105 – China’s Triple Pay Power Grab, GLP-1s for All, & Nvidia’s AI Audio Revolution

[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. 

[00:00:07] Vic: Happy Thanksgiving. Yes. Excited to have a couple of days off. It’s been a, feels like it’s been a busy fall. 

[00:00:14] Marcus: Yeah, we’re recording this on Wednesday. So by the time you’re listening, Thanksgiving will have already happened.

[00:00:18] Marcus: And we hope that you, uh, had a great time with family and or friends and you’re stuffed. Yeah. And maybe hitting the gym now at this point. Um, it’s a ghost town in our office today. Yeah. Streets are clear. And I 

[00:00:33] Vic: saw one person in the office, 

[00:00:34] Marcus: normally it’s like a hundred or something. Yeah, but we’re here.

[00:00:38] Marcus: Yes, we have a show to do. We have a show to do. Uh, we’re not going to belabor any points unless it’s something you want to say before we, we jump in. No, let’s dive in. All right, let’s dig in.

[00:00:57] Marcus: All right. So starting out with the economy, I [00:01:00] think the fed is watching data closely. PCE is, um, taking up ever so slightly. And, uh, it looks like the odd makers are. Saying now that a cut in December is more in the 50 50 range. 

[00:01:13] Vic: Yeah, I think that’s right. The PC was slightly higher, um, than last month. And I think, I’m going to say that’s probably okay that the economy is doing well.

[00:01:26] Vic: I think jobs are okay too. Seems 

[00:01:28] Marcus: like jobs have stabilized. So, 

[00:01:30] Vic: I think it would be, Fine. If for them to declare victory and say like we have navigated a soft landing, 

[00:01:37] Marcus: it doesn’t, it doesn’t seem like anyone really cares anymore. Yeah, I think that’s right. I mean, I think now that, now that the election is over and people basically think we’re going to get massive deregulation, massive slashing of, of, um, Government spending and sort of a return to prominence for for deals and general private market activity.

[00:01:57] Marcus: Everyone’s kind of like, whatever, right? 

[00:01:59] Vic: Yeah, [00:02:00] including the bond market. I think they’re just kind of waiting to see if the U. S. government can get more efficient. 

[00:02:04] Marcus: Yeah. Yeah. This story from Wall Street Journal FedMinutes signal more caution on cuts if inflation progress stalls. So I guess there was a meeting that was recorded.

[00:02:13] Vic: We kind of just covered this, that the minutes are released about 30 days after the meeting. So it just came out today. Got it. And in the meeting, there was unanimous consent on the 25 basis point cut that they made, but a lot of debate and discussion about the next meeting, which is what we just were talking about.

[00:02:29] Marcus: Yep. Uh, back to our commercial real estate story, Wall Street Journal, office conversions, find new life after property values plunge. So we’ve been talking Talking for a while about this, this transformation of the commercial real estate market, especially in big cities, where there’s all these buildings, where there is no return to work.

[00:02:45] Marcus: Um, it’s one thing for JP Morgan or Amazon to say return to work, but that’s not what every single company is able to do in the, in, in this new economy. So, um, what, what stuck out to me was this picture that they lead this article with the flat iron building. And it’s one of the most iconic buildings [00:03:00] in America, for sure.

[00:03:00] Marcus: Commercial real estate buildings in America, and it’s going to be redeveloped into condominiums. 

[00:03:04] Vic: Yeah, they can’t fill it, which is. shocking really that that building, I would think a lot of people would want to be working in that building. And, uh, it’s always been said to me by real estate people, People that it’s too hard, too expensive, too difficult.

[00:03:22] Vic: The building’s not structured to do a conversion. To do a conversion. Yeah. And it turns out that when the, when the values of the building get low enough and it’s a lot of vacancy, you find a way to do it, I guess. Right, right, right. But this, go ahead and talk about this chart. Yeah, 

[00:03:37] Marcus: yeah, yeah. This chart, uh, from uh, CBRE research is showing the complete underway and planned announced, uh, conversions from, uh, corporate real estate to residential.

[00:03:48] Marcus: And if you look, you know, from 2016 to 2023, basically somewhere between 25 and 50 a a year. Yeah. Um, that were completed. And then you get to 24 [00:04:00] and it gets to about 75 with another 25 that are underway. 2025. Uh, the underway and, and planned and announced is 275. 

[00:04:11] Vic: Right. Huge growth. Now it’s a small percentage of the square feet.

[00:04:19] Vic: But the growth is, is significant. I mean, exponential curve will make it make a difference over time. That’s right. That’s right. So I think it’s good, healthy. I mean, if we start seeing the downtown areas have people living there and more life, and then there’ll be shopping and. More likely to walk across the street to go to work.

[00:04:37] Vic: I think it feels healthy to go through this process. I 

[00:04:40] Marcus: mean, again, I’m, I’m pretty impressed by the resiliency of our overall economy and banking ecosystem. Now, a lot of that credit to the, to the Fed for the bank credit program that they put in place. But I mean, this has not resulted in the massive fallout that we were, you know, worried about.

[00:04:56] Marcus: I mean, the reason 

[00:04:58] Vic: we’ve been covering it is it had the [00:05:00] potential to do that and they’ve done a good job navigating it. Yeah. Excellent. 

[00:05:04] Marcus: All right, moving into VC deals. Autism provider Cortica gets 80 million in a strategic round to expand value based care contracts and footprint. So this is a Morgan Health deal.

[00:05:14] Marcus: Morgan Health is the evolution of JPMorgan’s efforts post their breakup with, you know, Berkshire Hathaway and Amazon. Uh, on, on Haven, uh, and this is, it’s, it’s a lot of like strategic partnerships and investing that they’re doing. Dan Mendelsohn is the, is the CEO there. Um, so 80 million raise for Cordica really sort of signals that they believe that as employers providing great autism care is, is a key need.

[00:05:40] Marcus: Yeah. 

[00:05:41] Vic: I mean, I think they have seen, I’ve seen the growth in neurodivergent children, including autism, but other things too, has been, just been kind of scary. So getting better and more holistic value based care solutions, I think is great. 

[00:05:57] Marcus: Yeah. It’s a significant 

[00:05:57] Vic: round. 

[00:05:58] Marcus: I mean, you know, [00:06:00] there’s certainly a sense that there is a, a rise of, um, Of, of neurodivergency and there’s also better screening than we’ve ever had before.

[00:06:10] Marcus: So especially as you’re looking at the entire spectrum. Um, and so it, it feels like there’s maybe a little bit of both. Yeah, it’s not 

[00:06:17] Vic: clear that there’s more prevalence. We may be just catching it more. But either way, it drives a need for more, more. more providers. 

[00:06:24] Marcus: Yeah. And the holy grail in this space really is improving outcomes.

[00:06:28] Marcus: You know, ABA is really the one, uh, uh, model for, for care in the autism space that is properly reimbursed. Um, but it’s, it’s in a place now where the outcomes are, uh, I mean, it’s certainly better than, than nothing. Um, but we, we don’t have great outcome data to show us how we’re going to evolve and improve on what the current model of care is.

[00:06:51] Marcus: And so. That’s we, we see so many businesses in the autism space claiming that they’re generating better outcomes. So it doesn’t surprise me [00:07:00] that they’re saying that as well, but I think the bottom line here is that Morgan health has sort of picked their, their partner and this is who they’re going to market with, um, ages ventures.

[00:07:07] Marcus: Uh, so this is VC firm. Uh, we, we mostly have been tracking it because, uh, Feinberg, uh, is, is, uh, is, is part of this team and they’ve been building out a health system, digital consortium, uh, Over the course of the last 18 months, I think they’ve been, they’ve been building this out. So they’ve added a couple of names.

[00:07:22] Marcus: One of them is a hometown name, uh, UPMC Enterprises and Vanderbilt Health have joined their collaborative. 

[00:07:29] Vic: Yeah. So they, they add to the nine systems that were in the founding group. So they have 11 total and I think it’s great that they’ve sort of shifted a little bit from, uh, where they started was really a studio.

[00:07:42] Vic: And now they’re talking about doing some spinoffs and growth investments. I think, uh, Just reading between the lines, it seems like some of the health systems want larger scaled solutions that they can actually implement, as opposed to sort of You know, pilot something. 

[00:07:56] Marcus: Yeah. And, and, and, uh, you know, they’ve got really good names in the [00:08:00] health systems, but they’re not large systems.

[00:08:02] Marcus: Um, Endeavor Health, Indiana University Health, Memorial Hermann’s Health System, Northwell Health, Novant Health, Ochsner Health, Ohio State, uh, Sharp Healthcare and Stanford Healthcare. So, you know, really strong brands. Uh, but not really regionals, right? I mean, you know, they’re, they’re in an area within a single state, I think for the most part there, you know, across all, all of those.

[00:08:22] Marcus: So it definitely seems like they’ve, they’ve got a, a, a core profile of the, of the size of the health system they’re looking to work with, you know, high quality probably in the funding, uh, Yeah, and open to innovation 

[00:08:34] Vic: and trying new things where when you go to a bigger system, it’s harder. 

[00:08:38] Marcus: Yeah. I mean, it’s, it’s got to really make operational sense and financial sense.

[00:08:43] Marcus: Medline is looking at raising 5 billion in a 2025 IPO. I was glad you brought this story up because I didn’t know that Medline wasn’t publicly traded. I mean, you know, it’s one of those companies that I just always equate as a competitor to Cardinal Health. 

[00:08:57] Vic: Yeah. 

[00:08:57] Marcus: Um, and obviously Cardinal Health’s publicly [00:09:00] traded.

[00:09:00] Marcus: Yeah. I wasn’t aware that they were, uh, owned by private equity. 

[00:09:04] Vic: Yeah. It, um, I mean, in reading the story, they started like a hundred years ago. selling aprons to the meatpacking industry. Um, and then they’ve evolved where they do a whole bunch of health care supplies and consumables and everything. Um, and I’m excited for, uh, they’re talking about a 50 billion valuation.

[00:09:25] Vic: Oh yeah. 5 billion IPO would be great healthcare. So I’m a cheerleader for this. Yeah. No, no, it’s a private equity backed firm. Now that. It was family owned for a long time and then maybe five or six years ago, um, Blackstone Carlisle owner Freeman, um, took it pri took it, uh, bought it out. Didn’t take it private, but bought it from the family.

[00:09:48] Marcus: Yep. So that’s, that’s a, that’s a great development. Hopefully they successfully get that done in 2025 and we’ve got, you know, more, more heft in the public markets. Uh, okay. Moving into policy. So the Trump [00:10:00] appointments continue and, uh, selected to lead the NIH is Dr. Jay Bhattacharya. 

[00:10:06] Vic: Yeah. Which is, uh, I shouldn’t be surprised anymore, but, but it is, uh, it was surprising to me.

[00:10:12] Vic: Leading NIH. As, uh, one of the largest critics of NIH, uh, through the COVID thing, I mean, he is at Stanford and a researcher and policy guy and was pretty, pretty vocal about alternative ways to manage the COVID pandemic and the public health response to the pandemic, uh, much more focused on, uh, protecting elderly and.

[00:10:40] Vic: Vulnerable populations, but then allowing young healthy people to move around and in fact, go ahead and get the disease to get sort of more population based, uh, immunity. And I think he was pretty, uh, frustrated in the [00:11:00] response he got, got kind of like, shut down and even taken off social media in some cases.

[00:11:05] Vic: And so he is a, I think he’s a credible guy. You know, Stanford certainly is a good place, but he’s going to bring a, certainly a new approach to NIH and science. 

[00:11:16] Marcus: Yeah, Dr. Bhattacharya was, I think, one of those very, very credible figures that for anyone who was open to the idea, um, that, uh, perhaps we were not getting, uh, the right answers.

[00:11:33] Marcus: the, the absolute best policy decisions as it pertained to how we were going to, you know, get through the pandemic. Right. When, when you listen to him, um, and, and far before, you know, way before, uh, you know, you had all the, all the crazy stuff. I mean, he was coming out and just saying, listen, I’m just, I’m simply presenting a different perspective, um, maybe a non consensus perspective on, on this, but from a [00:12:00] scientific, um, you know, model that that’s, That’s what we do in academia, right?

[00:12:04] Marcus: That’s what we’re supposed to do. Yeah, that’s what ideas, go 

[00:12:06] Vic: do research, and then Right. But 

[00:12:08] Marcus: in that environment, you know, uh, the very institutions that he was used to doing this in. you know, inconsistently. It was really his, his dismay was more with academia than it was, I think, with, with the government.

[00:12:22] Marcus: I think he was very, very upset with the way that he found academia to not, um, be open minded, open minded. Um, and, and, and really just, just changing what, what, what were the norms? It’s not even open mindedness as much as it was, here were the norms for how we dealt with non consensus views. And now you’re just totally blackballing me.

[00:12:41] Marcus: Right. You know, right. Um, and so he, he had, he grew a pretty big audience because he was able to leverage podcasts, uh, you know, leverage podcasts for the people who were saying, Hey, look, this COVID thing is a hoax or whatever, you know, and he went on there. And if you took the time to listen to any of his episodes, you’re like, you know, this guy is not a conspiracy theorist.

[00:12:59] Marcus: He’s simply, [00:13:00] he has a 

[00:13:00] Vic: different opinion, but he’s. I think he’s credible. 

[00:13:05] Marcus: He’s, he’s certainly credible. So look, I mean, uh, appointments like him and Marty McCurry and these are these things, you know, we’re gonna talk about Scott percent in a little bit. I mean, these are appointments that make me feel better, 

[00:13:17] Vic: you know, you know, for sure.

[00:13:19] Vic: Yeah. I mean, he’s going to, I think, really focus on peer reviewed science and make sure the peers that are reviewing it are not paid by a financial institution. That’s going to benefit from the outcome. Sort of a course, but, um, and that’ll be good overall. It’s gonna be, I think, a hard first year probably.

[00:13:39] Vic: Yeah. Uh, but it’ll be healthy in the long run. Yeah, I think that’s right. 

[00:13:43] Marcus: Uh, so you, you made this Google Doc laying out all the, I couldn’t keep straight of, I couldn’t keep it all straight . So, uh, laying out all the different, uh, uh, cabinet appointments. So if you’re not watching and you’re listening, you know, this is not gonna be that helpful.

[00:13:54] Marcus: But, uh, just kind of run through our slate so far. Yeah. 

[00:13:58] Vic: Yeah. So, um, [00:14:00] Robert Kennedy Jr. Is. at the top, HHS secretary. And then all of these departments will report in to him. Yep. Um, so we have CMS, uh, Dr. Oz, FDA commissioner, Dr. Marty McCary, we just spoke about. Yep. Uh, director of NAH, Dr. Brett Attardi, we just covered him.

[00:14:22] Vic: Yep. CDC director is, uh, Dr. Dave Weldon, um, and we can talk about him in a minute. And then, um, two others that got less, uh, press, but Jim O’Neill is going to be the deputy director of HHS. I think given, um, Kennedy’s set of responsibilities and just his experience or lack of experience running an administration, I think he’s likely to lean on the deputy a lot for internal Yep, I think, uh, General O’Neill’s very focused on bringing more efficiency to HHS, um, [00:15:00] where Robert Kennedy Jr.

[00:15:01] Vic: will probably be more on the high level, like, direction, vision. 

[00:15:05] Marcus: And also his special projects. 

[00:15:07] Vic: Yeah, yeah, that’s right, right, right. And then, I don’t know this woman, Dr. Janet Nish what? I don’t know either. She is, um, she’s a doctor. She’s named Surgeon General. Uh, she is a Fox contributor. I don’t think she’s practiced in a while, but we have bios down below.

[00:15:25] Vic: We can go look for the details. 

[00:15:28] Marcus: So let’s talk about Scott percent. So there was a, there was so much talk, uh, on social media about who was going to get the treasury secretary, most 

[00:15:36] Vic: heavily lobbied influenced that this was a position 

[00:15:40] Marcus: and percent is, was not Elon’s kind of pick was, was Elon’s pick. Um, but, but I think, uh, Elon talking about that brought All of this debate and conversation.

[00:15:51] Marcus: And I think the general consensus was percent is the, is the best pick. I thought so. Um, and, and, and so what you then saw [00:16:00] was Linda McMahon, who wanted to be the secretary of commerce, got secretary of education, then Lutnick got the secretary of commerce, which pretty much made way for percent to be named, um, uh, treasury secretary, which I think kind 

[00:16:11] Vic: of works out.

[00:16:13] Vic: Well, 

[00:16:13] Marcus: yeah, I mean, look, uh, percent is a real, real, real guy, right? Yeah. You know, um, you know, top tier private market player worked under Soros. Um, you know, well known for his economic theory. 

[00:16:25] Vic: Yeah. 

[00:16:25] Marcus: Uh, 

[00:16:26] Vic: he was a star macro markets, hedge fund trader. Yes. Um, then he launched his own hedge fund, which has been okay, uh, but he, he definitely is in the markets every day, trading against all these other traders and knows how the market works.

[00:16:43] Vic: Yeah. So I think it’s it’s what America should have is someone that really understands that space running Treasury. 

[00:16:50] Marcus: Yeah, I mean, that has played with skin in the game right at the highest level macro. Yeah, you know, because that’s, you know, Treasury, you basically have to work hand in hand with the Fed.

[00:16:59] Marcus: You [00:17:00] have to be an economic specialist. Yeah, it doesn’t say in all these different forces and this. This guy’s very experienced. 

[00:17:06] Vic: And he came out with his, um, 333 policy, um, which is modeled after a Japanese policy from 10 years ago, but it is, hopefully I’ll get it right. A 3%, uh, reduction of the deficit, the annual deficit to 3%.

[00:17:24] Vic: Right now it’s what? Six something, 6. Of GDP. Yeah. Yeah. So GDP is. roughly 20 trillion. So it’s 6 percent of that. He wants to cut that to 3%. So cut it in half a little more than half 3 percent GDP growth. Those things are going to cut against each other. Yeah. As you, as you cut government spending, which is like 30 percent of GDP.

[00:17:50] Vic: Yeah. It’s going to, it’s so, so it’s going to be hard to do both those things at once, but his goal is to do both of them. Um, and then 3 million barrels. [00:18:00] Additional or equivalent. I think he’s including natural gas, which is much more likely to happen. Um, in new production. So the US would be producing more energy.

[00:18:11] Vic: Um, well, we also are cutting our deficit and growing 

[00:18:15] Marcus: and importantly, he wants to do this in four years. Yeah, let’s get this done by 2028. So, I mean, the only thing you, as you pointed out, um, cutting the deficit means cutting government spending, cutting government spending would naturally cut GDP growth.

[00:18:35] Marcus: So you, the only way to make up for that, right. I mean, cause what are we growing at right now? You know, somewhere between high ones to low to mid twos percent on any quarter. So to get to three, the amount of productivity you’d need to spur in the, in the, uh, business sector, it’s kind of unreal, right? I mean, it’s gotta be like a total free for all just like money bonanza.

[00:18:59] Marcus: [00:19:00] Uh, so. Whether you can get it done or not, setting that as a goal has got to make the markets and investors super excited. Yes. Right. I mean, that’s how else can you interpret that? 

[00:19:13] Vic: Yeah, that’s right. It would, it would make our government debt much more secure. I mean, it’s already the most risk free debt, but it would make it, it’d 

[00:19:23] Marcus: be good for the dollar.

[00:19:23] Vic: Yeah. It’d be good for the dollar and it would be good for America. It’d be create jobs. It would create. growth everywhere. Now, whether he can do it or not, I don’t know, but having this caliber person with that goal, and then he’s already been talking about tariff policy and trying to kind of rein in Trump in order to be able to achieve these goals.

[00:19:47] Vic: Which, you know, whether he can do that or not, who knows? But the fact that he is trying to achieve these goals makes me feel like at least we have people working on it. 

[00:19:55] Marcus: If this guy can actually achieve that goal, uh, the Republicans will win for the next [00:20:00] 12 years. So I mean, that’s, that’s, that’s just prosperity like on steroids.

[00:20:06] Marcus: It’s just crazy. 

[00:20:07] Vic: Well, I mean, we, I think we were talking about it on, on air. I don’t know. It, it, this, uh, Trump win reminded me of the, the Ronald Reagan, Yeah, we talked about that. And, um, and they won for 12 years. Um, and it was because the economy did really well. Now we need to see, we’re looking forward, like we need to see the actual proof.

[00:20:31] Vic: I’m simply 

[00:20:31] Marcus: saying if they do that, they can do that or really come even reasonably close to that. It’s a lot of prosperity. 

[00:20:39] Vic: Yeah. 

[00:20:40] Marcus: Right. Yeah. 

[00:20:41] Vic: And the Democrats will have to figure out a way to add value and respond. And that will be good. That’ll be good as well. 

[00:20:47] Marcus: And look, everything is trade offs. So it’s not like, you know, land of milk and honey.

[00:20:52] Marcus: Right. I mean, something would suffer, somebody would suffer, something would be bad in all of that. So there’s always an opportunity to position against something. [00:21:00] Um, CMS, CMS releases 200 new Medicare residency slots. 

[00:21:04] Vic: Yeah. I was really happy to see this. We haven’t added to the residency slots, which is the number of new doctors we can make since 1997.

[00:21:15] Vic: And we need a lot of doctors. And not only did they add and fund 200 new positions, but they limited it to primary care and psychiatry. Wow. That’s great. Which is great. That’s great. Cause those are two areas. We really need a lot of new docs in. Yeah. 

[00:21:30] Marcus: And look, I mean, I think I don’t know how many docs I’ve talked to who’ve ta who have been complaining about the lack of residency slots.

[00:21:36] Marcus: Yeah, yeah. You know, you get all the way through med school and it’s like you can’t get placed. Right, right. You can’t get placed for residency. 

[00:21:41] Vic: Yeah. It’s, it’s ridiculous. And the amount of money that it costs compared to the drag on the system, because we don’t have primary care docs. Just it’s not they should be doing this every year, but I’m happy they did it this year.

[00:21:57] Marcus: Yep. Let’s continue on with CMS. Yeah CMS [00:22:00] is trying to get a lot done Before January right hits and so by demonstration and their CMS regime is reclassifying obesity to be a chronic disease. Is that correct? That’s right. Okay. And through that reclassification, now you can say that GLP 1 drugs will be covered by Medicare and by Medicaid, broadly making these new, very expensive, but also highly effective drugs.

[00:22:37] Marcus: Um, really taking on more The entire chronic disease sort of problem we have in America right now, the obesity, diabetes, heart disease, like that, that kind of trifecta and everything related to, to those things, um, making them just broadly accessible [00:23:00] and saying, look, the government is going to pay for it.

[00:23:01] Marcus: Now there is probably some health economics that plays into the growth and productivity, the, you know, the, the lowering of really, really expensive. I mean, cause, cause think about it, like, what, what is the cost of. You know, Medicare when, when someone is, is post stroke all the, you know, inpatient acute stuff and all, all of those things like, yes, okay, this is going to be 1, 000 a month, but I can tell you, like, if you have to have a, an extensive inpatient stay, because you had, you had a serious event through a lot 

[00:23:31] Vic: of months of that.

[00:23:31] Marcus: Oh, my gosh. Yeah. I mean, hundreds of thousands of dollars is what is what Medicare is going to pay and Medicare is going to pay it. You know, so I think there is some health economics underneath this decision. It’s not just a we’re just adding on this expensive, you know, because these drugs work. Like if they didn’t have the efficacy, that would be one thing, but they work.

[00:23:52] Vic: I mean, there’s no question about that. They work. I think the question is, it already is available to [00:24:00] treat diabetes. Yep. And so this is now becoming available for someone who is obese. Great. As we talked about last week, you don’t have to be that overweight to be classified obese. Um, but not diabetic, not diabetic, right.

[00:24:17] Vic: And we just had the Chevron doctrine overturned by the Supreme Court six months ago, maybe not even six months ago. And so they are trying to get around the prohibition against Medicare, paying for weight loss, weight loss, weight loss and cosmetic through any, any, um, You know, vanity kind of things in the 70s or 80s, what, there was a law passed that Medicare can’t pay for that.

[00:24:47] Vic: And so the. The effort is in to redefine weight loss, not as a vanity measure, but in treatment of a chronic disease called obesity. And [00:25:00] I think that’s a, that’s a semantic, that’s a definitional thing. I don’t know that that works. And then I think it would be beneficial, but it, but it’s going to be, it’s going to be open for challenge.

[00:25:16] Marcus: Yeah. I mean, I, I guess, It is definitely going to be open for challenge. And I think the, the key here is once you start it, if Trump has to unwind that, that’s going to be politically back. 

[00:25:28] Vic: So the political move that I think is brilliant, and I don’t know, I don’t know any of the backstory, but I don’t think that any of the Democrats starting with Biden on down, we’re not aware of this, they are offering this new benefit.

[00:25:48] Vic: And creating a infrastructure that is plausible, have it work, and then I think there’s a 60 day look back, which we are within [00:26:00] the 60 days of. It’s 53 days, I think, um, and so Trump’s gonna have to decide, does he want to, um, accept this, which, you know, his department of government efficiency does, the exact thing they’re trying to prevent is this.

[00:26:20] Vic: Or does he want to tell all the seniors, I’m effectively taking away your Mozambique? Um, it’s a pretty interesting move, uh, from a political point of view. 

[00:26:32] Marcus: Yeah. I mean, I can tell you that the old people in my life who are on Medicare are already kind of getting turned upside down with all the changes.

[00:26:40] Marcus: Happening in Medicare already. Yeah, you know all the prescription plan changes and you know, it’s too much for them to already process I mean you start talking about taking away a drug that they just want that they want Yeah, I I think it’s gonna be difficult. I think yeah, I think it’s gonna be difficult So yeah, this feels like a really really well timed well [00:27:00] placed political why 

[00:27:00] Vic: Biden didn’t do it two years ago Or maybe not.

[00:27:04] Marcus: Well, I don’t, I don’t, I don’t think Glp1 drugs had nearly the momentum anytime. But this year has been the breakout year for Glp1. So let’s, you know, amid a cost debate, this is Fierce Healthcare, amid a cost debate, new study finds 137 million U. S. adults are eligible for Glp1s. Right. 

[00:27:23] Vic: I think it would drive savings over a 10 or 20 year view, but I also think it would explode costs in a one year view to give.

[00:27:36] Vic: anyone who wanted it in Medicare access to GLP 

[00:27:41] Marcus: 1s. Yeah, I think, I think the Delta is less than nine years. 

[00:27:45] Vic: Maybe it’s not, yeah, whatever, I don’t know what the time frame is, but, um, you lose weight and you don’t have a negative health event sometime in the future. That’s where the saving comes. Right, sometime 

[00:27:57] Marcus: in the future, that’s right, that’s right.

[00:27:58] Vic: Yeah, so, [00:28:00] um, they published a study in JAMA about the number of people that would, would have, would want it, would have access or would benefit from it. But we don’t know sort of if we approved or even how they do the. You know economics. 

[00:28:17] Marcus: Yeah, I mean look at this point I think and this this will be interesting.

[00:28:22] Marcus: Um for Dr. Oz this is going to be a dr. Oz challenge, right? Yeah, and it’s going to land on his it’s going to land on On his desk and I and I think That it’s hard to look at the science here um and look at the The real epidemic that we have of obesity in America and play that out and not say This is this is a kind of miracle drug and and we have this incredible opportunity to dramatically improve the health of the country [00:29:00] in a relatively short period of time.

[00:29:02] Marcus: And what could be all the benefits for that? So the, these are the kind of interesting issues they’re going to have to face because if your entire agenda is cut spending, you know, you miss some opportunities, right? That’s, that’s always kind of the thing. And, um, I just think this is one of those areas that, that, that you need to kind of think about a little bit differently.

[00:29:28] Vic: And it’s going to be a Significant political decision in the first 20 days. 

[00:29:34] Marcus: Yeah. Yeah, 

[00:29:35] Vic: for sure. 

[00:29:36] Marcus: Uh, final CMS story here. CMS finalizes six year kidney transplant model with concessions to hobby hospital lobby after critique. So, uh, this is a model that they’ve been, uh, working on for a while. There was, I think, a bunch of issues around the incentives, both carrot and stick here, um, the timing of when this was going to roll out, uh, this rolls out to a specific [00:30:00] network, um, of, uh, Hospitals that perform these organ transplants, and basically they’ve upped the upside payment from 8, 000 to 15, 000, managed to keep the negative payment at 2, 000, but it looks like they’re still moving forward.

[00:30:18] Marcus: So if you’re part of the Organ Procurement and Transplantation Network, this is a mandatory model that CMS is going to roll out before the administration changes. 

[00:30:26] Vic: That’s right, and there’s 90, 000 people waiting for a kidney now. So I think it does make sense that we need to try to get that process faster, more efficient.

[00:30:39] Vic: Um, I don’t know the detail. I know it was heavily lobbied, uh, by both sides. And it seems like it got to a kind of a settlement that seems fair. 

[00:30:49] Marcus: Yeah, they also pulled out three quality measures and they removed a health equity payment adjustment. That’s now a voluntary, um, uh, part of the model. Probably smart [00:31:00] anticipating if you, if you keep that in just on the merit of that, like, you know, the Trump administration is going to going to kill it.

[00:31:06] Marcus: Signify Health is expanding its offerings and making more visits. Here’s how. So this is, uh, CVS Health owned Signify Health. This is, uh, CVS’s home health arm, and they’ve had a really good year. So finally, some good news for CVS Health. 

[00:31:21] Vic: Yeah, so this is, um, they have a little of telehealth, but they mostly send nurses, RNs, to the patient’s home to, um, do a health risk assessment and advise them on how they could manage their health better.

[00:31:39] Vic: Um, and they’ve had a lot of success as they integrated with CVS, um, getting many more patients to say, like, usually the pharmacist is now offering this. Would you like a home visit to sort of help you manage your health more? Um, and the thing that I was really surprised about, but it’s wonderful is that, you know, They’re starting [00:32:00] to catch the kind of mild cognitive impairment.

[00:32:04] Vic: in seniors that are, you know, not necessarily noticing the symptoms, but when the nurse gives them the, the test, which doesn’t take a long, I think it’s a 10 or 12 minute test. They can catch it early and there are treatments that are reasonably effective only if you catch it early. So I think it could be really, really beneficial on a lot of fronts.

[00:32:23] Marcus: Yeah, I think that’s been beaten 

[00:32:25] Vic: up on a lot of things. So it’s good to see them do something well. 

[00:32:28] Marcus: Yeah. Uh, United healthcare wins 2025 star ratings lawsuit requiring CMS to recalculate results. So this is. Three losses in a row, uh, for CMS. They’ve also lost to Elevance Health and Scan Health. So this whole rush to adjust the star ratings has pretty much been a failure and a waste of money and time for everybody.

[00:32:47] Vic: Yes, that’s right. I mean, there has to be a way to evaluate Medicare Advantage plans with some scale that everyone agrees to that’s reasonably [00:33:00] quantitative. I think we should hold them accountable to high SIR, high quality levels. Sure. But it just hasn’t been managed well. They’ve lost all three challenges.

[00:33:08] Marcus: And, and it’s crazy in that story, you know, to, to read that literally they got dinged on a single phone call. Yeah. Where actually the error was not on the insurer, but it was on the CMS tester. 

[00:33:21] Vic: Yeah, they didn’t, they didn’t. Track their note it correctly. Yeah, but that one call one call knocked them 

[00:33:28] Marcus: down from five stars to four stars So 

[00:33:30] Vic: like we need we need more data points I mean that one 

[00:33:33] Marcus: call can can stop you from getting five stars That is crazy when you understand like how much money the difference is right five stars and four stars.

[00:33:40] Marcus: Yeah It’s like how is that make sense? That’s not reasonable That’s not reasonable at all center. Well, Sanjay Shetty on Humana’s primary care gamble. So, uh, Humana, another beleaguered, uh, payer, but having some good news with their provider arm. 

[00:33:54] Vic: Yeah. They’ve had good success with center. Well, um, and even in some of the places [00:34:00] that Walmart failed in doing primary care, they have moved into the same exact building and they’re having success.

[00:34:07] Vic: And I think it’s because they’re focused on seniors only, and they have that You know, very contained population that they know how to take care of. Yeah. Yeah. So, so we see two payviders CVS and Humana both now having, starting to have some success. 

[00:34:24] Marcus: It’s good. Instacart launches snap eligibility screener for consumers and clinicians.

[00:34:28] Marcus: Yeah. I didn’t see this coming, 

[00:34:30] Vic: but I should have it. I mean, it makes complete sense that they would like to deliver more groceries to more people. It’s so simple. There are lots of people that have the right to get. Food benefits through snap and they just don’t know they’re eligible, but they have phones, but they, yeah, 

[00:34:46] Marcus: exactly.

[00:34:47] Marcus: Yeah. So this is, it makes so much sense and it, and it’s, it’s, it’s, it’s really great. It’s, this is really, really thoughtful and also likely to be very profitable for Instacart here. So, so, so good job. Instacart [00:35:00] community health systems, Nix is 120 million deal to sell three hospitals, community health systems based here in Nashville.

[00:35:06] Marcus: Um, you know, we know lots of great folks who, who are there working on trying to turn around, Uh, you know, this, this, uh, this, this health system that just went on a buying spree and at, you know, a bad timing, B didn’t necessarily buy great assets. Right. Just kind of thought bigger was better. And it was, it’s like five plus years.

[00:35:24] Marcus: They’ve been working on selling off all these assets. 

[00:35:26] Vic: They have a lot of debt from those, that buying spree and they. They’ve been selling a lot of hospitals. This one caught my attention because it failed because the the group, which is called Woodbridge, I looked them up. They’re a healthcare consultancy and they have a seems like a pretty reasonably strong leadership team.

[00:35:48] Vic: Had been doing consulting and then they sort of geared up to be able to run these hospitals. Okay. They used, uh, the investment big Ziggler. We know a bunch of the Ziggler guys. They’re, they’re one of the two or three best [00:36:00] places to do a bond offering to finance a deal like this. I don’t think you really could have got a better bank to do it.

[00:36:08] Vic: And they were not able to sell the bonds. And so the deal fell apart because no one would finance it. Um, so CHS now still has those assets. They tried to negotiate a, you know, lower price, different terms, and it just couldn’t get done. So it seems like, uh, not a good sign for that footprint or those, those three hospitals are really going to be difficult.

[00:36:30] Marcus: No, listen, uh, health system bonds. are tough right now. Yeah. That’s a, that’s a tough, tough, tough space. I mean, you, you got to have real heft, um, and some, and some good performance. But if you’re like smaller onesie Tuesday kind of thing, and also the financials are not looking great. 

[00:36:45] Vic: Yeah. 

[00:36:46] Marcus: I don’t think people want to finance that.

[00:36:47] Marcus: You know, it seems like there’s a lot of headwinds and it’s just, you’re not sure that the business is going to make it to the other side. You’re going to get your, your money back. 

[00:36:54] Vic: Yeah. Yeah. There’s all kinds of, yeah. Things like the population growth or lack of and [00:37:00] the payer networks and all those things.

[00:37:01] Vic: I think we’re not a lot of risk, a lot of risk, 

[00:37:04] Marcus: a lot of risk moving into pharma. Novartis lifts midterm sales guidance amid us expansion. So Novartis has been really working on a new strategy and ending certain partnerships, beefing up their pipelines in certain areas. Uh, and it seems like that all that work they’re doing is paying off.

[00:37:21] Vic: Yeah, I think that’s right. They sort of got their reorganized, they’re growing now, they’re doing some acquisitions, so. I think it’s a good, good sign. 

[00:37:29] Marcus: And Roche, uh, another, uh, farmer that has really cleaned up their focus, heavy focus on oncology right now. They are about to acquire Poseida Therapeutics in a deal worth up to 1.

[00:37:40] Marcus: 5 billion. This is a CAR T cell therapy deal. 

[00:37:44] Vic: Yeah. I’m really interested in CAR T because I think it’s going to be a huge win for all, all of the blood base. Yeah, yeah. Cancers. Cancers. And I think this, we’re starting to see, um, I think there’s two different strategies in Big Pharma that there’s [00:38:00] Roach and Novartis that are very focused in You know, a subset of disease states, Roche is sort of focused on oncology, um, and then there are the broader groups, and I think in the next administration it’s gonna be better to be focused and really deep in one area and have good science, because that’s what’s gonna carry it.

[00:38:19] Vic: Yep. The marketing heft and lobbying, I think, is gonna fall. 

[00:38:24] Marcus: Amgen’s obesity drug cut weight and closely watched studies. So Amgen has a, a Glip1 that’s in trial right now. The big difference is that you only need this once a month versus the weekly shots, uh, from our Glip1s that are out in market today.

[00:38:38] Marcus: Uh, but they fell just short of kind of the expectations or the hopes, uh, in their 52 week trial. 

[00:38:45] Vic: Yeah, it had, they had, people had significant loss, about 20 percent of the Weight loss, um, so it’s working, but a little bit less than expected, and they still are slow. I mean, it’s not going to be out for another year or so.

[00:38:58] Vic: This is not the final, [00:39:00] uh, clinical trial. But it was slightly under expectations. The shares were down. I think they still will get a drug to market. Just not clear if that once a month benefit will be worth it or not. Yeah. 

[00:39:14] Marcus: Yeah. And it’s, it’s, it’s hard to figure out exactly how you should factor this in.

[00:39:18] Marcus: I mean, Eli and Nova Nordis have years of, of, uh, you know, uh, front run on this market opportunity, but taking a shot once a month versus once a week, that’s, that’s a material life enhancing, you know, uh, difference. So if, if Amgen can, uh, you know, make some, some progress in their next trial, that might make investors a little bit more happy.

[00:39:43] Marcus: Yeah. And they 

[00:39:43] Vic: might have a price advantage. Yeah. They may use one fourth as much. Of the drug, so they could charge 1, 200, but they’d have much less cost to deliver it. Better margins. 

[00:39:54] Marcus: Better margins. Yeah. Teladoc Health launches AI motion detection solution to improve [00:40:00] patient safety in hospital beds. So, this sounds like something a startup would be Bringing the market except for Teladoc is a publicly traded company.

[00:40:10] Vic: Yeah. And I saw, I was at Vive last year, there were two or three startups doing this with good results. I mean, sure. It’s a, this is a story that I want to be excited about. It’s a, it’s a big problem. People fall. Oh yeah. Because they’re trying to get up out of bed to go to the bathroom or to go drink a water or whatever.

[00:40:28] Vic: Sure, sure. And hospital systems can’t find people to sit in the room, they’re called sitters. Yeah. You just can’t find the people to do it. And so automating that is, we should definitely do. Of course. And Teladoc has a solution. It sort of sits on top of the room TV with a little camera and supposedly it can differentiate between the nurse coming in and the patient getting out of bed, which is sounds useful, but I think all the, all the competitors do that.

[00:40:57] Marcus: Yeah. So, so is this what Teladoc is going to do? Are they, are [00:41:00] they just going to. Stop doing their current business, which is not working very well and move into AI. 

[00:41:07] Vic: They are trying to take their existing, uh, set of technologies and find solutions for 

[00:41:15] Marcus: this, an existing technology. I would have never associated Teladoc with a in hospital.

[00:41:20] Vic: Well, their roadmap, the first thing they did was build a little cart so they could wheel around their telehealth presence. Okay. Okay. I think in nursing homes and then eventually they went to hospitals for like, um, translation services or ancillary stuff on this, you know, TV that rolls around. And then they’ve taken that product and then extended it to the, the TV in the room.

[00:41:50] Vic: So they’re arguing it’s an extension of their roadmap, but I think they have a sort of, they have filled out as [00:42:00] much market share as they can get in the. telehealth, um, space to, you know, to patients for urgent care replacement stuff. And they’re trying to figure out a way to sell to health systems. I don’t think it’s going to be something that saves them.

[00:42:19] Vic: I went and looked at the stock price, which we have here. They were high flying when everything was high flying in the, you know, 2020, 2021, it got to 293 per share, and it’s currently sub 10. And so it’s not that this product is bad, it’s just it’s hard to get that excited. 

[00:42:40] Marcus: I mean, that’s the capitulation of, of that stock price Yeah.

[00:42:44] Marcus: Is brutal. Yes. You know, they’re kind of in the same class with, uh, 23 and me and you know Yeah. Right. Some of the other companies where the bottom has just really dropped out. Alright. Wrapping up our ai uh, rundown, Nvidia has rolled out its own, uh, gen AI model that is focused [00:43:00] on audio and, uh, what’s this thing called?

[00:43:02] Marcus: Uh, fdo? 

[00:43:03] Vic: Yeah. Yeah. Foundational Generative Audio Transformer. Opus One. fdo . Um. It’s interesting because it’s the first software only product that NVIDIA has released. And you and I both have done the demo. I think it’s worth doing the demo. It’s, it’s pretty interesting. I mean, it’s really good at little, uh, sound effects and snippets of songs and it’s text to sound.

[00:43:32] Vic: Uh, you can also take sound clips and then feed it into that and have it modify it. So it’s interesting. 

[00:43:41] Marcus: Look, I think if you’re, if you’re a composer or a producer, 

[00:43:44] Vic: yeah, 

[00:43:44] Marcus: I mean, this is, you know, because these are typically the sounds that you use. You have to buy like a sound bank, you know, and it’s got, okay, then you’re, you’re stuck with those.

[00:43:54] Marcus: And then maybe you can. Run different effects to, to change those basic sounds, but the idea that you [00:44:00] can use a prompt and say, create this net new sound for me and it does it. And okay, now I can take this and I can include it in a score for a movie, or I can include it in, in a song that I’m making. I mean, that’s, that’s pretty cool.

[00:44:11] Marcus: And I do really. Like that in video picked on an area that nobody else is focused on. It feels like all the other AI models. It’s like, there’s one video, one video and images 

[00:44:23] Vic: and 

[00:44:24] Marcus: video, but audio, nobody like really focused on that. So great way for them to differentiate 

[00:44:30] Vic: and contribute to the, to the market.

[00:44:34] Vic: And I think really kind of showcase that, you know, if you think of them as hardware only, that’s right. I think 

[00:44:39] Marcus: again, that’s right. 

[00:44:39] Vic: That, I think that was the point really, is that they’re moving up the stack. Okay. Because they see that other groups like Google, Amazon, everyone, they’re trying to go find chips.

[00:44:50] Vic: So, 

[00:44:50] Marcus: yep. Uber is taking their ability to run gig economies that has largely been around transportation and [00:45:00] delivery. Um, and now saying, we think we can do this for anything. And they’re starting with AI labeling. 

[00:45:07] Vic: Yeah. And I think it, um, it’s kind of a, um, non sequitur to go from driving to labeling AI data sets.

[00:45:17] Vic: Yeah. But I think it does make sense. They have all of these drivers that would like to make more money in a way that is on their schedule. And this is that. They could sit for two hours and label some data sets. And it’s not that it’s not out there. I mean, there’s lots of, uh, Amazon has Mechanical Turk and things like that, but it’s not, as dedicated and it’s, and Uber is good at managing these like gig economy workers.

[00:45:47] Marcus: Yeah. I mean, it’s, it’s their primary business. Mechanical Turk is a nice fun thing. But there’s nothing really at the scale of Uber for gig economy. And I think it makes perfect sense for them to find these other really high [00:46:00] demand, low skilled labor opportunities. And then just, you know, especially if they, if they’re not flashing a pan, but they’re like long term opportunities.

[00:46:08] Marcus: And roll, roll something out for him. I think it’s brilliant. 

[00:46:11] Vic: And they have a global gig economy. It’s not just us. I mean, I don’t know how many Nashville drivers will do it, but if you’re in another developing country, it could be really good way to add to your income. 

[00:46:22] Marcus: Also Uber’s publicly traded, right?

[00:46:24] Marcus: Yeah. Brilliant for them to find a way AI narrative. Brilliant way for them to get into the AI narrative. So very, very smart for Uber. Uh, and then final story, Wall Street Journal headline, China is bombarding tech talent with job offers. The West is freaking out. Sub headline, Huawei offered triple pay to lure staff from a key supplier of chip making parts, sparking German investigation.

[00:46:49] Vic: Yeah. I don’t see how this is illegal. You can pay someone more money to come to your company, and I think they’ll have success at that. Triple pay. [00:47:00] Whatever you make now, triple it. 

[00:47:03] Marcus: I mean, that’s just hilarious, right? I mean, have you heard of triple pay in America? No one’s doing that. No one’s doing that.

[00:47:12] Vic: And, um, I don’t know, it is just ways to change the game, right? Yeah. It’s just ways 

[00:47:17] Marcus: to change the game. 

[00:47:18] Vic: Yes. The Chinese government, I think, is playing a longer game. They can, they print the money so they can easily pay triple. And they were really frustrated about US sort of, you know, locking Huawei out of a lot of markets.

[00:47:36] Vic: Um, I don’t know if you saw Huawei drop their most recent phone yesterday or the day before. It looks great. It’s all Chinese chips, Chinese parts, Chinese everything. Yeah, but we can’t get it in America. We can’t get it. Yeah. Uh, it’s also really expensive. I think it’s like a thousand bucks. Oh, wow. Okay. But supposedly it’s very good, but 

[00:47:54] Marcus: it’s a premium.

[00:47:54] Marcus: It’s a premium device, a premium device. 

[00:47:56] Vic: I think it’s going to be really hard for [00:48:00] Apple because it’s Apple’s second biggest market in China. That’s 

[00:48:06] Marcus: right. I 

[00:48:06] Vic: mean, they’re not going to sell any devices in the U. S., but Apple sells a lot of iPhones in China and they’re going to take a piece of that market share.

[00:48:13] Vic: Yeah. So China’s not going to fall asleep. I mean, they’re going to compete and I don’t know, I think, uh, I think the West can beat them. But we have to actually get our act together and have better tech. 

[00:48:29] Marcus: I mean, to me, it’s, it’s just like, expect the unexpected, right? I mean, triple pay, that was the part I was reading, I was just like, oh my gosh.

[00:48:36] Marcus: Uh, any, anything is possible. And, uh, you know, it’s just, it’s just all these different conventions and, and, uh, value network things that we just assume are laws of the universe. They’re not. Yeah. They’re not. There’s all sorts of ways to break the back of a competitor. Yeah. And triple pay is certainly one.

[00:48:53] Vic: Right. Yeah, and in some of these, uh, chip manufacturing places, if you get three [00:49:00] really talented people, it can make a big swing to how Chinese chip makers are compared to Taiwan Semiconductor or someone else. Well, I 

[00:49:08] Marcus: think, I think the, the brilliance here is that Um, there’s, there’s two factors here. One is there really is a significant difference in, you know, a B plus and an A plus engineer in terms of the quality of the output that you’re going to get.

[00:49:29] Marcus: And then the other thing is, it is a little bit of a zero sum game. There are, these people are a fixed resource, right? They’re, you know, we’re not printing them on trees. It’s like, it’s hard to find the absolute best chip engineers in the world. Right. And so. Why wouldn’t you just play a salary war game and and try to aggregate as many as you can because because not only do you advance your own agenda You hurt.

[00:49:54] Marcus: Yeah, you’re here the other side here the other side. It’s just it’s really really smart So yeah, 

[00:49:59] Vic: [00:50:00] maybe we should offer triple play to VCS 

[00:50:01] Marcus: We have to pay for it’s different if you’re a government exactly exactly we’re not printing any money. Yeah, so, you know waiting for the 

[00:50:11] Vic: Bill’s with my face on 

[00:50:12] Marcus: him. I don’t want the CFTC.

[00:50:14] Marcus: Yeah, yeah, yeah, right, right. All right, man. Great show. Happy Thanksgiving, everybody. I hope that this helps you get caught up while you’re dealing with your your turkey insomnia. Hopefully 

[00:50:24] Vic: you’re working out on a treadmill while you’re listening to us. Yeah, 

[00:50:26] Marcus: and we’ll see y’all next [00:51:00] [00:52:00] [00:53:00] [00:54:00] [00:55:00] [00:56:00] [00:57:00] [00:58:00] [00:59:00] [01:00:00] [01:01:00] [01:02:00] [01:03:00] [01:04:00] [01:05:00] [01:06:00] [01:07:00] [01:08:00] [01:09:00] [01:10:00] [01:11:00] [01:12:00] [01:13:00] [01:14:00] [01:15:00] [01:16:00] [01:17:00] [01:18:00] [01:19:00] [01:20:00] [01:21:00] [01:22:00] [01:23:00] [01:24:00] [01:25:00] [01:26:00] [01:27:00] [01:28:00] [01:29:00] [01:30:00] [01:31:00] [01:32:00] [01:33:00] [01:34:00] [01:35:00] [01:36:00] [01:37:00] [01:38:00] week.