87 – How AI is Reviving Nuclear Power w/ The Return of Three Mile Island

[00:00:00] Marcus: 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. I have been in Atlanta and Charlotte and then back to Nashville this week. 

[00:00:14] Vic: Yeah, 

[00:00:15] Marcus: and I did those trips in 48 hours. 

[00:00:19] Vic: You're out on the road raising money man.

[00:00:22] Marcus: It's a fun 

[00:00:22] Vic: life. It's a glamorous life being a vc hotel room in charlotte is beautiful 

[00:00:29] Marcus: Thankfully in charlotte, I I uh, I have an aspen fellow who lives there Oh, and instead of staying in a hotel room. I got to stay with him. Yeah, which was so much cooler. So, um That was good and the trips were good. Uh, I went to atlanta to the steel sky ventures Lp meeting and maria And her team crushed it.

[00:00:50] Marcus: Awesome meeting, great networking, and then flew up to Charlotte for an Atrium Health event at Portal, which is their new center for diversity and entrepreneurship. [00:01:00] Um, that Manuel Bynum started. And that was awesome. Magic Johnson was the speaker. Oh, cool. And, uh, I mean, this guy is just crushing it. There's not a lot of people 

[00:01:08] Vic: that I am starstruck around, but Magic Johnson would be one of them.

[00:01:11] Marcus: He's And, like, as impressive as he is for all of his sports accolades, He's done business, a lot of business stuff. He is crushing business right now, dude. It's like Unbelievable. Yeah. Um, I do have to say that at this event, right before he went on, a gentleman, uh, had a pretty serious health incident happen.

[00:01:34] Marcus: Oh, in the audience? In the audience. Yeah. Like, looked like potentially a heart attack. Um, and everything sort of stopped. Everyone was calm. Probably no better place than, than there to have this because it's, it's, it's Atrium Health. Right. Literally the CEO of Atrium Health was there, knew the gentleman.

[00:01:53] Marcus: There were doctors in the room. Um, I, my understanding is that he got to a hospital and is fine. Got to an Atrium Health [00:02:00] hospital. He's fine. Uh, but it was, you know, it was one of those things where we're talking about business, blah, blah, blah. And then all of a sudden someone's life is in danger, like, you know, and it did, it just refocused everything a little bit, you know, um, around just what, what matters.

[00:02:20] Marcus: Priorities. Yeah. Right. And then, you know, we, we did go back to the event, but no one could. Look past what we had all just had this shared experience of, right? And so, yeah, um, I don't know. I don't even know why I'm telling you that other than just like, it's just what I've learned the last two weeks. You 

[00:02:39] Vic: know that I was focused on heart disease.

[00:02:41] Vic: I did my, uh, like stress test on my heart this week, which is pretty involved. I was over at Centennial, which is an HCA property. Great, great people. And they put you, they stress you. I mean, like, they get your heart rate up and basically monitor you all different ways. [00:03:00] 12, 12 lead ECG. What, what are they looking for?

[00:03:03] Vic: They're looking for as your heart rate spikes and you're under a lot of, you know, you're running on a treadmill at a steep incline. Yeah. Um, and they're trying to replicate. I mean, I work out a lot and my cardiologist, I think. rightly said, well, I need you to do this test so that when you're working out running a park somewhere, we know if your heart's having difficulties.

[00:03:26] Vic: And you can see like little issues as it gets under stress, as it starts pumping out 130, 140, 160, I think we got up to 168. Okay. Um, and it was good. I mean, the results were fine. My heart's fine. No, no problem as it gets stressed, but I guess as the heart becomes having to work harder, you can see. Maybe like any machine, it starts to have, you can see more easily the issues.

[00:03:52] Vic: I think I need to do that. Yes, I mean, if you don't have, um, any kind of [00:04:00] plaque, you probably don't need to. I have plaque. Yeah. And blockages and things, which would seem okay, I don't have symptoms. Right. But once you have known, you know Like hardening of the arteries or plaques. Yeah, then they the next thing is the next thing is that okay 

[00:04:17] Marcus: Well, i'll ask my doc about it.

[00:04:19] Marcus: I don't have plaque. Yeah, so you probably don't need to do it. Okay, okay 

[00:04:23] Vic: but i've gotten my Bad cholesterol down to 73. It was at 156 Holy cow, that's 

[00:04:30] Marcus: amazing statins are Phenomenal. I know I'm gonna seriously start exploring that. I mean, yeah, 70 

[00:04:36] Vic: is the level that I need to get below Okay, I'm like right on the edge, but but I feel good at me.

[00:04:42] Vic: I've made a lot of progress in last year That's awesome. 

[00:04:45] Marcus: All right. Well, I'm glad you're okay. I'm glad this distress test went. Well, I'm glad the gentleman. Yeah Recovering. Yeah, I don't know that he had a heart attack, but it Felt like that's probably what, what had happened. And, uh, I'm, I'm glad at least the last word that I got that he's [00:05:00] okay.

[00:05:00] Marcus: Um, and with that, we got a good show. Let's dig in.

[00:05:14] Marcus: All right. So we've got people talking about what the market is going to do, what the economy is going to do now that we have had our first, uh, fed, uh, rate cut. And it's funny that you pulled up this article because I was listening to a, uh, I was listening to a, it wasn't bankless. I think it was coin desk show.

[00:05:32] Marcus: They had Arthur Hayes on the bit max guy. He's always good for, for real contrarian take on things. And so in typical Arthur Hayes form, he was providing his contrarian take on how the market was likely going to do okay for like a Hot second, and then everyone was going to interpret the 50 basis point cut as a sign of a bunch of rot under the financial [00:06:00] system.

[00:06:00] Marcus: And then it would sort of tank the market. I don't think that's quite happened. Uh, yeah, and yet 

[00:06:05] Vic: it hasn't happened 

[00:06:05] Marcus: yet, but it, but it was, you know, It was at least a theory that I hadn't fully anticipated. And so something to sort of watch for, but this article is instead of, uh, coming up with different theories, it's looking backwards.

[00:06:18] Marcus: So looking at the, the last sets of, um, rate cuts all the way back to 1984 and trying to look one year from that rate cut, how has the market performed? Right. And, uh, in 1984, 1989, 1995, and 1998, we had, you know, the Great years after rate cuts from, yeah, from uh, 10% all the way up to 22.5%. Yeah. 

[00:06:41] Vic: I think that they took every first rate cut, so like when the fed pivoted to beginning the cut.

[00:06:45] Vic: Right. And then a year from that date. Right, 

[00:06:47] Marcus: right. Uh, but then if you look at, uh, the next two rate cuts, that would be 2001. Uh, and then 2007 the market did not do as well. Right now in 2001, we noted when we looked at this graph on the Wall [00:07:00] Street Journal article. It was already going down, but then you can see where September 11th happens, and then it really goes down.

[00:07:07] Marcus: And so, you know, there's no chance of it sort of recovering from that, but it was already headed down actually that year. Um, and then in 2007, that's a great financial crisis. So the first cut happens in September of 2007. And then from there, the market actually goes down 17, uh, 0. 8%. 

[00:07:23] Vic: And it didn't stop after a year either.

[00:07:24] Vic: It was several years to come back. 

[00:07:26] Marcus: Right. Um, and then the most recent, uh, The first cut was July 2019, right? And the market went up, uh, 8. 9 percent from there. But obviously, you know, we had, we had COVID and yeah. So 

[00:07:41] Vic: yeah. Yeah. So I like this way to look at the data because it's factual, right? There are a lot of people in press and podcasts and us trying to figure out where the market's going to go.

[00:07:54] Vic: Um, and I think this at least says to me, there's, there's. Two [00:08:00] different states of the world. The Fed is, um, maybe ahead of things and cooling down. Um, I mean, they have cooled down the market and now they're pivoting to everything is fine. Or they like in the. com crash or in the great financial recession, I believe the Fed was a little bit behind the curve and the, the negative impact of the economy was further than they were ready for, and so they, they were So there was a significant recession.

[00:08:33] Vic: And I don't know where we are today, but that's the debate. Is the Fed exactly on time or have they let it go too long? The rates were too high for too long and there's a lot of damage. 

[00:08:45] Marcus: You know, one thing that this, uh, this chart makes me think about is, you know, like Gen X talks about how much better life was in the eighties and the nineties.

[00:08:56] Marcus: When we were growing up, 

[00:08:56] Vic: yeah, we all remember the glory, uh, great [00:09:00] old glory days, but not true 

[00:09:02] Marcus: I'm, not sure that that's wrong. I mean all the rate cuts that happened. Yeah in the 80s and the 90s We came off of those 10 percent increase in 88 in 84 Yeah, 13. 9 percent increase in 89 and then the 90s forget about it the post internet 90s 

[00:09:19] Vic: Yeah, 

[00:09:20] Marcus: 22.

[00:09:20] Marcus: 9 percent market increase in 1995 after the first cut, and then 1998 22. 3%. So like maybe there is something to like things were just better in the 80s and 90s because once you get into the 2000s, it's like those rate cuts are followed by two, two times a down market. And then the 2019 one, okay, it's up 9%, but that's because of stimulus because that was COVID.

[00:09:45] Vic: Right? Yeah. I mean, I guess, uh, Paul Volcker and Alan Greenspan were the Fed Chairs, I think, during that time, maybe I'm missing one in the middle, but they're legendary Fed Chairs, I mean, maybe two of the [00:10:00] best regarded Fed Chairs in the history of the Fed, so yeah, I think they did a good job. I also think that the Boomers were in their prime.

[00:10:11] Vic: earning years and putting a lot of money into the stock market to get ready for retirement. The 401k whole thing really kicked off in the late 70s, but massive amounts of funds coming into the stock market. So it was a good time for a lot of reasons. Um, but I think the Fed also ran it pretty well then.

[00:10:32] Vic: So what's going on in China? Yeah, so this is what is a little concerning. China has been at zero inflation. We talked to them a couple of shows ago, even some parts deflationary and the government really pulled out every bag, every trick in their bags yesterday to try to stimulate the economy that they came out and said, they're going to do whatever it takes to hit [00:11:00] their goal of 5 percent GDP growth.

[00:11:04] Vic: They're not close to that right now. Their, their records are, I don't know how accurate their results are out of China, but they came out with five or six different stimulating tactics. Um, basically everything they could find to try to prop up, uh, loans to state, state owned entities, which are like sort of their, uh, providences and cutting rates and everything to do it.

[00:11:31] Vic: And it has helped in the last. Three days, the index for China is up like 10 percent in three days. Um, this I'm much more confident in the U S economy. Then I am the Chinese economy. Um, this could be a sugar high where you get a week or two of kind of everyone excited, but there actually may not be much pull through and growth, but I don't know, they're trying their best to [00:12:00] stimulate everything.

[00:12:01] Marcus: I mean, let's, let's just read a couple of paragraphs here. The Bank of China would reduce its short term seven day reverse repo rate, the central bank's main policy rate, from 1. 7 percent to 1. 5%, that's one thing. It would also cut the reserve rate. requirement ratio, the amount of reserves lenders must hold by half a percent, 

[00:12:21] Vic: which has a huge multiply.

[00:12:23] Vic: Oh my gosh. That's a, 

[00:12:24] Marcus: that's a, that's like a big fulcrum right there. Right. Also signaling a further potential cut. So like made a cut and then we're signaling we're likely going to do another cut, uh, this year 50 basis points. And they're going to add 142 billion. dollars of liquidity to the banking system.

[00:12:45] Vic: Right. That's what I meant. Like everything in the bag of tricks, like we're trying to do everything we can. And you can take that two ways, right? You could take that as they're really being supportive and that's wonderful, [00:13:00] which could be true, or they see how difficult it is and they're really worried.

[00:13:06] Vic: And so they're trying to think of everything they can do to keep it out of it. you know, the population being really upset. China's a, you know, a different kind of market. So, 

[00:13:18] Marcus: I mean, that's, that's a lot of central bank action right there. Yeah. Let's move into VC. So radiology vendor cure. ai, but that's cure spelled q u r e.

[00:13:27] Marcus: ai completes the 65 million series D funding round. And what makes this one stand out is that the company is based in Mumbai. 

[00:13:35] Vic: Yeah, so they're based in Mumbai. It's Mumbai technology, Indian technology, and USVCs providing money to bring it to the United States. 

[00:13:46] Marcus: Yeah, Light, uh, Lightspeed. That's a blue chip firm, um, leading the Series D, and, uh, this is more OUS radiology AI, uh, innovation.

[00:13:58] Marcus: coming, being funded [00:14:00] by USVC to bring it into the United States, uh, and it's FDA approved already. So 

[00:14:07] Vic: that's right. And so, uh, we've already talked about Australia, New Zealand being good at radiology. I think India is really good at AI and technology broadly, but they have a lot of excellent healthcare there.

[00:14:22] Vic: There's a lot of, a lot of cardiac innovations there. This seems like a really good radiology AI tool. Um, I take it as a good thing that we're now seeing global innovation and the U. S. is a market that Innovators want to come to. 

[00:14:39] Marcus: Yeah. And it's just, it's just nice to see that technology already have the FDA approval.

[00:14:42] Marcus: And we talked, we talked last week about, uh, FDA commissioner Cahill talking about radiology was kind of like tip of the spear. If you want to do AI, like they can, they can stomach that, they can handle that. Their internal ability to, to process those applications is already there. So, uh, it feels like.

[00:14:57] Marcus: About every week, we've been talking about a [00:15:00] large VC deal into radiology AI. Uh, and just seems like that's a wave that's gonna continue for a while. Cause there, there's a path to actually get this stuff commercialized. 

[00:15:10] Vic: Yeah, I think that's right. And, and We talked about this, um, previously, but radiologists have sort of been the interface between the healthcare industry and diagnostic imaging technology.

[00:15:24] Vic: They've been early adopters of technology. And so I think it kind of makes sense that they would be early adopters here as well. 

[00:15:29] Marcus: Yep. All right. Uh, a new pair, MA insurers, Zing Health. Banks 140 million to build out its special needs plan. Um, it's a, it's a C SNP and, uh, they are, the, the deal was led by Health 2047 Capital Partners, CRG and First Trust Capital Partners, as well as Town Hall Ventures and Leavitt Equity Partners.

[00:15:52] Marcus: So, uh, Uh, some, some important strategics there. Town Hall never leads any deals, um, but they, they are totally focused on the Medicaid [00:16:00] population. Um, Leavitt Equity Partners, obviously, strategic Medicaid, you know, experts there, uh, so good group of people around the table and just an interesting, uh, you know, new pair focusing on, on the C SNP space.

[00:16:13] Vic: Yeah. And, and I had to go look into the C SNP space.

[00:16:21] Vic: pretty broad definition, almost all chronic disease fits into that. So it's a significant percentage, maybe two thirds of all seniors have more than one chronic disease and would fit into this category. And it's 

[00:16:34] Marcus: pretty broad too. It's like, it could be stroke, could be an autoimmune disease, could be alcohol, 

[00:16:38] Vic: alcoholism.

[00:16:39] Vic: It's like any, any chronic disease, which is A lot of those right, uh, would categorize you like this. So, um, even though it's branded as special needs, that that's a payer strategy. Yes. Um, and it's a big market. 

[00:16:57] Marcus: All right. Uh, next story, Sentivo gets 75 million from [00:17:00] Cone Health Venture Arm and others. So Sentivo really, I think historically was a, a virtual, um, advanced primary care player focused on employers, but now they've attached a health plan to actually take risk on top of that.

[00:17:14] Marcus: And it seems like a pretty smart strategy. 

[00:17:17] Vic: Yeah, that's right. I guess it's great to see new payers and new payer business models and approaches coming to market and getting financed. I, I agree pairing advanced primary care where you have a much closer relationship with your primary care doc with a, a payer kind of wraparound service for employers, I think it makes a lot of sense.

[00:17:42] Vic: almost every payer has added concierge or Case management or primary care. And so they're just kind of going the other way, adding the other way. 

[00:17:55] Marcus: Yeah, I mean, it's interesting, right? It's it's payvider model. Yeah. Focus on self insured [00:18:00] employers, uh, strong virtual play. We already saw that, um, all, all things telehealth are going to get Expanded right through the house approval.

[00:18:09] Marcus: So that's good for continued long term viability Uh, they largely are raising debt in this in this round. It's it showed that they have already raised about 200 million dollars in equity financing So they're probably kind of done with that. I think if they're looking to scale they'd rather do that via debt than more dilution and equity Um, but yeah another interesting net new player, uh out there in the payer space Yeah, 

[00:18:30] Vic: and I think you have to strengthen the balance sheet and working capital in order to be a payer.

[00:18:36] Vic: Yep. So that's why. 

[00:18:38] Marcus: All right. Uh, big congratulations to my friend Maria, because I'm pretty sure SteelSky Ventures is an investor in MidiHealth, a women's health business that's focused, um, on women in the, the midlife hormonal change phase of, of life. Uh, 63 million Series B funding round. Lots of celebrities in this round.

[00:18:59] Marcus: Amy [00:19:00] Schumer, Tory Burch, Brandi Chastain, uh, who's sort of famous soccer player, a women's soccer player. Um, obviously along with, you know, some, some pretty serious, uh, in investors that, that are there as well, but, but definitely a very high profile, you know, female celebrity round. Um, they, I guess they contributed about 5 million to an SPV, um, to, to contribute into this 63 million B round.

[00:19:27] Vic: Yeah, I, I normally don't love celebrity tied financing, because I think they're not priced that well. But, but in this case, I think it makes a lot of sense. It's a dedicated virtual care service for women, and All of their customers really identify with these, these personalities. So I think in this case, it makes a lot of sense and it's smart.

[00:19:54] Marcus: Yeah. And, and also I think what I've noticed is there's been much more [00:20:00] of a, uh, uh, importance placed on bringing this topic of midlife hormonal change in, in women to the forefront. Yeah. Um, I think. It's, it's been more normalized in guys just in terms of, uh, you know, testosterone replacement therapy. So TRT is kind of how, how, how guys have been normalized in that conversation.

[00:20:19] Marcus: Uh, but for, for women, I think it's been kind of a taboo thing and, and now it's becoming much less, much more of a pure healthcare discussion, which is, which is great. 

[00:20:29] Vic: Yeah, it's, I think it's a little bit taboo. It also is, um, menopause and premenopause. There's a lot of. Kind of confusing symptoms and not every woman has the same 

[00:20:42] Marcus: symptoms.

[00:20:42] Marcus: Yeah, 

[00:20:43] Vic: and so I think there's a lot of patient education engagement Advocacy about there's a lot of treatments you can get and having a dedicated Virtual care company to help women with that process. I think makes a lot of sense. 

[00:20:57] Marcus: Yep. Fantastic. So congratulations to them. [00:21:00] Uh, and you know, probably for us, big, biggest story in VC of the week insight partners closed a 10 billion fund.

[00:21:07] Marcus: Uh, so insight, you know, truly. Uh, one of the blue chip funds that's out there. It's been a while since we've seen a multi billion dollar fund successfully get closed like this, um, insights. Great, great operators and 10 billion is a real number. 

[00:21:23] Vic: Yeah, it's, uh, I mean, insight and soft bank probably are the two tiger.

[00:21:29] Vic: Maybe three really high profile companies in the last kind of big run up time. And then they definitely took some down valuation, down marks over the last few years. So I think it's good for our industry to have a really well known brand like Insight Partners raise a 10 billion, a significant fund. And it's, it's good.

[00:21:53] Vic: They do a good job. 

[00:21:54] Marcus: I Yeah, I mean, to me, it just, it just says LPs are writing checks. Yeah. So that's, [00:22:00] that's great news. That's great news. All right, moving into the industry, uh, starting with policy, the FTC targets the three biggest PBMs over insulin rebates. So the first part of this headline, not really anything new, FTC targeting three biggest PBMs.

[00:22:13] Marcus: That's kind of par for the course, but over insulin rebates, I mean, I thought we had to kind of solve the insulin issue. Um, Yeah. I thought Eli Lilly kind of said, Hey, we're going to make this really affordable for everybody. So what you thought 

[00:22:28] Vic: that, cause that's what happened, that's what they're doing.

[00:22:30] Marcus: So, so what, what are we talking about here? 

[00:22:34] Vic: I don't think I can easily explain the motivations of the FTC, what, what they're, what they are claiming is that in 2019. Patients did not have access to inexpensive insulin, but they do today. That 

[00:22:48] Marcus: may be true, but But so 

[00:22:50] Vic: who cares? 

[00:22:50] Marcus: Yeah. And What was the last year that the insulin Yeah, uh, it might even be two years ago.

[00:22:55] Marcus: It was a while ago. 

[00:22:56] Vic: And so, I think they have [00:23:00] evidence maybe to prove this case. But I don't know why anyone would care. It's over and patients can get insulin now. So I don't really get it other than maybe they're going to try to prove a case. They can win. I'm not sure why it matters. 

[00:23:19] Marcus: All right. Just file this in the.

[00:23:21] Marcus: List of things we don't understand about what the FTC is doing, uh, interesting story here, a company called Particle Health that is not actually directly in the EHR space is suing Epic, um, on, on the premise that they are a monopoly, and really focused on information blocking, which is sort of an ONC no no, what caught my eye about this story that you found is that, uh, They filed this suit in the Southern District of New York.

[00:23:49] Marcus: So, um, that's, that's kind of the real deal when you're talking about U. S. attorneys. Uh, and so it, the, the case will get a good look. Now, of course, when you put [00:24:00] something through the SDNY, it doesn't mean it's necessarily going to get prosecuted. Um, whatever happens on the other side of this case is likely to set at least some meaningful set of precedent.

[00:24:10] Marcus: So, uh, I hope that Particle sort of has their game together, because, you know, if you're going to go for the king, you best not miss. Um, and it sounds like there's, there was some feedback from a legal expert from Vanderbilt saying this is probably going to be a tough case for them to win on a couple of different fronts.

[00:24:32] Vic: Yeah, I mean, I think it is, it's clear to me that Epic has a significant market share. approaching a monopoly. Of course, Cerner is there too. There's other providers, but they have 60, 70 percent market share. Uh, but Particle is not competing with them in the EMR space. As you said, they are arguing that [00:25:00] Epic limiting access to patient information impairs their ability in the, in the payer platform space to do their job.

[00:25:09] Vic: Um, I do not think that. EPIC is required to, to strike deals with every potential partner out there. That's not what's required of a monopoly. They do have to provide, you know, a good service to all of their constituents. Um, and so that's good. That's where it's going to be a challenge, I think, to prove this case that it's not as easy as they're competing directly against EPIC and EPIC is preventing them from.

[00:25:44] Vic: Offering a similar product. 

[00:25:47] Marcus: I mean look I think there are a lot of people who are probably cheering particle health on and yeah I'm cheering them on and there are a lot of people who would have wanted to file this kind of [00:26:00] case I just wonder what about Particle health made them feel that they had a, a case that was winnable.

[00:26:12] Marcus: So, and that's, that's a, that's a question meaning I don't have the answer. This article isn't going to give me the answer. And we'll, we'll watch this. Play out over the course of the next couple of years, I would imagine, but I, I'm certainly interested in why particle felt they had the ability to go after Epic.

[00:26:32] Vic: Yeah, we'll see. I mean, I think there is a real need to open up patient information for other health systems for payers, for any kind of advisors. 

[00:26:45] Marcus: Let me, let me just say this. I do not hear health systems complaining about Epic. No, no, their customers are very happy. Their customers love them. Yes. And are like, how do I become more of an Epic customer?

[00:26:59] Marcus: How do I go [00:27:00] deeper with Epic? They're not, you know, it's not, they're not like, oh my God, Judy's, you know, beating me up and making me do this. No, it's the opposite. And Cerner 

[00:27:09] Vic: and 

[00:27:09] Marcus: Oracle 

[00:27:11] Vic: are a good counterbalance. I mean, they exist. Yeah, they exist. And. They have plenty of resources. Sure. And they're not complaining about unfair practices.

[00:27:23] Vic: Um, I do have portfolio companies. I think there are a lot of startups and other ancillary things that want to plug into either the health system or the patient record or get information out that would like the system to be more open. And, um, if the patient is wanting to sign up or the physician group wants to access it, that it would be more open.

[00:27:50] Vic: Sure. Um, Epic is trying to align themselves with a couple of these, um, regional or national data sharing groups. As [00:28:00] the way they'll solve that. Um, I think that's what Partick was upset about. But I don't know that, that Epic is forced to, to just open it, open it up. Ozempic's 

[00:28:10] Marcus: CEO agrees to discuss lower prices for blockbuster weight loss drugs.

[00:28:15] Marcus: So this is another help committee, uh, meeting in, uh, in the Senate. Bernie's working hard. Bernie is working hard. Yeah. Bernie is working hard. So, yeah. He has brought the CEO of Novo Nordisk, uh, I think his name is, uh, Lars Jorgensen, uh, up to talk about Ozempic having a high list price, not being affordable enough in general, you know, U.

[00:28:36] Marcus: S. citizens pay more for prescription drugs than, you know, any other developed nation in the world. Um, why is that? And will you lower the prices? So it was interesting. The, uh, Uh, the CEO of Novo Nordisk tried to point to the PBMs and Bernie said, but aha, I've already received commitments from all the PBMs in writing that if you lower your prices, they won't take these [00:29:00] drugs off of their formularies.

[00:29:01] Marcus: Um, so he had that in the back pocket. I mean, Bernie's really working. Yes. You know, he's, he's setting this all up, right? He's like, he's like, I'm bringing you here because I'm going to get you on record to say. Yeah. That if I've got these folks agreeing to not kick you off the, the formulary that you will lower the cost.

[00:29:19] Marcus: And that's, that's, that's pretty slick. Yeah. That's pretty slick, Bernie. 

[00:29:24] Vic: And furthermore, he had the pricing in Canada and the UK. And it's like a difference of 1, 200 here and 140 in Canada and 90 something in the UK. For the exact, it's the exact same bottle, same pill and everything. Um, I think the price has to come down.

[00:29:44] Vic: It just, I mean, it has to come down. And, but I think what was interesting is, unlike the Stewart CEO, I mean, what you have to do with the Senate is exactly what he did. He showed up. Yeah. And he took the, [00:30:00] Barrage of complaints and when he was asked, like, will you lower your price given this email that I have in writing his response was, well, I need to read it to make sure that it has to all there's a lot of details, but But yes, we'll consider that or whatever.

[00:30:19] Vic: Like, I think that's what you have to do as a CEO of a big company, when you get subpoenaed by Congress, you have to show up and you're going to get yelled at. You're on C SPAN and, but at the end of the day, they want to make the point. They want some concessions. The price is going to have to come down.

[00:30:40] Vic: Novo Nordisk is still going to make a ton of money and they should make money. They have a good drug. I don't know that it makes sense to charge 12 times as much as over the border in Canada. Um, but it's because we have never cared before. 

[00:30:55] Marcus: Also, can we just compare the ability to focus [00:31:00] on timely and, and, and meaningful Situations in, in the public between the help committee and the FTC.

[00:31:11] Marcus: Yes. Like the help committee is crushing it. We're going to bring the stewards health CEO and okay. We're going to bring the Nova Norda CEO in and we're going to talk about these things and we're going to 

[00:31:20] Vic: drive pricing. 

[00:31:21] Marcus: Yeah. Yeah. We're going to triangulate it and we're going to, we're going to sort of help you all have a reasonable conversation about how to better serve the American public.

[00:31:30] Vic: And drive public opinion. So you have to make a change. Yeah. I mean that. That is, I think, effective politicking. 

[00:31:37] Marcus: Yes, and it makes sense, and it's topical. Yeah, we all care about 

[00:31:42] Vic: that. Versus insulin five years ago when it's already been fixed. I mean, it doesn't make sense. I mean, I don't know what strategy they have, but it's not a good one.

[00:31:53] Marcus: No more FTC bashing. Uh, the Department of Justice is suing Visa. Um, alleging [00:32:00] monopoly in debit card payments. This is something that had not necessarily been on my radar, but I am not a merchant, right? I mean, I don't, I don't live on small transactions that are happening on a day-to-day basis. Mm-Hmm. . And I have heard, uh, that the, the, the credit card fees.

[00:32:20] Marcus: Merchants are being charged are brutal and may even be part of why we're seeing ubiquitous tipping being presented in every single, um, register that we go to, even when there's not an actual server that gets paid tip wages there, because they're trying to offset, uh, the credit card fees. 

[00:32:40] Vic: I, I think that's right.

[00:32:42] Vic: I also think that, I mean, this is another example where visa was born in the seventies and eighties out of. Bank of America and other banks creating a network so that they could help customers move across out of their [00:33:00] regional and be able to charge around the world. At that point, American Express was the only real competitor.

[00:33:06] Vic: And the banks all got together and created this network for themselves and then they added on the, um, ATM cards, which now is called debit cards, so you can charge not out of a credit facility, but out of your checking account. Out of your checking account. And Upstarts that used to run ATM networks have created competitors.

[00:33:34] Vic: Visa gives benefits and bonuses based on volume to encourage merchants to Work with them. And that's what just the Department of Justice is upset about. That seems like a carrot that it's hard for me to get too mad about. Um, there are alternatives out there. They're just not very compelling. They don't, 

[00:33:59] Marcus: you know, I [00:34:00] would say on this one, it is likely that Visa is using their undeniably dominant position in the market to potentially, um, overburden small and medium sized businesses.

[00:34:15] Marcus: Merchants across the country, right? And it's pennies. I mean, is it really going to change a merchant's life? Oh margins are pretty thin especially if you're brick and mortar. 

[00:34:24] Vic: Yeah, 

[00:34:25] Marcus: margins are pretty thing. You think about labor costs you think about You know lease payments you think about you know, soft consumer, right?

[00:34:31] Marcus: I mean, I think I think actually it does it does matter quite a bit. You know, I think 

[00:34:37] Vic: I mean, I I don't know I'm always maybe skeptical of government intervention around Monopolistic tactics. I mean, for instance, Capital One is trying to buy Discover, and that would make Discover much more powerful and create a potential competitor to Visa.

[00:34:59] Vic: That would be good. [00:35:00] That'd be great. That'd be good. And I hope the FTC lets it through. Yeah, that would be good. Um, so I mean, the, the market is, and there's a lot of, uh, FinTech companies that are, that are coming up. So I just don't think this is a problem that needs to be addressed right now, but they are addressing it.

[00:35:16] Marcus: Yeah, but I mean, if you look at your own wallet, you have Visa and you have, you know, American Express and then because we're, you know, because of where we were, I only have Visa. Yeah, that's what I'm saying. 

[00:35:28] Vic: I don't even have a MacDopress, so I mean, I could just 

[00:35:29] Marcus: have 

[00:35:30] Vic: Visa. 

[00:35:30] Marcus: Yeah, so that's the thing. But that's because that's what I want.

[00:35:33] Marcus: I 

[00:35:33] Vic: mean, I don't 

[00:35:34] Marcus: Well, it's because that's what you want, but it's also because everyone takes it. Yes. You know what I mean? So it's, it's They've worked out the marketplace very well for themselves as a network. And when you are there, you get to leverage that power. And there is a likelihood that they are leveraging that power.

[00:35:51] Marcus: In a way where it, you know, it's kind of like giants get clumsy, you know what I mean? Cause they're giants, right? They may not even know how much they're burdening, you know, the [00:36:00] merchants, but the burden in the merchants, right? So, um, I don't know. I, I, I feel like this is, it's probably good to just kind of gut check them.

[00:36:07] Marcus: No, they're not going to get broken up. I don't think, you know, I don't think that that's, that's going to happen. 

[00:36:12] Vic: No, I think what's going to happen is they're going to have to stop doing as lucrative, uh, merchant benefits for volume, which. We'll end up, I think most likely, not with new competitors, but with merchants getting fewer.

[00:36:28] Vic: Benefits for volume, 

[00:36:30] Marcus: uh, Tennessee officials, pressure, ballot, health, hospital monopoly. So I don't think we've ever talked about this on, on, uh, health further. So, but we've talked about it a lot cause we live in Tennessee. So ballot health and we know the 

[00:36:41] Vic: ballot. We know the whole team about it. Yeah, they're good 

[00:36:43] Marcus: people up there.

[00:36:44] Vic: It's a hard, 

[00:36:46] Marcus: Yeah. I'm going to try to quickly summarize, a lot of our listeners don't live in Tennessee. Yeah. I'm going to try to quickly summarize this. So there were two health systems, um, between Virginia and Tennessee, right across that border, [00:37:00] uh, in, in the far West Tennessee. Yeah. Um, Bristol and sort of that whole area.

[00:37:05] Marcus: And they were obviously, you know, that, that region socioeconomically is not very strong. And so I think when you thought about the payer mix and, and small community nonprofit hospitals, they were probably both going upside down. They came up with an, With an idea to merge, it was, it would have required both Virginia and Tennessee because the health systems were on both sides to agree to that.

[00:37:29] Marcus: They created a copa agreement, um, and said, yes, you can merge, but you have to a. you know, invest in innovation and B, you have to deliver certain quality metrics because you're now going to have a monopoly in the space. You're not going to have any competition. So we can't have you decreasing access or decreasing the quality of care through this merger.

[00:37:53] Vic: Yes. And it was a highly negotiated set of criteria. Oh, it was a big deal. A lot of [00:38:00] several quarters of negotiation. Yeah. And I think it was 

[00:38:06] Marcus: They got to a settlement. Was this 2017? I'm trying to think about when this happened. 

[00:38:11] Vic: Yeah, that's about, that's probably right. It's about when it was, yeah. So, they got to an agreement, I think not because anyone thought it was ideal, but because the alternative of both systems losing money and not being able to perform is worse.

[00:38:29] Vic: And so that, that's, that's the setting of the table. 

[00:38:32] Marcus: So now let's call it seven years later. Um, it says here six years ago. So I guess, I guess 2018. So, so six years later, um, State of Tennessee is realizing that the, the rubric by which they tried to assess whether or not Ballard was going to be successful is insufficient, uh, because the rubric is insufficient.

[00:38:54] Marcus: Is delivering a grades and at the same time when they look at the actual [00:39:00] health of the region, it's declining. Um, and so they're now trying to renegotiate, um, this agreement. 

[00:39:11] Vic: That's right. I mean, ballot has gotten A's on all their reports and the state of Tennessee Health Department thinks the grading rubric is too easy.

[00:39:23] Vic: And whether it is or not, I don't know that it's my place to say, but they, it was a very negotiated rubric at the time, and it seems like Ballard has held up their end of it. And so maybe it makes sense to look at it every few years. I think it would. Like, I don't think a static rubric, given the pace of change, you know, on this show, we talk about new changes all the time.

[00:39:49] Vic: That makes sense that we should every 10 years do a new rubric. But just saying like, you're not happy with, you know, The population's health and so [00:40:00] therefore it has to change that seems like changing the changing the rubric unfairly 

[00:40:06] Marcus: Yeah, and it looks like I mean, I think we need to remember prior to the merger It's not like these hospitals were like knocking it out of the park, right?

[00:40:13] Marcus: Yeah, so so first of all, that's true second of all two years after the merger we had Right. And so they had to navigate all of that for that region. Um, and then you come out of that, you have labor issues, you have inflation, you have all these problems. And so I think what ballot has said is, yeah, you know, six years ago we signed a COPA agreement, but like, these are probably been six of the most difficult years, you know, let's just say the first two, we were just trying to merge and get our integration together, then literally got hit right with COVID.

[00:40:43] Marcus: Then we got hit with fed fund rate up to 5%, you know, boom, boom, boom, boom, boom, And so, 

[00:40:49] Vic: yeah, I know the team there that it's a difficult geography and also a 20 hospital system is good size, but it's still a [00:41:00] little subscale. It's, it's not, it's not a hundred facility system where you have enough scale to negotiate with power and spread overhead.

[00:41:10] Vic: And they, they do a good job. I mean, is it perfect? No, but, but as you said, the two systems previously weren't perfect either. So there'll be some kind of new settlement, I'm sure, but I think they do an okay job. 

[00:41:25] Marcus: Cigna trims Medicare Advantage plans in eight States. So this, this kind of twisted our heads because we were Cigna sell its Medicare Advantage business?

[00:41:35] Marcus: And, uh, turns out they have agreed to sell it, uh, but apparently it's not yet sold. 

[00:41:40] Vic: Yeah, I don't think it has cleared all of the, all of the various approvals and actually closed. Um, so HSHC bought them in, intends to buy them. There's an agreement to buy them. Yeah, 

[00:41:55] Marcus: HCSC. 

[00:41:57] Vic: HCSC, sorry. So I guess [00:42:00] Cigna is still managing the asset during this interim period.

[00:42:04] Vic: And they, like Humana a month ago, they're cutting back where they're offering Medicare Advantage services, which is a trend. I mean, that's good. It's, I think you have to have enough scale and reach to be successful. America advantage now. 

[00:42:23] Marcus: Yeah. I mean, it seems like they're, they're tightening up the asset for the eventual sale given all the changes that are happening in them.

[00:42:29] Marcus: Right. Uh, nonprofit hospitals received 37. 4 billion in federal local tax benefits in 2021 study fines. 

[00:42:37] Vic: Yeah. So this is an ongoing kind of Pretty low volume complaint, uh, that happens all the time, which is for profit health systems complain that they're competing head to head against Non profit systems that get a significant tax advantage.

[00:42:56] Vic: And so, um, this group that, [00:43:00] uh, I think Johns Hopkins and TCU were the main, um, kind of people looking into it. They tried to quantify, okay, exactly what is this, um, tax benefit that is at issue. And it's a, you know, significant number. 37 billion in one year. It's a lot of money. 

[00:43:21] Marcus: Yeah. I mean, I think, you know, you talked about it being a low volume complaint and maybe coming from the, the, the for-profit side.

[00:43:27] Marcus: I mean, I think it's becoming more of a political Yeah. Discussion. Right? Well, I mean the, 

[00:43:30] Vic: the, especially at the states level, they want the money. 

[00:43:34] Marcus: Yeah, yeah, yeah. Well, well, I mean the States and the feds. Yeah. Yeah. Too. I mean, I, I think, I think it's a DC question as well. Mm-Hmm. Like, Hey, you know, I mean, this is where you gonna have three 40 B and some of these other things.

[00:43:46] Marcus: Right. Hey, okay. You're a nonprofit. You need to be doing something different than the for profits, right? Like, like, You can't necessarily perform like a for profit, but then get all these [00:44:00] breaks as well. Right. So, and, and I, I think the, the consistent nonprofit answer has been look at our payer mix. Like there's, there's your difference right there.

[00:44:11] Marcus: You know, we take a different payer mix than, than the for profits do generally speaking. And so we are. More serving the community in terms of taking higher risk. What's interesting is that argument is changing a little bit as the whole Medicaid expansion, uh, with the commercial rate match, um, continues to spread.

[00:44:31] Marcus: Yeah, that's right. 

[00:44:32] Vic: If, if Medicaid is matching commercial, yes, you have a much broader payer mix, but that, that's not, that might be an advantage that doesn't really, 

[00:44:42] Marcus: yeah, I mean, I mean, you might say, bring it on, give me all the Medicaid I can, I can handle Mount Sinai partners with Noom. 

[00:44:48] Vic: Yeah. I wanted to put this right after the last story because Mount Sinai of course is a great nonprofit hospital, uh, they're partnering with Noom, which is that, uh, app based weight loss [00:45:00] coach.

[00:45:01] Vic: Um, that they used to have a ton of, uh, ads and commercials and things. I went to sign up for it just because I do this work and I wanted to test it out. And I was not willing to pay. It's like a hundred bucks a month to A hundred bucks a month? I mean, there's different levels. It goes from maybe 60 to 120.

[00:45:19] Vic: Wow. That's a lot of money. 

[00:45:21] Marcus: I, I, I mean, how effective is this thing? 

[00:45:25] Vic: That's a lot of money. I have friends that use it who, uh, Who are not price sensitive. Um, it's really helpful. It is a several times a day coach, advisor, advocate about, you know, hitting your health and wellness, exercise. A human? No, well, Technology?

[00:45:47] Vic: Mostly technology. There is a human, but, but I think it's mostly automated. Boy, that's expensive. I don't, I didn't pay for it, so I don't really know. People love it. They're valued at a billion dollars. So people are are are doing it. Yeah, people are, people are doing [00:46:00] it. And anyway, so Mount Sinai, which is a nonprofit.

[00:46:04] Vic: has partnered with them, and they're going to refer patients to Noom, who either have a too high of a BMI or express that they need to lose weight, but have trouble doing it on their own. They're going to refer them to Noom. There's no special deal. The patients will pay 60 a month, 70 a month. And then part of the deal for Mount Sinai is Noom will refer back patients that need it.

[00:46:34] Vic: bariatric surgery or, or, you know, fail, don't lose weight and need some kind of health care and surgical intervention. Um, that's the partnership. 

[00:46:46] Marcus: I just got to read this. Their last funding round was a 540 million series F closed in 2021. Of course. Yeah. Which brought the company's valuation to 3. 7 billion.

[00:46:58] Marcus: So they have [00:47:00] not been repriced since I would be really interested to know what What the reality of of that valuation is today, just because we all know 2021 was a funky, funky time, and we saw we saw a lot of companies valued at a billion dollars in 2021 that don't even exist anymore. 

[00:47:19] Vic: I think in general, the valuations are down 40 percent or so.

[00:47:25] Vic: It's on average and maybe, maybe 50 percent and this, um, is a high turn business, right? Like it's a lot of money to acquire customers and then they don't stay that long. And what the heck do 

[00:47:40] Marcus: you need 540 million for? I think they were spending on digital ads. Like, I think it's customer acquisition. That's what I mean.

[00:47:46] Marcus: Yeah. That's boy. Yeah. I mean, you gotta be really sticky for that. 

[00:47:53] Vic: I, you know, I think I would have been much more excited for Mount Sinai too. [00:48:00] Build their own weight advising coaching app. They could have done that for not a lot of money And then they would have owned a share in it, but they didn't do that 

[00:48:12] Marcus: Roche narrows pharma pipeline amid push into obesity market They've cut 25 of their pipeline teresa graham the chief of roche's pharma division says 

[00:48:21] Vic: yeah, so this is just another story in the um, The difficulties in pharma and biotech all the way back to nih and nsf Grants are flat to slightly down.

[00:48:37] Vic: The entire pipeline is thin, let's say, and Roach is cutting back to their best 11 disease areas. They didn't announce what those areas are. 

[00:48:51] Marcus: They are pushing into the weight loss 

[00:48:53] Vic: category. I think, I don't, I think they already maybe missed that boat, but, uh, but they're [00:49:00] following everyone in that. Um, I think it probably makes sense to.

[00:49:04] Vic: Focus. 11 disease states seems broad enough, but it's a, it's another sign that it's, it's difficult to be a publicly traded pharma company right now. 

[00:49:17] Marcus: Yeah. And look, saying you cut 20 percent of your 25 percent of your pipeline. I mean, that's, let's just call that 25 percent of clinical trials. Let's just call that some meaningful percentage of your headcount.

[00:49:28] Marcus: So there's a layoff attached to that. There's a whole bunch of capital that was maybe targeting Falling into those, that pipeline, uh, from a bunch of biotech companies that we're 

[00:49:39] Vic: hoping to sell into that. 

[00:49:42] Marcus: So that, uh, that's a, that's a big slimming of, of, of the pharma economy. Just by saying, just by a company like Roche saying we're cutting 25 percent of our pipeline.

[00:49:53] Vic: There's only like 10 or so, maybe not even 10. Household names. Yeah. Right. 

[00:49:57] Marcus: Right. At the level of a Roche. [00:50:00] Uh, okay. Down to, uh, uh, The sort of more patients, uh, centric stories. This is a story in the Wall Street Journal talking about the keys to aging at home. And my gosh, I feel like I never thought about this.

[00:50:13] Marcus: I never talked about this. And now every single day I think about this and I talk about this. Um, but this is a conversation about around frank conversations and financial planning and what to do in order to stay in your home as you grow older. And wow, this is a, this is a, Very real thing that if you don't, you know, it's like forever, I've been hearing about my Roth IRA, the 401k, you know, sort of all of that stuff.

[00:50:41] Marcus: Yeah, 

[00:50:41] Vic: right. 

[00:50:42] Marcus: And it's only recently that it's Been hey, what about your long term care plan? Do you have long term insurance? If not, like, what are your plans? Do you want to go into assisted living? I, we have a friend who, you know, based on his experience with his [00:51:00] parents said, you know, he and his wife, I think it's 65 are going to move into like one of those really cool independent.

[00:51:11] Marcus: So they get their social space, they 

[00:51:13] Vic: meet people and then they're just 

[00:51:15] Marcus: there. Yes. Yeah. Yes. And, and, and that way, like the change into that, it's just not as 

[00:51:22] Vic: hard when you're suffering from some health issue, when you're 75 or you already are in place there, um, that, that's. I think a viable strategy. A lot of seniors.

[00:51:36] Vic: want to live for as long as they can in their home. Yes. And this article is really talking about, um, having a conversation, you know, for, for our listeners, it's mostly with your parents. We, we maybe have some seniors listening, but mostly it's us talking to our parents and it's pretty awkward, right? Like you are the, I'm the [00:52:00] son and now I need to talk to my mother and my dad about their future.

[00:52:08] Vic: But this article is saying that you have to like fight through that and try to talk about it because there's there are simple things that if you understand you can address and there are other things that you really can't fix and you have to move, right? So if your bedroom is on a second floor, that's a real challenge.

[00:52:33] Vic: Like, you know, become a time when it's difficult to. get to where you need to sleep. And so it's just not functional. But there are other things, like this picture here, where if you have two or three steps up to the front door, which is almost every house, that is enough stairs that you cannot live there anymore.

[00:52:56] Vic: But you could solve that With enough time, you can [00:53:00] solve that by building a ramp or figuring out a new access point. Um, if you wait until you fall and break your hip, it's hard to get the contractor and get it all organized. There's the simple things like putting railings like near the shower and things that you have to have.

[00:53:22] Vic: installed before you fall, before you're about to fall, or they don't really matter. And so, and then there's a financial aspect that you might need a nurse to come in. And so I thought it was a good article we'll link to in the show notes. I sent it to my wife. There's just a lot of interesting things that are not intellectually that hard, but I hadn't thought of.

[00:53:44] Vic: They're emotionally hard. Yeah, they're, yes, that's right. They're emotionally 

[00:53:47] Marcus: hard. But I will say, if you have lived through an experience like I have lived through with my parents, it stops being emotionally hard. Yeah, because you understand the cost of [00:54:00] not having that conversation, you have the you understand the cost of not admitting that that is an eventuality and getting clear on what, what are you going to do at that point?

[00:54:09] Marcus: How are you going to navigate, you know, your life at that point, right? Yeah, 

[00:54:14] Vic: I think the positioning is, I want to help you if you want to stay in your home. I want to make that happen as much as you do, right? Let's work together to understand what the topics are and then work through them. But it's, you know, it's just admitting that we're mortal, which no one likes to do.

[00:54:35] Marcus: And, and, you know, the other really uncomfortable part about it is the financial planning part of it because it costs money. Yes. It costs money. Even the basics of transforming the house costs money. Yes. Um, and certainly staffing the house. Yes. Costs real money, right? And, and at some point, you know, there's a good chance you might need to staff the house.

[00:54:59] Marcus: [00:55:00] OpenAI is going to become a for profit company. Vic, you are a profit. 

[00:55:05] Vic: Yeah, this was not a hard thing to say, but yes, I knew this was coming. It is here. They are no longer a nonprofit, of course. Right. Um, they're raising money and they can't raise the money in a nonprofit setting because. Of course they can't raise the money enough for a friend to cap, they were capping the upside and then they're going to go public and you can't go public in a nonprofit thing.

[00:55:35] Vic: So I, I think there's a 10 step process for Sam Altman to take this company public and he's on like step three and it was turning into a for profit. And so, you know, I, 

[00:55:48] Marcus: I, I think we did not have as much media focus on tech companies when Facebook was coming, was coming of age. [00:56:00] But I think a very similar sort of shedding of the initial team happened at Facebook.

[00:56:06] Marcus: Yeah. You know, where Zuckerberg was, he had co founders, right? Um, you know, the, the, the founder of Asana, for example, is, is Zuckerberg's co founder. Dustin, Dustin Moskovich, I think is his name. I think that was one of the story of every of the yeah, but I guess the difference here is a huge spotlight has been on OpenAI ever since, you know, they they revealed chat GPT, right?

[00:56:32] Marcus: And we have seen just Sam. Emerging as the force, right? I mean, he was out for a half a second and then he was back and now everyone else is out, right? Um, and it's, I just think it's so interesting to have this kind of media magnifying glass on this company and watch the most recent departure being the CTO.[00:57:00] 

[00:57:00] Marcus: Um, and, and how that is sort of, every time someone departs, it's tied with some news. about OpenAI and what they're doing, right? Um, the entire board, all of his co founders, and now the CTO. I mean, he's the only person left from the original cast.

[00:57:19] Vic: Like I said, I think this happens often. I mean, but 

[00:57:23] Marcus: this thing is kind of different in this case, kind of shedding. This is, this is pretty extreme when you say like an entire board, all co founders and all, well, the thing that's different about this 

[00:57:32] Vic: than Facebook or really any company is that, um, I think most of the people around open AI early on would have said, and many would say today.

[00:57:45] Vic: That this technology is important for humanity and needs to be carefully checked, checked carefully controlled, and Sam Altman. Whether he is brilliant [00:58:00] or a villain, I don't think it matters. He launched chat GPT very publicly. And got a ton of attention and like, you know, opened up Pandora's box and you can't put it back now.

[00:58:14] Vic: It's not, you can't go back. 

[00:58:16] Marcus: So I got to get you out of here. So, um, really quickly, we do want to talk about meta and the Orion, um, AR glasses that were, uh, sort of announced, but are not available for sale. Uh, certainly from an aesthetic perspective, so much better than the Yeah. It's not even in the same universe.

[00:58:36] Marcus: They look pretty much like regular classes. Yeah. Yeah, a little thick, but, but you wouldn't really think twice about it. No, no. I mean, they're, they're definitely getting much more into the realm of what would be aesthetically acceptable. 

[00:58:52] Vic: Yeah. You could wear that at a meeting. That's right. And it wouldn't.

[00:58:56] Vic: Be like the old Google Glass. It was like a weird thing. No, or 

[00:58:59] Marcus: like the vision [00:59:00] pro, which is like this big, heavy headset, right? You can only sit on your couch with that thing. Right. Yeah. So, um, it's, it's really, look, Mark has not taken his foot off the gas on, on this, this meta thing. Right. I mean, he certainly has reshifted priorities, but he's not stopping, uh, advancing his efforts on, on what that next form factor is going to be.

[00:59:23] Marcus: And I, I have to say. Him sort of giving up on the hardware in terms of, uh, uh, in terms of the phone and focusing all in on the next form factor. Mm-Hmm. , yeah. Is a really, really smart, long game. Yeah, that's right. It's really, really smart. Infinite game play to make. And, uh, I think he's in the lead, you know, it's a nascent market.

[00:59:44] Marcus: There's no question about it, but the release of the Orion, it's like, ah, you know, that's starting to really look like something that could actually. 

[00:59:56] Vic: Yeah, that's right. And he has, unlike the other big [01:00:00] tech companies, he has his monetization engine very well aligned with AI and with with Orion. So Orion is not really ready yet, but, um, The way Facebook makes money selling me a bunch of stuff works very well with how they use an AI, and it'll work very well in, in VR and AR with glasses, so.

[01:00:24] Marcus: So last year when the writer strike was happening, and we talked about it. Yeah. Uh, I, I think I said that I thought the writers were going to lose, um, and I don't think they got much out of that deal, but here we are a year later and Lionsgate is signing an A. I. deal, uh, you know, and I think this was actually the very thing that they, that was the strike over the whole strike for five months was about no A.

[01:00:50] Marcus: I. without, you know, some type of, you know, Remuneration and that's not happening and Lionsgate is doing an AI [01:01:00] deal and now that Lionsgate is doing it, all the rest of the studios are going to do it. This is going to become common practice. Um, the guilds are all freaking out, but, but part of why they're freaking out is because they know they can't strike again.

[01:01:09] Marcus: Yeah. Right. And you want to know why they can't strike again? There's a story in a, um, online media brand called Sherwood that is covering Hollywood. And I didn't know this, but, um, they, this, this story came out on nine 18, the unemployment rate today in Hollywood. Is 13 percent and it's not getting better.

[01:01:33] Marcus: No, no. It's, and it's going to get worse, right? Uh, the streaming platforms, the media companies, everybody is downsizing. Shows are being canceled. Things are being consolidated. Um, and now the studios are going to move to AI. 

[01:01:50] Vic: And I think the movie experience has changed. I mean, there's not a lot of movies in the theaters that I can find [01:02:00] anymore.

[01:02:00] Vic: Like there just aren't. Movies that are in the theater that I want to see that aren't streaming at home as well Um, you and I both like this theater the belcourt theater So I go there to try to support them But it's it's not the experience like we when we grew up that there's a big Big screen experience that you want to get that you can't have elsewhere.

[01:02:22] Vic: That's kind of we've lost that. 

[01:02:25] Marcus: Yeah, so so this is the worst Unemployment rate in the film and tv industry You Since 2000, not including the pandemic, right? So the pandemic was just kind of crazy, right? You know, everybody was out of work, but outside of that, this is the worst it's been since 2000 and it's going to get worse.

[01:02:48] Marcus: And the trend is that it's going to get worse. So if you've got 13 percent unemployment with a likelihood of increasing, doesn't that feel like an industry is about to crater? [01:03:00] Or, or fully be transformed. Yeah, I 

[01:03:02] Vic: think 

[01:03:03] Marcus: it's, yes. Fully be transformed. Fully be transformed. 

[01:03:06] Vic: Yeah, we will be entertained in some way, but I don't think the Hollywood studios ever will have the influence or power, and then the actors and writers and all the people around that industry are not going to have the same kind of jobs and earning power.

[01:03:23] Vic: They're just not. 

[01:03:25] Marcus: I mean, so anyway, I just thought this has nothing to do with health care, but just in terms of understanding what the real economic, industrial impact of AI is going to be, can be, will be, I mean, look at this. This 

[01:03:42] Vic: is, there's going to be multiple, I mean, a year from now, we'll be looking at multiple industries that are.

[01:03:49] Vic: Losing 10%, 20 percent of their workforce. 

[01:03:53] Marcus: And what are we going to do with this? I mean, this is like crisis stuff. Yeah. Like unemployment is 

[01:03:58] Vic: really, really [01:04:00] scary. Especially when you have been in Hollywood, not as a famous actor, but you're, you're a, you're a side actor. You're making a living. You make a couple hundred thousand dollars a year.

[01:04:12] Vic: You've been doing that for 10 years, 15 years. You don't really have a lot of skills to go do something else. You're not gonna be a health care worker. And so we're gonna have large groups of people that are very frustrated. 

[01:04:31] Marcus: All right. Final story. I want to cover a three mile Island 

[01:04:35] Vic: reopening. Yeah, this is just a great, uh, symbol of how much power the AI companies are Absorbing and and plenty of absorb there.

[01:04:50] Vic: They're starting back up the most infamous nuclear generator Maybe well in our country [01:05:00] Yeah Because we need the power and Microsoft's buying all of it. They just did a contract. They'll take the entire load of Electricity off it, which is I should I was surprised shouldn't have been surprised, but I was surprised there Yeah, 

[01:05:17] Marcus: uh, just as a, as a tip to listeners, if you dig our podcast, one podcast that I like to listen to is called BG two.

[01:05:26] Marcus: Um, it's, uh, Brad Gurley, who's from altimeter. Um, and, uh, bill. No, no, no, no, no. Brad Gerner Gers. Brad Gerner and Bill Gurley. Yeah. Yeah. Brad Gerstner from Altimeter and Bill Gurley from Yes. Uh, bench Benchmark. 

[01:05:43] Vic: I think he said Benchmark. 

[01:05:44] Marcus: Yeah. Anyway, uh, these two guys, uh, I, I, I first started listening to them back when I listened to Lin.

[01:05:49] Marcus: I don't listen to All In anymore. Mm-Hmm. . But they've kind of split off and they do their own podcast. It's kind of a regular how often they publish it But it's awesome. Like everything I used to like about [01:06:00] all in I really like about bg2 because they just talk about innovation They don't talk about politics and crazy stuff And in any event, uh They the last two episodes they've been talking about nuclear power and two episodes ago.

[01:06:13] Marcus: They were at a nuclear power plant Um that has like received all this new capital as being like fired up and growing the ones that are Are 

[01:06:23] Vic: like standardized and they sort of print out Um, smaller reactors and they mass produce them and then like ship them somewhere. Those are really exciting. I don't know what, what G and G we're talking about.

[01:06:34] Marcus: Yeah. Yeah. So, so anyway, um, you know, if you're interested in learning more of, about sort of this wave of nuclear power, we're not going to cover it in depth, but I would recommend going to listen to BG2, that podcast, um, in the last two episodes, I think they're, they're really sort of digging into it. 

[01:06:50] Vic: Okay.

[01:06:50] Vic: We can put it, we'll put a link in the show notes for people. 

[01:06:52] Marcus: Yeah. Um, awesome. Well, let's get you out of here, man. Thank you. Great job on the show and I'll see you next [01:07:00] week.