Health:Further

Marcus and Vic unpack a turbulent week of global and economic shifts — from the Israel-Palestine ceasefire and U.S. government shutdown to rising layoffs, job stagnation, and Wall Street’s growing fixation on AI. They dive into China’s rare earth dominance, Trump’s trade maneuvers, and the growing tension between free markets and government control. In healthcare, they cover California’s crackdown on PBMs and private equity, telehealth funding freezes, labor strikes, and AI-driven innovations...

Show Notes

Links

2:25 - The Unofficial Jobs Numbers Are In and It’s Rough Out There WSJ

5:08 - Strong Bank Earnings Push S&P 500 Higher WSJ

6:42 - China, Betting It Can Win a Trade War, Is Playing Hardball With Trump WSJ

10:46 - China’s Rare Earth Restrictions Aim to Beat U.S. at Its Own Game NYT

12:11 - The Small Company in Europe Caught in the Big Trade War Between the U.S. and China NYT

19:15 - Powell Keeps Fed on Track to Lower Rates Again WSJ

23:24 - Seattle startup Brook.ai raises $28M to expand remote care platform GeekWire

25:45 - OutcomesAI raises $10m seed funding for AI nursing model Hospital Mgmt

28:34 - WellTheory Raises $14M to Expand Autoimmune Care Platform MedCity

29:29 - Vega Health launches out of stealth to help health systems purchase, monitor AI Fierce Healthcare

30:17 - ŌURA Snags $900M to Expand Smart Ring Globally MedCity

31:42 - California passes laws targeting PBMs, private equity Healthcare Dive

33:52 - AstraZeneca Strikes Drug-Pricing Deal With Trump Administration WSJ

35:32 - Medicare telehealth, hospital-at-home payments on hold Modern Healthcare

39:05 - Big Changes Are Coming for 2026 Medicare Plans. What You Need to Know. WSJ

40:57 - 31,000 Kaiser Permanente workers begin strike in Northern California, Hawaii Healthcare Dive

42:55 - To Find Workers, Hospitals Are Training Teenagers WSJ

45:07 - Hims & Hers to Offer Treatments for Menopause, Perimenopause WSJ

45:31 - Jefferson Health laying off roughly 650 employees amid 'significant financial headwinds' Fierce Healthcare

47:18 - Novo Nordisk to Acquire Akero Therapeutics for Up to $5.2 Billion WSJ

48:06 - Johnson & Johnson to Split Off Orthopedics Business WSJ

49:55 -

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What is Health:Further?

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

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.

Alright.

How's it going man?

It's good.

Another week.

Things are good here.

Nashville.

Yeah.

Beautiful weather.

Nice.

So I went to a, a, uh, musical here at Outsiders is in town.

Uh, one of our friends, I'm not gonna dox him, but one of our friends is a co-producer, so That's cool.

And it's Answorth, it's Answorth guy that, uh, he's a sophomore in college, uh, went to Answorth, so he is pretty young.

He's the, like, the star of it, which is cool.

Oh, that's awesome.

Yeah.

I I had no idea.

That's very cool.

Um, government's still shut down.

Yes.

Yeah.

And, uh, you know, it's been, it is been, it's been a, a another interesting week.

Uh, I think the, it feels like.

It's hard to pick out a main story, but I think you have to choose the, the, the ceasefire and the return of the hostages on, on both sides.

The hostages and the prisoners.

Yeah.

Between Israel and Palestine.

I think you have to sort of call that out as the, the moment of the week.

Although there, there were so many news moments, right.

I mean, to be fair, um, there were so many things that happened over the course of the last seven days.

It does feel like we are headed towards a prolonged government shutdown.

For the reason I think we discussed last week, right?

Which is open enrollment hits in two weeks.

It does seem that, uh, the Democrats have another two weeks in them to let these these rates roll out.

It, it, there's more and more rumblings about the reality of how much more the rates are gonna be.

I guess even Marjorie Taylor Green is, is talking about how much more the rates are gonna be for her case.

Yeah.

So, uh, it, it does seem, yeah, we have a story about it.

We have a story about it later.

Yeah.

This mean, there's starting to be, not exact details, but pretty good estimates of what it's gonna be.

Yeah.

The, the, yeah, I mean the, the, the calculus that, that I, I got wrong the first time, uh, but then last week I finally got clued into it.

Uh, I think it's, it's starting to play out, so, um, so yeah.

We'll, we'll, uh, we'll, we'll see where this all goes, but we've, we've got a long show and, uh.

You know, let's, let's, let's try to keep it shorter than we did last week.

Alright man.

So let's stick in.

Alright, so let's start with the, uh, the jobs numbers.

So these are unofficial jobs numbers, you know, not that many people are trusting the jobs numbers right now.

We, we've been covering it ever since the BLS had its, uh, revision, uh, of about a million folks.

And, and now, you know, nobody really trusts any of the numbers.

We're seeing data sets kind of drop out, uh, from, from government availability.

But we do have some unofficial job numbers and, uh, they're not looking great.

Yeah, and I think, you know, we all kind of feel, at least I feel it every day.

It doesn't seem like it's a really healthy job creation environment.

A bunch of private equity firms and banks who have large access to, you know, large numbers of companies or, um, people that are.

Money on deposit with banks are providing different views, but it's all lukewarm to somewhat bad.

Yeah.

And, and, and in fact, I mean we, we, it feels like we are in our third straight year of, uh, layoffs kind of being, uh, par for the course and continuing to be celebrated by Wall Street.

I I, I am curious at what point Wall Street is going to look at these, uh, layoffs and realize, uh, who's gonna buy the stuff.

Right.

But it, but it feels like we are just all in on AI data centers, new forms of energy.

We're putting all pricing.

There seems, seems like, uh, nation states are debasing their own currencies to print money to invest in this stuff.

That is the, the economy of the future.

It's, it's.

You know, I mean, I feel like if you, if you're not in the capital allocation market evaluation space, you may be questioning the reality of this, but I don't see how you can possibly question the reality of it from our seek.

It's so blatantly obvious that, um, capital is putting itself behind the, the elimination of human jobs and replacing it with, with artificial intelligence.

And, and you could, you could say the reasons are for, um, productivity gains, we're going to empower people to do more with less.

All these, all these different things.

But the, the net result in the short to midterm is a lot of lost jobs.

Yes.

No question.

I mean, we were kind of early on this, I think, but now, I mean, most of the country, I think is aware that there's not, not a lot of hiring going on.

I mean, there aren't, there aren't big layoffs yet.

We haven't seen significant layoffs, although there's a couple stories this week.

But, um, that's gonna be the next, uh.

Thing that happens, maybe, I don't know.

We'll see.

Yep.

Agree.

Strong bank earnings, push the s and p 500 higher.

These banks are, uh, the, the big banks, the six large banks.

Yeah.

First of all, they, uh, they have diverse business lines, so that's great.

Um, they kind of do well no matter how the market is doing.

Right.

I mean, I think about how well they did when, uh, SVB tanked and we were in the middle of a bank crisis and they started just picking up assets for almost nothing.

You know, the Fed is obviously there to support them because they play a critical role and, and, and expanding the fed's mandate out into the general public and, uh, and their trading capabilities.

You know, they're, they're being pretty quiet about it, but you know, they have to have some of the absolute best quants and the best AI technology helping them to trade right now.

Um, and so they are just crushing it quarter after quarter right now.

Yeah, and I think the deal activity is back.

IPOs are coming back.

Mm, yes.

Goldman Sachs for sure.

Yes.

Right, right.

Yeah.

So, I mean, this is the Khap economy.

I mean the Wall Street banks, this isn't your bank down the street, bank of America, JP Morgan, Goldman Sachs, they are killing it now, and they're the first to report.

So then we'll have healthcare, the tech group will report sort of in the later in the cycle.

But in general, every, you know, so far, the s and p 500 and even the Russell uh, earnings are really good.

So that's sort of the story.

The earnings are strong, stock market's strong, but we're not creating many jobs.

Yep.

Agreed.

China, but, you know, talks about big stories this week.

I mean, China and Trump and the tariff trade war was another really, really big story this week.

It, it triggered all sorts of different reactions in the market, depending on what statement, uh, Donald Trump put out on true social.

But clearly, uh, we're, we're starting to see that, uh, China is very formidable.

We, we've, we've known for a long time that they've got the upper hand when it comes to manufacturing.

Um, they're starting to flex some of their muscle around rare Earth.

And I think also, like, quite frankly.

While they've been very retrenched and very calm, um, and we're not talking about a true military war, but underneath the power of the dollar and the economy is the military.

Uh, I mean, their military is extremely powerful right now.

Right.

And, um, you know, we're, we're starting to hear rumblings about how we, we wouldn't do very well if there, if it, if there happened to be a conflict.

And of course, that plays a role in the ultimate, um, you know, negotiation and, um, and, and horse trading that goes on between, you know, these two superpowers.

And so it's, uh, it's, it's interesting.

We're seeing best in doubt.

They're making really, really strong statements around the trustworthiness of China.

Vic, what's your, what's your take on all these things?

I mean, I think this is the process that is a kind of preliminary actions before an actual, you know, hot war, right?

This, this is like a Cold War ish.

It's, it's economic fights.

It's a lot of, um, I don't know, political arguing back and forth.

Yeah.

Kind of, um, posturing, you know, China is the rising power and unfortunately, and I wish this wasn't true, but America is the, the existing incumbent, maybe declining power.

Maybe we will have a resurgence.

But we won World War ii and I think World War II all also started with economic fights at first, before it sort of escalated.

We won World War ii 'cause we could manufacture our, our, our economic base was much stronger than, than Germany, Japan.

We just had more capabilities and we're in the, we're in the reverse position today.

Yeah.

I, I think that's right.

So, you know, ultimately, I, I think a lot of these words are used because we are, um, you know, look, I think Trump is coming off of.

A big political geopolitical win, I should say.

Um, in terms of, uh, being able to claim, uh, credit for, uh, the ceasefire in the Middle East Yeah.

And the return of the, of the hostages of the, the final return of the hostages.

I think that he is leveraging that momentum in that moment, uh, into a horse trading, uh, exhibition with, with, uh, president Xi.

I, I, I'm not, I'm not confident, um, that this is the, the real precursor to the hot war.

It feels like a couple of jabs being thrown by both, but neither one is really sort of ready for the, for the real full conflict.

Oh, yeah.

I agree with that.

I, I don't think we're imminently gonna start that.

Yeah.

It's actually, I sort of think that.

Um, Trump's calculus, and I have no direct data, so this is just me just sort of guessing, but I think his calculus was every year China is getting stronger.

Yes.

With the trade balance as it is now.

And we have to bring manufacturing, you know, back into existence in the us We need to reinvigorate it and the longer we wait, the weaker we get.

Yeah.

So let's try to like start now.

Uh, and I agree with that.

His style is, is not my style, but I think he's right that we need to start creating manufacturing capacity here.

Yeah.

I, I think, I think all of that is true.

So this next story from the New York Times, China's rare earth restrictions aimed to beat the US head its own game.

Last week we were talking about the soybeans and the farmers.

That's, that's, that's wrapped up in this whole right joust.

But look, the, the rare earth.

Restriction is, is serious.

We've been covering for months now.

China's got 90 plus percent of the rare earth.

Yeah.

Covered.

Right.

And, and we are not gonna be able to, in any short amount of time spin it up.

It's just, it's too dirty and hard and difficult.

We have those minerals, but it's not easy to get, get to them.

No.

I mean, literally the US is in the position of seed stage startup Right.

Compared to China as like the Fortune one incumbent.

Right.

It's, it's like that's, that's the analogy.

That's how far off we are.

Right.

So it's, it's not even close.

The supply chain and sort of the engineering models by which we are creating all the electronics that drive our economy today are completely dependent on this China rare earth position.

And they control that, that part of the stack.

And so I think the reality is, as long as that's true, we will constantly leverage the things we have.

Right.

Um, relationships, buying power, a variety of different things.

But this, this is a very, very strong, excuse me, euphemism, but a very, very strong Trump card that China has.

Yes, that's right.

So next story.

New York Times small company in New York caught in the big trade war between the US and China company called Nexia.

It's a computer chip maker based in the Netherlands, uh, that was taken over by the Dutch government after pressure from officials in Washington.

So this is another aspect of the, the, the geopolitical pressure that's happening is Europe's kind of in the middle and it is getting pressured a lot, I think, by both sides, but it feels like more by the US to, you know, be part of NATO and, and do the things that, that an ally would do, which is so interesting because we've been very America first.

So this is, you know, a little bit of bullying.

We as a country right now are leveraging what we can.

Yeah, I think that's right.

It also, to me, it was surprising line that was crossed.

I mean, the government took this company over and the board of directors now has to go to the Netherlands to get things approved to take any, any corporate action.

I haven't seen that before.

And it, it, it makes me concerned about, you know, you have to be in line with whatever government you're working in under.

Um, now it's is a different world and not as good a world as it was before this story.

I mean, but, but truly this is where we're headed.

You know, I, I, I think this is one of the, uh, I think this is one of the best things about.

Being knowledgeable about crypto.

The fundamental story of, of crypto is Bitcoin.

The fundamental story of Bitcoin is, uh, the bank bailout.

And the fundamental problem with that is government interference in the free market and the debasement of the currency, um, for purposes that do not serve the C city.

Right, right.

And, and, and I think the longer you, you, you stay attuned to what's happening in the crypto world, the more you know that this is where this is all headed, right?

I mean, all this central bank stuff, all this money printing, all these wars, you know, whether they be trade wars or hot wars, right?

I mean, all these wars, I mean, it's, it's, it's all, it's all ultimately about control.

Yes.

And then the beautiful thing of crypto.

People don't appreciate 'cause everyone's just like trading to, to make a bunch of money today.

But I think the beautiful thing is that Bitcoin and, and most of crypto, the ability to defend yourself and stay anonymous or control your dollars or control your assets is far outweigh.

I mean, you can do that much more easily than you can attack someone.

And so it, it balances power.

I mean, it doesn't matter how many guns you have, you can't get my Bitcoin keys in in any, in any ever.

There's no way to get, there's no way to get it unless you sort of hold it under my head and I tell you it.

Um, but you can't just sort of take it by force any other way.

Yes.

And corporate structures as we are seeing now.

Are not that way.

No, no.

But I think it'd be interesting to watch is the, there are, I mean this company is small, but there are, there are big technology companies that I think are, would be, you know, maybe more powerful than, than nation states, except they don't have military.

And so how that evolves over the next 10 years is just gonna be interesting to watch.

I think that, that, that the companies are going to evolve to where they are independent, but I don't know that for sure.

It, it is to some degree downstream of the rise of China.

Because everything we're talking about already occurs in China.

Yes.

Right.

We remember Jack, Jack Ma disappeared.

Right, right.

You know what I mean?

Like, like we can't wrap our head around the idea of Jeff Bezos disappeared.

You know what I mean?

Right.

Um, but in Russia or in China, this already is the way it works.

And so it's not like it doesn't already happen like this in places in the world.

And, and look, it is, you can't say it's not capitalism in those places, it's just there's a spectrum of engagement by which the state asserts its control in the capitalist environment.

Right?

Yeah.

And yeah, and this was the first time that a western country that I know of took that action at least in many years.

Yeah.

But, but I, but again, it's be, it's downstream of the fact that the, the emerging winner does this by default, right?

Yeah.

It's in, it's in reaction to the China ascension.

Yes.

And, and, uh, there are other things we can look at, right?

I mean, because what we're really talking about is liberty, right?

You, you start a company, it's your corporate entity.

And you have ownership of it, right?

That, that property rights, right?

The co the corporation is your property.

So if we're to be seized without due process, like, you know, what, what is, what is the imminent domain that that give, that grants a nation state?

The authority to seize your property, right?

Is, is, is really the question.

And, and what we saw almost go down in Europe last week was the removal of the right to have private conversations.

If it wasn't for Germany in the very last minute, stopping that law that, that I think it emanated out of France and sort of swept across Europe.

You know, the UK is also doing a lot of this kind of stuff too.

Yeah.

Um, the EU was about to, you know, basically make signal and telegram illegal, you know, and, and for, and for listeners who don't know these, these are two apps.

The similar to WhatsApp, where you have end-to-end encryption and the, the conversations are only stored on, on your phone, on the client.

Right.

And this new law that was about to come out was going to say they have the right to, to continually scan your device for all things.

So to me it's like, okay, we're talking about a big corporation that we're not used to them taking from the rich, but they were about to take the liberty and the, and the privacy away from every EU citizen.

Yeah.

And they always do it under the guise of national security and protecting you.

Whether that's true or not.

And sometimes it's, sometimes it might be true, sometimes it's not true.

But either way, that's the avenue that's taken to, to take these steps.

Exactly.

So, you know, to me it is, you know, I don't want to use the authoritarian word, the, the removal of liberties in the west.

Uh, is an emerging is it's an emerging trend.

I don't think you can, you can argue with that to the Fed.

Powell keeps the Fed on track to lower rates again.

Yeah.

So that headline is, is expected, right?

They're gonna meet in a couple weeks.

But what's in the story that I, the reason I wanted to talk about is he also is ending, uh, um, QT.

Qt. Yes, exactly.

Yes, yes.

So, so, so, so Vic, expect more important.

Yeah.

Vic, explain that to, to the listeners please.

In the pandemic and other times, the Fed will buy assets in the market, which has the effect of pushing more, spending power, pushing more cash as they buy a bond, uh, both, uh, US bonds, and they did some corporate bonds too.

Then money goes out and people then spend that, um.

But then their balance sheet is quite a bit bigger and so that they don't have to, but, but it is traditional.

They would then try to reverse that and get back to where they started.

So they have been going through a process of doing the opposite and selling these back into the market, which has the, of course, the opposite effect.

It takes cash outta the market and constrains the economies.

It's like, it's like raising rates, but just a different method to do that.

And so he is gonna continue to lower rates it sounds like.

But he also is saying that they're gonna end quantitative tightening, uh, which they've been doing at a pretty slow pace, but a consistent pace every month, 40,$50 billion, um, being sort of sold off their balance sheet, which is again.

Kind of holding the economy back slightly.

Yep.

It, it's, it's, uh, you know, Vic, I, I have to give you your flowers on this week after week when we would do the show and Powell would sort of say, you know, not lowering yet, not lowering yet.

You know, you think about the, the, the story we started the show with, which is talking about the jobs numbers you've been saying for a while.

Uh, he's not, he's not paying attention to the, to the jobs.

Mm-hmm.

And, and of course we did have the revision and yes, we were off by a lot and all that, you know?

Yes.

To all that.

And he missed it.

Yeah, he did, he did miss it.

He should have been out in front of it.

Trump is right when he calls him too late, Powell.

Um, yeah.

So I got, I gotta, I gotta, yeah.

You the credit for, for calling that out.

That's right.

And I'll take the credit.

I think it's, it's also right to say the Fed is always backwards looking.

It's pretty hard to to be right in the future if you only look backwards, the comprehensive.

Of their analysis seem to be wanting.

Right.

Um, if you're only looking at data and you're not looking at the progress of AI and what it is likely to do and how fast it's evolving, and how much capital is rolling into it, and we've had more than a year's worth of time to see that.

Yes.

Right.

Like, to not have factored that in meaningfully shows their economic analysis is wanting.

Right.

I mean it's, it's, it's lacking the understanding of the force of nature that is technological progress and how it doesn't show up in data points and things like that.

But when it hits it's merciless, you know, it's, it's like, it's like, you know, it, it's like a natural disaster kind of, you know, all at once.

Yeah.

I mean, the, the Fed has.

A lot of smart people, they have more economic PhDs than anyone else.

Several thousand I think worked there.

You we should, we should get better results.

They, they don't do a good job.

It's a multi-factor challenge, you know, trying to figure out where the economy's going.

It's a big challenge, but it's, they could be doing a lot better on, on every front.

I mean, just stupid stuff.

Like the goal, their goal of inflation is 2%.

That's ludicrous.

No, no one, no one thinks that is real.

Yeah.

So they don't have credibility on that.

And, and I agree that, keep saying it means it's ridiculous.

I agree.

Alright, moving into the VC rundown from GeekWire, Seattle startup brooke.ai raises 28 million to expand remote care platform.

Yeah.

So this is like a new, uh, approach to remote patient monitoring.

Uh, they're bringing, you know, a lot more AI capabilities to it.

I'm paying attention to this space because I think it's gonna be an important niche in the healthcare space.

Um, and then it was kinda interesting that it was led by, you know, a health system, uh, UMass Memorial Health and Morningside.

So that's a funny, uh, combination for an early stage.

Company.

Um, just interesting.

I don't know if it's good or bad.

I'm not necessarily sure one way or the other, but, um, a series B being led by strategics like that and Morningside is usually even later.

Yes.

Um, it's interesting.

Yeah.

Well, uh, well, a couple things.

One, because of capital constriction and advanced maturity in companies, the, the rounds are getting more mature earlier, right?

We've said SEED is is more like a Series A. It's not, it's not what a Series A was, but it's, it's certainly not what a seed used to be, right?

I mean, you, you, you have, you have to be much more mature than it used to, than three, four years ago to successfully raise a, a good size seed round from a reputable firm, right?

Um, then on top of that, I think the AI imperative that, that these health systems have, you know, they have to start going on the offense and getting out in front of this stuff.

And I think it is smart to do that, not just by being a customer, but by getting on.

The cap table of these companies.

Right.

I mean, I think, I think these health systems are gonna have to take a play a, a play out of the, um, managed care organization's playbook and start getting much more serious about building up their investment balance sheets.

I, yes.

Really?

And, and, and not just with like the s and p 500, you know what I mean?

Right.

Yeah.

And, and hopefully, I mean, if they staff up for it, they should be able to make wise investments.

I mean, it's their market.

They, they should be able to know.

The other thing that I thought you were gonna say you didn't is it was founded in 2015 to do a b 10 years in is just similar to the same track.

You're saying these are later stage assets?

Yes.

Yes, they are.

Later stage.

They're later stage.

Okay.

Next story Outcomes.

AI raises $10 million seed funding for AI nursing model.

The funding will expedite the company's expansion into pharmaceutical partnerships, health systems, and virtual care programs.

Uh, is this a, is this European company?

Um, I don't think it's a European company, but I didn't look that up.

I don't know.

But it's funny how these things go in kind of, uh, uh, cycles or, or in clumps.

I mean, there's another nurse ai, uh, model coming outta Microsoft, I think it is.

We'll get to the story in the AI rundown, but, uh, all of a sudden people are turning to try to help nurses, which is great.

We need to help nurses.

Yeah.

And, uh, you know, but, but, uh, it's a model, right?

Mm-hmm.

So, you know, when, when you have Google out here doing models and, uh, I don't know, it just, I, I just, I just get a little bit, uh, confused, uh, about the, the confidence that folks have in, um, in executing the model.

Business.

Yeah.

You know, given the, the, the billions of dollars that these other companies are, are, are raising and the fact that they're all gonna come for healthcare mm-hmm.

At the end of the day.

Right.

They're all gonna come for healthcare.

So if you were doing an application on top of model, I would say something, I would feel differently about it.

Yeah.

I mean, my, my belief, but I don't know this company, is that the, the term model is, is, uh, not, they're not meaning a frontier model.

It's like a, maybe it's a, um, fine tuned model or it's like a new way to use AI in the, in the business model of delivering nursing.

Not really a, like a full on model that you don't need to build on something else.

I don't know that I care if it's, uh, frontier or, or you know, tuned.

As opposed to trained.

I, I, I think unless it is properly wrapped in a, in a broader, more valuable application, um, I mean with an interface and things like that, I, I just think, yeah, I agree with that.

You know, you can be attuned model and you're basically going to war with the foundation, with, with the frontier models.

Right, right.

I mean, they're not here to just be used.

It, it's, that's not, that's not how this works.

So Yeah, no question.

If you don't have some data or distribution advantage, you shouldn't be in the space, I don't think.

Yeah, and the, and, and the only reason why I'm being critical is because this is a seed round.

Yeah.

You know what I mean?

So it's $10 million seed round.

I'm almost like, nah, I don't know about that.

Uh, wealth theory raises 14 million to expand autoimmune care platforms.

So Series A led by General Catalyst participation from seven wire, uh, a cell, you know, very, very strong, uh, VCs around the table.

Yes.

Not that big of a round to be led by, by gc.

They're focused on the autoimmune space.

So we'll see if it's led by gc.

This makes me wonder whether or not it's gonna be rolled into the hatco and everything else they're doing.

Commu and those other types of platforms that GC is investing in.

Yeah.

But I don't know if the other VI mean there's some other strong VCs there.

Seven wire.

Yeah.

They're not gonna let them just sort of like do whatever they want.

They'll definitely have to be arm length, I would think.

Maybe, or, or, or maybe some of these other firms are, are coming alongside GC for the ride.

Right.

I mean, GC is much, much bigger.

Than Seven Wire.

Yeah.

In terms of a UM, I'm not sure about a cell.

A cell's a big, big firm, but pretty big.

Yeah.

But GC is crazy at this point.

Vega Health, uh, launches out of stealth to help health systems purchase and monitor ai.

Yeah.

So this is interesting.

Bessemer Ventures is creating this like a procurement thing, marketplace procurement tool.

Yeah.

Right?

Yeah.

Right.

Yeah.

I mean, and, and that's, that's a model they know well, right?

I mean, if you've been in health SaaS for decades Right.

You know, the procurement problem.

Right.

And so it, it seems like a, you know, old, old, uh, business model design applied now to ai.

Okay, got it.

Makes sense.

This is a small round, by the way,$4 million seat round from Bessemer.

That's very small for them.

You know what I mean?

I could write that size of checks.

So that's.

That's a small, small check from them.

Moving from small checks to huge checks, aura as in the Aura ring that I'm wearing, snags a $900 million round to expand the Smart Ring globally.

Uh, this funding was led by Fidelity.

Yeah.

Goodnight.

Good night.

Yeah, I think it priced them at 11 billion, I believe.

Okay.

Yeah.

Well, the post, post money.

Yeah, post.

Right.

They, they spoke at, uh, healthcare sessions here in Nashville two or three weeks ago, whenever that was.

Um, I listened to it.

It was a great sort of keynote, uh, discussion.

Well, they had, it was an interview with one other person.

Uh, they're moving into healthcare.

I mean, they came to Sessions.

The, it's a, it is a consumer tech moving into health, direct health, or they think they can, you know, catch sort of the emergence of new.

New degrees of disease maybe through their, through their wearable, which I think makes a lot of sense.

I'm fully bought in on that.

A hundred percent bought in on that.

That's, you know, the timing.

I don't, I don't know, but ultimately, yes, and they, and they are in the lead position.

Right.

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

They are, they're the lead dog, whoop.

Is that probably right alongside them, you know, but slightly different, you know, form factor.

Um, but you know, that's, that's huge.

And they just raised $200 million back in December, so not even a year later, picking up another 900 million.

That's massive.

Right.

Uh, okay.

Moving into policy, California passes laws targeting PBMs and private equity, so seems like California's gonna be in the news every single week now for Yeah, for these laws.

The, the, we talked about this last week and now, now we have the laws actually, uh, come to fruition.

Is this the same set of laws we were talking about last week, Vic?

So last week, uh, Newsom had signed one, uh, law sort of.

Preventing private equity owned assets from, I I remember that.

Inter interfering with care, whatever that means.

Whatever that means.

Right?

Yeah.

And there's two more this week, different different laws.

One is not allowing PBMs to do spread pricing, which is the whole model I, how you could do A PBM without spare pricing, which maybe is the point.

I, I don't.

Um, and then they have this other law that he did sign.

It was passed last week.

It was unclear if he was gonna sign it.

He did sign it.

That allows the state of California to review any time a private equity firm attempts to buy a healthcare asset.

I think that's how it's worded.

Wow.

The state gets to review.

It doesn't really allow them to stop it, because they don't know that that would fit with the, you know.

FTC and fed the feds, but you have to go through this review process, which is gonna maybe play, play with the other private equity law where they can now prevent you from interfering.

Well, I don't think that makes private equity any more excited about doing deals in California, that's for sure.

Yeah, I mean, I guess Gavin Newsom's sort of getting ready to run for president, but I don't, I don't understand, I don't know what this is trying to accomplish.

I mean, the PBM thing, I understand everyone hates PBMs.

Yes.

I'm not sure anyone understands them, but, but no, that's gonna create like a two, kinda like dealing with automobiles, a two tier system where a lot of PBMs are gonna have to figure out something.

In California, it's a big enough market.

The private equity thing is hard to even understand.

Yeah.

Yes, it's crazy.

Moving on to pharma, AstraZeneca strikes a drug pricing deal with the Trump administration.

The deal follows.

Pfizer's administration last week.

You know, so just really quickly before you dig into the details of this, I just wanna harken back to our conversation around the Dutch government, you know, uh, taking over that company.

You know, we, we, we, we, we've seen the Trump administration be incredibly involved in deals.

Um, you know, and so while not necessarily taking over, um, whether we're talking about Intel or we're talking about TikTok, I mean, you know, there, there's a lot of involvement, right?

Yes.

There's a lot of actual active involvement happening.

Um, you know, Trump, rx, you know, uh, you know, maybe not necessarily, uh, you know, taking over something, but getting into an industry and competing directly, um, with free market players.

It, it's, it's just a broader trend.

It's just a broader trend.

Yeah.

That, I think that's right.

And I mean.

Again, there's not a lot of detail in the story.

AstraZeneca said that they're gonna provide up to 80% off the list price of drugs through the Trump Rx site, and then they noted in their statement that in return the US was gonna delay any terrorist that might result.

Okay.

I'm not sure that was actually in the deal, but that's what they said in the story in this.

Okay.

So, yeah, I mean hmm.

Hmm.

What a, what a world we find ourselves in right now, man.

Uh, modern healthcare, Medicare, telehealth, hospital at home payments on hold.

Yeah.

So the, the ability for telehealth to be treated and reimbursed as you know.

With parody with in-person health visits.

Mm-hmm.

Started in a pandemic.

It's not a permanent law.

Congress has passed, it's a series of extensions.

Um, and that ended on October 1st or maybe September 30th.

And so CMS is, is saying they don't have the authority to make payments until that is renewed or, or that passed a permanent law.

And so as their procedure, they, they have to, they always hold the claims for 14 days.

I think they're business days, so we haven't actually hit the, I mean, today is the 16th, so we're just now hitting where they're holding back the money.

But I mean, we have portfolio companies that are, that are doing telehealth visits, sending bills in with the expectation that they'll be paid like they were paid in September.

I think that's reasonable, but, but they're not getting paid right now, and it's gonna quickly, I guess it depends on the company, but not many health companies have the ability to last too long without getting reimbursed.

And so this is one of many things that will sort of begin to be really painful in the government shutdown.

Yeah, I mean, I, I'm so tired of talking about telehealth, you know, and, and more broadly, I really struggle.

I feel like I'm showing my cards here a little bit, but I just really struggle with why, and, and I, I think it's actually reflected in, in the VC rundown every single week, right?

When we look at these companies, you know, you just, outside of some, some specialty areas, we've seen a lot of women's health services businesses, and we've seen pediatric businesses getting funded, but outside of that, it's all tech, right?

Yeah.

It's all tech.

And it's like, of course, why would you get into this business right now?

Mm-hmm.

Yeah.

Yeah, it's so unstable.

It's so unstable.

You know, I think at California doing all their stuff, it's just like, why?

Like why would you, you know, who's gonna do this?

Other than the incumbents, how, who's going to invest capital to try to make the care models better for both the cost of Americans and for the experience of Americans?

Who's, who's gonna do that?

I mean, I think we need clarity that the government will pay X for this procedure with that.

Then businesses can decide if they think they can deliver that in a sustainable way or not.

But just uncertainty is, is really a killer where they just can't do anything.

Yeah.

But also X has to be reasonably viable.

I mean, the people, you know, the people who get paid at CMS, they understand what's a viable rate and what's not.

You know what I mean?

Yeah.

So it's like y even put a rate out there that's not gonna like actually work.

Yeah.

I mean, I mean, parody would be great.

I think it is true that.

There's lower cost to do a telehealth visit for the provider than an in-person visit, but it's not, it's not dramatically lower.

You still have the same amount of time.

Sure.

Uh, so just some reasonable law.

The problem is that Congress is not reasonable and they can't pass any laws.

So no.

Both those things, both of those things are true.

Wall Street Journal, big changes are coming for 2026.

Medicare plans.

What you need to know, skinnier benefits, higher premiums and fewer options mean more than a million seniors should shop for new coverage during open enrollment.

This is, you know, one of many articles that are gonna come out in the next few weeks because it's gonna be really bad and it, I don't want to make it, you know, sugarcoated, it's gonna be really bad for seniors and I. They're not gonna be happy.

But the thing that I wanna talk about with you that I think is new, 'cause that's not that new.

If you go down the, there's gonna be fewer Part D plans.

Yeah.

It's not viable.

Emily has, what's that Emily's been telling us this for?

Yes.

Emily's been telling us forever.

And so you can see it here in 2024, there are 709 plans across the country and today there are 360, uh, so you know roughly half and it's going down even more.

And so that forces you to, you have to go with Medicare Advantage because if you, the way it works, you get regular Medicare fee for service, Medicare, and then you have to add Part D to get your pharmaceuticals.

Yeah.

Except for the Part D plan's not there.

Yeah.

Or if you go, if you don't wanna do that, then you go to Medicare Advantage, which packages it together.

Right.

In a lot of parts of the country.

There really is no alternative except Medicare advantage, and those plans are declining in their benefits and getting much harder.

So, yep.

That was the, that was the new thing in this article.

I mean, Emily's been talking about it, but it was interesting to see them put it out there.

Yeah, no, listen, uh, credit to Emily for sussing this out.

I, I think, I think a year ago is when she started to do the analysis.

Oh, maybe more than that.

Yes.

Uh, okay.

31,000 Kaiser Permanente workers begin to strike in northern California and Hawaii.

Yeah, they announced this last week.

We talked about it.

Yeah.

And they, they, they went on strike, I think today.

Yeah.

Okay.

So, you know, it's five day strike largest citizen's history.

Um, that's a lot of workers.

31,000 is a lot of workers.

Um, you know, I think the tar, they're targeting an organization that is, uh, margin rich.

Right.

So this, this will get resolved, but it is worth at least highlighting that we continue to have, you know, these big LA labor movements.

And, and look, I I think they're just gonna grow, right?

I mean, I think as you continue to have margin compression, you continue to have outsourcing, you continue to have, um, AI being brought in, upskilling and reskilling demands on workforces, we're gonna see more and more and more labor actions.

Um, I was listening to a podcast actually recently, uh, was the Patrick, uh, Beth David podcast, and he was interviewing, uh, the guy, uh, Sean O'Brien, who's boss of the Teamsters.

And, and they're, they're getting fired up.

They're getting fired up, and they, and you know, they have, they have a pretty big war chest, you know, the war chest is over a billion.

So, I mean, they, they could, they can actually like.

Hold the line and, and really, uh, you know, force a lot of strikes.

I'm not saying that teamster is, is is the union that that's, that's behind, you know, these, uh, healthcare workers.

But I'm just making the point that labor overall as a movement, I think is really starting to galvanize and, uh, you know, we, we, it was a storyline for months was the last year of the dock workers all Yeah.

Sort of, you know, carry that, that, that, uh, yeah.

That whole storyline for, for months.

I, I just think this is gonna be a continual thing.

We're gonna hear more and more and more about.

Yeah.

I mean, it's, it's the natural reaction to the K shape economy and all these Wall Street people making money and then jobs not being there.

I don't mean it's hard to blame people for trying to organize themselves and protect their livelihood.

Yeah.

That's just gonna happen.

Agreed.

Uh, okay.

Wall Street Journal defined workers, hospitals are training teenagers, health systems are joining with local high schools to create employee pipelines.

You can't sit and wait to see who shows up.

Yeah.

So this is Ballard Health in, in Tennessee.

We know the Ballard team.

They are leading, working with high schools and training them for a career in medicine, med tech and, and then advancing up to nursing and nurse practitioner.

You know, you, you could keep going.

I think it's good.

I don't know that it's gonna solve the labor shortage, but, but, you know, we need some good stories.

Well, and also, I mean, I, I, I think one of the most important things, I was just having a conversation with a, um, a nonprofit leader in the workforce development space and she, she wanted to talk to me to learn more about healthcare.

And, you know, I was like.

You're exactly right because even with the issues we have in healthcare that where we're going to, yes, we're going to offshore, we're going to do ai, you can look at the jobs, like We, healthcare is still going to be the leading employer and the healthcare industry has a voracious appetite for labor.

It just does, you know, it can't, it, it, it's not AI yet.

Right?

And, and even when it does have ai, it's not gonna be on, in the clinical theater where that's gonna start.

It's be a lot of administrative back office stuff is where they're gonna start with that.

So now there's all sorts of room.

And look, you know, these, the, these high schoolers, they, they're not dumb.

They see what's happening in college.

They see, you know, they, they see the, you know, the pe the, the kids ahead of them going there, accumulating all this debt, graduating and can't find a job, right?

And so it's like, ah, I don't know why not.

Just like, go get trained in high school and avoid debt.

Yes, no question.

And it, it's a good career.

We know one of the last places that AI takes over.

I mean, robotics is a long way away from being at scale.

Yes, it's great robots, but just the scale that you'd need to do.

Uh, we're gonna need people for a long time in healthcare and, and also the trust.

Like we're not, you know, yeah.

It's gonna, it's gonna take a while before we get to trust robots running into clinical theater.

It's just Right.

Just not gonna happen quickly.

Uh, Henson hears to offer treatments for menopause and perimenopause.

So, uh, they, they must see the trends and they must see all the, all the VC dollars going into this space.

Yeah.

I mean, I think they probably listened to health further, 'cause we talked about it last week and the success with, uh, women's health and then HIMSS came out this week, but hers, I guess, you know.

Yeah.

Uh, Jefferson Health laying off roughly 650 employees amid significant financial headwinds.

Uh, Jefferson's been working on, on right sizing their p and l for for a minute now.

Um, continuing to layoff.

So this, this, this layoff represents 1% of their workforce, and again, is a co couple of months after they posted a 200 million operating laws for their latest, latest fiscal year.

So still more work they have to do.

Of course, academic medical center, they're getting hit on both sides, right?

They get the healthcare cuts.

They probably have not the greatest payer mix.

And then their, their funding is also going down.

'cause Jefferson's a pretty reputable, um, academic center.

So just sort of a, a, a tough, uh, tough setup for them.

Yeah, and they, they have a, they pay vitamin, they have a plan.

Big change that I noticed is that their plan lost a ton of money.

They, in, uh, 24, they made a hundred million dollars in that division as far as gain, and this year they lost one 70.

And they're, they're blaming it on GLP ones and other medical expenses.

But certainly true.

I think there's a lot of plans navigating that.

It's a, it's a tough market.

I mean, I think it, they've been working for a long time, as you say, and they got probably more work to do, uh, credit to them.

We see at the bottom of the article here, Fitch ratings affirmed, its a rating for Jefferson Health, but revised a broader rating outlook from stable to negative.

So to me, that's a vote of confidence for management, but also an acknowledgement that this is not a great, you know, that that $200 million loss is not awesome.

Yeah.

And, and part of, you know, part of the reason they have to lay off people is to keep their rating.

Yes.

In order to be able to keep funding the business and Yes.

Continue for the, you know, they laid off 1% of the workforce.

They, they have to continue for the other 99% and for the community they're serving there.

Yes.

Okay.

Novo Nordis to acquire a carro therapeutics for up to $5.2 billion.

A carro is developing a drug to treat mash.

A liver disease correlated with obesity.

Yeah, that, that's right.

So I don't know the details of how the, how the compound works, but MASH is, is tough.

I mean, it, it's a, yeah, it's bad.

Yeah.

It, I mean it's a, you know, metabolic pathway cha after obesity, you get all these things, diabetes, liver disease.

And so if we, if it can help that, that'd be great.

Yeah.

And, and you know, this is all part of Novo's, uh, attempt to sort of continue to turn around the, the, the brand, so, right, right.

Uh, also, I, I, I think it's worth, worth noting that's pretty big acquisition.

5.2 billion.

Yeah.

Right.

Not small.

J and j is gonna split up their orthopedics business.

Artificial hip and knee replacement division is, is going to become a standalone company within 18 to 24 months.

Yeah.

So I was surprised about this, that they're saying it's not growing very quickly.

It's, you know, it's not growing the, the same pace that the rest of.

Change a, you know, new things are.

And so they're, they think they can get more value for shareholders by spinning it out into another company, you know, in theory so that shareholders that want sort of safe but not much growth, uh, would go there and people that want much more growth would, would stay with j and JI guess it makes sense.

It's a pretty big part of j and j that they're splitting off, but they must be confident in the rest of their pipeline.

I, I, I, I thought it's funny, I thought you were gonna go up somewhere different, which is to say that Wall Street is very, very, very, um.

Focused on these AI companies and while Johnson and Johnson has performed well, um, amongst healthcare companies, uh, healthcare as an index versus the Mag seven or mag six now, whatever, uh, has not performed well.

And, you know, the whole conglomerate as a business model is no longer in vogue.

Right?

And so it, it's, you're not rewarded by Wall Street Analyst anymore for having this like huge horizontal, um, you know, coverage in your industry.

You're rewarded for, you know, what it, what are your margins at the end of the day?

And I think JJ is saying, Hey, we don't need to have this huge sort of top line number.

We need to optimize for our margins in order to get the best stock price.

So that, that's, that's kind of what I think is, is, yeah.

Margins and growth, right?

Yes.

Margins and growth rate.

Yes.

Margins and growth rate, yes.

Kohler Health unveils smart toilet device to analyze hydration and gut health.

It was just this summer, uh, at the HFMA annual event, um, when one of the keynote speakers was going through a variety of different types of ways that we can improve healthcare.

And one of the key points of the talk, which is pretty aligned with RFK and Maha, was that we needed more loveless technology, meaning we needed to enable people to, uh, track their vitals in a much more seamless way that was not own onerous.

So it was kind of talking about the difference between.

Forcing someone to use the Omron blood pressure cuff, which no one ha there's like basically nil adherence to this, right?

Every doctor, including mine, every doctor asks you to do it.

No one does it.

You know what I mean?

Um, but it's like, guess what you do every day?

You sit it on your toilet and like, you know, if we can have an AA ring that picks up all these things, if you can have an Apple watch that picks up all these things, can we, can we leverage the toilet seat at this place that your body interacts with every, you know, every day as an opportunity to seamlessly collect key information, you know, from you?

I just think this is like, no brainer.

No brainer.

Yeah.

If they can do it, it turns, you know, the, the sale of a, you know, bathroom appliance into a monthly recurring revenue fee.

It's better health.

So it is good all around.

Yep.

Agree.

Okay.

Health and US New York Times the drug that took more than her appetite away.

So the subject's name is, uh, Jessica Serone.

Uh, and this is a story about sort of the, the power of Glip one drugs to impact, um, addiction broadly, not just food addiction.

Uh, you know, I think these, these drugs are, are clearly very broad in the potential applications they could have.

And people are, I think, probably rightfully looking at how they might be able to support addiction.

I actually had a friend, uh, who, I mean, Vic, you and I have both sort of been in recovery and, and, uh, you know, we don't, we don't drink actively anymore.

Yeah.

Just, but I, I have a friend who, who, uh, she, she, you know, stopped drinking and then, you know.

For per, per her words.

She, uh, you know, she, she fell off the wagon.

Um, then she put herself in, in rehab for 30 days.

And then she's, you know, she actually texted me because she knows, like, you know, we both weren't drinking for a period of time, and she was telling me about this drug that they gave her at the rehab center, and she was like, it's amazing.

I wish, like, you know, I wish we would've known about it before.

And she wanted to just put it on my radar and make sure I knew about it, you know, and I think we, we are, you know, just as we're looking at stem cells and peptides and, you know, um, BPC and, and all these different, uh, you know, so they gave you a friend to GLP one at, at the, at the recovery.

It wasn't a Glip one.

Uh, it, it, uh, I, I'll find the name here in a second, but like, um, the, the point is like more and more we're looking at exogenous methods to be able to support, you know, addiction.

Yeah.

And, and not just meetings and willpower and, you know what I mean?

Yeah.

And, and I'm, I'm all for that, man.

I mean, listen, yeah.

There's many things we can try to help people, you know, manage this, you know, addiction.

A one, one of the things I really like about it is it puts it more squarely in the category of a medical, you know, issue as opposed to some like character flaw or moral fail, right?

Yeah.

And it works methadone and suboxone, but we have other, other drugs for kinda the morphine based opioids, but they're not, they all have, they all have side effects and challenges with them.

And so, um, I think GLP ones, although they have side effects too, I think they're certainly manageable.

And if it can help one person, we should talk about it.

And, and that means it could help other people.

Maybe it's not good for everyone.

We need to do more studies.

I mean, this nonprofit in Rhode Island gave it to 15 of their patients.

That's not enough.

I mean, we need to be doing broader studies on this.

So agree, agree.

A historic crypto selloff erased over 19 billion, but two accounts made 160 million.

So this is the kind of stuff that definitely makes people say crypto is a casino.

Crypto is terrible.

I thought it was actually one of the, people talk about it as like one of the worst days.

But I, but if you actually understand what happened, uh, I think it was one of the greatest days in the history of crypto, actually.

I thought it WI think it's a sign that crypto is maturing.

So, so the, so the main thing is Trump announces a hundred percent tariffs on China, and basically that immediately precipitated this massive sell off in, in crypto.

Now, the sell off was not a manual sell off, it was an automated sell off.

It could not have happened that quickly if people were running to their Coinbase accounts to try to sell their Bitcoin.

It, it, it, it was long and short.

Right.

It, it, it was options straight.

Yeah.

You know, people, well, and I think, uh, I think the trader that made a bunch of money actually.

Heard things out of China that Trump reacted to.

So they put, I mean, maybe they had inside information, maybe they didn't.

I I mean, I think there's plenty of inside information.

Yeah.

If you just look at any m and a transaction, there's clearly leaks all over the place.

But, but they also, uh, they traded after China started talking about the rare earths and started being aggressive that then that caused Trump to do what he did Friday.

So, I mean, I think it just, it's trading right.

You're day trading crypto.

It, you shouldn't be day trading cred unless you're, unless you're willing to deal with this volatility.

I don't think it makes sense today.

Trade crypto thousand percent.

No, but that's nothing to do with the crypto market.

I mean, every market has swings and I think it's, to me it's healthy.

Yeah.

No, no.

Listen, I mean, the, the, the 19 billion did not come from a hack, and it did not come from, uh, you know, people running through their coin basic account.

It came from the liquidation of Bitcoin longs.

Right.

Once the Bitcoin price moved materially after a Trump announcement of a as, as it should have, you know, as of course, of course.

And that was the game.

Now, what I thought was so incredible was that these liquidations, for the most part, not all of them, because some of them were in, um, in different exchanges that are centralized, right?

Where there's, there's custody and there may be some fractional reserve stuff going on.

But in all the automated, what we call distributed exchanges, right, where the only real, um, intermediary is, is lines of code.

It's just software.

These liquidations happened automatically within an hour, in some cases, with no, with no flaw, because guess what?

All the assets was there, were there, all the collateral was there.

It wasn't fractionally being leveraged somewhere else, basically.

Like this is the kind of thing that would've brought many American banks to their knees.

I shouldn't even say American banks, many fractional banks around the world, many fractional centralized banks around the world would've been brought to their knees by this type of run.

And the crypto infrastructure just like processed it.

And then, and then, and then within 24 hours, the Bitcoin price was right back where it was, and then, and then subsequently hit an all time high.

Yeah.

That, that's right.

That's exactly my belief.

It's gonna be, I mean, it's healthier to have non fractional reserve.

The mon the money is the, the assets are there.

And if you, if you're trading a derivative product that ca is subject to being liquidated, you're getting some upside for that risk.

And once in a while, what's gonna happen.

Yes.

So I, I, I mean.

This was actually a, that's what I wanna talk about, because I think it's a, you know, it's a, it's, it's presented as like a gotcha, bad story, but I actually think it's the opposite of that.

It's a, it's a, it's a great story.

And, and, and, uh, you know, you, you kind of, uh, I, I've been dealing with a lot of, like, on the ground stuff here, but you, you, uh, you pointed out that, uh, the big token conference in Singapore and of course the, the adjunct to it, which is biology's network state, um, conference happened.

I was watching the Vitalik Butrin, um, who's the, who's the founder of Ethereum.

Yeah.

I was watching his, uh, his interview with Balaji and he was talking about, you know, hacks in Defi have gone, they're like, it's like, it, it's, it's almost like non-statistical now at this point.

Yeah.

Like, there's so few hacks because everyone's sort of learned, everyone's got the best practices, the audits are much better of the code.

Like everything is much, much tighter.

So.

We we're, we're kind of getting out of the wild, wild west, you know, world of crypto, I think, you know?

Yeah, yeah.

I heard that.

Say that, I heard that interview too as well.

And I agree that was a really, I hadn't paid attention to it, but the volume of money going through the Defi rails, Ethereum, Solana, Bitcoin Big Ones, ripple, ripple is much higher than it was in 20 16, 20 17, 20 18.

And the, all the co, all the code smart contracts being the, the most prominent one is much more hardened.

I mean, every time there's a hack or there's someone does code wrong and they get taken advantage of, then people fix that.

And so now over time, it's just gotten much more robust, which is what happens with these software platforms.

Yeah, no, it's, it's, it is remarkable.

And the idea that, that it's been open for all this time and.

There.

The long term technological risk is really more quantum than anything.

It's more at the fundamental layer of photography as opposed to a particular line of code.

But it, it proves a lot about the value of open source and about the value of transparency.

Like, you know, when there is sunshine, the quality goes up.

Yes.

Right.

You know, when, when, when there's shared interest and everyone is working on it together, but there's sunshine and everyone can see it, and everyone can chip in.

The quality of the security, the quality of the performance, the quality of the, you know, the resiliency.

It goes up.

It goes up, yes.

Sunshine, transparency, and then I think aligned interest, like if you create a smart project that can't be hacked.

You make money?

Yes.

A lot of money.

People are encouraged to go figure out a new, a new better way to do it.

Yes.

Agreed.

Alright, AI rundown, then we're outta here.

Google Cloud Unveils Health AI Agent partnerships.

So the technology Giant is working with Hackensack Meridian Health on multiple agents, including a tool that can summarize patient's medical records for providers.

It's hard to tell the quality of it, it's more just the story of they're doing this.

Uh, but I think it's great that Google is partnering with Hack Meridian's a good, a good system.

Uh, they're pretty innovative and so it'll be good to see the collaboration.

We a lot of facts as sort of how it's going, but good to see them working together.

Yeah.

And, and Vic, the, the, this story is exactly why I'm so bearish on, do you know, rolling out a model or, or an agent.

Mm-hmm.

You know?

Yeah.

Because I'm like.

Google and OpenAI and Claude and you know, who crock, they're all going to directly engage the healthcare industry, right.

With enterprise sales to do collaborative things.

It's like you're just not gonna, you're not gonna be able to touch either the capital base or the brand equity of these organizations.

So I just, to me, you know, it, it's, it's as much of a no-fly zone as Epic is as a health healthcare vc.

For me, for me, yeah.

I mean, we, sometime later we should have a discussion about that because I, I think if you can get data or distribution, you can hold, you can have a business there, but we should talk about that when we have more time.

I, I think it's market dependent.

I think it's market dependent.

I, I, I just don't think you can, you can sell it into health systems.

This is just my view about health systems.

Yeah.

You know what I mean?

I just, yeah.

You know, you, you, you gotta be going for something more specific, more, more post-acute.

Something like that.

I, but health systems, I don't believe in it.

Alright.

Microsoft's roll out generative AI tools for nurses.

Goodness gracious.

I mean, look, this is literally what I'm talking about.

Yeah.

And that startup that got funded, you know, this week to help nurses, you know, am I gonna pick Microsoft or some company?

I can't remember the name of this.

What I mean, 30 minutes ago.

This is what I mean.

I can't imagine writing the$10 million check and this story rolls out the same week.

Right.

Like, like, goodness gracious.

It feels like LP malpractice.

Right.

Okay.

Open ai, Broadcom Forge, multi-billion dollar chip development deal all in on chips everybody all the time.

Mm-hmm.

Yeah, that's right.

I mean, Sam Altman is he, I think he has committed to roughly a trillion dollars of CapEx.

He's now talking about.

Being the first company ever to raise a trillion dollars, which is ridiculous.

But, but yeah.

Problem is partnering with them and you know, of course they got, they got a bump in their share price, even though who knows if opening is gonna have any money to buy these things.

Yeah.

But, but it's like, I, I think the thing is, you would only push for that if you thought this was a civilizational step change.

Yeah.

If it was literally going to rewrite the way everything works.

That's, that's the only way you can justify raising ability.

A trillion dollars.

A trillion.

Well, I think that's, I think that's what Sam, I mean, there's, there's several people including Sam, that I think believe that.

Yes.

I think, I think, I think Elon believes it.

Yeah.

I think several people at Tropic, we have a and Tropic story.

I mean, Tropic believes it.

Yeah.

Uh, Sam Alman says chat, GPT will soon sext with verified adults.

This is sort of an extension of the whole development of character ai and all of these like different LLMs with personality, with narratives.

Kind of like you think about like a choose your own adventure, you know, mapping to an LLM.

Um, and some of them obviously are pg, some of are PG 13 sometimes have, are R rated, and then some of them are X rated.

Uh, Sam is now saying if you verify, uh, that you can now sext with, with, uh, you know, with, with an ai.

And to me it's like you've gotta be out of your mind to do that with Chache.

I don't know why.

I mean, this seems like an unforced error.

Like, why does open AI need to do this?

They are the leader.

I mean, so Elon came out with his companions and he was trying to catch up and so fine.

I don't get this at all.

I mean it is, we were talking about this last week.

Google is like the enterprise safe.

Maybe Microsoft is enterprise safe.

OpenAI has been trying hard to pretend like they're an enterprise grade company and then they come out with something like this that, I just don't get that.

Here's the thing.

He pretends that he's Apple, but he's meta, right?

Yes.

He's not, he's not Apple.

He's meta.

That's why.

Yeah.

I'm, I, you know, just seems pretty consistent to me.

Yeah.

I mean it's, of course people are gonna do it 'cause they're dumb, but it's not gonna be good for the OpenAI brand.

It's not gonna be good in the long run to raise a trillion dollars, I don't think.

No, there's plenty of erotica out on the internet.

I mean, it's not hard to find erotica.

I don't, I don't think we need it, but.

I dunno.

Well, you, you know, to, to me, the, the, the big thing is simply I don't find chat.

You, you know, Vic, I, I do everything I can to avoid, um, using chatt PTI know, I know.

I'm the same way I have an account because I want to be able to test things when they're, when they come out.

But, but I don't use it and I don't find that I, I miss anything.

I, I, no, no, you don't miss it because all the other ones are just as good.

Right.

They're just as good.

So, so I, I feel like this is maybe a good time to do a PSA, um, because I actually have a friend of mine asked me.

Uh, deriv this, of this question and I shared with him, and I think why wouldn't I share this more broadly here is, and actually Vic, I'd love to hear your version of this, but let me, let me just share like my, my AI lineup, like what I use and why.

So I use perplexity for research.

I've not perplex Perplexity Pro and I should say everything I'm about to say I pay for it.

So I pay, I pay like, let's just call it $20 a month on average.

So I pay, I pay for Perplex Perplexity Pro because of its sourcing and, and it's just, it's just, first of all, it's an application.

It's not a foundational model.

It leverages the best foundational models.

And it's really sort of designed for research.

It's great for research.

Um, I think it's better than the other ones in my view.

Like what it spits out is better.

So that's what I use for research.

I use Claude for, um, document review and document analysis as well as collaborative writing, but like, it sort of loses the, the, the tokens get a little wonky after too many, you know, iterations.

But, but I just find Claude because of the projects that you can set up, which are very similar to I think projects you can set up in chat GBT, which is why I like it.

It's great for analyzing documents.

I just, I just had it, like, I actually had it like analyze a, a, a contract that was in Spanish and it like helped me, like it helped me fully negotiate it, like with no problem.

So that, that's why I use, uh, Claude, my general purpose AI is Gemini, uh, because I can use Gemini Enterprise and, and, and as much as I trust Google Drive to, to store my, my documents and Gmail to store my email.

Because I'm paying and it's, it's an enterprise product.

Gemini is where I do my general purpose stuff, right?

I use Grok for current events and fact checking of current events, like did this actually happen?

Right?

And then I use Venice.

For anything that I think is like super sensitive.

And that's that for people who, you've probably not heard of Venice, but Venice is, uh, was created by a guy named Eric Vorhees.

He's a crypto pioneer, and it's a, it's a totally private, it's like, if, you know what signal is in messaging, Venice is basically signal for ai.

And so I, that's, I use Venice anytime.

I'm like, mm, this is a little sense.

This, this is like so sensitive.

I'm not even comfortable with putting it into my Gemini thing.

You know, I, I I, I like the peace of mind of having a purely private, maybe lower quality AI thing that I can use just to feel like, okay, I, I, I'm, I'm happy about this not being in a server somewhere.

So that's my stack that I use.

Yeah, I mean, I'm, I'm similar.

I have five tools.

I use Gemini as well for pretty much general purpose, but I, I find it good for writing.

Uh, and I've got several prompts with a lot of context maybe.

30 pages of context that I'll feed in if I want to help.

Like doing the email newsletter for this podcast.

Gemini does that in partnership with me.

I'm like going back and forth with it.

I use Claude for the projects, but also for coding.

I have set up a bunch of CPS model conduct protocol that allows Claude to, to work with me, build, you know, writing files, moving things around, interfacing with the internet, calling APIs, going to GitHub and pulling down a repo.

So Claude is my sort of vibe coding tool.

It is not very successful right now, but, but, uh, but I've done a lot of hours with Claude.

I use Grok for the current events.

Same, same as you.

Uh, I think, uh, any kind of research or information that is.

Within the last 90 days.

I don't think the frontier models really are good at, except for gr, Gemini would claim they're good at it.

They search through the Google search profile and they're, they're better than, than the Claude in GPT.

And then I use a, a Chinese, uh, agent called Manus, which I think is great, but it's, you know, it's, it's owned in China and it's, it's a server based thing.

So whatever information you give it is, you know, fully out there in the Chinese government if they care what I'm doing.

It's total non-starter for me, but I know, I know.

It's powerful and it, and it can like, run full tasks, automated and that's really great.

Yeah.

But like I was doing a, I'm doing a, a new investment.

I, I wanted to do a competitive landscape on a particular niche of healthcare, and you can give it this assignment like you would to a junior employee, give it an assignment, and then go to lunch.

And it comes back and it's, it's well done.

And then I've, I have a, I'm a, a lifetime member of Venice because I own some of their tokens, and so they give it to me for a, uh, I don't have a lot of uses for that, but, but yes, if I wanted to do something secure and have no know about it, that's what I'd use.

Yeah.

I mean, clearly because you use Venice, maybe you care less about that than I do.

I care less about that.

Venice is also good because you can use, like, I'll, I'll test through Venice.

You can test any model you want.

Yeah.

Like when a new model comes out, I want to test drive it.

You can easily, I don't have to sign up for anything and test it there, and.

You know, if it's, if there's some like thing that's catching data and not good as a new model or backdoor, I'm not exposed to it.

Testing.

Yeah.

Okay.

Thanks for that little sidebar.

That was, you know, I just felt like we talk about AI all the time, but you and I actually use it and it's, it's, yeah.

You know, it may be helpful to one of the listeners to sort of hear how we use it.

Uh, okay.

Let's wrap this thing up, man.

Google to invest 24 billion in AI in the US and India plans to invest approximately 15 billion in India over the next five years.

Yeah.

So, I mean, everyone's investing a ton of money.

The reason this is interesting is the, the selection of India was new.

I haven't seen a lot of people building data centers at scale in India, and so Google is, is moving into India.

I think it's a great opportunity.

India is maybe, uh, you know, it's maybe still a little bit behind as far as like, uh, legal structure and market.

Uh.

Structure, but I think it's coming on quickly.

So the Middle East and India is a pretty interesting space overall.

Yeah.

And Google's big enough.

I mean, yeah, I mean, you know, I, I think anything that's not China, Russia, and, um, North Korea is in play for an organization as big as Google, you know?

Yeah.

They can go in there as you, as you said before, with the exception of a military, they're bigger than the majority of countries in the world, right?

So they can go in there and they can navigate some of the, you know, market structure issues and things like that for, you know, you and I couldn't, but Google can, right?

So, okay.

Soon you'd be able to shop Walmart and chat GPT.

Here's why it matters.

Why does it matter, Vic?

It matters because they are gonna now be able to, you can buy things right out of, uh, Chet in this 800 million users weekly that are interested in buying stuff that Walmart has.

And then furthermore, they stock jumped, I think 5%.

A couple hours after they announced it on the news.

Yeah.

I mean, to me, to me the, the, the reason why it matters is because chat GPT is eating meaningful share of being a discovery engine.

Um, and if it can also take actions, then it starts to really kind of eat the browser.

Like, like it's, it started eating away at Google search with this, now it's eating away at Chrome entirely.

And I think that is a, that's a real, real issue for Google, right?

You know, if, if, if Chad GPT can just take you out of search, but take you outta Chrome, I think that's what they're doing.

That's what they're headed for, right?

Yeah.

And then, you know, Walmart's competing with Amazon primarily, and I don't know that Amazon's gonna partner in this way with atp, so it gives them a differentiator.

Against Amazon.

Yes.

Okay.

And then finally, uh, we have this story from Substack import AI 4 31.

The publication's called Import ai.

Uh, I guess this is probably post 4 31.

Uh, the title is Technological Optimism and Appropriate Fear.

What do We Do if AI Progress Keeps Happening?

Uh, it's written by a guy named Jack Clark.

Tell me about this guy, Vic.

Yeah, so he is one of the founders of OpenAI and then he went with a group of them who left OpenAI to found philanthropic because they felt like it was not safely developing the technology that's the formation of philanthropic.

Um, and so he is writing this pretty long piece about all the promise of ai, but also the fact that we really don't understand how it works or what you know, how to control it or how to keep it aligned with us from a motivation point of view and.

Any normal person should be scared.

He, he says, I'm fearful about how powerful this is, and yet I don't understand.

No one aaro really fully understands it.

So anyway, it, it got, it got attention because of, 'cause of Jack Clark.

But, but also the Trump administration is pushing to have a moratorium on state regulations.

And, you know, one of the, the outcomes of this piece is there should be someone somewhere that is keeping track of this stuff.

Because eventually it could be, it could be something that we need to regulate or control in some way.

And Trump administration and David Sachs didn't like that.

I know they don't like it, but I think it also is kind of true.

Yeah.

Uh, I, uh, thanks for, for ending it there.

I mean, um, I, I kind of came about this because.

Just, I was on X Pro and, uh, I, I didn't see this.

I saw David Sachs responding to this.

Oh, yeah.

Right.

Yeah.

And kind of saying that, that, uh, anthropic is engaging in regulatory capture efforts.

Right.

And that's kind of what this is about.

A sophisticated regulatory capture.

I mean, you know, you know my feelings about that guy, but, but I, but I think, I think the important thing is he is the AI czar Right, right.

For America.

Yeah.

You know, and, and America is, you know, one of the two powers in the world that, that matters in this stuff.

And I mean, I understand philanthropic is maybe behind Google and OpenAI as far as users and pace, but, but I do not believe that they're doing a sophisticated regulatory capture play.

I think, I think the company was formed.

For the express purpose of trying to bring this powerful technology into the world in a safe way.

And so all the people there and their mission and just the way ethos is this, it's not trying to capture regulators.

Now, whether they're right or not is unknowable for five or 10 years, but it seems clear to me that this tech technology is very powerful.

Um, and we don't understand it.

And as an example, he, he showed the, uh, the Dallas Fed's estimates of the impact of AI on GDP.

Oh, yeah.

Just a comically, ludicrously bad projection.

But I, I, I, I mean, I mean, but what is it?

I mean, all it, all it, all it demonstrates to me is the humility to understand two things.

One.

This technology has the potential to be the most important technology we've ever created as humanity, right?

Two, we don't know two if that's true.

Right?

Because they, they, they present three different scenarios here, right?

So the first one is, it might be true, and then if it's true, we don't know which way it's gonna go.

Right.

Right, right.

And and to me that's all that, that's all that this chart that if you're listening, you don't see, but basically it, it, it, it, it show, it shows a straight line, sort of up and to the right, which is just like, you know, the normal path of human progress.

GD p's growing, everything's fine, blah, blah, blah.

And then there's two peel offs.

One is exponentially up, and though there wasn't exponentially down.

And it's kind of like we're either going to the moon with like the most unbelievable ascent of humanity that like, it's just gonna blow all of our minds.

Utopia, effectively.

Right.

Or we're dead.

That's right.

And it's gonna be very promising and everyone's gonna be very excited about all of the incredible gains, maybe forever.

Or until something happens and we get misaligned with AI that we don't understand and then we're dead and there's not a lot of steps where you could see a warning along the way.

'cause it's gonna get more and more powerful, which will be great until it's more powerful than we are and we can't control it.

I don't know.

I think, I think it's, it's too simplistic for David Sachs or the Trump administration broadly to say, this is regulatory capture and, and discount it.

I I don't think that's what it's, and they might be wrong.

I hope they're wrong.

But to be cautious I think is You don't understand it unless you're cautious.

Yeah.

I mean, I, I think they representing the nation state of the United States of America.

As we talked about a whole lot at the beginning of the show are engaged in a war of many forms with China.

Yes.

And you and I have been talking about, you know, the many ways we go over week, the many ways in which China is actually ahead of America in ai, not in always, right.

Yeah.

But just last week, Jensen Wang gave us a breakdown of the stack.

Right, right, right.

And in many ways, energy.

Yes.

Open source, yes.

Application layer.

Yes.

Ability for their society to adopt new, new technology.

Yes.

General positioning of leaders in their society, engineers versus our society lawyers.

Yes.

Right.

Like they have a lot.

Of advantages.

They have cultural advantages.

They have, you know, energy, which is really kind of foundational layer advantages, energy advantages.

They don't have to work things through a democracy.

They're not a democracy.

Right, right.

And so the United States government, if it wants to maintain its position vis-a-vis, China simply cannot have a position that is in any way accepting of the idea that we have to slow down.

And I think we as the general public, just need to internalize that and just take everything that they say with that grain of salt, like understanding.

It's just, it's simply not an option for them.

And so That makes sense.

That makes sense.

It doesn't mean very smart and he, he's aware of all this stuff.

Totally.

But that, that's right.

So.

Behind the scenes, they're considering all these things.

But then when you come out, I mean, I don't want 50 different regulations of AI either, so I'm not in favor of every state putting regulation down.

Um, but I also don't think it's true to say that I'm not slightly worried that we're gonna lose control of the AI because we have no way to know how we're gonna keep it contained.

But, so I, I think I might end up, if I was sitting in the C which I plan to never be, you might end up with the same reaction on X because you can't have 50 states doing regulation.

And so the, the best answer is to push down this guy and say, you're trying to, you're trying to do something for your own best interest and just kill the story.

Premier is right?

Yeah.

So, so I, you know, my view is that the Anthropic leadership, and this is why I like to use Claude, has, has kept the, the reality of the situation front and center in all their communications.

Mm-hmm.

From day one.

Yeah.

And that is not always going to align them with the position of the United States government.

It's just not.

And, and, and, and I think that that puts them at a disadvantage right now.

Right.

Because another theme we've talked about throughout the show is that the United States government is getting very, very active in, in the free market.

Yeah.

Right.

And you know, whether that is through s shows of support or, or non-support on X all the way through to getting involved contractually all the way to deals where if you do this we'll do that.

Right.

You know, tariff protections and things of that nature.

And so taking a principle position that is not aligned with that of the United States government, uh, in this era is likely to be disadvantaged to you disa a disadvantage to your enterprise.

Yes.

Yeah.

No, no question about that.

And I'll go further.

I think they're behind.

Well.

Oh, okay.

Okay.

Users brand awareness, momentum capital raise, meaning in venture markets, they're behind.

Their technology is great, but that's not So we're gonna win.

Yeah.

And any time they spend thinking about safety and writing this piece.

Open.

AI's not doing that.

No.

I mean, they're going full on acceleration and Yeah.

Anthropics competing with somebody who's just like both feet on the gas, full steam ahead and they're gonna get outcompeted.

I, I fear, but, but I, I'm a cheerleader for them and that's why, part of the reason I use them.

Yep.

Agree.

And I think a better product, but it's, they're losing, they don't have the same momentum.

Agree.

Okay, man.

Another great show.

Thank you so much.

Uh, yeah.

And uh, we'll be remote next week as well.

Okay.

All right.

Have a good night.

You too.

Bye.

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