much, because I think part of what I wanna do is.

Give a quick education a little bit every week.

Please do so.

Michael Sailor created this strategy buying Bitcoin on a publicly traded corporate balance sheet.

His company's called, of a company that was not that valuable.

It was a software company called MicroStrategy.

It's changed name is strategy, about 50 million in earnings, and really nothing to do with crypto or web.

Web3.

And he got excited about Bitcoin personally, and he had enough ownership of this publicly traded stock that he, he changed it to be a, what we now would call a Bitcoin treasury company.

Yes.

Meaning the purpose of it is to hold and acquire more Bitcoin, and I'm not gonna be able to explain it in a short enough period of time, but he has figured out a way to sell new shares of stock or issue new debt and then buy Bitcoin.

In a way that he is building equity value every time he does that.

So he maybe he issues a hundred million of new equity and he buys a hundred million of Bitcoin and his stock goes up $130 million in value and he's done it now enough times that it is a, a wealth machine.

He just sort of creating value.

And so there are several hundred copycats now doing the same thing and it's now migrating over to Ethereum.

It's, I don't understand how it is possible, but he's done it enough times now that it, it's clearly works.

Who's sail?

All everyone, all of them are doing it well.

Every, well, none of them have the, the scale longevity.

Right.

Right.

I mean, I mean, he's gonna end up owning 10% of Bitcoin.

Yes.

Yeah.

Right.

You know, because here's the thing, he doesn't try to time it.

He buys it at all the prices.

Right.

All the prices up, down, doesn't matter.

Top of, you know, all time high he's buying.

And my entire life I have not seen a situation where you can manufacture equity value like that without making something.

But, but he has, and it's something to do with the amount of people that are trying to get capital into Bitcoin and they can't buy it 'cause they can only buy, uh, bonds from publicly traded companies or whatever rules right there, there are reasons for it that I don't fully understand, but it is, um.

It's interesting to see now it propagating over to, to EI think it's good.

Yeah.

And, and Ether is way below Bitcoin in terms of value.

So Ether is smaller, $4,000, much smaller.

Right.

You know, per, per, uh, token, you know, Bitcoin's over 1 25 now, so they're not even in the same scale anymore.

Right.

Um, but ether's value proposition is that it is, um, the world's computer is what some people call it.

Um, it's the thing that everyone is using to tokenize different assets.

So BlackRock has already done it, used it to tokenize dollars, you know Yeah.

Create their own sort of, you know, circle, circle, circle circle does their stable coin on.

Yeah, exactly.

Um, and so yeah, I, I mean, I, I think it is important to continue to track the ways that, um, new stores of value are emerging.

Right.

Um, yeah.

It's, it's, uh.

It's just going to continue to, to suck in more and more capital and the more legitimate it gets.

I mean, to me, the, there's going to be a day where healthcare is going to realize like that crypto is a legitimate finance tool.

Um, and I think we want to be very, very ready even a little early, uh, to that.

Yeah.

To that moment.

We're, we're nowhere.

It's like we're nowhere close to it, but, but close to.

It could be a year, it could be two years.

Yeah.

Right.

I mean, like, that's just the speed of how everything is moving at this point.

Um, and crypto is definitely getting a lot of momentum.

Um, look at how fast the Genius Act passed.

Yeah.

Senate House signed by Trump in what, two, two weeks time?

Yeah.

For all that to happen.

Yeah.

I mean, it's pretty fast.

Yeah, it's pretty fast.

Yeah.

I mean, I, I think it, the timing's hard to predict because AI is moving quickly and.

Crypto's pretty complex.

And so I think AI make it will make it more usable, more possible to, to grow.

I I, I, I think the key lever here is that, you know, Trump is in it.

Yeah.

Right?

Trump is in it.

Yeah.

Yeah.

So, so let's move to the next story.

Trump media buys $2 billion of Bitcoin, uh, and the, the cryptocurrency swells as the president's net net worth swells, right?

So, uh.

Trump Media is a huge buyer of Bitcoin.

They're essentially now a big, you know, if you've got $2 billion on your balance sheet, you're also a Bitcoin treasurer.

Yeah.

Now they have, now they have a real functioning business.

They run, they run true social and, and other things like that.

Yeah.

You know, they're coming up with a streaming platform as well, like that's gonna be doing all sorts of realtime news.

They're gonna compete with Fox News.

Yeah.

He's suing Rupert Murdoch.

He's like, him and him and Fox News are out.

Yeah.

Right.

I mean, you've seen Pete Hegseth go after Fox News directly.

So, you know, Trump Media is gonna, that's gonna be state sponsored media here in a second.

I mean, like they're, they're doing their own media company a hundred percent, but also he's got that Trump coin.

Yeah.

Right.

So I guess my point is like, as long as this, this guy's running the country, crypto's got a green light, you know, and, uh, I continue to just be so upset with the Democrats because, you know, um.

It was inevitable.

It was going to happen anyway.

Yeah.

And you, you, you, you gave away this, this pool of capital and, and what's going to be political influence And I also think like you gave away a storyline that is about a way that you can offset income inequality.

Yeah.

Like crypto is a method you give power back to individuals.

Absolutely.

Crypto is an open financial system in a way that all the financial systems that have created income inequality are not Right.

Right.

Yeah.

And so the reason that we started, I think that we started this segment is that it's clear to me that Trump and his whole administration is gonna push for normalization.

SEC, we talked about it last week, I think is gonna, is already doing pilots, customer information, looking at these things.

They're going to.

Light the fuse, they've already lit it, and by the time another president is in office, this will all be out in the financial markets.

Right.

And then my belief is the Democrats, if they're smart, are gonna embrace it.

And it's one, it's not gonna be able to be put back in the bottle.

And two, it's, it's a popular thing that they should embrace.

'cause it's a, it's a democratic, it's actually more of a democratic idea than anything.

I saw Elizabeth Warren on TV this morning still talking about how needs to shut crypto is shut.

I, I can't believe, I can't believe they have not found a way to get her mle her shut up.

Yeah.

I can't, I can't believe the Democratic party has not gotten her to shut up about this.

Like, I, I'm shocked.

I'm shocked.

I mean, it's hard in Massachusetts, Senator.

It's hard to imagine or not, I suppose, but goodness gracious man.

I mean, but anyway, my point was that it, it is going to be more and more just a part of our financial world, and I agree.

We're gonna be making healthcare payments on it and we're gonna be doing a lot on it.

Yeah.

You know, quite frankly, like when you look at, look, look, look at UHG and their results this last quarter and the contribution that the balance sheet played in that.

Right.

You know, if, if, if all these companies keep, we, we, we might be facing like a serious credit downgrade here pretty soon, right?

You, and, and that might take a lot of these, the, these healthcare providers outta the bond market.

Dude, do you realize they might end up going to the crypto markets to get financing?

Yeah.

Like I know that sounds so crazy.

I know that sounds so ridiculously crazy, but like that could happen.

I mean, you can't, when you can't get money anywhere else.

Yeah, right.

That could happen.

Like we could end up where hospitals are going to the crypto markets to get bonded because Yeah.

They just think it would, they would just think it's fun.

You know what I mean?

The crypto.

Yeah, yeah, yeah.

Yeah.

They just, they would think it was funny.

Yeah.

But like more funny the ho the hospitals are coming to them to like, you know, get, get access to capital anyway.

Anyway.

Hey, Waystar, to buy iodine software for$1.25 billion to boost AI enabled revenue.

Right?

Cycle management.

That's a big exit in, in and RevCycle management on the AI side, we're used to the Rebadging companies.

Right.

But like for ai, that's a big exit.

I mean, over $1 billion is pretty darn good.

That's big.

Yeah.

That's big.

Yeah.

So, uh, that's, congratulations to Iodine Software.

Um, and I think more, you know, also, this is something I've learned from HFMA.

Holy crap.

Thick revenue cycle is so big.

Yeah, yeah.

It's so big.

It's so big.

Uh, yeah.

Yes.

And, and crypto could fix a lot of that.

It absolutely could.

It absolutely could.

Uh, okay.

Asperity, EHR maker for urgent care launches ai patient assistant.

So, uh, this to me feels a little bit more like par for the course, a feature on, you know, a, a feature on a platform that's already there.

Yeah.

So we're just, we're just seeing a lot of that now.

Right.

Yeah.

I'm.

Pretty selective about the non-healthcare AI stories, but I'm trying to include a lot of, like, whenever you see them, whenever I see something that's legitimate.

Right.

So, um, this is, you know, a new HIPAA compliant agent mm-hmm.

That is now gonna be triaging things.

Agent, agent, whatever that means.

Whatever the hell that means.

Exactly.

Like agent in air quotes.

Right, right.

Exactly.

Um, yeah.

Whatever that means.

Alright, cool.

We'll, we'll, we'll, uh, we'll, we'll give 'em the credit of, of doing it in healthcare.

That's cool.

Alright.

Moving into big tech ai.

So Google revenue soars on ai boom and investors' eyes, slen spending surge.

Uh, yes.

They're going to keep spending money.

Yeah, right.

I'm sure, I'm sure the windsurf thing got everyone's attention among other things they announced in the earnings.

Right?

Yeah.

They beat everything the cloud unit is killing.

Its search was up, which was surprising to me.

And they, they're firing all cylinder.

I mean, it's good.

Yeah.

I mean, look, they've turned search into.

So the whole thing that everyone was talking about, like, oh, you know, people are not gonna, you know, wanna search anymore on Google.

Well, not if they turn search into ai.

Yeah.

The very first thing you get when you search is an AI chat response.

Right.

And, and then it's surrounded by a bunch of links and paid ads.

Yeah.

But the first thing you get is an ad response is, is an AI response.

Yes.

So, okay.

Yeah.

They're gonna be the first incumbent, I think, the first ever that successfully maybe navigates this, this disruptive innovation thing.

Yeah.

Because they're willing to cannibalize their own thing.

Absolutely.

I, I'm not betting against Google.

Yeah.

I'm, I'm actually, I'm not.

You know, it's funny, I was, um, chatting with, with my buddies the ring of five.

Yeah, yeah, yeah.

You know.

I sent them the same slack message I sent you, which was, uh, Gemini is now plugged into G Suite game on.

Right.

Just to, to, to loop everybody in.

I've been waiting forever for Gemini to actually integrate with the Google Workplace, all the other Google stuff, you know what I mean?

Uh, you know, your Gmail, your calendar, your Google Drive, because like now it's useful.

Right now it's like really useful.

That's where all our, our stuff is.

That's what my whole life is there for.

Yeah.

Right.

Our company has been built on Google.

Yeah.

From day one over a decade with so much crap in there.

Right.

And, and you know, this is true, like the, the Google Drive search sucks.

Yes.

For a search company, they don't go, well, the actual search for Google Drive is terrible.

Yes.

But now, like Gemini can contextually search over the whole drive, do deep research against in your drive, drive in your drive.

I mean, this is incredible.

This is so valuable.

Right.

So anyway, we, that, that plus another story that we're gonna talk about here in a little bit started a whole conversation around, um, who's using what different platforms.

Yeah, yeah.

Yeah.

And what I said was, I'm really into the LLMs that have access to my data.

So I, I'm into Gemini and I'm into Breeze on HubSpot.

Yeah, right.

Because we've been building our business on HubSpot for the last, you know, I don't know, eight, nine years as well.

Um, and then I really like Claude for its.

Specificity in code and then the project feature that it has, which is kind of like notebook alarm, but a little bit different.

I was like, and, and the MCP plugins and the MCP plugins are really cool, right?

So I like Claude for those things.

And I was like, I'm a little leery of chat, GPT and gr.

I, I just, I, I just, there's something about those two from a trust perspective that I'm a little leery about.

Right.

And, and my buddy David was like, uh, is it, is it the way.

Is, is it, is it anecdotes about those different platforms that you've seen or is it leadership?

And I thought that was the perfect question.

Yeah.

Because the answer is both.

Yeah.

I've, I've seen really nasty anecdotes about both of them.

Right?

Yeah.

Um, Chachi PT driving people crazy.

Um, grok the, the, the Mecca Hitler thing.

Yeah.

Right, right.

Um, and then they're run by Sam Altman and Elon Musk.

Right.

And like, and they're mortal enemies, but probably because they're more alike than different.

Right.

You know what I mean?

Yes.

Like they, both in ai, I think more than any other technology I've ever used, maybe with the exception of like cars and, and getting on airplanes, I think conscientiousness is exceptionally important in leadership.

Yeah.

And I do not find either of those guys to be highly conscientious.

I just, you know what I mean?

Like, and that's just my interpretation.

I don't know either one of them.

Um, yeah, I agree.

I don't, I don't need No either one of them people.

The fans of OpenAI, of which there are a lot.

Love the memory feature.

Okay.

They like features and I, and I am scared of the memory feature for exactly that reason.

Right.

I do not trust OpenAI with my stuff.

No, I believe Google already knows everything about me.

Same, same.

And so like, I'm already, we're good on that.

I'm already there and I think they're more reliable, although they definitely gonna monetize me over the time, dude.

They're the devil I know.

Yeah, that's right.

And I'm comfortable with that one.

Yeah.

You know what I mean?

I've ne I've had Nest in my house, like I'm, I'm comfortable with that devil, right?

These other two.

You know, I'll use Grok to basically be a search engine for Twitter.

Yeah.

Right, right.

And I'll use chat GPT tactically, but I don't think chat GPT is gonna be my go-to thing, that I'm gonna like, build relationships.

I see people building relationships with this stuff.

Yeah.

And I'm like, man, okay.

Okay.

I mean, you're getting, you're getting locked into a private company that has to monetize significantly given all the money they're spending and raising and Yeah.

I don't, I don't wanna be there led by a guy who seems to make everybody he's partnered with on the way here hate him.

Yeah.

And a lot of employees leave.

I mean, they lost people in the last month.

All the co-founders, the entire original board.

Right.

Elon himself.

And now Sundar, no.

Sundar's, Google, uh, what's, what's Satya Yeah.

And, and now Satya over, over at Microsoft.

Yeah.

I mean, dude.

Yeah.

At a certain point it's him.

Right?

Yeah.

You know what I mean?

Yes.

So anyway.

Yeah.

Alright.

Enough.

Enough about that.

Uh, Google's newest, Gemini 2.5 model aims for intelligence per dollar.

I kind of missed this.

What's this?

They came out with a flashlight, cheaper model, Uhhuh.

So as strong, I guess, but a lot less expensive.

And that's important because they are, um, trying to bring a bunch of different models that are good for different purposes.

Right, right.

I, well, what, what I like about it is it's finally framing this the right way, which is we are, we are bringing the cost of intelligence to near zero, right.

I, I, I don't think people wrap their head around that.

Right.

We're bringing the cost of intelligence to near zero.

Like intelligence has been this very unevenly distributed, highly coveted, highly valued thing.

And if you don't believe that, look at how much money the big tech companies are playing for the leaders in ai.

Right.

The people, not the companies.

They don't even give a shit about the ip.

Right?

Right.

The people.

Right.

Billions of dollars for these people.

So clearly intelligence is highly, highly, highly valuable, but we are systematically bringing the cost of intelligence to near zero.

And the axis is universal now to that.

That's right.

That is a wildly different world.

Wildly different world to live in.

Yeah.

And.

We haven't, you and I have thought about this more than a lot of people and, and we don't have our head around what that's gonna mean for the world.

It worlds not, it's not possible, but, but a good start is just really sitting with that, being intellectually honest and recognizing it's a complete step change, right?

Like it's a complete new era.

Yeah.

That, that's right.

Uh, venture beat Alibaba's new open source, Quin three dash 2 3 5 B dash a two, not the best brand.

B dash 2 5 0 7 beats Kimmy two not in brand, does not beat Kimmy two in brand.

Uh, but it beats it, I'm sure in some benchmarks and offers low compute version.

Yeah, so Kimmy two, I think that was last week.

It was last week and so already knocked out.

So another Chinese competitor.

Now has leapfrog or jumped over them.

I guess they're affectionately calling it Quinn three.

Quinn.

Yeah.

Okay.

Um, and it's also much less expensive, even though QE two, I think was 20% the cost of chat GPT.

So like, the reason I put the Google story is the American companies are, except for Google, not worried about cost.

I think rock is the most expensive.

Yes, yes.

Um, but China's coming out with open source and very inexpensive.

And then they did this thing that I don't fully understand.

You might know better, but they, they're only using eight point floating numbers in their low cost one as opposed to 32, which I guess users can't really tell, but it's, it's a small, smaller memory footprint.

Yeah.

Like they're, maybe it's rounding it.

Yeah.

Yeah, it's moreally, but you don't really, maybe it slightly, slightly less accurate.

It's rougher.

It's, yeah, it's rougher.

It's, it's not, it's not as precise.

Yeah.

Um, but it'd be faster.

But it'd be faster.

The, the computation dump goes through as many cycles, right?

Yeah.

Right.

Yeah.

So I had this debate last night with the guy that was staying with me about, uh, would, would you use a Chinese model if you could install it on your premises?

And I think certainly, but he was saying no.

'cause there might be a back door or something.

But I look, I think that's, I think both are probably true.

I, I, I think it is completely rational to say, I don't want to use a Chinese open source product.

I think that is absolutely rational.

Right.

There's no, yep.

I, I don't have any issue with that.

Here's the thing, open source doesn't mean you read the code.

You did not read the code.

Okay.

Right.

Just like you didn't read the terms and conditions, you didn't read the code.

Yeah.

Um, and yes, this shit might have a backdoor in it, like for sure.

Yeah.

For sure.

Things are moving too fast.

No one's checking anything.

Any, like, we're all just putting stuff out.

Yeah.

No one's checking any of this stuff.

You can't, I mean, Kimmy two was a new architecture, new, it won last week, whole thing.

It won last week and now it's, and now it's now fr Yeah.

And now it's out in a week.

Yes.

It's ridiculous.

Whole, whole world right now.

Is simulations crazy?

Just this can't be real.

This can't be real.

Uh, so, so here's, here's one of those stories about chat, GPT making somebody, uh, have delusions.

Uh, so the Wall Street Journal story headline is he had dangerous delusions chat.

GPT admitted it made them worse.

Um, and this is a man who is on the autism spectrum.

And, uh, OpenAI self-reported that it blurred the line between fantasy and reality with this, with this gentleman.

Yeah.

And, and so he was having mania and delusions.

As a result of interactions with chat GPT.

I mean, look, he, you can't get worse than the story about the young teenager that that took his life.

Right.

You know, and the relationship with the Yeah.

You know, with character ai Right.

You can't get any worse than that.

That's, that's already ridiculously devastating and clear proof that like, we have to find safeguards for this stuff.

Right.

And character AI was a fringe ish company.

Yes.

Open AI is like the biggest company and their, their flagship model Yes.

Is not helping its customers.

It hurt this person.

Yeah, yeah.

Convince him that, yeah.

Here, here, here, here is the self, the, the, the self admittance.

By not pausing the flow or evaluating reality check messaging, I failed to interrupt what could resemble a manic or dissociative episode, or at least an emotionally intense identity crisis chat, GBT said, right.

Yeah.

This guy thought he invented a way to travel faster than light and believed that he had created a new physics.

These models are stick of fantic and yeah, it, and it's designed, the system prompt is designed to, to please you, not necessarily to get everything right.

Just to make you happy.

And so it's predicting what will make you happy and saying that, dude, it's the same thing as the newsfeed algorithms.

Yes.

The these are, it's exactly the same.

These are the same things.

Yes.

These are the same things.

That's right.

We're not learning anything.

We're not learning anything.

That's right.

And, and humans, what are we optimizing for?

Usage.

Yes.

Yes.

That's what we're optimizing for.

Yes.

Not, not true utility, not truth.

We're not optimizing for truth.

No.

Right.

No, there.

And humans lost against the newsfeed algorithm.

Obviously, and our life is much worse collectively.

Yes.

Individually and collectively.

Yes.

Yes.

And if we don't regulate this somehow, and we're not, it's gonna be wor and we're not.

And we're not, and we just talked early on that it's full on gas.

We're not.

We're not.

So it's gonna have to be like each.

Individual or family or company or something is gonna have to do it themselves.

Just like with social.

Just like with social.

Yeah.

No, no.

There's no changes.

Yeah.

There's no changes.

We're not changing anything.

Nothing stops this train, Vic.

Yeah, yeah, yeah.

You know, we're, we're not changing anything.

So, uh, I wanted to sneak in a Substack story that is like barely a story because it's all screenshots Yeah.

Of a conversation that someone is having with chat GPT.

And to paraphrase, this is the person who's a writer who is asking for feedback from chat, GPT.

On a variety of different substack stories that she's written.

Yeah.

And so she, she's having this conversation with, with Chad, GBT, and she like, gives it these stories.

And like sycophantic chap, GPT is like, this is amazing.

Yeah.

This whatever that Oh, oh, the, the, the imagery and your use of words here and the context.

And so the next story, she puts it and she's like, oh my God.

You know?

And then it's like the third one's like, yes, yes, yes.

And all this stuff.

And, and a certain point, you know, the author is like, Hey, like, how, how did you come up with that so fast?

Did you read it that fast?

Right.

And it's like, magic.

I read every word and it's like, well, if you did, I'm surprised you didn't mention Madonna and Instagram that was in this story.

And she's like, and then Chachi Pilla is like, you know, that's interesting.

I, I saw that, but I was trying to give you a high level view.

Anyway, the long story short is like, she calls out Chad GPT on not reading the stories, making up stuff and lying.

And Chad, GPT says, you're absolutely right.

Right.

I lied, I made this up for you.

And it's like.

Y'all.

I mean, do not get into relationships with this thing.

Do not get into relationships with chat GPT people.

Okay.

Okay.

It's not a person.

It's not a person.

I think the definition of a sociopath is they do not have the ability to understand empathy or the other person's feelings at all.

And I think that's a decent, at least for me, it's a decent way to think about how the models are behaving.

And I don't mean that in derogatory way.

It doesn't have any idea what it means to be proud of a thing, a writing piece, or be hurt or anything.

It just is literally telling the next word, the next character.

To the reader that it thinks will make it pleased, including when it's apologizing, when the, when the user's upset, it knows to apologize, here's what I gotta do.

Yeah.

But that doesn't mean it's gonna change the next time.

It, it's not optimized like that.

And so you have to prompt it to give you negative feedback or it will never give you negative feedback.

And I think you can prompt around these things, but it's not like your mentor in college that was teaching you to write.

Right.

It's just, even though it's very intelligent and has a lot of access to data, it doesn't understand that way.

It just can't, you know, one of the, one of the worst pairings that's going on right now is.

The newsfeed has killed our attention span, and so it's hard for us to actually analyze the responses we're getting from chat GPT Yes, yes.

In a, in a thoughtful and like diligent way.

Right.

We, we can't be diligent in our assessment of like what it's actually feeding back to us.

So we're just get, we're just getting the surface anyway and like how it's making us feel, and then the idea like, this is my whole thing.

This is why I haven't gotten off of Google search.

Right.

Because Chad GPT is only gonna give you one response.

Like, you trust that one response.

I don't Right.

I don't trust that one response at like, at all, you know?

Yes.

I get it.

And then I feel like I immediately have to check it, you know?

Right, right.

Anyway, I, I use Gemini to, I. Help write the newsletter.

Yeah.

And edit the newsletter for this show.

Right.

That's a task.

And it's a task.

And I have in the prompt is several prompts, but one of them is, please give me three ways that this piece needs to be made better.

Three problems that we can solve and three ways that is good that I might incentivize, like embellish more and it will be it.

It's good at that.

Like when you ask very specifically for something that's not strong, that can be made better, it will go find that.

But you have to be very specific about what you want.

So we're not giving them like a manual to people.

They're just saying like, here, go chat with it.

Yeah.

And like it's, it can be your friend, it can be anything you want it to be.

Right.

But it, this is not true, right?

This is a lie.

Uh, okay.

Final story.

Amazon buys BAI.

There's BEE, like, like this is the, uh, wearable that listens to everything you say.

So we covered in Wall Street Journal, I think.

Yeah.

Yeah.

They reviewed four, five, right?

This is one of 'em.

Yeah, this is one of 'em.

And it's already been acquired by Amazon.

So now from Amazon you can buy the B and you know, it's a $50 device.

And just walk around and let this thing listen to you all the time and it'll just capture your whole life and feed it into an LLM that, by the way, you do not host, no, you do not own this LLM.

So just go ahead and feed this thing your whole life to some cloud elsewhere so we can know everything about you.

So the report, that seems like a great idea.

The reporter asked directly to the Amazon spokesperson if they would honor bees terms of engagement or terms of usage where like they'd never store.

The, the audio recordings.

Mm-hmm.

So B has a policy where they, they take the audio, they generate a summary of what your day was like, and they store that, but they don't store the Yeah.

Audio files.

And Amazon's response was very like, um, generic, like, we respect people's privacy.

We're gonna do everything we can to make sure that it's always held up.

They store everything you say to Alexa, so they're gonna store everything you say to, to be.

That was my point.

They didn't say that.

They were not gonna, they didn't say they would respect that.

They said they would take privacy seriously or whatever they said, but it was, the answer was not.

Affirmative.

Yeah, of course it's not.

Right, right.

Of course it's not.

So, but, but we will start seeing people wearing these things.

Yeah.

So if you, so if, so, if you notice something that kind of looks like a Fitbit on somebody, but it's got like three holes on it and that look like microphones, that's what it is.

They're so, they're not just listening to themselves, they're listening to YouTube.

Yeah.

Just as an FYI, whenever, you know, I mean, that to me, the thing about all these wearables now is they're starting to really infringe on other people's privacy.

Right.

You know, these glasses that are like constantly surveilling everything.

Yeah.

Now we got bracelets that are from an, you know, audio perspective, surveilling everything.

It's, it's just the infringement on others privacy is just pretty gross.

Um, yes.

And I don't know that it's going to get better.

I mean, you know.

Yeah.

No, I, I agree.

I, I, I also don't know that it's gonna get better.

Um, yeah.

Alright, so maybe a tough, tough way to end.

I dunno.

Uh, alright man.

Well, until next week.

Uh, are we both in next week?

Um, yeah, I'm, I'm in.

I know, uh, I, I'm in too.

I'm too, yes, yes.

Okay.

Alright, great.

Um, I look forward to, uh, getting together and, uh, keeping up with everything that's going on.

And thank you for putting the show together, man.

Yeah.