102 – RFK Jr. Takes the Helm: What’s Next for U.S. Healthcare?

Marcus: 0:00

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Vic: 0:07

All right, Vic. How's it going? It's going well. I don't know. I feel like we're through the election. We're seeing all the aftermath now. But, uh, I don't know. I feel pretty good about that.

Marcus: 0:18

Yeah, definitely have that. Back half of Q4 feeling starting to settle in, you know, yeah I'm gonna

Vic: 0:26

push through and get some stuff done before December really makes it hard But yeah, it's starting to it's trying to get in the holiday season almost.

Marcus: 0:34

Yeah, I feel like I'm I'm pretty much just starting to prepare for January at this point. Like, I mean, I'm getting things done and we're gonna kick some things off. You know, we're talking about getting our newsletter off the ground in December or some little things like that. But for the most part, like,

Vic: 0:50

I'm trying to get two deals done before then. Uh, but I already know what they are and have the terms, and I think I'm just going to get it across the finish line. So hopefully, well,

Marcus: 0:59

good luck with that. We have a lot to talk about. Um, oh, maybe before we start, uh, did you enjoy the, the GNVCA panel?

Vic: 1:09

I thought it was great. I think it's good for Nashville that we're convening, um, all the venture capitalists or, or the venture capital community. Yeah. Sharing. Uh, policy things. It was well done. Yeah.

Marcus: 1:22

Yeah. I, I think it's good. I, it feels like a sign of maturity that our venture capital community is now not just, you know, meeting at the Bellamy Country Club. No offense, but like, you know, it's kind of out in the open and it's diverse and it's multiple industries and it's new people new to town. And, you know, I saw Chris from Edison Partners there and, you know, it's

Vic: 1:42

just, It's just kind of like, yeah, not everything. And I didn't know everyone there, which is, which is healthy. And I met some new people, which is great. Yeah,

Marcus: 1:49

exactly. So it's nice to see the development of everything. Uh, but yes, we are in week two, uh, post Trump victory and the, um, the appointments are coming in fast and furious and all sorts of things are moving around. So. Let's go ahead and start the process. Let's dig in. All right. Uh, inflation came in at 2. 6%, not really that surprising, uh, in terms of a slight bump and also not likely to derail the plans for another, uh, cut in December. Small cut.

Vic: 2:31

Yeah, I think that's right. This was. pretty widely expected. It's a slight uptick, maybe 30, 40 basis points from last month, but I think everyone was expecting something similar. The real question is, is it going to keep going up? I mean, there's a pretty decent turn up, which is not a big deal at 2. 6, but if it keeps going to 2. 8 or 3, I don't know if the five cuts that are predicted for next year are still on the table or not. The next one in December seems like everyone's saying is still in place. But there's some point when inflation ticks up too high that the Fed will want to stop cutting.

Marcus: 3:13

Yeah, and kind of the sideshow here. I mean, there's so much stuff flying around, uh, that we'll see whether or not there's enough focus on, uh, to, to, to change anything. But there has been a storyline around, uh, Powell being asked, uh, in a public interview that if, if Trump asked him to step down, would he step down? And he very quickly responded. No. Yeah. And then he said, and then he also said not permitted by law. Like he was very clear. Yeah. Not permitted by

Vic: 3:40

law. I agree with that. I'm not a. Big pal fan. I think he's been okay, but I'm a big fan of the fed chair should not be subject to any presidents being, you know, whim of deciding to replace him. I think that's just not healthy in general. So I'd like to see him hold that line. And then in two years, his term will be up. And that's the point that Trump could do whatever.

Marcus: 4:04

Just quick question. I don't want to sit on this too long, but you said you're not a big pal fan and you think he's been okay. How would you rate his handling of, of, uh, the, the post pandemic, you know, run up of inflation? I mean, it seems to me, everyone was saying we were going to get into a recession. We haven't, everyone kept calling we're, we're in one room, but we'd never actually got to an, like a full blown recession.

Vic: 4:29

Yeah.

Marcus: 4:29

Um, seems like we're about to be risk on here, you know, uh, under the, the, the change of administration interest rates are coming down. We, we, we suffered for, you know, two years, I agree, like it's about to turn around to risk on. So, I mean, I, I guess I'm just wondering where, what could he have done better? Cause I think a lot of people would look at this and say, probably one of the best runs in a very, very difficult period of any fed chair in modern history, some would probably argue that. So I'm just interested in, yeah, I mean, I,

Vic: 5:02

I, I agree with everything you said except that interest rates are coming down. I don't think, I mean, he has brought the short term rates down that he controls, but the longer term rates have not come down. Yeah. And I think that's because he is not, uh, fully transparent and is not really data driven, even though he says he's data driven. So, that's where I have, I mean, I don't know that I'm qualified to critique his skills, but that's where it is difficult for me. He's, he's Proclaiming to be data driven and have a 2 percent inflation target. And we're, we haven't been below 2 percent in a long time and yet he's easing. And so I don't know. I just think it's, um, he has a hard job. I'll say that. So it's a difficult thing. He has navigated a pretty good soft landing and I think that it is concerning 10 year rates are up, and so that's making it harder to buy a house, buy a car, finance your business. Yeah. Um, and that's really his trust, or his, um, his view, the market's view of his performance. Um, I don't know, maybe I'm being overly harsh. Yeah. So, I guess, I'm not What I should say was more explicit is I think it's fine for the president to critique the Fed or for me to critique the Fed or anyone, but I think it is valuable for our country to have the Fed in a, I think it's a 12 year appointment or a 10 year appointment. And, and no matter what he does, even if he frustrates you or she frustrates you, You can't just pull them out of it. I think that's healthy

Marcus: 7:04

Yeah, he's got two more years and I like the idea that he will be seeing out I mean he's seen us through this much of it. I I would prefer he finish Uh the term, you know, I would it's just a really

Vic: 7:18

bad precedent That at any point any president in the future can just fire the fed Leader and put someone else in that. That's not healthy. Totally agree.

Marcus: 7:29

Uh, all right. That was our only, uh, economy story. We're switching right into VC land and starting with a deal in the VC space, but not a traditional deal at all. This is general catalyst has been working for a while now through their health assurance transformation, LLC hat co on the acquisition of Summa health, which is small to midsize health system in Ohio, and there were Questions around whether or not it was going to happen. There was scrutiny from the AG, but they've signed the definitive agreement.

Vic: 8:01

Yeah. Yeah, I think it's great to see it progressing forward. Hopefully it'll get closed. I think we've covered this before. The reason General Catalyst wanted to do this is to have enough control to be able to try out all the things that they think could make a payvider health system with the health system and the insurance side much more effective, efficient, deliver better care at lower cost. And so I think it's great to see what they can do, whether they are really successful or run into hurdles, it doesn't really matter. I think it will, we'll all learn from watching it.

Marcus: 8:39

I mean, they, they have a, they have a multi billion dollar health system. They've got a very successful, experienced health system CEO. And they've got a boatload of technology that they've been investing in. So this is a sort of a net new experiment. We've, we've never seen those three things combined, uh, to see what happens when you've got all of those things together. So it's going to be pretty interesting.

Vic: 9:07

I can't think of her name, but I heard at, uh, the Aspen health leaders thing, the general catalyst woman spoke and she was saying it really was the pace of bringing new innovations, bringing change to market that they wanted to accelerate. Right. Hmm. Which I'm totally agree with that.

Marcus: 9:25

Yeah, totally, totally agree with that. And here's what will be really interesting. With that pace, are they thinking that General Catalyst is the sole provider of those innovations? Or that they create An innovation layer that the whole organization can run on, but that things can plug into very quickly, because I think one of the big problems today is the core platforms do not absorb innovation, um, intentionally it's, it's, it's philosophically against what they are trying to do. So, um, Obviously General Catalyst has a full suite of very integrated platforms, but there's going to be a constant need for more and more innovation over time. And it'll be interesting to see whether or not they want to funnel that all through themselves, or if they're going to actually allow this platform that they're building to be something that can absorb third party innovation.

Vic: 10:27

Yeah, I don't, I don't know if, if we know that, but either way, I think we'll learn a lot. Even if they keep it only general catalyst tools, which hopefully they won't, I think we'll still learn what works and what doesn't work, even if there might be multiple tools that could do that function, you're right. I think health systems are not designed for Significant and fast, like, iterative innovation, trying things, and I think General Health is going to change that.

Marcus: 10:55

Yep. Alright, uh, 5 million to expand access to integrated pediatric mental health care.

Vic: 11:02

Yeah, so this is, uh, investment, uh, the company's in New York, and I think it's sort of another in the, same vein of sort of integrating holistic care for patients. I mean, mental health is comorbid with many, many other diseases. And so integrating it into the pediatric clinic, I think it's really valuable. So, um, I'm not, we're not involved in this deal, but I think it's interesting.

Marcus: 11:27

Yeah. So it integrated behavioral health there. They were founded in partnership with Child Mind Institute, a nonprofit in children's mental health, uh, based in New York City. And I'm sure they're going to work with a very, very small population at first. 5. 5 million is not a lot when you're actually delivering services. Um, but it'll be interesting to see how they're going to differentiate. They've got a good group of, um, LPs around the table, uh, Redesign Health, Blue Venture Fund, and True Wealth Ventures. I think Blue Venture Fund kind of stands out to me there because if you're in the New York market and you've got Blue Ventures on your side, uh, that's, that's going to be positive for sure. Yeah. Stepful raises 31. 5 million to address healthcare staffing shortage with AI power training. This one seems like, uh, I get why they were able to attract a 31 million check. The intersection of workforce development and AI seems like a winning pitch, at least. The delivery is a completely different matter, but it doesn't surprise me with that pitch, they were able to get some big dollars in the door.

Vic: 12:28

Yeah, and they're really addressing the supply of workers. And the problem that they're trying to fix is a huge problem. It takes way too long and it's too expensive. Multiple years, they're, they're claiming 20, 000 for. An individual to get trained to be a medical assistant or a pharmacy tech or you know, all the other health care workers that are not a physician but are critical in the delivery of care. We need maybe more of those. Yeah. And there just aren't enough. And so being able to make them for something like one 10th of that time and cost, and we have people that. Need need jobs today and with AI coming I think there's gonna be a lot of people that are looking to change jobs We've talked about it previously We're gonna need people in health care for a long time Maybe fewer over the next 10 years, but still we need a lot of people. So yeah, I think this is a great

Marcus: 13:24

I mean, workforce development for health systems in particular is, I mean, it's one of the few industries where we've seen over the last 10 years, large health systems have gotten in the education business, like full on buying or building nursing schools, you know, going into partnerships to set up new med schools specifically so they can have their own dedicated pipeline that learns things their way. Um, and they can have the rotation sort of, you know, set up ready to go. So yeah, I mean, anything you can do around. Workforce development, you know, growing that inflow of staffing is, I think, going to find a big audience. Yeah,

Vic: 13:56

that's right.

Marcus: 13:57

All right, uh, probably the biggest story of the week as it pertains to vc is forward health. This was um a Big money raiser, uh, they brought in 400 million dollars with their concept of care pods, which were autonomous Uh doctor's offices or standalone where you walk in and it's you and a bunch of telehealth and a bunch of mechanics going on inside of that pod Uh, they have shut down, um abruptly shut down actually, uh, and it's You know, it's, it's obviously high profile because the design was sleek. It feels like one of those, like, Hey, we're going to bring healthcare into the future plays. Um, quite frankly, I'm actually surprised they, they were only able to get to 400 million considering some of the, the deals that raised billions over the last five years. But 400 million is, is where they stop.

Vic: 14:44

Yeah. I mean, it didn't work. It didn't work. So I think that the problem is that like, I, I, I didn't work. How much did they raise? Yeah. Yeah. Yeah. Nothing to do with how much they raise. It was a great vision. It is a great vision to be able to put in the lobby of our building or anywhere, put at this pod, which is much more convenient to do. And then through, through telemedicine, you have a medical, a doctor or another, um, specialist that you can interact with where it. I think struggled is sort of just how all the robotics and everything in the pod. It's a lot to get to get to work properly. And the human body, well, it is quite similar. My body is different than yours. If you're elderly or you're a pediatric patient, there's just lots of different type people. And so I think it was maybe ahead of its time. We actually, I know some of the angel investors that are in this And I mean, as, as recent as like a month ago, people, they were super excited about the growth. I mean, they raised a hundred million dollars less than a year ago, uh, but they shut down in the last 48 hours.

Marcus: 16:06

The founder used to be, uh, the, the CEO for Special Pro. He headed up special projects for the CEO of, uh, Google Alphabet. Yeah. Um, founded Sidewalk Labs. Um, so, you know, I think had an incredible name, an incredible network. Uh, raised money in the Series D by from Founders Fund, coastal Ventures, SoftBank, mark Benioff, uh, the weekend. I mean, so clearly kind of a, a-list. kind of person who was able to get access to those kind of investors. Um, but yeah, it's, look, healthcare is hard.

Vic: 16:40

And it may not, I would love to be able to go into a pod and have it work. But if you can't reliably draw blood and do the lab work, then you have to go to another place and get the blood drawn. So yes, healthcare is hard.

Marcus: 16:54

Healthcare is hard. Uh, Yeah, and one of the things I guess was in the Business Insider article, they were talking about how I guess the blood test didn't work and maybe someone got stuck in the pod a couple of times.

Vic: 17:07

Yeah, I mean, the information interviewed, I think it was like 20, we'll link to the several former employees they found and it was anonymous. I mean, they didn't disclose who, so they would share, but yeah, it says patients kept getting trapped in the pods, which implies maybe more than once. But even one time, if you can't get out of the pod, that's not going to be good on social media. Yeah, that's right. That's right.

Marcus: 17:35

All right. Private equity gears up for deals to take off. I forwarded you this morning a report from Bank of America, their securities department, talking about how they view the landscape being very favorable for M& A deals. This is Wall Street Journal Pro Private Equity posting basically the same thing. Uh, everyone seems to anticipate under a Trump administration, lowered regulatory burden and pressure on M and a. And so everyone's getting excited for deal time again.

Vic: 18:00

Yeah. I mean, Trump is a deal guy. Literally. I mean, literally he's a deal guy. And one of the, one of the people on CNBC, I can't remember who it was, but said that, you know, the office of president is pretty powerful and what the president measures and maps and tracks often. Often is impacted. Yeah. And Trump is going to look at wall street and financial markets and he, he wants deals to happen. So, um, I think it's very likely that there'll be much more friendly private equity and M and a market, which I think will be healthy. It's sort of a pendulum. I think the, the last administration maybe took the restriction a little bit too far and we'll swing back. Maybe they go a little bit too far the other direction, but. It's just, I think one of the good things about our country is you have the two parties and they'll, they self correct and maybe they also go a little too far, but we're, we're about to move into the Pendulum swinging towards the deal making side.

Marcus: 19:04

Yeah. Uh, Brian Valencia, who's the partner at, uh, Calvin Ferge, um, yesterday. Yeah. Right. The, on the, on the, um, on the tax, on the, on the panel on the G Yeah. The GM VCA panel, uh, covering all the, all the tax stuff. Uh, he was talking about the corporate tax rate may be dropping from 21% to 20%. Mm-Hmm.. Um, basically capital gains, unlikely, maybe it ends up getting a little scrutiny, but probably unlikely that there's any real issues there. Potentially some issues around, uh, capital, uh, uh, carried interest. So that's that, that possibly can end up being a little bit of a football, uh, that gets played with. But generally speaking, all signs point to the

Vic: 19:48

SBI C thing is, is, or S. I'm saying that right? We have a small business tax credit. Oh, yeah, yeah, yeah, yeah, yeah, um,

Marcus: 19:56

qualified small business. Yeah, yeah, right. Yeah, so, so everything seems to be in place for an accelerated, you know, deal environment.

Vic: 20:04

Yeah, I mean, it'll be, it's going to depend on who is the head of the FTC. Um, but either way, I think we better

Marcus: 20:12

as Trump readies of reset of antitrust policy, look to these sectors for deals. So, uh, there's a focus on MNA that could happen in tech and in healthcare. Those have been areas of scrutiny previously from the FTC. So, you know, I, I'm kind of confused. I hear a lot of people saying Lena Khan is going to make it because JD Vance really likes her and she's got a couple of other, and I get that part, but I don't, the track record of who she's targeted does not jive with that. For me. Um, I, I don't, I mean, is she just gonna, like, do a bow face on everything she did? She's not gonna make it. It doesn't make sense to me.

Vic: 20:49

I think, um What I have, I mean, I don't know JD Fan, so I've read stuff by him. Um, he is very critical of big tech like Google, um, using its monopoly power to harm consumers, harm customers. Um, so I think that, I think there'll still will be a lot of scrutiny on, you know, is tech providing, you know, sufficient value to its customers as opposed to using its monopoly power to take, you know, unfair advantage of customers. Yeah. The Republicans will, I think, take the view that a merger acquisition should not be allowed if it's going to Impair competition and make the customers less well off where I think there's a difference is the Lena Khan and the Democratic side. We're more interested in not allowing companies to grow too big because they might cause harm in the future, and I think the difference is going to be that that might is going to be. Not considered anymore like you either are going to cause harm to consumers right now with this transaction Or we it's not really to be considered in the in the preventing m& a So I think jd vance is in favor of breaking up google. Um, well, but Who he picks or who trump picks? I do not think lena khan is going to make it but I don't think it's going to be as friendly to Just every transaction as maybe wall street expects it to be.

Marcus: 22:28

Well, I think google In particular, you know, we're not talking about all of big tech, right? I mean, I think probably who go a meta, the two that are being bandied around. Well, I think Google's number one, uh, you know, we, we did see recently Mark Zuckerberg sort of, you know, posted that letter where he was saying, Hey, this happened, you know, during the last election and I was fired. You know, asked to do this, that, and the third. So he kind of was playing that side of the fence to kind of say, Hey, listen, I understand if this goes down, you're going to target me. And I'm going to come out and come clean on this stuff. Jeff Bezos, um, held the Washington Post up from making any particular, uh, endorsement. And then as soon as Trump was elected, gave him a glowing sort of congratulations. Yeah. So I think, I think Bezos probably has already had some communication with the Trump Uh, family and is probably protecting Amazon, uh, because the last time and I think Bezos

Vic: 23:27

wanted his prime. Election coverage to not be like taken over by the Washington Post

Marcus: 23:35

Well, I think the bigger issue is Amazon Web Services and the number of deals they do with the government Yeah, which is 30 percent of GDP spending forget it's a crime special I think it I think he's worried about AWS and government spending and he wants to I think Google is in real trouble because The Trump administration is going to have them in their crosshairs. They're so mad about YouTube. They're so mad about Google search results and how they feel like all that stuff is censorship. Um, I think there's going to be a lot of scrutiny directly on them.

Vic: 24:11

Yeah, it definitely is. And I don't know where it'll come out, but I think that, um, if Google is using its monopoly like power to disadvantage customers. That's what the FTC is supposed to be doing. Now, there's going to be a lot of, you know, testimony and debates about to what extent or how should there be remedies? I think that's probably healthy. I think it is not appropriate to just say you can't let any M& A transactions happen because. That could accrue to monopoly power in the future. That, that means like VC can't sell something for a hundred, two hundred, 300 million because there's no one to sell it to.

Marcus: 25:02

Yeah. Yeah. I think, I think VC has sufficiently, um, implanted itself in the Trump administration to where anything at the FTC that continues to clog up VC deals is not going to be permitted. I just think whether we're talking about Peter Thiel, or we're talking about David Sachs, or we're talking about Chamath, or Vance himself, Chamath, all of them. I mean, All In, what they, what they did for, for Trump. They all in was one of the first legitimizers for Trump in the podcast ecosystem.

Vic: 25:35

And honestly, we are probably very biased, but I don't think any deal under 500 million is going to affect the market landscape. No, no. Just not, it's just not, I mean, it's important to us, it's important to the VC business to exist, but I just don't think it affects things like that.

Marcus: 25:55

All right. Let's

Vic: 25:56

keep,

Marcus: 25:56

let's carry on. Uh, Oh, big one. Trump selects RFK Jr. To lead HHS. So, yeah.

Vic: 26:02

So this happened like an hour

Marcus: 26:04

ago. I mean, wow.

Vic: 26:06

Yeah. So this will get, this will drop on Saturday. We're recording Thursday. It just occurred. HHS is a huge position and it's top dog. It's got to be exactly what Robert Kennedy Jr. Wanted. It

Marcus: 26:24

seems masterful what he's pulled off here. Yeah.

Vic: 26:27

Yeah, we were talking before the show. I think it's worth repeating if he had not dropped out of the race It's pretty clear. He would have lost. I think that's why he dropped out, but he would have pulled real votes But he would have pulled votes And it would have been much closer for Trump. I think Robert Kennedy pulled a bunch of disenfranchised Democratic voters to either not vote at all or vote for Trump. And he's getting to make the change that the entire reason he ran was to make these changes. And so, yes, masterful. By him and by Trump, honestly, to, to be willing to be open to it. The question is, what is he going to, what's he going to do? How's he going to use it?

Marcus: 27:18

Well, HHS is the top dog. It, it, uh, oversees all of the public health agencies to include NIH, CDC, FDA, CMS. I mean, it's, it's everything. It's everything. Um, he's, it seems like he's been, I mean, like

Vic: 27:36

everything, health, food, public health related. And I have been trying to figure out what Robert Kennedy is going to focus on. Seems like he's really targeting food and the ingredients into food. And then also kind of how NIH and CDC and the scientific administrations do the work they do. And trying to pull out conflicts of interest. Those seem like okay things to focus on. Um, but there's a lot of health policy that, um, he could easily swing into. Yeah. That, that, you know,

Marcus: 28:26

those things would be relatively benign for the healthcare industry. Yeah. And I just. I'm curious as to whether or not he does not have more serious intentions for the industry itself. Um, I doubt those, those things will be focused at the delivery of care as much as they'll be focused at pharmaceuticals. Um, I think he's, he's very focused on what we put in our body. Yeah, right. He's very focused on what we put on our body. So, um, Yeah, I

Vic: 28:55

think

Marcus: 28:56

I'm probably largely aligned with that. Yeah, so it'll it'll it'll be interesting. Yeah, it'll be interesting for sure Australia plans a social media ban for under 16s. This came from the bbc is about a week ago when it came through You know a lot of people Will say okay big deal kids will just lie about their age. It happens all the time Anyway, but I I do think there's something really meaningful about a nation state passing a law that basically says Social media is not is so unsafe for children That They're banned. There's no like, hey, take a class so you understand it better, blah, blah, blah, they're banned. I mean, you're banned from it like you're banned from alcohol. You're banned from it like you're banned from smoking. You know, it's, it's in that class of things now. And, um, I wonder how many more countries will follow suit.

Vic: 29:50

I mean, I, I think I'm in favor of it. Enforcement is going to be hard, but, but at least it gives the parents a chance. Right, like, you can't drive a car if you're not 16. Yeah. And yes, a kid can go out and steal his dad's keys and start the car and drive off. You know, when the parent catches them, they get to say, that's not allowed. It's illegal. It's illegal. You can't do that. And it just gives the parent more ground to, to try to help their kid not. Dive into social media when they're 12, 14, 15. Right. I

Marcus: 30:33

mean, the parent, the school, I think it's everyone who surrounds the child, right? You know, because the parent's only with the child some of the day. Right. And is also not the only authority figure, right? So it's all the other, you know, the coach on the team or whatever. Yeah.

Vic: 30:45

Yeah, so I mean, it, it, it, it adds credibility and I think it is damaging to children. Yeah, damaging to adults too, but it's definitely damaging to children.

Marcus: 30:56

Congressized site neutral pay bills for lame duck session. This is for modern healthcare, always sort of covering how the payments are going to flow out of DC. And this is, I think, something that a lot of people who are advocating for more, uh, for a more competitive healthcare system. Ecosystem, this is, this is kind of what they want, you know, more price transparency, more consumer options and less favorable payment models for hospitals over ambulatory care.

Vic: 31:27

Yeah, I mean, right now, the same services are reimbursed significantly higher in inpatient facilities, even if the service is not. An overnight stay in patient service. You come for an outpatient procedure and the health system gets reimbursed more. And. that is justified by the amount of overhead we as a society have asked the health system to build. And I, I understand that argument. We, we have a lot of friends here in town that are health system executives. And I also understand the other side, which is, okay, that, that might be important in the burn unit or when you have a life flight coming in for, for trauma. But how does that relate to. me getting this procedure done when I can go to an ambulatory center. It's the same exact thing. You might argue it's sometimes it's closer and easier and yet they're paid less. And so there's a fairness argument that I think is challenging on both sides. The health systems are required to offer all of these services. Right. And yet they don't make enough money from the trauma and burn and ed. And So really, the solution is probably we should reimburse those services more to be able to pay for this, the overhead they need, and then reimburse the same for the other stuff. Yeah,

Marcus: 33:01

I mean, I think you're making a great point. In the world of hospitals, there is so much robbing Peter to pay Paul. I'm over cross subsidize. Yeah, yeah, it's so much. And it's just like, how about pay them for some of the really hard work that they do and then make the rest of it and even playing field? For everybody. Yes. Instead of making these sets of services sort of captured in what may not even be the right side of care for it.

Vic: 33:30

And I think it made sense when it occurred because I don't know, they were, they were the only place doing these services. Yeah, it's a very different world now. But now we've changed and it's much more transparent. So I'm not sure what will happen in the lame duck session, but I think. Our health system friends that are listening need to start getting ready. There's going to be a lot of pressure on this site of service reimbursement being the same.

Marcus: 33:55

Republicans choose John Thune as the new Senate leader for second Trump era. So that, that little saga, at least for now dies down. There was a lot of talk around this secret vote that was going to happen. And, um, whether they're talking about it being between John Cor, uh, Cornyn, Rick Scott, and John Thune, but I think really. Everyone was eyeing Rick Scott because that was Trump's pick and that was who he wanted and he had been, you know Leveraging social media to try to create pressure around that to happen, but it did not happen

Vic: 34:25

Yeah, and I I think it's it's healthy for the Senate to have its own leadership that is not beholden to the president. And so I know there's a lot of Republicans that wanted to see, you know, sort of Rick Scott and just anything can get through the Senate. But I think it's probably good that, that there's some checks and balances. I mean, there are Republicans, but they're going to have to, they're going to have to talk to each other. And John Thune is really, uh, Mitch McConnell, um, he was Mitch, Mitch McConnell's. Uh, second lieutenant for a long time. So it's really an extension of the existing power dynamic in the Senate, which I think is probably okay. I mean, Trump has plenty of power and The Senate, which are Republicans, they'll share a lot of common interests. Oh, yeah. But not all not being like, they're not

Marcus: 35:22

all

Vic: 35:22

mega,

Marcus: 35:23

not all pledge allegiance to Trump. I mean,

Vic: 35:25

which will be good. I think that's a good thing. I mean, it will make it more difficult. It'll make it maybe slower, but that's probably okay.

Marcus: 35:32

The Republicans have clinched the house. So we, I think yesterday it was like that there were two seats away and now it's a

Vic: 35:40

one, a couple of seats yesterday. Then. You know a couple of Trump's nominees for other cabinet positions are in the house Yeah, and so they're gonna have to run the elections. They have elections. They're gonna have a very small We have a small majority in the house, but they'll control the committees. They'll control the docket. It makes a big difference to have one extra seat versus

Marcus: 36:05

now that they spent this last term, this last two years where they controlled the house, figuring out how they were all going to get along. Because again, It's really kind of not one Republican party, right? I mean, yes, you know, uh, when you talk about Marjorie Taylor Greene and you know, some of these folks, it's just like

Vic: 36:22

the same way they're all because we only have a two party system. Each of them are like this. I don't know. Yeah. Right.

Marcus: 36:29

Right. So, but I, I will say, I do feel like they work through a lot of it. Mike Johnson has. at least been a steady hand, you know, for back half of this year and Trump is backing him, which I think will actually keep the, keep the loudest voices in, in house under, under control. Um, so I would anticipate actually a much more orderly house, uh, for the next two years and probably one that's very productive advancing what Donald Trump wants.

Vic: 37:02

Yeah. I mean, I think we will, we will know by end of March. Because they need to extend Trump's tax cuts that expire. So in 2017, I anticipate that happening, that'll happen. But, but if you're going to use budget reconciliation, you have to pay for it. Yeah. So they're going to have to find, um, revenues or savings somewhere else. So that, I think that'll be the first. Signal of we, we are aligned and we are aligned and they, they know they have a common idea of how they're going to structure it or they're all fighting over how to get it through reconciliation.

Marcus: 37:43

Well, the MAGA house reps were the, they were the activists last time, right? Now Trump is in the White House, so that, to me, that just feels like that should align them better, right? Like Trump will tell the House, this is what I want you to do. The MAGA House reps will say, you heard what he said. Mike Johnson's gonna say, you heard what he said. And I think everyone's gonna do it. I mean, less so in the Senate. Less so in the Senate. But in the House, I feel like Trump is gonna have pretty good controls.

Vic: 38:14

Yeah, I mean, I think you have, If he can get a handle on the deficit, this is where the Department of Government Efficiency Doge thing is going to be interesting. If they can actually cut spending, everything gets easier. Yeah. But if they can't, then you have a bunch of deficit hawks that will be concerned about things.

Marcus: 38:35

I anticipate that they will in fact cut cut spending. Let's let's shift over to payers. Um, United Health and Emeticis, they were picked on by the DOJ this week, uh, investigating their deal. I mean, I don't know. This feels very lame duck to me. Um, yeah, this is this

Vic: 38:57

DOJ, what do you enforce error? Why would the DOJ bother? They're not gonna gonna be in, is after the re You're not even, you're not gonna be in the seat to prosecute it. Silly, silly. And so obviously United and edis are gonna fight it. Yeah, of course. And then there's gonna be a, as new head of the DOJ, who's gonna, I think probably gonna drop it. So the whole thing is. It's ridiculous.

Marcus: 39:20

Yeah, seems, seems pretty silly to me. All right. Major payers saw mixed results in Q3. Um, how did they fare? Basically United, uh, made enough profit for all of them times three, basically. It's

Vic: 39:34

crazy. It's incredible. I mean, if people are watching the, there's a chart up here talking about the quarterly profit and 6 billion in quarterly profit. And when you add up everybody else, it's. It's three and a half. Yeah. Um, but that's, that's Humana, Elevent, CVS, Cygnus, and Teen. These are big companies. I know. And United is just lapping the field.

Marcus: 40:01

Now, I think the craziest thing here to me is United Health Group versus CVS. Yeah. Because they are two similar, Positioned companies in terms of their stature on the stock market, right. And their revenue, the market cap, the top line revenue. Yeah. Those kinds of things.

Vic: 40:19

Yeah. About roughly a hundred billion in quarterly revenue. Yeah.

Marcus: 40:24

And I mean, CVS is the worst performing of this batch.

Vic: 40:27

Yeah. And the change from last year CVS made awful little over two, two and a half billion in 2023. Yeah. In the third quarter. Yeah. And they barely were profitable. Fairly. Fairly. Now, as we talked about last time, the new CEO, I think, threw every cost and everything he could get into the kitchen sink because he's not getting painted with this thing. But still, they still have a dramatic fall from grace. So and then the MLR just quickly, um, again, like UnitedHealth. Was right at 85. Yep. Um, and Cigna, who does, as we've talked about before, it's mostly employers, was at 82. Yeah, every,

Marcus: 41:12

everybody was up year over year on MLR. every payer was up. Everybody was up, and pretty much everybody was up between 2 to 3 points. Yeah. CVS was up 10 points. It's just like, of course there's implosion going on over there. Like the, the, the, the math is not math and that's right. That does not work. Uh, all right. Onward Oracle and Meharry medical college collaborate on innovation hub wellness center in Nashville. Uh, so this is good news. I actually heard about this. My buddy, uh, Ritesh Patel, who works at fin partners, uh, In their digital health his background. He worked at Ogilvy health So he's done a lot of like really strategic stuff partnering with the health care industry Um, he he tipped me off to this. He was like, hey, I just want you to know this is going down Send it to me last week. Um, it's great. It's great news, right? I mean immediately oracle making an impact coming into town picking an important institution to partner with bring more innovation My harry has had a heck of a year. Uh, you know, we could look at the bloomberg Contribution Bloomberg philanthropy contribution to their endowment, basically doubling it, um, adding over a hundred, oh yeah, adding 120 million to their endowment. So I think they're like 250 or something like that now. Um, and now this, this Oracle, you know, I mean, they're, they're having a banner year in terms of like really being able to bring in big partnerships.

Vic: 42:31

Yeah, it's going to be great for Meharry, great for Nashville, and I think it'll be great for Oracle. Yeah,

Marcus: 42:35

yeah. So, so good news. Look forward to seeing what they work on together. Um, Kaiser Permanente looks to slash costs as industry headwinds bring 608 million operating loss in Q3. Not expected.

Vic: 42:47

Yeah, so they weren't in the process. The payor review, because they're sort of a payvider and they're not profit. Yeah, mostly thought of as a provider. Yeah, with

Marcus: 42:55

an internal, you know,

Vic: 42:56

insurance company. I was really surprised that they went to a 600 million loss in third quarter. And then the next story, they have made some cuts to try to correct that. Um, I think Kaiser's Going to be fine, but but having that big of a loss is really surprising.

Marcus: 43:14

Yeah, I would love to sort of know what happened Yeah here, you know because actually that there's they're saying that the Geisinger acquisition actually it contributed positively It added 13 million as a gain. So there's something fundamentally went wrong Um, over the last, you know, couple of quarters here and, uh, it would be, it would be worth, worth understanding better. You know, I wonder whether or not some of the Medicare Advantage stuff kind of came to, came home to roost with them as well.

Vic: 43:39

Yeah, they're thought of as a, as a provider, but I think they are having the same effects as the payer side that we

Marcus: 43:47

saw. Yeah, I think you're probably right about that. Amazon One Medical rolls out telehealth treatment services in competition with Roe, Hims and Hers. Yeah,

Vic: 43:55

I mean a little bit surprised it took Amazon so long, honestly, but um, but seems like something they can easily move into and Disrupt that space.

Marcus: 44:06

Agree.

Vic: 44:07

Hair, hair loss, ED. Um, these are pretty straightforward things that you'd prefer to do online and telehealth that, that really is what Roe and Hems did really well. And I just think they are going to struggle in the next couple of years that they don't have a lot of barriers to entry people, you know, that they're compounding GLP one, which is making a lot of money right now, but I don't know how long lasting that's going to be. Right. Right. So, I don't know. I think it's. Not surprising. And I think Amazon is going to do well with it.

Marcus: 44:44

Yeah. Look, I mean, I, I think Amazon just has so much trust at this point. Yeah. Um, they've done such a great job with all of our consumer data and, you know, never being that brand that's let us down. And, uh, one medical is a really good brand on its own. Prior to Amazon owning it, one medical had fantastic reviews. Everyone sort of loved one medical. So it's a marriage of two great brands. Um, very, very strong technology company. I expect the telehealth services to be. Uh, highly competitive, likely to be as good if not better, you know, from a user experience to what Roe and Hibs and Hers are, are delivering. So Amazon and Walmart

Vic: 45:21

and everyone tried to do kind of general primary care. Yeah. And that's pretty hard. That's hard. But this niche primary care where I have this one thing I need, I'm losing my hair, I'm going bald, and I need help. Right. They can, they can solve that and I think get a good gross margin and net profit

Marcus: 45:40

there. Uh, Cardinal Health inks two deals worth 3. 9 billion to expand diabetes, uh, and GI businesses. So yes, Cardinal Health is moving into building out specialty networks, um, makes, makes a A lot of sense that, you know, it's not sort of the payvider model, but there's a new integrated vertical model for manufacturing companies, right, to say, Hey, we create all these things. We ship them out. Why don't we kind of control who we ship them out to? Let's create a captive audience there.

Vic: 46:06

Yeah, I mean, it makes sense. It is similar to the payvider where they're expanding from. distribution, which is low margin, huge volume, and they do a great job at that. Sure. But it's pretty competitive. It's very competitive. So now they're moving into much more specialized things, higher margin, and much more sticky. It's hard to, it's hard to switch off that.

Marcus: 46:29

Yeah, yeah. I think it's really smart. And also, when you're moving into, you know, some of these specialty spaces, you're, you're not directly kind of competing with your big, big, big customers on the health system side as well. So you're not angering people when you go into GI, for example, right? You know, that's, that's, that's kind of fair space. So, um, yeah, now it will be interesting for a lot of these independent, uh, physician groups that, you know, specialty groups, Cardinal bring in the Cardinal health balance sheet behind what they're doing. It could be kind of a transformation for cardinal health, quite frankly, you know, where they really start to become much more known for the delivery of care from a nationwide perspective.

Vic: 47:08

Yeah, I think it's going to be challenging in the gastro and diabetes provider space. If you're not with a big firm, you need to get with one quickly.

Marcus: 47:20

Yeah, that's exactly

Vic: 47:21

right.

Marcus: 47:21

A little bit old, but Nova Nortis had a great quarter with their wegovy, uh, drug sales. They beat expectations year over year, 79%, you know, uh, gross up. So just, you know, wegovy. Yeah.

Vic: 47:33

All the GLP one derivatives continue to just crush the, the. Popularity, the demand, the sales. I don't know that they're going to be able to hold pricing and it seems like there's a lot of competitive products coming into the market, but they're, they're very popular and they're, and they having success. People are, people are losing weight. They're, they're having derivative benefits too. Like not drinking as much, not doing other things.

Marcus: 48:00

Let me tell you something that I, that I know. Um, I know that. In the diabetes space, they are now looking at, uh, not just looking at, they're doing this, they're starting to recommend subscribing GLP 1s in place of insulin. Really? Yes.

Vic: 48:25

Will you taper off insulin? Do they just don't give you insulin? They're replacing

Marcus: 48:28

it. They're replacing it. Wow. I'm not going to tell you how I know that, but I know that. This is a real world case. Yeah, so you

Vic: 48:35

know of a patient or I know of

Marcus: 48:38

a patient where that is being recommended.

Vic: 48:40

And their blood sugar is stable and okay? Yes, stable. Yeah.

Marcus: 48:45

Yeah. Yeah. I think what has happened is that this person has been progressing well. Um, and so it's like, well, instead of like, You know, insulin every day, like let's do this once a week.

Vic: 48:58

Yeah. I

Marcus: 49:00

mean, that seems like a huge win for all round. I mean, I think patients, you know, I think that I beg patients are going to really love that, but you know, what happens if GLP one start eating into insulin, you know, not insulin prices already become sort of much more generic, but it's just something to think about. Like lip ones are just eating so much. The kind of software eats the world. Like lip ones are eating the world, man. That's right. It's crazy. It's crazy. China has detained a senior AstraZeneca executive. This is a story where basically this, uh, this China chief for AstraZeneca, Leon Wang was in Hong Kong and the Chinese government, uh, suspected that perhaps, um, he was leading, uh, AstraZeneca in illegally importing certain drugs, uh, from Hong Kong into China, maybe improperly collecting patient data. And so he's being detained. And the language from AstraZeneca. Is very like to the point. It's just like, this is what's happening. There's no opinion on it. There's no, we rebuke the Chinese government for doing this. It's very like, matter of fact, this is exactly what happened.

Vic: 50:06

Yeah, to me, it's pretty scary. These drugs are approved for use in Hong Kong. Hong Kong is very close to mainland China, and there's lots of people going back and forth. Of course, some people, whether it's approved by the company or not, there definitely is going to be Some migration of the drug across, across over to mainland China, or someone has, I think it's an oncology drug, yeah, breast cancer drug. Someone has breast cancer and they want the drug, I mean, they'll go to a lot of lengths to go over to Hong Kong and try to get it. I think it's difficult to hold Leon Wang responsible, but we don't know any of the facts, but no,

Marcus: 50:51

I mean, look, it's to me, it's just a watch this space to kind of story, right? I mean, we have no details on this, but I think China is going to be, uh, getting more aggressive in a variety of different ways, um, in the days, weeks, months to come because they're under a lot of pressure. Yeah, it's going to get worse and worse with tariffs. Oh my gosh, forget about it.

Vic: 51:18

I mean, I cannot think of A company or an executive that would want to go start a business in China now, I mean, oh, no, so it's just not gonna, I mean, stories like this are not going to encourage foreign investment. No one's going to go over there. Yeah,

Marcus: 51:38

open notes partners with a bridge to study how AI generated notes can benefit patients into our AI rundown a bridge. Kind of consistently showing up in the AI rundown. I think they are cementing themselves from a share of mind as a real player here to stay, and that's constantly doing partnerships.

Vic: 51:59

Yeah,

Marcus: 51:59

and

Vic: 52:00

partnerships to get credibility.

Marcus: 52:01

Yes.

Vic: 52:03

earn it. Yeah. Like I, I don't think, I don't know open notes well, but I don't think they will just give a free pass. I think they're going to actually going to look at it.

Marcus: 52:10

Yeah. So, so open notes is a health transparency research group, part of Beth Israel, um, in Boston. Uh, and look, I think we're going to need a lot of support. studies on AI, because the jury is out on many a thing, uh, what the long term impact of this is going to be. And so I, I'm start, I feel like we're starting to see a strategy around AI companies, um, proactively partnering with groups to do studies, to create research, to get objective third parties involved. You know, around the table and also to make sure they are being appropriately positioned as good actors. Right? Right. We, we want sunshine on this topic. We, you know, we want someone besides us sort of analyzing what we're, what we're doing and coming up with, with, uh, analysis of whether or not it's good or not. Um, next, the, the next guest show we have is, is going to be, uh, along these lines.

Vic: 53:02

Yeah. Right. And we'll dig into that model. I think we need several bodies. Really looking into this. I mean, the thing about health care is, even with humans People die in healthcare. So like there's going to be times when the patient doesn't do that. Well, we know that. And so finding a way to do research and make sure that we're delivering the best care we can in a combination of AI and humans, I think is something we have to figure out.

Marcus: 53:32

Absolutely. Mass General, Emory, test AI models from Amazon and open AI. So more, more testing.

Vic: 53:40

Yeah. All of a sudden. The Boston area is doing a lot of testing and analysis on AI models. Yeah,

Marcus: 53:46

yeah. So working with OpenAI, again, OpenAI is demonstrating that they are serious about healthcare and partnering with, you know, real big brands in the healthcare space, but also Amazon showing up here. And this is maybe the first time we've had a story where Amazon's name was included when I was talking about assessing models. Yeah. Um, I think that's interesting pairing it with the, the, the story about Amazon in one medical. Um, but also we, we know that Amazon's sort of big investment in the space has really been an anthropic and Claude, which is easily by many people's account, the best model in the market today.

Vic: 54:24

Yeah. I was surprised that Amazon was participating, um, for exactly that reason. I haven't seen them out front using the Amazon brand as like a leading LLM model. They have lots of tools in their, in their systems, in their cloud systems. Um, so either they're sort of partnering with Anthropic and, There was some reason to put Amazon forward here, or they're trying to, to create a retail facing brand, although I haven't seen it anywhere else yet.

Marcus: 55:02

Mm hmm. Mm hmm. So, uh, it's something to watch. Are we going to see more of Amazon being the lead brand when it comes to AI models in health care? Right. As opposed to Anthropic and Clawed, that may be a strategic decision, right, to use the Amazon brand because of the, you know, the power of Amazon in the cloud world with AWS and things of that nature, right? Behavioral Health Provider Rogers to deploy AI chatbot from Limbic to speed up patient intake. We're seeing more and more of the chat bots in the behavioral health space. Um, Rogers is a big, uh, behavioral health player. Limbic is an actual LLM based chat bot. So not like Wobot as far as, as far as we know, I don't know if, I don't know if Wobot has gotten off of just being pure sort of machine learning and, and, um, predetermined, uh, outcomes and has moved to stochastic LLMs. But, uh, yeah, I mean, More chat bots in behavioral health.

Vic: 55:57

Yeah, that's right. And it looks like it came out of the UK. I didn't really know limbic before this story There's been a lot of study in the UK about it. But it is yeah it's a competitor we'll bought and we'll see that the reason it makes sense in behavioral health is there's a lot of talk therapy a lot of very commonly accepted, um, techniques like cognitive behavioral therapy. Um, so it would be amenable to a chat interaction, but, but it also, you know, it can hallucinate. So, and I don't mean hallucinate like it's going crazy, but it could just say things that aren't exactly on topic. And so we'll, we need to see, but I think we are going full speed ahead into using. Generative AI for clinical care with patients. And there's going to be studies like the last two we just talked about, but there are also people just using it in the wild. Oh yeah.

Marcus: 57:05

Oh yeah, for sure. Presbyterian healthcare services taps RhythmX AI to roll out Gen AI copilots for primary care. So this feels like exactly what TK was telling us was going to happen.

Vic: 57:15

Yeah. It makes me a little nervous, but it also just is. It's just the way it's going to be. I mean, we just got it. It's just going to happen. It's here. We literally

Marcus: 57:23

have been talking about it every week for over a year now. Nothing about this is surprising us.

Vic: 57:28

Yeah. Yeah. It's not surprising. Yeah. And I'm also not sure. But I mean,

Marcus: 57:35

I guess I would say the reason why it's happening, we understand why it's happening because it has to happen.

Vic: 57:41

It's necessary. And, and they're going to places where there's a shortage of clinicians, behavioral health and primary care. There's, there are not enough humans. To do to treat the patients we have. No,

Marcus: 57:53

and the incentives are not set up in a way where we're going to have some major change in that trend. Yes. Not fast enough. That's right. We're not going to have a change in that trend fast enough. So, we're going to have to move to AI. Yeah. That's just, everyone's got to get used to it.

Vic: 58:08

I think that's right.

Marcus: 58:09

All right. Final story, open AI, Google and Anthropic are struggling to build more advanced AI. I feel like I hear stories on both sides of the spectrum of this argument every week. So I don't know what to believe. Sam Altman was saying we might get AGI next year. And then this story is saying a bunch of people are like, eh, the, the, the scaling is not working as they hoped. Then, you know, and to me, I kind of feel like, um, It's just the expectations have been set so high, right? I mean, the advancements that they have made in the last two years have just been tremendous, but they have spent a lot of money getting there. And now it's almost like people are saying, if you don't get to AGI, it ain't good enough. You know, I, I feel like they're looking at these, I feel like they're looking at the amount of money invested, the revenue being generated, the proliferation of these tools versus the actual adoption of these tools, right? They're in every piece of software we have, how many people are actually using them, right? So they've been fully distributed. And so now it's just a question of, ah, what's, what's going to, what's going to happen here. Right. And we're looking to build more advanced AI. You know, we, we want the AI that comes that immediately just like takes over and runs a company. Yeah, you know, anything short of that seems to not be acceptable.

Vic: 59:27

Yeah. Well, when you spend hundreds of billions of dollars, you have to create a big market to, to grab. I, I sort of come down to the fact that I think it's going to be slow. I think the tooling around the existing systems and actually using these things and building interfaces and ways to get it into SAS tools or into. applications that can actually be useful, which is not writing a poem or giving me 30, uh, subject lines for an email. I mean, that's what it does now. And it's really good at that, but it's difficult to get that into a business setting where I can really use it. I've worked on it a lot, and I have some use cases, but, uh, That's, I think, the frontier models are not that interesting to me, like, spending multiple billions of dollars to get another turn on reliability or complexity, they're good now. Llama's good now. They're like, they are plenty good. It's much more the tooling and the infrastructure and the interfaces and, and making it usable that I think is.

Marcus: 1:00:42

I think 2025 is definitely going to be the year of software companies figuring out the right places to inject AI in the work in their existing workflows to meaningfully make The user's experience more productive and more joyful. That's one thing. Yeah. Two agents have got to become real. Like we, you know, and at a minimum we got to see him show up for like executive assistants. Like everyone should be able to have an executive assistant. Okay. Like if we can't get there, how do you think we're going to get to the next thing? Right. You know, book my restaurants, book my flights, book my hotel, you know, the basics. Like we got to get baseline agent. If we can't get those two things done, it's going to be a hard year for valuations on the AI side, I think.

Vic: 1:01:37

Yeah, there's no question. I mean, the amount of money and hype and energy being put into the next project. Open AI, the next Gemini, the next Claude. When I don't know that that really would make that much of a difference. I mean, say it's 10 times faster, better. It still isn't interfaced into places where I can use it. I don't mean, I think this story is probably right. That the next versions are not getting the same like leap in performance that they got from GPT 3 to 4. But I don't know that's the real challenge. The challenge is that there's not a product or like a business model or just The chat interface not connected to anything is not, just not enough.

Marcus: 1:02:34

I, I've, I've long, I've long felt that the interface was far from ideal. Like, it's a great interface to experience what LLMs can do. Yeah, to

Vic: 1:02:46

test it for the first time.

Marcus: 1:02:47

Right, but from a working perspective, it's not what I want to be

Vic: 1:02:51

using. No, it's gotta be. Either in email or slacker teams or hitting API's where I don't even have to mess with it. I

Marcus: 1:02:58

actually can't believe AI is still not embedded in Slack in some way, shape or form. Yeah, that to me is the most mind, mind boggling thing. I'm like, I'm in this thing every single day and it still doesn't have any form of AI that like, or no one has made an AI plugin that makes sense for Slack. I'm like, why?

Vic: 1:03:18

Yeah. I mean, I have one. You have to be a developer. Yeah. I mean, it is hard, it's not easy to do. We need a no code, just turn it on and it works. And the one I have is not that. Yeah. And so I spent a weekend trying to get it to interact with Slack. And it, it does, but it not, it breaks all that means it, you know, it's, my code is not super tight. And so it doesn't, if I don't put in the exact right thing into Slack, it doesn't work. Yeah. It's just not reliable. Yeah.

Marcus: 1:03:50

All right. Good run now. Anything we, uh, we left out?

Vic: 1:03:53

Yeah, I don't think so. Excited. Just mean there's gonna be a lot of political changes in the next couple weeks.

Marcus: 1:03:58

Oh, man. Look, the RFK one is that's for us. I think right now that's the big one. Just because he's a little bit unpredictable.

Vic: 1:04:09

Be really interesting to see. I mean, by the time people are listening to this, I think he will have, you know, Yeah. And so like, what is he going to talk about as his key things he's focused on? Right. I think it's going to be outside of like detailed CMS policy that we would care about. Right. More like ingredients for food or scientific research.

Marcus: 1:04:32

And those are things that the general public will really resonate with. Yeah, they understand. It's

Vic: 1:04:37

easy to have a soundbite. Everyone understands it. Yeah. Yeah. You show the, he showed something. I saw that. Like this is what the McDonald's fries have in London. This is what they have in New York City. And no one's

Marcus: 1:04:49

going to cry for McDonald's. That's

Vic: 1:04:51

easy to understand having to change their ingredients.

Marcus: 1:04:53

That's right. No one's going to cry for McDonald's needing to like, make their ingredients more healthy for America. Yeah. That's, that's an easy one. And it's

Vic: 1:04:59

not that the fries in London, Taste that much worse. No, they just are a little bit harder. Maybe they don't last as long. You have to throw them out after a month.

Marcus: 1:05:07

I mean, I tell you what's going to be really interesting. These things, especially around big food, right? Have just been, I mean, you know, we've had documentaries made about it and everything like that. But if RFK can actually like, undo some of that stuff, it really is going to call into question, what have the leaders for the last 30 years, especially maybe the last 20 years, what have they been doing? Allowing big supersized me was 20 years ago. Yeah. Yeah. So, so, I mean, it's going to be a real question, right? Like, okay. If in fact this guy is able to come in and in a relatively short period of time, Make meaningful changes to what's in our food. And he doesn't run into all these crazy walls. Like if he's able to get it done, it really is going to call on the question. What has been the holdup on this? I mean, I think what has

Vic: 1:06:01

been the holdup is conflicts of interest.

Marcus: 1:06:03

Well, that, well, I mean, that will. That will be a damning. I think that is going to very much change how we look back at the leadership we've had over the last 20 years. That's it's just, you know, it's it's clearly one of the two big things that have been allowed to, um, You may say three, uh, but I'm, I'm going to stick with two, the, the two big things that have been allowed to, to touch all of us have been the food supply and social media. These are kind of the two things that they're in all of our houses and all of our hands and all of our bodies, you know, at this point, social media is in your mind, it's in your brain, right? Yeah. And if, and who are they benefiting? This is what I'm saying, only the companies, only the companies, they, you know, they do not benefit the general public in any meaningful way. So kind of a big deal if this administration is able to take on those two big forces and actually do something about it.

Vic: 1:07:11

Yeah, I mean, I read a book called Fiat Food, which is Crypto guy that wrote it, but it was the history of food for like the last 200 years and incredibly well researched. I mean, like whole proof of work. He has maybe 500, 600 end notes. Um, and it's really damning all of the food legacy, just not great things that were completely conflicts of interest. Now I'm not an expert at food. I read it because it came out of the crypto world, but if. If 10 percent of it's true, it's terrible. So, um, it'll be really interesting. I think, and then before the next show, Robert Kennedy jr. We'll have given a couple of press, you know, press, uh, conferences and talked a little bit. I hopefully he will focus on food ingredients and getting it to be healthy food. Yeah.

Marcus: 1:08:14

Also like regenerative, uh, regenerative farming. He he's, he's bringing it to the table, which is a, which is a big thing. Our, our soil health is a big issue.

Vic: 1:08:21

Yes. Yeah. Yeah, and we throw tons of fertilizer on it and we over farm it. We don't need all the current corn syrup that we make. And the only reason we make it is because we pay the farmers to make corn. So there's a lot of pieces that are, I think you'd have 80%, 85% Support in I mean my fruit loops don't need to be such bright green and red right if it's going to be healthier they'll still be pretty sweet yeah it just won't look so bright

Marcus: 1:08:51

yeah

Vic: 1:08:51

um so I don't know I think there's plenty of things that would have huge uh support and hopefully he'll stay out of like detailed reimbursement stuff um at least for a little while yeah but we'll see yeah

Marcus: 1:09:09

all right man see you next week yeah