15 – AI Chatbots as Friends | US CPI at 3.2%, but Deflation in China | Hospital Prices set by CMS for 2024 | Wegovy for Heart Disease

Marcus: [00:00:00] All right. Show 15. How’s it going?

Vic: It’s going well. The, uh, news keeps flowing in every week. We’ve got new stuff to talk about.

Marcus: Uh, yeah, I would love to take a break talking about the fed, but we cannot because it’s yet another big day. There’s new stuff. I know. And, and that is driving the narrative. So, um, with no further ado, let’s dig in.

Let’s get, let’s get after it. So

CPI was reported. Today, correct?

Vic: Yep. That’s right. For July came out today. Not much change really. I mean, the, uh, the headline number was slightly up for a year over year, but flat on month over month. I don’t know, maybe somehow the way to calculate their annualized. Um, so it shows up on the chart here.

We’re showing, like we did a month ago, we’re showing the same chart to try to keep consistency about the headline and [00:01:00] then core. And it’s sort of the same story. The headline is pretty good, uh, because energy costs are down dramatically, but the core, which is what the Fed watches for the most part. is well above the, um, this, uh, BLS has the 10 year average indicated, but it also, I left it in there cause it’s, it’s right at the feds target, which is two.

Marcus: Yeah. Yeah. So we’re, we’re still no closer to that on, on the core. All right. So that’s, that’s

Vic: sort

Marcus: of the

Vic: headline thing. That’s what everyone’s talking about today, but I want, I’m kind of bored of that. Agree. Agree. So I wanted to talk about. I think the Fed is, um, you know, I’m going to say, I think they’re making a mistake.

I think they’re, they’re not reacting to what I’m seeing in the global economy. And I wanted to sort of talk through a couple of things I’m seeing out there and just see what your thoughts are. Talk through it.

Marcus: Yeah. I was driving around all day, uh, actually engaging in the healthcare system and actually had a [00:02:00] great experience today.

Uh, so shout out to Vanderbilt, uh, um, really, really good experience today, uh, with them and my parents. So anyway, um, yeah. Yeah. You, you had this whole story around China and, uh, kind of shocking, kind of shocking story.

Vic: Yeah. I mean, I think most people are watching the S and P 500 stock prices and feeling like inflation is high.

And, uh, We are going to have a soft landing and my stock portfolio is up and everything’s good. And then you see this out of China, which is yeah, pretty shocking. They’re in deflation and they have had deflation CPI negative for nine months in a row. And so this is a confusing chart that shows the Producer price index.

So like what manufacturing companies, which is what I really care about in China. Right. What are they seeing in pricing? And they’re at negative [00:03:00] 5 percent annualized. So like their prices that the producers in China are able to get is, is going down pretty dramatically. The reason I care about that is I think Europe and America is largely who they’re selling to.

Yes. And so that, I think that means we’re buying a lot less stuff from China.

Marcus: Well, that reflects from the last GDP report. Yes. We’re not buying stuff. We’re buying services and we’re not buying stuff. Right.

Vic: And so to me, this says that inflation globally should not be a big concern. China is a big driver of the economy.

They make, I don’t know what percentage, but a significant percentage of the The stuff that we all buy and they’re seeing really negative price. Prices are coming down. They’re not going up. So that got me thinking, you know, are there, are there things [00:04:00] to look at? And I, and I found their Maersk report. So Maersk is, uh, for people that don’t know it, it, I don’t know what percentage that they have, maybe 50%, 60 percent of, uh, global shipping.

Mostly the big, uh, container ships, um, you know, where you have like a container of stuff that then goes on a train or a truck when it gets here.

Marcus: Yeah. As soon as you

Vic: see the logo, you recognize it. Yeah. We should have put the logo up here, but, um, yeah, it’s, it, they have this huge ships with, I don’t know, like 30 football fields, right.

Right. Right. Containers. Right. And they’re, so they’re, I think they’re a good indicator of global trade. And this chart is showing the volumes, the container volumes, by different verticals. But the interesting thing is they’re, they’re all down pretty dramatically since probably the second quarter of 22.

Right. So in [00:05:00] COVID obviously shipping went to zero or very low, and then there was a huge boom and we all remember the, the cost of a container went up like 15 times because you couldn’t get containers. But then since then, it’s been slowly down. And then the last year or so it’s been down pretty dramatically.

Yeah, 50%. And so again, I’m not a PhD economist, and the Fed employs more economists in PhD than anyone in the world. But it seems pretty clear that if China has deflation and global trade is, is falling so dramatically, Our risk is not to the upside and inflation is going to be a big problem. It’s more like recession and, you know, potentially deflation here.

And so then we need to start thinking about, well, have we seen anything in the U S that would [00:06:00] be indicative of that? And so, yes, uh, Moody’s came out on Tuesday and they downgraded multiple banks, 10, 12 regional banks because the banks are struggling. Especially the smaller banks because of interest rates.

Yeah. I mean, fundamentally, fundamentally, the interest rates went up. In my opinion, too quickly for a bank to adjust its book of loans in any reasonable way. They can’t move their book that quickly. They can’t really hedge it that quickly because they have to make new loans. And so that we saw bank failures in the spring Moody’s is, is saying, I think pretty clearly that We’re not finished with that.

And whether we have more bank failures or they’re just suffering, they are still kind of working through that. And I think the, the best case is loan [00:07:00] growth is not right. They don’t want to make loans. And the worst case is there, there’s more shoes to fall. So I don’t know. I mean, I think it’s, uh, we can keep going on these things, but it’s, it just stacks up where like, I don’t know what the feds thinking.

Marcus: Yeah. I don’t know what they’re thinking either, but we are, we’re now pretty squarely where, you know, the middle of August, so we’re pretty squarely into the second half of the year. Um, we just did a 25 basis point hike. So even if you take next month off, I mean, we still haven’t even really felt the impact of that last hike.

Um, and yeah, there’s just no good news. I mean, there’s, there’s no good news.

Vic: Yeah. The, uh, it’s hard for me to see where the economy is overheating. Yeah. I just don’t think that’s real now. The unemployment rate is still low, but they’re not going to affect that. Like, [00:08:00] so that’s a lagging indicator

Marcus: and they’re not going to affect that.

I mean, Employment and unemployment. I mean, look, we had a lot of people die, unfortunately, during the pandemic. That has to be factored in. We have a lot more ways that people can make money now. Um, there’s so many ways for people to be, you know, and, and, and we like it that way. I mean, I like for there to be a lot of Ubers out there on the road when I’m going to go to the airport, I like for there to be, you know, Drivers out there when I want to order, you know, Postmates or whatever.

Um, I, I, I like this gig economy that we have. I like the people that have other options that I’m sorry, they don’t fit into the other narrative. And oh, by the way, like, you know, employment as it has been set up is clearly under a cultural revolution. We clearly are having massive labor issues with, you know, our, our institutional, you know, You know, organizations of, of today, whether it [00:09:00] be Hollywood studios or, you know, shipping and trucking companies, or it clearly like this is all going to have to get reworked.

So I’m tired of focusing on the unemployment number. That’s not a number I care about. I mean, you know,

Vic: I mean, I think that’s exactly my view that a lot of people unfortunately died in the pandemic, but. Even more people, in my estimation, realize life’s too short. Why am I driving in an hour, doing a job I hate?

I can figure out a way to make things work, make ends meet. In some other way. And they’re doing gig things. They, I know some millennials that are, that are getting money from their parents. I know some parents that are getting money from their millennials. They’re just like making it work in different ways.

They’re not necessarily looking for a job that the fed is tracking.

Marcus: Yeah. And you’re, you’re just not going to bump that number up. I mean, you know, more people starting businesses, you know, as people keep starting businesses, people are hiring people away from other places. I mean, it’s just, we have a dynamic economy, the [00:10:00] unemployment number.

It’s not. What it used to be. Yes.

Vic: And at the very least, it’s a lagging indicator. So once the Fed Yes. Is able to push the unemployment rate up, it’ll be too late. They’ll have, it won’t be a soft landing, in my opinion. So, so then the, just quickly, the, the Wall Street Journal came out with the, uh, kind of a summary that I thought was pretty good of s and p 500 earnings.

Of course, the market cap, it’s been up 19, 20 percent for the year, but the earnings is down. And so the stock prices are up, but the companies underneath those prices is, is not, they’re not making any money. So the multiples are going up, which is. Good. If you own the stock, but I don’t know how sustainable that is.

I mean, that’s not a sign of a hot economy. And then you found the credit card things.

Marcus: Yeah, well, this, you know, I found this one because I’m, I’m trying to make sure my sons, you know, who are now in the age where they’re getting credit card offers and, you know, all that kinds of like, I want to make sure they understand.[00:11:00]

That, you know, this is serious business when the rates go up like this. Right. And, uh, I mean, the

Vic: rates are what, 22, 23%. Yeah. It’s

Marcus: higher in some cases. I mean, I think, you know, um, it’s really insane. So anyway, uh, market watch came out, uh, on the 9th and, uh, I think this was a fed data, you know, data point that came out, um, that the credit card debt is now a trillion dollars.

I mean, Uh, you know, credit card debt compounds to, you know what I mean? And, and, and with these compounds the most, yeah, exactly. And with these rates up the way that they are. Um, and I think also in addition to just the debt volume, we also have delinquency rates. Yeah,

Vic: that’s increasing. I think it’s 7 percent or so.

So it’s a lot of people are behind. Right. And once you get behind at 22%, it’s hard to catch up.

Marcus: I mean, it’s, it’s, it’s not the same kind of extreme trend, but it’s a similar trend to our share of distressed firms that we talked about in the last show. Right. I mean, you know, when you raise rates, you’re going to have more bad credit and more bad debt.

Right. So [00:12:00] yeah, nothing. So I don’t even know what to say. I mean, like what, what are we going to say? Because I don’t know how to predict how the Fed is going to respond. I mean, China being in deflation, that’s another thing. I mean, we really, we’re in pretty uncharted territory. I mean, you know, we had a board meeting this, this week and, and, uh, as we were preparing for it, we, we had to reflect that we’ve been in business for 10 years.

And this is the first time in the history of our business. It’s not the first time in the history of, you know, us being professionals or anything like that, but this first time in the history of this business that we’re running, jumpstart health investors, um, that the economy has done anything like this.

So it’s completely uncharted territory to see China, you know, in deflation, the UK inflation, you know, true inflation North of 10%. It’s just kind of like. I don’t, I don’t know how to make sense of this. I don’t, and we’re tracking it every week. We’re trying to make sense of it, but I don’t, I don’t know [00:13:00] how to make sense of it.

And I think, you know, we keep talking every week on a show that’s supposed to be about healthcare innovation, about the Fed. We’re doing this every single week. Yeah. The

Vic: Fed needs to get the hell out of the way. Right.

Marcus: I’d like to talk about healthcare innovation, but guess what? Healthcare innovation takes money.

Vic: Yeah.

Marcus: And like the money is messed up right now. You know, um, I don’t think we’ve. We’ve talked about it on the show, um, and we can just pass this along to our producer to, to include, but five straight quarters of decline in deal making in the venture space, five straight quarters. Yeah. Like we’re, we’re, we’re, we’re moving into a year and a half.

Vic: And there are companies and people and jobs that rely on raising money to keep going. And when the VCs pull back, it affects real people.

Marcus: Yeah. And it affects making healthcare better so that it costs less.

Vic: Yes. And [00:14:00] I mean, I’m ready. You’re ready. A hundred entrepreneurs are ready. The Fed needs to get the hell away and just let us.

Do we do?

Marcus: Yeah. Yeah. Yeah. I mean, it’s, it’s, uh, it’s, it’s rough. And then, and then also like, you know, we’re going to, we’re going to shift down and talk a little bit about, um, you know, the Medicare final rule, uh, which didn’t just come out, but we’re, we’re finally getting around to talking about it. Um, and our, our friends at HFMA have done a really nice writeup, uh, on their website.

The title of it is five things to know about Medicare’s, uh, fiscal year 24 final rule for inpatient, COVID 19. Payments as hospitals foresee adverse impacts. And they have five points. I want to just kind of focus on three points.

Vic: We’ll link to the whole article. Yeah, but yeah.

Marcus: Yeah. So, so, so the first point is disappointment with a payment update.

And I think that’s understandable. Um, 3. 1 percent increase, um, that is effectively maybe right on target with inflation. If you smoothed it all out for the year, maybe, maybe, [00:15:00]

Vic: I think it’s lagging. Meaning like they don’t, inflation popped up and now they’re updating it. Right. And so it’s behind the time and then it’s barely keeping up, maybe.

If you don’t include gas, I think hospitals use energy. Right. To heat and cool and

Marcus: Put the lights on. Right. So that’s, that’s not good. And there’s a whole downstream set of things that happen because of that. Right. Um, less people take Medicare, you know, less providers take it, right. They just, they, they can’t make the numbers work.

They just say, you know, we can’t accept it. So that’s less access to care when we’re talking about health equity and access to care. It starts with the money people.

Vic: Yes. And then this two years ago, this caused the workforce issue. Yeah. Like inflation increases the people that are working there. They need to buy food, pay rent, make car payments, just the normal day to day stuff.

[00:16:00] So they need to raise, keep up with inflation, not to get ahead, just to maintain where they are. And the hospitals don’t set prices. They’re price takers and everything flows off this. So. CMS changing it by 3%. People say that’s only half of, of healthcare. I mean, first of all, it’s half, but the second thing is almost all the payers.

Refer to this, they tag off this, if you don’t increase this enough, it doesn’t

Marcus: increase all, all the, well, this is the pair of last resort. So of course this would be what you would key off of. Right? I mean, it makes, makes sense, right? Yeah. Um, so that, that’s kind of the first point. Um, the second point is, is there their third point, um, title, A big hit to uncompensated care payments.

Um, so. You know, we’ve been talking about payer mix. We’ve been talking about the difference in nonprofits and for profits, how a lot of the nonprofits are doing a lot more charity care, and they’re also the ones with the, with the harder payer mix. So they’re going to be more [00:17:00] impacted by, you know, this final rule, not really being, keeping up with inflation anyway.

So just, just on the measure, they’re going to be impacted by that. But furthermore, um, According to this, to this article in the final rule, um, the uncompensated care payment subcategory, uh, within the, um, disproportionate share payments will total 5. 9 billion for nearly 2, 400 hospitals that’s down by more than 950 million from the previous year.

So down by. A billion dollars, right, for all the bad debt or the charity care that these hospitals that are already seriously struggling with will receive.

Vic: Which is ridiculous. Like, they’re going to need more of that. It needs to increase. And, I don’t know, I feel like the federal government is printing money and increasing the federal debt all the time.

Another, [00:18:00] another billion, they, they should take care of the hospitals, or like, if you’re gonna spend money. Taking care of the health of our most needy people is somewhere to spend money.

Marcus: And then, and then, uh, this final one, which is a little too wonky to totally go into, cause it has something to do with different States and the subsidies and how they cover the premiums of patients, but something we should just be paying more attention to and tracking is, um, this disproportionate share hospital, care.

Concept, right? That, that is, it’s, it’s a fundamental concept in the way that, that Medicare pays out. It’s based on, I think, 15%, um, of your, of your overall base is sort of disproportionately Medicare and Medicaid. Um, I think you have

Vic: to hit at least that to start getting a payment. I believe. Yeah, exactly.

So it’s, it’s basically urban, mostly urban, poor, located hospitals that are necessary. What, what I would have called safety net hospitals. Previously, I don’t know if that [00:19:00] term is, is out of favor or not, but, but they get extra support.

Marcus: Yeah. Because I think essential hospitals is more. Yeah. Um, well, anyway, there’s been a change to this, to this, um, this formula and the calculation I think is going to make it harder for hospitals to qualify.

Yeah. So, you know, it’s just sort of a stack of really difficult results here for, um, for the hospital industry.

Vic: That’s right. And, and I know that the hospitals are trying to make their case, but it feels like the, it’s not getting through to the bureaucrats and the politicians in the way that, you know, Makes a difference.

Marcus: Yeah. So, and look, we’ve, we’ve been talking about this stuff for weeks now. Um, it’s just not making sense anymore. I, I, I can’t, I just can’t [00:20:00] see the proof of the need for the Fed to continue to keep the rates this high because they’re creating this incredibly instable economic environment for us to all try to navigate.

When we have really big problems to try to solve,

we get, as a result, these decreases. In these annual final rules that are coming down. I mean, like the, the pressure that’s coming from all, when I see this, let me tell you what I see as a, as a healthcare VC, I just see three times harder to try to get any hospital exec to listen to what we have to offer.

In the healthcare innovation landscape.

Vic: Yeah, they can’t, they can’t pay attention.

Marcus: They can’t pay attention to us. Like the, you know, these things are creating just existential crises. And we, you know, [00:21:00] we, we spent time in the last two episodes talking about all the merger challenges, the attorney generals, you know, sort of, you know, conflicting with that.

The hospitals having to resort to filing bankruptcy to force attorney generals to create mergers happening. I mean, it just, honestly, it just seems like this is all too hard. It’s just a little too difficult. Like it should not be. Yeah,

Vic: and the Fed and everyone in D. C. is like fighting the last war. Like, I don’t care about inflation.

I think productivity has been really low. We haven’t had strong productivity in years. And that’s what I mean, obviously I’m talking my own books. I’m a VC, but bringing new productivity into healthcare, into hospitals, into home health, into the overall market, that would affect inflation in a positive way.

And we would get more done with fewer costs as opposed to [00:22:00] crushing the economy. So you can invest in education. You can invest in helping people understand how to use technology. There’s a lot of places you could invest to try to make productivity more effective, more broadly utilized across the economy.

I think it would, it would filter and sort of lift everyone up. Instead, they’re deciding to fight inflation by trying to kill jobs somehow. But as we talked about before, people aren’t getting jobs in the traditional way. So I don’t know the Fed can really control that. Anyway, they’re just using the wrong tools.

Yeah,

Marcus: I mean, I think I am now pretty firmly in the camp that it’s time for them to pause and, and probably even consider turning around. I mean, I, I don’t, they’re not making an impact on the CPI, but they are making an impact on other stuff, right? They’re creating. You know, downgrades of banks, they are, you know, crushing the venture capital industry.

They are, you [00:23:00] know, deflating the hell out of China. Um, and look, I’m not like a fan of China or anything like that, but we have to understand we’re interconnected, right? I mean, China is, is a massive part of the supply chain. If, if they are deflated to oblivion, there’s a lot of stuff we’re not going to get.

Vic: We are the buyers. That’s what I mean. They can’t deflate without our economy. Going down. It just hasn’t filtered in. I don’t think the second half rebound is real. I don’t think the economy is going to grow in the second half.

Marcus: And so where would it grow? Like, where would you see the growth? Where would the growth come from?

And seriously, like, let’s, let’s play this out. What area we can kind of run down industry by industry. We already know. The, the, the, the shipping situation, right? So just, just basic goods would buy retail. Yeah. Retail is no

Vic: dead, not happening. Not happening.

Marcus: Goods are not on the credit cards are at a trillion and delinquency rates are up.

So there’s a retail that’s not happening.

Vic: Banks aren’t [00:24:00] loaning money.

Marcus: So,

Vic: so,

Marcus: so

Vic: it’s

Marcus: hard to, it’s not going to be commercial real estate. It’s not going to be construction and development. It’s not going to be those areas.

Vic: So you have

Marcus: travel that’s going to continue to do

Vic: travel will be fine. That’s

Marcus: going to do well.

Cause people, it’s going to do fine.

Vic: There’s wealthy people that want to travel around. I, I, I booked 10 trips,

Marcus: you know, and look, and then, you know, I got speaking gigs. I got, you know, you gotta be, you gotta defend your world championship in three weeks, but like. Yeah. Like I’m going to travel. So, so, so travel and hospitality, that’s going to continue to grow

Vic: healthcare.

I think healthcare is the healthcare companies that are publicly traded have done well. They almost, I mean, there’s a whole bunch of them, but the ones I follow have beat the earnings estimate and raised guidance, but then they don’t have like a sexy AI narrative. And so their stocks have gone down. I think health care is Yeah, the beads were not rewarded.

Marcus: Yeah. [00:25:00]

Vic: Um, So I don’t, I think health care will be fine. Health care is a part of the economy that will do well, but it’s going to be a down economy. It’s going

Marcus: to be a down economy. We’ve talked about that over the last two, three weeks as well. Right. I mean, it’s not, you’re, you’re not going to get the kind of measurable growth that, that, that we’re, we’re talking about here, right?

Well, it

Vic: doesn’t lead to inflation. No, I mean, no. By the last story, like healthcare prices are, are fixed. They can’t drive inflation.

Marcus: They’re fixed.

Vic: And so, and then you have financial services. And it, I think it’s fraying. I mean, like, okay.

Marcus: Financial services are in trouble. People like seriously, I

Vic: mean, if the banks are in trouble, eventually it’s going to filter to the stock market.

I mean, it hasn’t been true the last six months, but eventually if earnings keep going down, the multiples can’t go up forever. I mean, like it will run out eventually. [00:26:00] So I don’t see the case where. The Fed should be nervous. Now the, the, uh,

Marcus: especially relative to our peers. It’s like South America is in shambles.

They just assassinated one of their presidential candidates in Ecuador. Right. I mean, we’re doing it to them. This is my, this is my point. It’s like Africa is getting killed compared to our peers. We’re fine. Like the American economy is fine. It’s doing fine. Like let some pressure off. Come on. I mean, it’s just, yeah,

Vic: no, the thing that I don’t understand, I mean, I’ve tried to study crypto.

I, I’m a, I own Bitcoin. And so in that world, you, you talk about the reserve currency and the debt in, in the U. S. government. I don’t really understand the, how the Fed needs to maintain. [00:27:00] The interest rates and inflation to be able to sort of slowly inflate the dead away and how they’re trying to guide the ship where it is 2 percent to 4 percent inflation forever to get the debt under control while keeping their rates low.

They’re trying to do some kind of dance like that. That is way over what I can foresee. It’s not even

Marcus: clear that that’s the, that’s what they should be doing. Well,

Vic: they haven’t said that. I mean, I think if you say that it kind of ruins, if that’s the goal, they wouldn’t say it, but I don’t think they, I don’t know if that’s going to work.

I mean, like if you created the economy and we go into deflation, it’s going to be terrible for the debt. So it’s, it’s, it’s. I don’t know. I don’t get it. Maybe there’s a lot of smart people at the fed. So I’m always like thinking that maybe I’m missing something, but I just don’t, I don’t get it.

Marcus: It’s time to let off [00:28:00] steam.

Okay. Uh, with that, we’re going to take a break, let Doug talk about jumpstart foundry, and

Doug Edwards: then we’ll be back. Thanks guys. For the opportunity to talk about our precede fund jumpstart foundry. My name is Doug Edwards, CEO of jumpstart health investors, the parent company of jumpstart foundry. We’re so excited to be able to talk about, uh, early stage venture investing.

Certainly the need for us to change the crazy world of healthcare in the United States. We are spending 20 percent of our GDP north of 4 trillion a year on healthcare with suboptimal outcomes. Jumpstart Foundry exists to help us find and identify and invest in innovative companies that are going to make a difference in healthcare.

in our country. Every year, Jumpstart Foundry invests a fund, raises a fund, and deploys that across 30, 40, 50 assets every year, allowing ease of access for our limited partners to invest to help us make something better in healthcare. Some of the benefits of Jumpstart Foundry is there’s no management fees.[00:29:00]

We deploy all the capital that’s raised every year in the fund. We find the best and brightest typically around single digit percentage of companies that apply for funding from Dumpstart and we invest in the most incredible, robust, Innovative solutions and founders in the United States. Over the last nine years, Jumpstart Foundry has invested in nearly 200 early stage, pre seed stage companies in the country through those most innovative solutions that Jumpstart Foundry invest in.

We also provide great returns and a great experience for our limited partners. We partner with AngelList to administer the fund, making that ease of access, not only with low minimums, but the ease of investing in venture much better. We all know that healthcare is broken. Everyone deserves better. Come alongside us with Jumpstart Foundry.

Invest in making the future of healthcare better and make something better in healthcare. Thank you guys. Now back to the show.

Marcus: All right. We’re back. Um, story from the wall street [00:30:00] journal about artificial intelligence as artificial intimacy. I mean, it’s basically her.

Vic: Yeah. It’s the movie. It’s her, but

Marcus: it’s actually real.

I mean, it’s duh. Of course it was going to be real. I mean, You know, look at the amount of, I mean, online dating, you know, look at the spectrum from, of online dating to pornography online. I mean, of course,

Vic: the early adopters of tech, always

Marcus: pornography

Vic: is always one of the early ones, early movies, early internet, early AI, and

Marcus: not to say by the way that intimacy is, that’s not what we’re saying, but just relationships, love, sex, that whole thing.

Obviously AI was going to be brought into that world.

Vic: And I, sex certainly is a thread of it, but I think a lot of people are lonely. I think it’s really, um, I don’t know. It’s, it’s an epidemic of loneliness after the pandemic. I think some people [00:31:00] haven’t really got reconnected in the same way. I think work from home is amazing for some people and is isolating.

For other people. And so I think it’s, it’s natural that you would be, you’d find chatting with a thing that isn’t a human, but that interacts with you and seems very responsive, seems to care about you because it’s trained to care about you. That gives people some comfort, but it’s not going anywhere. I mean, it’s not going to be lasting.

I don’t think you’ll get actual fulfillment through that. So I think it’s a symptom of, of problems.

Marcus: Yeah. So this is, this is, uh, this is a result of generative AI and that technology and what it, you know, all the ways we can sort of think about how it can impact humanity. Um, I agree with [00:32:00] you. I think that loneliness is a massive issue.

Um, it’s an issue that our surgeon generals really focused on right now. Um, It does concern me that we are moving in the direction of AI. I think that, you know, technology and the phones are a big culprit in the loneliness epidemic. I think people aren’t doing real life things with other people. Um, You know, engaging in their community, engaging with their neighbors, um, you know, uh, playing sports even for fun, you know what I mean?

Like not, you know, you don’t need to be super competitive, but like, I mean,

Vic: just walk, go walk on a trail,

Marcus: go

Vic: walk in the park.

Marcus: Yeah. And, and, and remember how to like, say hi to strangers and meet new people. Um, You know, I never, I never, and old fogey here, you know what I mean? Back in my day, yeah, but, but like, I really never did use online dating.

I mean, I just never used it because I didn’t

Vic: either. I mean,

Marcus: we were

Vic: lucky and it was [00:33:00] early.

Marcus: Yeah. Yeah. Yeah. Yeah. Well, yeah. I mean, like when it was going on, it was like weird. Yeah, we were, you know, we were coming around and, you know, when Rachel and I met, it was probably like the very beginning of people like looking at doing it.

And now, you know, I think the vast majority of couples do meet via online dating. Right. Um, which, which, which is fine. But you have to actually

Vic: meet in person. I think you need to meet in person eventually.

Marcus: Well, you do need to meet in person, but, but I guess what I’m saying is when I was young, one of the things I had to learn how to do was walk up And say hi to a girl.

Yeah, like I had to learn how to like make the first move. Yes, right. And just that whole process. I mean, I was talking with with a couple Rachel and I went to went to dinner with a couple last night. We were talking about how great it was that our son, um, waited tables for the for the first time. You know, for the, for the summer, like last summer, shout out to the Goldberg brothers for, for hiring them.

Um, but we were talking about how [00:34:00] great it was because we saw the change in him. You know, once he had to walk up to a table, say, hi, you know, my name is. Ball, you know, and you

Vic: do that a thousand times and you realize most people will say hi back. And it’s okay.

Marcus: Exactly. And then, then you realize, Hey, you know, you might get a little bit more of a tip.

If you come up with a joke or something and then you realize, you know, sometimes people You know, coming up with a joke is just being present and being aware. And like, anyway, it’s not, maybe

Vic: not a scripted joke, but maybe you comment on something that, that they’re doing.

Marcus: Yeah. I guess what I’m just trying to make the point of is that those things, even if they are inherently natural, they take practice and the more that we keep offering these like digital alternatives, we remove the imperative to practice these things.

Vic: Yes.

Marcus: And I, I actually, I mean, it’s, it’s one of the reasons why like. Um, I like to use AI to edit my writing, but I don’t like, I’ve tried it a couple times now. I [00:35:00] don’t want to use AI to write instead of me. Yeah, because like I’ve, I feel like then I’m gonna lose my reps. As a writer and I’m going to lose how to be a good writer.

Like that’s, what’s going to happen. You know, it’s not just about the end product. It’s about the process and about, you know, what, what I’m learning as I’m getting my own thoughts together and putting them on the page. Right. Yeah. So anyway, I agree

Vic: with that, but, but I want to get back to the social stuff.

Cause I think, um, I mean, for me. AI is sort of along the same continuum of social media, right? So like, it’s an escapism thing. Like it’s fun and it’s, um, it’s a way to escape and have a laugh or something that is like, In the moment, kind of intriguing, but it’s not, it’s, it’s not real feelings. It’s not sort of sharing something with someone else, even on the phone, you can do a [00:36:00] possible in person, especially like you can talk about something you’re going through good, bad, scary, exciting, and, and the other person feels it.

And in social media, I feel like it’s so, um, fake, like everyone’s saying, like, look at this thing I’m doing in my best five minutes of the day. And it’s not like their whole life. It’s just like a, what they want to show of their life. And then AI is even further on that spectrum where it’s, um, not even another person, it’s a completely machine based interaction.

Marcus: So the parallel to social media, I think has many. Important lessons to be gleaned. Um, as you know, Vic, I got involved in social media in 2007 and I was podcasting in 2005, so, um, I was doing these things. I [00:37:00] don’t know if it was at the very beginning, but it was pretty damn early. Okay. And I can tell you when I was doing those things, I only could see the upside.

I could not imagine a world in which we had, you know, these algorithms pushing stuff out on social media, where every time I open one of these apps, the stuff that’s in my feed, it’s not even stuff I follow. It’s not stuff I want to see. And it’s stuff it’s figured out because of, I don’t know, whatever demographic.

And maybe I’ve clicked on a thing here or two. Even if

Vic: you like hover over something for another half a second, right. It keeps track.

Marcus: Right. And, and here, here’s a really sort of scary thing. The, the ultimate problem with social media really boils down to the fact that we, We couldn’t make a subscription business model work.

So we ended up doing advertising and we did advertising. We [00:38:00] sold our souls because we just said, whatever, it doesn’t matter. Like it doesn’t matter that you didn’t actually subscribe to this content. You’re going to get this content. Right. And it doesn’t matter that this content actually is not. Going to make you feel good about yourself and accumulation over time.

And it doesn’t matter that, you know, you’re going to post stuff solely for like the Dopa hit of seeing the likes and keep hitting refresh, refresh and wasting. I don’t know how much of your life doing that. Like that wasn’t what I thought social media was going to be in 2007. That wasn’t

Vic: what the. Dream was in 2007, but that’s what it’s

Marcus: turned into.

It’s totally what it’s turned into. And I

Vic: think the algorithms have learned, I, I’m saddened by this and I would not have predicted it in 2007, but they have learned that rage and fear and hate for other people that aren’t like me, that sucks in my attention much more strongly than empathy [00:39:00] and love and kindness.

Marcus: Yes.

Vic: And so they can get more attention and sell more ads to me. And so I think that, We have a lot of problems in our society and people are people and they’re going to do stupid shit. But I think social media exaggerates the bad side of our society to make money. And what I’m fearful is that AI is going to be like much better at that.

Much better at that.

Marcus: I don’t care about the technology nearly as much as I care about the business model. Yeah. And we have not figured out what the prevailing business model for AI is going to be. I am imagining. It’s going to be advertising. Yeah. I’m imagining it’s going to be advertising and that’s going to be absolutely horrific, horrific, because you’re not going to own your data.

Just like right now, you’re not going to, I mean, you saw what happened on, on, uh, on, on what, you know, the website formerly known as Twitter with the guy who had the X handle since like the beginning, since [00:40:00] 2007, he, he, he actually thought that was like his handle.

Vic: Yeah, no. Twitter owns all that. I mean, literally.

Well, actually, X owns that now. I

Marcus: mean, what did they give them? They gave them some really shitty derivative like, at x27342 or whatever. And they offered them a tour of the office? I didn’t see the tour of the office thing. I mean, you know, dude, it’s like, we are totally missing the plot. We don’t understand like, okay, you, you allow AI to like, do this thing for you.

Like, and I know I’ve talked a lot about the benefits of AI. Like if we’re, if we’re talking about. A menial task that isn’t that, that is effectively a human running some decision tree to get to an output, right. Where they are prone to error. And it’s just, and it, you know, quite frankly, there’s no disrespect to that person in their job, but in the larger scheme of things, it’s a cog in a machine right in a, in a larger industrial machine, [00:41:00] then yes, like by all means get AI in there so we can lower the cost so that the government does not, you know,

Vic: Not many people like those jobs.

I’m all about

Marcus: like AI for those things. That’s fantastic. That’s great. You know, let’s get people doing more meaningful work. Okay, for sure. But that’s not what we’re talking about here.

Vic: I’m much me. We’ve all seen the stories about. I forget the person’s name. It’s someone predicting that AI will be tasked about making paper clips and then we’ll all be killed because they’ll just make a ton of paper clips forever and take all the resources.

I’m not scared about that. I’m scared about AI being really good at getting our attention so much that we never leave the house. We just are sucked in and we don’t take a, take our dog on a walk in the park and hang out with our neighbor because we love the, the made up AI friend. That isn’t a real person, and is never gonna actually share intimacy with us.

Because it’s [00:42:00] just us reflecting ourselves.

Marcus: Yeah, I, I was sharing with, with, uh, with our friends at dinner last night when I was talking about jiu jitsu that, um, one of my, you know, there are many things I love about jiu jitsu, many things I love about it, but one of the things I love about it is, When I step onto the mat and especially when it’s time to start doing our rounds, which are sparring rounds, you know, when it’s time to start doing our rounds, you’re

Vic: not thinking about our show.

You cannot think

Marcus: about anything else. It’s you and this person and you’re just completely present. You’re in that moment and you’re engaged and you’re thinking and you’re, you’re advancing or you’re defending or, you know, and you’re focusing on your breath. And it’s not

Vic: life and death, but it’s as close as you can get.

Without it being life and death.

Marcus: Yeah. And, and the bottom line is like, it’s me interacting with another human and we are absolutely focused on what we’re doing or, you know, in that moment, you know, [00:43:00] and all of this technology, especially as it, it seeks to either interrupt our, our interactions with another human, or it seeks to, you know, take away some tasks that we as humans did.

Like we really need to think about that critically, you know, we really need to think about. What do we lose when we give this up? You know, what do we lose?

Vic: Yeah So now getting back to your writing example, like I agree I find that I don’t know what I think about a topic. I honestly don’t know Yeah, until I try to write it in a coherent way, right and I’ll start writing something and The first four paragraphs end up getting thrown away because by by the second page I’m actually I’ve learned what I think Even though I’ve been just taking it out of my own head, right?

It’s like journaling is that way to like you start writing and then you learn about yourself and what [00:44:00] you think about something And what i’m worried about is In high school and college and even middle school doing that, like five paragraph essay and like getting not even good, but just like practicing at getting your thoughts into an organized thing.

I think kids aren’t going to do anymore. And that’s sad. We’re going to lose. Sort of that way to sort of organize our thought and

Marcus: that’s a big deal. Yes That’s not a little deal like writing is not the product of writing, right? That’s not what the process

Vic: is the thing

Marcus: Yes Yes And what goes on in your brain when you are doing that process and what goes in your brain when you remove that?

The need to do that process, right. You know, when we’re just shipping things and anyway, um, I feel like we didn’t even really properly critique the article, but I don’t feel like I have to, because like, I’m, you know, on one [00:45:00] hand, I understand, you know, for, for people that for whatever reason, can’t get their nutrition and their exercise game together, look, we’re going to, we’re going to talk about, we’ll go over in a little bit, you know, um, a pharmacological approach, um, you know, Might, you know, it can absolutely make sense.

Right. So I’m not saying we should not have these tools in place for certain people, but I, you know, when we look at how we, how we ran away with things with social media and with phones in particular, those things in particular, We should take a little time and be more thoughtful about how fast things can move now at the speed of the internet, you know, around the world and how fast humanity can change, like functionally, fundamentally change.

And we

Vic: haven’t taken lessons from social media. No. And so we’re playing with this more powerful technology and. We’re not even trying to use it in a way that would be uplifting to the [00:46:00] human experience. And I understand people are lonely and sad and they get some small relief from talking to a chatbot.

I don’t begrudge that person from not suffering in the moment, but it’s a sign of Um, problems in our, in our society and their healthcare problems because behavioral health and loneliness is inherently a thing

Marcus: that’s health. Um, okay. So we spent a bunch of time talking about that. Now let’s go back to like, actually like health systems, health systems using AI.

So modern healthcare came out report. Only 6 percent of health systems have generative AI, uh, strategy. Which is ridiculous. I mean, I mean, is it though? It is. I mean, we just, we just talked about like how stressed they are and how they can’t stay open and all this other kind of stuff. I mean, I, I told you a bunch of months ago that I was the first person to tell a bunch of my like health system, executive [00:47:00] GP, literally they had never seen it until I opened up my phone and showed it to him.

Vic: I know. And that. Is not, and these are like real deal executives. That’s not, that’s not appropriate. The payers, the payers are gonna crush them. The payers are gonna crush them. They’re gonna use AI to dispute every claim that the health system sent. Every claim. And if the health systems are not ready for that, I’m not talking about in the clinical setting, like telling docs what to treat, like, no, that that’s nothing that I’m saying that you have to have an AI strategy around your revenue cycle.

You have to, it’s going to be, it’s an arms race. And if they’re not trying, they’re going to, they’re going to lose.

Marcus: Well, I mean, I think I have a little bit more empathy for them. I mean, I think part of the issue is that generative AI is not. Um, proven or tested in high reli, high [00:48:00] reliability, high availability, you know, environments.

And so, you know, the health systems, they’re not even, I don’t even think you can categorize them sort of on the innovation spectrum as fast followers. And so there’s no real good, you know, generative AI is being used in a, You know, meaningful way other than in earnings calls to try to boost stocks, you know, stock prices just by saying the words.

Um, so I get that part. I, I, I think that I think the strategy, the fact that there’s not a strategy in place, I think that’s what, that’s what you’re, that’s what you’re

Vic: highlighting. Yeah, yeah. And I don’t think the payers are going to tell him. Like, no, they’re not going to say, Hey, we’re using AI. They’re just going to escalate the disputes.

Yeah. Well, okay. And then to your point about it may not be ready.

Marcus: Yeah. It’s, it’s definitely not ready. So, so stability AI, when you were doing a great job of tracking, like, you know, especially early on all the different players in the AI space [00:49:00] and you definitely had sort of stability, um, in a quadrant of, of, of high performers in terms of, you know, what they were doing with stable diffusion.

Yeah. I mean, they’re open source

Vic: stability, AI, and meta. Probably the two biggest open source. Promoters.

Marcus: Yeah. Um, so this is a Bloomberg story that came out, uh, on the eighth, uh, stability AI is losing executives, engineers, and it’s edge. Um, I think just to kind of show you how fast the space is moving, uh, you know, they’re called stability, but not, not feeling, you know, not feeling very stable.

Um, and, and I think that’s part of the deal, right? It’s like, we are absolutely. Um, in what analysts would call a hype cycle with this stuff. And it’s hard to tell where to make solid investments. Um, this stuff is still largely experimental. It really is still very experimental and they’re, they’re upgrading and they’re sending out new, new, new versions.

Now, you know, part of. This story is just, you know, issues at the company and people are saying that the CEO, you know, sort of [00:50:00] over promises things and things like that. I mean, that’s just kind of typical company stuff.

Vic: Yeah. But

Marcus: they’ve had

Vic: trouble raising money too.

Marcus: Well, okay. Back to the capital markets.

Right. Um, which is interesting because all I keep hearing about is how much money, you know, VCs are plumbing into AI. That’s all I hear. Um, I haven’t actually seen it represented in any of the pitch book, you know, reports. I mean,

Vic: yeah, it’s, it’s, I can’t see part, but It is a hype cycle. I think it’s overdone.

There’s too much money being put in. Like every hype cycle, that will lay, kind of lay the groundwork, lay the rails. A lot of VCs will lose money, but a lot of that creative destruction will, will sort of lay the foundation for, you know, the next sort of wave of things that actually work out. I just was reacting to, in the back office of health systems, Where there aren’t patients to be seen, they need to start creating a strategy for how they’re going to sort of use these tools.

Cause they’re powerful tools and it’s an arms [00:51:00] race against the other side.

Marcus: Well, as soon as, as soon as Judy Faulkner says, this is a, how she’s rolling out generative AI, then 55 percent of health systems will have a strategy. It’ll be whatever she says. All right. Um, so this Medicaid enrollment story, I think is something that we just need to.

Um, or, or disenrollment, um, I think it’s just something we need to track. It’s, it’s still so fresh and, and raw that I don’t think we can assert anything. But yeah, well, let’s, let’s

Vic: frame it for people. Cause, um, during COVID, yep. Which I think had bipartisan, probably a hundred percent support. I’m saying that I hopefully, I don’t know if it was or not, but, but we, as a country said, we’re not going to disenroll anyone off Medicaid.

It’s hard to find people. It’s hard to work. Like we just need to take care of the people and we’re not going to throw anyone. And so since from there until May, April or May, this year, [00:52:00] Medicaid did not disenroll any people. So three years, three years. And eventually, at least I think eventually we need to get back to, of course, the more normal process.

And it was delayed. It was tied to the formal ending of the pandemic emergency or whatever it was called. And that got delayed and delayed. And then it, it happened. So now across the country, we have to find 90 million people and see if they’re still eligible or not. And that is involved, like if you are pregnant.

Under a certain income level that I can’t say you’re eligible, but then you have the baby, you know, typically in nine months, you have the baby. So it’s been three years and there’s different rules for [00:53:00] children. And sometimes the mom’s covered, sometimes not. And so the government is supposed to catch up to them.

I think it’s annually just to sort of re enroll them or if they’ve gotten a job or they were a single mother and they got married or they moved to another state and they’re not in that state anymore, then they. Disenrolled that’s kind of the normal process. We’ve never had to contact this many people.

I don’t think in the history of America now, and so we have this problem of finding people. And then there’s a policy that if they don’t respond, they get unenrolled. And that’s what Kaiser is saying is. Unfair, and I think there’s certainly some something true about

Marcus: that. And then the process varies by state.

Yes.

Vic: Cause some states [00:54:00] are, have, have a, I can’t understand how it all works, but some states have expanded Medicaid and they have a relationship with the government where they get more funding and some states haven’t, and also some states are. Um, more willing to spend more money to protect people. And some states are more concerned about saving money.

So you have 50 different varieties. And obviously red and blue states trend differently on that. And so there’s, and then you have the insurance companies. Who are, you know, most of the, most of, of Medicaid is managed through MCOs, so all the big payers have an MCO arm that takes in money and then pays claims and sort of obviously if you are still enrolled, but you moved out of Tennessee and you now live in Wisconsin.

The MCO is still getting paid to [00:55:00] take care of the person in Tennessee, but they’re not, there’s not a lot of claims in Tennessee because they moved out of the state. And so you have people with PR campaigns and lobbying sometimes for social concerns, because there’s a lot of examples where someone lost coverage and they shouldn’t have lost coverage.

And then you also have other concerns, let’s say. And so there’s all kinds of noise. And I think it’s. Pretty clear that we need more time, but each state’s going to decide how much time and how to go about this.

Marcus: So the headline number is that as of August 10th, Today, 4. 287 million Medicaid enrollees have been disenrolled.

So that, I mean, I think that number is significant enough that there’s going to have to be a whistle blown on the field and we’re going to have to figure out what’s going on here. Right. Because. Like, let’s say that some percentage of them have gone on the market. Some of the [00:56:00] percentage of them are working a job and now part of a group plan, you know, all those things are almost certainly true.

Almost things are certainly true. Um, it’s also certainly true that there is some percentage of these people who are alive for three years. haven’t been doing anything to remain enrolled for whatever reason, have not been contacted. They didn’t understand the mail that they got, whatever they’ve now been disenrolled and they are now part of the uncompensated care category.

Right. Right. So that that’s of all the things, that’s the thing I’m focused on, right. Is we, we almost certainly through this process are going to increase. The uncompensated care category from where it has been over the last two years, and we are decreasing the amount of funding, uh, at CMS that we are planning to pay the hospital.

So writ large, this is a bad overlay.

Vic: Yeah. The federal government will spend less in [00:57:00] Medicaid and they could easily increase the uncompensated care bucket as they’re doing this as a backstop, for instance. I think it’s also very possible to look back and say, Well, in the history, how many people, on average, find jobs and move and come off the rolls in normal times and try to get some benchmark.

I mean, you and I are looking at 4. 2 million people. I can’t tell you if that is the normal churn or it’s 10 times the normal churn. Like, we don’t have any frame of reference. So it’s a big number, but it’s, it’s a big country. And these are facts that. are available, just you have different people with like different sides trying to foment for whatever purpose they have.

And there’s no leader in DC that is actually looking out for all the people that will say, well, here’s the situation and let’s do the right thing and take [00:58:00] care of the people that need to be taken care of. We can go knock on their door. I mean, I don’t know. I mean, I think it’s very easy to throw out something from the government that looks like junk mail.

I can totally see myself doing that. But there, there must be ways to find these people. Yeah. And, I don’t know, it feels like a problem that we could solve if we took down the, the emotion and just kind of try to figure out where are the real people that need help, and where have people just moved on and, The MCO is collecting money, but we don’t need to keep paying for that.

Marcus: Well, again, I think when you say we, you got, you got to pick, well, you got to pick your state. Uh, there’s no unified.

Vic: Go down the state. They have all the states listed out, I think. So there’s all, there’s all the states. Yeah.

Marcus: I mean, I mean, so you can

Vic: see Texas and Florida, Arkansas. I mean, it’s the Republican states.

Marcus: Yeah. I was happy.

Vic: Tennessee’s way in the [00:59:00] back. Um, maybe, maybe because we don’t have as big a population. I don’t know, but perhaps, you know, Arkansas is not that big.

Marcus: We do have a very strong, uh, uh, Medicaid operation here. They

Vic: probably are running, they’re probably finding people. Yeah.

Marcus: Yeah. We have a very strong operation here.

So shout out to all the 10 care folks and all the MCOs here in Tennessee. Shout out to y’all for being very low on that list. Good job. Yeah. Um, okay. So, uh, final thing, we’re just going to kind of shoot back to this, uh, this whole, uh, GLP one. Uh, I mean, everyone’s

Vic: talking about what go V Zimpik, I can’t get away from it.

So we have to come back to it. Yeah,

Marcus: yeah, yeah, yeah. For sure. For sure.

Vic: So, uh, Novartis came out with a new study this week saying what we go V, which is their weight management drug, their, their GLP one drug. that they have shown in, in a clinical study that it reduces, um, I think it’s [01:00:00] acute cardiac risk or the risk of an acute cardiac event by 20%.

And so that, that seems really impactful. There’s a lot of people with cardiac disease in the country and more importantly, CMS and therefore all the other payers. It’s in the actual law enabling CMS, they do not pay for weight loss treatments or drugs. It’s it’s in the law. So they would never pay for a Govee for what it was initially indicated for by the FDA, which is, uh, for obese patients to lose weight.

And so this is an avenue now to be a reimbursed. Yeah.

Marcus: It’s an additional pathway. Yeah. It’s

Vic: additional. And I think it’s a smart strategy for a Novartis. Their stock has gone to the moon. Um, and maybe rightly, it’s a big market. I think it’s [01:01:00] going to be really powerful. A lot of people have heart disease.

And I also think that I learned with the Alzheimer’s drug a couple of years ago, and then we talked about it with, um, digital therapies. The fact that you get approved by FDA does not mean that you’ll get reimbursed by CMS. Right. Right. And so we’re going to have that same dance that we talked about with Aaron that we, that we keep coming back to that FDA’s mandate is, is it safe and effective?

Yes. They are not tasked with a cost benefit analysis. And then CMS is supposed to be thinking about the cost benefit analysis. And at the same time, the Biden administration is, is really pushing to get drug pricing down. And

Marcus: if

Vic: you pay 1, 300 a month for every obese person that has heart disease, That’s not [01:02:00] gonna get drug spend down.

That’s that’s really expensive. So we’re gonna see a battle there.

Marcus: Yeah, and then you found this poll, uh, in, uh, the, um, this Kaiser. Um,

Vic: yeah. Yeah. I thought this was interesting because everyone is, uh, talking about it and it’s really exciting. We all, I know people, I think, you know, people, we all know people that have taken it and lost significant weight.

Kaiser asked a series of questions like, would you take a medication to lose weight if it was safe and effective? And 45 percent of people, and I think we were trying to look before the show, I think it’s all adults. I think they just ask everyone. Yeah. So whether you’re, you know, fairly thin with a little pot belly or you’re obese, they kind of asked all adults.

Right. And of that broad population, 45 percent would take a medication if it was safe and effective. I think I would take one.

Marcus: Yeah. I think we, we discussed this. I would not. You would not. Right. Yeah.

Vic: And then [01:03:00] the, the next question is, well, What if it is injectable only, which these drugs are, and that it falls down now to 23%.

And that’s where I would not do that. It’s cut in half. So like I I’m in that category that,

Marcus: and it is an injection.

Vic: Yeah. Both, both versions right now, there’s, there’s another, there’s a whole bunch of things in the pipeline that are pills, but they’re not available. And then they asked, well, what if it wasn’t covered by insurance, which we go V is not.

And unless you have diabetes with LVA1C. Ozempic is not, it goes down to 16%. Goes to 16%, so now only 16%. Yeah. And then the reason I’m not on it today is the last question that, which is, what if we told you that you can never go off it without gaining the weight back, which is in fact what the technology, what the drug does.

Right. It’s you have, it’s addictive. It’s not addictive, but stay on it. You don’t have the benefit if you don’t stay on it.

Marcus: Yeah, you stay on it or you need to. Leverage [01:04:00] where it got to you with exercise and correct to stay there, to stay there with your behavior.

Vic: Yes. But it curbs your appetite. And so it’s difficult to stay with the calorie intake and the exercise.

You’d have to increase the exercise. Yes. You could do that today without the drug. That’s

Marcus: why I would

Vic: not take it

Marcus: at

Vic: all anyway. Right. And so, so that’s at 14%. So I think it’s interesting that this is so much excitement, but I think a lot of it is because People don’t know that it’s injected, and that if you stop injecting it, you gain the weight back, and that it’s not covered.

And so, that is going to be, you know, sort of one part, and then I think CMS is going to fight pain for it. And so I, I think it’s, it’s a really interesting technology, and there’s going to be lots of ways that the GLP 1 pathway is useful in healthcare, because weight loss is valuable to lots of diseases.

Sure, sure. Sure. But we’re in the [01:05:00] early innings and I’m not sure this is. The breakout thing yet. It’s going to be impactful, but I don’t know if it’s going to be,

Marcus: we’ll see. The only thing I want to say is when AirPods first came out and I saw people walking on the street with those things, I was like, I’m never putting those things in my ear.

And if you see me, there’s a 50 percent chance that things are in my ear. So anyway, you know, to your point, it’s early days. Um, final thing before we get off, you know, I think it might’ve been the last episode or maybe two episodes before that we were talking about, um, well, we always talk about, you know, the fed and the impact on all sorts of markets.

And we talked about the, um, impact to private equity. Um, and I just want to give a shout out to my friends at Clayton, do Billy and rice, uh, at least it’s a good story, right? You know, they just raised their largest fund. Ever. I think, yeah, 26 billion. It was in the, in the wall street journal. Um, so that’s unbelievable in this market.

So, I mean, I just want to shout out someone who’s doing [01:06:00] well and also

Vic: it’s really hard and they have delivered returns. Yeah, and they’re really good in all different industries, but healthcare and healthcare. Yeah.

Marcus: Yeah. Yeah. I mean, I mean, that’s, it’s great news because they are committed to healthcare as an industry segment.

They, you know, I think a large percentage of their fund gets allocated to healthcare. They’ve, they’ve put some really big players out into the market. Agilon, um, you know, they, they put together Vera whole health with cast light, um, they do stuff in the biotech space as well. So anyway, yeah, congratulations.

They deserve it. And they’re also bad ass. So like, congratulations.

Vic: Um, all right. Well, look, this is a good show. Hopefully the fed will listen. And then by next week we will have them on, you know, changing their whole course.

Marcus: That’s not going to happen next week, but I don’t, we don’t have no CPI print and no expectation of a rate height next week.

So what are we going to do? We have to find something actually to talk about. We will talk about more interesting stuff. All right. Sounds good. Till next week. [01:07:00] Bye.