21 – Let’s Get the Easy Decisions Right: Reauthorize AIDS Treatment | Stay out of Small Healthcare Acquisitions | Fund the Government

Marcus: [00:00:00] Here

Vic: we are. We’re back. We’re

Marcus: back again. That was a delay, man. I’m like, uh, you’re gonna say something. You said it

Vic: so officially.

Marcus: I know. Well,

Vic: I feel like we need one of those things.

Marcus: Chop, chop. Episode 21. Uh, we’re not, we’re not, we’re not rookies anymore. We don’t need to like marvel at ourselves that we’re on the mic.

You know, we need to get to work, dude. Um, I was in New York beginning of the week for the Clinton global initiative, my first time attending. Thank you to Natalie Byrne, uh, strategist for all things comms, um, and, uh, partnerships at jumpstart Nova. And, uh, Catherine and I were up there. We were up there with a, uh, a portfolio founder.

Who’s, uh, we haven’t yet announced it, so I’m not going to disclose that part. Um, new portfolio company. That’s right. Yeah. Um, but. Man, uh, I gotta say, really well done event in terms of just how, just how tight the production was. I mean, as someone who has a history of throwing events, it was, it was [00:01:00] meaningfully better from a production perspective than pretty much, pretty much everything I’ve been to, I’d say.

I mean, I think the

Vic: Clintons are pretty, pretty good at that stuff. Yeah.

Marcus: It was, it was very good. It had like this mini DNC feel to it, you know, so you could definitely sort of tell it was on another level and also that there were really important people there, but, but they did a really good job of like leveling the playing field.

Nobody sort of felt better than anyone else, you know? Um, and obviously it’s during a United Nations general assembly week. So all the,

Vic: all the big guns are around anyway.

Marcus: Yeah, yeah, yeah. So, um, but it was cool. And we, we, you know, we’ll, we’ll top. Touch on some of the stuff, uh, that, that happened there. Uh, what have you been doing this week?

I’ve

Vic: been, uh, raising money. Then we’re hosting, we were hosting a bunch of people, entrepreneurs in town for 3686. So we had all kinds of, uh, craziness. We hosted a happy hour and then I did a dinner. Um, I don’t know a lot, a lot of [00:02:00] activities around town.

Marcus: Yeah. I mean, conferences in New York, ton of conferences here in town, uh, the healthcare sessions, Nashville healthcare sessions.

So, uh, congratulations to the healthcare council on, on executing their first healthcare sessions conference, 3686 launch Tennessee. So yeah, it’s, uh, it’s definitely feeling like conference season is upon us again. That’s right. You know, HLTH. Yeah. Out in Vegas, everyone’s going to, you know, lose their minds over that.

Uh, I will not be there. I will be with my Aspen fellows hanging out in Philly. Um, but man, we got it. We got a good show. We got a lot to talk about. Yeah, I’m excited. All right. Let’s get to it.

All right. First thing we’re just going to talk on, uh, the fed got to talk about the fed. Uh, Jerome Powell came out, he paused. I think we kind of felt like he was going to pause this time around

Vic: the, uh, the most hawkish pause that. I can imagine where he was pretty, pretty hawkish, pretty, [00:03:00] uh, you know, still talking about fighting inflation and we’re going to keep the interest rates higher for longer.

And yet he didn’t raise rates, which is probably good. Yeah. I

Marcus: mean, CPI went

Vic: up. Yeah. So. I think oil, I mean, oil’s up. That’s right. Ren is very delayed, of course. And so it’s highly predictable. We knew inflation is going to be high for a long time.

Marcus: Long

Vic: time.

Marcus: Yeah. This, this is a, this is a bit of a new normal, I think, uh, for us.

There’s, there’s so much, uh, geopolitical stuff underlying this. I mean, you know, the oil is, is very up and down, up and down, you know, we can’t really get a handle on it.

Vic: Yeah. Listen, I think it’s going to, we’ve looked at the charts in the past. It’s. It’s going to be a long time to get to 2 percent inflation.

I just don’t think we’re going to get there.

Marcus: And he also, in addition to saying we’re going to fight the long fight, he also talked about, um, decreasing the balance sheet, uh, which is basically signaling they’re going to go into, uh, [00:04:00] quantitative tightening. Uh, so they’re going to remove liquidity from the market.

They’re going to, you know, stop buying back. Um, and that’s going to have its own negative impact, uh, especially for us in the capital markets, um, it’s going to drive interest rates up, you know, for people who are looking to get yield knowing the feds, not necessarily going to buy those bonds. Um, so what are your, what are your thoughts on that?

I mean, I think, I think we’re going to talk more about QT and future shows just cause it’s going to be a new player. We, we’ve been talking about the fed funds rate. We’re going to have to start talking about QT. Um, but what were your thoughts as you heard him, you know, start to roll out that language?

Vic: Yeah, I think he is just going to pull out all the different ways to combat inflation. And unfortunately he has a decent number of tools and they all are going to be restrictive to economic growth. And it’s very confusing. And I think we don’t have enough time because there’s so many news stories today, but To talk about quantitative [00:05:00] tightening kind of how it works talk about the kind of the market for Money, right and basically in quantitative tightening the fed’s taking supply out of the market And that tends to drive up rates So they either can set the the base rate or they can remove supply either way It has the same effect.

Yeah. Yeah, right

Marcus: has the same effect. Yeah Um, yeah, so so it’s an interesting way of You You know, getting the same effect without coming out and saying 25 basis points. Right. You know, um, yeah, the market reacted

Vic: pretty negative. The stock market. Oh yeah. Pretty negative. We don’t want to

Marcus: hear about removing liquidity from the market.

That’s going

Vic: to be, I mean, some of the, some of the dot plots were all in next year, no changes, so long time for. Yeah, so the public markets were rough.

Marcus: Yeah. Uh, so on that note, let’s talk about the Instacart IPO. Um, you know, the Instacart has a health [00:06:00] edge to it. But, um, I think the most important thing is, This is an IPO that was, um, delayed significantly repriced, publicly repriced.

We, we know, uh, you know, how, how big of a haircut they, they had to take before they could go out. Um, I think you watched the price action post IPO, and I think you said it went out at 30, came up to 33, went back down to 30. So, you know, congratulations to the bankers for getting the price right for the public market, right.

At least in terms of the initial launch. But. Obviously those growth stage investors that put capital in it, the really, really high valuations, um, probably in 2021. Right. I mean, you know, those, those rounds, um, they took a big hit.

Vic: Yeah. I mean, it got up to 39 billion, I think at the peak. And I remember that because we were negotiating to, to, for them to acquire one of our portfolio companies all for all equity.

Marcus: Mm hmm.

Vic: And I’m really glad we walked away and didn’t take equity [00:07:00] at that valuation because they went public at like 10, yeah, I

Marcus: thought it was nine. And, uh, and, and so they, they lost 75 percent of the value. That’s right. That’s a lot of value lost. Yeah. That’s a lot of value.

Vic: It’s going to be a long time for the stock to get to a hundred or whatever it would be to, to get to that.

Um, they, they just had invested at a too high of a price. And I think, uh, I mean, the, the article in the wall street journal, but this is before the IPO is, you know, expensive lesson for venture firms. Um, that’s right. It costs them billions of dollars in losses. So, I

Marcus: mean, just kind of a question for you. So we’re now, as the IPO market opens up, we’re, we’re now getting a real good picture on the corrections, right?

Um, it’s nice that the IPO market is opening up. And also it seems like part of why it’s opening up is the private market [00:08:00] investors and the founders have all sort of said, listen, we have no idea when this market’s going to turn. Like, you know, Powell’s giving no indication. It’s turning anytime soon. If we want to go, we got to just take our medicine and go and then try to create value in public in the sunshine.

Um, so it seems like part of the reason why the IPO IPO market is Quote, unquote opening is because the private investors are finally willing to reprice in order to get out.

Vic: Yeah, I think that was right about that’s right about Instacart was right about arm. Um, these private holders were kind of hoping for the fed to relent and there’d be another big upswing.

And I think everyone thinks that’s not happening anymore. So you either are going to stay private for another two years, three years, minimum, right? And for both Instacart and ARM, they’re, they’ve been wanting to get out for a long time already. Um, or you kind of accept the, the [00:09:00] reality where you are now and take the The later stage equity providers took a significant haircut, but they are, it’s a liquid security now, and they can maybe at least build the business.

Marcus: Yeah. Yeah. I mean, I, I guess my, my question is if in fact the IPO market is now quote unquote open because we’re just going to take our medicine. How long do you think, I mean, it was, it really was a flash. It was really. You know, at most 18 months of the, the crazy run up, right. And valuations, I mean, do you think it’s just 18 months and then we sort of wash out all that bad vintage and then we’re, we’re back to, you know, a market where we’re pricing things correctly and sort of the expect, the exit expectations are appropriately aligned with, with where the market where the public market will value a company, and then we’re kind of back in the game.

I mean, you know, because right now I feel like. You know, you think [00:10:00] about, uh, having bad gas in the system, it’s got to like kind of work its way through, but then once it’s all cleared out, you know, car can still work, you know, you just gotta get some, some good gas in behind it. So I’m just wondering, you know, do you think that this, this, uh, this clear out process is going to be as time boxed as that?

Crazy run up vintage was, you know, the 21, you know, first half of 22 vintage.

Vic: Uh, I think that the Business, there’s some business models that just will not work in this environment, right? So so some companies just die. There’s some companies just are gonna die. Yeah, and they Never had really strong unit economics anyway, right?

They weren’t if you took away the venture subsidies with very low cost capital just Playing for the quick ipo exit Then it was never going to work. Yeah. Right. So there’s a lot of those companies and you can’t [00:11:00] take those companies public today. Um, Instacart is profitable and it’s really going to be a challenge.

I think for DoorDash, they, they are also public, but they don’t have the same like grocery advertising part. They’re not as profitable. And so I think it’s going to be a. A really interesting competitive sort of dynamic between those two, but I don’t think there’s, there’s probably half the businesses, maybe more than half that the model doesn’t work with it without significant venture money.

And then a super aggressive valuation in the IPO markets priced of, I don’t know, something like 20 times revenue or some crazy amount it doesn’t function. And so you have a fight between really the liquidation press stack and the early stage. Investors that are in the money and the management [00:12:00] team, like, should we correct this and try to rebuild the business?

Or should we sell and get 10 cents in the dollar of the liquidation preference stack? I think those are the fights that are going on now, but that’s going to, that’s going to work. It’s like that problem is going to work this way through the market in the next six to 12 months and people will decide one way or the other, and then it’ll be over.

I mean, I

Marcus: think about the entire biotech industry. The entire space. I mean, um, you know, therapeutics broadly, especially if they don’t have a clear pathway in through the FDA into CMS with sort of codes in place. Like, I mean, that’s a that’s an entire space where it feels like we’re going to lose progress for for the for the foreseeable future.

Yeah. Right. I mean, that’s an industry that is so capital market dependent, uh, you know, to your point, there’s no unit economics, zero, it’s all spreadsheet unit economics. It’s not material. Right. So, um, [00:13:00] that feels like a space that’s going to be really challenging and even more challenges. You start to pull liquidity out of the market.

Vic: Yeah. And, and I think we’ll see, I’m a. I’m of the mind that there’s going to be, um, some pretty significant liquidity credit events over the next year, and the Fed wants negative events. The Fed wants to Stay higher for longer, but that there might be something that happens that prevents them from doing that.

And I, I feel like we’re in this boom bus cycle where there’ll be some problem. You know, last October we had the UK market blow up. There’s something about October. There’s been a lot of crashes in October and then there’s just a lot of, uh, Issues around the world that something could flip and it could be really scary quickly in the Fed changes Mm hmm, and then they can’t really fix it without throwing tons of liquidity at it Which of course ends up in the stock market [00:14:00] first and then it filters out.

So I, I don’t know, I think there’s a 50, 50 chances, a decent chance that by summer next year, even though there’s been a lot of problems, the fed has come back and there’s all kinds of liquidity. Again, I think kind of the cycles are accelerating. I don’t have. I wish you’d probably look at that, but it feels like the boom bus cycle used to be the business cycle used to be like a five year cycle.

And I think it’s faster than that now. And there’s something about the amount of debt to GDP and the fed trying to control the whole world versus just the U S where they, they ride to the rescue too often. And the only way they salute solve it is by just oceans of liquidity, which then props up maybe companies that don’t need to be propped up again.

And then that creates the next problem. There’s opportunities for VCs like us to sell into that. So if you’re

Marcus: tracking it really closely, I mean, one thing I can tell you, [00:15:00] yeah. One thing I can tell you for sure was not on my dance card. When I started my journey into VC was going to be talking about the fed every week.

Vic: I don’t know how we got to that.

Marcus: Yeah. They used to be a non actor. When I started in this industry, they didn’t even mean anything. And now they mean everything. It’s crazy. It’s,

Vic: uh, you know, Well, I mean, our fund cycle, right? We’re going to invest over three to four years and then sell assets in the next three to four years.

And when you had a five year cycle, you could get, you could be in the right side of the Fed that whole time. Now, if it’s 18 months or 20 months, 36 months at the outside, that’s inside the window, right? So you have to be. I don’t know, like in a ready position and able to gear back where all of our portfolio companies are now, like miserly, we have to be cashflow positive, cut costs, and then we’re gonna have to turn on a dime and be ready to exit.

Marcus: Yeah. And, and that, but I think that that Starts to close the aperture on the kinds of [00:16:00] companies you feel like you can invest in that you can maneuver in that way. So for example, for example, like back to biotech, I don’t feel like biotech companies can maneuver in that type of fast cycle, whereas a SAS company.

Absolutely can maneuver in that kind of fast cycle. You can

Vic: put the lever of growth up and back. Up and down. Yeah. No problem. Fairly easily. Yeah.

Marcus: Yeah. Exactly. You know, because you’ve got these great gross margins.

Vic: Yeah. And they’re productive. And it’s, it’s, it’s, uh, it’s a lever based business, right? We’re going to feed our growth Engine.

And we’re going to spend. And we’re not going to have any earnings. Yep. Or we’re going to, and we’re going to grow up 300 percent a year. Right. Or we’re going to gear back and just grow on cash flow. That means we can only grow at 50 percent a year. Yep. And we’ll still burn. Yeah,

Marcus: exactly. So grown. All right.

Um, let’s, let’s do a little addendum to our trust conversation from last week. Uh, New York times article about, uh, a a procedure that was performed on multiple [00:17:00] patients, uh, at New York Presbyterian, um, using, uh, umbilical cord blood and spinal surgeries, and it was not FDA approved. So you found the story, give us a little bit of a headline on it.

Vic: Yeah. So there’s a product that is, uh, trying to get approved, but it is not approved. It uses umbilical cord blood, in some way to alleviate, uh, spinal pain during surgeries. And it, it looks like it could be a good product eventually, but it’s not, not approved now. And New York Prez is, is a, you know, one of the better brands in New York City.

It’s a great hospital. But they treated 40 patients. With this, with this tool, with this, this blood based, uh, like. Additive. That isn’t, is not approved. And then when, when that came to light, instead of notifying the [00:18:00] patients, gosh, we made a mistake and you know, there’s humans involved, people are going to make mistakes.

They tried to not tell anyone. And then the. One of the surgeons, I think, and a couple other workers then report were whistleblowers, and it all came out, of course. Mm hmm. And so it’s just another in this, unfortunately, long list of, there’s trust issues. We can’t, we can’t trust that these institutions are doing the right thing.

Marcus: Yeah, so, so I, I want to just, Provide a, a personal story because I think it, it hyper focuses on exactly what the problem is in this story. So, uh, my, my father, when he was still living in Brooklyn, um, had a brain aneurysm, uh, ended up being rushed to Ities Hospital, uh, in Brooklyn, uh, where my mom was working as a medical biller at the time.

And, um. He ended up being very lucky [00:19:00] because there was a top neurosurgeon who was there, uh, who had been working on an experimental, uh, mode of surgery, which was taking a steering needle up through the groin and up to the, to the brain and then dropping coils. And now it’s a very, very standard procedure that they’ve, you know, they’ve, they’ve iterated on many, many times since then.

At that time, it was not FDA approved. Um, when they assessed my father, they, they came and talked to my mom because he was not conscious. Right. Uh, so she had power of attorney and they came to her and they said, listen, you know, uh, we have, we have a. An approach that we think can save his life. And, uh, and, you know, fast track, it did save his life and restored him effectively a hundred percent.

Right. Um, so they came to us and said, we have, we have this procedure, but it is not FDA approved. Okay. Um, and. You know, we think if we try this procedure, we can save his life. And we think if we cannot save his procedure, there’s a very low likelihood that we [00:20:00] can save his life. Yeah. Okay. Gosh, that’s a lot of pressure on her.

It’s a lot of pressure. Now, thankfully she worked there. Yeah. So she said, I don’t want to hear that from you. I want to hear that from a doctor who I know. So she made them go get, You know, said doctor someone else

Vic: is not trying to prove himself or whatever doing the surgery.

Marcus: Yes. So she went and got, you know, one of the doctors she had a relationship with and the doctors convened.

And then that doctor who she trusted came to her and said, Isabel. Yes. It’s

Vic: not 100 percent anything, but this is a better option. Yes. I, I,

Marcus: I can recommend that you should agree. So then she signed off. Right? Yeah. Waving liability because this was not FDA approved and understanding that, uh, and then, you know, the beautiful part of the story is that my dad’s life was saved by this non FDA approved procedure, which then ended up going in journals, right?

I mean, you know, it ended up being part of, I’m sure a great legacy for this neurosurgeon, right? And, and, [00:21:00] and producing this breakthrough that has saved countless lives at this point. So the point being using non FDA approved procedures. Methods in surgeries. That’s not the problem. That’s not the problem, right?

That it’s the disclosure. Yes That’s not the problem. It’s

Vic: the disclosure and the the trying to just Act like the patient’s not gonna understand and we know better and we just won’t say anything and do it and then when it comes to light trying to cover it up and and Neither of those things is acceptable and it is Yes, it, there’s lots of situations where we don’t have great approved treatments and The doctor wants to try something else and the patient can decide if they feel comfortable or not.

That’s right this is not that [00:22:00] and in America in New York City for the second week in a row You can’t do that. And I don’t know how many times the New York Times has to Break a story and have us talk about this bad behavior. It sounds like we’re

Marcus: going to hear about it a lot more. It sounds like it’s becoming a beat and we’re going to hear about it a lot more.

That’s, that’s what I’m sort of picking up by you finding these stories. And, you know, last week it was ProPublica coming up with a story. Now there’s a whole podcast series on the, on the Columbia situation. That’s, that’s, that’s spreading like wildfire.

Vic: But the way to stop the reporters from. From

Marcus: not doing it.

Vic: This is not do it. Right.

Marcus: Right. Yeah. Well, well, you know, I mean, hopefully the reporting is going to be a disincentive, uh, for people doing it, but I mean, we just want to share an addendum to the trust story. It’s, I think it’s a theme we need to continue to cover because ultimately, um, and I think the sad thing is it’s coming from health systems, um, you know, that are [00:23:00] already embattled on multiple fronts.

You know, we don’t, um, necessarily need health systems also dealing with a crisis of trust. Um, all right. So, so shifting to a slightly political, but also I think public health, global health story, uh, Nicholas Kristof, who was the, the award winning journalist who wrote the story in the New York times that we featured before around life expectancy and the variance in life expectancy, depending on what state you’re in and really sort of do that profile on Mississippi talking about, you know, just the horrible.

Uh, you know, health issues that dealing with their, uh, he wrote a story this week. Uh, the headline is, will Republicans abandon this medical triumph? So,

Vic: and he does opinion pieces. So I want to say that, but, but it’s a lot of facts, a lot of facts in this. It’s really well written.

Marcus: It’s really strong. And in fact, heavy opinion pieces.

Correct. Not, not your, not your typical opinion piece. Right. Right. Um, so, um, So the thing I wanted to say about this [00:24:00] is, this is a story around PEPFAR, uh, which was a program, uh, that was, uh, put in place under George W. Bush’s administration. Yeah, I didn’t know what this was before this story. So, so the crazy thing is, I didn’t know about this until Monday when I was sitting at the plenary session for the Clinton Global Initiative.

Oh, they talked about it there. Yes, Chelsea Clinton was interviewing a woman from Africa who was a champion in, you know, the fight against AIDS and she was talking about PEPFAR. Like, literally, she had one message for the audience. Please reauthorize PEPFAR because what she was saying was this program had been critical, not just in America.

I think this is the, this is the crazy thing, not just in America, but globally creating the situation that we have today where she was just running down lists of, of, of countries, uh, in, in Africa. where they’ve, they’ve hit critical [00:25:00] milestones in terms of decreasing the population’s, uh, infections with AIDS.

Yeah. Um, because they have milestones they’re trying to hit and she listed off like five or six different countries where they’ve managed to hit these milestones. Yeah, they’ve

Vic: made very significant, positive progress. Yes. Because of this program. Yes. Which, there’s lots of people involved, but it’s, but it’s largely a U.

S. Yes. Program.

Marcus: Yeah. Yeah. And it’s, it’s a look, it’s a, it’s important because it’s counterbalanced against, you know, a government shutdown right now. Also basically being driven by the Republicans. Yeah, but this was a Republican program. So PEPFAR stands for the president’s emergency plan for AIDS relief.

And it was a multi billion dollar authorization to send out. You know, life saving medications around the world. And as those life saving medications got better and better and better, right. They really started to save lives and take the sting out of AIDS. I mean, when we think [00:26:00] about how AIDS. You know, we experienced it back when we were growing up.

It was devastating. It was a

Vic: death sentence in a fast way.

Marcus: And scary, and super, super scary. I mean, AIDS just is not that scary anymore. And, you know, I’m not saying that it’s not a horrible disease that we need to, that we don’t need to continue to really work at. Well,

Vic: it’s a chronic disease now. It’s not a death sentence.

Yes,

Marcus: exactly. And PEPFAR, As a, as an, as a body of, of political will is a, is a key component to why it is that, and you know, look, the Republicans deserve credit here, right? I mean, this is part of a Republican legacy, a

Vic: Republican president. He put this plan in place. And it had a great global effect.

Marcus: Yeah. So, so I would imagine that this story is coming out this week because it is UN global assembly week.

Yes. And, uh, and they’re trying to get the message out about this program that nobody had heard of before. Okay. [00:27:00] Because it’s up for reauthorization now and. You know, in all likelihood, there’s no, it’s not going to be

Vic: authorized. Yeah.

Marcus: But in all likelihood, it’s not going to be reauthorized. That’s, that’s the, I mean, I think that’s why there’s this campaign that includes this, you know, this article that, that included it being kind of the main story that, that, that I took away from the opening plenary session of CGI.

You haven’t heard about this, but this thing has totally, you know, put AIDS in a box and we’re very close to finishing the job. That was kind of what I took away from that, that, uh, that presentation. We’re very close to, to, uh, finishing the job, but if we pull back on this now, it actually could. Start to come back.

Vic: Yeah.

Marcus: So it’s pretty scary. I mean, honestly, I, with everything else we got going on, you know, like COVID surgeons and, you know, all this other kind of stuff, I’m not really up for an age resurgence.

Vic: And it’s not that fucking hard. Like [00:28:00] you can either say it’s the right public health thing for humanity to do.

The U S has plenty of ability to fund this. That’s not a question, or you can say we want to continue to promote U. S. interests in Africa, or you can say all of the above. And I don’t really care what you say, we should reauthorize this and fund it. There’s, there’s no one, I can’t think of an argument that makes sense that doesn’t.

Reauthorize it.

Marcus: Yeah. And look, global stability is in the United States interest. Yes. So, you know, this is one of those things that I think we have a vested interest in, in, in seeing continue and, and also, you know, just our legacy, uh, you know, the world is being reminded of the importance and the power of America on this front.

This is a great opportunity for America to stand up and say, yes, we’re going to continue to be, you know, a leader. [00:29:00] In, in the world and public health. Um, so I

Vic: mean, why wouldn’t we, who wants to not help people with AIDS in other parts of the world or in the U S anywhere?

Marcus: I’m, I’m adding my support to please Republicans.

Yes. Reauthorize PEPFAR. Yes. It’s not. Difficult. That would be great. Um, okay. I think that’s our, that’s our PSA.

Vic: We can’t get any further than that.

Marcus: Yeah. There’s nothing more to say other than like, we want to make sure that our listeners know about this program because we didn’t know about it before this week.

And

Vic: yes, the Republicans are buffoons in the house and they’re playing around with shutting down the government and stupid stuff, but they could do this easily. And it’s not, it’s just not that hard.

Marcus: Yeah, stop, stop vaping in, uh, in movie theaters and, uh, reauthorize PEPFAR. Okay, uh, Elevance. health. This is a story you found.

This is kind of a continuation. We, we pulled this one apart a little bit, but this is a [00:30:00] continuation on the blue cross blue shield CVS care mark, uh, PBM storyline,

Vic: right? We, we had, uh, I think a great section last week comparing the cost of a drug and one in a PBM and, uh, and one of the cost plus platforms.

And so this caught my attention because, um, care, long Rx, which is Uh, Elevance’s PBM made the brilliant move that they’re gonna automatically, when you go to the pharmacy to get your, to get your medication, they automatically check a bunch of other cash discount programs. You don’t have to opt in and they just give you the better price, which seems very customer patient friendly.

Who doesn’t want that? It’s great. Yep. And so I started looking at it and it’s, it’s brilliant. I mean, why wouldn’t they? Get you the cheaper amount. Yeah. Um, and then you started asking me, well, how does that fit with the rest of [00:31:00] Carillon, which, which sort of, I didn’t know much about and we sort of dug into.

Marcus: Yeah. Well, I, I, I have a portfolio company that that’s having some interactions with Carillon and those, those, those interactions are, they are emergent because Carillon has taken over a previous pair relationship. Yeah. Okay. So that, that was why it stuck out to me. I was like, Carillon RX, hold on. Well, the Carillon I’m interfacing with is not, uh, yeah, it’s not the RX.

And so if you scroll down into this healthcare finance news article, um, that’s where you will see, uh, that Elevance Health announced the launch of healthcare services brand Carillon in June, 2022. You and I both missed that.

Vic: And maybe let’s take a step back Anthem.

Marcus: Yes. So we’re saying Elevance. Right.

Vic: And that’s the right name.

And it’s also the old anthem set of properties. Right. Big, big pair, big, probably the biggest, one of the biggest blues.

Marcus: The important part being, it’s a blue.

Vic: Yes, it’s a blue, and they have multi [00:32:00] state Multi

Marcus: state

Vic: blue. And they were very The reason I knew them is they’re very acquisitive. They bought a bunch of venture backed companies.

Yes, they bought Aspire Health. Yeah, they bought Aspire Health from here, and they bought several things. And they are pursuing the payvider strategy. Yes. Um, that’s what I knew about them. And then they rebranded

Marcus: to Elevance. To Elevance. Away from Anthem. Right. And then they, and then they launched Carillon, which, which we’re going to go into here in a second.

Which it

Vic: says that the article was in June a year ago, 22, and I missed that. But really it was

Marcus: just

Vic: a

Marcus: brand, right? I mean, you know, it wasn’t doing much in June. And I think

Vic: they probably quietly, I don’t know how

Marcus: big the launch was pretty quiet. I think it was pretty quiet. Rebrand was not quite, um, so then it starts to kind of go down and talk about the larger trend.

And you start to very quickly realize Carillon is to Elevance as Optum is to UHG, right? And you, [00:33:00] you also start to connect the dots of the blues leaving CVS Caremark. And then this whole story here around the Elevance care, you know, Carillon RX, you know, model. And then at the bottom of this. Article, it says that, uh, earlier this year, Elevan said it would be pursuing an acquisition of Blue Cross Blue Shield of Louisiana.

So they’re adding yet another state. To.

Vic: It’s a huge market share in Louisiana. Yes. I mean, it’s, I don’t know what percentage, but significant.

Marcus: Right. And so what, what you and I sort of said is, okay, game on, right? Because here we have the payvital model that has been pioneered by, by UHG. And then replicated replicated, meaning followed, right.

Yeah. Um, by Cigna ever North and we knew elevance was, was following it, but now I think we’re, we’re getting a better sense of the shape of it. And the fact that they are, [00:34:00] they both acquired a bunch of healthcare services, things have now rebranded all of those things underneath Carillon. And they’re also growing the payer side of the business, uh, on the blue side.

Yeah. Marketing

Vic: to other. Payers, particularly Blues, in a consolidated, uh, healthcare services brand like Optum, in this case it’s Carillon, is, is really impressive and that’s what makes it game on. Like, they can stitch together several payers and the Blues all pal around together already.

Marcus: Yeah, so, so, I, I think, I think there was a general feeling.

In the past and Wednesday, the past, I mean, before today, the last two years or something, yeah, that, that the blues. Were, you know, fragmented, not organized, didn’t really sort of have the infrastructure, the mothership that, that UHG had put [00:35:00] together

Vic: and their protection against competition had, has disappeared this year.

Yeah. So they’re going to start losing some of their ASO business. Right. And it seemed like, say

Marcus: a little more about that, by the way, just so we don’t,

Vic: for, I don’t know, 50 years or so, the blues signed an agreement that they wouldn’t. They wouldn’t, uh, compete against each other for the large employer books of business.

And so, if you’re Blue Cross of Tennessee, you have, um, a relationship with large employers in Tennessee, say Pilot Flying J, or, I don’t know, FedEx, and no other blue, I mean, there was a, there was a negotiated agreement, no other blue would bid on that business. And the 50 years or whatever it was, some large number of years ended.

And so, and they got, and, uh, I think it was Home Depot, someone in Atlanta, [00:36:00] um, sued to sort of make sure it didn’t happen again. And so now they have to have at least two bids. And so all, a lot of the blues have a significant book of business in their home state because, because no other blue could bid on and that.

almost certainly they’re going to lose some of those competitive bids. So I was viewing it as, well, it’s going to be fracturing and they’ll start fighting, and it’s just going to be kind of a hard competitive position compared to the nationwide payers that don’t have, never had that advantage, but now they don’t have the headwind.

And that’s still around, but this is a really interesting way they could, you know,

Marcus: For sure. Um, and, and especially if they start decoupling, you know, if, especially if the blues who through necessity were working with health care services, you know, um, organizations within other communities. Yeah, [00:37:00] like Optum.

Yes. Well, I mean, more specifically like CVS Caremark. I mean, like that, cause that actually happens. That’s not theoretical. Um, they stop working with them and they start working with Carillon RX. Um, it’s game on, it’s game on. Right. And I, and I think it just further cements that this payvider thing, this is basically the future of, of healthcare in America.

I mean, this is it, this is how it’s going to work.

Vic: Yes. The health systems. I don’t know how they’re going to respond, but they are behind.

Marcus: So, uh, you can take the show notes. We’re going to put a link to carillon. com. Um, but just read through this and tell me this is not optimum. Like, you know, and, and some of the listeners may be like, okay, you know, finally you caught up.

I mean, we’ve known about Caroline forever, but. You know, we weren’t really tracking to fully understand, but when we looked at it, we looked at the about us page and we started to kind of see the different components, um, which you see down at the bottom businesses. Yeah. You know, the different businesses we’re like, [00:38:00] okay, we know some of these businesses, my nexus.

I mean, you know, we know them. Uh, we remember when they got acquired and now they’re Carillon insights. That sounds a whole lot like optimum insight. Right. Right. You know what I mean? So, I mean, they’re literally just like Carillon RX. Okay. Well, OptumRX, Carillon Health, OptumHealth. I mean, they’re literally.

Just like taking the template and just slapping their own name on there and aggregating blues.

Vic: Yeah, the thing, the only thing that they have changed that will be interesting to see how the market responds. Except for Aspire, is, uh, UHG has been really careful about leaving the brands where they are. They don’t really change, um, the brand that much.

So they buy Change Healthcare, or they buy Change Healthcare is OptumInsights. It’s OptumInsight. Oh, they have Change Healthcare. Oh,

Marcus: yeah.

Vic: Okay. Well, so maybe it’s all no, no, no, no, no, no. I think this is the

Marcus: playbook. Yeah. I think this is the [00:39:00] playbook.

Vic: Is NaviHealth changed names?

Marcus: No, NaviHealth hasn’t changed names.

I mean, the, the, the services businesses, which is kind of why Aspire Health, that’s what I think happened with Aspire Health. The services based businesses don’t have their names change, but, but if, if it’s like a business unit technology kind of play, they pull that in. Yeah. They pull that in. Okay. Yeah.

Vic: Well, yeah. So they, they, they’ve built this portfolio. Largely through acquisitions and it’s pretty strong.

Marcus: Yeah. Now they’re unifying it through, through, through branding and probably some other, you know, forms of alignment and probably some, some level of technology alignment. Um, and yeah, it’s, it’s just game on.

Right. I mean, I think we have to start taking the blues more seriously and looking at Elevance as like the leader of the blues, um, as it pertains to what the future of the business model is going to be, especially if they’re actually acquiring You know, other state businesses. That’s, that to me is a, is a, that’s a clear [00:40:00] signal that, that they, they’re the leader in the space.

Vic: There’s no question they’re the leader in the blues space. Yeah, that’s

Marcus: what, that’s what I mean.

Vic: It’ll be interesting to see how, I mean Cigna’s been working on this longer. But Evernorth has been a slower process to get going, at least in my estimation. And then CVS does doesn’t have this component, as far as I know.

Um, although of course they have the old Caremark. Yeah. You know, it just I think you’re right. It feels like the payers and the payvider, the competition is heating up, it’s game on, and they’re gonna compete for who is dominant. And I don’t think the health systems really are there. No. But they’re just not, they’re just not in the game.

And I’d like to see them in the game. They’re not in the game. But they’re not in the game right now.

Marcus: They’re not in the

Vic: game.

Marcus: Uh, okay, so then, you know, we’re gonna shift to our payvider on the health system side. Uh, Kaiser. Which I’m rooting [00:41:00] for, but. They got a ways

Vic: to go.

Marcus: Yeah. So they are the latest victim of, you know, the return of the unions.

Um, we got all sorts of unions, you know, striking UAW, right. A strike still going on. Although I think that feels like it’s waning. Um, and, and now we’ve got a consortium of, uh, of 67, 000 Kaiser permanente workers that have voted to authorize a strike.

Vic: Yeah. And it’s interesting. They preempted. The end of the contract, so the contract ends September 30th, and they claim that there’s not, there’s bad faith negotiating going on, and then Kaiser responded pretty transparently saying we are negotiating, doing, trying to get this to the finish line, um, but either way it seems pretty neat.

And whether they get something done or they strike, it [00:42:00] seems rough.

Marcus: Yeah, so one of the things I’ve noticed in these union strikes is In some cases, the unions are striking against a, you know, an employer that in the macro is actually well positioned and pretty strong and where it feels like there’s a real win win that can come out of the strike.

Um, but in some cases, and I, and I hate to put the writer strike in this, in this bucket, you know, within their own contained world. Right. Of the writers and the studios, certainly the writers can look at the studio CEOs. They can look at, you know, profit margins. They can look at those things and they could say, this is ridiculous.

We should be getting more X, Y, Z, right? Yeah. So

Vic: in, in, in, in

Marcus: that close

Vic: between those two sides. Correct.

Marcus: In that close context, uh, and I’m very, very empathetic as [00:43:00] it pertains to the AI issue, right? And, and, and the use, the, you know, the using of copyrighted materials, using of likeness, uh, you know, and leveraging that, uh, you know, from the perspective of someone who is a writer and talent and, you know, cares about my own personal intellectual property, I’m very, you know, empathetic to, to that particular issue.

Um, however, in the macro, The studios are weak. They are under siege and under threat by all the distribution platforms, oversaturation of content in the market, and just new content platforms like TikTok that are taking more attention, especially from younger generations, right? So the overall format, the overall format is being deprecated, quite frankly.

Um, and so the studios are, Our week, the studio is a week and you’re trying to get heavy negotiation leverage from a weak player in the macro, you know, environment. It doesn’t mean you can’t win that battle, [00:44:00] but there is, there is a, there, there is some negated long term mid to long term value in the, in the effort.

And this feels similar to me, right? Which is to say, I don’t know enough about the details here, you know, You very well in, in the, in the micro just looking at the 67, 000 workers and whatever information they have specifically about their, you know, arrangement as, as a labor force with the administrators and the people that are leading Kaiser Permanente.

They absolutely could have a very, you know, good case, right? But man, Kaiser’s a hell system. I mean Yeah, right. Kaiser’s a hell system, trying to figure out how negotiate

Vic: against Eveillance in California.

Marcus: Dude, they’re trying to figure out how to navigate their way to being like a proper payvider, but like, they’re dealing with They’re a, they’re a, they’re a hell system.

Vic: It, I mean, I, I agree with you completely. It feels like a shrinking pie. shrinking market [00:45:00] and people are fighting over the smaller, like what can I get in this situation because it looks really scary as opposed to the payers that are, are building and growing the pie. And I mean, I think we both, we, it’s, it’s a hard job to work in a health system and people should be paid a fair, a fair wage.

It’s, it’s hard work. And at the same time, Kaiser’s negotiating against all of these. payers and if they pay their employees too much that it’s going to hurt them in those negotiations and over time the pie is going to shrink faster and faster and faster and that’s kind of what’s going on the writers strike too with the studios like sure the writers can get more for a minute I wa I watch YouTube probably more than I watch movies.

No, that’s that’s the thing,

Marcus: right? It’s, it’s like this writer strike has happened and it’s like I’m not hurting for [00:46:00] content. Yeah. At all. Exactly. I, this has not impacted my life one bit. Yes, dude. My, my, my net, my Netflix cue, and my Max Q the number of shows that I still haven’t seen. Yeah. I can’t watch them all in this lifetime.

Right. That are out today. You can never make another show for the rest of your life. I can’t watch all the content that’s out there between now and the day I die, so like. This is not going to hurt me.

Vic: Yeah. And, and, and I watch a lot of content that’s not scripted. Not, there is no writer in it. That’s right.

And that’s a trend that’s not going back. And so, so they’re fighting over this shrinking, shrinking thing. We’re making content right

Marcus: now. Yes. Right,

Vic: right. We didn’t pay any writers to do this. No, no. So it, I think you’re right. It, it is the labor battles are in the wrong place, kind of. But

Marcus: but they’re I mean, they’re understandable in the micro.

I understand. I don’t I don’t know. I don’t know what other alternatives they have to improve the condition of the labor workforce. I mean, [00:47:00] obviously, inflation is creating a lot of pressure here, too, right? There’s there’s environmental pressures that are creating the need for higher wages, um, that are enemies to the to the company.

Yeah,

Vic: that’s right. But but the. The revenue for health systems is capped.

Marcus: That, that, that is the, that’s the ultimate point. So there’s no more money.

Vic: Like, like you can, you can say the CEO should make less and fine. This is a struggling market of health systems and taking the best run and The best hope. The best forward looking integrated system with payer, provider.

They’re on both coasts now. Both coasts are striking. It is. It’s just sad. It doesn’t mean that I don’t think people deserve a great wage. Just, I think it’s short sighted and I don’t know where it’s going to go, but it makes me worried.

Marcus: I mean, [00:48:00] when you compare it to the story we just talked about with the Everlands Carillon, and I don’t think that they’re in a position where they’re going to have union, you know, they don’t employ union workers.

That’s, I don’t see that happening. Right. So it, it just, uh, It just accrues more and more leverage to the payvi to the, to the payviders that actually started as insurance companies. That’s right. You know. All right. I think that’s a good time to take a break. We’ll let Doug, uh, share a little bit about jumpstart foundry, and then we’ll come back to close out the show.

Doug Edwards: Thanks guys for the opportunity to talk about our pre seed 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. [00:49:00] 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 health care. Some of the benefits of Jumpstart Foundry is there’s no management fees. 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 Jumpstart 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 invests in, we also provide great returns and a great experience for our limited partner.

We partner with AngelList [00:50:00] 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. So quickly, we just want to talk about, um, some FTC stuff. Uh, Lena Khan announced that she was going to crack down. Lena Khan is the FTC chair for anyone who doesn’t know. Uh, and, uh, she’s has decided she wants to crack down on below the radar deals. And Vic, can you please define below the radar deals?

Vic: Below the radar is below a hundred million dollars in an acquisition.

Marcus: Okay. So literally this is like target range for us. Yeah. These are our deals. Yes. So Lena con wants to start regulating small, you can’t even call it small cap strategic M and a tuck in acquisitions [00:51:00] in healthcare specifically. Yeah. In healthcare specifically.

Yeah.

Vic: And the, uh, I mean, I think it’s kind of like if you’re a major league baseball player and you can’t hit anything, let’s just go down to high school and play,

Marcus: dude. I want to like her, but like, come on hundred million dollars. That’s first of all, do you have the resources to actually do that fairly?

Vic: She does not have the resources to do that. And she, and who cares? I mean, like she needs to figure out what is actually important and go fight that.

Marcus: I don’t think people understand how small a hundred million dollars is.

Vic: I mean, I don’t know the size of the Amgen acquisition. [00:52:00] Um, usually she’s doing something that is like 10 billion to 50 billion.

And the FTC for years has not. Dealt with below a hundred million because what you’re saying, it’s too small. They’re not resources and they don’t really care.

Marcus: She she’s identifying a fundamental reality of the modern technology economy, which is the pace at which it operates. There is an entire company building competency.

That comes through M and a where companies will buy companies will buy companies that are really Products that become features that can be bolted on to their overall distribution platform. Okay. Yeah, that’s what she’s highlighting And I mean I get it but like so you’re gonna try to stop that Like that like that is that is [00:53:00] so baked in to the way that the market works right now I just don’t even, I don’t even, like, there’s so many founders who want to sell at a hundred million.

There’s so many VCs who want to exit at a hundred million. Like, there’s so many players in the market who, this is, they’re playing for this.

Vic: I have a core difference of opinion from her. I do not think the government can control the entire market. You have to let the, Open free market work. She’s upset that there have been some times when big tech and you can pick any of the big ones.

So Google, Apple, Microsoft, they all do it. If they see a up and coming. trend, they, they will attempt to buy [00:54:00] all the companies in that space to protect their brand, protect their position. And I understand that. And the way to fix that is not to go stop every possible acquisition, but it’s to sort of enable competition so that a company can get bigger and decline and go be the next Nvidia.

And Nvidia is not going to sell. They’re trying to. And so it just is not realistic for her to think she’s going to control every deal. And only let the good ones in and block the other ones down at this level. She’s losing every case up at the way where she is. So taking on a whole bunch of little ones doesn’t make sense.

I mean, that’s just like going down to high school and to

Marcus: announce this at the Oliver Wyman health innovation summit and say, you’re going to focus on [00:55:00] healthcare. I mean, dude, Judy Faulkner at Epic is not. Acquiring companies at a hundred million. Okay. She’s not buying anything. She’s just building it all.

There, there are no, there are no tech monopolies that are doing this. Now there are payviders who are acquiring these, these capabilities, you know, a hundred million here, you know, 300 million there, you know, several billion in some cases, right. Depending if it’s a really, really big, you know, services organization.

Um, but like, you’re going to stop that. I mean, it’s, it’s, it’s, it’s crazy. They’re buying capabilities. They don’t currently have.

Vic: Yes, you know, she’s, she’s going to lose in court. I mean, she, she can’t, she’s not going to be successful and it doesn’t make sense.

Marcus: So then you pointed out to me now for anyone who doesn’t know how these, how these agencies work, you know, they’re led by commissions.

The, the commissions are generally going to be, and maybe generally always going to be majority led by the administration that is currently, I

Vic: think by policy. [00:56:00] Yeah. Yeah. It’s three to two, three to two by whatever, The administration is in the White House. It’s

Marcus: really in the White House. So what you end up having is, you know, two, um, uh, commissioners that are the minority and they are the dissenting minority and, you know, they’re not going to win votes on pure party lines, but through argumentation and dissenting and, you know, you, you get more balance in how these decisions get made.

They can shape the, the direction. For

Vic: sure. For sure. By how they dissent. Make.

Marcus: Make. Good arguments.

Vic: Yeah, right. It makes the whole thing better. It’s the process better have two sides of a Argument.

Marcus: So what you pointed out is you just have to go to FTC gov go look at the about page. Look at the Commissioner’s staff and what you will find is literally there’s a paragraph that says The commission is headed by five commissioners nominated by the president and confirmed by the Senate, each serving a seven year term.

No more than three commissioners can be at the same political party. The president chooses one commissioner to act [00:57:00] as chair. Okay. So you have that paragraph. That paragraph is above three commissioners listed. So the three commissioners are obviously Democrats. Yes. There are no Republican minority dissenting commissioners.

At the FTC right now. Yes,

Vic: there was a Republican and she resigned in protest over something in February, some action. I can’t remember which one, but one of the one of the big cases she didn’t think was worth the FTC’s time and in protest resigned. And. Biden either, I don’t know the details. Biden either.

Hasn’t nominated a Republican because you can’t put a Democrat on here. No, no. He either hasn’t nominated a Republican or the Senate, which is controlled by Democrats hasn’t [00:58:00] confirmed who he’s nominated. And I don’t know which it is or no one will serve, which also can be served or no one will serve.

Marcus: Look, I, I don’t know what it is, but um, if you want to see what. What looks like, well, no, I was going to say, if you want to see what high functioning descent looks like from a commissioner, go look at the sec and look at Hester Pierce. Um, you know, she hasn’t went anything. Okay. Gary Gensler is like, you know, he’s got his agenda.

He’s running away with stuff, but she presents a very thoughtful counterpoint to him regularly. And at a minimum, it’s a signal to the market that the sec is not this One way train and that as the things are going through, it’s really Ga Gary Gensler’s agenda. So you at least know that there are people in there that are, um, presenting opposing viewpoints, right?

Yes. And that, that is helpful. That on its [00:59:00] merit, on a, on its merit alone is really, really helpful.

Vic: Yes. And these agencies have hundreds or thousands of people that work in them from both political parties and it is useful in the SEC for. People to feel like they’re at least their concerns are aired in the boardroom where the big decisions are made.

That’s right. And I think they probably, I mean, if they work there anytime, they understand how the political stuff goes. Of course, you have to. And so the FTC is the same. And I cannot believe that no one will serve. I mean, it’s a prestigious seat. And so somehow it’s dysfunction either in the nominations or in their confirmation.

Marcus: So, I mean, this, this matters because the FTC is, um, You know, a big player in whether or not deals get done and, uh, health [01:00:00] systems. Are going to continue to need deals to get done because that is still the primary way they’re going to be able to, um, find economic viability and it’s, it should not be encouraging to anybody that a spotlight is going to, you know, intensify on healthcare, starting to look at deals, a hundred million dollars in less.

I mean, that should not warm and fuzzy anybody who cares about healthcare, figuring out how it’s going to navigate out of this problem. Yes.

Vic: There’s no

Marcus: question. Alright, let’s finish up the dysfunction with, uh, the House GOP. Um, they floated a new plan to avert the government shutdown, but the fact that we’re even talking about a government shutdown after we just went through this, like, how, how many games of chicken can we actually play?

And at what point do you just stop believing the game of chicken? I don’t believe the game of chicken right now. Well, how can you after the last one we just went through, what, four months ago? Yes. Is that ceiling? Was it four months ago? Three months ago?

Vic: They, they are [01:01:00] gonna figure out something, but the reason to talk about this is that the Republican controlled house tried to come up with a plan to fund the government and they couldn’t agree themselves.

Yeah, that’s, that’s the whole storyline of this. So there’s no,

Marcus: there’s no plan to even talk about. That’s the whole storyline of this current house GOP. Yes. They are not unified. No, no,

Vic: they’re they’re the opposite of unified. Yes, they can’t get anything. They can’t agree on anything and It just is sad. I mean like for our country to Not have the ability to do the really the the first and most important thing that Congress has to do Which is create a budget to fund the federal government [01:02:00] That’s the first thing they have to do and they can’t do it and I think you’re right They will figure out something to kick the can down the road It’d

Marcus: be really

Vic: suboptimal gonna be suboptimal and and it just gives no one Confidence that that we have people that know what they’re doing.

I mean, it would be fine to have an opinion about The Republicans think we should control spending in some way, and the Democrats fight against that, and they have a discussion and come up with something. But that’s not We can’t even get there because they can’t get their act together. No.

Marcus: Um, so yeah, I mean, I think we just had to talk about the government shutdown just because it’s, it’s news, but it just further magnifies the problem that DC is and DC is critical to healthcare, you know, and it’s, it’s, it’s not looking good.

It’s just not looking [01:03:00] good.

Vic: So they should keep supporting.

Marcus: Yes, do that. Figure, figure out how to, like, reauthorize PEPFAR, guys.

Vic: And then, let’s, let’s just take whatever Solution that you’re going to do on October 6th and let’s do it now.

Marcus: And, and, and stay out a hundred million dollar M and a deals. Yes. You have better things to do.

All right. Um, let’s see, I think, I think that’s the show. I think that’s the show. And I think next week I’m going to be in Louisville, uh, for, um, what was aging 2. 0. Now it’s called optimize. So I’ll be, I’ll be at a panel, but I think I’m going to drive back up here and be here in time for the show. Okay, we’ll figure it out.

We’ll figure it out. Yeah. All right, man. Thanks for the show. All right. [01:04:00] Bye.