43 – Inflation update | Health Systems Comeback | Change Healthcare Cyberattack | YCom & Techstars | AI Rundown

Marcus: [00:00:00] Back from a week of break that we had to take, unfortunately, there was some stuff we had to handle. So we’re back now.

Vic: Hopefully we won’t miss many times, but once in a while, we got to take care of internal things.

Marcus: That’s right. So anyway, we are back. Um, and the world feels like a wild

Vic: day today.

Marcus: Today, I mean, actually we, we just went through the whole run out of the show.

Marcus: We didn’t even include the AT& T store, right? Uh, man, I don’t think it’s just today. I mean, I think the last two weeks, I mean, Navalny was killed last week. Yeah. Um, gosh, man, the whole Nikki Haley, Trump thing, the Fannie Willis thing, and these are not even healthcare things, but they’re just like the world.

Vic: Yeah.

Marcus: Uh, just going nuts. We got the political

Vic: thing. It’s just going to be.

Marcus: Bad. It’s not even March

Vic: yet. Yeah. That’s what I mean. It’s going to be bad for the next nine months.

Marcus: Yeah. We got the healthcare stuff covered, but like, man, the last two weeks have been really, [00:01:00] really intense, but stock market’s doing fine.

Marcus: How’s your portfolio looking?

Vic: It’s

Marcus: okay.

Vic: As long as you’re in the food, the right names, that’s good. My, my names happen to be growth oriented. And actually I meant to. Bring it. I was gonna, I was getting it all ready for the show because the healthcare index, which is HLV, is the ticker, it was the best index year to date.

Vic: Um, until yesterday and now with NVIDIA’s craziness, we lost out to the tech, to the tech indexes, but healthcare is having a pretty good run. Yeah, look, it’s

Marcus: steady Eddie, man. It’s, it’s a, it’s a, it’s a place you want to be. And, and I think that that bodes well for Nashville, you know, we’re very well positioned, um, to continue to know where it’s going to understand it.

Marcus: And to continue to innovate in it. So all of that is really good. Um, we’ve got a big show, so let’s, uh, let’s dig in.[00:02:00]

Marcus: All right. First up, we’re going to talk about the CPI. All right, Vic, what’s going on here?

Vic: So last week it was a little higher than people were hoping 3. 1. And so that sort of crushed people’s hopes that the fed will, we’re not getting a cut. Yeah. We’re not getting a cut. Yeah. We might not get a cut. I think we’re not going to get a cut.

Vic: My prediction, I think, until after the election. Wow. Now, maybe we’ll get a 25 basis point cut in the summer. We don’t really a cut. I mean, that’s the thing.

Marcus: We don’t actually need it. Yes. Everything is kind of ripping. So what, like, where, you know, the stock market, after having all time highs. Cannot look at the Fed and say, well, you need to cut.

Marcus: You can’t do

Vic: it. I think, you know, I’m not sure we’ve ever had a soft landing, but, but the Fed’s [00:03:00] doing a pretty good job to pull off a soft landing.

Marcus: Yes. And so GDP growth, all time high stock market. Real estate market is starting to move again. Residential is moving again. Um, even commercial is, you know, in certain pockets, uh, resurging.

Vic: Yeah, I mean, there’s starting to be transactions where buildings are sold at lower valuations, but it’s not cratering the market, which is the American way. If you bought at really high prices and no one’s, you know, Sign leases anymore. Maybe you should lose a little money, but that’s very different than the entire market freezing up and not functioning

Marcus: Yeah,

Vic: yeah,

Marcus: I think it’s great and the banks still appear to be okay.

Vic: Yes, so Inflation was 3. 1 Slightly higher not at the 2 percent right where they want it to be but the next image is Cumulative price changes over a long period of time and that That’s the one that really just struck [00:04:00] me. Like we talk about 3%, 5%, you know, let’s get to 2%. That’s an annualized number.

Vic: Right. We almost never have prices go down. Right.

Marcus: And it’s, it’s annualized year over year.

Vic: Yeah. So, right. So, so you don’t, the price of a car or a box of Wheaties is 3% higher this year than last year. You

Marcus: failed to see the compounding impact of that happening year over year, right? Right. Yes.

Vic: And so the Labor Department puts out this cumulative price changes.

Vic: And I think inflation is the slope of the line. And for people that are not able to watch, first of all, you should watch on YouTube. Uh, we’ll try to describe it. So starting at 2016, you kind of have like a slow, I mean, as we remember, inflation was pretty low. And so the slope of the line is positive, meaning it’s sloped up.

Vic: But a pretty, pretty low rate. Yep. And that is thought to be healthy because it makes [00:05:00] people spend or invest their dollars As opposed to just sit on cash, deflation, meaning the slope going down, is really bad because then everyone holds their cash because I can buy more tomorrow than today. So I think you want a slight positive slope, but then sort of post COVID it went very, as we remember, really fast inflation.

Vic: Yep. And then it’s sort of the Fed raised rates and it’s sort of come back to a more normalized rate, 3%.

Marcus: Yeah. But the angle of the curve, uh, from, what was that 22 to 24 is still a, it’s still a, uh, a, a. Yeah, we want it to be a 2 percent and it’s at 3,

Vic: 3,

Marcus: 4. Right. And so you get to really see how that changes the trajectory of overall price increases for us as consumers.

Marcus: And I think this chart does a really good job of illustrating why, generally [00:06:00] speaking, people don’t feel like the economy is doing well.

Vic: Yeah. I mean, the stuff that I had to pay 100 for in 2016, Which wasn’t that long ago, eight years ago. Right. Now I have to pay 130 for it, for the same thing. And wages have not kept up at that rate.

Marcus: Right.

Vic: And so I think that is a real challenge. And it’s particularly a challenge for people that don’t have, uh, a lot of assets. Meaning they, they live in paycheck to paycheck, roughly. And they rent a house and they lease a car. And they are going backwards.

Marcus: Right.

Vic: If you have assets like a car, a house, stock portfolio, then those have typically gone up more than inflation.

Marcus: I think what’s, what’s particularly insidious and tricky is, The 100 thing that now costs 130, you’re not buying, if you’re the average American, you’re not buying that many of those. It’s the thing that costs, that used to cost a dollar and now costs 1. [00:07:00] 30. Right. You buy that every day. Yeah. Right? Multiple times a day, maybe.

Marcus: And that just, you know, that’s gas, right? That’s a bunch of different stuff. And that just like eats away at your earnings. And if you’re not earning it at a clip that can, you know, significantly Compensate for that increase. That’s tough. That’s tough and it’s tough to look around and feel like things are going great When you hear about gdp growth you hear about wall street, you know all time highs when that’s the the kind of slope You’re trying to overcome from an earnings perspective

Vic: Yeah, I mean say i’m not gonna get it right but say your take home pay is 700 a week,

Marcus: right?

Vic: The other way to think about it is you now can buy 30 less food gas Entertainment movie tickets Then you’re used to for that same amount. Yeah, in less than 10 years. Yes, right.

Marcus: That’s a really hard. That’s hard. That’s hard. Um, all right. Well, look, [00:08:00] that’s a good rundown. We don’t have any feedback from the Fed right now.

Marcus: So we’ll just continue to track the metrics, but always good to, you know, review them and kind of see where we are. And generally speaking, from the investment world, we’re okay, kind of going to be flat and continuing to correct in some aspects and grow in other aspects, mostly AI. Um, but for the general consumer, it’s tough.

Vic: And for healthcare broadly, Dr. Quinn. Slow and consistent inflation is okay. Right. Like prices adjust on a lag. But it’s okay, we as an industry have a lot of trouble with very fast inflation or up and down and all over the place.

Marcus: Yep. Alright, so we are going to go through a run of four stories from Fierce Healthcare, so shout out to them for, uh, producing really good news.

Marcus: Uh, so the first one is the story that actually happened, uh, Probably two weeks ago, uh, the bankruptcy of Kano Health. Um, so this is a SPAC, one of those companies that ended up going public during the, the Fast and [00:09:00] Furious high run up, um, was pretty deep in partnership with Humana, um, and recently filed for Chapter 11.

Marcus: Just, uh, their debts exceed a billion dollars, and, um, they are a business that was pretty heavy as a provider in the Medicare Advantage space. So, they recently, uh, sold some of their senior care stuff to Humana, um, to their CenterWell business line, uh, but a billion dollars in, in, in debt. And I, and I think this is the tricky thing.

Marcus: The margins are so thin for these government based businesses that, um, you know, when, when you’re already not quite, uh, Dialed in on your operating model and you see a shift, uh, on the, on the payment side of things or on the star rating side of things. I mean, that, that swing can put you under underwater really, really quickly.

Marcus: So.

Vic: Yeah, we kind of talked about it last show, I think, maybe two shows ago, about Amazon sort of pulling back and not saying that they’ll keep coming. Primary care is a hard market. Yep. It’s a really important market. [00:10:00] I think it has a lot of power as far as the referral patterns. For sure. But Canada was in that group of Darling, advanced primary care, really high growth companies, but they were really focused at, Medicare, Medicare Advantage, particularly, and that’s, they didn’t execute well enough, and it’s a hard, it’s a hard space.

Marcus: Yeah, so, I mean, sad story, mostly because this was a publicly traded company, right, and we, we hate to see, uh, public market investors, you know, get into a deal, it’s, uh, it’s pretty hyped up, it’s in the healthcare space, so, Seems like, you know, they’re providing care for seniors, all the things that, that, you know, you might look at and say, this is a company I might want to invest in.

Marcus: And then that company ends up going, uh, upside down. So, um, in general, the

Vic: SPAC companies have not performed well.

Marcus: Yes.

Vic: There’s probably a reason for the IPO underwriting process that is maybe frustratingly slow, but healthy.

Marcus: Yeah. And I mean, look, here’s the [00:11:00] thing. Uh, I think that we, we that are. Investors that really need a healthy IPO market.

Marcus: We, we need to be champions for, um, smart regulation, uh, on companies going public. Right. I mean, you know, the, this back thing that was, unfortunately that was driven by a lot of private market investors that that’s the truth, you know? Um, we found a loophole, the world was distracted. The world was distracted.

Marcus: The world wanted proof that the economy was still working. And we shoved a bunch of companies that had no business being publicly traded companies onto the public market that, that, you know, we collectively, the, the private, uh, investor industry, we did that. And it just, it just shows that, you know, the incentives have to be aligned, but you also have to have some smart regulation in place because you can’t trust us either.

Marcus: You know, unfortunately, and I don’t mean you and I mean, you know, as a, as a, yeah, look, [00:12:00] economic actors act in their own short term best interest and they’ll, they’ll, they will gladly, gladly hand the bag over to the general public. No problem.

Vic: Yeah, no problem. Yeah. I mean, I think it is. Both things can be true.

Vic: We have to find a way to get more companies public. There’s not enough volume of companies that are public now compared to 20 years ago. It’s a lot more expensive, it’s a lot harder, a lot more regulatory burden to be public. And yet, we need to protect the public so they’re not buying things that maybe, you know are not well developed enough to be public.

Vic: Yeah.

Marcus: I mean, it’s short sighted, right? Okay, you get away with it for a year, but then you’re going to pay for it in subsequent years, right? Yeah, and unfortunately And no one’s going to feel bad for you.

Vic: Right, right. Yeah, but the people that put together the SPAC deals typically got out. Before the bankruptcy.

Marcus: You know what I would love to see, I’d love to see a rundown of the breakdown by sector and sub-sector of these SPACs. Yeah. Because we’ve covered a [00:13:00] fair number of healthcare ones, right. I mean, you know, pear Therapeutics. Yeah. We’ve covered Kano. Um, I know that there’s stuff in the biotech space that went out via spac Yeah.

Marcus: That had no business going out via spac. Did Clover go out via spac? I think Clover, I think it did. I think Clover was, was a Chamath, uh, spac. It was a lot of healthcare. SPACs. Yeah. I mean, I’d be, I’d be interested to see. How that weighs up against other subsectors, you know?

Vic: Yeah. I mean, the SPACs as a, as a whole are really bad.

Vic: I don’t know if we are better or worse, but we can definitely try to find a guest maybe who really knows that space.

Marcus: We should ask Emily to get some, get some answers for us. Um, okay, now let’s go to some, some happy news in the healthcare space. Uh, boy, health systems, non profit health systems, Kaiser Permanente, 4.

Marcus: 1 billion of profit exceeds 100 billion of operating revenues in 2023. I mean, clap for the boys. That is unreal. Uh, that those [00:14:00] operating revenues are, what is that, uh, 25 percent of, of sort of a UHG, uh, from an, from an operating revenue perspective, that’s pretty damn good for a health system.

Vic: Yeah. And, and all of them, I mean, HCA tenant came out first.

Vic: And we have three or four today. They’re all doing well. Yeah, the health systems are back. The labor expense has come down. And the patient volume and acuity, the thing I was surprised about is the acuity. There, I mean, unfortunately, a bunch of stuff was delayed during COVID. And now patients are coming back.

Vic: And they’re, they’re a lot sicker. They’re more expensive. And that’s, Unfortunately, that drives more patient volume, more billables. Yep,

Marcus: that’s right. That’s right. So anyway, look, I mean, congratulations to Kaiser. Obviously, they are continuing to move forward on their Um, merger with Geisinger, the rise in health effort.

Marcus: That’s going to be, uh, I think something to watch in the future as we see two [00:15:00] giants in the nonprofit space, uh, in the nonprofit payvider space, really merging, bringing best practices together, giving coast to coast coverage, and then probably looking at what businesses they can add in the middle of the United States, uh, to their, to their fabric.

Marcus: So just impressive, impressive results for Kaiser.

Vic: Yeah. And I think it’s, we need, we need the. Healthy, competitive dynamic where there are health systems that are strong enough and begin underwriting care to, to keep the payviders that really started on the payer side, keep them honest and keep it right.

Marcus: Absolutely. We need a healthy dynamic here. And, uh, and look, I think the other thing is like, we need examples to point out to the health system world. You guys can do the pay writer model to now, of course, you know, Kaiser has been doing it for a very, very long time. It’s like embedded into their DNA. So it’s not something that can easily be done.

Marcus: Uh, but for everyone who’s complaining about the payers doing it, it’s, it’s great to have an example of a company like Kaiser that’s doing it as [00:16:00] well. Yes. Right. All right. Uh, Ascension, this is a great turnaround story. Uh, they, they had almost 400 million in, uh, net income in Q4 of last year, right? The numbers just came out.

Marcus: So that’s a, that’s a fantastic turnaround.

Vic: Yeah. Yeah. They’re, they are a well run business. They, they, like all the health systems, they struggled.

Marcus: They were, they were down bad. Yes. They were down bad. I mean, they had several. At the lowest point, they were losing 2 billion a year. Is that right? Yes. Yes. So that’s a great turnaround to get to a 400 million swing positive on a quarter.

Marcus: It’s really good. Yes. Um, and, and, and I think it’s the same things, right? Uh, the acuity driving higher per patient revenues. And, and, and the cost

Vic: to deliver services. Yes. The nursing, the travel nursing. I mean, they still have some travelers, but it’s not the same percentage that it was before. Yeah. Much, much better.

Marcus: Yeah. They’ve got that all dialed in. So that’s great. So on the large system side of things, your Kaiser’s, your [00:17:00] Ascension, that’s fantastic. These are organizations in good markets. Um, I’ve been spending a lot of time at ascension facility recently. Uh, you know, have a, have a loved one. Who’s who’s that one getting, getting great care have to say.

Marcus: Um, but tell two, two worlds here, half of rural hospitals are losing money. So this story also in fierce healthcare, um, citing some information from charters that says that rural hospitals are continuing to struggle. And that, as we talked about with Emily, that rising MA enrollment is not really going to help them.

Vic: Yeah, that’s right. There’s definitely a scale aspect to success in health systems. I think you need scale to have the, uh, SG& A leveraged across enough, enough volume of patients. And you need scale to be able to negotiate with payer contracts. And so for both those reasons, I think we’re going to keep seeing consolidation.

Vic: Because we have to see consolidation. [00:18:00] Uh, unfortunately the FTC is standing in the way of some of those things, but we’re, we’re going to need to see that because they’re not going to survive. I mean, they, they, they can’t make it.

Marcus: Yeah. So a couple of, uh, points that this analysis, uh, makes one. The, the rural hospitals that are in the 10 remaining Medicaid non expansion states are doing far worse.

Marcus: Um, and so that’s sad. We, we live in one of those states here in Tennessee. So that’s, that’s sad to know that our, our rural communities are likely doing far worse in terms of the performance of their hospitals. Uh, we, we learned from Emily, I guess. a week or two ago that M. A. has now tripped over 50 percent penetration, and so the majority of seniors are now on Medicare Advantage, so that conveys to the rural populations.

Marcus: We know that there’s higher costs now that are going to be associated with that than there were projected four or five years ago. Um, you know, the, the drug models are gonna be really, really tough. Uh, they don’t have the best PBM infrastructure out [00:19:00] there. They don’t even have the great pharmacies out there, quite frankly.

Marcus: Yeah. Um, three 40 B is still under attack. Closing the stores. It’s closing the stores. These markets. Exactly. So, I mean, this is just all bad trends basically in, in, in rural America. And you know, look, here’s the thing. It’s like. You. We just talked about your Kaisers and your Ascensions and how they’re doing really well, and that reflects well on not just those communities being able to get care, but also workforce, you know, health systems in many towns and cities across America are the largest employer in those towns and cities, right?

Marcus: And in these rural towns, we’re going to get less care, we’re going to get worse care, and we’re going to have lower employment. And we wonder why there is rural versus urban divide, uh, politically. I mean, this, this is one of the most fundamental places you could look for in society from an equity perspective to see where there might be a fissure in, in political views.

Marcus: And clearly, I mean, something is, is, is really, really off here. [00:20:00] That we can’t find a way to viably take care of our rural, rural citizens here in America.

Vic: Yeah, I agree with that completely. And this is not a jobs program. I said, like, I think it’s a healthcare issue. We need to structure our healthcare system to deliver care to the people that need it in rural America and in urban America, but rural citizens.

Vic: But the economic conditions are different, right? They are different. And there’s, there’s too much overhead. In the rural health systems because they don’t have the scale and they don’t have negotiating leverage and and and and they have a difficult hand to play.

Marcus: Yeah, so, so, okay, let’s let’s just talk through that really quickly.

Marcus: So totally agree, but changing out your model. That’s a process of transformation.

Vic: Yeah.

Marcus: And that actually requires some front end investment to transform from current state to future state.

Vic: Yes.

Marcus: Right? You know what I mean? You want to get to that lower OPEX, you don’t just get, you can’t just get there [00:21:00] by only cutting costs.

Marcus: I mean, that’s, that’s part of the equation. There’s no question. But there is some level of investment to transform to what the future sustainable, lower cost, reliable state is going to be. And I think the problem is we don’t see where that capital is coming from, like, like, where is that support? Where is that stimulus?

Marcus: Where is that investment coming from to help them transform into the future state that doesn’t seem to exist

Vic: that doesn’t exist, partially because it doesn’t It hasn’t been shown a model that can be profitable and partially because it’s hard for a rural subscale nonprofit that by definition is a nonprofit to, to easily attract risk capital, but I think starting where there’s actually something to talk about, which is, I think the, the service model that would work in a rural community has to be different than in an urban community.[00:22:00]

Vic: You can’t, you can’t have the same set of procedures you’re doing. So you, you shouldn’t be a, you know, tertiary, you know, doing open heart surgery. You have to decide this is what we have a lot of volume in and we’re going to be really good at that. And then we’re going to partner with. Somebody, any of these names up here or others in the most nearby local urban center, and we will then get the patient sort of stabilized.

Vic: And if they need that higher level service, we’ll ship them there. That allows you to then reprioritize how you’re buying equipment and hiring people and organizing things in a way that I think is sustainable. There’s a lot of emotion around that. People don’t want to give up. Their, their ability to do that once a month procedure, because it’s, it’s, it feels good to say like our hospital does all of these [00:23:00] different procedures, but if you don’t do enough of them, it’s sub scale.

Marcus: Well, I think that is true. And I think another challenge is that. rural areas tend to have a lot of old people.

Vic: Yeah.

Marcus: Um, and old people cost a lot of money to care for, you know, the end of life is the, the most expensive window of life and, uh, almost, almost too tightly correlated. These populations are likely to be, um, at a minimum on Medicare, um, but potentially also dual eligible.

Marcus: Yeah. Um, and that means that the, you know, Centers that are providing health care to these populations have to be able to provide some of the most expensive care on government programs at the worst margins, um, at a place where it’s acute, chronic and sort of longstanding. So I think all of that together, you know, there’s not enough sort of young people doing knee replacements to offset that.

Marcus: So I [00:24:00] think all of that together, you know, there’s not enough sort of young people doing knee replacements to offset that. Yeah, population payer mix challenge. Right? Um, and so I, I’m not sure what the answer is there, but that’s a, that’s a very, very difficult problem because, because it’s a problem even in urban settings.

Marcus: Right? I mean, we’re not ready as an overall health care system and I’m living it right now. We’re not ready as an overall health care system to care for, um, our, our elders. Yeah, at the scale

Vic: that they’re but they’re aging every day, right? Right. They’re coming, right? I mean like as you get to be 75 78 80 82 85 you by definition you need more health care.

Marcus: You absolutely do Yeah, and and and I guess what I’m saying is That healthcare costs money. And if you are dealing with a population that is likely to have pensions plus their social security, plus, [00:25:00] you know, a good Medicare package, plus some savings, uh, maybe some long term insurance, right. Just the overall profile.

Marcus: The payer, uh, really, I mean, the patient there, but, you know, of the, of the payer, it’s just better in the urban setting, generally speaking, than it is in the, in the rural setting. And so even as we talk about, okay, we need to shift these things thinking about. Doing that where most of your patients are likely to be seniors.

Marcus: That’s tough. Yeah, that’s tough because that’s a group that needs a lot of intense care, you know, and home health, home health is hard. Like home health is not the panacea that people are making it out to be. It’s really not, not when it comes to seniors. Like if you’re talking about acute recovery from something and you’re choosing your home as opposed to recovering in a bed.

Marcus: Home health for

Vic: a three week recovery is different than home health for the rest of your life. Yeah. That’s the point. Two very, very, very different things. And we don’t reimburse it at a level where it is, it’s possible to deliver the care that, that we [00:26:00] all would expect for our, our loved ones.

Marcus: Yeah. I think people are going to be shocked when they get there and it’s time to consider home health versus, you know, sort of a nursing home or whatever.

Marcus: And, and you, you, when you understand what home health is and what home health is versus caregiving, like when you really understand that, you start realizing why people make the hard choice to do assisted living, why people make the hard choice to do a nursing home, because it’s, for most people, it’s not viable.

Vic: Yes. You cannot, home health as it is reimbursed today. And delivered. Does not care for people enough without multiple. Home. Non paid family caregivers also supporting many, many hours. Yes. And that is not possible for many families, and it’s not sustainable. Like, so that whole system is, needs to be. Redone.

Vic: That’s right. [00:27:00] All right.

Marcus: We went down a little bit of a rabbit hole.

Vic: We are looking for innovators to come with a solution for that.

Marcus: That’s right. All right. One more story that we’re going to take a break. Um, our neighbors change health care. I mean, a story, you know, a company you’ve got history with, um, you, you literally funded change health care that MD on purchased and then change the name of the whole company

Vic: in it.

Vic: And they are shut down now. Yeah. They got a cyber attack, I think yesterday, I believe. Yeah. And it’s not functioning. And they, I don’t know the stats, but it’s over half all the payments touch Change Healthcare in some way. Pharmacies. And pharmacies, pharmacies are not able to dispense drugs. They can’t, they can’t check if you are covered or not.

Vic: They don’t know how to bill. They can’t, the systems don’t work. And so it’s, it’s um, it’s pretty scary, honestly.

Marcus: Well, look, um, I [00:28:00] mean, I feel like every once in a while we talk about cyber security, and I can’t remember if you shared it with me or I shared it with you, but the, um, the testimony, uh, of, of the guy from the FBI who was talking to Senate about the budget and was, and remember that?

Marcus: Yeah, yeah,

Vic: you shared it with me. Okay. Really surprised. I hadn’t seen it. Yeah.

Marcus: And he was, he was pleading with them that we are outmanned 50 to one in cyber war today. And we’re talking about coming back on this stuff, right? And it’s like every day you’re hearing about another major. Component of the healthcare system getting hit and it’s escalating to really bad places now I mean it started at health systems and that was that that was bad enough.

Marcus: Yeah health health systems bad enough You know our friends at Arden brutal brutal how long they were down for and what they had to do to continue to deliver care For those communities right [00:29:00] brutal but change health care. That’s We’re, we’re, we’re getting this, we’re getting, this is the underlying

Vic: utility that over half the system runs on the rails that run on it.

Vic: And there, I mean, we know they’re here in Nashville. We know a lot, bunch of people there. They are good people, but they got hacked. And there’s, there’s a lot of attacks. I think it’s in the millions per day. And I, the reason it’s scary to me is like, they’ll, they’ll fix it, but it’s, it’s going to happen again and again and again, and we talked about it earlier, AT& T was down today,

Marcus: like the, yeah, and no one knows why, and no one has said why, but I think that the overall scary trend here is every system has a vulnerability and in America, you know, Our operating [00:30:00] system, despite what people think, they may think it’s democracy, but it’s capitalism.

Marcus: That’s a fundamental operating system here. It’s capitalism. And that means we have preferred for, uh, the private market to provide services And be compensated for those services and for competition to occur between those private market actors, uh, to deliver the best services to the customer, to the market more broadly, and to society.

Marcus: And we’ve now reached sort of a logical conclusion where these companies have gotten so big that. They are, in effect, utilities. They’re not government entities at all. They are private market companies. But the services they provide are so core to our societal operations that they’re fundamentally utilities.

Marcus: And so then the question becomes, in an era where cyber attacks are not just [00:31:00] about holding someone up for ransom, but they could be part of geopolitical tensions, Are companies really equipped to protect themselves against enemies, foreign enemies of the United States of America? I mean,

Vic: that’s an easy question.

Vic: They’re not prepared. That’s why it’s scary that they are, they’re not incented that way. You don’t win a deal because you haven’t 10 years. And so you’re incented to invest. Enough to like, do the bare minimum, but as we talked about a couple of shows ago, it’s defending is much harder than attacking, right?

Vic: So you can be a thinly capitalized bad actor in some other country. First of all, you’re in another country with very little rules, low cost of living. It’s easy to [00:32:00] fund that attack. And then you don’t need that many people to spin up 30 AIs that are going to attack all over the place. And, yeah, Change Healthcare has to fend off those things.

Vic: And, let’s say that they get 20 million attacks a day. If they fend off 19, 999, then one gets through, they’re on the, the, we’re talking about them, and that’s not sustainable. I mean, so it’s going to be, and unfortunately I think it, it pays, they, they end up paying the ransom. Right. So I, I don’t know where this ends, but it’s not good.

Vic: People can’t get their medications today, and this is happening more and more frequently.

Marcus: Yeah. Uh, and more and more of this. Circles that I am in, people are just resigned to say it’s not if it’s when, and it’s more now about [00:33:00] deciding how you’re going to handle it when, right. You know what I mean? Like they’re, they’re not, they’re not saying if it happens to us that we’re arriving at a place where people are just accepting the fact that they almost certainly cannot stop it.

Marcus: They almost certainly cannot stop it from happening. And in a world where you can, where you just have decided, you cannot stop it from happening. That means Regular service interruptions and regular service interruptions starts to destabilize society. I’m sorry We are not as Americans. We’re not used to regular service interruptions.

Marcus: We think that’s the stuff of third world country, right? We’re not used to that, but we might have to start getting used to that. Unfortunately, you know either that or decentralized Either that or decentralize. I mean, you know, security through decentralization. Yeah. I mean, because part of the, part of the issue here is it’s too easy to wipe out too much.

Marcus: [00:34:00] Right. That’s, that’s the problem. If you have

Vic: one, one large entity acting as the trusted partner in the middle of payment networks, which is the definition of change healthcare. It’s a huge honeypot target for bad actors to attack. Versus a decentralized You know, trustless network, which is not as efficient to run day to day, going back to your capital markets thing, it’s, it’s harder to get going, you have to invest more to get it started, but then it’s more resilient at scale, right?

Vic: And I, several years ago, decided My, my data is, is going to be hacked and I, I’m just, I’m going to live with the assumption that I’m on the dark web. People probably have all kinds of stuff. I mean, it’s just, I, I understand that I’ve given that up a long time ago. [00:35:00] That’s different than like, my wife sent me an email this morning saying my phone doesn’t work.

Vic: So if, if you need to call me, you can’t. And so like call a neighbor or something. She sent me that email. I couldn’t call her back. And I don’t know any of our neighbor’s numbers, and I don’t know if they’re on AT& T, so like, I now need to create different systems, yeah, different systems. Yes, redundancies.

Marcus: I’ve got, I mean, I think you know this, I’ve got two phones

Vic: on two different systems. Right, right.

Marcus: And I’ve got two internet service providers in my house. Yeah. And we talked on, before the show, about how we should get Starlink. Yeah, yes. And I, I’m probably going to buy Starlink tonight. I’m sorry, like, I need

Vic: redundancy, like, that’s, yes.

Vic: And the, the cost is, is not, I mean, we are lucky that the [00:36:00] cost is not the thing for us. Right. It just is the, the effort of getting it set up and for another 60 bucks a month, and I’ll have two different cell phones that both can function, um, yes, and two different internet providers, Starlink. Um, but not everyone can do that and most cannot.

Vic: When we go back to the inflation cost of living going up more than wages, people are gonna get scared and mad and that makes me really worried. Gonna get bored maybe? Yeah. Maybe already are. Maybe already Are There are people probably in a pharmacy right now that, that are yelling and mad.

Vic: I don’t think we can put like it back in Pandora’s box. It’s already open. We wanted all this technology. And I mean, personal liberties and freedom is, is core to the American way of [00:37:00] life, but it also opens this up to all this stuff. It’s very, it’s probably hard to attack China because they’ve locked down everything.

Vic: You can’t, you can’t access it. So I don’t know. All right. On that note,

Marcus: we’ll take a break. Yeah. Uh, Doug share a little bit about, uh, Jumpstart Foundry. We’ll be right back.

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.

Doug Edwards: 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 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 health care in our country.

Doug Edwards: Every year, Jumpstart Foundry invests a fund, raises a fund, and [00:38:00] 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.

Doug Edwards: 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 Foundries invested in nearly 200 early stage pre-seed stage companies in the country.

Doug Edwards: Through those most innovative solutions that jumps our 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.

Doug Edwards: We all know that healthcare is broken. Everyone deserves better. Come [00:39:00] 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: Alright, you were talking earlier about NVIDIA. Uh, this company, I mean, this will not last forever.

Marcus: Okay? This will not last forever. But right now. NVIDIA is forecasting sales of 24 billion for the current quarter.

Vic: Yeah. It’s, it’s hard to get your head around. They, they are. I think they hit 2 trillion today. They’re either right at 2 trillion market cap or right over 2 trillion. That’s trillion. And there are not many companies.

Vic: There’s only 2 or 3 companies in the history of companies that have done this. And they are much bigger. Apple or someone like that who has many projects, [00:40:00] many products, and 40 years of track record. I mean, NVIDIA is not even a new company. They’re not a new company. They’ve been around forever. But they have gone like 7x in value because of their AI.

Vic: They opened up their graphics chips that were the best gaming chips to help with AI and, and it was brilliant. It was brilliant. Yeah.

Marcus: Yeah.

Vic: Yeah. So, yeah, they may mean any mean that the. Financial system is challenging in some ways, but one of the things that’s good was when you, when you make this much money, Competitors will try to, try to come and, and grab it.

Vic: Now, they have a big lead, and they have a pretty good stack all integrated together. So, it’s gonna take a while, but there’ll be other people that can,

Marcus: Yeah, anyway, just unbelievable run, uh, for, for NVIDIA, uh, and then [00:41:00] you were telling me about the update, uh, in Grok on, on the AI chip side of things. Right, I was doing it verbally.

Marcus: Yeah. Yeah. So, of course, I, I go, I went to, you know, x. com, went to my account, I, I, I paid to get the access to the Grok. Yeah. So, I had the Grok, and I like.

Vic: Yeah, because X has the AI LLM, named Grok. Right, right, right. It’s got an And I was not paying attention to the spelling. And I think they

Marcus: may have an X AI chip.

Marcus: They do have an X AI chip.

Vic: That is not quite as good. Right, that Elon is building. So, I was like And Tesla has a bunch of Proprietary technology, right?

Marcus: And you were like, no, no, no, no, no. It’s, it, I think it’s different. It’s Rock with a Q, right? GROQ. And then as soon as you said that, I remembered I had seen a tweet, uh, from Chamath.

Marcus: Yeah. Where he was talking about how grok with A-Q-G-R-O-Q. was like beasting on performance against all these other chips that were out there. Um, [00:42:00] and, uh, lo and behold, there is another Grock in the AI space, uh, that right now is apparently the one to watch. And so this is a good one for Chamath. I think he’s the lead investor on the deal.

Marcus: Uh, and,

Vic: you know, look, I think he started it with like, Three engineers and just like started them working on, you know, from ground up chip design credit to him.

Marcus: I mean, I, I do like seeing stories like this where, uh, a guy like him who spends a lot of time talking, um, Delivers something like this, uh, because it, it just sort of backs up, you know, people who get those platforms and get that amount of money.

Marcus: There is something there. Yeah. There’s something there from an execution perspective that, look, if you’re outside of the arena and your, and your everyday thing is just being a critic, it’s fine. You could talk shit. But like, for those of us who are in the arena, it’s really, really hard to get to this level.

Marcus: It’s like really, really hard to get to this level. And to continue to [00:43:00] like put hits out is really, really hard. So I just, you know, look, credit.

Vic: Yeah. And I think that, um, I believe what Jamal saw, but what I certainly see, parodying some of his stuff is that. You have to have the capability to go all the way down to the silicon direct consumer, right?

Vic: So Google has that ability. They have they have their own chips. They have Android phones. I don’t think Microsoft has that. So, like, they don’t have, maybe they have some half assed phone, but they don’t really have a phone anyone uses.

Marcus: No, but they’ve got their own, I mean, they’ve got a pretty big device business.

Marcus: My father in law was in town over the weekend, and, like, he went to the Apple store, bought an iPad, realized it wasn’t what he wanted, and he ordered a Surface Pro. I mean, you know, so, now, granted, he’s, you know, He’s in a certain generation, but [00:44:00] I think Microsoft is still selling devices at a pretty good clip.

Marcus: So, I think they have a straightforward lane. I think Apple’s got a straightforward lane. I think Google’s got a pretty straightforward lane. Um, Facebook has figured out how to refine their lane, right? Their end point is all of their, you know, a billion, you know, more than a billion, two billion people across all their social network platforms.

Marcus: That’s really pretty good. solid. So they haven’t needed the physical endpoint. I mean, they’re working on the whole meta thing, but like, that’s not it.

Vic: Yeah. But when you think about like perplexity or anthropic or something like that, they, they, it’s going to be, even if they are the best, it’s going to be hard.

Vic: Yeah. It’s going to be

Marcus: hard, but it’s going to be hard. And Jamath noted it in a post. It’s going to be hard because a meaningful percentage of their OPEX is going to the hard metal. Right. That’s the problem. Like a meaningful percentage of their OPEX is going to the hard metal. And what that really means is that you, you can’t really, [00:45:00] you can’t really play this game without sufficient capital.

Marcus: Now the only space, and this kind of gets into a conversation that we had, I mean, we skipped last week, so it might’ve been the last episode we had where we’re talking about open source. Um, I actually do think this is where open source. AI offers a real lane for competitors. Like I’m, I’m not that bullish on the closed sourced software only AI companies.

Marcus: I’m like, I don’t know how you compete with Google at the end of the day, but the open source as a movement, as an overall movement, I feel like does have a, a path forward because while it doesn’t have the benefit on the OPEX side Having the metal itself, it has the collective intelligence on the software side.

Marcus: So you, so you’re, you’re kind of offsetting, you’re saving on that, you’re saving on that side. Right? You’re saving on that side. You’re, you’re crowdsourcing and open sourcing. [00:46:00] Yeah. All, you know, you’re bring, you’re bringing all that intelligence there. To leverage, and then you’re competing at the application layer, right?

Marcus: Leveraging all that collected intelligence. So yeah, I think that’s that’s a that’s a real angle that, you know, we collectively as small guys can can play with. Yes,

Vic: yeah. And I think that, uh, I mean, I believe that the open source performance. Over time, not today, not today, things move quickly. Yeah. So like over the next six, 12, 18 months, the open web is a finite set of data.

Vic: So, so it’s eventually even the open source models will get good enough and they’ll catch up and then the, the lead that open AI and Google has will slowly. Not even slowly. It’s already not huge, but it will be, there’ll be parody there.

Marcus: Yeah. And then did you see that, uh, that Google open sourced? Yeah, some models.

Marcus: Yeah, it’s kind of a nerf.

Vic: It’s a [00:47:00] nerfed. It’s not their full model, but they open source like they have a different name. Jim, Jimmy or something. Gemma, Gemma. Yeah,

Marcus: yeah, yeah. I mean, look to me, that’s not that different from like Android and chromium. Right. Versus Chrome. Right. And we were talking earlier about my browser, like I don’t use Chrome, I use Brave.

Marcus: Right. And the Brave browser is built on Chromium, right? So, I, I, I’m okay with it not being the full blown Gemini thing, as long as they’re, they’re contributing back to the open source world, that’s, that’s cool.

Vic: Yeah. And, and, what made me think of that is, like, for us, as small Seed investors in healthcare.

Vic: If you have access to unique data, you can use a general purpose model and an open source model and then add in your proprietary data in this healthcare niche and I think be really competitive. Especially if you have an application or a use case or a way to get distribution. So that, I think that’s going to be a really interesting place for investment [00:48:00] over time.

Marcus: All right. Let’s, uh, let’s go to our space early stage venture. So we’re going to talk a little bit about both. Yeah, both Ycom and, uh, and Techstars. So you brought this Ycom story up about their requests for startups. So, uh, what, what’s going on here?

Vic: Yeah. So every, uh, Well, just for context, the accelerator model, these were the first two, and they still are the best known by far.

Marcus: Well, and Y Com is the first.

Vic: Yeah, Y Com is the first, and the next one we’re going to talk about is the second, really. But Y Com is the first, they have the lion’s share of the huge unicorn wins. And every five to seven years, it’s not an organized thing, I don’t think. They come out with, like, what they want to invest in now.

Vic: And a lot of people, including me, watch that, because then It’s just like this, uh, community thing where if, if every entrepreneur in the world realizes that this is what Y Combinator wants to invest in, they all start building to that [00:49:00] and I want to know what that is. Right. And they came out with this probably last week.

Vic: And I think it’s 21, but there’s several that are in health care, which is pretty interesting that they’re because they didn’t use to really do much in health care.

Marcus: Yeah. There’s, there’s four of them. So, uh, on a list of 21, uh, four of them are clearly healthcare. Uh, so 16 is a way to end cancer, 17 foundational models for biological systems, 18, the managed service organization model for healthcare, 19 eliminating middlemen in healthcare.

Marcus: It’s pretty good.

Vic: Yeah.

Marcus: Yeah,

Vic: and the, uh, the last two, I find really interesting, eliminating the middleman we need to do, and it’s also really hard to do, um, the managed service organization is almost like healthcare as a service, I guess, um, [00:50:00] which I think is interesting.

Marcus: Well, I mean, it’s, I mean, MSOs are, are out there already, right?

Marcus: They’re already out there. But I think that. Making them run efficiently, making them more tech enabled, um, and better aligning them with innovations in the payment models is a real opportunity across a whole bunch of different specialties, for sure. And I think that’s what they’re, they’re focusing on.

Marcus: They, they, they highlight three different companies that they’ve invested in, um, nutrition space, mental health space and the autism care space. Um, you know, and those are, look, those are, The kinds of things that we like to do to, you know, so, uh, welcome to the party.

Vic: Yeah, that’s right.

Marcus: Okay, and then moving to Techstars, this is less of a healthcare thing and just more of, I think, a market correction thing.

Marcus: Um, so, for those who don’t know, Techstars is special, they’re special in the, [00:51:00] in, in the story of, of the innovation of venture capital in America, but they’re also special to us. Because literally, the founders of Techstars, uh, two, two guys, Brad Felt and, um, and David Cohen, when Vic and I got together to start Jumpstart Foundry with 18 other, you know, people here in Nashville, Tennessee, and we wanted to do an accelerator, those guys literally mailed us a binder.

Marcus: Yeah, there were

Vic: only two to really Look at. Yeah. And we thought about it and Y Combinator in San Francisco was just not the model that we thought we could Right. Replicate. Right. And they were very friendly and they literally mailed us. Yeah. Mailed us the binder of like, here’s our playbook. Yeah. Yeah. It was great.

Marcus: It wasn’t like a Google Drive, it was a physical binder with a bunch of paper ago piece of paper. Uh, on it. And so, you know, we, we’ve watched them and known them and been able to leverage, you know, a lot of their, their great thinking. And over the years, Techstars has exploded all over the world. Um, setting up [00:52:00] Techstars in many, many cities all over the world.

Marcus: Uh, as well as, uh, you know, working in partnership with lots of organizations like, uh, you know, UnitedHealthcare and, um, and C Sinai, CS Sinai. Yeah. So in, in the healthcare space. So they, they have a new CEO. We, we’ve talked about in, in a couple of episodes, uh, leading up to now that Foundry Group, which is Brad Feld.

Marcus: Right. And other partners, um, venture firm based in Boulder, Colorado. That I think is sort of like where Techstars was incubated out of. Yeah. Yeah. Um, has finished, they’re, they’re shutting down, right? They’re never gonna raise another fund. They’re, they’re closing shop. And now, uh, Techstars is moving, they’re moving out of Boulder, they’re moving their headquarters to New York City, and they are.

Marcus: consolidating. So they really had a presence in, I mean, just about any city you could think of, there was a tech star there and they’re shutting down a lot of those, those different tech stars. They’re really sort of focusing on the primary, uh, venture capital markets in America. So I [00:53:00] think it’s going to be New York, San Francisco, LA, Boston.

Marcus: Um, and they’re, They’re still going to do a lot of deals, but they are fine tuning their model. They’re not going to have nearly as much, uh, in person classes. Um, it’s, it’s just a total reboot of, of the model and sort of a move into where the, where the future of venture is going. And I think to a degree, it’s, it’s.

Marcus: It’s important because I think tech stars was the beginning of this whole rise of the rest movement. You know what I mean? This whole, you can create entrepreneurial ecosystems anywhere. You can do this anywhere and for them to now move out of Boulder, Colorado and into New York City. Uh, I think it, it brings question to that entire startup community model.

Vic: Yeah, that’s right. It also, they were the, um, The biggest and boldest attempt to scale the venture [00:54:00] capital model, scale the accelerator model, and it’s a hard thing to scale because it requires a lot of teaching and advice and helping one team of three founders figure out something. And sort of letting a community of people that have two hours of training take on that is, is hard to accomplish successfully.

Vic: They’ve had a lot of good success, but I think it is sort of, uh, It’s a correction.

Marcus: So look, uh, two big announcements from the, the, really the, the, the co creators of the accelerator movement, uh, we owe a lot to both of them and, uh, seeing them, you know, in the boulder

Vic: scene, really, they created a lot of the tech venture capital boulder scene.

Marcus: Yeah. So seeing, seeing these types of changes, I think are meaningful. I think we’re kind of going through our own changes here as [00:55:00] well. And they’re, they’re not as well, well formed at the moment, but, uh, it just feels like for us, it’s, it’s important to continue to, to watch Ycom and Techstars, watch the moves that they make, um, all right.

Marcus: Two final stories. So the first, uh, Journal, and it is in the health and wellness section, the, the, the headline of the story is the case against an annual physical. And I just, I just want to say that I’ve had more real life first person and family. Encounters with primary care and meaningful and important, uh, in the last 12 months, then probably in my entire life, like the last 12 months have just been so intense and so much of it has been centered around the primary care physician.

Marcus: Okay, and this, this headline of the case against an annual physical, I [00:56:00] know that there’s a lot to it, but for me, It is. It’s a triggering thing. It’s a triggering headline and a

Vic: neg and a bad negative trigger.

Marcus: Yes, because it’s exactly right. Like it’s not even about the annual physical. It’s about, we really need to rethink primary care.

Marcus: Yes, really. It’s time for a serious full on reboot. Primary care today is the cause of so much suffering in so many. Households in America. And I realized that it’s because they’re not paid correctly. They’re not respected. Uh, they get the short end of the stick versus specialists. Uh, the insurance model incentivizes and drives a lot of maladaptive behavior in terms of the way that they.

Marcus: Guide their patients, their [00:57:00] panel of patients through the healthcare system, what they advise, what they don’t advise, whether or not they’re actually being preventative in nature or not, whether they’re looking them in the eyes or looking at a screen, typing an Epic. But my God, the implications of getting this shit wrong.

Marcus: Are so huge and the annual physical is kind of like it’s the it’s the metaphor for how bad it is. Yes, right. It’s the metaphor for it’s so useless. It’s so useless, especially when it doesn’t even catch half the shit it’s intended to catch. Right?

Vic: That’s that’s

Vic: it’s a it’s a journalism thing to put out a triggering headline because it I was mad this morning. I was mad. But I opened the story and read it, and it’s absolutely right. I, I [00:58:00] don’t want to go wait in the waiting room and then have to strip down to the, to the gown and wait in the, in the office room, the patient room for 20 30 minutes.

Vic: Who knows what is going on? I’ve had to leave the room and like go look for my doctor before. And I have, and I’m, I have a good doctor. And then they come in, and the physical exam aspect is not the important aspect of it. No! What, what I need, and what they could become, but they are not today, is a partner in how do I navigate my particular health situation today and over the next several years?

Vic: How should I think about my diet? What diagnostic things should I get? Like, really be my partner thinking through this. Thanks. And the problem is we don’t reimburse that way. We don’t, [00:59:00] we don’t pay them to, to do that. And It’s the most challenging specialty because of the reimbursement model is just misaligned.

Vic: I think

Marcus: when we were talking to, um, TK from, uh, Virtua, and he was making the very good point that, uh, we’re going to get to the point where we’re going to need AI to replace doctors. No question. I, I gotta tell you, I think there’s a huge percentage of Americans that would be better off with full panel, biannual.

Marcus: Blood tests, and then having those results run through a well vetted peer reviewed LLM and AI to like, assess it. Then, then what we get today? Like, And then, and then make a call on what the, what the right preventative next step of escalation is, you know, which it could be, uh, you know, it could be [01:00:00] some nutrition change.

Marcus: It could be, Hey, I want you to see the specialist. It could be a next level diagnostic depends on what your needs are. Yeah. It depends on what your needs are, right? It depends on what your needs are, but I literally had, I literally had a doctor not take my concern. Seriously. And it forced me to switch doctors.

Marcus: And that’s sad, because this is a lot of

Vic: people won’t do that. They just, like, assume, well, okay, and they’re not right. You know why I did it? Because,

Marcus: I’ll tell you who I credit with this. I credit Scott Hamilton with this. Because When I was getting to know Scott, we went to breakfast, and one of the things that he said that really stuck out to me, um, and for [01:01:00] the listeners, like, if you don’t, I’m talking about Scott Hamilton, the Olympic gold medalist in figure skating.

Marcus: Um, Scott, Scott is a, you know, cancer survivor, warrior, runs a fantastic foundation that I get to be on the board of, and he’s based here in Nashville, Tennessee. So, um, we, we had, we had breakfast one day, and he was telling me, You need a seventh opinion, right? And, and that really makes it an important point, doesn’t it?

Marcus: Right. You can’t even stop at a second opinion. You need a seventh opinion. And what that tells you, first six are all different. Well, what it tells you is you have to be your own advocate. Yes. You cannot cede control of your health to a third party. Like this is the weirdest thing about. Our health care industry, right?

Marcus: We have a fundamental knowledge of the principal agent problem in almost [01:02:00] every other domain. Yeah. We know in almost every other domain, it is your responsibility if you are the principal. And if you have an agent, you have to watch their incentives.

Vic: If I’m buying a house, I want a realtor, but I don’t trust them a hundred percent because we’re not, I understand.

Vic: You have to check your work. We have, yes, right.

Marcus: Only in medicine, where the stakes are the highest, do we cede control to physicians as sovereign. Right. It’s nuts! It’s nuts and literally like there will be people who will hear me say this and and will have a visceral reaction and feel that I am like being immoral and what I’m saying right now, like that’s how baked into the system.

Marcus: This is forget how many people died due to. Improper diagnosis, failure to [01:03:00] diagnose, failure to act fast enough, like, anyway. I

Vic: mean, I mean, just start with what we call the people in the interaction. Patient, I think, means you wait politely and then do what you’re told. That’s right. And that’s not how I behave in, in any other interaction.

Vic: That’s not how I behave in healthcare either. But it is, uh, it’s a cultural thing. Back probably a hundred years

Marcus: and it

Vic: has to has to change.

Marcus: It’s got to change and I’m sorry I’m sorry docs. We got a

Vic: I want a blood test and AI, but I also want it doesn’t even need be an MD But I would like someone who is empathetic and can help me Navigate whatever [01:04:00] the AI says because it can be scary And it can be complicated.

Vic: And so like, it may be that it’s a health coach, it doesn’t have to be necessary, but I think we will need humans. And so, I’m actually pretty excited about the opportunity for our health providers to leverage AI, stop sort of checking the box of did I get this data point, this data point, and instead get all that ahead of time, get the AI to sort of ingest it all, and then help me navigate it, help me understand it, help me process it.

Marcus: Let me, let me, let me clarify, because you could very easily take that one sound bite, I said it, and I’m sure somebody will, and sort of run with it, okay? Um, I don’t want to navigate my health care by myself. Of course I want a trained, vetted, board certified clinician to be my partner. Yeah. To be my trusted partner.

Marcus: That’s what I want, to be my trusted partner. What I’m saying is, [01:05:00] I have found that I have to pay A ridiculous amount of money to get that it exists. It does exist, and there happen to be doctors who agree with what I’m saying here. Yeah, and it’s just a better way to practice. It’s just that they can’t do it inside of the current insurance PCP model.

Vic: Yes. They can’t do it in that model. They don’t get paid that way and there’s not enough time and they wouldn’t, they wouldn’t be able to pay their bills. Right. And that is sad because we are taking generations of people that really want to go into medicine to care for patients and we’re systematically teaching them you can’t go into primary care unless you don’t want to make much money.

Vic: That’s wrong, and not, not good. Alright.

Vic: I [01:06:00] will, we’ll post this, there’s a, there’s a JAMA study. So like, once you get beyond the headline, there’s a JAMA study that looked at the actual data, and the facts are that the annual physical does not improve health outcomes, unless, the physician takes time to review all of your social determinants of health, all of all the things that you are interacting with in order to try to prevent future chronic disease, which they almost never do that.

Vic: So the role of coming in and interacting with a healthcare professional is valuable only if they teach the patient, which I shouldn’t start, teach their person about how to navigate their health, how to be more healthy. It doesn’t matter My heart sounded like, or my lung sounded like, because it’s a one time data point and it’s not, it’s not statistically relevant.

Vic: Anyway, so there’s a JAMA study about it.

Marcus: Yeah, [01:07:00] and just one other thing, I mean, uh, I, I, I do think that the other side of the coin Of this argument that I’m making of the point that Scott made when he said you need a seventh opinion is it’s your responsibility to get the seventh opinion like stop ceding sovereignty and be sovereign actually be responsible because because here’s the deal the thing about the principal agent problem at the end of the day.

Marcus: If the principal allows the agent to screw the principal, it’s the principal’s fault. It’s your fault. Like, you know, we, that’s, I think that’s the other narrative we’ve got to get over. We gotta get over letting ourselves off the hook on this shit. Like, what is a doctor supposed to do for you in the four, two or four times a year they see you for 15 minutes?

Marcus: What can they possibly do for you? You are with you the rest of the time. Like, even if they told you every right thing to do.

Vic: Yeah, you have to [01:08:00] take initiative yourself. You don’t have to

Marcus: walk out the door and go do it or not do it, right? So,

Vic: bleh. It is an important topic, obviously. And so, well, I don’t like the headline, it caused me to read it enough to talk about it.

Marcus: Final story, and I will be far less, uh, emotional about this one. Well, I mean, the reason I’m going to be is because we talked about this. It’s, it’s got religious, ideological, Implications to it, which I don’t think the previous story did.

Marcus: Yeah. Um, and it’s very, very fresh. And I think it is, and I’m not a woman. And so therefore I’m going to remove the emotion from this piece. Uh, but the state of Alabama, their Supreme court, um, ruled in an eight to one verdict that embryos are entitled to the [01:09:00] same rights as, uh, all humans. And so, therefore, IVF as a process, which necessitates certain embryos, I mean, in that parlance, being killed, is, uh, is too risky of a process for clinics to deliver in the state of Alabama now.

Marcus: And so at the last time I looked today, and I’m sure the number has increased, but the last time I, I saw on the news, three prominent IVF clinics in the state of Alabama have ceased delivering that service. Um, and, uh, look, we, we, we’ve had a conversation around the, the fissure in the United States and certainly states rights are a thing, but we are, we’re pushing things to the states that, um, [01:10:00] Are simply de unifying.

Marcus: Uh, the country and and making it to where people are feeling like they have to flee certain states to go to other states, uh, to do things that they never thought they would have to flee the state for, you know, I’m sure that the women, uh, that that that the many women in the state of Alabama who, uh, Have been working with their partners, uh, on the IVF process, whether they be deeply religious or secular.

Vic: Yeah. They want to have a child.

Marcus: Did not imagine a year ago that they would wake up and need to buy a plane ticket to take their embryos to another state to have them preserved.

Vic: So I blame our two dysfunctional political parties, both sides. I blame. [01:11:00] And the reason I blame them is I think that. There is a lot of common ground that the society has.

Vic: Certain things should not, certain, you shouldn’t abort a child after it’s born. Or like there’s certain times when it’s, it is not appropriate. You can’t kill a one year old for instance. Obviously. And, and there are times when it’s not, it’s not a human, an embryo could not survive on its own. And there’s a lot of common ground.

Vic: And I believe that both sides are choosing to not find middle ground and create a federal policy because they both like to raise money and drive their base. Like throw red meat to their base around aspects of the issue. And it’s not, it’s not what our politicians should be [01:12:00] doing. They ought to be trying to help us find common ground.

Vic: And I think it’s sad. There are people in Alabama that want to have Child and not everyone can buy a plane ticket and fly to another state. Of course not.

Marcus: Yeah, but also there is a little bit of money anyway. Yeah, there’s a little bit of correlation here, but but look, I mean, at the at the highest level, I certainly agree with you.

Marcus: We have devolved, uh, objectively this issue aside, we’ve devolved to a place where our political parties seem to exist to fight each other.

Vic: Yeah, they’re not trying to solve anything, because that makes it.

Marcus: Yeah, um, they, they, they seem to resist to fight each other. They seem to only be able to, fix their lips to talk about each other.

Marcus: Um, except for when they’re talking about themselves and they’re fighting, they’re fighting within themselves. And we have that on both parties. We have that in both parties. Uh, on this particular issue, this is clearly Alabama breaking [01:13:00] from what was the norm. And I think we have to identify that, um, that this is Alabama breaking from what was the, the norm across the other 50 states.

Marcus: Um, IVF was a procedure that. Prior to today, you were able to deliver in any of the states in the United States of America.

Vic: I have never heard anyone claim in any way that, that it was not appropriate.

Marcus: And I, I know, I know people who are deeply Christian, deeply patriotic, and certainly Republicans who have conceived via IVF

Marcus: and this outcome, uh, this is, this is an outcome of the Republican party. Alabama is a deeply red state. This would not have been [01:14:00] able to get through if it was not an agenda of If it was not part of the agenda of the republican party of the state of alabama. It’s important to say that Um, governor kemp of georgia has already come out and said he wants to protect the right for ibf in his state So, you know, we’re not going to make this a national republican issue But in the state of alabama the republican party in the state of alabama.

Marcus: This is what they Did This was part of their agenda and that’s why it’s it’s arrived. Um, and in Tennessee is

Vic: not that much different. Come on, of course not. So Alabama is maybe the most conservative, most deep red state, but Tennessee is right. Behind it. My mother called me last weekend because she saw something on tv about nashville.

Vic: Oh the nazis the nazi thing Marching

Marcus: through through downtown. Yeah,

Vic: and yes, I believe in free speech, but I also am embarrassed that that’s going on in nashville

Marcus: so, [01:15:00] uh god, I hate when we end on a on a Somber note. I hate when we do it, but um What what to say what to say? Uh, I I I certainly am very sorry You To the citizens of, uh, of the state of Alabama for whom this is, uh, this is life altering, right?

Marcus: I mean, you know, for some, for some families, they’re going to have to move. They’re gonna have to move, you know? Yeah. Um, and that’s, that’s sad. And, and it just seems so wholly unnecessary. So I don’t know, I don’t know what to say. I mean, I, I, I do understand that this kind of law is coming from, I mean, look, Nikki Haley agreed with it.

Marcus: So, you know, I mean, I do understand that this law is coming from an ethical and a moral foundation based in religion, based in deep belief that, and those beliefs [01:16:00] from the people that hold them deeply and would fight for something like this, believe that they are doing the right and the good thing. You know, I, I, I, I objectively understand that.

Vic: I don’t believe that’s,

Marcus: that’s that common. Oh, oh, oh. I do, I do. I, I, look, I, I, I believe many of the people who have done many really bad things in the past have thought they were the good people. That’s definitely

Vic: true.

Marcus: That, that, that’s what I’m saying. Definitely. That’s, that’s, that’s, that’s what I’m saying.

Marcus: That’s what I’m saying. Um, but there’s

Vic: political and career benefit to making a big new case precedent. And the thing that I’m worried about is it’s an escalating thing, like there’s going to be more and more blue and red states that do crazy stuff that they shouldn’t,

Marcus: that aren’t the best thing for their citizens.

Marcus: There’s not a question about it. There’s not a question about it. And also, listen, there will be ramifications to the Republican Party for this as well. Like, [01:17:00] somewhere an election will be lost for this. There’s no question about that. No question about that. All right. Um. I missed last week. I’m glad we’re back.

Marcus: Yeah. Um, and uh, we will do our best to not miss again. Vibes.

Vic: I’m, I’m headed to California for Vibes next week. Oh, yeah. We’re going to have a slew of shows. It’s going to be a lot of stuff. That’s good. I’m doing a couple guest shows there. Excited about that. It’s going to be good.

Marcus: Yeah. It’s going to be good.

Marcus: Alright, well, look, we’re back, um, as always. California will be different

Vic: than

Marcus: Alabama. So yes, yes, it will. Yes, it will. As always. And listen, I think we’re going to get better at making this point. We don’t buy ads on Facebook. The only way that our show will grow is if you tell somebody about it. And I know you’re listening because like you tell me that you’re listening to the shows and you bring up specific things in the shows.

Marcus: But listen, do me a favor. Like literally. for your boy. Do me a [01:18:00] favor. Tell one person this week. That’s how you say

Vic: one person is all we need. Yes.

Marcus: One person who you think would actually benefit from listening to the show. Just tell one person. Just do it for me.

Vic: Yeah. And find me at Vive. I’ll be there.

Marcus: All right.

Marcus: Till next time.