48 – State of Union, GLP-1 Rundown, HIMSS is Fading, AI Software Engineer: Devin

Vic: [00:00:00] I just, uh, just came in hot from California like an hour ago. Yeah. You were doing college tours. Yeah. Yeah. I have two sons. The second one, um, we were all around LA and Southern California looking at schools. And I have to tell you the California university system is incredible. I mean, it’s real, I don’t know if, if, you know, an out of state.

Vic: White kid from Nashville can, can get in, but, but it’s really impressive. Like all the community colleges, junior colleges, the state schools, all the way up to UCLA, Caltech, Berkeley, it’s pretty impressive set up there.

Marcus: We, we, we did that tour. We started in the, in, in NorCal, we did Berkeley and UC Davis, and then we went down to SoCal and we did UCLA and Caltech and he ended up in Knoxville.

Vic: Yeah. Yeah. I, I, uh, I mean, he went to maybe six schools in like five days. Every school, I want to go to be a freshman. Mm

Marcus: hmm.

Vic: Like, it’s, I did not appreciate it [00:01:00] when I was that age. And California’s beautiful. And California’s beautiful. In March, it’s, you know, really nice. Yep. Yeah, so there’s a lot of, a lot of good places to learn and a lot going on.

Marcus: And then, uh, before we start talking about the stories of the week, you, uh, we, we, we published a couple of guest episodes. Uh, so Dr. Jay bought that. We were both on that one. Great, great, uh, conversation with him. Uh, but then you, you, uh, had a conversation while you were out at vibe.

Vic: Yeah. Wait, Dr. Medell from UCLA.

Vic: Sort of a different perspective on health equity, because she’s a practitioner, a physician. Um, much more about, um, delivering care and hands on and also some policies. So a lot of overlap, but, but I think it was a good bookend, uh, to JBOD as well. Um, and I learned a ton. I mean, really, um. It was really fun to do, and we were both at Vive, so we did kind of a field recording, and great.

Marcus: Awesome. And then, uh, you [00:02:00] also recorded a show that’ll be live next week, right? Yeah,

Vic: yeah, on nutrition and food as medicine with a woman named Lauren Driscoll, who’s the CEO of Nourished, which is a sort of food as medicine, nutrition, and I think she’s delivering nutrition services in 46 states. Oh, wow.

Vic: Really fast growth. Wow. She’s great. And, uh, she, again, I learned a lot from her about not only, of course, food is our fuel. I mean, it’s, I think, I think most of our audience, including me, has known for a long time that food is medicine, of course. But getting the right food, getting healthy food, To duly eligibles, which is where nourish really starts or people that are in food deserts or have difficult situations.

Vic: There’s a lot of logistic Challenges in that that is much more nuanced than just saying like hey go eat healthy food, right? So, um, we’ll drop that in the next [00:03:00] week or so, but that was good to

Marcus: look forward to it All right, but with that we will dig in

Marcus: Quickly because I don’t think there’s much Much of value here to discuss, uh, inflation picks up to 3. 2%, um, slightly hotter than expected. All this really means I think is that the Fed is not going to do any rate cuts anytime soon.

Vic: Yeah, I think that’s right. The, uh, we, we watch the macro. Economy because it’s so intertwined with the reimbursement rates and the price of both public and private assets that I care about, but I think you’re right that the Fed is doing a pretty good job at navigating this, like thread the needle, pull inflation down from seven, eight, nine, where it was a year and a half ago to not to their target, but approaching it.

Vic: And we really haven’t [00:04:00] seen. A lot of economic damage. And so inflation is a little bit harder than expected.

Marcus: Yeah,

Vic: I think that’s right. It’s just sort of steady as she goes. No real change.

Marcus: Anecdotally. We’re not going to go into big detail on it, but, um, big Bitcoin officially officially hit all time highs.

Marcus: It broke 70 K, uh, this week. So it’s just kind of into the next stratosphere. ETH, uh, Ethereum for those who don’t really know what the hell I’m talking about, uh, Ethereum went over 4, 000. Um, Solana over one 60. So all of crypto is full on bull market. Yeah. Um, so the avenue is coming up. And I mean, the reason why I’m bringing that up is because you, you, you overlay all time highs in the stock market with all time highs in the crypto market.

Marcus: And that basically just says the risk on markets are totally fine with. Kind of steady as she goes right now. Like we don’t really need a rate cut. Yeah Kind of pouring money into until we haven’t seen

Vic: Significant job loss. I [00:05:00] mean there there are layoffs and various, uh, one off things, but overall I don’t know the the economic, uh, unemployment rate’s not it hasn’t really jumped up So I think it’s the fed’s likely to stay where it is now Um and just continue to monitor.

Vic: I don’t see a cut coming

Marcus: All right. So I think big story of the week other than Oppenheimer winning the Oscars is the State of the Union. Joe Biden delivered. I think it’s universally been seen as a big win for him. Um, I think he came across much stronger than people expected him to, uh, his critics basically have moved on or said nothing because it’s hard to really critique his performance.

Marcus: Um, was that, was that your take from, from watching it?

Vic: I watched it, um, with a lot more interest than I usually watch it just to see, like, you know, who was going to show up and President Biden [00:06:00] really showed up and delivered a great, great speech. I mean, whether he had a thousand policy policy details, no one’s going to agree with all the policy details, but but he was well prepared, energetic.

Vic: He knew he knew some Republican hecklers were going to, of course. Yell at him with things and he was ready for it mg every time. Yeah, of course. Um, but he, he was, he was really strong. That mean, the question will be can he keep it up over the marathon of the campaign? But, but listen, he, if he, if he couldn’t do the state of union, it was gonna be really bad.

Vic: So he absolutely, we know, we know he can step it up and deliver when the stakes are high. Yeah. And that’s, that’s, I think that’s great for everything. Whether you, no matter what side you like, I think we will all benefit from an actual campaign with both sides strong.

Marcus: And he’s the standing

Vic: president of the United States of America.

Vic: Yeah, it’s great that he’s, that he can, [00:07:00] he can give a good speech.

Marcus: I don’t love all the memes and the, and the quick videos of him like, you know, stumbling. Not, not, not his speech impediment. The actual, like, where his words are totally, you know, incomprehensible. So like, I was happy that he delivered strong.

Marcus: That was great.

Vic: Yeah. And I mean, I would challenge any of the people on Twitter complaining about one flub to stand up in front of. Whatever it is, 150 million people and give an hour and a half speech. It’s not that easy to do.

Marcus: Now you’re talking about keyboard warriors, right? I don’t care about them, I just care about the general comfort level that the overall electorate has with the fact that our two candidates going into the next four years of governing the country are questionable.

Marcus: Questionable. So any, any positive, uh, signs? He did a great job. Any positive. Okay. So modern healthcare did a nice little rundown of his healthcare policy points. And, [00:08:00] you know, sometimes I can’t tell if, if it’s just because we are focused on it. We live in it and we work in it, or they’re really making a big deal about it.

Marcus: Just how, how much they’re basing their campaign around healthcare. Um, but it certainly feels like a pretty significant platform. And some of it just feels like, especially as it pertains to, you know, women’s autonomy Yeah. Over their body, like that has become a much like it’s a healthcare issue. But it’s a much bigger political issue, right?

Marcus: Yeah, that’s right. And so leading with reproductive health, uh, it’s like the Alabama Supreme Court gave Biden a gift , you know, for Yeah, that’s right. For, for any woman who was on the fence or might have been sort of starting to settle into the Dobbs, uh, reality. You know, this, I, I don’t know what, what do you even say about this?

Marcus: Um, it, it’s just, it’s just an easy political win for them.

Vic: Yeah. It’s, it’s gonna. I [00:09:00] mean, I think it’s gonna get out the vote for Democratic. Like hardcore democrats to vote because they’ve seen the repercussions when they don’t vote. Yeah So that that’s the value of the issue not that um in a really like deep blue state There’s really any significant change that’s going to happen.

Vic: No, no, no, but it will it it Galvanizes energizes the base turnout is important, especially in swing

Marcus: states Right, especially for the incumbent

Vic: incumbent

Marcus: typically has trouble getting and look, these are swing state issues like that’s the thing. Like these are issues that were not sort of the typical Republican Democrat.

Marcus: Issues they’ve become that as you know, we’ve had the religious fundamentalists take over You know the republican party and um, it’s just it’s just not clear that those are winning issues, right? But you know what’s really funny is that the republicans knew this was going to be an issue You can tell by who they selected to handle the response, right?

Marcus: Um, yes. Katie Brit Center, Katie, Brit [00:10:00] from Alabama. I thought she did a good job. I mean, she did a good job because she told her own personal story. Yeah. Right. Um, so it, it, it’s, you can’t really refute someone telling their personal story. Yeah.

Vic: That’s a hard

Marcus: position to speak.

Vic: Yeah. And I think she did the best job that someone could do in that.

Marcus: Yeah. But the political strategist knew Yes. That this was something they needed to offset. Yeah. They

Vic: get a young woman from Alabama who has kids and can talk directly to it. Right. That’s right. The thing that I think is interesting is for decades. A Republican strategy to get out their own base. Has been overturning Roe v.

Vic: Wade. Yeah, now it’s done. And now they’ve caught the boss, like, Oh, crap, now, now, uh, we need to find something else. Right, right. And that, that’s, um, it just kind of swings around.

Marcus: Yeah, or we gotta try to explain to people somehow that this is okay. Right, right. That everything’s gonna be fine, which, you know, no one who is concerned about this is.

Marcus: prescription drugs. Nothing new here. They’ve been pushing this for well over a year and a half. So, um, this, this is a big one. [00:11:00] I think it’s going to be a popular one. You know, no, for better for worse. I don’t think there’s a lot of popular sentiment around, uh, around pharmaceutical companies. Generally speaking, uh, they They get a very bad rap, um, in terms of being, you know, bad actors, the whole issue with opioids, the general profit margins that are made there.

Marcus: So it’s just a, it’s a, it’s an easy political win. It’s an

Vic: easy win. It’s there’s easy math to say and Biden did where like the manufacturer is still making money. Of course, you don’t see all of the R and D that goes to waste. That’s not where it worked, but, but no one feels bad for the pharmaceutical companies.

Vic: And that’s, this is going to continue.

Marcus: Yep. So that, that one is a, is a pretty straightforward one. Um, health insurance exchanges. I mean, this is just continuing on with Obamacare. Um, and that’s Joe Biden’s going to do that. Right. I mean, just, just, I’m going to protect the, the open exchange. It’s, it’s good for coverage.

Marcus: It’s good for access. It’s good for competition, right. You know, it, it [00:12:00] gives you the competition, you know, through the line. So,

Vic: yeah, I don’t know. more of a, you know, red state, blue state political point.

Marcus: And then the women’s health initiative and, and quick shout out to my, my good friend, Maria toler, um, she and I both raised our funds at the same time together.

Marcus: And so we, we kinda came up together and, uh, I’m, I’m so proud of her. She, she. She positioned around women’s health, you know, and she did it when everyone basically talked about how it’s not a real, it’s not a fundable market opportunity. It’s small, it’s niche. She was always like, it’s half the population.

Marcus: Like, this is ridiculous, right? I mean, just kind of shows you the, uh, the misogyny that, that happens in the capital allocation space. But now, I mean, it has become a huge deal. And I think she’s had, you Two or three different appearances in the last six months with, um, the first lady. Uh, she was just on the today show, uh, with Maria Shriver.

Marcus: So like Maria, like, you know, she, she fought [00:13:00] through all the guys who were telling her that women’s health is like, not a thing. And now she is on the platform, right. As women’s health has been elevated to be a huge thing. And she’s got the largest funding. I guess what the largest fund in women’s health is like less than a hundred million dollars right now.

Marcus: It’s crazy,

Vic: but it’ll be good for

Marcus: her. Yeah, no, no, it’s awesome. So, and, and, and she’s a friend. We co invested in May together. She did the pre seed, we did the seed. So, anyway, just, you know, shout out to her. And, and, uh, I’m really happy that she’s getting, uh, a lot of the credit as she deserves for innovating in women’s health before it was cool to do so.

Marcus: Um, so that’s basically everything in modern health care. No, no surprises for us. It was nothing really new. Nope.

Vic: He didn’t unveil anything new in health care.

Marcus: Yep. Okay. I hate that we have to do this because we were kind of early on this whole story, but we have to, we have to, the world

Vic: has caught up to the change stuff.

Marcus: Right. So we have to continue on with a little bit of a, an update on the change healthcare thing. I think the big news coming out of this week is that the white house actually got involved [00:14:00] publicly. Uh, apparently summoned the CEO of United health group to the white house. Um, and I don’t know if Biden actually met with Andrew Whitty, you know, it seems to me it was more like HHS and related agencies, probably CMS was there, um, meeting with them, but, you know, just the, the, the political positioning is escalating.

Marcus: As the days and the weeks continue where where the system is still not 100 percent back up, you know, I know that there are portions that are up at the I don’t have like a, you know, there’s no dashboard that kind of tells you these systems are up. These systems are down. I know that the pharmacy has

Vic: a site, but they haven’t updated it.

Vic: Yeah, long

Marcus: time. I know the pharmacy stuff is mostly back. Um, and I think there are other aspects, other Aspects of the system that are back, but it’s still not 100 percent back. So, um, look, it’s just becoming more and more of a mainstream story. Uh, I do think it’s incredible that it has been almost a month and it’s still not like a full on mainstream story.

Marcus: I think if you were to ask 10 people on the street, [00:15:00] I think nine out of 10 would not. Yeah. I think nine out of 10 would. Yeah. Yeah. Um, so I think it’s still incredible that healthcare is such an important part of our economy is such an important part of, you know, sort of our national infrastructure. And it’s still so Byzantine that most people don’t understand what’s going on.

Marcus: Um, but yeah, look, I mean, it’s, it’s, uh, it’s just rough. It’s just rough. What else is there to say? Yeah. I mean,

Vic: I, I hope I never get called to the White House. I think that’s right. I’m not going to win a Super Bowl. And when you get called to the White House, it’s typically to get reprimanded for something.

Vic: But I don’t know what. The White House can say to UnitedHealth Group that they aren’t, haven’t already thought of and tried. Yeah, man. I mean. It’s just like a, it’s just a thing that they do to show it’s important.

Marcus: Yeah, yeah. We’re on it. We hear you. We’re working on it. I mean, you know, this is, it’s political calculus.

Marcus: They have to do it. Um, I, the [00:16:00] longer this goes on, the more I am, I am so glad that UHG bought Change Healthcare because as, as we’ve said in previous episodes, you and I know this company, this is a Nashville company. Like if this company did not have the resources and the backing of UHG, if UHG can’t get this thing up and running inside of three weeks, do you know how long this thing would have been down as an independent?

Marcus: I mean, dude, like, like, that’s, that’s what everyone needs to kind of wrap their head around. I mean,

Vic: I think it’s five times longer. Like, brutal. We don’t know how long it’s going to be that you, your nature. Whatever it is. But it’s going to be five times more. It’s like Channing

Marcus: Sharpe said, talking about the money he made from the Cat Williams episode.

Marcus: Whatever you think, three exit. Whatever you think it was going to take for UHG, three exit. Because, man. Dude, USG is the, this is the, we’re talking about literally the most capable healthcare company in America.

Vic: Yes.

Marcus: The biggest balance sheet. They [00:17:00] have the most tech. The most tech. The most cash. Right.

Marcus: Everything, right? Like, if anyone can shoulder this challenge, it’s them, and they’re still down. Yes. So, everyone, You know, I, I, I hate weird rewriting of narratives, right? You know, I hated when people did it during COVID or after COVID. Everyone was like, Oh, you know, the vaccines, it’s like, shut up. You were in line.

Marcus: Like, you know what I mean? Like, I hated that. And I hate this too, because look, they have not owned this company a year. They haven’t owned them a year. Like they are cleaning up a mess that Oh, yeah, they didn’t, they didn’t clean this. It’s, it’s their mess because they bought it. Okay. Yes. And so, yes. That’s, that’s the responsibility of m and a.

Marcus: Right. You know, you buy it, you, you buy it, you own it. Right. But yeah, they did not, the technical

Vic: debt that they acquired technic to change. I mean, it’s. There’s a lot of systems in like COBOL and old [00:18:00] stuff in the nineties. Yes. Our listeners don’t even know what it is, you know, it’s hard to work on and outdated and hard to keep up with.

Vic: And the, the cyber criminals, I think that’s the ideal place because there’s all kinds of. Things I don’t understand about ways to get in.

Marcus: So this whole thing has created an opportunity for other individuals and organizations to come off looking like heroes, obviously, right? Because cash is not flowing.

Marcus: And so people do have to come in and backstop, you know, when SVB went down, the fed was the hero, right? They came in, they bailed everybody out, you know, with the treasury and the FDIC and they created the bank thing and everyone loved it.

Marcus: Yeah.

Marcus: Yeah. And in this case, you know, it’s not, it’s not quite as centralized, but I just noticed this story came across my feet in LinkedIn.

Marcus: Um, Christine, uh, Meyer, I think it’s probably how you pronounce her last name. Um, she’s a doctor and she tells this personal story with this picture of her home. Right. [00:19:00] So she starts the, the post saying, This is our home. We moved in the same year we started our practice. It is not a mansion, but it is an absolute Haven.

Marcus: And it is a very nice house, by the way. Um, my kids took their first steps here, learned to ride bikes here. So you’re like, where’s she going with this? Right. And then, you know, she goes, we were so proud the day we paid off the mortgage and it officially became ours free and clear. And then she tags UHG as the United health group cyber attack fallout continues into its third week.

Marcus: We are still not getting paid. It basically goes on to say she thought she was going to have to take out a HELOC.

Vic: Right. In order to, to, in order to

Marcus: keep operating her business. And then Allidade came in, which is the ACO that she’s a part of. Um, and basically forwarded the money.

Vic: Yeah.

Marcus: Right. And, and so she, she gives, uh, uh, Farzad Mostashari.

Marcus: Uh, a big shout out on LinkedIn and, you know, the post was, was very popular. And so it’s got over a thousand, I mean, you don’t see a lot of healthcare posts get over a thousand, uh, [00:20:00] responses over a thousand responses. And, uh, Farzad is actually, you know, one of the top commenters, uh, on, you know, he chimes in and says, you know, so glad we could, we could be helpful.

Marcus: You’re an amazing leader. We’re learning from you every day. So it’s, it’s just, you know, it’s interesting to kind of see how You know, chaos creates opportunities for other organizations and individuals to step up and build goodwill, right? Um, yeah, I mean, I think in

Vic: health care broadly, I mean, there’s 14 million people that work in health care, I think, or something, but, but broadly people get into health care because they actually want to help other, other people and take care of them.

Vic: And so, in general, I think the community of health care workers are well intentioned and, It’s great that, that Prasad and Alidaid stepped up and, and it’s not surprising, like they, they should, it’s great for them [00:21:00] and we should take care of our doctors that didn’t do anything wrong and the money is there somewhere in the system, it just isn’t flowing to her and I think at the same time, it’s, it’s the American way, like the United is going to suffer and there’s opportunities for ACOs and other payers and other people to come in and that’s probably healthy.

Vic: To have a little more justification in, in how all of the payments get processed.

Marcus: One thing I was reflecting on was the fact that the industry has still kind of chugged along. Clearly, you know, Christine’s story is a real story. Okay. And, and, and if she’s one story, there are thousands of stories like it out there.

Marcus: Okay. There’s no question. However, generally speaking, the industry has found a way to continue on to carry on. Right. And I think what is really. Interesting about that is the fact that an [00:22:00] Allidade can step in and do that. I think one thing we need to remember is that this industry was pretty compromised just two years ago, coming out of COVID, you know, our, our health systems were all really struggling.

Marcus: Um, you know, we, we weren’t a healthy industry to be able to withstand the shock of something like this. Like had this happened two years earlier. This could have been far worse, right? Because there may not have been the ability to, um, fill in the gaps where, you know, United is trying to bring the network back up, but now, you know, generally speaking, our health systems are doing much better.

Marcus: They’re performing much better. Um, everyone’s just better off financially than they were. So we have this, this kind of goes back to the fed, right? Um, the economy really has kind of recovered and, and there is a little bit less fragility. Industry wide such that even though this one issue is [00:23:00] stopping day to day payment flow, um, people can chip in and there is a little bit of balance sheet available to, to help out those who were dependent on the network.

Vic: Yeah, I think that’s right. What I’d like to see the White House do that I haven’t seen them do, maybe they have, is we need to figure out how to combat the, the cybercrime and AI, and all the attacks, and I don’t know if it’s a new kind of way to pull in young people to get involved, like a Peace Corps thing, we don’t have any answer right now, I’m not sure that’s the best answer, but This is going to keep happening.

Marcus: Enable more competition. Uh, don’t stifle M and a don’t stifle the, the, the private markets when it comes to capital allocation, uh, don’t create unnecessary regulatory issues and stop, uh, choking off blockchain. Yeah, seriously. Like the idea that you’re going to fix this with regulation and not have [00:24:00] unintended consequences.

Vic: Yeah, that’s not gonna work. That’s

Marcus: not gonna work. Yeah. Um, we have technology to address these issues now. We totally do.

Vic: Yeah. I mean, blockchain and Web3 technology would take some building, but it’s available now. It’s available now. It’s not built out.

Marcus: Well, it’s not that it’s not built out. It’s that the reason why I’m saying it’s not that it’s not built out.

Marcus: We, we have the Bitcoin network. Yeah. The Bitcoin network has not gone down

Vic: ever. And I don’t, it’s hard for me to imagine it going down.

Marcus: Hasn’t gone down. Yeah. Right. It’s a shared ledger. It’s running transactions. What, what, what more do you need?

Vic: Yeah, it’s moving money. I mean, that’s the biggest honeypot you could attack that exists.

Vic: It’s a

Marcus: trillion plus dollar honeypot. Right.

Vic: I think it’s not.

Marcus: With no nation state backing it. So like there, if you, if you manage to bring down the Bitcoin network, there’s no military that’s [00:25:00] like immediately going to jump in the United States military. It’s not for sure. Not.

Vic: Yeah. So that demonstrates to me that it is.

Vic: Robust and resilient, resilient. It’s hard to attack.

Marcus: It’s at least worth exploring. It’s at least worth running some pilots. It’s at least worth creating some initiatives. We’re not doing any of that, right?

Vic: Well, I’ve wanted to dig into that a little bit more in the show. So in future weeks, we should, we should have a guest or look into that more.

Vic: Cause that is, I mean, it’s clear with the change healthcare issue. We have, we have found a National security, like, vulnerable area. Totally. And we need to figure out a solution for our industry.

Marcus: Totally, totally. All right. Um, moving on, but staying with the payvider world, uh, Cigna Evernorth, they have expanded their GLP one program and probably more importantly, uh, they have rolled out a behavioral healthcare group.

Marcus: [00:26:00] So they’ve employed a thousand, uh, providers directly, uh, Cigna continuing to, you know, copy, quite frankly, the USG playbook and, and build out the acquisition of, uh, providers.

Vic: I was really interested to see the behavioral healthcare group. Get created, because I think we need more behavioral health providers.

Vic: We need them more in network, and that doesn’t necessarily guarantee they’ll be in the Cigna networks, but it certainly makes it likely that they’ll have some network coverage there.

Marcus: Yeah, and also, I mean, the fact that they are, uh, Enhancing their support for GLP one. I think it’s it’s demonstrating that this this solution.

Marcus: It’s kind of getting on both ends, right? It’s growing in indications in terms of what is being approved for by the FDA. And then that is necessarily expanding the waiting list of people who want it on the patient side. And so, um, it’s it’s hard to think about a single Drug category that has come on this [00:27:00] quick and and forced the kind of, uh, hard questions to be answered by payers by employers.

Marcus: How are they going to navigate this? Because it’s the beginning of a total paradigm shift. You know, it’s almost like the kind of thing we kept expecting to come from cell therapies.

Vic: Yeah,

Marcus: right. It just ended up coming through the weight loss channel.

Vic: Yeah, that’s right. I think the cell therapies, which we might have a story on later.

Vic: It is, um. It’s hard, it’s hard to scale it, right? You have to customize it to the particular disease state. It has a lot of, uh, back and forth with the patient. Manufacturing is totally different. You just produce it and you can mass produce it and it’s still really effective.

Marcus: Yep, yep. But it has that same, uh The broad, the

Vic: broad, um, application.

Vic: Yes, yes. Yeah, because, and that’s why I was so excited to talk about, um With more driscoll and [00:28:00] nourished food and, and weight is, is comorbid with almost all the chronic diseases.

Marcus: Yep. Staying with the GLP one stuff. Medicare now has a pathway to support GLP ones because it was recently, uh, approved for heart issues.

Marcus: I mean, so now this thing, weight loss, kidneys, kidney was the fast follower. Kidney was

Vic: the first, was the first one that wasn’t weight loss.

Marcus: That’s right. That was, that was the fast follower and now heart.

Vic: Yeah.

Marcus: I

Vic: mean, we’re getting

Marcus: pretty close to the whole I would guess diabetes is gonna be there. I was about to say, we’re getting pretty close to the whole suite of chronic care issues, right?

Marcus: I mean, you know, CKD, ASCVD, and then, uh, diabetes. Like, that kinda covers it. Yeah.

Vic: And if you get, um, coverage for CKD, diabetes, and cardiovascular, Do you need weight loss? You get you get a lot of the patients, right? Exactly. [00:29:00] Exactly. I think it’s written in the statute that medicare will not cover weight loss things And so they’re having to figure out a way to do it.

Vic: It’s going to be a lot of money. So I don’t know that that has all been worked through, but, but yeah, it’s coming.

Marcus: But again, it just shows how GLP ones are just bursting into all of these areas and forcing conversations that were not present before. Right. So this is, it’s a, it’s an amazing new category of drug.

Marcus: I know people get tired of how I’m talking about it, but like, it’s, it’s a game changer. It really is a fundamental hand shaker. As we talked about

Vic: last week, I’m still worried about the long term effects, but ain’t nobody else worried about it. They’re just going fast.

Marcus: Well, I mean, look, the status quo is very bad, and we have not been successful.

Marcus: And addressing the status quo, and we’ve been trending just only in one way for decades now. So when it comes to obesity and all the comorbidities. So, you know, look, I mean, what are you gonna, what are you gonna do? That’s right. Um, all right. And [00:30:00] then one more story before we take a break. Uh, Eli Lilly and this, this is actually still more GLP 1 stuff.

Marcus: Uh, you know, part of the whole Lilly Direct initiative. They are now partnered with Amazon as really a delivery partner, but it’s starting to Demonstrate the kinds of partnerships that we’re going to see pharmaceutical companies engage in, um, as they continue to define what a direct to consumer strategy looks like and what kind of partners they need, both on the provider and the, and the pharmacy side of things.

Marcus: Um, Eli Lilly and Amazon, that’s a, that’s a massive set of partners right there.

Vic: Yeah, and the, um, they have providers in the loop, but they’re not branded providers. There’s, there’s sort of partnerships with a bunch of. Various people. Yeah, because to prescribe drugs, you need to have a doctor in the loop.

Vic: Yep But what I think is interesting is that the lily Consumer brand and the amazon consumer brand are really strong Yep, and so it may be true that they can go direct to patients stretch consumer and [00:31:00] have unbranded doctors around Um and swap them out as needed um The health systems they have brand identity, but it’s not as strong as the consumer facing brands That’s been a challenge.

Vic: Um, and I don’t know, we’ll see how it plays out, but that’s what I think is interesting here. Well,

Marcus: look, I mean, I think the thing that I’m realizing is that I think Eli Lilly has a real shot at building a true consumer brand. I think they already have a pretty good brand. Brand from a brand ID perspective and a brand recognition

Vic: perspective.

Vic: I think they’re number two to J& J.

Marcus: Yeah, exactly.

Vic: J& J It’s baby powder. Yeah, they’ve had their own challenges with with baby powder But Lily has a much more focused Health brand and it’s pretty good. I

Marcus: mean Lily is not An over the counter brand, whereas J& J is an over the counter brand, and so [00:32:00] they’re, they’re taking this behind the counter brand and they’re bringing it, you know, it’s not, it’s not actually over the counter, but it’s, it’s direct to consumer, you know, and, and I think it’s, you know, it’s actually even an attractive brand, you know, Lily, it sounds good, it’s a pretty font, I mean, you know, just kind of getting into all the consumer realities of it, I mean, I think they’re, they’re pretty well positioned.

Marcus: Yeah, it’s U. S.

Vic: based. U. S. based. Middle America. So it’s a, it’s a, it’s a good story. Yeah. A lot of the other pharmaceutical brands are not completely us based. They all have us subsidiaries, but

Marcus: yeah. Yeah. So, uh, anyway, GLP one season, it continues. All right. We’ll take a break. Let Doug share a little bit about jumpstart foundry.

Marcus: And when we come back, we’re going to do a rundown on what happened at hymns this week.

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 [00:33:00] for us to change the crazy world of healthcare in the United States.

Doug Edwards: We are spending 20 percent of our GDP north of 4 trillion a year on healthcare with suboptimal outcomes. Jumpstart Foundry exists to help us find and identify and invest in innovative companies that are going to make a difference in healthcare in our country. Every year, Jumpstart Foundry invests a fund, raises a fund, and deploys that across 30, 40, 50 assets every year, allowing ease of access for our limited partners.

Doug Edwards: 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.

Doug Edwards: Over the last nine years, Jumpstart Foundry has [00:34:00] 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 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 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. All right, so we’re back.

Marcus: There’s only one thing we want to talk about at HIMSS, which is Google Cloud.

Vic: Yeah, HIMSS is, uh, I don’t know. I was looking hard for stories coming out of HIMSS, and there just wasn’t that much exciting stories. Now, it wasn’t there. It just, I don’t know. It feels like Who do you know who went?

Marcus: That’s the better question.

Vic: One of our LPs went. Okay. Um, and I couldn’t find [00:35:00] portfolio companies that were there, uh, cause he wanted to meet a couple.

Vic: Um, yeah, it was, it was, it seemed really quiet compared to Vive. I mean, that’s the real story, that there’s no stories.

Marcus: I, I mean, you want to talk about a fall from grace. It started with COVID. Yeah. And kind of the way that HIMSS handled COVID with the sponsors and the money and all that kind of stuff.

Marcus: Opened the door for Vive. Vive, Vive launched right after, like, vaccines were out. Right, right. I remember, like, it was Miami of 21, right? Yeah.

Vic: The reason that, I think the reason they went to Miami was the only place they could go. Right,

Marcus: right, right. And, and, and went, went right back at it. And man, in, in three short years, three, four short years, they have taken a huge chunk out of him’s, um, brand power.

Marcus: The health, uh,

Vic: I think Vive was health at first. They added Chime. Yeah. [00:36:00] And adding Chime really gave them, uh, like the clout and the girth to be able to compete with him.

Marcus: I mean, yes, but also like. Chime was nowhere in the same universe of relevance that HIMSS was. I mean, it’s, it’s like, yes, for health bringing Chime in, but I think probably more importantly, Chime partnering with health.

Marcus: Yes, right. You know, like, yes, Chime gave health the credibility and that’s cool, but And just the

Vic: breadth of the continuing ed stuff, all those things that people value at conferences that I don’t. Care about, they can do that with time. But

Marcus: like credit words, do the health team executes their ass off when it comes to an event, you and I’ve done it, it’s super hard.

Marcus: They are really, really good at this. They, they deserve all the success that they’re getting. Um, okay. So Google cloud. is advancing all their Gen AI solutions. Um, Vertex is their AI suite. Um, they’ve built it out alongside of a specific, [00:37:00] uh, trained language model called MedLM, uh, that they’re building out.

Marcus: So, did I tell you I’m going to Google Cloud Next? No. No. Yeah. When is that? It’s in April. Okay. Yeah. I’m yeah. It’s like in a month or something like that. Yeah. I’m going. I’m going because I, I just believe that this, the seat that we’ve had here in Nashville watching Google partner with HCA CHS. Life point, you know, their Google is way more integrated into health systems than people understand.

Marcus: And I think they did it really smartly. Instead of trying to do it at the application layer, they did it at the fundamental cloud and data layer. And now they’re rolling out these, you know, this AI capability, and it’s going to be against real world stuff that they’ve worked out with these, you know, super large health systems.

Marcus: And so I think it’s going to be very well informed. Um, Karen DeSalvo is their chief health officer. She’s super smart. Uh, so I, I can’t wait to [00:38:00] go learn, you know, everyone’s like dogging on them because the Gemini launch and all the sort of bad, you know, race stuff that they had happening. I don’t even get caught up in that shit.

Marcus: I mean, I, I think when it comes to healthcare AI, Google’s going to be a massive force.

Vic: Yeah. They’re LLM med med med alum. It was, um, It was really good before ChatGPT. Right. And they have been really focused on kind of fine tuning. LLMs for healthcare and medicine and almost scientific research, too. Um, and they were hesitant about launching it.

Vic: I was reading a paper from, like, September before ChatGPT launched, so September of 23, I guess. 22, maybe. Mm hmm. When they say in this paper I remember this. It’s ready, but we’re concerned about cultural interactions with healthcare in the developing [00:39:00] world. Mm hmm. And what they mean is like, Hindu religious practice versus Muslim versus Christian.

Vic: They were not concerned with getting the LLM right. Um, they were just worried about sort of how it would impact the world. And that’s kind of how Google’s culture is. And they might be, not might be, I think they’re overly cautious compared to the competitive landscape. Um, but they have a ton of really sharp people and I’m excited to see what you have there.

Marcus: Yeah, so probably the antithesis to Google these days is, uh, Elon. Um, he’s, you know, constantly throwing barbs at, at both, uh, both Google and OpenAI. And, uh, he’s going to open source Grok. Now look, I, I think that that’s a smart and necessary move because there’s no way that’s That grok is going to keep up with open AI or, uh, what Google’s doing with Gemini with the resources that he has to allocate to it, [00:40:00] right?

Marcus: He’s, he’s got to be totally focused on what they’re doing at Tesla with self driving cars. And I don’t know if you heard the, he’s got

Vic: four jobs. He’s got to be totally focused on. Yeah.

Marcus: Yeah. I mean, did you see that, uh, that SpaceX like just lost a rocket?

Vic: Oh, no.

Marcus: Yeah. Just lost the rocket. So he’s got a lot of stuff going on.

Marcus: I, you know, I don’t think a chat bot is like where he can put all his focus. So open sourcing, it is really smart. It’s worked out very well for meta, right? The llama model is continuing to increase in the velocity of its ability to be a super fast follower against the GPT suite. So, um, look, I, I think it’s, I think it’s smart.

Marcus: And also we got to remember that the grok, uh, Uh, data set, which is the Twitter

Vic: feed

Marcus: unparalleled when it, when it comes to breaking news, unparalleled, unparalleled, still, I think this is a

Vic: part of his fight with open AI, of course, I mean, he, he sued them like the week before and then came out with this and I think that’s [00:41:00] the bigger piece.

Vic: I think, I think he’s open sourcing Grock. Yes, because he has to, and he’s never going to keep up, but also because it’s symbolically good. He’s, he’s. Requesting that open AI open source their stuff, and it’s a pretty, it’s a pretty compelling argument. He, he put 40 million into a non profit to advance AI for the good of humanity in a non profit.

Vic: And I, he claims, I haven’t seen it, but supposedly there were documents that when AGI is reached, when general intelligence and the AI is smarter than all of us, at that point, they would open source that and everything before that, and then they would close it and try to control the AGI. And what he’s saying is you, you either have reached AGI and you should tell everyone, or you should open source the models [00:42:00] that I funded.

Vic: And I, it’s, I think that seems kind of fair. Um, I didn’t give 40 million, but if I had to a nonprofit, I’d be upset if then they started making money themselves. So anyway, I think, I think the graph opens open sources part and parcel with his request around that. They’re not going to actually do it.

Marcus: You know, there’s going to be some really important books and documentaries, um, that are going to have to be done about open AI, uh, because we really, I, I can’t, I mean, maybe the NFL, but I’m trying to think about a nonprofit that basically went for profit, um, that, that has the, the, the, this kind of impact and I, I, the NFL is the only one I can think of.

Vic: That’s. That’s a pretty good one. It’s the only one. The, uh, the [00:43:00] thing that’s interesting is he makes a case, which I think is right, that it’s a hack now. One should create a non profit, do all the hard R& D in the frame of getting tax breaks, and then when you figure out what works, then change it into a non profit, into a for profit and make a bunch of money.

Marcus: Um, the system allows it system,

Vic: the system,

Marcus: the system allows it. So, I mean, you can sue if you want, but I think that. I think it’s going to be a tax code change. I mean, under which administration? Who’s going to green light that tax code? I don’t see that being favorable or friendly to either the Dems or the, or the Republicans.

Marcus: They both have too many nonprofits that they prop up that, you know, they use as shelter and they probably use to, to create the, you know, you think about the whole [00:44:00] C3, C4, then you have a pack and then I, I struggle to see that working. I’m a

Vic: VC. Should I create a non profit to do healthcare research and then take what we learned?

Vic: Not

Marcus: everybody can raise the kind of capital that Sam Altman was able to raise. So, so like it’s not a, I mean, it’s, it’s harder now than it has been almost at any time in the last 10 years to raise non profit dollars. Right. So some of this is like kind of worked out by the market. Yeah. Um, and also some of it is just, you know, Extraordinary people in extraordinary circumstances.

Marcus: Like it’s really a Silicon Valley problem. I mean, like how likely is it that this could ever happen in Nashville?

Vic: I don’t think it’s likely at all.

Marcus: And it’s one of the, in Nashville is one of the fastest growing cities in America. Like we’re still a tier two city, but I’m just, I’m, I’m laying it out. Just sort of say.

Marcus: Here’s a city that now is on the map for things like the Super Bowl and things like that. So it’s a credible city. It’s like a top 20 city in America. This could not happen here. [00:45:00] Okay. So that just kind of tells you it’s a limited, you know, spectrum of, of, of situations where. This is even something you’ve got to really work hard on.

Marcus: Now

Marcus: you could tax code it if you thought it was going to be politically a good thing to do, but I’m not sure it is. I’m not, I’m not sure it’s a, it’s a great political thing to do from a donor perspective. Like I think there’s a bunch of donors who would be like, don’t touch that. Leave that alone.

Vic: Yeah.

Vic: Yeah. It’s just a funny thing. Like either Elon Musk was a seed investor in a for profit company and put 40 million in as the first money. Or he did a non profit that they changed the mandate and they’re, they’re no longer following the mandate that he invested. I

Marcus: think the latter is more likely.

Vic: Yeah. I think the latter is more likely.

Vic: What they should do, what they should have done previously is, Give them the money back [00:46:00] to not have all of this bad PR because it, whatever, Sam, almost trying to raise 7 trillion. Like this is ridiculous.

Marcus: It is ridiculous. It is ridiculous. So we’re probably spent too while he’s also doing world coin. Yes.

Marcus: Yes. This Sam Altman guy is, he is going to be somebody we’re going to have to really watch. Cause while everyone was talking about the open AI thing, I’m like, do you guys know what he’s doing with world coin?

Vic: Yeah.

Marcus: Well, he is paying people

Vic: to To get their eyeball scanned and then be able to identify all the people that he has scanned.

Vic: He’s painting them in world coin value, maybe Bitcoin and ETH.

Marcus: I mean, anytime you want to sort of talk about, ah, Skynet, that’s just the movies. What the hell is the point of world coin?

Vic: Yes. There’s no point . Like there’s no point unless you want to find what people, you can find any story can.

Marcus: Yeah. You can make up any story you want [00:47:00] about how it’s good, verifiable trust system, blah, blah, blah.

Marcus: It’s like, yeah. And tracking. Yes, full on tracking. Like that literally sounds like selling your soul.

Vic: Yes. And there’s no reason someone should have that much power and control.

Marcus: It’s ridiculous. It’s ridiculous.

Vic: But then just easier, like, near term, Sam Altman personally owns, he personally owns the Open AI VC Fund.

Vic: It’s, it’s a hundred million dollars. It’s not a corporate asset. And they claim they’re going to, that was a clerical error, and they’re going to fix it later. I mean. Oh, man. But Elon’s no different. I mean, these people are They’re masters of the universe. They are doing lots of things

Marcus: The problem is No one feels bad for Elon.

Marcus: Yes. He’s not going to get any sympathy in a suit [00:48:00] about, okay, dude, you’re literally the richest man on earth. Like, I’m sorry, you, you’ve made it to where we look in the sky and we can’t tell if it’s a star or a satellite. Like, do we really feel sorry for you? Right. You know, I don’t think we do. Okay.

Marcus: Moving on, uh, final AI story. I have such mixed feelings about this one because I knew it was going to happen. Yeah. And, and I, not only did I know it was going to happen, I’ve known this was going to happen For a long, long time. I wanted

Vic: to learn to code like five years ago and you told me not to

Marcus: because of this.

Marcus: I’ve been telling people this for a very long time. I, so for the listeners who don’t know my backstory, I was a college dropout waiter here in Nashville. Um, and I taught myself how to code in the years 2000 and 2001, and that was my transition out of being a waiter and into being a salaried employee, which then got me into the startup world, which then got me to meet Vic, which then got me into venture capital, which got me here.

Marcus: Okay. That’s [00:49:00] my, that’s my story in a, in a, in a nutshell. And there’s a lot of.

Vic: Stories like that where software engineering, you can, if you’re smart enough, not everyone has the aptitude, but if you’re smart, you can learn it and pull yourself up and be good, or you used to be able to be.

Marcus: So in 2000, when I did that, there was no code academy, there were no code bootcamps, which are everywhere now, um, all the ability to like learn code and, you know, be Black girls code and all, all these different programs around code, code, code.

Marcus: Everyone needs to learn how to code. Right. Um,

Vic: I will

Marcus: come up in the

Vic: last 20

Marcus: years. Yeah, well, I think it’s really come up in the last 10 years. I think it’s the last 10 years. I think right along with the accelerators came all the coding schools, right? Kind of side by side. And there was a certain point where I just could see that the tooling, it wasn’t even AI based.

Marcus: It was the tooling we were using was abstracting. What we were doing as software engineers so [00:50:00] far that it was like, you’re not even really coding anymore. You know, you’re, you’re, you’re laying out some high level instructions and the code is coding. The code’s actually coding. You’re not really coding anymore.

Marcus: The compilers.

Vic: I mean, you’re getting more and more high level compilers.

Marcus: I was about to say, it was higher level than what we would normally refer to as a compiler in the software engineering space. Yeah, I mean, you have

Vic: like C compilers or, or, Direct language, but then you used to have four GLS, which were like, and then you had, uh, environments and packages like.

Vic: Ruby and Rails, for instance.

Marcus: Yes. Yeah. frameworks, frameworks, and you know, anyway, you could see that the logical end was going to be, the code was going to code itself. That was the obvious logical end. So I can’t believe it’s taken this long, but this week a company called Cognition, Cognition Labs, they announced Devon, which is the first AI software engineer.

Marcus: I cannot believe it took this long [00:51:00] because. I thought it wasn’t going to be long after Microsoft and GitHub announced co pilot that we were going to have the first full on software engineer, but, but still here we are, right? Um, this, this, uh, software engineer evaluated on the SWB bench benchmark. What, which asks an AI to resolve GitHub issues found in real world open source projects, Devin correctly resolves 13.

Marcus: 86 percent of the issues. Unassisted more than one out of 10 issues with no assistance. This AI can fix and that’s today. Do you know what we’re going to be the end of the year? Like it’s going to, do it all. It’s going to do it all a hundred percent. Like what is going to happen to the software development industry to comp side to like, let’s just frame it.

Marcus: Cause not

Vic: everyone listening knows GitHub or knows what all this means. I had to watch the 20 minute thing to really figure, [00:52:00] but the easiest way for me to understand it was Upwork is a. It’s a community where you can go on as a freelancer and do projects. A lot of them are software based and not all software based.

Vic: And as a person that needs something built, you can go on and request it. It’s like a matchmaking thing for freelancers, basically. And they completed a job on Upwork with, again, Devon did it with no human assistant. They took the, the files that were given by the person requesting the job in Upwork. And then it cranked through it and fix it and it was a really interesting, but really complex thing about how do you self driving cars?

Vic: How does the car know if this is a white line or a crack in the pavement or like it’s sort of a computer vision. Yep. And it did it, shipped it back and got paid. [00:53:00] There was no human there

Marcus: and and I just to go one step further. It’s not just the code that’s required to do that. It’s things that like we would consider to be point click things, right?

Marcus: Like in the world of the general knowledge worker, there’s all sorts of things you do. That are not writing or not math, right? It’s point click. You got to download a file, then you got to upload it here. And then you got to like review it. And then, you know, planning there’s planning, there’s logistics, software engineers have the same stuff.

Marcus: They have to commit code. They have to check out code. They have to run it through a compiler. They have to run it through a bug testing environment. They have to push it to production. They have to verify that it actually worked. Like there’s all sorts of things in addition to writing code. That software engineers do.

Vic: And the code,

Marcus: this thing is doing that, it’s doing

Vic: that. It’s doing that. It’s doing that in an automated way that is unsupervised. What I mean by that is it, it plans like, okay, [00:54:00] here’s the outline of what the work’s going to be needed to do. I need to check out these things. I need to find this thing on GitHub.

Vic: I need to download it. I need to install all the packages. And then it, it does the coding. It never works on the first time and it doesn’t work in these demos either. Of course, it doesn’t work in the first time. That’s how it is to build up. That’s right. Software doesn’t work on the first time you do it.

Vic: the first time. And so then it goes through the debugging process. It has a whole QA module. It is doing the work of a software engineer. It’s a, it’s a software engineer and it never gets tired. It doesn’t need to be paid. It’s not, it’s going to work on holidays. It just, it. Goes and it, I don’t know what the scaling thing is, but it can be replicated hundreds, thousands, millions of times.

Marcus: Uh, yeah, I mean, I, man, I don’t even the, the implications of this one are actually pretty scary for me. Um, [00:55:00] because our economy, as we understand it today has been built on the productivity of humans that are software engineers, like that, that is the, like, if you look at Magnificent seven. Okay. Yes. If you look at Google or you look at meta or you look at amazon or you look at any of these companies, what has been the fundamental unit of productivity?

Marcus: Across all those companies, software engineering. Like that, that, let’s be, let’s be totally clear. It’s not business development, it’s not design, it, it is software engineering. That is the fundamental productive unit.

Marcus: A whole bunch of humans got rich. Right. In the run up of these companies over the last 20 years.

Vic: And we were all happy to, I’m happy to pay Epic! [00:56:00] For Google, for Epic. Because I get Google search answers much better than I had in the 90s. That’s right. That’s right. And I know they use my search history to position ads.

Vic: And that’s part of the deal. The question is, can humans still drive better, faster, more productivity? By using these tools, you have a software engineer tool that can just build something for you. It’s, it’s, it’s not, there’s gonna be a transition. Like, we don’t know how to do that. All. It’s, it’s,

Marcus: it’s not the, it’s not the objective question of can we do it right because we can.

Marcus: We can for sure. I think for me it is much more a sense that we are as a population right now.

Marcus: We [00:57:00] seem to be, and this is very, very, very subjective and not objective, so this is opinion. We seem to be less resilient and less able to handle, I think, significant change right now. That’s, that’s kind of my, my read on us as, as humans right now, you know, certainly Americans.

Vic: Well, my view is that the boomer, the society of the boomers created.

Vic: Is old and it’s been going on for a long time and the things that were really brilliant in the 50s and 60s, Medicare, really impactful on humanity. It’s been around for 50 years. Yeah, and fraying. And fraying. And the millennials haven’t stepped up yet because they haven’t had to. Well, not They’re going to, that as a

Marcus: class, they’re going to have to figure out Well, I mean, they haven’t had to, but they [00:58:00] have not.

Marcus: Been supported to, you know, Scott Galloway, um, always makes this point. He always makes the point that, you know, when not just the boomers, but even our generation, Vic, I think, I feel like generation X is actually the last generation, um, where, where this is true and maybe the elder millennials can, can slide in there too, where it was actually reasonable to buy a house.

Vic: Yeah.

Marcus: You know, um, it’s, When you look at the, you know, the younger millennials and certainly Gen Z, the ROI on the things that we as a society have asked them to do and set them up to do, it sucks. Of course they wanna be TikTok influencers, right? Why the hell would they wanna do anything else? Yeah. Why the hell would they wanna do anything else like Logan Paul all day?

Marcus: That’s, yes, that’s what I wanna do. Why do I want, why would I wanna go to some, some school?

Vic: Right? For what [00:59:00] I mean, so the way. I think the cliff notes of that are the, the American dream doesn’t exist right now, or it’s not, it’s not clear to me what my boys or your boys who are, you know, late teens, early twenties, what is the dream for them without, without you and I helping them?

Vic: Like, if you just are going to teach yourself, whatever you taught yourself, how to code, maybe it’s something different. Now, I think there’s a lot of opportunity for entrepreneurs. in this space, but it’s, it’s super hard because it’s because the distribution’s not there. The structure’s not there. It’s not there.

Marcus: I, I don’t, I don’t think I understood how, how important the message in the book that I wrote over five years Yeah, means to me now, like, I mean, I, I felt strongly about it then, but it’s like, man, being a generalist and an entrepreneur is, I don’t, I can’t think [01:00:00] of anything less risky. I hate to say it that way, but like, if you understand how the economy works, you understand the fundamental value exchange for productivity.

Marcus: And now you look at what is happening to productivity, especially the productivity that we have most heralded, that we have paid the most for, that we’ve oriented, we’ve corralled everybody towards, right? It’s all been computer oriented productivity, and now there’s an entire being that’s going to do it better than a human.

Marcus: Right. So the only way I think you navigate that for some period of time is entrepreneurship. I don’t know. I don’t know how long that lasts, right? I mean, there’s questions around how long that lasts, but at least, at least you’re constantly observing, you know, synthesizing all the things you’re taking in and finding ways to sort of stack on top, [01:01:00] stack on top, stack on top.

Marcus: At least you, you get, you get that angle, but man, when you’re a cog in the machine creating productivity for. For someone else? Brutal. Brutal.

Vic: I mean, there are millions of software engineers that need to figure out a plan. Right? Because it’s one thing when we outsource call centers and then we automate that, but I’m still doing my Python code.

Vic: And it’s different when now we don’t need that anymore. Because those are knowledge workers. They’ve spent they’ve spent Five, 10, 20 years building their tradecraft, building their expertise. You

Marcus: know, back to the whole policy thing, I struggle to see how the next administration that is elected is not forced to put some [01:02:00] regulation in place because the job loss that this threatens, it would, it would be disastrous for any administration, like any administration.

Marcus: I just don’t, I just don’t know how.

Vic: Well, I think it’s going to be, it’s always slower than I expect it to be and then more impactful in 10 years. So like

Marcus: it’s, no, but that, that, so like that, that, that rule is compressing.

Vic: Yeah.

Marcus: That, so I, I hear what you’re saying always, but like you need to start accelerating that.

Vic: Yeah. Yeah. So the, um, I mean, I think, um, universal basic income is the first thing that will happen. I don’t think job protection. I don’t know how you would do job protection. You’re going to tell Google they have to have X number of software engineers. Actually, they’re doing that in their nursing homes.

Vic: I was

Marcus: about to say. I was about to say. What do you think MLR is? What do [01:03:00] you think 70 percent labor rates are in nursing homes? I mean, yeah, yeah. They’re regulating your P& L and telling you how much you have to spend on labor. So, look, I just think this is, this is a huge rug pull. Yeah. That’s, that’s about to happen.

Marcus: We’ve been telling people for the last 15 years, You need to learn how to code! STEM! STEM! Are you kidding me? Like, like, you can STEM your ass, like, for, for the next 10 years, and you’re never gonna be able to beat Devin.

Vic: No, you can’t beat Devin. No! What you can do, I think, is learn to Use Devin and his or her peers to do more.

Vic: Devin’s going to use Devin.

Marcus: Hold on. Can we just scroll down to like look at the, at the, at the, at this post on Twitter. So, or X, whatever you want to call it. So after you get past all [01:04:00] the PR stuff, right, you know, you start seeing, you start seeing, you know, uh, right. Uh, here’s a question. Can Devin create Devin?

Marcus: Right. Yeah, we had a good run, bros. As a software engineer, I’m finished. Please, sirs. My family needs to eat, sirs. Please stop development on this, sirs. Right? I mean, like, yeah, this is real. This is real people who understand what’s going on. They get it. And they know because they’ve been building software to replace people forever, forever.

Marcus: So they know right that the software is going to be better than them at building a building software. They know that.

Vic: And with this demo, how many other AI companies can work on similar things? A lot, right? It’s Devin can build Devins, but you didn’t have to do that. There’s going to be lots. It’s going to create,

Marcus: it’s going to create unbelievable amounts of [01:05:00] competition.

Marcus: No, no question. And that’s going to like push productivity. And that’s going to be like, I’m not, I don’t want to diminish the upside. I don’t want to diminish the upside of the, you know, effective acceleration is right. There, there is an upside to all this. No question. Like, yeah, we, we, we’ve talked about it.

Marcus: Like, think about. The next 30 GLP ones that are going to, you know, come out of this. Think about all the things that are going to happen to, to save people’s lives. It’s going to be, it’s going to be tremendous upside to all this AI stuff. No question. It’s just that there will also be downside. Yes, there will be, there will be human suffering that comes as a result of this.

Marcus: Right. Um, I would say there always is. I

Vic: mean, we don’t like to focus on it, but there was. There was suffering when the Industrial Revolution came out. Yes. There was suffering when cars came out. I mean, there were, you know, the, the people that had horse, horse drawn carriages didn’t do that well. [01:06:00] Yeah.

Vic: There’s a transition for the workforce. And the thing that makes me worried is how fast this is changing. It’s the

Marcus: rate of change. It’s the rate of change,

Vic: but also like how many jobs do we need? How many people do we need? Like, I don’t know. So that’s why I went to universal basic income. We need people to be able to eat.

Vic: I think we already have precedent out of the, out of the pandemic, our

Marcus: fundamental understanding, like this is where, this is where that guy, Brian Johnson, who, who sold Braintree and now is like trying to figure out how to not die. The whole don’t die guy, he’s somebody we got to bring into this whole, you know, health further thread, but his whole premise is that we are entering an era where we literally know nothing now.

Marcus: Like, like we’re back to the big, to the point where we know nothing. Okay. And we have to just assume that that’s, that that’s real and a perfect way to, or to prove that that’s correct is there’s two things that are [01:07:00] simultaneously inching towards being reality. One human productivity is a. Is on the verge of being eclipsed by computer productivity, like, like autonomous, sovereign computer productivity, and at the same time, and this is equally crazy, the cost of energy could go to near zero.

Marcus: Right. Like we’re, we’re getting, and by the way, those two things are pushing each other, right? Right. As the AI gets smarter, it’s advancing our ability to find alternative methods of getting to energy, right? Like we’re getting to the real core. Yeah, solar,

Vic: wind, geothermal are going to be We are

Marcus: getting to the core of thermodynamics at a rate of change that we can’t even wrap our head around.

Marcus: And so as you inch towards that, then the cost of energy comes down, boom, boom, boom. Boom. Then you start moving into this world where everything, like, productivity used to be the fundamental crank of the economy. But at some [01:08:00] point it’s going to be for, at what, for what purpose? Right, like, like our fundamental rules of economics start to go into question, right?

Marcus: Don’t don’t you think like because before it was based on the fundamental assertion that we were expending human energy Thermodynamically to create value like like the productivity came at a real cost.

Vic: Yeah, we used to have to do Physical work right that’s what I mean animals here to do work, right?

Vic: Then we Invented the steam engine, right? And other engines. Yeah, but where human human muscle power was superseded. Yes, but but but you have to build the engine. So the engineering and even the R and D around that, right?

Marcus: And the materials to build it. So those became those became very valuable. And then the plant that did the manufacturing and then the repair of the engine, right?

Marcus: So, so it all continued to work. But now we’re just moving to this. Yes. Next level where it’s, it’s a [01:09:00] question as to whether or not it’s, it’s still works. So anyway,

Vic: yeah, well, the, the, the question I think becomes what do we want government to provide? And what do we expect the free market to provide? And how do those things interact together?

Vic: And I think we are in a whole new world of that because we, we need them to stay out of the way in some areas that we needed them to come in and help in, in different areas. And the thing that makes me worried is we need, we need Xs or millennials in there that are not going to die in the next 10 years.

Vic: Agree. So,

Marcus: all right, listen,

Vic: the long rant.

Marcus: Yeah, no, no, no. Actually. I kind of want to stop there. We had a couple more stories, but I’m exhausted. Yeah, this is, this is the

Vic: story. I mean, Devin is. is the big story. I

Marcus: can’t come down from that, from that rant and then talk about the other two stories we had. So maybe we’ll go to those [01:10:00] next week.

Marcus: Um, yeah, man, look, this stuff is moving very, very quickly. Uh, I appreciate you continuing to pull these stories together. Cause they keep me aware. And I think, you know, they, they help us to do our job effectively as investors, you know, not just in terms of doing the capital that we, you know, That we, we raised from limited partners, but also in trying to, trying to support our portfolio companies and help guide them and, you know, uh, help, help them navigate this stuff because the, the ground is moving underneath all of our feet.

Vic: Yeah.

Marcus: Right.

Vic: Yeah, I think that’s right. And I think over the next six months, maybe we need to start adding in the how not to die longevity, you know, if this explosion of productivity occurs. And we have lots of resources to put at something. What, how do we want to make our health better? Yeah, you start

Marcus: adding in CRISPR and, you know, all these other kind of things.

Marcus: It’s like, yeah.

Vic: And then I think the whole idea of, uh, pairing AI with, with, uh, token blockchain to [01:11:00] prevent attacks like, like change healthcare. There’s. I want to dig into some of those things, maybe find an expert or two and try to work on it.

Marcus: Here’s the final note I want to just end on. When you and I started Jumpstart Health Investors 10 years ago, when we would talk about these kind of things, and we, look, we, we did, we did a, uh, uh, a token play.

Marcus: Yeah, yeah, we’ve been playing with these things for a long time. Yeah, we, we’ve done a lot of these things before. We knew even when we were doing them, they were, Proof of concept at best. Like we would always have to hedge ourselves in terms of how real this, this was, how long it was going to take. It would take, you know, we’ve been saying everything will take 10 years for 10 years.

Vic: Yeah.

Marcus: Okay. And it’s just not true anymore. Right? Like it’s, we’re actually living in the future today now, right? We’re living in the future today. CRISPR is real today. Right? GLP [01:12:00] one is here. Today, Devin is working on Upwork projects today. Today, you know, Bitcoin is still up and BlackRock that was saying it was ridiculous three years ago now owns more Bitcoin than anybody.

Marcus: Today, like we even have to get ourselves to fully wrap, wrap our heads around the fact that the moment we’ve been talking about for 10 years here is literally here now we’re living in it. Uh, Totally insane

Vic: and fun. I mean, it’s gonna be wild, but it’ll be fun. I think it’s rising. Think it’ll be fun.

Marcus: It’s, I, I think, I think, I think it’s fun because we are very, very fortunate to be literate in it.

Marcus: Yes. Um, and so look, that’s what we’re doing this show for. We’re, we’re, yes. We’re trying to stay literate and we’re also trying to help others be literate.

Vic: Yeah. So let us know if there’s other areas we need to bring into the discussion. Other topics. Let us know if you have a guest that we should bring in.

Vic: And tell some friends that we want to get a bigger community.

Marcus: [01:13:00] But clearly, as you can see, we’re not only going to be talking about the Fed and policy. Like we’re going to keep talking about tech. We’re going to talk about crypto. We’re going to talk about, you know, CRISPR, we’re going to keep pushing the boundaries because my friends, all that stuff is here today with that.

Marcus: See you next week.