67 – The End of Cable News? How Social Media is Dominating Politics

Marcus: [00:00:00] If you enjoy this content, please take a moment to rate and review it. Your feedback will greatly impact our ability to reach more people. Thank you. All right. Interesting week this week. The political landscape is just kind of unprecedented, right? We we’ve had former president Trump convicted. Was it three weeks ago now at this point?

Vic: Yeah, I guess it’s three weeks ago.

Marcus: And this week. He, he’s had a great PR run since then, by the way, um, but this week he, he appeared on Logan Paul’s podcast. Yeah. You know, Logan Paul’s one of the largest social media

Vic: Right.

Marcus: influencers in the world, um, who also happens to be, uh, a boxer, but also happens to be a, a WWE superstar.

Marcus: He’s a wrestler, a professional wrestler. And so he’s the United States champion there. And, uh, they did, they had a face off with Trump and like

Vic: a heavyweight fight or something.

Marcus: Yeah. Yeah. Yeah. And, um, [00:01:00] I was watching it. And it, it just really hammered home that we are in our fifth, I think, election that’s ultimately going to be determined by social media.

Marcus: I mean, Obama ushered this stuff in five elections ago, five elections ago. And now here we are where it’s like, it just feels like cable TV is just, I don’t even know what they’re doing, you know, but they’re not driving. They’re not driving the discussion and they look, they look like all they really can do, and this is, you know, all of them, is, Pedal fear, like they can’t get anyone leaned in or excited about anything.

Marcus: Somehow Logan Paul managed to figure out a way to present Trump in a way that is like interesting, distinctly different from anything you would see [00:02:00] on Fox, MSNBC or CNBC.

Vic: Yeah.

Marcus: Um, and the reason why I’m bringing all that up is because president Biden is not present on this. I don’t know if he knows who

Vic: Logan Paul is, but he’s certainly not.

Vic: He’s not present in

Marcus: social media. He’s not present on this channel, and I just think about how good Obama was at this. Yeah, he was so good at this, you know. He’s still pretty damn good at it, even though he’s not, you know, running for anything. Uh, and Man, it just feels like the reality is that social media is going to drive the result and Yet, we can’t quite say that officially, you know what I mean?

Marcus: Because it would truly mean it’s the end of an era for the old establishment Even though it’s it’s pretty clear to me all the old guard media is, you know going out bad Paramount can’t even get a deal done to get acquired right now and [00:03:00] So, yeah, I mean, I’m saying all this on a, on a podcast, right, but it’s, it’s just the democratization of media is really driving everything,

Vic: you know?

Vic: So, I don’t get news from cable TV. I don’t rely on that for my source of news. I read the Wall Street Journal and the New York Times every day. And then I have maybe 10, 12 podcasts in different domains. Right, right. That feed me tech news, healthcare policy news, crypto news, whatever. That’s where I get my news and part of the reason is sort of what you’re saying that the thing that I think about Trump, why people love him and why people hate him is he’s the first presidential policy that I know that he’s just trying to get attention.

Vic: It’s a, it’s a social media attention wins. It doesn’t matter if you love him or hate him, if you are talking about him or attend watching anything with his face on it. [00:04:00] He thinks he wins and I think that is kind of sad for our democracy, but it’s also true

Marcus: It’s true. And and when I saw him with logan paul, I was like, that’s a perfect pair to attention, right?

Marcus: You know, right like seekers just like all they do is is yeah, they’re gonna just one attention. They cross pollinate each other Yeah, and they probably call each other like, you know, we get a ton of attention, right? Exactly you coming on my podcast like that would get a ton of attention. It’s like yeah, let’s do it

Vic: You know, so anyway, so the the debate’s coming up.

Marcus: I

Vic: know and I’m kind of scared about it, but that’s the chance Biden has.

Marcus: Yeah, I, I don’t know. I, I, I think the reason why I brought it up is that this happened three weeks after a conviction, like a felony conviction on all counts, you know, and it just sort of demonstrates that[00:05:00]

Marcus: like the baseline. Of what is the strategy to win versus, you know, what will land you in the loser seat. It’s shifted. It, it, it just has, it just has shifted. You know, um, there’s so many things about Elon Musk, right. That are just so antithetical to what the prototypical see. I mean, even like even comparing must to Steve jobs, it’s like.

Marcus: Musk is nothing like Steve Jobs, you know what I mean, nothing like Steve Jobs and yet, you know, I sat there and I watched the launch of, of, you know, the SpaceX Starship is unbelievable. It was, you know, I watched it for a half hour and it was unbelievable and so I guess just, just trying to like reconcile this, um, just trying to reconcile this shift in society [00:06:00] is, You know, it’s like, I feel like I can do it at 48 years old, you know, like I’m not so old that I can’t make the leap, but it’s certainly not a leap I personally want to make, you know, like, um, and I, and I think that’s what I think about.

Marcus: I think about how does this influence, um, how I would mentor. Young people, how does this influence how I talk to my kids? Um, because those are the, these are the standards of success that they are out there looking at. You know, I can set my own example just by living my life the way that I do, but I don’t know.

Marcus: It just,

Vic: I mean, the millennial generation, someone or some group of people has to step up and Run for office and try to lead their their native in social media They will understand it better than you and I do and I don’t mind lots of attention um kind of [00:07:00] grabbing charades and stunts By politicians, but there’s not equal on both sides and there’s not enough of it so like if you had a bunch of candidates all having opinions and bringing out policy, but also You native and social media and using it to their advantage.

Vic: I think you’d have a better, a better choice, you’d have more options to pick from. Right now, we, we don’t, the Dems haven’t really attempted to do it.

Marcus: Which is crazy, because like I said, this is the fifth election, the first two were Obama. Like, like, the Dems started this. Yeah. You know what I mean? Like, that’s, that, I think that’s the part that I’m just like, uh, I don’t, I don’t.

Marcus: I don’t get it. Um, but we’re, we’re healthcare show, but listen, like we’re kidding ourselves. If we don’t admit we are in election season now, we like we are, we’re in election season now for real, for real. And, um, there’s so [00:08:00] many things that people are hesitant to do until they know how this thing is all gonna play out.

Marcus: You know what I mean? Um, and so, yeah, it doesn’t affect most, much of what we’re going to talk about here. Although some of it today, but it was my takeaway from the week. You know, my takeaway from the week and really is my takeaway from the week, Donald Trump, but this week it was the, it was the Logan Paul podcast thing.

Marcus: And I was just like, wow, wow. Like that is going to draw that is going to grow his base so much. I mean, so much

Vic: it, I was talking to my son about this cause he was, um, frustrated about the conviction, not really resulting in any change in the polls, except maybe positive for Trump. Yeah, and it just is, I think, um, poor strategy on the Democratic side.

Vic: Like, they didn’t [00:09:00] need to bring that case, they didn’t need to bring that case right before the election. They thought it would be beneficial and it, and it backfired on them.

Marcus: Yeah, and I think about your son’s frustration with that, and I think his frustration is like, Hold on. It’s not even about Donald Trump.

Marcus: It’s like, hold on, like a conviction is, yeah, it’s all good. It doesn’t

Vic: matter. Yeah.

Marcus: Conviction doesn’t

Vic: matter. Right. Or even as a positive that, and that doesn’t, it just doesn’t, it doesn’t square with, you know, 17 to 20 year old person like trying to figure it out and what we’re trying to tell them Yeah,

Marcus: right, right, you know play by the rules don’t get in trouble, you know kind of basic things, right?

Marcus: It’s uh, we’re headed into an interesting three four months ahead for sure We are heading into a very interesting three, four months ahead.

Vic: Yeah, and it’s not healthcare, but we have to just, I mean, we’re humans. We have to interact with the world. So we end up talking about some of this stuff.

Marcus: Yeah. I promise this is not going to be an every week thing.

Marcus: Just the Logan Paul thing kind of got me this week. So, um, anyway, with that, we got some real [00:10:00] health further stuff to talk about. So let’s dig in.

Marcus: All right. Uh,

Vic: let’s quickly run through the day yesterday. The CPI was slightly better. We have a chart, the next page, but then the fed came out and kind of gave a half hour press conference with not saying much other than all’s well, soft landing. We might be able to get a cut at the end of the year and the stock market and everyone loved that.

Marcus: Okay. Here’s an interesting question. Do you think they cut between now? And the election, or do you think they, they explicitly avoid cutting to just basically not create any change in. In the status quo. I mean, that’s, that’s something I hadn’t really thought about in the context of the election because it was more like, okay, are they going to [00:11:00] cut this year?

Marcus: And I think people thought they might cut earlier in the year. We’re in June now. So now you’re,

Vic: you’re in the window, September, November and December. So there’s a September meeting before the election.

Marcus: Okay. So which is their one real, the one real chance.

Vic: My, I bet they don’t. My opinion is that It depends on if they actually look at the data they tell us they look at, or if they have other data sources that they’re not sharing, um, with the data that’s streamed, but they, They claim to use CPI and, and other inflation facts that are published, it, it’s going to be flat, not going to keep improving because of the last year rates.

Vic: So, like, last year we had a lot of, um, inflation improvement in the next couple of months. And so compare, this is a relative thing, so compared to a year ago, it’s going to be hard to keep going down because we went down a lot earlier. a year ago. I mean, that was [00:12:00] like up here. So I think it’s going to seem like inflation is flattened out or even slight uptick.

Vic: And so in September there, it’s going to be hard for them to cut. And if they do cut, it’s going to be because they see something that is not good in the overall global macro thing that we’re not privy to. Right. And they don’t care about the election because they’re trying to fix something else. Right.

Vic: ECB cut. Yes, exactly. ECB is, I think Europe, Europe’s not doing good, is not doing very well. Europe’s not doing well. Right? Exactly.

Marcus: U us is doing well. Yeah, we’re, that’s right. We’re, we’re very strong right now. I mean, I mean, I think the only, the only potential sort of headwinds that I’ve heard about recently are the whole petrodollar thing that people are talking about that Yeah.

Marcus: The petro dollar ended. Yeah. Yeah, so that’s I mean,

Vic: but

Marcus: we don’t really

Vic: know that’s not gonna affect anything in the next six months. That’s right That’s like a six to 20 year thing in my opinion. That’s right. Yeah. Um, yeah, all the all the all the [00:13:00] crypto bitcoin crypto Yeah, people are all over that.

Marcus: Well I think it’s fair.

Marcus: Yes. Yes, they they they are Um, but but more more circles are talking about that as well. Um, You know, so anything else? I mean, CPI is that 3.

Vic: 3 or 3. 4? The core, getting

Marcus: me down to 3. 4 is pretty great.

Vic: It’s great. My expectation is it’s going to be below

Marcus: being below three and a half, like getting to the bottom half of three, you’re starting to kind of break away from four for real at the core, you know, Yeah, which is the sticky piece.

Vic: Yeah. I mean, my opinion is three to three and a half should be the target. Well, I don’t think we’re going to get to,

Marcus: I know, but I’m just saying breaking below three and a half kind of could give you confidence that maybe you can get to three. Right. You know, and if you can get the three, you’re, that’s probably as good as you’re going to get.

Marcus: Yeah. I think they got to change the [00:14:00] benchmark, but that’s, that’s for another. Yeah. I don’t know if they’re going to do that. That’s for another day. All right. Anything else about this? Yeah. All right. More, uh, all time highs on the stock market, S and P 500 NASDAQ. Everyone loved the short dip in CPI.

Marcus: Everyone loved Jay Powell’s talking points and, uh, all time highs again.

Vic: Yeah. Yeah. Risk on everyone is just like full steam ahead, which is, you know, I understand, and hopefully it’ll last.

Marcus: Alright, so, continuing with our coverage on all things freight, because you’ve decided this is a topic you’re into.

Marcus: I’m interested

Vic: in freight and unions. Yeah, yeah, yeah. So this one caught

Marcus: my opinion. I’m interested in unions. I actually kind of like the freight. You know, conversation. It’s a, it’s a different set of economic data that is, is good to look at. So, uh, the dock workers, basically across the East Coast, all the way down to Texas.

Marcus: Yeah, it’s not

Vic: California. It’s everything. Yeah, East Coast down in Texas,

Marcus: right? Yeah, right. They are threatening to strike. It’s not just [00:15:00] about wages. It’s actually about automation. Yeah. Yeah. They want no introduction of automation. And if they can’t agree to that term, They’re just gonna shut down the ports basically.

Vic: Yeah. And the um, negotiation period started like on Tuesday, supposed to be 60 days and then the contract ends I think September 30th. Okay. And the union just didn’t show to the first day, which I thought was an interesting tactic. And they pointed out that there’s some automation in one of the ports that they had a problem with.

Vic: The, the management claims that had been approved, I haven’t, it doesn’t matter, they manufactured a story to get our attention, but it’s destined for a fight, right? Like the chance that there’s no automation in the ports seems low to me, but that’s what the union is fighting for.

Marcus: I think it’s a [00:16:00] decent card to play it, you know, over the long term, there’s no way it’s a sustainable approach, but for right now, if you’re trying to extend the life of dock workers for as long as possible, from the unionist point of view, it makes all the sense in the world, just saying no to automation or we strike right now, like that’s, you’re starting at the beginning, they have no momentum on automation yet.

Marcus: Right, right. And it’s a long walk from. Fully human or yeah, you need the dock workers. Yeah, 10

Vic: years at least. Yeah, it’s a

Marcus: long walk. And so This is really pretty smart, right? I mean if you just say no or we just walk off Look, we’re talking about national security, you know, like these docks have to operate Yeah, our country offshored too many things.

Vic: Yeah,

Marcus: so, um

Vic: So again with the election you’re gonna have the potential for a strike october 1st, and I don’t know [00:17:00]

Marcus: Just a good storyline to watch. I mean, there’s nothing more to say other than like, that’s a, that’s a storyline to watch. All right. Moving into VC, um, better health raise 14 million to deploy expanded payer partnerships, better health is a chronic care management.

Marcus: Supplying company, um, they were backed in this round by care first blue cross, blue shield, which, uh, their venture arm health works, which is that’s the mid Atlantic, uh, blue cross, blue shield. Yeah.

Vic: It’s like, uh, Maryland. Yeah.

Marcus: Yeah. Mid Atlantic. Uh, and basically better health is like Omada. Is that, is that correct?

Vic: Yeah. They’re like a model, but they also, they really focus on the supplies, which is interesting. I don’t know how it affects their revenue model, but the. They focus on sending you all the stuff you need for your chronic disease Testing strips other other stuff and not just like diabetes not just diabetes.[00:18:00]

Vic: They uh, there’s several um wound care diabetes Uh chronic retention and incontinence, I guess maybe diapers You

Marcus: know, you know what’s interesting about this. I mean, this is cardinal health’s business This is this is medline’s business and cardinal health has an at home delivery Hmm I’ve seen, I’ve seen it.

Marcus: So that, that’s interesting. It’s like a,

Vic: it’s like a disease management carve out of supplies. Yeah. Yeah. They have support and care management services. They’ve added on since kind of like a model, but they started more in the moving physical goods. Right. And I think for the most part, they’ve been working with providers and now Um, care versus investing, but obviously they’re going to start selling to payers too.

Vic: Interesting.

Marcus: All right. Well, 10 million round. That’s a, that’s a strong round. And obviously if health works is in, that means that blue and probably others will be, you know, working with them. Yeah. [00:19:00] Um, so we’ll keep an eye on better health. All right. Grace raises 10 million series a for caregiver support.

Marcus: Uh, so more in the caregiver space, more

Vic: aging, kind of aging, and also. somewhat home health because a lot of aging is home health. I

Marcus: think this is going to be a big space. I think this is going to be a big space, Vic. Um, so, you know, the, the question I continue to have about it though, is you can, you can pack in the capital, uh, the workforce.

Marcus: Is, is really going to be the, the, the question for this industry. And I’m, it’s not entirely clear to me how the, the capital addresses the workforce shortage that we’re going to run into. Um, and you can’t fix the aging population with technology. That is, I mean, I’m from lived experience. That’s not at all how it works.

Marcus: So, you know, make sense to me, I’m sure for a while, you know, to the degree that you can pay them well, but I, I would be interested to see and [00:20:00] see what they’re doing from a pay perspective. If they’ve just decided they’re just going to pay the caregivers better. Um, you know, are there differentiating aspects to what kind of services they’re going to provide, um, in the home?

Marcus: Cause that’s another area where I think you can win in a, in a bake off. Um, yeah,

Vic: I mean, I’m biased. We have tried this market maybe four times, and then I have an, I have a portfolio company in this space right now. That I’m excited about, but it’s, you have to figure out a creative business model. Because there’s not a lot of margin there, so it’s a, it’s a tricky thing to do, and, and Grace has not disclosed, at least to me, I can’t find the details of how they’re doing it.

Vic: They call their employees social workers, which is an interesting title to give your employees, um, in a for profit company.

Marcus: Yeah, I mean, the, the, you know, the question is what, what clinical, Capabilities do those social workers have and social workers can have clinical capabilities, but you [00:21:00] know, I don’t think

Vic: it’s much clinical.

Vic: I think it’s planning advice, um, and then assistance. That’s not. Not actually delivering health care. Yeah, I, I, I think it’s homemade. Yeah, that’s right. Yeah. And personal care, like in, in the home health space, you call it personal care.

Marcus: Yeah. So, so look, that’s a hard thing to play. I’m employing homemade right now.

Marcus: So, um, and our homemades are fantastic, but like you said, that’s not a, the majority of the Cash goes to the aid. Yeah, you know, um, and if, if, uh, if folks don’t have long term care insurance There’s not that you know, you’re you’re you’re basically focused on an affluent buyer, right? You know, yes, this is expensive.

Marcus: This is six figures a year to actually provide 40 hours of care to an aging love Yeah, and

Vic: even if you pay him, well, it’s a hard job.

Marcus: It can be I mean I think it depends on the [00:22:00] home that they’re going into You know what I mean? Yeah. And, and, and like, yeah, it’s, it’s, it depends. I just think aging in

Vic: general is hard, like, by definition, you are getting more frail, you, you need a lot of support.

Vic: Yes. And it is frustrating for the senior, often, because they’d rather not have support, but they need, so I, I, that’s why I think it’s hard, I think, Not that you can’t have a calling for it, but I think it’s all right. I wouldn’t want to do it.

Marcus: Yep. Okay. Stitch PEO. Um, so this is a PEO focused on doctors.

Marcus: They’ve got 9 million to support independent, independent medical practices with PEO services, like, you know, Insperity, Trinet, et cetera, sort of that whole, um, universe of PEO, but just focused on docs. So what, what do you, I like

Vic: this story because, uh, the, the physician practice thing for a long time, they didn’t.

Vic: They didn’t worry about HR and benefits and anything. I mean, they had [00:23:00] some staff, but it was mostly the docs employing themselves with support staff. And, Nowadays, I think you have to have full HR stack to track the administrative staff, the nurses, even the younger docs. Sure. Expect that. And so this is a PEO designed for physician groups, um, that I think is pretty interesting.

Marcus: Yeah. It’s a, it’s a, it’s a shrinking market, you know, independent physician practices are not growing. Yeah. Right. They’re, they’re shrinking. Many of them are getting bought up by the Optums of the world and things like that. Um, so, it’s interesting and I wonder what the real play here is. Right. You know, is because, because when you do a PEO, you take on the responsibility of being the employer.

Marcus: So you’re actually the employer. So it feels to me a little bit like a weirdly, um, like a little bit of a Trojan horse to maybe building a physician group. [00:24:00] You know, you know what I mean? If that makes sense. Um, it’s, it’s just an interesting model, uh, How might you then take that and work with GPOs or work with payers or right?

Marcus: You know, I mean, what, what, what’s, what’s the, what’s the marketplace you could create by aggregating a critical mass of independent physician groups through a PEO where you are the actual employer? Like, what’s pretty interesting. What are the points of leverage there? Right?

Vic: I mean, I don’t assume they will be working on network pricing and contracting.

Vic: But if you sort of began to aggregate. Maybe even out of market opportunities for something, maybe you could grow into that.

Marcus: Yeah, it’s, I mean, I just don’t know where the line is, but They are actually going to employ the docs, right? That’s the, that’s the fundamental, the

Vic: docs

Marcus: and all the support staff.

Marcus: Yeah. That’s the value prop of a PEO. So that that’ll be an interesting one to watch. Um, I do think it’s a novel idea. I hadn’t really heard of somebody specifically doing that for, you know, docs. So, yeah. Alright, moving on to the markets. [00:25:00] Uh, Raspberry Pi. This is a cool story. So, for those who don’t know, Raspberry Pi was basically, uh, a company that came along with the maker movement.

Marcus: Right? Where, where we, we realized Maybe in the 90s? I mean, a long time ago. Really in the nineties, or maybe not. Are they that old? I, I feel like it was a little bit more in the two thousands. Okay. Maybe. But um, but it, it was basically when we realized, hey, you know, we’ve got open source software, we’ve got really cheap hardware.

Marcus: Mm-Hmm. and software is gonna power everything and can even power like new creations. Like we can build new hardware things. So they just started like sh sending out motherboards like with, with a chip embedded with Linux on the chip. And you can just like, and almost

Vic: like, uh. I don’t know, like a lego sesame, you could easily set it up.

Vic: You had to learn hardware, but it was designed for makers for guys in their Mostly guys at the kitchen table like working on something.

Marcus: Yeah, at the end of Radio Shack you could buy a Raspberry Pi at Radio Shack. Right, you know what I mean? So, so it was cool. It was a, I had one. I bought one for my son.

Marcus: You [00:26:00] know, it was like a really cool tinkering thing. So Raspberry Pi, I hadn’t heard that name in like forever. And here they are. They’re going public, but they’re not going public. In the U. S., they’re going public in the U. K.

Vic: Yeah, which I think is great. They, they, the market cap, it, it priced, it’s in, it’s in pounds, so it’s confusing, but it priced, and then went up dramatically in the first day, which is what you want to say, it closed at 690 million.

Vic: And so it’s, it’s a pretty small IPO, which is perfect for the London exchange. And I think really healthy to have an alternative for venture backed companies that you don’t have to be a billion, 2 billion, 3 billion to go public in London.

Marcus: Yeah, I mean, I think the story, well, two stories here. One, um, really cool to have a new computing company go public.

Marcus: Yeah. Two, um, it’s, it’s sub a billion dollars, right? Yeah. And that’s, it’s a great outcome because the, the shares soared in the, in the [00:27:00] first 24 hours of trading. Yeah. So that’s, that’s great. And,

Vic: um. And their own still 60% ish by a non profit that is trying to, Get more maker, more people tinkering with computers, which is great.

Vic: Super cool. Super cool. So, uh, and if you add a cheap open source AI thing on top of it, you might have a fun little toy, so I don’t know.

Marcus: So, so, so segueing that, that story, um, the end of last week news came out that, uh, it wants to make their own stock exchange. And of course this. You know, it’s impossible to hear this story and not think Elon Musk is somewhere underneath the hood working on this, right?

Marcus: You know, he has railed against the coasts. He has talked about, you know, how much he hates Delaware. He’s reincorporating Tesla in Texas. Um, it seems to me At least somebody has talked to him about, Hey, if we set up a Texas stock [00:28:00] exchange, would you potentially move some of the shares? If not all of them to for Tesla to that stock exchange, or maybe would you put, you know, SpaceX on it?

Marcus: Maybe would you launch SpaceX on it or something like that?

Vic: Right. Um, but there was some PE firms. That were in the story to that there were maybe maybe more willing to be public about it. Yeah, but just wanting more optionality, basically.

Marcus: Yeah. So, so, so I think I think the thing here is, um, that and the reason why I said all that is I think everyone knows Elon Musk is very anti D.

Marcus: I, um, and you know, they, you know, to Elon Greg Abbott is basically positioning, uh, you know, the Texas Stock Exchange as like a stock exchange for non woke companies, right? You know what I mean? So, so And

Vic: what is up with the NRA branding, like, in this background? I’m not sure. I don’t know, man.

Marcus: But, but, but I think the thing is that, um, a lot of people may not know that, Exchanges like Nasdaq actually have [00:29:00] requirements, um, for companies before they list, and they’re not all financial.

Marcus: Some of them are like board makeup. So, for example, Nasdaq, uh, says, you know, you must have one woman on the board in order to, you know, List on NASDAQ, right? That’s a, that’s a requirement to be on that exchange. Uh, and so, you know, whether you think that’s right or wrong, that creates an opportunity for alternative exchanges to say, we won’t create those kinds of requirements, right?

Marcus: It’s not, it’s not a requirement in America to have a, You know, a woman on the board. So why, why must it be a requirement on all publicly traded companies to have a woman on the board? And so that I’m just saying it creates the opening for alternative exchanges and also for more competition around trading fees and enlisting fees and all those kinds of things.

Marcus: So I, I think it’s pretty interesting. And. Look, Vic, from our, I mean, the Wall Street Journal, obviously, you know, this position is saying like, like, it’s

Vic: named after Wall Street, right? Exactly.

Marcus: So they’re saying a Texas stock [00:30:00] exchange wants to take on New York. The odds aren’t good from for you and I sitting in Nashville, Tennessee.

Marcus: I think

Vic: it’d be great.

Marcus: I think we have the opinion that the Southeast United States, I mean, we could just look at how our city is growing Southeast United States is. the hottest segment of the United States, whether you agree with the politics or you don’t from an economic perspective, from a business growth perspective, from a wealth accumulation perspective, from a headquarter relocation perspective.

Marcus: It’s, it’s the Southeast United States. I’m sorry. And even though Texas is kind of Southwest, Texas is basically part of that whole movement. Um, and so, um, I see this happening and I see, I think it’s going to happen. And I see them building a pretty strong set of companies that end up getting listed on this thing.

Marcus: And if anything, that competition could end up opening up NASDAQ and the New York stock exchange.

Vic: That’s where I was going to go. You know, even if you don’t list there. The presence of another stock market [00:31:00] will be healthy. Yeah, it’d be healthy for nasdaq. And I think it I think it’s a good thing to have women on the board diverse on the board is good But you could do that in the texas stock exchange.

Vic: You’re just not required. It’s not like you can’t list right, right um, they’re just they don’t like all of that prescriptive like somehow nasdaq is Directing us to do something that we’ve decided we’re not ready to do. We can’t find a candidate or whatever the reason is. I think more options are better for venture backed companies, for investors, for everyone, except NASDAQ and NYSE.

Marcus: Yeah. I mean, look, the theme here is that over the last three years, IPO window, after, after SPAC land happened, IPO window has. Basically been shot. I mean, we have an IPO here and there, you know, but for the most part, and a lot of companies going public, which means that a ton of value is trapped in the private markets.[00:32:00]

Marcus: It’s aggregating at the top amongst growth and growth equity and private equity, right? Um, and Realizations have slowed significantly. Distributions have slowed significantly, right? I mean, our asset class overall is struggling because of the consolidation of the public markets into 10 companies.

Vic: Yeah.

Vic: When I, when I started at Massey Birch in 2000, the plan was to take how many public as a financing method. Wow. And then, and, and it was a hundred million dollars to 200 million market cap. Yeah, right. It was small and. You weren’t, the VCs were not leaving, like, you were not immortalized, it was a financing transaction.

Vic: It was part of the financing pathway, is what you’re saying. And then you would be acquired by a strategic acquirer. Wow. And that doesn’t exist anymore. No. That’s not a, that’s not a thing now. No. And the change is Sarbanes Oxley, I think. Yes. [00:33:00] All of the requirements, reporting, which, Thanks, Enron. Which were needed after Enron.

Vic: I think it went to like too much red tape cost bureaucracy and just the level to go public went first, it was like 750, then a billion. Now it’s more than that. So I love London and Texas stepping up and having alternatives.

Marcus: Well, I mean, the truth is right that liquidity will find a way, right? It’s going to find a way.

Marcus: And if it’s trapped in, In New York, it’s going to go into London or Texas or crypto or, right. I mean, like, like it, but the liquidity has to find a path to like grow. Um, it can’t be trapped and it can’t be stuck. But, and you know, the other problem with, with, with wall street is it’s a closed game. You know, there’s five IBs who do all the IPOs.

Marcus: There’s a short list of people who ever get access to [00:34:00] secondaries. It’s like, it’s, it’s a, it’s a closed game. You’re not going to play that game.

Vic: No, that I would, we could go play in London or, or Dallas. You mean Dallas or

Marcus: maybe Texas? I mean, seriously. Right. I mean, I don’t care where it’s listed. So anyway, I, I think this is.

Marcus: A great development. I agree with you. Um, even if I, I think the Nasdaq, you know, uh, requirements for boards are great, even if I think that I think competition is going to, um, force this market to open up some, um, and we do, we do, we need this market to open up some. Um, all right. I think it was a good time for us to take a break, uh, share a little bit about jumpstart foundry when we get back, we’re going to get into our.

Marcus: Uh, look at policy.

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 [00:35:00] investing. Certainly the need 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 to invest to help us make something better in healthcare.

Doug Edwards: 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 Dumpstart, and we invest in the most incredible, robust, Innovative solutions and founders in the United States.

Doug Edwards: Over the [00:36:00] last nine years, Jumpstart Foundry has invested in nearly 200 early stage, pre seed stage companies in the country. Through those most innovative solutions that Jumpstart Foundry invest in, we also provide great returns and a great experience for our limited partners. We partner with AngelList to administer the fund, making that ease of access, not only with low minimums, but the ease of investing in venture much better.

Doug Edwards: We all know that healthcare is broken. Join Everyone deserves better. Come alongside us with Jumpstart Foundry, invest in making the future of healthcare better and make something better in healthcare. Thank you guys. Now back to the show.

Marcus: All right, unpacking policy. So CMS projects, national health spending grew 7.

Marcus: 5 percent in 2023 to 4. 8 trillion. So Vic, when you and I started, 10 years ago, uh, and you were teaching me a lot about health care 10 years ago, because I didn’t know. I just knew tech. Um, I believe the number was 2 trillion.

Vic: Yeah.

Marcus: [00:37:00] Am I right? It was 2 something. It was in the twos. Yeah.

Vic: We always used to say 2 trillion.

Vic: It was like 2. 2, 2. 3. But it was safe. Conservatives say 2, because you knew it was more than that. Right. And then, sometime before the pandemic, I started switching to 3. Because it, it just had gotten closer to three, one wasn’t two anymore. Yeah. But now it’s, it’s

Marcus: almost 5 trillion. Well, I mean, basically if it was 4.8 in 2023, it’s five now.

Vic: Yeah, that’s right. Because it grew at seven point a half percent in that one year. Right. So another, and we know what infl

Marcus: inflation alone. Yeah. Inflation alone, it’s five, it’s 5 trillion. So we are now at $5 trillion in spending in healthcare.

Vic: Yeah. Which is, it’s hard to even get your head around how much money that is.

Vic: Right, that, I think that’s 5, 000 billion. Yes. Is that right? Yes. Um, which I don’t even [00:38:00] fully understand what a billion is, but it’s, it’s a lot of damn money. And that’s in one year. So it’s, um, it’s hard to comprehend and it doesn’t seem like it’s used in all the right places, but I don’t know where to cut.

Marcus: This is a big market. Yeah. Yeah. Lots to lots to do. There’s a big, big, big market. All right. The Biden administration advances plan to remove medical debt from credit scores. So this is an interesting one because like when I heard it, I immediately went to, that’s a good idea because like, you know, medical debt is like the number one source of bankruptcy.

Marcus: The

Vic: number one source of bankruptcy is a lot. We’ve done a story here a couple weeks ago. Yeah. A lot of pain and suffering and hardship if you get a cancer diagnosis or really any significant diagnosis. Right. Um, yeah. It’s, it’s really bad. And yet, if you take it off the credit scores. [00:39:00] Is anyone gonna pay

Vic: Like why would you

Marcus: pay? I like, as soon as you said that, I was like, duh. You know, like, you know, you always have to, it’s economics always like, where’s the incentives? Right, right. And it’s like, oh yeah, you’re right. Like if it’s not on my credit score, why would I pay? Like, like I would pay because it’s the honorable thing to do.

Marcus: Yeah. Right. But there’s no real penalty. Like my credit score is my only real penalty for not paying for something. Right. Yeah.

Vic: And then maybe you wanna go back to the. Hospital, I mean, sure, but that’s going to be pretty far out of mind right now. So and also

Marcus: hospitals rarely turn people away. Yeah, for coming through.

Vic: You do that. Can’t do that.

Marcus: Exactly.

Vic: Yeah. So I understand Biden hearing constituents in various lookouts being really upset about it and understand it’s an election year. And this is going to be really popular in the with the voters. [00:40:00] But I don’t know how it actually could

Marcus: work. I mean, it’s popular with some voters.

Marcus: Uh, I don’t think it’s going to be popular with all voters much in the same way. I don’t think, you know, um, forgiving student debt was popular with all voters.

Vic: Everyone who. Had to work hard to pay their bills over several years last year. Now I don’t necessarily want you to get off it free. It’s one of those,

Marcus: it’s one of those kind of kind of issues, right?

Marcus: That, um, I don’t, I don’t even think it’s, it’s, it’s a purely, um, party line issue either. It’s, it’s more of a like, Why should you get off? Because I had to pay mine, right? Do I, do I get a refund or something? Right. Um, so anyway, interesting, uh, strategy leading into the, into the election. I think the big story though, is that Medicare.

Marcus: It’s going to recalculate the quality ratings of Medicare Advantage [00:41:00] plans. So back in October, November, when the Medicare Advantage rule came out, you and I had to do, we had to call in Emily and say, we got to do like a big story about this because a lot of change.

Vic: And, and directionally good. I mean, they, they were trying to get the payers to focus on better outcomes, better customer patient member engagement.

Vic: In a bunch of different ways.

Marcus: Yeah, well, they framed it as we went through an introductory period with the Medicare Advantage program. And during that period, star ratings were generally more lenient. Yeah. Because obviously people, it’s a pilot. People had to kind of create capabilities and we had to build a market.

Marcus: You have to incentivize people to want to be a part of the market. All this other kind of stuff. But, but that now was the time to revisit and adjust the star ratings and really start to tune for more quality and more value [00:42:00] creation in exchange for, you know, reward payments, and that was met with shock.

Marcus: By the pair ecosystem, you know, it was as if they didn’t know that this was coming at all. Now, I’m not, I’m not deep enough in it to say whether or not the messaging here was insufficient or they did not give people the kind of, hey, we’re on a 24 month wind down. You know, it felt to me like it was pretty out of nowhere.

Vic: I think it was. A year to two years faster than anyone predicted. It feels that way. Based on the response. So, but I don’t know that equals they’re not a lot. They don’t have the authority to do it. Well, okay. So, but they’ve lost three court cases. So, uh, Elevance scan and blue cross of Georgia, all sued in various, uh, state or district courts claiming [00:43:00] that it was It’s an unfair change to the policy or similar and all three won.

Vic: And so today, CMS has, it’s like a do over like, uh, sorry, let’s just roll back. We’re not doing any of that anymore. We’ll pay you all the money back. Um, sorry. And it’s a lot of money. I think Humana is going to get 150, 000, 000. Um, Scan is getting 250, 000, 000. It’s a significant amount of money.

Marcus: Alright, so we, we, we have to talk about this for a second.

Marcus: So, we spent months basically saying Medicare Advantage is screwed. The whole industry, everyone was talking, Oh my God, Medicare advantages grew. Cigna called off their humanity went away from it. You know, Bruce Broussard, CEO of Humana, former CEO of Humana at this point, you know, said, uh, you know, we, we have to [00:44:00] downgrade all the projections, all this stuff and sorry.

Marcus: Oops. No, that’s all wrong because CMS can’t win in court. Just like the FTC can’t win in court. Just like the SEC can’t win in court. What is going on that the Biden administration’s agencies can’t get anything done like they propose these things, and then they get sued, and they are losing in court.

Vic: Yeah, and so there’s there’s two sides.

Vic: I don’t know which side I believe. So let me just lay out the two sides, and then we can talk about which one we think. I think that the Democratic agencies. led by Biden, and, and he appointed everyone to them, [00:45:00] maybe are trying to push policy that is overreaching. That’s one side of the argument. And the courts are neutral and unbiased, and just sort of calling balls and strikes, and they’re overreaching.

Vic: That’s one frame of reference. The other frame of reference is the Biden administration is trying to execute their duty of. The executive branch, and the courts are overly harsh, overly conservative, they are much more Republican appointed, broadly, I mean there’s certainly differences, and they are unfairly pushing back to try to legislate from the bench.

Vic: Those are the two sides. I don’t know, I’m sure it’s some of both, but it’s, it’s, it is a consistent theme that whether, whoever is, is in the wrong, and I think it’s probably some of each, [00:46:00] the courts have like the, the last say. So, so you, you get a temporary thing with executive action or an FTC, um, try to stop a, uh, But, but the courts have the end of the day, so it’s like a speed to market the agencies have, but then if they can’t get it through the court system, it doesn’t actually take effect very long.

Vic: But it’s just, it’s really dysfunctional. It’s not a good way to run a country.

Marcus: Yeah, well, I mean, so I think that the, the Republican Party has, uh, they figured out a couple of things. That the Democrats are very behind on. Uh, and I think those things are that, one, winning state House and state Senate elections is really powerful.

Marcus: Um, and also [00:47:00] focusing on winning state judges, circuit judges, and state Supreme Courts is really valuable. And stacking those things. And I think It really is a bit of a, um, it’s a bit of a kryptonite to losing the, the white house, right? It’s like, if you look at the combination of the Supreme court and then these circuit courts, like how much does it matter that the white house?

Marcus: is democratic if the agencies cannot push an agenda through they cannot now first of all now you might say what the hell are the regulatory agencies doing trying to push any agenda through the regulatory agencies they don’t they have no business doing that right that’s that’s also that’s also a position you can take

Vic: well i mean that right that that’s that’s why i [00:48:00] tried to frame it as the two different points of view like you could say cms’s job Is to steer Medi Medicaid and Medicare through Medicare Advantage.

Vic: In a way that will deliver better outcomes and better patient care. I think that is their job. Now, whether the star ratings came on too fast or were too harsh or were too anything, we can debate. But if you just take CMS, which, you know, it’s a healthcare show, I think clearly it’s within their mandate to work on the star rating, work on the Medicare Advantage system, and how they pay, how they reimburse claims.

Vic: If they do things that are overreaching, like they have, I mean, I don’t know what the facts are. Most policy, there is a lot of telegraphing. We’re gonna change this in 24 months. We’re gonna change [00:49:00] it in 18 months. We’re gonna change it in 12 months. No one is surprised. Right. And there definitely were a lot of payers that were surprised.

Vic: I mean, I had portfolio companies that got calls from payers like, Oh crap, we need, we need this service. Can you help? Which the answer was yes. Right. But that doesn’t usually happen. And so I think there was a timing issue, but the bigger question is, Um, you know, is it gonna change when the Republican Party really for, um, the whole abortion issue?

Vic: It was a 25 year, 25 year long term plan with people that funded, you know, everything. In quotes, educational sessions with law school students because they knew that in 15 years, they’ll be important to have, you know, indoctrinated, I’m saying that maybe [00:50:00] overly harshly, but it was a long term strategy. So I think you could reverse it, but it’s going to take 20 years and take a long time.

Vic: It’s going to take a long time. It’s going to take a long time. I mean,

Marcus: I think for me, it just It is driving a whole nother level of skepticism around agency action and agency rulemaking, right? Um, when the FTC chief says we’re going to do X, Y, Z, When the SEC chief chair Yeah. You know, Gensler says, you know, Ethereum over my dead body.

Marcus: You know when, when CMS says, Hey, we’re updating ? Yeah. The star rating, it’s kind of like, we’ll see what the court has to say about it. Right. I mean, and that, that was not my. My thinking going in, but now I’ve just seen it would be one thing if we were just watching CMS, but we are watching across agencies, right?

Marcus: And so we’re seeing a pattern of the agencies [00:51:00] losing

Vic: what they need to get their act together.

Marcus: Well, get there. What does get their act together? I mean, I mean, they, they have decided this is the thing that I, that, that we care about. This is what we’re going to focus on. This is our position and they can’t get it done.

Marcus: I mean, what, what would get it done? What would get it done?

Vic: I’m going to say something that’s political, and hopefully it’s okay. We might get a lot of comments. I think Lena Khan is trying to build her own personal brand.

Marcus: She was appointed to the FTC chair. All regulators are trying to build their own personal brand.

Marcus: So that’s not unique to her. She could

Vic: have picked fights that were easier to win in court, I think. And built up some momentum instead, she has gone after really high profile things with not airtight cases

Marcus: hired based on her whole thesis around Amazon, like, so, so she Yeah, but [00:52:00] so maybe she wasn’t the right person to a point, right?

Marcus: It’s right. In that case, this is election issue. You can’t blame her. For who she is. Yeah. Yeah. She, she came in with that agenda, right? Yeah.

Vic: Well, the, the, the FTC and the SEC both are,

Marcus: and she was clearly put into that position because people expected her do what she was, they wanted her to, they wanted her to take on that, that agenda at the Ft C level.

Vic: In that example, I think a lot of that was overreaching for what is actually. Preventing competitive markets. When

Marcus: you say overreaching, do you mean, like, I think what you actually mean is If you had played it out from a game theory perspective, you would have seen you wouldn’t have been successful with that.

Marcus: Yes, so you shouldn’t try that. And so you should have picked, you should have picked something that game theory would have given you a better chance at actually being successful with. Is that what you’re saying? Yes,

Vic: that’s what I’m saying.

Marcus: And, and, and, and, okay, so that’s [00:53:00] interesting. So would you then say that is true for what happened at the SEC and what happened at, uh, here in CMS with, with the star rating?

Marcus: Yes, Because you like the star rating adjustment.

Vic: I

Marcus: like the star

Vic: rating adjustment. I think it, the only thing that I would think could be questioned is the timing of it.

Marcus: And I don’t know. The timing is a big question though. Yeah.

Vic: It’s

Marcus: a big question.

Vic: Right. So I like the star rating changes. I think they’re needed.

Vic: And if you can’t get good reviews because your members don’t like the service. In my opinion, you should not get bonus payments. By definition, you’re not as good as other ones that do have the five star rating. I haven’t looked into the court cases to understand, like, how they were settled, but it did happen much faster than I’ve ever seen it occur in CMS policy before.[00:54:00]

Vic: I think that is I think CMS has done a decent job. I, I like CMS. I think they, they have a hard job. They’re doing the best they can. It’s really interesting. I mean, we talked about it last week, the, the changing of the, like the Medicaid state supplemental payments. To help rural communities stay afloat and keep delivering care is pretty smart.

Vic: And I think within their rights to change that policy, that’s free money coming, so no one’s going to really fight that. FTC and SEC, like the whole crypto thing, it started in 2017. With people trying to get definition on what is a security, we have this new thing, coins. coins. And I think a lot of them should be classified as securities, but not all of them, it depends on what they’re used [00:55:00] for.

Vic: And the SEC’s job is to give some clarity there. Yeah, and they avoided it. And they just avoided it.

Marcus: I mean, they actually did worse than avoid it. They threatened, they

Vic: threatened, but then they didn’t give

Marcus: clarity. They trapped people. They said, come in and talk to us. And then when you came in, they like, they like issued sanctions against you.

Marcus: I mean, it was, it was terrible. Right. I mean, the behavior was. really, really bad. Um, anyway, so, so let’s, let’s pivot

Vic: to, well, anyway,

Marcus: I’m in the same place as you episode two of health further. We started talking about the Chevron deference doctor. That’s right. Episode two. Uh, and then somewhere in the thirties, we brought Emily in to give us like a really deep sort of review about what was going on with it.

Marcus: We talked about how Scalia’s son, uh, had written that. That, uh, op ed in the, in the journal basically saying Chevron’s done, um, and, uh, you know, basically the agencies are about to [00:56:00] get, you know, their, their legs cut off from under them. And it feels like, to me, it’s not even necessary because the courts are already dealing with it.

Vic: And I have to say that this would not be as important if Congress would get their shit together and actually be able to pass anything. I don’t see that changing. So part of the reason that the government’s not functioning very well is the whole group that’s supposed to be writing laws isn’t doing anything.

Vic: And so, but yes, the political came out with a summary of kind of what to expect. They have, the Supreme Court has not come out on the Chevron doctrine yet. It’s sometime this summer. I don’t know exactly when. Um, it seems like Politico is saying that they may not end Chevron, but even if they don’t, they’re, they give three different options of how they could modify it to make it much more narrow of a sort of deference to [00:57:00] the agencies.

Vic: So it seems like maybe there’s not clarity on that it’s going to be, you know, Exactly overturned or reversed, but but eroded or constrained in some way.

Marcus: Look, yes, I expect it’s going to be certainly diminished if not destroyed. Um, but I think there’s a there’s a bigger issue here, which is, I think, specifically, it feels to me like Democratic administrations. are impaired in their ability to drive their political agenda through their agencies because of what’s happening at the circuit courts up to the Supreme Court.

Marcus: Yeah. And the court system, right? And the judicial system. Yeah. And that is a branch of And you can change that, but not quickly. American body politic that we have [00:58:00] not thought about that much until the last Like two years, right, but now it’s like, I think we got to think about it a lot more.

Vic: Yeah,

Marcus: I think we got to think about it a lot more because,

Vic: uh, I mean, we don’t want 70 percent of our just of our judges across the whole system to be either party.

Vic: And I think it’s something like that now where they’re they’re sort of republican leaning

Marcus: I I think we just did not think about the justice system having a partisan Bend to it for a very long time and and now

Vic: Democrats

Marcus: didn’t

Vic: I think republicans very intentionally. Well, well the right to life The right to life people did that’s not really republicans as much as the the religious right to life Yes, which is not a huge You Segment, but a very, uh, but they are embedded in the Republican party.

Vic: Very [00:59:00] well financed and very loud segment. Yeah. Embedded in, and embedded

Marcus: in

Vic: the Republican

Marcus: party. Yeah. That’s where they’re embedded. Yeah. I look I to, to me this was a, this particular Medicare thing. The other things I was like, I, I, I was kind of more with you where I was like, okay, you know Lena Khan, you should be picking better battles.

Marcus: Mm-Hmm. , you know Gary Gensler. This is like silly, you know, the Ethereum thing. Why are you against this? This makes no sense. But this CMS stars bit. Right. I mean, to me, the fact that CMS just lost this and basically we’re going to have a windfall of, I think, billions of dollars, right? It’s about to flow back into Medicare Advantage to the payers and Medicare Advantage is like back game on.

Marcus: Yeah, it’s back game on, right? I mean, total reversal that to me. Is like, uh, okay, we, we have a different landscape now, we have a different landscape and we need to start really studying these, these courts, you know, I want to know what courts [01:00:00] there, you know, these agencies are losing in and I want to understand them better and who’s sitting in these courts and who are the judges that are making these decisions, um, you know, because this could be a much bigger challenge for the Democratic Party going forward, much bigger, and that’s got implications for our industry.

Marcus: It really does, you know.

Vic: Yeah,

Marcus: there’s no question. All right. Moving into care in our communities, uh, Baltimore, they are, uh, piloting a program where nurses are going door to door, uh, bringing primary care to the whole neighborhood. And it is modeled on, um, the approach to healthcare that has been, uh, much talked about and studied in health reform circles from Costa Rica.

Vic: Which on one hand, I think it’s great that. They’re doing this in Baltimore. Baltimore needs better health care, better public health, like services in the community.

Marcus: Baltimore also needs like a [01:01:00] lot of community healing. So I like the idea of like actually going out and engaging in their communities. Right.

Vic: Yeah. So I, I’m very much in favor of that. And, and I think public health, whether it’s delivered by traditional providers or the government or payers, I don’t care who delivers it. Public health things, There’s no question that the cost benefit is, is very positive. We should, we should pay for public health things all the time.

Vic: And so I think that is great.

Marcus: And, and it’s, it’s noteworthy because in America we have not, we’ve opted to really shift away from public health, you know?

Vic: Yeah, that’s right. And so I think it’s great that they’re, they’re doing this in Baltimore. I was surprised you knew about it. I was surprised that the model is.

Vic: 30 years ago in Costa Rica, they did this. [01:02:00] What that means to me is we have known about it. I haven’t known about it, but people have known about it for 25 years. And we now are testing it out in one city, but it seems like pretty. Straightforward. Why did it take so long? And is America really having to copy Costa Rica?

Vic: I guess we are.

Marcus: Well, I, okay, so this is one of those things that I would not know if it were not for the Aspen Health Innovators Fellowship. So, I learned about this because we, we, we, we read about it, um, because Atul Gawande, um, who’s known for, you know, the checklist method, and You know, he was hired to lead Haven, you know, he’s a luminary doctor around health innovation, health reform.

Marcus: And how do we make our healthcare system better? Um, he, he went down to Costa Rica and he studied this and he wrote about it and then it ended up getting, you know, covered by the New Yorker, et cetera. We’ll, we’ll put a link in

Vic: the show notes. Yeah.

Marcus: Yeah. But, um, you know, this is, he, he [01:03:00] went down there and he studied it and, you know, Basically, it was like, it works.

Marcus: Guess what happens when you actually invest in your public health system? Guess what happens when you actually bring doctors and nurses and clinicians into people’s homes, kind of like we used to do back in the day, you get good results, right? You know, you get people actually, you know, feeling like someone cares about them and communicating about what’s going on and actually adhering to the guidance they’re getting from their.

Marcus: They’re, they’re clinicians, right? Um, and also, there’s real relationships. You know, people are serving the people in their communities. I mean, you think about the way that our system is set up today. Urgent cares, it’s very retail like. Everything moves into hospitals. It’s like, these people even, you know.

Marcus: When’s the last time you went to a doctor who actually, like, knew, What’s going on in your family?

Vic: Yeah, well, I mean, because we’re in Nashville and I’m a privileged guy, but most people do not have any relationship with their, their That’s right. That’s

Marcus: right. [01:04:00]

Vic: I shouldn’t be asking you that! Quick promo, I have a guest show coming out probably next week with my cardiologist who I’m buddies with.

Vic: But that’s not It’s very commoditized, almost like an assembly line. Like, you see the doc for seven minutes, then he moves on to the next one. And they do the best they can in that short amount of time, but it’s super tight. It’s industrialized. Yes. It’s industrialized. It’s industrialized. It’s not,

Marcus: it’s not, it’s not.

Marcus: Communal, right? And I think that, look, when you read the Atul Gawande study on what happened in Costa Rica, the main thing you walk away with is, it’s just communal, you know, I mean, it’s public health, but it’s, it’s a little deeper than that, right? I mean, it’s a, it’s a fundamental difference in the cultural approach to what it means to care for our neighbors.

Marcus: And our community members. Right. And so I look, I love that is happening in Baltimore. I think that’s a, it’s a great city to, to, to try to get that done in. [01:05:00] Um,

Vic: and we should try to replicate it in other cities. I mean, we could use it in Nashville. We could use every

Marcus: city could use it really for sure.

Marcus: Absolutely. Totally agree. Um, all right. So, cool. Addis Home Care is going to buy Gentiva’s personal care biz for 350 million. So this gets back into the home care, except for on the much, much larger side, multi state, um, uh, provider, uh, CDNR was the, the backer behind Gentiva. Um, they were the largest, uh, personal care provider in, um, In Texas and are headquartered in Atlanta.

Marcus: And so Addis home care, which is a NASDAQ traded company has acquired them. So this is consolidation. This is a big private equity win. Um, and sort of just more around the growth in the hospice, home care, personal care, caregiving space.

Vic: Yeah, that’s right. It’s, it’s consolidating because you need to have scale to be able to.

Vic: To make the business work and so we’ve covered on the show [01:06:00] before there’s probably three or four big. Almost nationwide players that have several regions, and then it falls off pretty dramatically to, to regional or even state to state things. Um, but the home care space is still very fractured, and I think it’s going to continue to consolidate more and more.

Marcus: Yeah, so anyway, congratulations to, uh, to CDNR, uh, and our friends there on, um, on an exit here. Uh, more consolidation. This, this, this is an interesting space. Um, you know, I think that there, there are people in the home care space we could start to bring on as guests. I, I, yeah. I do think there’s a lot to unpack in Yeah.

Marcus: In, in this space. And so, you know, this is, this is a noteworthy acquisition here. Um, but also I think just signals, there’s a lot of movement happening in the home care space. Yeah. Alright. Uh. Closing the loop on Ascension’s cyber security event, uh, I think you commented they’ve done a tremendous job in terms of their communication on this.

Marcus: Yeah, they

Vic: really, it’s a [01:07:00] best practices kind of thing. Very open, honest, I mean they didn’t always have great news, but today it is. Pretty close to finished.

Marcus: Yeah. Yeah. So, you know, if you go to the Ascension page, they’ve they’ve got a sort of a full Update on what’s happened. Basically, they figured out that it looks like it was One of their employees just, you know downloaded and and

Vic: yeah clicked on a file that we all know We shouldn’t click on but sometimes I open an email I don’t really pay attention and I’m just opening whatever was sent to me.

Vic: That’s right. I can easily And they say in here that they believe it was just an honest mistake, but it caused You know, decent amount of chaos, right? Well,

Marcus: yeah. Yeah. So, so look, I mean, uh, right now They’re saying they have no evidence that any data was taken from their EHR. That’s obviously great news Um, they are proactively going to provide credit monitoring for uh, you know, all the patients who have records So I expect i’ll be getting a letter Because i’ve been to st thomas before so I know i’m in the [01:08:00] system

Vic: And the the uh, the phishing scams are getting better and better.

Vic: My wife had a flight, uh, maybe a tuesday sometime this week Mm hmm And it was like early in the morning flight at 11 at night, she gets a text from American Airlines saying, sorry, your flight got canceled. Click here to rebook. And, you know, she’s like half asleep and luckily, I don’t even know why she opened up her app to try to see what the changes were because she thought that would be faster, but it wasn’t because she thought it was suspicious and there were no changes.

Vic: It was, and when you looked at it carefully, it was not exactly spelled right. The phone number wasn’t really the right number, but the, like someone knew that she had a flight on American the next morning. And so like, it’s in context and [01:09:00] pretty good. So I can easily see someone working and they’re in the middle of shift and they just, they just make a mistake.

Marcus: That’s, that’s rough. That’s rough. Um, well, anyway, uh, just. Happy that Ascension is pretty much on the other side of this. And, uh, you know, certainly congratulations on, you know, the work they did to track down what the source of the issue was. All right, our AI rundown. So Krista’s Health is deploying ABRIDGE’s generative AI tool for clinical documentation.

Marcus: Um, Abridge is basically one of, I think, two or three big leaders in the um, clinical documentation gen AI space. They’re, they’re really kind of cleaning up. So Krista’s Health is another big logo for their slide good to see

Vic: adoptions starting to flow through the, the channels.

Marcus: Yeah, I mean, I think we can clearly say that documentation is a viable use case for AI in healthcare, period.

Marcus: End of story. Yes, that’s right.

Vic: Makes, [01:10:00] makes sense. I don’t think anyone’s going to argue with it. And Revenue Cycle, I think is right on the heels.

Marcus: Yes, and probably will surpass but just won’t be talked about as much because it’s revenue cycle, right? It’s not patient facing Modern healthcare has a nice little rundown about healthcare AI investment being on the rise I would say, you know, they’ve got five talking points Some of these are just kind of silly.

Marcus: Uh, AI is winning over other tech investments. Uh, duh. Um, clinical uses for AI is a hot area for investment agree. Um, challenges lie ahead with regulations and payer approval, obviously. Um, but the, the fifth one I think is, is the one that. Caught my eye, which is fewer funds will close, but the sum raised will grow.

Marcus: So, uh, Silicon Valley bank, which is where modern healthcare pulled a lot of their data for this, uh, this five point list. Um, I guess put out a report. It used to be, you could like go to Silicon Valley bank’s website and they just would give all this information away

Vic: to you can’t anymore. Yeah.

Marcus: The, the, the new website, the new [01:11:00] owners, yeah, yeah.

Marcus: They’re trying to rebuild their, their bank, their book of business. But anyway, um, yeah. Silicon Valley Bank has predicted 66 global venture capital funds focused on healthcare AI will close this year. When we say close, it doesn’t mean go out of business, it means they’re going to have like

Vic: There’ll be a new fund.

Vic: There’ll be a new

Marcus: fund. Yeah. Um, compared with 68 funds in 2023 and 101 funds in 2022s. So as we know, 2022, that was still the good time. Lots of capital was rolling in. Lots of new funds were getting launched. Um, obviously there’s been a, you know, pretty much everything’s been cut in half since then. So that’s not that that’s surprising, but, uh, they are, they’re expecting 16.

Marcus: 9 billion in funds raised, um, this year, an increase from 9. 7 billion in 2023. So that, that was a little bit of a. You know, I open to me. I look last year was the worst year to raise a fund. There’s no question about that. [01:12:00] Um, this year is not that much better feeling, you know, but, but it, but it’s not last year and it looks like for AI, um, funds are rolling in, funds are rolling in from LPs.

Vic: Yeah. I, I was surprised at the magnitude, but I’m not surprised that the funds are getting bigger. I mean, there just are a lot of institutional investors. Yeah. That are trying to deploy capital and they only want to be in the top tier, however they define that top tier VCs. And so it just kind of concentrates capital with a smaller number of funds.

Vic: Now we’re obviously biased cause we run a seed fund that is small by design small, but, um, I think it’s harder to deploy that money, especially in, in the markets getting reasonable valuations, but, but I don’t know that that really plays that much into the. The calculation, I think they’re just trying to deploy capital.

Marcus: [01:13:00] All right. Final story. Um, this was WWDC week for Apple, um, their big worldwide developer conference. And, uh, it’s always a big deal because they roll out a bunch of new tech and skydivers

Vic: come in and all kinds of stuff. Yeah.

Marcus: It’s, you know, all the new things that you’re going to be able to build on Apple’s new versions of Mac iOS, iOS, and iPad iOS, that’s kind of the focus.

Marcus: And this year, of course they had to. talk about AI. And so, what did they do? They rolled out AI as Apple Intelligence. Yeah. And, um, for the most part, uh, they tightened up some aspects of iOS, but the big announcement is really that they’re partnering with OpenAI.

Vic: And that they are going to have pretty commonly available AI services that are available in their newest phones coming out like for Christmas.

Vic: Thanks. [01:14:00] Siri will get an update, maybe by Christmas, maybe next year. It’s kind of slow. Um, they, they’re going to have the, kind of the base, the base, Use cases stitched together where you can open your phone and get an email summarized and then tell it to respond in a similar tone than the last one you did.

Vic: So all like the, the general population, the people that are Apple customers, which is a lot, which is a lot, they don’t need the cutting bleeding edge, some, some new model. It’ll be good enough. And I think that was, that was received well by wall street. Just the fact that they. are not ignoring it anymore, I think the stock market liked, so the stock was up significantly.

Vic: I think we should talk about, like, how the market is evolving and Apple has avoided any [01:15:00] significant capital investment. Yep. And yet they seem to be, like, fast following You know, in a pretty smart way, and is that going to come back to bite them or not?

Marcus: Well, I’ll just tell you as an Apple buyer, um, I am nowhere close to ditching Apple.

Marcus: So, they’ve got me in terms of the hardware, the integration of the hardware, um, and that’s where they make their money. Right. They don’t make their money in software. They make their money on their hardware. Yeah.

Vic: But what has been worrying people is the upgrade cycle is getting longer and long. People are not getting every phone now.

Vic: Maybe the hope is with these new tools, they

Marcus: will, I fully understand that. But I, I’m just saying like the AI issue with Apple, right? The AI issue with Apple. [01:16:00] Apple, their distribution capability comes through their hardware. And then subsequent to the hardware, the integration between macOS, iOS, and iPadOS.

Marcus: It’s, it’s, it’s, it’s amazing. You know, and whatever this watch the OS is, right, you know, but it’s the integration of all these apple operating systems on the hardware that is just on matched. So if you care about that. Yeah, it’s really sticky. It’s really, really sticky. And for me, it’s like, there’s no way.

Marcus: I mean, I have an Android phone that I’ve used largely to like, keep up with Android because I’m a technologist and I don’t want to be left behind. And I want to know if Google’s doing something kind of cool, but I’ll just tell you, like, in terms of integration of hardware across desktop, laptop, you know, uh, tablet phone watch, there’s nothing remotely close to that.

Marcus: Right. And so I. I [01:17:00] say all that to say it’s a totally fine strategy for them to not go all in and let everybody else burn all their capital trying to figure it out and for them to just be the distribution channel via their hardware. I don’t, I don’t think they need to figure out, you know, and, and let me just harken back to.

Marcus: Uh, a similar worry that people had. I remember when everyone was worried about Facebook because they didn’t have a phone. Yeah. You know? Oh, Facebook, you need a phone. Facebook, you need a phone. No, they don’t. They have the social graph. Right. They don’t need a phone. They don’t need a phone. Like, they are still the number one social networking platform.

Marcus: Right. Over a decade later, after trying to do a phone and realizing they’re not really phone makers, you know, it’s not really what they do. So I, I think what I think is going on is we are in an AI hype cycle. Okay. Now AI. It’s very real, but the hype [01:18:00] cycle causes weird analysis, right? And an outsized value being associated with it and a diminishment of non AI value.

Marcus: Which I think is just great buying opportunities, right? You know what I mean? Like if you, if you understand the fundamental stickiness of Apple and you feel like their stock price is getting dinged because they’re not directly in the AI game, you should be a buyer, right? You should be a buyer because I don’t think somehow AI is going to totally disrupt Apple.

Marcus: You got to, again, it’s a long walk. It’s a long walk.

Vic: Yeah. So I agree with that. I think it’s similar to the internet where there was a Incredible hype cycle with all kinds of websites for everything and spending tons of money, a super ad just for a website and then that crashed. But it also wa is true that the internet [01:19:00] changed the entire economy.

Vic: Yes. And I think AI will be the same. I think the hype cycle has a function in that it, it. It gets all of the infrastructure put in place, all of the chips, all of this data center. It’s all being, it’s all being laid down. Now, to me, that doesn’t mean that the leaders today are going to be the eventual winners.

Vic: Like in 99, Facebook and Google, maybe Google existed, but, but Facebook and all the, all the big winners of web two weren’t even around yet.

Marcus: Next year, when Apple rolls all this stuff out, Apple will create. The largest increase in usage of AI right in the in the world. Yes, yes, right. Like that’s that’s the power of Apple.

Vic: Yeah, right. The um, I guess the grief that I am carrying [01:20:00] around is Steve Jobs not around. So it used to be that Apple had the walled garden that was really good. And then they also had great product development, and they lost the product development. They don’t have that anymore. They just have the walled garden that is very well integrated together.

Vic: If you don’t want to think about it, you just buy Apple products and they all work. That’s right. And I use a Google Pixel phone because I want to. Play with it and all the stuff they announced, like the image changes and things that they’re toting is going to be great with AI. I mean, I’ve had my Pixel phone for a year and a half.

Vic: The Android phones do not have that integration easy. You have to be willing to, like, muck around with it and make it work, which I like to do, but most people don’t want to do. I mean,

Marcus: I mean, I, I like to do it. I just don’t have the time for it. Yeah. That, that’s a, you know, [01:21:00] apple is a time saver. The stuff that it, that it it does through these integrations.

Marcus: Yeah. Is just, it’s just magic and it just empowers me to do more things. So I, I agree with you. I, you know, look, the day Steve Jobs died was one of the most memorable days of my life in terms of a person dying.

Vic: Yeah,

Marcus: right. You know, I mean, I had, I had iPhone one.

Vic: Yeah.

Marcus: You know, I was on Mac OS X back in 2001.

Marcus: You know, I mean, I, I love what Steve jobs did. Yeah. Love it. You know, and, and no, Apple’s not as excited. They don’t have,

Vic: they don’t have that product development chops. They just don’t have it. No, it’s not as exciting as it was. It’s definitely not. But, and I think the big loser this week in my mind was Microsoft.

Vic: They were not because OpenAI is part because OpenAI, which is supposed

Marcus: to be Microsoft’s partner is partnering with Apple, right? That’s [01:22:00] the that’s the problem.

Vic: And so Microsoft has spent I don’t know how many billions of dollars with OpenAI and on their own copilot and other things. And it’s not clear they’re really differentiating from either Apple.

Vic: That hasn’t spent almost anything or meta that has spent some money, but then open sourced it to let the community grab it

Marcus: or Google that is rolling Gemini into workspace. And I think it’s going to be very competitive with office, like, like they’re, you know, they’re continuing to keep that parody on the comparison between workspace and office through the integration of Gemini,

Vic: right?

Vic: Right. And Google, Google, Microsoft have both invested a lot. But I think Google’s more like rolling it themselves. Yeah, right. Whereas Microsoft has this weird partnership that they don’t, they don’t really control Sam Altman and OpenAI, but they have this, I [01:23:00] don’t know what it is, like a partnership there.

Vic: Um, they own 49 percent of the profits, I guess, or some something. Um, so I don’t know. It just, it seemed to me that even though they’re, Maybe the number one or number two most valuable company in the world because the Office franchise is Prince Money. But I, I, I don’t know that Microsoft, I think it was a bad week for Microsoft, but no one deducted their stock.

Vic: I just.

Marcus: I, I actually like your, uh, I like your assessment there. I mean, I, I, I would say to me the biggest issue was OpenAI. Was positioned to be Microsoft’s partner and clearly Apple and Microsoft are competitive, clearly, and so that’s not great, right? That’s not great.

Vic: Yeah, they got out negotiated because the terms of the deal, obviously.

Vic: Didn’t [01:24:00] didn’t prevent open AI from doing doing a deal with Apple. Yeah, so we’ll see I mean it may not matter And we’re talking about whether you know, they’re number one or number 10. I mean, they’re all doing well, right? We’ll see.

Marcus: All right. Great show big. Yeah. See you next week