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Vic and Marcus break down the latest in AI and markets—from agentic tools reshaping work and Nvidia’s data-center dominance to the real threat of job loss across creative industries. They hit gold’s surge past $4,000, global market shifts, and China’s trade pivots, then move into healthcare: UnitedHealthcare vs. Johns Hopkins, new startup funding, Trump-era policy moves, and the rising wave of home diagnostics. The episode closes with the AI arms race, Microsoft, OpenAI, AMD, and Elon’s data-...
Vic and Marcus break down the latest in AI and markets—from agentic tools reshaping work and Nvidia’s data-center dominance to the real threat of job loss across creative industries. They hit gold’s surge past $4,000, global market shifts, and China’s trade pivots, then move into healthcare: UnitedHealthcare vs. Johns Hopkins, new startup funding, Trump-era policy moves, and the rising wave of home diagnostics. The episode closes with the AI arms race, Microsoft, OpenAI, AMD, and Elon’s data-center push, asking if compute is the new oil.
Links
14:30 - Gold Prices Top $4,000 for First Time WSJ
22:07 - America’s Soybean Farmers Are Panicking Over the Loss of Chinese Buyers WSJ
25:13 - A Tech Rebound Lifts U.S. Stocks, and the March to Record Highs Resumes WSJ
27:12 - DUOS snags $130M equity investment to scale AI benefits platform for seniors Fierce Healthcare
28:02 - Truepill co-founder's latest startup, Foundation Health, banks $20M to bring AI to pharmacy operations Fierce Healthcare
30:13 - Oath Surgical raises $24m to advance outpatient surgical care network Medical Device Network
31:09 - Attuned Intelligence Emerges from Stealth with $13M to Automate Hospital Call Centers with Supervised AI HIT
31:37 - Heidi Health raises $65M to expand global reach of its AI medical scribe platform Mobi health
32:44 - Remedy Robotics Debuts Pioneering Endovascular Surgical Robotic System and Completes World's First Fully Remote Neurointerventional Procedures Newswire
33:56 - Q3 2025 market overview: Signals out of sync Rock Health
38:17 - Qualtrics to buy Press Ganey Forsta for $6.75B to expand its reach in healthcare Fierce Healthcare
41:44 - Trump Wants to Overhaul Drug Sales. A Company Tied to His Son Stands to Benefit. WSJ
44:35 -
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.
If you enjoy this content, please take a moment to rate and review it.
Your feedback will greatly impact our ability to reach more people.
Thank you.
How's it going man?
It's good.
I'm, uh, doing well.
Things are good here in Nashville.
Good, good.
Uh, same here.
Uh, things are, things are good in, uh, Mexico City this week.
Um, I am.
Still working out the recording setup.
So like, if you're watching this, we've got some shine on the forehead, just the, these lights in this room.
I don't, I don't quite have that all figured out, but I think generally speaking, we've got the, the audio situation, uh, pretty good.
Um, you know, this week, Vic, for me, I, I've been, uh, just, just trying to, I don't know, detach from the intensity of all the, the political stuff and, um, you know, spend a little bit of time focused on what's happening in the, in the technology space.
Um, and not, not, not like ai 'cause everyone's always sort of talking about ai, but more like, you know, what's happening around, um, you know, apps and what's happening around crypto build out and, mm-hmm.
The thing that I, that I have found, uh, is that there's not much happening.
Um, yeah.
You know, AI has taken all the energy, a AI has taken all the energy, and I think everybody is so focused on trying to figure out how to cross this chasm of, um, the way we use computers today.
Right.
I mean, down to the, not so much the hardware, but really the interfaces, I think we're probably two steps away from the phone not being the real device.
You know, I think Zuckerberg is, is is still too early on that stuff.
Yeah.
But, but the interface, right.
This, this push to get the interface beyond buttons and swipes right into, um, ambient talking, um, you know, AirPods just agents Yeah.
Things being age agentic.
It, it really feels like that is where all of the, um.
Human intelligence is focused right now.
Like we, we we're kind of at a standstill on the, the kind of innovation and development we've, we've been accustomed to over the last, you know, 20 years.
Yeah.
That, that's right.
The, the LOM pure technology is plenty good enough.
It'll, it'll get better, but it's plenty good enough now.
It's, it is the interface and the vibe Coding does not yet work.
I got excited.
It's not there about this thing, Lindy, and then I canceled it yesterday.
'cause it, it just doesn't, it doesn't really work to put into a production like it Well, I mean, it could work for a 16-year-old who could spend all day on it.
Right.
But I mean, well if can, if you can build your own app and push it into Google Cloud.
Then you can work with a vibe coding and do that faster.
But yes, these people that are saying English is the new coding language is not yet true.
No, it's not.
It's not yet true.
Far away, but it's not true.
No, it's not yet true.
Um, there is a podcast, you know, Dan Shipper from every, um, has a podcast called AI and I, AI and I, yeah.
And he, uh, he interviewed Aaron Levy, the CEO of Box.
Yeah.
Um, who, who just, just a quick side note.
I mean, I al when I see him, I always think of it as, as like a kid, CEO He's been CEO of that company for almost 20 years.
Yeah.
Right.
He's not a kid anymore.
He's not a kid anymore, you know?
Yeah.
Um, but anyway, uh, he, he, I find him to always be sort of grounding.
I think about him as like an even more, like a, like a less sensational Benioff.
Just like kind of someone who really understands the practical reality of enterprise software and, and what the innovation cycles actually look like.
And I, I, I think he kind of captured it, man, you know, which is to say we, we are eventually going to lose many, many, many jobs to ai.
I don't think there's a question about that, but we're actually quite a ways away from that today.
Right?
Now that doesn't mean that large corporations won't, won't jump the gun and just like start, you know, throwing all their resources at AI and just deciding they're gonna fire people because they want the stock price, you know, appreciation that comes with that.
Um, but, but I think what he said was that for the most part, what AI is going to enable is a higher level of productivity for every person who decides to invest the time into learning it.
And, and, and, and those people will outcompete those who don't do it.
Um, and, and I, I, I think at least for some period of time, that's the reality we're in today, right?
October, 2025.
Where we find ourselves today is we're gonna talk a lot about job losses in ai, but, but what's actually happening on the ground is the people who are spending the time obsessing about how to do their existing workflows with ai, um, are gonna beat the people who aren't.
Yeah, I think that's right.
I mean, the, the thing I'm starting to believe is that we're not gonna get, it's gonna be a lot of years before we get to where gen, you know, generative ai, I'm gonna call it non-deterministic ai, where it's a, it's a probability function.
So every time it runs.
Like rolling dice.
You can predict, you can say most likely what will come out, but it's not deterministic.
It's not no.
That, you know, um, that is not going to be sufficient as a standalone.
Like the, the only project that I've successfully been using now mixes, you know, some actual old fashioned Python code that is deterministic.
It's gonna do the same thing every time.
Right.
And then it combines that with like modules, like sandbox controlled places where the tool is generative, not a deterministic.
Right.
And that has been successful doing it all in a vibe coding thing where it's, it's all generative, at least for me, has not worked at a level of quality that I could show anyone that I could use.
No.
Now ha, having said everything I just said, um.
They are, they are tuning LLMs to really, uh, have a broader capability when it comes to tasks, especially tasks that people who used software previously did.
And I do think that, um, there are specific, uh, industries where there will be, um, accelerated job loss.
You know, one of those being, um, you know, the motion picture industry.
I, I, I, I do firmly believe that what, what, what soa you know, we, we were already kind of like wow.
With, with, with vo, you know?
Mm-hmm.
From Google.
But I, I think SOA too has, has pretty squarely presented, um, a case that.
We're not gonna need the super expensive visual effects studios that we've had in the past.
We, you know, we may not even need the, the robust game studios that we've had in the past.
Right.
And so, um, many, many of, uh, many of the c the digital creative professions, the, those to me do seem like they are today endangered.
Yeah, I think, I think that's right.
It's gonna be this slow rolling process with things like that where there you could, you could take, um, pieces that go into a game that a developer would spend a lot of time building a, a house, and they make that house look realistic.
And then it, it fits into the world of the game that I think can be done much, much more quickly and more inexpensively.
And, and the quality is very good.
I think Google is dropping their.
Vo next version tomorrow.
It's a rumor.
We haven't seen it yet, but yeah, they're just gonna keep getting better and better.
And then I think places like call centers and, um, credit card companies, financial services, accounting, I think might wait.
There's like a lot of data that you have for decades of data that you can feed into the models will be better than somewhere that doesn't have a lot of recorded data.
Um, but it's gonna be kind of messy and uneven.
Yeah.
And, and a lot of these jobs, it's, it's, it's interesting, right?
Like a lot of these jobs are, uh, I don't know, maybe, maybe this is not true about the call center.
I, I'm, I'm, I'm pretty squarely fixated on the digital creative jobs.
Those jobs, to me, feel new, right?
I mean, you know, and, and, and also those jobs feel like they in fact disrupted, um, analog jobs.
You know.
Yeah.
That where people, you know, if you didn't transition your analog design or photography skills into the digital realm, you probably got replaced by someone who performed that skill.
Right.
And so there, there's a, there's a, um, there seems to be sort of a predictable path there, whereas, you know, where we're talking about taking over something that a human has always done and it's never been done by software.
Right.
Like those things, that's where I think it's a, we're, we're a, a pretty good step away, um, from those jobs being entirely disrupted.
Yeah.
And, and there's gonna be some job creation as well where there will be more, there'll be more games with fewer users, more, more movies with fewer users.
'cause the cost to develop them is gonna come down.
And I don't know how that will flush out, but there'll be more and more people that are able to produce marketable digital creative content.
That, you know, probably is, you know, there's pros and cons.
I don't know if it's a net positive or net negative, but there's, there's people that win and people that lose in that process.
And I think the takeaway, I, because I talk to people all the time that, um, you know, they are not as focused on this as I am because I'm a maniac about it.
And they say, well, what, what, what should I do to protect my job?
I think the key is just start playing with it today.
Start using it.
'cause the, the people that get replaced are gonna first be the, the Luddites that don't at all want to use, they're trying to avoid the tool.
Um, so where VCs, I think VCs that can use ai.
Will be protected for longer than VCs that put their head in the sand and are, are not able to use AI at all.
Well, yeah.
And at the same time, like there are so many, I I I think one of the, the, the core points you're making is that there's a, when it comes to actually bringing something to life in the human world, there's a level of orchestration and, and even commercialization that these, these non-deterministic oms just, there's no proof they can do that, that today.
Yeah.
Right.
There's no proof they can do that.
Their prediction engines, they can't, and this is another thing Aaron was bringing up.
It's like there's so many unmeasured human to human touchpoints in the economy that are critical for the actual Yeah.
Delivery of value, right?
That, that don't fit on a spreadsheet nicely anywhere.
They don't fit on a, on a six page Amazon brief, but they're fundamental to it.
Right.
And, and, and that's where LLMs have no ability today.
Right?
They, any, anything that, that depends on constantly emerging reality.
The LLMs can, by the nature of what they are, cannot do anything with because they're predictive token engines, right?
Yeah.
Or, or, you know, proba, predictive probability token engines.
So they, they need the data in order to make the next correct prediction, you know?
Yeah.
Um, and, and, and so that's the thing.
It's like as, as human culture continues to emerge, that's just sort of the nature of, of life.
Um, that that's where we are at the moment.
Indispensable.
That's where at for, for the, for the time being where we're indispensable.
But these things that are kind of the creating components that need to be orchestrated by humans for commercialization.
Yeah.
That whole layer of things is, is, is, is, that's where it gets kind of scary from a job perspective.
That's right.
So you need to keep like learning.
What, what you can do differently, better, faster, more effectively.
There's a lot of things that humans aren't good at, that deterministic software and non-deterministic software is good at.
And yes, incorporate that into your job or your life, I think is like, I, I'm, I don't like to drive and I looking forward to the day where I can just get in a Waymo or a Tesla or whatever the brand is and ride around, go home.
Um, I think humans are pretty bad at driving in general.
We kill, we have a lot of deaths.
Agree.
Agree.
Completely agree.
Um, alright.
Uh, thanks for engaging with me in that, that exercise.
I mean, I, I, I feel like there's been so much noise and we're even gonna end the show today talking a little bit about that, but there's been so much noise about AI taking away jobs and, and you and I have Yeah.
Been part of proliferating that noise.
Um, but, but I, I do think it's an important time to sort of just step back for a second and, and say, okay, but that's not where we are today.
Right.
Um, across the board, it is, it, it is true in pockets and, and what are the properties of those pockets so that we can be more precise in who we're in, who we're worried about.
Right.
As opposed to just like a broad panic.
Yeah.
And I think the, I mean, we got a lot of feedback last week from our sort of off script discussion, um, just kind of riffing on things.
I, I think the audience likes, likes sort of pockets like this where we're talking about something.
You know, is involved in the news, but maybe not tied directly to a story.
Yeah.
Uh, so with that, let's get to our first story and let's dig in.
Starting with gold prices topping 4,000 for the first time as we were prepping for the show, you know, you and I were, were, yeah, we were batting back and forth.
What does this actually mean?
I think that the easy default answer is it means people are worried and they're sort of flying back to the old trustworthy story of value.
Yes.
Okay.
Um, but at the same time, we have to look at the, the US stock market and say, is the US stock market crashing?
And the answer is, uh, it's taken a dip, but by no means is it crashing?
Um, yeah, sort of.
It's all on line yesterday, so today was down, but it's, you know.
That's right from the all high, but like half a percent.
Yeah, that's right.
So, so I turn, I turned the mic over to you, Vic, like what do you read into gold hitting an all time high of $4,000 while the stock market itself is also continuing to gain, I mean, I think we've been talking about it in different segments over the past six months is there's going to be, I think a, a bunch of inflation, a bunch of government spending that happens over the next couple years.
Our debt situation where the government is shut down right now fighting over the debt, the debt levels.
Sure.
Our debt is continuing to, to spiral up and so to me this is a signal of various traders.
Losing confidence in the US government, you know, from it is the most stable government in the world always gonna be there to now more uncertainty.
Not that there's any imminent thing, but it's not as strong as it once was, and that there's gonna be a ton of inflation.
Yet the stock market, it's sort of that K shape economy.
If you have financial assets, the US government and others are gonna prop up those financial assets with mm-hmm.
You know, cheaper interest rates or bailouts or whatever.
Um, sure.
Which will be okay for the solving the immediate crisis, whatever that crisis is, but it's gonna drive inflation and so people are going to gold to try to hedge against that.
Or they're, if they're younger, I mean.
I, I'm not that young, but, but I, I buy Bitcoin as opposed to gold, but, but Bitcoin also is that, I mean, it's not, it came down today, but this week it hit it all time high, I think.
Yes.
Okay.
So I agree with everything that you said.
I want to add something to it that has just sort of hit me in the last couple of weeks.
I think some of it has to do with spending more, more time in different countries, right?
It's thinking of the US dollar as the fundamental denominator for all other assets in the world, right?
So I think when we look at gold topping 4,000, it assumes that the dollar is like this stable thing and gold is like gaining against this, you know, stable, um, element on the periodic table, right?
And, and, and the truth is it's not right.
It's revocable, it's fungible and it, and, and it's only a denominator in so far as.
The dollar has dominance.
Right.
And I, I think that the reason why equities, um, are continuing to grow at the same time, gold and Bitcoin are continuing to grow at the same time other nation state currencies are growing against the US dollar is because the US dollar as the dominant reserve nation state currency is the thing being questioned right now, globally.
Globally and, and, and for good reason, right?
I mean, there's a lot of other stuff happening around the world.
There's the, the, the union of the bricks.
There's what's happening in Japan right now.
There's, you know, it's, it's a very dynamic world.
Um, obviously there's all the different trade and tariff activities that President Trump has put into effect all year.
There's looming, you know, there's, there's wars, there's potential ending to wars, there's potential new wars that are flaring up.
So with all of that uncertainty in the US sort of.
You know, weirdly at the center of, of much of it.
Right.
You know, because President Trump is, uh, uh, he likes to be very involved with many things, right?
Yeah.
He's at the center, everything.
Yeah.
Um, yeah.
Yeah.
He likes to be in, involved in, in many things.
Um, I, what I read into it is at a minimum, people are saying, uh, it seems like the US dollar might be overextended, you know?
And, uh, yeah.
And, and maybe it's time to diverse, so, you know, not, it's not the end.
I, I feel like so often when we have these conversations about the US dollar, people can only think about it in binary terms.
Like, like a switch flips, and it's just like, either it is the reserve currency or it's not the reserve currency.
And as long as it's a reserve currency, it's a hundred percent the reserve currency.
And I think, no, it's a, it's, it's a, it's a shifting that's happening, you know?
And so anyway, that was, that's mine.
Yeah.
That's why, I mean, I guess I, I agree.
I. Where I thought you were gonna go, you didn't quite go.
So I'll, I'll say what, what I was thinking.
Okay.
Which is the price of, maybe it's one ounce of gold or the, this is priced, like one ounce of gold is worth $4,000.
That can increase if the value of gold increases or if the purchasing p power of dollars decreases.
That's right.
But you need more dollars to, to buy the same thing.
And so That's right.
One way to think about inflation is it's, it's sort of the, the debasement or the, I don't like that word.
'cause people don't understand it.
It's the deduction or the reduction of how much $1 can buy.
Mm-hmm.
So if it is 4% inflation next year, you can buy 4% less stuff.
Mm-hmm.
Um, is what inflation means.
And so if we have a lot of inflation, it means dollars are gonna be less valuable.
And things like gold that are priced in dollars or Bitcoin or a piece of real estate.
Even if they don't change, their pricing might change because the value of each dollar has gone down.
Yes.
Does that make sense?
I'm not sure I to explain that a well, but Yes.
Yeah.
Yes, yes.
I It's probably both like people, people value gold more in scary, uncertain times where you're certain we have, and also the value of each of those$4,000 is getting less, less valuable.
I built on what you said and then you built on what I said.
Uh, and, and I, you know, I think if we had a Bloomberg terminal, we probably could ask it's AI and, and, and probably get something that tells us that we're, we're, we're pretty much right.
You know, we're, we're pretty much right.
That ultimately these are all signs of the, the global markets asking questions about the US dollar, right.
As, as its purchasing power is not as stable as it has been in the past.
Right.
And I was trying to explain the ke of economy to my son a couple days ago, and it's hard to explain like, why is a lower part of the K doing poorly?
And I, I think it's because all of their net worth is in dollars in a checking account.
Or, you know, they don't have financial assets that are, um, priced like gold.
They're priced in dollars that appreciate as inflation happens.
And so they just get the loss of purchasing power, which you and I get everyone gets.
But if you have financial assets, then you also get the benefit of kinda the inverse of that purchasing power.
Yep.
Uh, okay, next story.
Uh, also, wall Street Journal soybean farmers are panicking over the loss of Chinese buyers, uh, I should say American, uh, soybean farmers are, are, uh, panicking over the loss of Chinese buyers.
So what's the, what's the backstory here, Vic?
So, China is by far the largest purchaser of our soybeans.
Every year for 30 years, they've been the largest buyer.
And because of the tariff and trade fights, they decided, and I think that one of the benefits of China is that from the government, like on high, they just came down and said, we're not buying US soybeans any longer.
They haven't bought any soybeans this year at all.
And that leaves, of course, a very large gap in the market, um, that are making the farmers very nervous.
Um, Trump has already been talking about doing, um, subsidies to farmers to help, you know, offset trade and tariff problems.
I just was not paying attention.
I thought it was just sort of platitudes to keep a big base happy.
But he, there's gonna, we're gonna have to come in and buy soybeans, um, because a lot of farmers are not gonna survive with this.
Uh, yes.
In addition to everything you just said, uh, in this story they talk about other, um, countries that are soybean producers, Brazil and Argentina, and the fact that in addition to China shutting off, um, the, the general purchase of, of soybeans, they also have been shifting away from the US and, and buying soybeans from, uh, Brazil and Argentina.
Um, Brazil and China are both, uh, founding members of Bricks, uh, which is a, uh, financial, um, alignment of, uh, countries that, uh, essentially stand counter to.
Um, I think the G seven is probably the best way to to to position it, you know, where, where the US is sort of in the center with the US dollar, and so they don't have a universal.
Um, currency.
They each have their own currency, but they are forming very, very strong economic ties.
And, uh, I think while that's probably secondary to the, to the, um, sort of furlough of purchasing that the China's doing in soybeans, period, it's all, it's, it's an important secondary story to tell here, right?
Yeah.
Yeah.
No question.
All these stories are, are interrelated, right?
But I think, yes, the other countries are going to move away from America and using dollars, uh, and then it's very lightning.
The article says that the Trump administration is considering 10 billion to 14 billion subsidies of farmers.
That's one example of many where the government's going to print more dollars and give it to some people, in this case, farmers, which maybe it needs to do, I think it probably does need to do, but that's gonna drive inflation.
Yeah.
So we just go around the merry-go-round.
Agree.
Um, okay.
And then we, you know, we were talking about during the gold segment that, uh, that the stock market did hit at, at an all time high.
The 33rd time in 2025, the s and p index closes for a record high.
I mean, and again, it there, there's only one story to this s and p index hitting these all time highs over and over again.
Um, it, it's, it's tech, uh, more precisely it's mag seven more, more precisely.
It's, it's ai, right?
Um, and, and so I think this really, uh.
Continues to punctuate how tip of the spear AI is to this economy.
And even though, uh, it, it's not having a practical impact in terms of like, if you were to look at American GDP and you were to say how much of it is fueled by actual ai?
I don't mean speculative ai, I don't mean applying future, you know, uh, value to today's revenue.
I mean, I mean it's, it's very little.
It's very little of, of the American GDP is actually driven by artificial intelligence, but man, are we betting the whole house on it, right?
I mean, it's it that it is the bet of our lifetimes, it feels like.
Yeah.
I mean, I didn't put the story in, but um, there was a research paper that came out I think yesterday that, um, the data center build out, so the AI data center, capital investment.
Yeah, accounted for, I think 95% of GDP in the last, in the last nine months.
Like it's basically all of GDP is accounted for in investing in, you know, big buildings where no one works with a bunch of technology and maybe that will pay off.
It also might be a bunch of stranded assets, is some combination probably.
Uh, but yes, we're living on this like CapEx fueled, maybe hope that AI comes around.
Yeah, it's, it's, it's remarkable how, how, how focused that is.
Uh, okay.
Moving into the BC rundown, uh, duos, spelled DUOS snags 130 million in equity investment to scale AI benefits platform for seniors.
This is fierce healthcare.
Yeah.
So this is AI targeted directly at seniors and Medicare Advantage plans huge round.
Uh, but it's a big market.
There's a lot of.
Opportunity there.
Yeah.
Uh, the investors around the table ftv with participation from Forerunner.
Uh, I just wanna make a note.
Forerunner is doing more and more in healthcare.
Um, so that's just something as a, as a footnote, you and I should offline take a look at that, but I, I'm glad we do the VC rundown 'cause it, it shows me which funds are, um, yeah.
That, that are not a hundred percent.
Healthcare are showing up more and more in healthcare, and Four Runner Ventures is showing up more and more and in, and in pretty sizable rounds.
Um, so that's, that's worth tracking.
Uh, true Pill co-founders, latest startup foundation, health banks, 20 million to bring AI to pharmacy operations.
Uh, pharmacy operations is definitely a, uh, you know, a space.
I've, I've seen a whole lot and I think I've always just been concerned.
I mean, uh, you know, actually, I don't even think we have the story in here, but Rite Aid.
Uh, finally called the quits, right?
I mean, they finally have down their stores.
Why didn't those, their last 80 stores?
Yeah, yeah, yeah.
And, and we, and we know that independent pharmacies also are, are just so you know, um, yeah.
Embattled, right?
Yeah.
I mean, the, the transfer pricing of the PBMs who own a lot of the, you know, the big platform chain pharmacies has really cut a lot of the profit margins out.
It's not, it's very difficult to run a pharmacy.
And there's not enough workers.
Uh, so it's great to see technology being about to be here.
Vanderbilt, uh, invested along with defined ventures in this deal.
So it's good to see Vanity Vandy getting involved.
I think it's gonna be good.
Yeah.
But, but isn't that interesting that a, that a health system, uh, you know, invested in this, right?
So it's like the, the, the pharmacy, you know, when you say pharmacy operations, I mean, I think people might, might traditionally think okay, like dedicated pharmacists, but I, I, I think it's gonna be more, you know, embedded pharmacies inside of health systems and, and big pay vital.
Um, where, where this might be helpful.
Yeah, I think it's, it's both end.
I mean, Intermountain and Vanderbilt, both investor, they both are concerned about their internal inpatient pharmacies, but I think there's a lot of concern with making sure you can get medications dispensed.
Once the patient leaves, when, you know, when they, when they get discharged.
There are places in this country where there's just pharmacy deserts.
We talk about food deserts.
Now there's pharmacy deserts.
We have to drive a long way to get your drugs.
And that drives compliance down obvi, obviously.
Yeah, yeah, for sure.
Um, so look, we'll, we'll see.
I, I, I personally have avoided, uh, pharmacy deals, but you know, again, if Vanderbilt's in, uh, then they at least have a, have a strong anchor, um, you know, client there, uh, old surgical raise is 24 million to advance outpatient surgical care network.
You pointed out this was sort of the first time, at least in a while, that you've seen a VC deal and outpatient surgery.
Yeah, yeah, that's right.
It's, uh, it's coming outta San Francisco and Oregon.
Uh, so not what I'm used to seeing.
Like out of the Nashville crowd.
Um, outpatient surgery is really benefiting from the, you know, um, site of care neutrality, uh, payment reform.
Um, but it's also hard to operate, um, at scale.
And so I'm, I'm hopeful.
We'll, we'll see.
Yeah.
Uh, people around on the table here, FPV Ventures again, so this is the second deal they led.
Yeah.
Uh, in this week's rundown.
So that's something to note.
Uh, and then supported by it, McKesson Ventures, um, black Opal Ventures and rogue VCs.
So all, all, all notable names there.
Uh, on the, on the cap table there.
Yeah.
Um, attuned intelligence emerges from stealth with 13 million to automate hospital call centers with supervised ai.
Yeah.
So this is good to see more competition in this space.
It's pretty crowded already.
Um, but, uh, they're sort of having supervised AI a lot more attention to quality and human in the loop, which I think at the hospital call centers is really important.
Okay.
Uh, and Heidi Health raises 65 million to expand global reach of its AI medical scribe platform.
So I think the important thing here is global reach, because we're talking about an Australia based company.
So we, you and I are constantly talking about how this space is very, very, uh, you know, crowded.
Um, and the, we would never want to invest in the space.
Uh, but we're talking about the US when, when we say that, right?
And so Heidi Health is based in Australia, um, and there are many, many other markets around the world where subscribed technology is absolutely going to be used.
And it looks like this is, you know, maybe the equivalent, uh, of an abridge or something like that.
Um, you know, coming out of the Australia, uh, con Australian continent.
Yeah, yeah, that's right.
They have a presence here, but I, I think I haven't seen 'em a lot.
I think it's fairly limited, but the expansion money is, is really designed.
They say in the article for Ireland, France, Spain.
South Africa, Hong Kong, Germany.
Right.
It definitely is that like next tier, uh, where they, they need technology, but maybe they don't have as many.
Abridge is probably not there right now.
Yep.
Yep.
Agreed.
Um, okay.
This, this story we, we grabbed from the Newswire, 'cause you originally saw it on Axios, but we just don't have access to like the super pro edition, but Remedy Robotics, uh, robotics, um, they had around, I think it was 35 million you said.
Yeah, that's right.
35 million.
I think Axios had the exclusive for that.
Okay.
I love eos, but, but, uh, we, I couldn't find, uh, a way to show it to people.
Yep.
Um, and so this is a, a robotics, uh, device company for, um, I need to say it right.
It's, it's a endovascular surgery.
So this is going through your, um, artery into the heart and removing a, you know, either a stroke or a clot.
Um, and.
It saves lives, but it's, you need a lot of physician skill to be able to do it, and there just aren't enough cath labs with enough doctors to treat all the patients with heart disease.
Um, so it would be great to get this out.
Many more docs will be able to, to use it, it fits right into the cath lab kind of set up.
Um, so pretty exciting.
I don't know.
I haven't seen the results, but, uh, but exciting to see it come out.
Yep.
Uh, rock Health came out with their q3, uh, market overview.
Uh, they always do a great job of covering the digital health and, and, and, uh, healthcare investment markets.
Um, and so, I mean, I, I think.
A lot of capital raised this year.
You know, relative to last year, uh, 3.5 billion raised across 107 deals, bringing the total year to date to 9.9 billion across 351 deals.
So that seems like relatively healthy activity.
Um, but I think that the big thing you noticed in here was, uh, that it's getting hard to track the benchmarks because now.
Uh, I guess, you know, startups and maybe even the investors who are writing the term sheets are ditching the, the traditional labels, you know, seed, pre-seed series A, series B, series C, if, if we don't have those, those markers, it's very tough to sort of organize how capitals flowing across different maturity levels in the, in the, in the venture markets.
Um, but we also know like the last three, four years have been highly disruptive to that structure of named rounds.
Um, and, uh, you know, I would say just even c to series A for, for those who are not in, in our business, we talk about, um, when a company moves from one stage to the next stage, we call that a graduation.
You graduate from being a seed stage company to a series a company.
And the graduation rates just like they would be in a, in a.
In a university or high school.
The graduation rates have been declining rapidly year over year.
Um, but a lot of these companies still need money.
And so, you know, they're staying at seed or they're staying at Series A longer.
And we've been, you know, what we have been seeing is seed a seed B seed one seed two seed extension, right.
Series A one series A two.
Right.
You know, like kind of these, these, uh, the sequels of, of a round in the same stage.
Right.
You know, because, uh, the companies can't quite graduate and it seems like everyone's maybe decided they're getting tired of that and they're just not gonna label the rounds anymore, which, uh, is actually pretty problematic for our ability to measure the space.
Right?
Yeah, that's right.
And I think it's, I don't see it going, going back.
I mean, I think each company and each, uh, board of directors, if they're looking at, gosh, it's a hard market to raise money, um.
Why, why do we, why don't we put together a seed extension or a seed three or whatever seed two, right?
Um, or an A minus or whatever.
You just sort of like make up different names, um, because you don't wanna be compared to, you know, what, four years ago was what was needed to be an a, a company.
Um, but you're right, that makes it very difficult to track anything because this.
There's just no labels.
No labels that mean anything.
Yeah.
Yeah.
So, I mean, I, I don't know.
We, we, uh, every quarter, you know, and we're, we're at the end of the, the, the third quarter, and so obviously, you know, the, the reports are gonna start coming out.
Rock health, you know, they typically come pretty early, but Carta and PitchBook, they'll start coming with their reports and we really count on that to be able to communicate.
Two portfolio founders of like, Hey, this is the reality of the market today.
You know, this is what it's looking like for graduation rates.
This is what it's looking like for you to get to that next round.
Um, and we also use it to communicate with our LPs, right?
And to kinda say, Hey, you know, uh, markets are looking good, or markets are not looking so good and not having those markers anymore.
I mean, I, I don't know, Vic, I just feel like we're getting this deterioration of data we can trust.
Like, you know, it's, it started with BLS, you know, and, and, and now now we're, we're here in the venture world.
Like we're losing the underpinnings of the data we use to try to forecast the future.
And, and we're not the Fed.
So, I mean, I'm, I'm sure the Fed has a much harder job than we do.
Uh, but you know, I don't know.
I just, I just feel like the quality of the data is eroding.
Yeah.
That, that's right.
I think we're gonna need to start tracking our own data in terms of revenue or employees or customer account or something that is, uh, we can be confident every company will have, so we can.
Even just report to our investors or report to each other, or, um, ab Absolutely.
We need benchmarks.
Yeah, absolutely.
Yeah.
We're losing our benchmarks.
That's right.
Um, okay.
And then one more story that we weren't quite sure where it fits, but, uh, I, I liked Vic's idea to stick it here in the VC rundown, uh, but it's, but it's actually a, a very, very large acquisition.
Qualtrics is buying Press Ganey Forta, uh, for $6.75 billion to expand their reach in healthcare.
So, uh, I think most people know Qualtrics is like the, the, the big survey company, kind of the enterprise survey company.
Um, and, uh, press Ganey Forster, uh, has been a big sort of growing.
Uh, uh, acquisition machine in the healthcare space, you know, specifically around, uh, you know, HE DDIs and, and, and, uh, consumerism and marketing and patient engagement and sort of all those types of things.
Um, and now it's becoming like one massive, massive company.
And so, uh, a couple things on this one, you know, this kind of consolidation is.
Interesting.
Um, I don't, I, my view is, when I think about Qualtrics as a, as a former technologist, I don't view them as an incredibly, um, innovative company.
Um, meaning I, I don't, I don't see Qualtrics rolling out the, the, the freshest flashiest, coolest tech technology and Press Ganey.
You know, I thought, I have always thought about them as a big acquirer, right?
You know, someone who, like, they've, you know, they're great at go to market, they've got great customer relationships and they bring new capabilities to those customers through acquisition.
And so, um, you know, one, is this an even bigger balance sheet to buy more companies, um, to deploy out into the market?
That's one question.
But then the second question is, you know, is there a concentration risk here?
Are we approaching a monopoly just in terms of the scale, uh, of, of this company serving, uh, health systems when it comes to patient engagement, consumerism, marketing, et cetera?
Yeah.
Yeah, I think that's right.
There's, it's.
I don't know.
I have hope that, I mean, press Ganey has always, in my mind, been really good at distribution.
And they bought, they bought products and then they were very strong at sort of taking that product that maybe one of our companies has sort of gotten that some distribution, but limited and then they push it to everyone.
That's, that's sort of their game.
Um, Qualtrics slash Press, Ganey Forster could be great at, they could do that same thing even better.
Um, that's the positive side, that the negative side is they might be so big that they don't want to do any acquisition under 500 million, which would be really negative for the startup market.
Right.
Yeah.
So it's, it's, it's just an interesting thing like competition, I think.
Breeds more acquisition, right?
Because you, you're looking for new, uh, new, new competencies and, and you know, I think what they're saying here is that Qualtrics didn't have a, a great foothold in healthcare.
And so this is getting them a bigger foothold.
But the thing I'm sort of watching out for is, um, you know, and there are other big, big brands in space.
Truvin is sort of another, you know, very, very big company that is a regular Requirer.
So, um, you know, there's still, yeah, exactly.
There, there's still other folks in the space, but, uh, th this is now a, a very big company, right?
This is now a very big company.
And, and so just something to watch from the dynamics of does this accelerate m and a, uh, for, for this sector, or does it sort of decrease it?
Right.
Alright.
Uh, now we're moving into policy.
So Trump wants to overhaul drug sales in a company that is tied to his son stands to benefit.
I don't, I don't think this is surprising to anyone.
You know, the, uh, the Trump family is, uh, they're enterprising.
They're, they're all doing deals all the time and, uh, I don't think they make any, uh, apologies about, uh, lining up policies with their commercial efforts.
And which comes first is, is kind of a chicken in the egg story, but, but Vic, just a little bit more detail on this one.
And, and in this case we're talking about Donald Trump Jr. Yeah, that's right.
So it's, uh, I mean like everything that the Trump family has decided that if they do things in a very transparent, open manner.
Then they can sort of do I think, whatever, whatever they want.
It started with the Trump coin, you know, on Inauguration Day, right?
That's right.
Um, which was a very clear way to monetize the position that Donald Trump was getting inaugurated into.
I, I don't think that's controversial.
I mean, even strong Republicans would say that.
And so it's just a different way to handle potential conflicts that I've never seen before, um, at this scale.
And I think we need to start getting used to the fact that this is the way that that government is now working in the us.
But yes, blink RX is the company name.
Uh, Donald Junior joined the board and invested in it.
Uh, I think this summer, the policy with the various drug manufacturers using online prescription.
Companies like Blink Rx is not set yet.
It's going to be set in the next month or two.
We're starting to get, you know, concepts put out.
Um, and so Wall Street Journal is pointing this out.
I think it is.
Uh, it's just part of how things happen now.
Yeah.
Yeah.
I mean, last week we were reporting on Trump rx, right?
I mean, like, this is right to me.
It's, it's like, uh, this is going to happen, right?
Um, this is, this is the new way that business regulation and conflicts of interest is handled.
The Trump administration is not shying away from being, disclosing things, which, which is I think, positive compared to not disclosing things, but they.
They kind of feel like once we put it out there, you can do whatever you want and Yeah.
I don't think we're gonna put the genie back in the bottle.
It's just No, no.
We're, we're, we're not gonna put the genie back in the bottle.
That's, that's exactly right.
Uh, on the other side of, of the, the coin, uh, governor Newsom in California has signed a bill to curb private equity role in healthcare.
You tried to explain this to me before we hit record and I couldn't quite understand the, the, um, the details of this new bill.
So let, let's try it one more time in real time while we're recording.
What, what specifically does this do to limit private equity's role?
I mean, the interpretation is gonna be interesting to watch, I think, but it, this bill, which is now signed into law, prohibits private equity firms or hedge funds from interfering in healthcare decisions, including those related to billing and coding.
Okay.
Um, how that is interpreted, you know, is unclear.
Yeah.
But it could be interpreted, you know, broadly to, to be all of the practice of medicine in, in coding, pre-auth.
Like how are things coded?
Um, maybe it is on a very narrow basis.
Um, I think it's going to be a challenge for private equity.
Could it, could it, could it, could it somehow have, um, could it, could it somehow have a, uh, like, like an impact on the state's ability to force, let's say a private equity owned hospital to continue to operate even when they're losing money?
The guy's name is Halbotton, I guess he's a, a congressman.
His quote is, um, does rising private equity investments in healthcare?
And this, this bill demands that modern enforcement tools are not used to restrict investment, but they make sure that they don't hurt patient outcomes or drive up the cost of care.
Okay.
And so, I mean, everyone wants there to be lower cost of care and better outcomes.
I think all the private equity investors want that.
Sure.
But how that gets implemented is kind of in the eye of the beholder.
Like, like you're saying that if you, maybe you shut down a service line at a hospital mm-hmm.
Because it, there's not enough demand.
Mm-hmm.
If there is one patient that would like to use that service line, then that is hurting their outcome.
And so it's just a, it's a challenge to navigate in, in.
That sort of opaqueness.
Yeah.
Yeah.
There's another bill that is not signed yet, but passed, and so it's not clear if Newsom will sign it or not.
And that empowers the state to review, um, the investments that private equity companies have made and then fines and other things that hasn't been signed yet.
So it's not clear, um, if that will be signed or not.
Hmm.
Okay.
Uh, we'll, we'll just have to track that and, and see, see what the actual, uh, impact of that bill is.
Uh, Dr. Oz was, uh, with the Aspen Institute and he spoke about the shutdown, Medicaid cuts, Medicare Advantage audits and more.
Uh, I have to say, I'm, I'm an Aspen Institute fellow, um, and I was actually a little surprised, uh, to see Dr. Oz there, but I, I think maybe, um, it, it simply because like I. I would sort of think of the Aspen Institute as maybe one of those think tanks that, um, the Trump administration did not see as like, I don't know, aligned or, or, you know, uh, yeah, just, just like a, a place that they would, that they would, uh, be seen platforming their, their, their views.
But, but I, I was, I was happy to see it.
It just was, I'll just admit, honestly, it was a surprise to see it.
Um, and, and you know, it sounds like basically he is, you know, reiterating the points, uh, that, you know, the Republican party were making during the one big beautiful bill March to approval, uh, which is that the cuts to Medicaid are not actually cuts to the poor, but, uh, about fraud, waste to abuse, and we need to reopen the government.
Is that, is that, is that basically what happened here?
Yeah, he, he, um, he said a bunch of talking points that we have already heard.
Um.
That are Republican talking points.
Mm-hmm.
Um, but then he did say that he would like to see this guy Dan Broman, named as Medicaid director.
Okay.
Um, so that to me that was new.
So, so he has, um, now talked about who he wants to be.
Supposedly he's in the interviewing and sort of approval process.
I didn't know this person before, you know, two days ago.
He doesn't have experience in government.
Um, he's a, he's a businessman and I'm sure he would be good, but, but, um, that was new.
So like that name now is out there in charge of Medicaid, or not yet, but, but would be in charge of Medicaid.
So we need to learn more about him assuming he gets appointed.
Yep.
Okay.
Uh, okay.
Moving into payers, uh, United Healthcare and Johns Hopkins, uh, continue their battle and, you know.
We're, we're, we're not into the drama of, of these, these debates, but I think what what is interesting about this one in particular is, is, is the nature of the, the, the debate, right?
Which is that Johns Hopkins wants more, uh, say over which employers, uh, can be within their network.
Is that, is that, is that the fundamental disagreement here?
Well, as characterized by UnitedHealthcare, Johns Hopkins, uh, has stated it is about rates, but it's, I mean, United Healthcare is claiming that the sticking point is not rates, but it is that Johns Hopkins will not accept their, their sort of different, you know, the different networks that they have where that you can get in network, A, B, C, D.
And they sign up Employers and employers typically choose a network that, and sometimes they move around network 'cause the pricing could be different and different.
Their networks have different capabilities.
Mm-hmm.
Um, Johns Hopkins wants to be able to themselves selectively exclude employers that they don't align with.
I'm not clear what aligned with means from a health system with an employer, but that's what, that's what United is claiming is a sticking point.
So what the quote is, um, a provider that selectively and unilaterally turns away patients regardless of medical need or coverage, dips, disrupts equitable access to care.
And that sounds right, but I'm sure there's another side to this story.
Yeah, yeah.
Yeah.
I mean, I mean obviously there's, there, there's two sides, but I, I wonder.
It, it's not lost on me that Johns Hopkins is, is a, is a university, uh, based health system.
Um, they were, you know, probably, you know, one of the first big name, uh, universities to be, uh, you know, diminished in terms of their funding for, um, NIH based, uh, research.
Uh, and so, you know, there, there's, there's so many things, uh, that, that could be underneath.
This, and I, well, I guess what I just wonder is whether or not this is systemic, like is this, is this isolated to this particular relationship in this particular market, um, with this particular university health system?
Um, or is there some pattern here that that is, is being covered?
Because Johns Hopkins is such a high profile name, but it is actually happening in, in, uh, in other markets with other, um, university health systems around the country.
So it's, it's just a, it, I'm, I'm just curious about that.
I don't have an answer to it, but, um, it is curious.
Yeah.
I mean, that's why it's worth talking about, I think, is that if this becomes a trend of many academic medical centers, then that would, that would change a lot of things.
If it's only John Hopkins, then it matters if you're in Baltimore.
But it doesn't matter that maybe they pull people from all around the country, but.
But it is just that one system, so it's hard to know.
Yeah, and, and, and, and look, I mean, I, I think it's, uh, it's now explicit because it, there, there have been so many instances of it.
I mean, we can go completely away from healthcare and look at everything that's happened with Disney and now, you know, um, and Jimmy Kimmel and the, the mass cancellations of Hulu, uh, and now Elon Musk and, and you know, what he's, what he's attempting to do with Netflix.
Um, you know, one of the ways that, that, that people are, uh, you know, exercising their.
Their, their belief system is through, you know, uh, you know, boycotts or, or, or different economic actions that they can take.
Right.
You know, sort of taking the playbook of nation state sanctions and, uh, you know, exhibiting it, saying, Hey, look, people, people listen to the pocketbook.
We're gonna sort of act in, in that manner.
And, um, you know, it's one thing we see labor organized to do it.
When you start seeing organizations start to make these, these, um, these calls, it, it, it feels like this is, you know, you know, if it feels like this could go viral, right.
Um, you know, if, if there's, if there's principal differences, especially as, as different employers, you know, um, take on different, you know.
Positions on different matters that that could cause huge, uh, you know, ethical issues for universities.
Right.
I mean, I think that's, that's the other thing.
There's a, there's a whole backstory here to, well, why would Johns Hopkins not be interested in aligning with certain employers?
You know, perhaps they have what for them is a good reason.
Right.
You know, perhaps for them, it, it's a, it's a, it's a really good reason.
So th those are the kind of things I'm, I'm just curious about being underneath this story, you know?
Yeah.
And I think that's, that's right.
And it's also, I think, going to, it's sad if we get to that point where hospitals are refusing care because they don't like where the person works.
That's gonna be worse medicine overall.
And we may end up being there, and it might even be, might even be a good decision for the hospital, but it's not gonna be good for the people that live there.
Right.
Yeah.
I mean at the end of the day, we, we, we, we are the losers, I dunno the details, but it's Yeah, yeah, yeah.
At the, at the end of the day, we we're the losers of all these sort of organization versus organization, you know, power versus power battles.
Um, okay, so now moving to a story really around the Affordable Care Act, which in so many ways is, is the, the centerpiece of the, the government shutdown.
The Wall Street Journal has done a little story here talking about the, uh, the healthcare subsidies sort of.
Who is getting these subsidies and they, they start the article with a map that lays out where the growth per by percentage has happened in the Affordable Care Act, uh, marketplace.
And, you know, the, the range here is anywhere from 0% growth, uh, from 2020 to 2025 up to north of 150% growth.
You know, it's, it's pretty clear that the south and the, and the Midwest are where the majority of the growth has ha has happened.
Um, you know, our home state, Tennessee, and many states across the, the, the south have north of 150% percentage growth.
Right.
Um, and, and I think that, that, that probably aligns with socioeconomic status in, in those, in those states.
We, we then look at the next chart, uh, a little bit further down, and it, it talks about what percentage of people enrolled in Affordable Care Care Act plans receive a subsidy.
And I had actually never seen this.
Um, so this source is from the Kaiser Family Foundation.
They don't exactly lay it out, but it's basically 90% across the board.
Um, it's basically 90% of the, the, the families, uh, the people that are enrolled in Affordable Care Act plans receive a subsidy.
And so if these subsidies go away, I mean, you can really see what kind of sticker shock we're in for.
Um, and, and I think what, like 30 days?
Right?
When, when do the, when, when do the renewal start, start opening up?
Well, the, the decision point is, is I think it's November 1st.
It might be the 15th, but then the, the payments will be in January.
Yeah.
Yeah.
But, but the, but we'll see new rates in a month, right?
Yeah.
Yes, yes.
Yeah, yeah.
Yeah.
So the rates are gonna be high.
We know the rates are gonna be high.
Oh, they're gonna be incredible.
Right.
Um, and they're gonna be up 2015 to 25%.
Yeah, they, they, they're gonna be up big time.
And, and I think that this, this starts to add a little bit more, um.
Strategic value to the Democrat's decision to shut down the government, right?
Which is to say, um, are they gonna get anything out of it, uh, in terms of a shift of the law, right?
They don't really have any leverage to get anything out of it in terms of a shift of the law, right?
They, that they, they don't have the votes, they don't have the control.
This, this is effectively a protest, right?
Mm-hmm.
So, but it's a protest that calls attention to the issue such that the Wall Street Journal is doing this, this story on it and such that people are saying, what is this shutdown about again?
Right?
And, and I had, I, I had thought about it.
I mean, I was, I was talking to Emily about this, uh, you know, on Tuesday I had, I had thought about it simply from the perspective of what they can achieve.
Directly from a policy perspective, like can they actually get the subsidies, you know, put back in.
And, and my view was, I didn't see where they had the leverage to do that.
But if you think about the, just like game theorying this thing out a little bit, if you think about it from the perspective of they are executing this protest with enough, with enough proximity to the rollout of the new rates, such that when the sticker shock hits this broad swath of Americans, they realize, oh, this is what the Democrats were making all that noise about.
Right.
And that actually could give them some moral high ground as they roll into campaigning for the, for the midterms.
Yeah.
Even if they decide to reopen the government.
So that, so that's, that's actually a, a, a strategy that I had not previously con contemplated.
That's, and that makes good sense.
Yeah.
The Schumer, Schumer or someone in the Democrat Party, it's a very smart strategy.
Because if they, if they win the fight and Trump administration does something with the subsidies, puts'em back or makes the, makes it less dire, they can claim victory.
And if they lose, I think they still win because then they get to like point and say, see, we were trying to make this better.
And so it's a, it's a great political calculation that is going to benefit the Democrats now.
Um, and then it, the, as we can see from the map states, that didn't expand, I think is how it breaks down.
But, but a lot of red states are gonna get the lion's share of the challenges, um, if the subsidies go away.
Yeah.
So, um, I mean, I think the Republicans would say, well, you're.
You know, you're trying to re-litigate something was already passed in the summer.
Yeah, that's right.
And I, I think the answer is yes, they are.
And they win either way.
They politically they win either way now.
Yeah.
I, I, well, well, here's the thing.
I, I think there's only one way they're gonna win.
And I think it's the latter, right?
I think it's, I think it's the, the, the court of public opinion.
Mm-hmm.
And I was skeptical about that because I, my, the, the, the variables I had used were, um, as this thing drags out, the general public will say, we want our government open.
What the hell is the problem?
But I hadn't thought about the timing of the rollout of the new rates.
Yeah.
And, and that, that is different calculus.
And that is, I, I, I think that is probably politically a win for the Dems, right?
I mean, given the cards they had to play, I think it's, it's a, yes, it's a good play.
Yes, given the cards they have, I think your, your, your thoughts last week, or maybe it's two weeks ago, like the Democrats need some coherent plan for the government deficit and like where the country's going from, you know, how we're gonna pay for all of our entitlements and they don't have that.
And so, um, they gotta figure that out.
But this, this was a good gambit almost no matter what.
I think that it's, they're better off than they were September 1st.
Yeah, I, I, I agree with that.
Uh, okay.
Moving into providers, women's metabolic health provider, AARA Health expands to 50 states.
This is, you know, an atypical story for us.
When we talk about providers, we typically are talking about health systems, um, not maybe a smaller, um, women's health provider.
But Vic, why'd you pick this story for us to cover?
Yeah, it's sort of a, there's two, I'm covering this.
I'm interested in this theme, uh, where the.
The healthcare delivery systems now are going nationwide and really focused on, uh, delivering a particular thing, in this case, women's health, uh, to the entire country so that everyone can, and then they can really invest in brand and TV ads.
And, um, I mean, HIMSS certainly did that with the, with the Super Bowl ad.
Um, but then as I read it, the results that they have sort of hidden down in the story are incredibly positive.
And, and I just think we need some good news today in the news cycle.
It's so, the whole world is so bad that, um, they have some great results.
And so after 10 months, two thirds of the, uh, pre-diabetic patients that they worked with had normalized their A1C levels.
So 66% and 77% of diabetics had reduced their A1C levels out out of the diabetic range.
And I have not seen results like this around diabetes care in, in a nationwide thing like this.
Ever particular companies have done it, uh, with a lot of focus, but, uh, but it was, it's great to see that you can really make a difference in women's health.
Yeah.
Uh, I mean, we, we have definitely seen, I may, may, you know, maybe this week was the first week that we didn't have like a, you know, a big story about a women's health VC deal, but there've been, you know, week after week great VC deals happening in this space, and it's like.
What, what women's health advocates, whether they, whether they be patient advocates or, you know, innovators and investors have been saying for a very long time, is, this is low hanging fruit because women are effectively second class citizens in the healthcare system as it stands today.
Um, the system is oriented towards men and, um, simply if we were talking about this before, we hit record, simply orienting the health towards women because they are different gender.
There's, there's differences, there's clear biological differences, like there's clear, you know, it's like simply orienting healthcare towards women as opposed to you're a person.
Then you're not a man, so we'll do the best.
Okay.
With Yeah.
Especially metabolic diseases.
Especially metabolic diseases.
Yeah.
I mean like maybe joint replacement or something else might be, uh, might not be as different.
Uh, but, but metabolic is this lot of, there's a lot of differences.
Differences, female by men.
There just aren't, we, we, we have different hormone makeup.
We process fast differently.
It's like, right.
Yeah.
So anyway, it, it simply orienting can, can make huge advances in the quality of the outcomes.
Right.
And, and not, not to say that's where these companies are, are starting and ending, but it's like, gosh, we, we have so much ground that we can cover simply by orienting right.
Tens of thousands of Kaiser Permanente workers with expired contracts to strike on October 14th.
We, we've been covering that this is about to happen.
We know that Kaiser is well positioned to negotiate and end this strike.
Um, is there anything noteworthy beyond the fact that it's, it's almost certainly gonna happen.
No, I mean, the way that they have to do it with the, the state laws to give, they have to give notice.
Um, so they, you know, the, the union has given notice that they're gonna walk, walk off the job for five days off the 14th.
So, um, I don't know.
Now is the time to come to some settlement, I think.
Uh, but so that's just the reason they're bringing up quickly.
Like I think it, there's a decent chance that it's gonna happen next week.
It's Tuesday, so, you know.
Yeah.
Couple days from now.
Okay.
Going into pharma, Amgen lowers cholesterol medication price after Trump calls for price cuts.
This is Repatha, which is a quite a big drug.
Yeah.
They, it is a, like a second or third line cholesterol drug.
So it's not the first statin you get.
It's, it's an injectable.
It's, it's more, it's when you need more assistance.
But I think it was a smart thing.
They, they sort of made the term administration happy.
They get, they're going direct, they, they sort of agreed on a, on $239 monthly.
And I think probably the reality is that there's a lot of pre-auth against this drug and there's a lot of, um, challenges that they face.
And so they were able to find a, a drug that I think they'll be very happy at 2 39 and not have that, that all that friction to get their drug put to market.
Um, and then the short administration is happy with Amgen and, and it kind of goes from there.
Yeah, look, I mean, look, at the end of the day, I'm sure Amgen has made tons of money off this drug over the years that they've had it in market.
And, uh, lowering the price at a time when American families are are, are truly going to be challenged with inflation, job loss, so many other things.
Uh, it's, it's a win for the American people.
So, uh, no issues with that.
Um, okay, we've got two stories in, in Health and us.
Uh, the first one, uh, from the Wall Street Journal.
Patients are diagnos diagnosing themselves with home tests, di devices and chatbots.
It's, this is like a, a, a, yes, we know this story.
Um, but I, I, I guess.
It's, it's, it's important to, to, to pay attention to it because we are now, I think, starting to see the begi, the early critical mass of the, the medicine 3.0 movement that, you know, uh, the, the, the thought leaders in the space, like the Peter Atilla and the, um, Andrew Humor mens have been ushering in for five plus years now.
Right.
Um, uh, a time.
And, and I think AI has only, uh, accelerated that, uh, where people are saying, listen, you know, my healthcare costs are high, my healthcare trust is low, and I have to take, I have to have more agency in, uh, taking care of myself.
Like, I can't totally turn this over to, um, a, a third party.
And I, I think this is, this is what the beginning of Medicine 3.0 looks like.
Yeah.
No, no question.
And I think we have a lot of industry.
You know, doctors and healthcare administrators and payers or investors in that space, in our audience.
And I think that, uh, part of this is a wake up call.
Like we need to deliver better care, better quality, lower costs, more, more openness, more more visibility to the patients, or they will go seek answers on their own.
That, uh, the thing I've been telling everyone I talked to, I learned that at dinner over sessions, is, um, a friend of mine at dinner had a contact at OpenAI and he said 49% of all chats are related to healthcare.
So like, that's globally and there's a lot, um, people are asking Chachi, pt, what does this symptom mean?
And then they're going to get their own lab tests down the street, and that's a trend that's gonna continue.
Um, and if you're in the industry.
We need to be more like patient centric, more patient facing in order to help them.
Right.
As opposed to tell 'em like, no, no, you can't do that.
Just trust the person in the white jacket in the Yeah.
No, I, I mean, look, I, I think, and, and, and I, I think that this story, you know, ties in with our, our evolving investment thesis.
That, that this is becoming more of a mainstream, um, model and, and, and, and more true first class healthcare, right?
Yeah.
It's starting at really expensive concierge, like a lot of things do, like, let's take cell phones.
I mean, that's right.
Cell, everyone's in the eighties only really wealthy people had them.
But then, you know, it sort of filters to be more effective, less expensive, more broad based over time, and that the same thing will happen here.
Yes.
Alright.
I'm gonna turn this next story to you from the Washington Post about, um, how to stop the number one killer of Americans long before any symptoms.
This is, uh, you know, personal to you and also, uh, you know, a big focal point of your, your new book, uh, which Congratulations was published this week.
Um, yeah.
Uh, elevate his Health 2050.
Uh, so, so, you know, talk a little bit about this.
Yeah.
So I have heart disease and um, I had a real wake up call when a lab test, you know, at, at HCA where I go suggested that I needed further testing and 50% of my whittle maker vein, you know, which is called widowmaker 'cause it kills a lot of people, um, is blocked.
That was their wake up call.
And so I did a whole series of health further around diving into heart disease.
Um, and then when I wrote my book, I, and you know, it's kind of a policy book.
It's, it's ai, post ai, what should healthcare policy be is sort of the quick summary.
Right.
And it's pretty abstract.
And so for nine chapters I talk about like what I think health policy should be really around sort of focusing on values and getting outta the political fights.
But it's very technical and I tried to make it approachable, but it's it's healthcare policy.
And so I ended with kind of a moonshot project to end heart disease in 10 years and laid out, uh, kind of a plan to do that.
And then in the Washington Post, uh, there's this article today, which is four days after the, they must have read my book quickly.
Um, 'cause the book only been a couple years, but this guy, Steven Nien, I guess at Cleveland Clinic is saying the exact, exact, uh, exact thing the book's saying, um, which is, if we could just screen people earlier.
I called for screening every one of our 35 with a very inexpensive calcium score.
He says in this article, you could reduce death of heart disease by 80%, which is incredible.
I was calling for an end to heart disease 'cause that sells more books, but 80% is, there's a lot of deaths.
900,000 people died of heart disease in 2023.
And so 80% of that is 700,000 people.
And the reason is we're, we are designed as a health industry to assess risk of death from heart disease in the next 10 years.
I'm 55.
I want to live much more than 10 years.
So, so the 10 year risk is not very material to me.
I don't care about that.
I don't want to die of heart disease at all.
And we just need to fix that.
Yeah, okay.
And it would save a ton of money and save a ton of lives.
And so it's great to see the Washington Post, you know, support my book.
And, uh, I'll send them some recognition.
Uh, I mean, you know, to me, there, there's a little bit of a continuation of, of the conversation we had last week around, around screening, right.
Um, yeah, I, I just, I, I can't stop feeling that this is such a, such a simple, simple risk reward, um, pro con trade to make, uh, you know, and, and that is not to say that the trade does not come with false positives and, you know, a, a bunch of things.
There's no question.
But I, I just kind of go back to, but what, what is the cost of every miss or undiagnosed person's life?
You know what I mean?
Like, like what is the cost?
Yeah.
You know, what is the cost of e every one?
Every one, every single one, you know?
Um, and I just think it doesn't get enough weight when we're, when we're evaluating cost, you know, benefits, right?
Yeah.
Of, of, of doing this kind of stuff.
And there's low, I mean, we're talking about low hanging fruit in women's health.
There's low hanging fruit here, right?
The, the, the cost of a calcium screen,$80, and it's, it's as much radiation as you get when you're flying airplane.
So it's not that there's no risk, but if you, if you go on a trip vacation, you're, you're getting the same amount of radiation, right?
And that's it.
And it's a binary score.
You either have calcium in your arteries and therefore have heart disease, or you don't.
And then we can triage people and say, okay, if you have heart disease, we should get you into care.
And if you don't, then it is about a 10 year warranty.
You don't have to worry about heart disease for 10 years.
It's an easy one to pick.
It's a low hanging fruit, and it's the number one killer.
So we, you know, we should, i, i com completely agree.
And of course I'm highly supportive of you, you know, getting this word out because it's, it's personal to you and, and you know, obviously as your partner and you know, long-term friend, uh, you know, I hope we, you know, we're, we've been friends long enough that we're lifelong friends, but I hope we're really lifelong friends, you know, and, and, uh, I hope our lives live a long time.
Yeah, yeah, exactly.
And that, that's, that's dependent on you, you know, uh, you know, winning, winning this battle against heart disease.
Right.
You know, that's, it's, that's part of the deal.
Well, and, and I mean, I, I have my cholesterol under control in good shape, but, but, uh, that's because I was lucky enough to be at a, you caught it really good primary care doc who caught it.
Yeah.
You caught it, you caught it.
It's not, it's asymptomatic.
You don't have any symptoms.
Um, so it's.
Something I'm passionate about.
So thanks for letting me share.
Yeah, absolutely.
Absolutely.
Um, okay, so we are now doing our one story on, uh, Web3.
I, I, I continue to, in my head.
Commit to helping you curate stories on this space.
But I do think if we're gonna pick one, this is the story to pick.
Yeah.
Um, New York Stock Exchange owner to invest up to $2 billion in poly market.
So for anyone who's been living under a rock poly market is, um, a wisdom of the crowd platform that leverages gamification and betting, um, to generate predictions around what is going to happen in the world, in the real world.
And it grew in prominence as it predicted far in advance of any of the polls, the election of President Trump, um, in, in the last election.
And, uh, it has not been very much, uh, present in the United States because of its ties to Ethereum, cryptocurrency, um, and how that fell afoul of the Biden administration's regulatory.
Um, agenda.
And so it's making its way into the United States.
Um, and this investment, I think, really sort of solidifies that Intercontinental exchange, um, is investing $2 billion in poly market.
They would not do that if they did not believe that poly market was going to have a clear path to be fully available in the United States.
And so I think this, this, I, I think the, the point here is that, is that our listeners need to get ready for poly market, um, to be a real part of their lives, right?
In the same way that the news and polling is part of your life.
Poly market is, is, uh, is, is about to be, uh, a cornerstone of the way that we think about how the future's gonna play out.
Yeah, and I love the picture too.
We just maybe scroll up a little bit.
You see Shane from Poly Market and Jeffrey, they mean they, they couldn't represent their relative companies any better.
I mean, you know, Jeffrey's super buttoned up and older, and then Shane's, you know.
He's great.
He's, but he, but he's much younger.
He, yeah, he, exactly.
Zach, he's a hacker.
I mean, you know, like, yeah.
I, I, you know, I, I, I don't follow anyone on this, but he's in one of my lists and, and I saw a post where he had a picture of himself in 2020 from his office.
That was his, his bathroom, you know, and he was like running outta money, almost had to give up, you know, ended up betting it all, and you know, now look at where we are.
Right.
You know, with this $2 billion investment.
And I mean, yeah, you're right.
I mean, look at him.
He's a, he's a, he's a, he's an Ethereum hacker, right?
That's what he is.
And, um, and he's about to be the CEO, uh, of, of a company that's gonna be more important than Gallup.
Yeah.
Oh yeah.
But I mean, not, listen, I never look for Gallup results.
Yes, yes.
So that's, so it's just another sign.
We have one every week.
We're gonna start having more.
That Web3 is, is coming to change infrastructure.
Exactly.
Um, okay.
AI rundown, and I think we'll run through these stories pretty quickly here.
So two stories back to back on Microsoft, um, you know, Microsoft is, and, and, and related to healthcare, right?
So the first story is that Microsoft is, uh, pushing away from its dependence on open ai.
Um, and really, you know, deepening their focus in healthcare through a partnership with Harvard, uh, specifically Harvard Medical School, um, to roll out, uh, uh, uh, medicine specific, uh, ai.
Yeah, and it's, I mean, I, I think it's great to have Microsoft trying to catch up.
Uh, so they are a big partner with open ai, but, but have to, they hired, uh.
Suleman who's there in the picture, and they're, they're running now.
Hard to, to catch up, which would be great.
It's good for the market.
Yep.
Uh, and then the second story, uh, which is even a better story for me is Microsoft has released on GitHub, I believe, um, AI tools to help rural hospitals improve their financials.
So, you know, we all know that, that rural hospitals, especially, they were already, you know, embattled.
And then once HR one went through, it was kind of like, you know, dead man walking.
You know, we have this $50 billion, whatever you call it, healthcare, Innova Rural Innovation Fund.
It's not gonna save these hospitals.
Um, and, and so it, it, it really should be a all hands on deck moment, but we're also distracted with so many things.
It's such a, you know, challenging time.
Uh, so it's so cool that, you know, one of the biggest, uh, and, and wealthiest companies in the world, Microsoft is starting to, you know, give back in some way, shape, or form.
And they're providing a free, uh, openly available AI claims denial navigator, right?
Um, that is, is really can help these small rural clinics that can't afford any of this stuff, uh, to, to, to play the game with, with the big guys, right?
Because the insurers that they're dealing with are, are much, much larger than they are.
So, uh, to me, this is a, this is a great story and hopefully it's a model for how, um, you know, these technology companies that really are the basis of the American economy at this point, um, can give back to some of these industries that are going to struggle and, and really are gonna need AI to make it across the chasm.
No question.
And, and I think it has another positive, which is, well, first of all, Microsoft owns GitHub.
Not everyone listening maybe knows that, but it's fair point.
It's their properties.
Fair point.
I saw the story and I was not aware.
It, GitHub has, I think it's like 80 models available for free to try out.
In their model sandbox.
And so I, I thought, well, maybe I'll go check it out.
And, and now I'm using models on GitHub.
'cause it's fun.
You can, you can, you can't use a ton of tokens, but you can use enough to, to test several things.
That's cool.
And it's, I want to test all these models and, uh, use one API to test them all.
So I think it's a great thing to do for rural hospitals.
And they're also bringing awareness to sort of the power of GitHub in a way that is gonna be good for Microsoft.
So, yeah.
Awesome.
Uh, okay.
Moving to Bloomberg.
They've got a story here around.
NVIDIA's fast and furious deal making.
Uh, you know, the, the term I've just kind of heard over and over on podcasts as they're describing NVIDIA's deal making is circular deals.
Right.
You know, Nvidia gives you money, use that money to buy Nvidia chips basically.
Right.
Um, and, and, uh, but what I love about this article is that they have a fantastic, um, visual here to sort of, uh, help illustrate all the deals.
But what I love most about it is in this visual, and you can't see it if you're just listening, um, uh, but we'll, we'll put the link in the show notes.
What I love most about this visual is that it puts Nvidia at the center and, and that is what I think Gen Wang and the team at Nvidia are doing, is they are putting themselves at the center of the future of the AI economy.
By leveraging their unbelievable capital and their, um, chip availability to, to deeply integrate themselves in all of these different players.
You know, who people might consider to be, uh, you know, competitors, but they're just embedding themselves in all sorts of ways that ensure that over the long term they will be there.
Right?
Um, and, and if you think this thing is only gonna grow in the long term, uh, then you can see how Nvidia.
Becomes you, you know, I mean, who knows how valuable they're 4.5 trillion today.
So, uh, but it's, it's just, it's really, really smart.
Um, they're trading, uh, they're trading in the currencies of hardware, software, investment services, venture capital, um, and across organizations like Intel Core Weave, um, open ai, uh, uh, X AI figure, ai, mistral.
It's just, it's, it's, it's a brilliant way to not think petty in the small term and think about the future of the world and just say, I, they, I wanna be in all these companies, right.
You know, even the ones who could potentially, you know, create chips that would disrupt me in the future.
So it, I just think it's, it's brilliant.
Yeah.
I, I agree.
I mean, they, first of all, it may be a circular, but they have like 85, 80 7% margins.
Yeah.
So, you know, like, yes.
They, they give 'em a hundred dollars and they use a hundred dollars to buy chips.
But, but that revenue is high margin revenue.
So Nvidia will do fine.
And then they're also getting everyone, I mean, CUDA is their, like software that connects it all together, that if you're gonna train a large model with Nvidia, you need to use, they're just gonna standardize like their chips and their software as the defacto standard for the whole market.
Yes.
And that's, that's also good for Nvidia.
So they'll they'll be fine.
The circular deals will work fine.
Yeah.
Yeah.
I, I, I, I, I do understand why they annoy everybody.
Um, but I think if you think about it as a strategy for Nvidia to ensure that they are integrated in all of these companies in very strategic ways for the long term, um, it's, it's really, really smart.
It's really smart.
Yeah.
It's, I think it's a little different than when we were putting broadband out there, because broadband, you know, that maybe there's some proprietary aspects, but it was a lot of.
Commodity based stuff.
Yeah, agree.
Build out the internet.
Agree.
Um, okay.
Going into some open AI stories.
So the first one, OpenAI, is reversing the stance on the use of co copyright works in soa.
So for anyone who didn't know, um, OpenAI just said, Hey, you have 48 hours to, um, you know, say no to your copyright.
Uh, or we're just gonna use them.
And I mean, obviously, you know, this is just ridiculous.
Like the idea that you were required to opt out by default with 48 hours is just, uh, you know, it's, it's just not even whatever.
I mean, these, these are the things that just make me not just not be a, a fan of, of, of this company in the sky.
But I, I don't know.
I'm sitting enough to think it was, I, I think it was planned the whole time.
It, it helped the launch go.
'cause you could have how to train your Dragon Dragons in the launch.
And then once the launch is successful and they have the number one app out there.
Then they pull it back.
Apologize, move on.
I think it was calculated.
Yeah.
I I, you're probably right.
That right.
I mean, I have no evidence of that.
No, no, no.
Listen, you're probably right.
And, and, and like, you know, did we need one more thing to be angry about right now?
You know?
Right.
Just not a fan.
Um, OpenAI a MD announced massive computing deal marking the new phase of the AI boom.
Um, so this is interesting, uh, bringing a MD into the picture, uh, you know, little known fact, uh, AMD's, the CEO.
Lisa Sue is, uh, the first cousin once removed of Jensen Wang, and so, uh, you know, sure.
I guess Nvidia and a MD are two different publicly traded companies, but I bet their family office is doing just fine.
Um, and it's, it's, it's hard for me to, you know, it's just, it's just like a simulation we live in that, that that's actually the case.
Mm-hmm.
Um, but, uh, but yeah, look, I mean, everyone is, is making sure that they don't have a singular point of failure, um, whether it's at the chip layer or the model layer or the power layer.
Um, there's a lot of, uh, you know, a lot of partnerships being struck and, and I think to some degree that's kind of an, uh, you know, all boats rise environment when there's not overdependence or too much trust in any one of these partnerships.
Yeah, yeah, that's right.
I mean, it's, uh, it's good for open eye to have other suppliers, but I, I don't think AMD's a competitor to.
It's just sort of like other inference stuff.
Yeah.
Yeah.
And, and, and I mean, the, the, the headline here is that open, open AI through this commitment will, will, um, achieve 10% ownership of a MD if a MD hits their, their milestones for chip deployment.
So, you know, it's, it's, it's incentive based.
It's an opportunity for a MD to, you know, get back in the game with the leading model in, in, in the United States right now.
And, and, you know, we'll see, we'll see how it goes.
Um, OpenAI announces their apps, SDK, which allows chat GPT to launch and run third party apps like Zillow, Canva, and Spotify.
So we're, we're, we're starting to get, uh, we're, we're getting very close to, to agentic AI being real.
Yeah.
This was a big announcement to me like.
Leveraging their user data, which is they have 800 million weekly users, which is a yes.
Big number.
I am not one of them.
Um, I'm, I'm not a weekly user.
I am, I am, I do pay them 20 bucks a month, um, just to see what they have.
Yeah.
I, I, I, I pay them.
I just, I just am not a regular user, but Yeah.
You don't use it weekly, right?
Yeah.
But the memory feature, which I have turned off, um, people love and, and it, it collects information on you as you're chatting that then customizes personalizes it for you.
Of course.
Um, that's super sticky.
It's also, you know, giving them everything about you.
And then they use that to sort of, uh, allow these third party developers, which will be small startups eventually, but now it is the big guys, Zillow, Canva, Spotify.
To deliver an in, like in chat experience where you could play music or, you know, design a, the example they give is design a flyer for your dog walking company.
Um, I think it is, it's really smart.
I mean, they're going to be able to leverage this massive user base to pull in a bunch of app developers, and then they have, they have all the data that it's flowing through them so they can see which sub-markets are profitable.
It, we were talking earlier, it reminds me of, of Facebook in the, in the mobile space where, um, they brought the users and they convinced all these app developers to build on their platform, which worked for a while until they decided they wanted to make more money and then, then they just took the profitable areas.
I don't know.
It's, I see the value and it also is scary because it's, it's happening quickly and, and they could run the table where they have all the users.
Yeah, the, the, you know, I think OpenAI is a company that presents like Apple, but is actually like meta.
I am so leery of their privacy, uh, and data, you know, um, practices.
And I'm almost sure they're going to, you know, the, the, the number one thing I'm hearing about OpenAI, uh, that is really concerning me is that startups are more and more referring to them as a discovery engine.
Um, because, because they're, they're starting to take over such a big percentage of search, right?
Um, and that just tells me they're not, they're, they're gonna, they're gonna pick the winners, right?
And, and they're gonna start to also sell ads.
Um, I think, I think that's, that's almost certainly they, they, they have to generate more revenue.
Uh, and so if they're really gonna take a chunk out of Google, um, it's not enough to just take the search traffic.
You have to, you have to also take the ad revenue too.
Um, and, and.
I'm sorry, but you know, my history is that, uh, you know, where, where, where, where I think Google did a great job was they offered an enterprise product with proper enterprise protections that you could pay for.
And you were, you sort of were opted out of all of the, the ad engine stuff that they had to offer.
Right.
Um, and, and that's, you know, and that's not true with meta.
It's like if you're in meta, you're, you're part of the product.
Um, and it just feels to me that if you're in open ai, they haven't proven to me otherwise.
You're, you're part of the product, you know, that's my beef with them, you know?
Yeah.
And I agree completely, and it's a big, big momentum that is running in one direction.
I mean, 800 million weekly users are a lot.
Oh yeah.
Oh yeah.
No, they're, they're gonna be huge.
They're gonna be huge.
But every, but, but the beauty thing, the beauty of it is I. They don't have an a monopoly, right?
I mean, like you, you have the option to use perplexity or Gemini or GR or whatever, that there are other very, very viable alternatives.
So that's if there was a bright spot Oh, yeah.
Today, you know, which, which is not true in social networking, right?
I mean, like, there's not an alternative to meta.
Mm-hmm.
You can't tell me TikTok is an alternative to meta.
TikTok is an entertainment platform.
It's not a social platform.
If you want social, you're basic, you know, you're, you're either on meta or you're on X.
This is not two great options, you know?
So what I love about the, the frontier model world is we've got Anthropic and Daria, like, you know what I mean?
Like you could be with Yeah, we could be with the nerds over on clo.
Yeah.
And it's, it's great.
It works great.
It's great, you know?
Yeah, yeah, yeah.
That's right.
Alright, let's talk about Elon and Memphis.
Uh, I mean, unbelievable the, the relationships that Elon must have in Tennessee, uh, to, to build out what he's building in this state.
You know, not just the data centers in Memphis, but also the, the boring tunnel, building a tunnel underneath Nashville, Tennessee.
But, um, let, let's, let's talk about what, what he's building with Colossus in, in Memphis as, as a, as the data center that will help Xai, you know, um, win the AI race.
Yeah, so he's spending 13 billion in cash this year, and most of it is going into Colossus two in Memphis, Tennessee, in chips and infrastructure and energy.
Um, it is called Colossus.
It is a huge operation and the biggest data center connected altogether in the world, and he's betting that that will lead to.
A much better large Anish model.
Much better because it, the scaling loss have always kept up in the past.
I don't know.
I mean, it is a pretty good bet, but it's, yeah, it's going on in Tennessee.
He just moved into Tennessee like a year ago, a year and a half ago maybe.
Yeah.
But he is been building a lights.
He's the number one corporate, he's says number two, ta taxpayer corporate taxpayer in, in Memphis after FedEx.
Um, but there's not a lot of jobs being created.
It, there's a lot of tax base, but not that many jobs.
And also a lot of power usage and a lot of water demands and a lot of concerns about pollution.
Yes, that's right.
So yeah.
Now he did, he is sending some of his employees to walk around Memphis and pick up trash as he's, you know, using the water at a pace that no one else does.
So, I mean, Elon knows how to like, do some local, uh, local stuff, but, but it, yeah, it's, it's.
It's a huge place.
This, this, this world is, is just, it can't be real.
It can't be real.
Yeah, that's right.
Uh, Intel debuts a new technology and make or break moment for the CEO's turnaround bid.
I was super excited to see this.
I'm not technical enough to know, uh, if it's gonna work or not, but, but they have created a couple things they claim are breakthroughs.
There's certainly big innovations in chip design that are gonna allow them to compete with, or, or they would say, uh, try to try to unseat Nvidia something about how they're delivering power to the circuits.
It's on the backside of the chip, which is good for heat dissipation somehow, um, much more efficient.
It, it doesn't matter.
They, they are pushing this and it's great to see that again, this competition.
It's not gonna be a one one horse market.
Mm, mm-hmm.
Anthropic and IBM are partnering in a bit for AI business customers.
So, you know, this is, I think great because, uh, I think IBM is one of those, uh, not much thought of really, really strong, um, IIC consulting companies.
Right.
And, and they have really strong, longstanding contracts.
Uh, and they bring in partners.
I mean, they, it's, it's been a long time since they've created any great technology.
Um, but they do bring technology into the enterprise and it's usually, you know, um, alternatives to the traditional, uh, you know, Microsoft offerings.
And it's great to see anthropic and, and IBM be in partnership here 'cause this means Anthropic is gonna have an enterprise, you know, uh, chance at, at being viable.
Yeah.
Yeah.
That's right.
And, and to your point about, um, Google having enterprise.
And OpenAI, not meta, not they announced their Claude Enterprise in September.
So, um, they, they, they're ready to go with Enterprise and it's, it's, as you said, I mean, it's sort of, you pay more, but then it's, it's your own data.
You're not getting served ads and, and.
They're not funneling the data out to target an ad at your house.
I think it's, it's great to have 'em come together.
Yeah, agree.
The, the CO IC le letter, um, this is a, uh, this is a, an X account that, that you and I track, and every once in a while they've got something that we gotta bring to the show.
This graph that they have here.
If, if you're not watching, you definitely need to click on the link in, in the show notes.
Um, it really shows that, that the, the demand.
For, for compute that this AI race is creating is, is making it to where, you know, we, we, we had this whole industrial era where the, the engine, um, was, was critical for productivity and oil was, was really what drove that.
For a while there you had people talking about data being, being oil.
Um, but I think that was, you know, maybe data was soil as opposed to oil.
Uh, compute is oil.
Um, the demand for compute is growing twice as fast as chip efficiency.
And so that sort of underscores Elon building out Colossus the growth of so many data centers happening around the world.
Um, this is the currency.
Do you have compute, you know, you were just talking about, um, access to tokens.
You know, tokens are really just, um.
In, in themselves that they're actually just a representation of, you know, access to compute.
Um, and I, I can tell you, I think most people have not wrapped their head around, uh, compute as, as fuel, right?
For, for the ai, as in that access to this compute is going to become an incredible war, right?
'cause whoever can get the most compute can, can power the most ai, um, to win at the end of the day.
I remember, uh, back before you and I started working together, back when I was at Emma, um, we, and you used to, like, this is before cloud computing, when you start to put your, your rack, uh, together.
Yeah.
You had to physically go and put it in.
Yeah.
Yeah.
You had to go in there and you had to put your servers in a rack and literally plug them in.
And so we were, we were down at, um, inflow.
David Clements was the CEO at the time.
Um, interesting of that, of that data center.
And um, you know.
We had this rack, and I remember Vanderbilt like bought all the power in the, in the data center.
They like, they did a contract with influence and they bought all the power.
And Vic, we had a rack, I had space to put the server in.
I could not plug the server in.
So you had to pull it out.
I mean, I, no, we had to move to another data center.
That's what I mean.
You had to pull it out and go somewhere else.
Yeah.
Yeah.
Because you couldn't get the power.
Yeah, yeah, yeah.
We couldn't get the power that Vanderbilt had bought all the power.
Right, right.
And so, and so that's a scenario, that's a scenario we did not anticipate.
And, and it really happened.
And so, um, I think it's important for people to understand because compute is going to be this highly valued commodity.
There will be wars over access to it, and we just all assume we all have access to these AI models today.
This is, I don't think this is like.
Built in assumption.
It, it, it is limited.
Compute is limited.
Um, and, uh, I I think over time as we start to maybe run into compute shortages or compute cartels where groups are just sort of like hoarding all the compute, you know, you could look at like the Bitcoin, um, holding companies or like holding all the Bitcoin.
Um, it could mean, you know, compute inequality could become a problem.
Yes.
So, yes.
You know why I just wanna introduce this, this concept to people of like, compute is the, is the core commodity here, folks.
That is why Elon is building Colossus in Tennessee where there's relatively inexpensive power and he can leave the Virginia, San Francisco, Texas, and.
Get better access.
Uh, but that's why open Eyes doing Target and Oracle's doing all the thing, it's gonna be the coin of the round where the, the most important thing, and one of the great things about our free market, uh, kind of capital markets is they can, they can gather capital and get it in the right place relatively efficiently.
Um, but, but we have been hampered in power generation because it's dirty and bad for the environment and difficult.
China is way ahead of us in that.
We'll get to a quote on that in a minute.
Um, but, but there's gonna be a lot of data centers needed.
I mean, we, I thought we were building a lot of data centers and this down, further down, we don't have enough data centers.
There's gonna be more and more that need to be built.
Um.
So I think the message is like, strap up because it's gonna get more so not, not less so in the next two years.
Yes.
Um, okay.
Next post is also from X, uh, Brian Ramel is, uh, sharing a rundown of Jensen Wang on CNBC.
I really love the way that he has, um, synthesized what Jensen talked about, but it's, it's great.
Jensen talks about, um, AI as a stack, and he's being interviewed and he is being asked how, how far ahead is the US from China?
First of all, it's a pretty presumptive question.
You know, it's a leading question.
It, it presumes we are ahead.
But, um, you know, she's asking him how far ahead is the US from China?
And he gives a fantastic answer, which he says it depends on what part of stack you're talking about.
So he says, you know, fundamentally energy, China's way ahead of us on energy.
We are ahead on chips.
China's competitive on infrastructure.
Um, China is competitive on AI models.
We have the highest performing models, but they've got the best open source models.
Um.
We have more regulation, they have less regulation, so they're iterating faster.
And where he really sort of gave them the true edge.
So at the end of the day, like at the bottom and the top of the stack, they're actually ahead.
The only place where we're clearly ahead, he said, is chips.
Um, but the top of the stack is applications.
And what he said is it's, and, and this is true man, you know, it's, it's impossible for Americans to really understand because we don't go to China, um, how rapidly their society adopts.
Technology and adopts new innovations and um, and, and they are an engineering led society, not a lawyer led society.
Right.
Most of their leaders, um, have engineering backgrounds.
Most of our leaders have le legal backgrounds and so we sort of focus on courts and regulations and, and things like that.
And they focus on building, building, building, and um, and they just have more apps in the wild that are actually working.
Um, so who is more likely to build the first AI enabled hospital?
China.
Right.
Um, yeah, no question about that.
You know, and, and, and, and the thing is like the US is a head on chips, but because China is a head on open source models and as we've covered so many times, they've figured out ways to do more with less.
Um, it's like how big of an advantage is even being a head on chips.
That's, that's a, it's, it's debatable, right?
I mean, if you've got the energy, you've got the open source models, you've got no regulation and you adopt and adapt applications faster, who is actually ahead?
Yeah.
I mean they, they are gonna lose on efficiency.
Our chips are more efficient, but they have more energy by a factor of 10 probably.
And they have open source models and plenty of good chips and better models and their competitive markets are brutal.
And that makes like their entrepreneurs and their business executives really battle heartened and really strong.
Yes.
And we are not ready today to compete with them.
So, I mean, I think, I think we jenssen's right?
We have plenty of work to do.
I mean, we have some advantages, but, but we need to.
Pay attention.
'cause they're going to, they, I mean the thing I always get comfortable with that we would win in the end with China is their population is aging.
They don't have a big group coming up Yeah.
As far as young people.
But with robotics, they, I'm not sure they're gonna need that anymore, so.
Right.
It may not matter.
Um, and that's what's gotten me really nervous in the last few months.
Alright.
We're ending with Bernie.
Bernie stands apart from much of the gerontocracy because, um, he seems to have more of a pulse on.
You know, young people, younger generations and technology than most of the gerontocracy.
Uh, I, I, I will give Trump credit that, that I also feel that he is not, uh, sort of your typical, uh, geriatric, uh, you know, people are talking about his health and his age a lot, but he still resonates with the youth and, and the youth understand him in a way that, you know, uh, Pelosi for example, does not, and Joe Biden, quite frankly do not.
So, um, but Bernie Sanders does.
He does, uh, and he is warning that AI could erase a hundred million jobs and he's taken to YouTube and sort of put together this entire explainer about this with his own policy recommendations.
Um, we're going to share the link to both the article from Emerge as well as the YouTube link.
Um, and I don't know that we believe that his policy, uh, is exactly correct.
What I think is fantastic is he's saying the quiet part out loud.
Um, and this is something I think Bernie has done a great job of doing throughout his political career, is saying the quiet part out loud, saying the part that that, you know, if you're in a party, the party line may not quite allow you to say this is the value of him being an independent is he can simply say the thing.
Um, and you know, we started this show with about a 10 minute discussion around, you know, AI and jobs and I think we were trying to right size for where we are today, but inevitably.
We're clearly in a place where if AI can wipe out certain segments of the economy, it is marching towards a future where it can wipe out whole layers of the economy from the labor perspective and to to, for our politicians in both parties, to, to not take that potential future seriously.
Um, by communicating it in the way that Bernie has here, uh, is, is shameful actually.
And so I give a, a ton of credit to him for at least saying this is a very possible future.
It's a very possible future.
And, and our leaders have to start seriously discussing what types of policies we would put in place in, in an economy where we would have that kind of, um, labor collapse.
So I just said a whole bunch.
What, what do you gotta say about it?
Yeah, I, I agree.
I mean, I think everyone listening should watch.
It's a 12 minute video on YouTube.
It's not, not too long and burn.
I mean, the picture here, he looks, you know, he is wind blowing thing.
Yeah, there he is.
I mean, he is, he's very sober.
Mean, he describes the situation, I think pretty well.
And then he has a plan to protect the citizens of the United States, which is his job to do.
Right.
And I think whether I disagree with parts of it, yes I do, but I'm happy that someone is taking their job seriously and trying to protect the people, the humans, because no one else seems to be doing it.
And so I think, uh, we need to start having these conversations.
And some of his ideas are right, some are extreme, it doesn't matter.
We need to start understanding.
You know, this is an ex exponential curve.
I mean, it's the reason I wrote my book, like what happens in healthcare when we have a four order magnitude increase in capabilities, right?
So it is 10,000 times better.
How do we think about allocating resources to the population in that setting?
And, and that's a few years from now, that's five years from now, 10 years from now.
And so we're all gonna be alive then.
And we need to understand, yes, it's gonna affect jobs negatively.
It's all also gonna have a lot of really positive effects.
And people should listen to Bernie.
'cause the Democrats are going to be, they're gonna have a populous movement, and it's the only choice they have gonna look like this.
It's the only choice.
And it's, it's the only choice they have.
Yeah.
And, and it's gonna be a. A compelling opportunity for a lot of voters.
They're gonna win a lot of elections.
So this is sort of a precursor of what's to come over the next five years.
Bernie is too old to run for president next time, but people are gonna listen to this and there'll be, I think there'll be a movement in Democratic Party that is, you're seeing it in New York right now, and it's gonna be more like this.
Yeah.
Agree.
Agree.
Um, okay.
Uh, long show, good show.
Uh, lots covered, lots discussed.
And, uh, hopefully next week when we come back, there's some.
Progress on this government shutdown.
Hopefully, uh, something we didn't talk a whole lot about or really at all.
Um, but hopefully the, uh, the peace talks in the Middle East actually stick.
It's a little early to sort of say that this week, but I think by next week we hopefully we'll have some indications that, you know, things will be, you know, receding and, and that we'll, we'll put an end to the, to the violence in, in the Middle East.
Um, and uh, you know, hopefully you and I will be back to do another show.
Yeah, yeah.
I hope.
I hope so.
I hope so too.
Uh, alright man.
Thanks for putting it together as always.
See you next week.
Yeah.
Okay.
Bye.