Mark Cuban 如何让医疗重新变得负担得起

简要描述Brief Description

马克·库班探讨了药品价格透明化、当地药房的可及性、小规模生产、直接医疗保健合同，以及人工智能如何帮助雇主和患者了解自身选择。对话还探讨了临床工作、个性化医疗、政策和创业。Mark Cuban discusses transparent drug pricing, local pharmacy access, small-scale manufacturing, direct healthcare contracts, and the ways AI could help employers and patients understand their options. The conversation also explores clinical work, personalized medicine, policy, and entrepreneurship.

目录Table of Contents

• 开篇：竞争与医疗保健的可负担性
  Opening: competition and healthcare affordability
• 药品获取、制造舱与直接合同
  Drug access, manufacturing pods, and direct contracts
• 保险经济学与不透明合同
  Insurance economics and opaque contracts
• 使用 AI 审核福利合同
  Using AI to review benefit contracts
• 信任、制造规模与长期业务
  Trust, manufacturing scale, and the long-term business
• AI 技能、入门级工作与耐心的选择
  AI skills, entry-level work, and patient options
• 个性化医疗与医生的作用
  Personalized medicine and the role of doctors
• 电子健康记录（EHR）合作关系与医疗支出的价值
  EHR partnerships and the value of healthcare spending
• 透明度、免赔额与一种替代性融资模式
  Transparency, deductibles, and an alternative financing model
• 社交媒体与传达人工智能的价值
  Social media and communicating the value of AI
• 创业与人工智能学习
  Entrepreneurship and learning with AI

开篇：竞争与医疗保健的可负担性Opening: competition and healthcare affordability

我们所处的并不是一个高效的医疗保健市场，其经济机制已经失灵。医疗保健领域的诸多弊病之一，就是完全缺乏竞争机制。仅仅是 plus drugs 的出现，就已经迫使现有企业作出改变。We are not in an efficient healthcare market. The economics are broken. One of the many ills of healthcare is that it completely lacks competitive dynamics. Just merely by the presence of plus drugs, you've actually forced change in the incumbents.

United Health拥有3000多家子公司，每年内部公司间资金转移达1500亿美元。很多时候，他们会提高保费、提高免赔额，同时迫使你与一家他们已经拥有、而你却不知道归他们所有的公司建立关系。最终使命是颠覆医疗保健行业，让医疗服务再次变得负担得起。United Health 3,000 plus subsidiaries, $150 billion in intercomp transfers annually. There's often times when they will increase premiums, increase deductibles, and at the same time force you into a relationship with a company they already own and you don't know they own them. The ultimate mission is to disrupt healthcare so that it's affordable again.

有没有哪个领域会让你觉得：“为什么没人涉足这里？”现在正是创业的最佳时机。我认为，最大的挑战，以及 AI 将产生最大影响的地方是……好了，Mark，欢迎来到播客。Is there like some area where you're like, why is no one building here? There's no better time to be an entrepreneur than right now. The biggest challenge and where AI, I think, is going to have the biggest impact is Well, Mark, welcome to the podcast.

非常感谢你们邀请我参加。谢谢你们邀请我来，大家好。朱莉，马克在这个领域的贡献，哪些地方让你印象深刻？你一直觉得马克在 Cos Drugs 做的事情，或者总体来说他所做的事情，哪些地方特别吸引你？你为什么邀请他上节目？Thanks so much for joining. Thanks for having me on, guys. Julie, what has struck you about Mark's contributions in the space? What what have you always found fascinating about about what Mark's been up to with Cos Drugs or and just in general, and why you invited him on to the show?

我是说，马克，呃，首先，你有勇气以一种引起巨大轰动的方式，踏入医疗保健这个泥潭。很多很多人——你知道，也处在马克你这样的优越位置、拥有如此庞大受众的人——几十年来都被吓住了，不敢这么做。所以，嗯，我一直很喜欢看市场对马克你在医疗保健领域所做的事作出反应。我想，你知道，我只知道一件事：马克，你我以前聊过这个，嗯，医疗保健就像是一个行业，而医疗保健的众多弊病之一，就是它完全缺乏竞争机制和竞争力量、自由市场机制之类的东西。令人着迷的是，仅仅因为 Cost Plus Drugs 的存在——这只是一个例子，我们也会聊聊你做的其他事情——仅仅因为它的存在，因为这个实体的存在，也因为你所代表的、你正在做的事情，你实际上就迫使那些既有企业作出了改变。否则，即使有政策介入，即使有各种各样其他力量，它们在几十年里也从来、从来没有改变过。所以，这就是其中一点。是啊，因为我没机会看到那些事，我不跟那些人打交道。I mean Mark uh first of all just had the courage to enter into the morass that is healthcare in a way that made such a splash and that many many people who you know also are in the privileged position that Mark is in to just have such a huge audience have um been intimidated you know to do over over many many decades and so um I've loved watching uh the market react to what Mark has done in healthcare. I think you know the one thing I know Mark you and I have talked about this in the past but um healthcare is like one of the industries like one of the many ills of healthcare is that it completely lacks competitive dynamics and competitive forces free market dynamics all that kind of stuff and what's been fascinating to watch is just merely by the presence of cost plus drugs as one one example and we'll talk about others that you've done to but um just merely by that by by the presence of that of that entity and what you what you represent and what you're doing you've actually forced uh change in the incumbents that otherwise like even with policy, even with like all sorts of other forces like never never changed over the course of many many decades. So that's that's one of Yeah, cuz I don't get to see that stuff cuz I don't talk to those guys.

然后我觉得，正如你刚才提到的，即使没有合同，我认为从市场需求端来看，人们也意识到，他们需要表明人们有某种途径能够获得你的产品，对吧？所以，也许即便没有直接合同，嗯，你知道，我确实听到有人把你们的解决方案说成是他们网络的一部分。说真的，大三家甚至大六家拿我们的名字来当作一种回应请求的方式，我一点也不惊讶。你知道，在讨论定价时，他们会这么做，因为他们知道我们的价格是公开的，任何人都可以调用我们的 API，而那些稍微有点脑子的公司每天都会抓取这些数据，然后对他们说：“你们得把价格压到比这个更低。”所以我能理解这一点。And then I think to your point like even absent a contract, I think people are recognizing from the demand side of the market that they need to show that there is some pathway for people to get your product, right? And so perhaps even in the absence of a direct contract, um you know, I do I do hear people talking about you know, your solution as part of their network. Really, it truly does not surprise me when the big three or even the big six use our name as kind of a way to um counter the request, you know, you know, in the discussion of pricing cuz they know that our prices are public, that anybody can take our API, and big companies that have half a brain are pulling that data on a daily basis and they're saying, "You have to beat this price." And so I can see that.

不过，你知道，我至少遇到过一家公司，也可能不止一家，他们说：“哦，是啊，你知道，三大巨头里随便哪一家都告诉我们，你们属于他们的网络；我们能拿到你们更便宜的价格，而且我们跟三大巨头中的任何一家都没有协议。”But, you know, I've had at least one company and probably more um that have said, "Oh, yeah, it's, you know, pick one of the big three has told us that you're part of their network and we get your prices where you're cheaper, and we don't have an agreement at all with any of the big three."

药物获取、模块化生产单元与直接合同Drug access, manufacturing pods, and direct contracts

Mark，我们先把视角拉远，盘点一下你们业务目前的发展情况。你们在2022年起步时只有几十种药品。今年4月，你说已经发展到大约4,000种。你们正涉足制造、医院合同，甚至可能包括基于人工智能的医疗服务。Mark, let's zoom out and take stock about where where you're at with the business. You you launched in 2022 uh with a few dozen drugs. In April this year, you said you were up to roughly 4,000. Uh you're getting into manufacturing, hospital contracts, potentially AI based care.

你能不能简单盘点一下业务目前的情况？我来给你介绍一下。我们于2022年6月19日——我是说1月19日——推出了 costblooddrugs.com。网站上有111种药物，全都是仿制药。说实话，我们当时完全不知道会是什么情况。Why don't you take stock a little bit of where the business? I'll give you the rundown. So, we launched costblooddrugs.com June 19th, I mean January 19th of 2022. 111 medications, purely generic, and you know, we didn't know what to expect at all.

我出去开始谈这件事，它马上就火了，对吧？然后你知道，我们的销量促使制造商扩大了与我们合作的产品组合，我们也得以增加更多制造商。所以现在，正如你所说，我们大概有 4,000 个 SKU，而且我们的业务每周都在持续增长。I went out and started talking about it and it immediately blew up, right? And then you know our volumes there led the manufacturers to expand their portfolio with us and we were able to add additional manufacturers. So now as you said we have you know 4,000 SKs give or take and our business every week is up and to the right.

所以，我们最大的挑战就是跟上它的发展。这是第一部分。然后，面对邮购，显而易见的回应就是：我今天就得把东西拿到手。于是我们创建了一个叫 teamcubancard.com 的东西。我没给它起这个名字。So our biggest challenge is just keeping up with it. So that's segment number one. Then the obvious response to mail order is well I need to pick things up today. And so we created what's called the teamcubancard.com. I did not name it.

它基本上是一张折扣卡，持卡人可以去与我们合作的1.7万家药房中的任何一家，在当地取药。我们的大多数药品都可以这样取——不是所有药品，而是大多数。因为我非常支持独立药房，所以我们会向合作药房支付12美元的配药费。这意味着，对于价格最低的药品，我们的价格会更贵：比如一种5美元的他汀类药物，加上12美元配药费，你在别处买会更便宜。但另一方面，如果你确实想支持独立药房，也可以在那里取便宜的药。And it's basically a discount card that allows you to go to any of the 17,000armacies that have affiliated with us and pick up any of our not any of but most of our drugs locally because we pay I'm a big believer in supporting independent pharmacy. So, we pay our affiliate umarmacies $12 um fill fee, which means that's going to make us more expensive for the lowest cost drugs because if you have a $5 statin plus $12, you're going to get it cheaper somewhere else. But at the same side, if you really want to support your independentarmacies, you can pick up the cheap drugs.

但对于价格更高的药物，比如专科仿制药和生物类似药，价格实际上便宜得多。对于生物类似药、胰岛素以及需要冷链运输的药品，通过我们的 Team Cuban Card 团队在当地购买并取货，实际上更便宜。这就是我们所提供服务中的第二大支柱。But on the more expensive drugs, the specialty generics, the bioimilars were actually much cheaper. And for things like bioimilars and insulin and things that have cold shipping, it's actually cheaper to buy it and pick it up locally through our team Cuban carb. So that's the second um stool in what we offer.

第三个是成本加成型市场平台。好，在谈成本加成型市场平台之前，先回到我们在达拉斯的药品制造业务。我联合创始人亚历克斯·奥克斯曼斯基博士最初给我发冷邮件时，想制造一些药品，也就是列在 FDA 短缺药品清单上的仿制药，因为其中有儿童癌症药物。Third is cost plus marketplace. Well, before I get to cost plus marketplace, let me go back to our Dallas manufacturing. So a big part of um Alex, my co-founder, Dr. Oxmanski, his original cold email to me was he wanted to manufacture drugs that were generic drugs that are on the FDA short supply list because there are pediatric cancer drugs.

医院里广泛使用的药物有很多，比如 Penov um Ptocin、肾上腺素，这一长串药物。我们能够利用 AI 和机器人技术，把原本需要占据一个甚至更大的橄榄球场的生产空间缩减到 5,000 平方英尺。不仅如此，我们还能每四小时切换生产一种药物。这样，我们就能生产够用六个月的供应量，然后切换生产线，再生产下一种药物，继续这样做。我们把这些产品卖给医院和诊所。作为这项工作的延伸，因为我们一直在为你们做这件事，所以五年前我们就开始着手做这方面的工作了。There are things that are widely used in hospitals. penov um ptocin, epinephrine, this long list of drugs and we were able to use AI and to use um robotics to shrink what would have been a football field or more into 5,000 square ft. And um not only that, but we were able to turn drugs every four hours. So we can make a six-mon supply, turn the line, and then go to the next drug and continue doing and we sell those products to hospitals and clinics. an extension of that because we've been doing that for you, we started working on that five years ago.

嗯，我们已经能够将同样的机器人技术和人工智能集成到一个制造工厂中——如果你愿意的话，它的大小相当于一辆半挂卡车。我们称这些工厂为“舱体”。这些舱体可以用于各种用途，也可以运往任何地方。Um, we've been able to take those same robotics and AI and shrink it into a manufacturing plant, if you will, the size of a tractor trailer. And we call those pods. And those pods can be used for anything and shipped anywhere.

政府是我们的第一个客户。嗯，我们最近刚在这里交付了第一台，随后又拿到了第二台的订单。他们告诉我们后面还有更多订单，因为如果发生生态灾难，只要 FEMA 在场，我们就可以把设备送过去。如果发生天气灾害、军事灾难——但愿不要——我们也可以把设备运过去，并进行配置，让它们生产任何特定类型的药物。The government was our first customer. Um, we've shipped the first one here recently where we just got an order for a second and they told us there's more behind that because if there's an ecological disaster, we can send it to FEMA if the if FEMA's around. If there is um weather disaster, military disaster, god forbid, we can ship them there and configure them to make any specific type of drug.

因此，我们可以为无菌注射剂配置一个生产舱——你知道，多个生产舱可以串联起来，这样我们就能扩大规模；或者，你也可以让一个生产舱用作无菌室，另一个生产舱生产仿制药片剂。我不是这方面的专家。Alex 可以详细介绍，但我最引以为豪的一点——其实《Stat News》昨天还是前天刚写了一篇相关报道——是我们可以对这些生产舱进行配置，用来生产 N-of-1 疗法，这样我们就能把生产舱运到研究型医院。这些生产舱的成本大约是 2,000 万美元。把它运到研究型医院后，如果他们专门研究某些疗法，服务于那些属于 N-of-1 类别的患者，就能在那里生产并快速迭代。现在，我们正在达拉斯的第一家生产设施里生产这些 ASO 药物。别问我 ASO 是什么意思，因为我连它都念不出来。So we can configure a pod for um sterile injectables for you know multiple pods can be daisy chained together so we can scale and or you can have one as being a sterile room and another doing the the tablet work for generics and I'm not the expert on this. Alex can go into this in precise detail, but the thing I'm most proud of, and actually Stat News just wrote a story on this yesterday, the day before, is that we can take these pods and configure them to do um N of one therapies so that we can ship the pod to a research hospital. And these pods cost about $20 million. ship it to a research hospital and if they're if they specialize in any types of therapies that you know for those people that are in the N of one category they can make it and iterate very quickly there and then now we're doing these ASO drugs and don't ask me what ASO stands for because I can't pronounce it um out of our um first manufacturing facility in Dallas.

这就是第二部分。通过这项制造业务，我们创建了 cost plusmarketplace.com。呃，抱歉，是 Cost Plus Marketplace。Cost Plus Marketplace 会把我们生产的无菌注射剂，以及我们从其他供应商或制造商采购的无菌注射剂，以成本加 10 或成本加 12 的价格卖给诊所、医院、医疗服务提供者，以及任何想以最低价格购买这些药品的人。So that's part two. From that manufacturing, we created cost plusmarketplace.com. Um, sorry, cost plus marketplace. And cost plus marketplace takes those sterile injectables we make and that we also others that we source from other providers or other manufacturers and we sell them at a cost plus 10 or cost plus 12 to clinics, hospitals, providers, whoever want to buy them at the cheapest price.

而且我们确实能每年帮医院节省数百万美元。嗯，不过我们最大的挑战是，我们能说服首席执行官，却不一定总能说服采购人员去做这件事。嗯，最后，因为我自己作为自保型雇主的经历，也因为我四处拜访医院的首席执行官和首席财务官，了解他们与大型保险公司的关系——尤其是那些垂直整合的大型保险公司——以及他们喜欢和不喜欢的种种方面，而他们大多是不喜欢。And we literally can save hospitals millions of dollars a year. Um but our biggest challenge there is we convince the CEOs but we can't always convince the purchasing people to do it. Um and then finally um because of my own experiences as a self-insured employer and going around and talking to hospital CEOs and CFOs and learning their relationship with the big carriers, the big vertically integrated carriers and all the things they like and dislike mostly dislike.

我去找他们，说：“听着，我知道你们讨厌那些延迟、拒付、preos、逾期付款、追扣，还有你们知道的，你们的计划，或者说保险公司的计划，不断提高免赔额，逼得医疗服务提供者成了次级贷款机构，因为他们必须先收取免赔额，才能提供医疗服务，或者才能拿到保险赔付。既然我知道这些情况，我想谈一份直接合同，但我有两个条件。接下来我会告诉你们，为了这两个条件，我会给你们什么。”I went to them and said, "Look, I know you hate um the delays, the denies, the preos, the, you know, the late pays, the clawbacks, the fact that, you know, the your plans are or the carrier plans keep on increasing deductibles, turning the uh providers into subprime lenders because they have to collect the deductibles before they can offer the care or before they can get access to the insurance money. Knowing all these things, I'd like to work out a direct contract, but I want two things. I'm going to tell you what I'm going to give you in exchange for those two things.

第一，我会相信医生。除非情况特别离谱，否则就相信医生。所以你不需要事先授权，也不会遭到拒绝。不过，我们曾经遇到过一位患有孟乔森综合征的人，当时不得不拒绝其申请。One, I'm going to trust the doctor. Unless it's something crazy, trust the doctor. So, you're not going to need a pre-auth. There aren't going to be denials. Now, we had somebody who had Munchhousen's disease that required a denial.

不过，你知道，除此之外，如果费用高得离谱，我也会按时支付合同约定的价格。我会自掏腰包为患者承担费用。要么我来付，要么我来承担患者本人的信用风险。But, you know, other than that, if it's something crazy, I'm going to pay the price that we contract for on time. I'm going to take responsibility for the patient out of pocket. Either I'll pay it or I'll I'll take the credit risk for the patient itself.

所以你不是——你并不是一家次级贷款机构，你知道的。作为交换，我要两样东西。首先，我要更优惠的价格，因为你们相关的行政管理、运营开销和医生工时都少得多。你们的收益率会更高。So you don't you're not a subprime lender, you know, and in exchange for all that, I want two things. I want a better price because your associated administration and overhead and doctor time is much less. Your yield's going to be higher.

我还希望能够把我们签署的合同，也就是我们双方之间的这份直接合同，发布到 cost pluswwellness.com 上。这样它就可以成为所有这类合同的开源资源，任何雇主都可以使用，任何服务提供商也可以发布自己的合同；即使你不想发布或使用这些合同，也可以把它们作为自己谈判时的模板。And I want the ability to take the contract we signed, this direct contract between us, and publish it on cost pluswwellness.com. So it can act as an open source for all of these contracts so that any employer can use them and any provider can post their contract and even if you don't want to post or use, you can use them as templates in your own negotiations.

保险经济学与不透明合同Insurance economics and opaque contracts

嗯，Mark，我很喜欢你上一篇文章，因为我觉得那就是我们来回交流的起点。几周前，我发表了一篇文章，谈的是我所说的医疗保险计划的“大替代周期”。我的意思是，长期以来，雇主赞助的医疗福利一直是我国规模最大的保险类别。嗯，如果你这么看的话。你知道，大约有1.55亿美国人享有雇主赞助的福利，甚至更多。对，更多。Well, I love the last piece, Mark, because I think that was the genesis of our thread back and forth when I published a piece a few weeks ago on what I'm calling like the great replacement cycle of health plans and for I mean for so long so you know employer sponsored health benefits is the largest class of insurance in our country. um if you think about it that way. So, you know, roughly about I think 155 million Americans are covered by an employer sponsored benefit or more. Yeah, more.

但无论如何，这涉及全国一半以上的地区，大约占全国的 60%。从历史上看，这个市场一直完全被这些大型企业垄断，比如这些国家级运营商。而且从初创公司的角度来看，这一直是个难以进入的市场，对吧？But in any case, it's more than half the country, 60% of the country. And um historically, it's been completely, you know, monopolized by the buas like these national carriers. And um and it's been an unadressable market from a startup perspective, right?

这些关系似乎根深蒂固。你需要拥有这些全国性网络，才能参与竞争。所以，进入这个领域的门槛成本对初创公司来说太高了，而且这些关系也实在是根深蒂固。Like it's the relationships were super entrenched. You needed these national networks to, you know, be able to play in the game. And so the like starting cost to sort of enter the arena was was too high for startups to get into and the relationships were just too entrenched.

现在，呃，保费涨幅简直离谱得要命，对吧？比如今年，我们甚至看到一些初创公司里，有些 BUA 强行要求保费同比上涨 60%。而且事情比你想的还要糟，Julie。Now uh the premium uh increases are just freaking ridiculous, right? Like this year we're seeing even amongst our startups um some Buas are forcing like 60% year-over-year increases in premiums. And it's just it's even worse than you think, Julie.

你知道，并不是说不介入，而是因为他们是垂直整合的。所以，United Health有3000多家子公司，每年内部公司间转移达1500亿美元。按GDP计算，这相当于在美国各州中排名第14位。You know, not not to step in, but because they're vertically integrated. So, United Health 3,000 plus subsidiaries, $150 billion in intercomp transfers annually. That would make them number 14 in GDP in the United States among states.

这就说明它们的规模有多大。CVS Sigma也紧随其后。很多时候，他们会提高保费、提高免赔额、增加自付费用，同时把你转到他们已经拥有的某家公司，或者实际上强迫你与这家公司建立关系，而你甚至不知道这家公司是他们旗下的。And so, that tells you how big they are. And CVS Sigma are not far behind. And so there's often times when they will increase premiums, increase deductibles, increase um out-of-pocket costs, and at the same time redirect you or actually force you into a relationship with a company they already own and you don't know they own them.

你知道，我们谈的是雇主提供的保险，尤其是那些自行承保的雇主。通过公司获得医疗保险的人中，有 60% 是通过自行承保的雇主获得保险的。这些雇主需要有人来处理所有医疗理赔。先不说药房理赔，医疗理赔这类事务通常由第三方管理机构处理。如果这些机构归大型蓝十字蓝盾保险公司所有，就称为 ASO，即“仅提供行政服务”。And you talk about, you know, employer based insurance, particularly those who self-insure. 60% of people who get their health care from companies get it from self-insured employers. And those employers need someone to process all the medical claims. put aside pharmacy, the medical claims, those things are called thirdparty administrators. And if they're owned by the big buas, they're called ASOS, administrative services only.

而那些管理机构，你知道，我们总是听说 PBM 存在的问题，以及它们如何通过价差获利。嗯，在医疗服务这一边，情况糟糕一百万倍，因为它也占据了市场的一大块。什么？当然，相比之下，它占据的市场份额也更大。And those administrators, you know, we hear all the time about the problems with PBMs and how they spread price. Well, on the medical side, it's a million times worse because it's also chunk of market. What's that? It's also the bigger chunk of the market relative to of course.

是的，医疗这部分要大得多。你知道，这部分占10%，而且还在增长，其他部分则占90%。他们的做法是，保险计划和医院各自签订合同。医院除非在市场上占据主导地位，否则就会讨厌 BUAs 和这些合同；但更重要的是，无论双方之间是什么关系，自我保险的雇主都完全不知道这段关系的具体条款。Yeah, it the medical side is much bigger. you know, 10% in growing versus the other 90%. And what they do is the plans and the hospitals have their own contracts. And the hospitals, unless they're market dominant, have the hate the buas and those contracts, but more importantly, whatever that relationship is, the self-insured employer has no idea what the terms of that relationship is.

对吧？虽然你可以去医院查询 tick 文件，也就是关于这种关系和该计划的价格透明度文件，但它们并不总是准确的。但最终的情况是，雇主支付的价格——也就是自保雇主支付的价格——很少与医院收取的金额或实际支付给医院的金额相符。Right? Even though it's possible you can go on the hospital and look up the tick file, you know, the transparency files for that relationship and that plan, they're not always correct. They're not always right. But what ends up happening is the price that your the employer pays, the self-insured employer pays rarely matches the amount that was charged or the amount that was paid to the hospital.

所以这里存在价差定价。更糟的是，那些由 BUAS 所有的 ASO 让人根本无法核对这些数字，也就看不出你到底付得更多还是更少。他们还会做一些事情，你知道，有些文件叫作 835 和 837 文件，里面包含发送给医院的数据，以及针对这些理赔所支付的金额。So there's a spread pricing there. And to make matters worse, those ASOs that are owned by the BUAS make it impossible to reconcile the numbers so that you can see if you're paying more or less. And they do things, you know, there's these things called 835 and 837 files, which is the data that's sent to the hospital and the amount of money that's paid in response to those claims.

而且雇主根本无法访问这些信息。很多情况下，他们甚至无法查看自己的理赔记录。正如你所说，Julie，这套体系实在太不公平了。想办法把他们排除在外、绕过他们，正是当下医疗保健领域变革的关键，也是大家梦寐以求的目标。And the employers have no access to it. And in many cases, they don't even have access to their own claims. It is just so rigged to your point Julie trying to you know remove them and disintermediate them is the key the holy grail to what's happening in healthcare right now.

是的。而且我们，怎么说呢，真的非常期待看到大量初创公司涌入这个市场。除了这些市场力量之外，另一个重要原因是，经济压力已经到了临界点；此外，AI 也能发挥重要作用，让人们在很短的时间内打造出一套完整的健康计划服务，同时减少你所说的那些手工工作。Yeah. And we're I mean we're super excited to see just an influx of um startups that are now able to go after this market. A big reason why in addition to all these market forces and again like the economics just getting to a breaking point is the fact that AI can play a significant role in enabling a full stack like health plan offering to be built in a way that reduces all the craft that you're describing in a very short period of time.

但这一切归根结底取决于谁来承担风险。至于 AI，我是个铁杆粉丝。我全身心拥抱它，也热爱它。我认为它在临床方面很重要，在运营方面也很重要，而短期内它在合同方面最为重要。But this all comes down to who takes the risk. While AI I'm a huge AI fan. Live it, love it. I think it's important on the clinical side. I think it's important on the operational side. I think it's most important short term on the contractual side.

但现实是，在一个已经失灵的金融体系中，即使你把 AI 引入经济、运营和流程，也无法修复问题，因为你在一开始就提到了这一点，Julian，你完全正确。我们的医疗保健市场并不高效，经济体系已经失灵。But the reality is in a broken financial system, even when you introduce AI into the economics and the operations and the processes, when it's already broken, you can't fix it because you brought up the point right at the beginning, Julian, you're 100% right. We are not in an efficient health care market. The economics are broken.

你可以看出这一点，因为如果没有价格发现机制，这本身就是一种保护，会让你无法拥有高效的市场。但更糟的是，市场和经济学真正开始崩溃的地方就在这里。这也让 AI 在短期内的运营层面（而非临床层面）面临困难：合同规模很大、期限又很长，BUA 通过他们的 ASO，简直成了合同上的恐怖分子。And you see that because if you don't have price discovery, that's one thing that protects you, that keeps you from having an efficient market. But what's even worse, and here's where the market, the economics really start to fall apart. And what makes it tough for AI in the short term operationally and less so clinically, the contracts are so big and so long, the buas through their ASOS get to be contractual terrorists.

我所说的合同恐怖主义，是指达拉斯市的PBM合同。我还没能看到他们的ASO合同，足足有1335页。嗯。地球上没有哪群人能喝下足够多的咖啡，查出他们试图蒙混过关的所有内容。And what I mean by contractual terrorism, the city of Dallas on their PBM contract, I haven't been able to see their ASO contract yet, 1335 pages. Mhm. There's no group of humans with enough coffee on the planet to be able to catch everything they try to squeeze by.

因此，结果就是，无论是什么 AI，一旦你签了合同，希望你能先用 AI 来避免签下一份糟糕的合同。我认为这对所有人来说都是最容易着手的事情。但一旦你签下了那些条款你并未完全理解、甚至根本无法保护自己免受其影响的合同，对方就赢了。这个世界上没有任何 AI 能保护你。And so, as a result, no matter what AI, once you sign a contract, now hopefully you use AI to prevent yourself from signing a bad contract. And I think that's the lowhanging fruit for everybody, but once you sign that contract with terms you don't fully understand and conditions you don't fully you can't even protect yourself against, they win. There's no AI in the planet that can protect you.

而且，当你试图在计划方面跟他们竞争时，对吧，听起来不错，我也完全支持，对吧？Sidecar 和许多其他公司正在做的事情确实很聪明，但他们遇到了问题，因为你知道，没错，配套网络是必需的，没错，搭建一个网络很难。但那些 BUA 有那么多子公司，他们总会在某个地方跟你[爆粗口]，而你甚至都意识不到。And when you try to compete with them on plans, right, that sounds good and I'm all for it, right? What sidecar is doing and so many others are doing is really smart, but they're having problems because, you know, yes, the wraparound networks are needed and yes, putting together a network is hard. But those buas have so many subsidiaries, they [expletive] with you somewhere and you don't even realize it.

这就是终极挑战。也正因如此，我如此支持《拆分医疗巨头法案》，并主张打击这些公司，因为我希望——我希望这是一个开放的市场，让每一位创业者都能以各种可能的方式使用 AI。And that's the ultimate challenge. And that's why I'm so big on the break up big medicine bill and going after these companies because I want I want this to be an open market for every entrepreneur, you know, to use AI in every way possible.

使用 AI 审查福利合同Using AI to review benefit contracts

所以，你说的正是我要谈的方向，Mark。AI发挥作用的一个领域，无论好坏，就是它让人们清楚地看到，人类设计的底层系统有多么糟糕。现在付款方和医疗服务提供方之间正在发生的这场先发制人的机器人之战就是如此。人们把问题归咎于AI，但实际上并非如此；AI只是在最大程度上执行现有的按服务收费计费体系，让我们看清了这个体系有多么糟糕。所以我很好奇，你怎么看这件事最终会走向何方？显然，你们的直接签约方法听起来能够减少很多信息不对称，让合同更加清晰，等等。And so you were you went exactly where I was going to go, Mark, which is one of the areas where AI is playing a role for better for worse is that it is just shining a light on how broken the underlying system that humans designed is right. So the whole like prior bot war situation that's happening right now between payers and providers is one of you know people blame the AI but it's actually no it's like AI is just implementing the existing fee for service billing system to the full extent and showing us how broken that system is. So I'm curious to like what your take is on what's the end state of that like clearly your direct contracting uh methodology it sounds like is able to reduce a lot of the information asymmetry and contract clarity and things of that sort.

这就是要采取的措施吗？至于机器人之战，围绕索赔以及编码升级和编码降级展开的那些事，都是短期的，对吧？这就像你知道的，好吧，我得减点肥，所以我不吃米饭了，也不再天天吃霜糖玉米片了，对吧？这在边缘上有点用，短期内也算是个不错的策略，但它并不会真正改变一切，因为 AI 是个伟大的均衡器。你的 AI、我的 AI——你是 OpenAI，我是 Anthropic，或者不管是什么——我们会彼此较量，你可能赢几局，我也可能赢几局，但最终它们会在某种程度上相互抵消。所以，我不认为长期来看会有戏剧性的变化。也许如果你先入场，就能抢占一些先机；当一方拥有它而另一方没有时，也会出现一些诉讼和挑战。不过，医院一侧的收入周期管理做得相当不错。Is that what it's going to take or so the bot wars in terms of claims and up coding and down coding that's short-term stuff right that's just like you know okay I need to lose some weight I'm not going to eat you know my rice I'm not going to eat my frosted flakes every day right it's nice on the periphery and it's good short-term play but it doesn't really change everything because AI is a great equalizer your AI my AI you're open, you know, open AI, myanthropic, whatever it is, we're going to battle each other out and you might win a couple innings, I'll win a couple innings, but they're they're going to net out at some level. So, I don't see dramatic change in the long term. Maybe if you're first in, you can pick up some things and you see some um lawsuits and you see some challenges um when one side has it and the other side doesn't, but the revenue cycle management on the hospital side is pretty darn good.

而我认为，Buas有一个很大的问题，因为它们是通过收购发展起来的。我们提到过这3,000家子公司，这意味着有大量彼此隔离的数据。即便可以想办法获取理赔数据和某些特定信息，以便进行升级编码，而且他们也确实在这么做，但对BUA这边来说，要成为AI原生公司仍然很难。And the Buas have an have a big problem in my opinion because they grew through acquisitions. We mentioned these 3,000 subsidiaries. That's a lot of siloed data. And even though you can try to find ways to get access to claims and specific things that allow you to upcode and they're doing that, it's going to be hard for them to be become AI native companies on the BUA side.

我认为从长远来看，他们会面临挑战。但这一切都要从更早的时候开始，我怎么强调都不为过：这一切都发生在你……在那些雇主签署合同之前。如果你们每一家投资组合公司都说：“你知道吗？”And I think over the long term they're going to be challenged. But all of this starts, and I can't say this enough, all of this starts before you before those employers sign their contracts. If every one of your portfolio companies said, "You know what?

我打算把现有的福利合同交给 AI 分析。如果我有经纪人、顾问、嗯，TPA，或者 PBM 合同，我就会用 AI 分析现有合同，并输入一个只问一个问题的提示词：他们到底在哪些地方在坑我？我该怎么办？I'm going to run my existing benefits contract. If I have a broker, if I have a consultant, if I have um a TPA, if I have a PBM contract, I'm running my existing contract through AI and I'm asking and I'm using a prompt that asks a single question. Where are they [expletive] me over? what should I do about it?

而在30秒内，你就会看到砰、砰、砰、砰、砰、砰、砰、砰、砰。我见过它们处理合同的情形——我得告诉你们，我有多喜欢 AI 智能体。所以，我全都用。我用 Grockbot。And within 30 seconds, you're going to see bam, bam, bam, bam, bam, bam, bam, bam, bam. And the things I've seen running through contracts because let me just tell you how much I love AI agents. So, I use them all. I use Grockbot.

我和埃里克都是 NBA 球迷。所以我买了卢卡·东契奇套餐，嗯，因为它好像是 77.69 美元什么的。我当时就想，这太棒了。慢炖锅，77 美元，卢卡套餐。我懂你。然后我还有 Gemini 套餐，还有 OpenAI 的套餐，等等等等。I use Eric and I are NBA fans. And so, I got the Luca um Donix plant because it's $77.69 or something. I'm like, this is brilliant. Crockpot, $77, the Luca plan. I got you. And then I have the Gemini plan. And then I have OpenAI's plan, etc. etc.

我也会使用 agents 和 Instinct，然后……我会使用 agents，然后告诉它：“出去帮我找出每一个有公开记录申请机会的州政府实体、组织和企业。我想让你从这些实体那里找出所有合同、RFP，不管是什么，只要你能找到的都要。然后帮我写一封信来申请这些资料。把它放进一封电子邮件里，存到我的草稿中。”And I use the agents and instinct too and dot and I use the agents and I say you go out and find me every state entity organization enterprise that um has an open records opportunity and I want you to find me every single contract RFP whatever it is you can find um from those entities and I want you to write the letter to request it. Put it in an email. Put it in my draft.

让我稍微个性化一下。弄好后告诉我，我就点发送。很棒，对吧？那些一直排在清单末尾、我总想做却始终没能做的事，现在感觉就像都要实现了。Let me personalize it some. tell me when it's there and I'll hit send. And it's amazing, right? Stuff that's always been at the bottom of the list that I always wanted to get to but never could. Now it's just like this stuff is coming.

于是我把它放到 Google Drive 上，每个不同的 LLM 都能访问。我每次都会告诉它们，只要 Drive 上有新东西上传，你们就去看一遍，告诉我好消息、坏消息，以及应该怎么做，然后再给我一个简单版本，这样我就能发给公司、学校之类的地方。然后，哒哒哒哒哒。And so I put it up on Google Drive and each of the different um LLMs has access to it. And I just tell them all every time there's a new um something new loads on the drive, you go through and you tell me, you give me the good news, you give me the bad news, you give me what should be done, and then you give me the simple version so I can send to the company or, you know, school or whatever it is. And bam, bam, bam, bam, bam.

这就是我能看到 PBM 领域三大巨头和 ASO 领域的 BUAS 签下的所有这些合同的地方。因此，我能具体看到这些企业是如何坑骗这些学区的。天哪，从丹佛到达拉斯，再到沃思堡的城市和工会。And that's where I get to see all these contracts that the big three on the PBM side and the BUAS on the ASO side are signing. And so I get to see specifically how all these enterprises are getting ripped off these school districts. Oh my god, cities from Denver to Dallas to Fort Worth unions.

我的意思是，你想想看，再回到你那个特别好的观点，Julie：如果那67%——也就是代表着1.6亿多美国人的雇主——真的只做一件事，一件事就好：在签合同之前先用 AI 审一遍，再据此进行谈判，那么大型 buas、大型 PBM 及其所有子公司的整个体系都会崩溃。这个国家的医疗保健成本会直线下降。所以我去和雇主交谈，去和投资者交谈，聊到他们投资组合中的公司时，他们就会问：“我们需要立法吗？”I mean, and if you think about it, again, going back to your perfect point, Julie, is if that 67%, if the employers representing 67%, the 160 million plus Americans actually did one thing, one thing, ran their contracts through AI before they signed them and negotiated from that, the entire system for the big buas and big PBMs and all their subsidiaries would collapse. The cost of health care in this country would drop like a rock. And so when I go and I talk to employers, when I go talk to investors and talk about their portfolio companies and they're like, "Do we need legislation?

“我们需要这个那个吗？”我会说：“不，你得聪明点，把自己的工作做好，找一个我称之为医疗保健 CEO 或 CFO 的人来负责，他唯一的工作就是管理合同以及所有相关事宜。”你会发现，医疗保健成本会降下来。等我们把你带到这一步之后，就可以马上谈谈划出直接合同，以及做其他所有这些事情。比如，我曾告诉几家上市公司这么做，后来他们回来跟我说：“天哪，我们完全不知道自己被坑得有多惨。”我一直求他们在季度财报电话会议上提这件事，可他们不肯，因为不管出于什么原因，即使他们离开了，还是得继续跟那些 buas 做生意。对。Do we need this that?" I'm like, "No, you need to be smart and do your job and bring in somebody that I call a healthcare CEO or CFO whose only job is to manage the contracts and everything associated with it." And you will find that your health care costs will go down. And then once we get you there, then we can talk about carving out for direct contracts and doing all these other things immediately. Like there's a couple um public companies that I told to do this and came back to me and were like, "Oh my god, we had no idea how badly we were ripped uh ripped off and I'm begging them to mention it on their quarterly earnings conference calls and they won't do it because they still have to do business with those buas even though if they left them for whatever reason." Yeah.

所以，如果我们只做这一件事，把合同都过一遍。说真的，如果你有超过 1,500 名员工，对于我们的会员来说——我应该说，对于那家初创公司、那家科技公司来说——最快省下数百万甚至更多的方法（具体取决于你们被坑得有多惨），就是做我刚才说的：把合同交给 AI 处理。And so if we just do that one thing, run the contract soup. Literally, if you have more than 1,500 employees, the quickest way for or members I should say, the quickest way for that startup, that tech company, maybe depending on how bad you're ripped off, into the millions or more, is to just do what I just said, run your contracts through AI.

信任、制造规模与长期业务Trust, manufacturing scale, and the long-term business

是的。Mo、Mark，也许我们可以把视角拉远一点，你们能多谈谈对这项业务未来几年的宏大愿景，以及你们认为应该如何分阶段实现吗？有几件事。首先，我的意思是，我们的终极使命是颠覆医疗保健体系，让医疗再次变得负担得起。Yeah. Mo Mark, maybe maybe zooming out, c can you share more about sort of the grand vision for the business a few years out and maybe how you think about sequencing to get there? So, a couple things. One, I mean, the ultimate mission is to disrupt health care so that it's affordable again.

我支持全民医保，但在拥有准确的数据、让人们能够基于真实数据做决定之前，我们还无法实现全民医保。所以，这是一个更大的系统。无论最终会朝哪个方向发展，我只想颠覆医疗保健行业，让人们思考经济层面的问题时，能够觉得：好，我清楚地知道现在的情况，以及我们该如何实现目标。这比其他任何事情都更关乎教育。就像我之前提到的，Cost Plus Drugs 的商业模式就是如此。And I'm a fan of universal health care, but you can't get to universal health care until you have correct data and people can make decisions based off of real data. So, that's bigger system. whatever direction it ends up going, I just want to disrupt healthcare so that when people think about the economics, it becomes okay, I know exactly what's going on, how we get there, more education than anything else. Like I mentioned before in terms of the business of cost plus drugs.

你看，有人可能会来到零售网站，说：“我们要按成本加价 1%。”好吧，信任仍然是我们的核心产品。这就是我努力做到的事。我们在营销或广告上没有花一分钱。刚开始的时候，所有来自农业领域的人都说：“哦，你们会被干垮的。”我就说：“不，你知道的，人们会告诉别人他们省了多少钱。”然后他们就会信任我们。Look, somebody could come along for the retail site and say, "We're going to do cost plus 1%." Okay, trust is still our primary product. That's what I try. We don't spend any money on marketing or advertising. And when we first got started, all the people who came from farming said, "Oh, you're going to get killed." I'm like, "No, you know, people are going to tell others how much money they saved." And then they're going to trust us.

而这正是整个医疗保健经济领域所缺少的一样东西：信任。因此，只要我们言出必行、完全透明，并且只收取固定的15%加价，就能赢得人们的信任。这会在某种程度上保护我们。And that's the one thing missing in all of healthcare economics, trust. And so once we gain their trust by doing exactly what we said by being fully transparent, only having a set markup of 15% will garner people trust. So that'll protect us elite to some level.

不过，Grand Dio 的愿景是这样的：我跟你说过那些售价 2000 万美元的舱体吧，那些利润空间很大。我们认为，两年内每年能卖几百个，五年内每年能卖几千个。所以你给我一千个舱体，让我每个卖 2000 万美元，嗯，我们的业绩就会非常、非常、非常好。But the Grand Dio's vision, those pods I told you about that sell for $20 million, there's good margin in those. And we think we can sell within two years, a couple hundred a year, within five years, a couple thousand a year. So you give me, you know, a thousand um pods to sell at $20 million each, we're going to be doing really, really, really good.

而且这会彻底改变医疗保健，因为我们可以把这些设备串联起来。比如说，我们完全可以在德克萨斯州达拉斯用这些设备生产仿制药片，成本甚至低于我们付给印度合作制造商的价格。不过，我们不会一味追求最低价。And it'll completely change healthcare because we can daisy chain those things. Like literally, we could manufacture tableted generic drugs in Dallas, Texas using these and make them for less than we pay India, the manufacturers we partner with in India. Now, we don't go for the cheapest price.

我们选择最好的制造商，所以会多付一点钱。但我们仍然可以以更低的成本生产。唯一阻碍我们的是，每申报一种仿制药，我们都得申请一个叫作“另一份新药申请”的东西，呃。We go for the best manufacturer. So, we pay a little bit more. But still, we can make it for less. The only thing holding us back is that for each generic we have to fill out we have to um apply for something called another new drug application.

而且这些东西每一个都要花36.5万美元，外加其他费用。所以如果你想做一千个，那就是3.65亿美元，再加上所有舱体的成本。我们想表达的是：如果我们真的想把药品制造业带回美国、实现本土生产，我们全力支持，而且我们做得到。你们已经在其他领域与我们合作，所以我们认为这会成为我们业务的重要组成部分，我们也已经做好了规划：在costplusddrugs.com上，如果某样东西是由我们在美国本土制造的，我们会加上一面小小的美国国旗。不过这大概还要两年，因为我们得完成大量FDA相关工作。但这就是大方向——如果我们一年能卖出价值200亿美元的舱体，埃隆，你可要当心了。那么，你的看法是，展望未来几年，无论技术变得多么先进，它都不会独自从根本上颠覆医疗保健行业，还需要发生其他更具结构性的变化，对吗？And each one of those things cost $365,000 plus other fees. So you want to do a thousand of them that's $365 million plus all the cost of the pods. We're trying to say look if we truly want to um bring manufacturing and onshore for medications we're here for it and we can do it. you're already working with us in other areas and so we think we'll get there as a big part of what we'll do and we've already planned so that on cost plusddrugs.com we'll put a little bit of little American flag when something is manufactured by us here in the US but that's probably two years away just because of all the work we have to do with the FDA but that's the big picture if we're if we're selling $20 billion worth of pods a year watch out Elon and so is your view that as If you look out the next few years, no matter how good the technology gets, it's not going to sort of disrupt uh sort of healthcare on its own and that there needs to be other more structural changes that need to happen.

是的，是的。有监管俘获，也有规模俘获。眼下在经济层面，完全是规模俘获。你听听 Cordians 的电话会议，或者读读那些大型垂直整合企业的会议记录，就会发现他们会谈论技术，但有一件事他们从来不说：这些技术最终会降低雇主和患者的成本。Yeah. Yeah. There's regulatory capture and there's scale capture. Right now on the economic side, it's all scale capture. And when you listen to the cordians conference calls or read the transcripts for all those big vertically integrated companies, they talk about technology, but the one thing they never say is this is going to translate into lower costs for employers and patients.

他们总说这会提升我们的盈利。你知道，我们会给股东带来更多回报。我们会回购股票。但在我能让所有这些雇主都明白之前，对吧，他们还是会继续把事情弄得几乎不可能。They always say this is going to improve our earnings. You know, we're going to return more to shareholders. We're going to buy back stock. But until I'm able to educate all these employers, right, they're going to keep on making it nearly impossible.

这就是为什么，你知道，朱莉之前谈到 CVS 时，我提到我们不直接跟他们中的任何一家打交道，因为我们必须在他们体系之外开展工作，否则就会掉进他们的陷阱；他们当初就是用合同把我套住的。Which is why, you know, when Julie talked about earlier about CVS, why I mentioned we don't deal with any of them directly because we have to work outside of them because otherwise you fall into their trap and they gave me with their contracts.

AI技能、入门级工作与患者选择方案AI skills, entry-level work, and patient options

马克，在这一切当中，你怎么看？你谈了很多结构性问题，但现实是，正如你之前所说，人工智能会在很大程度上改变这个行业人们工作的性质。你怎么看？我听你经常谈到，我们该如何让年轻人才群体为未来做好准备，以及在当今时代，怎样才算是做好了职业准备？你觉得这对医疗行业来说会是什么样？Mark, what do you um in all this, you know, you're talking a lot about uh structural things, but there is a reality of what you described earlier like AI will change the nature of people's jobs in this industry quite a bit. What do you think is I've heard you talk a lot about, you know, how do we sort of futureproof our, you know, young pools of talent and you know, what is um being like sort of career ready look like in this day and age? What do you think that looks like for healthcare?

比如说，未来5年医疗行业的劳动力会是什么样？我的意思是，它和其他任何行业都一样。你仍然得招聘初级员工，因为不管是什么模型，它一发布就已经落后了，对吧？它已经落后了。所以每个模型都会有延迟，因此你需要一些人，他们了解正在发生的一切，能够构建上下文、与模型打交道、在流程中担任人工环节、理解后果等等。你还需要让这些人随着组织的发展不断成长，这样随着所有这些事情发生变化，他们都见证过实施过程的历史，也就能为组织创造价值。这是第一点。Like what does the workforce of healthcare look like in the next 5 years? I mean, it looks the same as any other industry. you have to still hire entry-level people because no matter what the model is the minute it's released that's it right it's it's behind it's behind and so there's latency associated with every model and so you need people who can who are aware of everything that's going on that create context and deal with the models be the human in the loop understand the consequences etc and you need those people to grow with the organization over time so that all as all these things changed they've seen the history of the implementation and they can bring value to the organization. So that's part one.

你不能就这样取消所有入门级职位。第二，你必须帮助这些人以及其他所有白领从业者学会如何使用 AI，因为 AI 不会取代工作岗位。懂得使用 AI 的人，会取代那些不懂得使用 AI 的人的工作。You can't just get rid of all entry- level positions. Part two, you have to enable those people and everybody else white collar oriented how to use AI because AI doesn't replace jobs. People who know how to use AI replace the jobs of people who don't know how to use AI.

这就是第二部分。第三部分则是更宏观的事情。第一步是试着让高管层了解 AI 究竟是如何运作的，教他们智能体如何运作，教他们如何使用模型，让他们了解开源模型和闭源模型之间的区别，以及你需要采取的各种不同措施。So that's part two. And then part three is the bigger picture stuff. The first step to that is trying to educate the seauite on how AI even works. Teaching them how agents work. Teaching them how to use a model. Teaching them, you know, the difference between open- source and closed models and the things you different things you have to do.

帮助他们理解，我们三人正在进行的这场精彩对话所涉及的模型延迟，目前还不在任何模型中，直到这段对话发表后才会出现。所以，如果我们说出一些大家都能拿去使用的内容，那么模型都还落后，整个 AI 领域也都还落后。这一点是毋庸置疑的。当然，你知道，大语言模型处理的是文本和一些图片，并不了解视频中发生的那些现实世界的事情。Helping them understand the latency of a model that this brilliant conversation the three of us is having are having is in no model anywhere and won't be until it's published. So, if we say something that we can all go out and use, the models are all behind and AI is all behind. So that's a given and of course you know LLMs are text and some pictures and don't deal with you know all the you know real world things that are going on in video.

所以，作为 CEO 以及高管团队的一员，你必须能够理解所有这些事情会如何影响你的公司。等你对此有了充分的把握，就可以开始尝试各种新做法了，因为你可以借此找到让事情以新方式发展、使客户受益或创造新机会的方法。这就是 AI 的神奇之处，对吧？So you have to be able to understand as a CEO and in the seauite how all those things impact your company. Once you get a good grasp on that then you just start fooling around right because there you can just find new ways for things to happen that benefit your customers or create new opportunities. And that's the brilliance of AI, right?

AI并不聪明。它可能懂书本知识，但不懂人情世故，也不懂创业。必须有人在一旁引导和帮助它。但在拥有一支了解它如何运作的高管团队之前，这对那个组织来说会非常困难。AI is not smart. It's, you know, it's book smart maybe, but it's not street smart. It's not, you know, entrepreneur smart. You've got to have somebody there who guides it and helps it. But until you have a seauite that understands how it works, it's going to be very difficult for that organization.

我的意思是，我真的曾经和一家消费食品公司的负责人坐下来交谈，他当时在跟我聊收购的事，那还是几个月前。他说：“对，因为 GLP-1 的原因，等等等等。”我就说：“好吧，那我们来这么做。咱们拿你们销量第一的产品——你们的曲奇，对吧？然后我会让 Chat GPT 做出一个竞品，它对 GLP-1 用户更友好，而且定价更低。”I mean, I literally sat with the head of a consumer food company and he was talking to me about acquisitions and this was months ago and he was like, "Yeah, because of GLP1's yada yada yada." And I'm like, "Okay, well, let's do this. Let's take your number one product, your cookie, right? And I'm going to ask Chat GPT to create a competitor that is more GLP-1 friendly and will be priced lower.

我想要一份完整的物料清单，包括供应来源，以及制造所需的一切、我必须做的事情。大约三分钟后，我们就给他回复了，他当时就说：“哦，[脏话]！”他完全没想到。现在，如果你完全不知道该怎么办，这个问题可以问大语言模型。你不可能对如何让公司用上 AI 一无所知，而在我看来，这才是大多数组织面临的最大难题。如今，对创业者来说，不管他们提出这个问题并试图落实的是什么，现在都是创业的最佳时机。你知道，会有地下室里的万亿富翁。也会有人推出自己的智能体蜂群，以创业的方式来做这件事。And I want a full bill of materials. I want sources, everything manufacturing. what I have to do and in about 3 minutes we got back to him and he was like oh [expletive] he had no idea now if you have no idea that's a question you can ask an LLM you don't have no idea on how to enable your company to use AI and that to me is the greatest greater struggle for most organizations now for entrepreneurs asking that question and trying to implement no matter what it is there's no better time to be an entrepreneur than right now you know There will be the trillionaire in the basement. There will be, you know, somebody who puts out their own um agent swarm but does it on a um entrepreneurial basis.

你知道，现在仍然存在一些挑战，尤其是对智能体来说。智能体看不到社交媒体帖子，也无法审阅这些帖子，对吧？而且，要为数量可观的帖子获取文字记录也很困难。它们也没法观看广告或看到广告。You know, now there's still challenges particularly for agents. So agents don't see social media posts. They can't review them, right? And it's hard to get transcripts for any material amount of them. They can't, you know, watch ads or see ads.

所以，如果我们要迈向由智能体驱动的个人经济，那么我们与这些智能体沟通商业信息的方式就必须发生很多变化。比如说，我当时真的只是在和公司里的一位同事瞎琢磨，我们一起做了这么个东西，你可以去看看。它其实还没有真正投入使用。And so if we're moving to an agent-driven economy for individuals, there's going to have to be a lot of changes that occur in how we communicate commerce to those agents. Like literally, I was fooling around with one of the guys in my company and we created this thing and you can go check it out. It's not truly active.

它叫 agentfeeds.dev。整个想法就是，把你帖子的文字稿放到呃 agentfeeds.dev dev 里，然后复制粘贴出来，让任何人都能复制粘贴——你知道，任何你关注的人都可以把它放进他们的智能体里。嘿，关注这个主题的所有信息流，它会把所有广告都抓取下来，并提供你需要的所有信息，这样你的智能体就能更及时地了解这些类别的内容，或者诸如此类的东西。It's called agentfeeds.dev. And the whole idea is you take the transcript of your post and you just put it into um agentfeeds.dev dev and then you copy and paste it for anybody can copy and paste, you know, anybody you follow into their agents. Hey, follow all the feeds for this and it takes all the ads and gives you all the information you need so your agent is more up to date on those categories or whatever.

你会看到，你知道，你会看到这类事物大量涌现，但我们仍然得解决信任问题，以及所有我们都知道的关于 AI 的问题和挑战。不过，回到医疗保健领域谈机遇，最大的挑战，以及我认为 AI 除了临床领域之外将产生最大影响的地方，是患者和消费者，对吧？他们能够查看自己拿到的那些经济方面的东西，比如你知道的，福利账单，对吧？You're going to see, you know, you're going to see an explosion of those types of things, but we still have to get through trust and you all the things we all know about AI and the issues we all know about AI. But in terms of opportunities going back to health care, the biggest challenge and where AI I think is going to be have the biggest impact other than clinical is by patients by consumers, right? And being able to look at the things that you are given on the economic side that you know uh the benefits bill, right?

EOB，对吧？福利说明（Explanation of Benefits），对吧？我觉得消费者会从这里获得最大的好处。所以现在，我不知道，全国大概有一半人都生活在恐慌中，对吧？全国有40%的人付不起一笔400美元的紧急账单。The EOB, right? The explanation of benefits, right? And here's where I think um consumers will get the greatest benefit. So right now there's terror in I don't know half the country, right? 40% of people in the country can't afford a $400 emergency bill.

所以我总是告诉大家，在任何事情发生之前，先打开你最喜欢的 AI 模型，让它给你列出所有非营利医院。然后去联系这些医院，询问它们提供哪些财务援助服务，因为所有非营利医院都必须设有财务援助计划。其中有些计划确实很好；对有些人来说，选择这些计划会更划算。我不想替别人做决定，但你可以向 AI 提问，比如：我原本要支付的保险计划保费，能不能存入货币市场基金赚取利息？因为我已经和当地的非营利医院谈过自己的情况，也已经充分了解他们的财务援助计划。现在，这些财务援助计划是根据联邦贫困线设定的，多数情况下，收费标准会参考联邦贫困线，但收入上限可能高达联邦贫困线的 600%；在某些州，这对一些家庭来说可能超过 10 万美元。因此，患者、消费者和家庭了解自己有哪些选择，尤其是如何获得非营利医院提供的这些援助，将会带来巨大的影响。And so what I always tell people is before anything happens, go into your favorite AI model and say get me a list of all the nonprofit hospitals. go to go to them and ask them what their financial support services are because all um all nonprofit hospitals have to have financial assistance programs and some of them are really good and for some people you're better off and I don't want to make the decisions for people but you can ask the questions of the AI to say whatever my um insurance plan premium was going to be I'm going to put it in a money market fund and let it collect interest because I've already discussed my situ situation with the local nonprofit hospital and I know everything there is to know about their financial assistance plan. Now those financial assistance plans are created and the pricing is a reference price to the federal pover poverty levels in most cases but it can go up to 600% of federal pro poverty level which can be over $100,000 for some families in some states. So patients slashconsumers slashfamilies understanding what their options are and how to procure those options from particularly nonprofit hospitals is going to be enormous.

如果我要在这个领域创业，呃，我会去找每一家非营利医院，制定一套方案，推出我让人们可以使用的智能体。嘿，你知道，如果你担心自己要怎么付账单，或者怎么付家人的账单，而且你银行里没多少钱，不管怎样，只要你的收入低于 X 美元，就把这段内容复制粘贴到你的 Muse、DOT，或者 Claude Co-work 里——不管是什么工具——它就会知道该来找我们并提出问题。所以我给医院负责人上课时，我就会说：“你们不明白。”If I was going to start a company um in this space, I would go to every nonprofit hospital and set up a plan that post agents that I enable people to use. Hey, you know, if you're concerned about how you're going to be able to pay for your bills or your family bills and you, you know, you don't have much money in the bank, whatever you're making under X number of dollars, copy and paste this into your Muse or into your DOT or into, you know, your um Claude Co-work, whatever it is, and it'll know to come here to us and ask questions. And so when I taught the heads of hospitals, I'm like, you don't understand.

你们的营销做得真差。你们依赖 BUAs 及其计划，还得成为他们网络的一部分，才能让他们给你们输送患者。这很荒唐，对吧？你们要是让人们更容易使用你们的财务援助项目，也许可以去找一家当地银行，也许可以教人们如何为中小型公司使用，呃，止损。You guys suck at marketing. You are dependent on the buas and their plans and being part of their network to feed you patients. That's ridiculous, right? You if you make it easy for people to use your financial assistance programs, maybe go to a local bank, maybe show people how to learn use um stop-loss for smaller medium-sized companies.

他们有很多选择，可以利用它为患者提供更好的服务，因为这才是真正存在巨大脱节的地方。他们可以提供更好的保险方案，也可以利用技术降低价格，并更高效地组建医疗服务网络或协商直接合同。So many options for them to use it to make things better for patients because that's really where the big disconnect is. You can offer better plans. You can use technology to reduce the price and become more efficient in how you create a network or negotiating direct contracts.

但在最终用户真正接受它并知道如何使用它之前，肯定会遇到一些挑战。不过，我们每个人在某种程度上都会学会使用它，就像当年我们学着使用电子表格一样——那时我们还觉得它太复杂了。我年纪够大，还记得当时人们觉得电子表格很难用，你得跟他们解释，他们还得花 500 美元买 Lotus 123。But until the end user truly embraces it and knows how to use it, there's going to be challenges. But all of us at some level, just like we learned to use spreadsheets back in the day when we thought it was too complicated. I'm old enough to remember when people thought spreadsheets were hard, you know, and you had to explain to them and they had to pay $500 for Lotus 123.

但现在我们经历这场转变时，同样的事情也在发生。人们嘛，确实有很多人反对AII，也有很多人反对cal、反对一切。这只是时间问题。嗯，要让他们克服对AI的恐惧，办法就是向他们展示这些东西如何真正地帮助和保护他们，并减轻他们心中固有的恐惧——以防万一真的出了大问题。But the same thing is happening now as we go through this transition and people, yeah, there's a lot of people who are anti-AII, but there are a lot of people who are anti-cal, anti- everything. That's just a matter of time. Um, but once you get the way you get them to overcome AI is their fear of AI is to show them how these are the things that can really benefit you and protect you and reduce the inherent fear that you have in the event that something goes really really wrong.

个性化医疗与医生的作用Personalized medicine and the role of doctors

是啊。很多年前，Aaron·斯沃茨有句名言，你知道的：“信息渴望自由。”嗯，是啊。而且我知道，在医疗健康领域，之前的对话中你对这件事是否会发生有些怀疑，因为正如你提到的，数据有很多都被隔离在各个孤岛里，而且你知道，数据之所以被这样掌控，有很多战略上的原因；在某种程度上，这些数据就是他们的优势。所以我这么说，是想问你：你认为前沿实验室——比如 OpenAI 和 Anthropic，它们在这个领域的雄心都很大——最终会产生什么影响？它们或者其他公司会重塑医疗健康领域吗？或者说……我来告诉你，确切地告诉你。嗯，我也算是在推销自己的书吧：随着模型能力不断提升，在分析你的 DNA 并了解它所能掌握的一切之后，为你量身定制一种药物的成本将趋近于零。Yeah. There's this um famous Aaron Schwarz quote from many years ago. You know, information wants to be free. Um Yeah. And uh and I know in healthcare in a previous conversation you've been a bit skeptical that will happen because as you mentioned there's a lot of siloed data and there's a lot of you know strategic reasons why why that data is is you know that is their their advantage to some degree and so I say that to ask you what do you think the ultimate impact of the frontier labs you know open AI and thropic have have very big ambitions in the space either them or others will be in re reshaping uh healthcare or sort of you know I'll tell you exactly I'll tell you exactly um and I'm selling my own book here a little The cost of designing a drug personalized to you after reviewing your DNA and knowing everything that it knows will start approaching zero as the capabilities of models go up.

对吧？我们谈论 GPU 以及它们会如何变得更快、背后的网络、所需的电力，但真正会改变一切、让它们效率更高的是算法。对吧？而且我们甚至不知道算法的进步速度会有多快。未来某个时候，不管是 5 年、10 年还是 20 年，他们会从 Eric、Julie 和 Mark 身上获取一些信息，然后说，先从非处方药开始。因为你想想，对吧，你走进药店，买这个，呃，不好意思，什么来着，Advil、Tylenol，对吧，布洛芬，而我们都觉得它对每个人的影响都会完全一样。Right? We talk about GPUs and how they'll get faster, the networks behind them, the power required, but it's the algorithms that are going to change everything and make them more efficient. Right? And we don't even know what the speed of improvement are going to be on algorithms. at some point in time, whether it's 5 years, 10 years, 20 years, they're going to take something from Eric, Julie, and Mark, and they're going to say, starting with over the counter, because if you think about it, right, you walk into a drugstore, you get this, you know, um, excuse me, whatever, Advil, Tylenol, right, ibuprofen, and we all think it's going to impact us the exact same way.

而且我们得通过实验来看看它会如何影响我们的身体。身体简直完全说不通。所以，随着这些前沿模型的处理能力和分析能力越来越强，它们就能真正针对非处方药进行个性化调整，而不用经历那么多麻烦，去试着弄明白这些问题，对吧？然后突然之间，比如说，这是我个人用的布洛芬，这是我个人的剂量，或者这些非处方药的某种混合搭配，啪，你就开始调整它了。And we have to experiment to see how it impacts our body. the body makes no sense whatsoever. And so as the processing power and the analytics power of these models from the frontier models gets better, they will be able to really truly personalize over the pro over-the-c counter drugs without a lot of the mishagos you have to go through to try to figure these things out, right? And now all of a sudden if here's my personal um ibuprofen, here's my personal dose or mixture of whatever these over-the-c counter drugs, bam, you start to change it.

接下来你就会开始制作其他为你量身定制的药物。因为说到底，我们所有人都服用艾乐妥，然后在艾乐妥、拜瑞妥或华法林之间做选择，这从全局来看完全说不通。所以，能够根据个人情况来定制这些药物，意义重大。我跟两位 Frontier 的修士说过：“如果你们真想聪明点，就拿出你们每月 20 美元或 200 美元的订阅费，等这项服务推出后把它包含进去。因为到那时候，你们为此付出的边际成本——你看，如今光是为了响应一个这样的请求而进行推理以及完成所有相关工作，成本就很高，对吧？”Then you get into, you know, making other drugs that are personalized for you because again, the fact that we all take Eloquis and decide between Eloquis or Zerelto or Warfare makes no sense whatsoever in the big scheme of things. And so being able to take those things and personalize that medicine. And what I have told two of the Frontier monks, I said, "If you really want to be smart, you take your $20 or your $200 um subscription and you include that service once it's available because your marginal cost for doing this at that point in time, look, the inference and everything that has to happen just to respond to a request today expensive like this, right?

成本正在迅速下降。不过，这种个性化医疗也会经历同样的过程。起初成本会非常高。但随着我们对人体、身体里的各种变量以及大脑等有更多了解，也更了解各种药物，并弄清楚如何为每个人实现“单人疗法”（N-of-1）。Coming down very quickly. But the same thing is going to happen for this type of personalized medicine. Initially it's going to be enormous. But as we understand the human body more and understand all the variables in our body more and our brains more etc and understand the medications and figure out how to do the end of one for everybody.

它会包含在普通订阅里，因为没理由不这么做。23andMe 有多贵？现在花 99 美元或更少，就能检测你的 DNA。所以我可能会先付 99 美元。如果我愿意的话，就把 DNA 样本交给他们。It will be part of a normal subscription because there's no reason it should be. How expensive is 23 and me? You pay $99 or less now to get your DNA looked at. And so maybe I pay $99 upfront. I give them my DNA if I'm willing to do that.

你知道，显然，出于隐私方面的考虑，他们会把它存储起来。然后他们就接着砰砰砰砰砰砰。你知道，也许你想知道可能会有什么问题。也许你不想根据自己的 DNA 知道可能会有什么问题。You know, obviously for privy privacy concerns, they store it. They continue to bam bam bam bam bam bam. You know, maybe you want to know what could be wrong. Maybe you don't want to know what could be wrong based off of your DNA.

但如果真的出了什么问题，他们就能获得所有这些药物和机会，还能实时制造这些药物。还有销售我的书。我们希望我们的生产舱就在现场，能够制造这些药物，因为只有我们有能力做到这一点。我认为这种情况在很长一段时间内都不会改变。But if something does go wrong, they have access to all these drugs, all these opportunities, and the ability to create them in real time. and selling my book. We want our pods to be right there to be able to manufacture them because we're the only ones capable of doing it. And I don't see that changing for a long time.

我觉得还有一件事，Mark，在这种情况下，人们可能没有充分意识到它的重要性：随着这一切发生，你刚才描述的事情也会发生，药物也会逐渐变得更适合这个国家乃至全世界的每一个人。嗯，这实际上是医疗服务提供方式面临的最具颠覆性的力量之一，对吧？你想想，医疗保健中有多少工作，其实是医生帮助患者弄清楚为什么某种药对他们不起作用，进行剂量调整、逐步滴定剂量，并改变患者的行为，让他们的生活适应药物，而不是反过来让药物适应他们。嗯，我想你知道这一点，但别忘了，由于我之前提到的那种延迟，如果Mark走进医院，说“我刚试了这种新的个性化药物，结果开始吐个不停”，那你还是需要医生。I think one of the things also, Mark, that people um probably don't appreciate as much as they should in that context is that as that happens is what you just described happens and as drugs become just better products for like every individual in the country or in the world. Um that is actually one of the most disruptive forces for care delivery, right? like how much of healthare is actually the job of the doctor helping patients figure out why a drug doesn't work for them and calibrating and doing met titration and changing behavior to make your your life work for the drug as opposed to the other way around. And so um that's something that I think you know but remember because of that latency I mentioned earlier you're still going to need doctors if Mark walks into the hospital and I just tried this new personalized um medicine and I just start puking my guts out.

是啊，你还是需要远程医疗。可以通过视频进行，对吧？然后可以让那里的机器人问：“马克，你感觉怎么样？”对吧？接着终结者可能会走进来，说：“你的时间到了。”我也说不准。但我还是更希望有个真人在那里，能运用五官亲自观察、提出问题，看到哭泣的妈妈、哭泣的儿子或孩子之类的，并能把这些都纳入情境之中。Yeah, you still need tele. You can have it on video, right? Then you can have a robot there say, "How do you feel, Mark?" Right? And the Terminator might might walk in and say, "Your time is up." I don't know. But but I'd rather have a human there with all five senses being able to take a look and ask questions and see the crying mom or the crying son or child or whatever and be able to include that in the context.

所以我认为，这永远不会取代医生，我们甚至不应该尝试这么做，因为——你们也知道，尤其是在这方面，技术的普及情况如何。你仍然得知道该问什么问题，也得知道哪些变量重要，哪些不重要。And so I don't think ever that will replace doctors and we shouldn't even try because and you know, you guys know how adoption of technology is particularly for this. You still have to know the questions to ask. You still have to know what the variables are that matter versus the ones that don't.

你仍然要认识到，即使处理成本有望在未来某个时候降到零，你知道，它仍然是有成本的，哪怕成本只是时间。所以，你知道，你需要有人在场，并且接受过所有这些方面的教育。我想，朱莉，正如你所说，医生的角色可能发生巨大变化的地方在于，他们在医学院将如何接受培训。You still have to realize that even as processing costs drop towards zero hopefully at some point in time that you know there's still a cost associated with it even if that cost is only time. And so you know you need somebody there who's been educated in all those pieces. I think to your point, Julie, where things might change dramatically when it comes to the role of the doctor is how they'll be trained in medical school.

他们不会被教授完全相同的内容。他们必须学会如何利用公开证据或其他可用资源，以及如何提取信息——哪怕只是 DNA 信息——理解其中包含什么、模型对此有什么看法，并能够把这些内容转述给当事人。因为你知道，实际上，要让这件事完美运作，每个人都必须拥有自己的模型，而这对所有人来说都很困难，尽管未来几年会创建并支持数百万、甚至数亿或数十亿个模型。此外，知识产权也会成为这个等式和流程中一个全新的问题，因为你知道，直到最近，大家奉行的还是“不发表就出局”。They won't be taught the exact same things. They'll have to learn how to use open evidence or whatever else is available out there to and how to extract information even if it's just that DNA information and understanding what's in there and what the model thinks about it and being able to translate that to the person because you know effectively in order for this to work perfectly everybody has to have their own model and that's going to be difficult for everybody even though there's going to be millions or not if not hundreds of millions or billions of models created and supported over the next years. And plus on top of that, IP becomes a totally different problem that gets introduced into this equation and process because you know up until recently it's been publish or perish.

如果你是医生，创造了某样东西，你可能希望每个人都能用上它；也许你甚至可以授权他人使用，并从中赚点钱。但现在，你知道，如果你试着申请专利，每个 12 岁的孩子都会说：“嘿，看看这个专利，稍微改一改，然后申请我自己的专利。”对吧？或者，如果这是医疗领域的一项新手术流程，你可能会说：“不，你得采用我的模式，每次使用都得付我 9,999 美元。”对吧？又或者是要使用推理功能，你知道，你必须使用我指定的软件，因为没人会免费放弃自己的知识产权。这会带来更多问题。And if you're a doctor and you create something, you want everybody to happen, maybe you can even license it and make some money off of it. But now, you know, if you try to patent something, every 12-year-old is saying, "Hey, look at this patent, change it just a little bit and make my own patent." Right? or if it's, you know, a new procedure in healthcare, you know, you might say, "No, you have to come to my model and you have to pay me $9,999 every access, right? Or to use inference, you know, you're going to use this software that I require because nobody's going to give away that IP for free." And that creates a lot more problems.

我认为，很多 AI 创业者的一些底层理念是——回到 Erica 的话题，信息渴望自由。信息也许想要自由，但拥有知识产权的人可不这么想，所以这会改变我们与模型互动的方式。你知道，我们可以讨论那些会选择用哪个成本最低的模型来回答问题的前端，但我们还没讨论过：我们要从哪里找到训练模型、对模型进行后训练、用 RAG 增强模型所需的知识产权，不管具体是哪种方式。如果那个人不愿意提供这些内容，可这些内容又绝对必不可少。你们觉得我说得有道理吗？还是觉得我就是个笨蛋？我觉得这真的很有意思，因为它也引出了一个问题：未来医生的角色是什么？I think part of the underpinning that a lot of AI entrepreneurs have is that going back to Erica, information wants to be free. the information wh may want to be free but the person who owns the IP feels differently and so that's going to change how we interact with models and you know we can argue about you know frontends that choose which model is least expensive to answer the question but we haven't had the discussion on where we find the IP that's needed to either train that model post- trainin that model you know rag that model whatever it may be if that person isn't making it available but It's absolutely required. Does that make sense to you guys or do you guys think I'm an idiot? You know, I think it's really interesting because it also brings up the point of like what is the role of the doctor in the future?

所以，第一点，我同意。实际上，我认为未来我们会需要更多医生，因为随着医疗建议越来越丰富，更多人会要求获得医疗保健，也就是现实中的实际医疗服务。因此我们会发现，我们确实需要更多医生。而且，关于你所描述的当今医生的角色，有一点值得一提：这份工作非常程式化，对吧？It so number one, I agree that actually I think we're going to need more doctors in the future because as care uh advice becomes more abundant, more people are going to demand healthcare, actual like real life healthcare services. And so we're going to find we actually need more doctors. And um there's something to be said about what you what you're describing as like the role of the doctor today is very rote, right?

这有点像是：这些就是你必须完成的任务、必须达到的质量指标。老实说，在传统医疗环境中，医生被要求做的很多事情，几乎都不需要动脑子。而你描述的情形，就像是在说：如果医疗模式转向让医生真正更像是医生科学家，对吧？It's kind of like the these are the tasks you got to do these quality measures. It's like you like barely need to use your brain honestly for a lot of the things that doctors are asked to do in the traditional healthcare setting. And what you're describing is like what if like the paradigm moves towards physicians are actually like more physician scientists, right?

就好像，他们的工作实际上就是获取那些我们可能还没有在人群整体层面掌握的最前沿信息；但就个体而言，他们处于收集新数据、形成关于人们如何反应的新见解的最前线。对我来说，“新数据”这个概念本身就让这份工作听起来很有吸引力。是的。Like it's actually their job is to take like the bleeding edge of information that we may not know at population scale yet, but on an individual basis they're at the tip of the spear of collecting novel data, generating novel insights about how people are reacting. Novel data by definition stimulating job description to me. Yes.

没错。因为从定义上来说，你完全正确。对。新型数据就等同于个人。嗯。正是如此。而且对于这类数据，我们会进行纵向监测。你知道，比如血压就是我们总在谈论的例子，嗯，这方面的原则和你说的差不多。Yes. Because by definition, you're exactly right. Right. Novel data equals person. Mhm. Exactly. And with like data, we're going to have longitudinal monitoring. You know, like the blood pressure is the one that like we always talk about is where, you know, it's kind of the same principle as what you're saying.

我们一年才量一次血压，这事儿其实挺荒唐的，因为血压会变化。我可不是，我这儿就有这个[脏话]。你嘛，嗯，你可真前沿。你知道吗，不过很快我们就会有可穿戴设备，能实时测量血压，几乎每天都在测。The fact that we take our blood pressure like once a year is kind of ridiculous because it changes. Not me. I got this [expletive] right here. You're Yeah, you're cutting edge. And you know, but soon we're going to have wearables that are just measuring it in real time like every single day.

这样一来，你就能更精准地了解自己对不同治疗干预措施的反应，甚至包括饮食、锻炼之类的影响。你知道，朱莉，你提到了一个很好的观点，关于新信息——这关系到每个人找工作，对吧？对于那些可能跟不上这些变化的人来说，你们会需要人工智能翻译工具。你知道，无论是在这个国家还是世界上的任何地方，普通人只是想过上富足的生活，不管那意味着什么。And like you'll have a much more precise understanding of how you're responding to different therapeutic interventions and even like diet and exercise and all that kind of stuff. And you know that's going to you bring up a good point Julie in terms of novel um information and that's everybody in terms of finding jobs, right? You're going to need AI translators for people who may not keep up with these things. you know, regular people that are in wherever in this country or in the world who just, you know, want to live their abundance life, whatever that may be.

而且你需要有人来充当翻译，解读这种情况或这个人身上有哪些新颖之处；你知道，怎样才能让人工智能理解这些内容，又怎样才能让人工智能的输出适用于这些新颖之处和这个人。这会成为一项工作，而且要从一个人身上提取人工智能所需的一切会非常困难。你需要有人在那里负责这件事，我想。也许有人设想会有一台人形机器人来问你这些问题，而有人会对此感到自在。And you're going to need people who are going to be the translators for what's novel about this circumstance or this individual and how do you, you know, make it valid to AI and the output of the AI valid to the novel to the individual. That's going to be a job and it's going to be very difficult to extract everything um from an individual that the AI is going to need and you're gonna have need to have a person I think there to do it. Maybe somebody envisions a humanoid robot that is going to ask you those questions and somebody's going to be comfortable.

我不，我不认为……我不认为那会发生。是的。I don't I don't think I don't think that's going to happen. Yeah.

电子健康记录（EHR）合作关系与医疗支出价值EHR partnerships and the value of healthcare spending

顺便问一下，Mark，我好像从没听你谈过另一批根深蒂固的既有企业，也就是电子健康记录（EHR）公司。嗯哼。你对这个市场有什么看法？在 AI 时代，它会如何变化、发展，或者保持不变？你觉得未来几年会是什么样子？By the way, Mark, I don't think I've ever heard you talk about another set of entrenched incumbents, which is the EHR companies. Uhhuh. What what's your what's your theory of the case there on how that market changes or evolves or doesn't um in the age of AI and what that looks like in the next few years?

说实话，我不知道。你知道，EHR领域由Epic主导，这基本上是他们的天下。所以我就多少把这事交给他们处理，尽量专注于自己能发挥作用的地方，因为你知道，我们和他们有合作。我们认为，在开处方时，也就是医生在场、为患者提供不同选择的时候，提供定价信息，尤其是药品价格，是他们刚刚发布的那项新公告的一部分。对，没错。Honestly, I don't know. You know, the EHR is dominated by Epic and it's their world, you know, and so I've just kind of deferred to them and tried to stick where I can have an impact because, you know, we partner with them. We think offering um pricing particularly pharmaceutical pricing at the point of um script where the doctor is there offering them different options is a part of that new announcement that they just made about the Yeah, exactly.

没错。比如和 Epic、亚马逊等合作。嗯，我觉得这是个很大的加分项，也确实有必要，但就他们的实际业务以及哪些部分容易被颠覆而言，我并不是有资格评判的人。好吧，顺便说一句，我对那则公告有个疑问：我很喜欢他们宣布这件事，但接着他们又说要到明年五月才会推出，我当时就想，为什么要等这么久？Exactly. with Epic and Amazon etc. Um so I think that's a big plus and I think that's needed but in terms of their actual business and where it's disruptible I'm not really the one qualified for that. Okay. My problem with, by the way, with that announcement was that they I love that they announced it and then they said it's not going to be available till May of next year and I was like, why take so long?

那件事跟我一点关系都没有。好吧，这在这个行业很常见，对吧？是啊。你们觉得，10年后，医疗保健支出占GDP的比例还会是五分之一或六分之一左右吗？是不是会有这么一种终极状态：需求远远超过我们能提供的，而随着事情变得更容易、效率更高，GDP也在增长——希望每年能增长5%——到某个时候，我们的需求还是会达到上限，也就是经济总量的五分之一左右。I had nothing to do with that. Okay, that's typical in this industry, right? Yeah. Do do you guys think that in 10 years uh you know healthcare is still going to be a fifth or a sixth of whatever it is now of GDP and that there's kind of this just sort of terminal as it sort of terminal state where there's just you know way more demand than um than sort of you know we can supply and just as it gets easier as it gets more efficient we're still and as GDP grows you know even 5% a year hopefully it's at some point our demand is still going to just cap at you know 1/5if of the economy.

我是这么认为的。是的。不过，这笔支出带来的价值应该是——嗯，你从员工身上获得的价值会增加。是的，因为他们会更健康。是的。所以，健康管理和很多人所说的“疾病治疗”是有区别的，对吧？前者是让人们保持健康，这样他们的工作效率会更高，停工时间会更少，而且你知道，他们也会更聪明，因为学习起来更容易，等等。I do. Yeah. But the value that we get out of that spend should be well the value you get out of the people will increase. Yeah. Because they'll be healthier. Yeah. So there's a difference when it's health when it's sick care, right, as a lot of people refer to um versus when it's keeping people healthy and they're more productive and there's less downtime and you know they're they're smarter because it's easier to learn etc.

嗯，所以我认为，我们将获得更高的生产力，其带来的收益足以弥补这一点，而这是我们现在还没有的。Um so I think we'll get greater productivity that'll more than account for it which we don't get now.

透明度、免赔额与一种替代性融资模式Transparency, deductibles, and an alternative financing model

Z，稍微把视角拉远一点，你知道，Mark，我们有一位共同的朋友，是一位非常知名的民调专家。我就不在这里透露他的身份了，但他认为，或者说他做过一些研究表明，如果你参选公职，他觉得你有可能赢。当然，你也说过自己永远不会参选。Z zooming out a bit, you know, Mark, we both we have a mutual friend who's a very prominent pollster. I won't out him here, but he um he he he he believes that or he's done some work to indicate that um if you ever ran for office, he thinks you could win. Now, of course, you you've said you never you'll never run.

嗯，所以，不过我们现在只是假设性地聊聊，但如果你是总统，或者你在给下一任总统提供建议，我很好奇，你会怎么想？要最大程度地应对我们医疗保健方面的挑战，最有力的切入点是什么？然后我还想听听你更广泛的政策立场，你最……这其实很简单。这和我对那些我曾经作证过的州所说的一样。Um, so but so we're just speaking hypothetically now, but I if if you were president or if you were advising the the next president, I'm I'm I'm curious how how you would uh mo, you know, think what is the leverage to most address sort of our our healthcare challenges and then I want to hear your your broader uh sort of, you know, policy positions you'd be most. It's really easy. It's the same thing I tell states, you know, that I've testified for.

第一，公开与任何接受纳税人资金的人签订的所有合同，不得作任何删节。因为一旦这么做，就会开始形成一个高效市场，成本也会下降。第二，规定任何人只要能找到比其保险计划当前自付金额更低的价格，就可以将这笔费用计入免赔额。One, make all contracts with anybody who takes taxpayer money public. No redactions. because the minute that happens, you start to have an efficient market and the costs go down. Two, make it so that anybody who can find a better price for less than their current out- of- pocket with their plan, make it apply to their deductible.

允许将其计入他们的免赔额。已有八个州在一定程度上这样做了。嗯，有三个州要求非营利医院公布完整的总账，细化到每一笔明细，以及所有采购的，嗯，收据和要求，对吧？Allow it to apply to their deductible. Eight states do that at some level already. Um, three, for nonprofit hospitals, require them to publish their entire general ledger down to each detailed entry and all their procurement um, receipts and requirements, right?

这样每个人都能看到。这是我们的钱。我们是纳税人，对吧？第四，与我们目前的保险计划不同，那些大型保险公司的收入有72%来自纳税人。他们已经不再承担风险。So that everybody gets to see it. It's our money. We're the taxpayers, right? Four, instead of um current insurance plans the way we have them, 72% of those big carriers um revenue comes from taxpayers. They don't take risk anymore.

他们靠这个赚钱。对他们来说，一切都是套利机会。所以，既然知道这一点，我们也得考虑到，有一笔债我们直到死都还不清，那就是保险保费。想想看。不管是 Medicare，除非你参加的是 Medicaid，对吧？They off it. Everything's an arbitrage for them. So, knowing that, we also have to consider that the one debt we never pay off till the day we die is our insurance premiums. Think about that. whether it's Medicare, unless you're on Medicaid, right?

你要一直付钱，直到你离世；而在现行制度以及可能可预见的未来制度下，当你需要用到它时，还得努力争取。对我来说，如果我们能创建一个计划，让你只要存入一笔钱——就假设是你在所在州购买 ACA 银级计划所需支付的保费——然后我们去和银行谈妥一项协议，比如说，在得克萨斯州，一个五口之家按你的收入水平每月需要支付 2,100 美元，对吧？你只要不断存入 2,100 美元，资金就会持续累积，而且归你所有。不过，想参加这个计划，就必须存入这笔钱。然后，如果你遇到医疗方面或药物方面的状况，对吧？你就可以动用这笔钱。如果钱不够，我们已经和银行谈妥了一项协议，届时会发生两件事。You are paying till the day you expire and when you need it, you have to fight for it in the current system and probably foreseeable systems. to me if we were able to create a program where you just deposited what would be let's just say how much you'd pay for a premium under the an ACA silver plan in your state and we just went and did a deal with the bank and we said okay in Texas for a family of five it's $2,100 at your income right so you just keep on depositing $2,100 and it cruise and you own it but it has to be deposited if you want to participate in this program and then if you have a um medical incident or pharmaceutical incident, right? You can take that money. If it's not enough, we've worked out a deal with the bank where two things happen.

第一，银行会在止损机制启动之前向你贷款，也就是说，我们会拿出你存入的部分资金，用于止损保障。第二，联邦政府或州政府会为这笔贷款提供担保，这样贷款提供方就不会蒙受损失；我们仍然会从你的工资中扣款，让你偿还贷款。而且，如果你运气好，从未发生过意外，等你65岁开始享受 Medicare 时，就能拿回所有这些钱以及全部累计利息。因为你想想，联邦政府会像为我们的互联网提供保障那样，或者说，会为你的学生贷款提供担保。One, the bank will loan you money up until a point where stop-loss kicks in, which means we're going to take part of that money you deposit and use it for stop-loss coverage. and two, the federal government or the state is going to guarantee that loan to you so that the provider is not out and we're still going to, you know, deduct it from your payroll so that you pay it back. And if you know, you're lucky and you never have an incident and you get to save all that money when you turn 65 and go on Medicare, you just get all that money and all the acred interest. Because if you think about it, the federal government will, you know, like our internet cover or um guarantee your student loans.

他们会为 SBA 贷款提供担保，会为房贷提供担保，或者给你首付，对吧？第三世界国家。我们会为所有这些事情提供担保，甚至包括农业方面的。但最重要的是，你知道，我们的医疗保障，祝你好运。你知道，你出了严重车祸，祝你好运，我们也许会把你推给医院处理。They'll guarantee SBA loans. They'll guarantee home loans or give you a down payment, right? Third world country. We'll guarantee all these things, even agricultural things. But the most important thing, you know, covering our health care, good luck. you know, you're in a bad accident, good luck to you, and we'll maybe push it off to the hospitals.

他们必须接纳你。所以，我会制定一个计划，说你必须，你知道，你必须呃存入这笔钱。银行会提供担保，就像抵押贷款那样，诸如此类。我们会把这笔钱借给你，然后在超过某个金额后，比如说 4 万，或者其他金额，会有联邦止损计划。They have to take you in. So, I would create a plan that says you have to, you know, you have to um deposit this money. The bank will have a guarantee just like a mortgage, whatever. We'll loan you this money and then we'll have federal stop-loss programs above some amount, 40,000, whatever it may be.

现在突然之间，保险公司就拜拜了。现在突然之间，你也不用再抗争了，因为这钱是你的，你想怎么花就怎么花。接下来我们就得设定一些门槛，规定你可以把钱花在哪里、怎么花。这样你就不会把钱直接给你的表弟比利——他说他要帮你修、修好你断了的脚趾，对吧？Now, all of a sudden, bye-bye insurance companies. Now all of a sudden you're not fighting back because it's your money to spend as you choose. Now we'll have to set thresholds on where and how you could spend it. So you don't just go give it to your cousin Billy who said he's going to fix your fix your broken toe, right?

但在这些限制条件下，我觉得我们现在突然有了一个更好的系统。所以如果要我就医疗保健方面提供建议，我会这么做。But within those constraints, I think now all of a sudden we have a better system. So that's what I would do if I was advising um in terms of healthcare.

社交媒体与传达人工智能的价值Social media and communicating the value of AI

那、那你知道，你的特长之一就是讲故事，以及更广泛意义上的营销。那 AI 行业呢？显然，AI 在美国特别不受欢迎。如果你要给 OpenAI 提建议，或者给 Anthropic 提建议，告诉他们该怎么改变这些数字；再加上围绕数据中心的那一系列风波——我很好奇，你会给整个 AI 行业什么建议。我跟他们聊过这些，对吧？我告诉他们，他们简直是蠢货。你知道，现在这个国家里几乎每个人的想法，究竟是由什么左右的？What what about u you know one of your gifts is storytelling and marketing more generally. What about the AI industry in terms of you obviously AI is you know uniquely unpopular in in the US if you were advising you know open AI if you're advising anthropic on how to sort of ch change those numbers and then there's the whole sort of data center uh sort of saga I'm curious what your advice would be to the broader AI industry. I've had these conversations right with them and I told them they're idiots, you know, because what controls how every pretty much everybody in this country thinks right now?

社交媒体算法。说真的，我昨天和一位20、23岁的同事朋友聊天，我们聊到了政治。我们在讨论昨天投给了谁，以及怎么投、为什么这么投。我问：“那你的朋友呢，那些其他23、24岁的人呢？”对方说，他们的朋友住在德州，却根本不知道肯·帕克斯顿或詹姆斯·特里科是谁——或者说，叫什么名字。对我来说这简直难以置信，对这个人来说也一样，真的。但这恰恰印证了一点：算法会让你看到更多你主动去寻找的东西。如果你真的拥有最好的 AI，你应该不只能逆向分析这些算法，还能制定一套营销营销方案，因为你们肯定会告诉所有人，你们可以通过——你懂的——你们的机器人、bot 还是 dot 之类的来做营销方案。然后就真的在那里开始营销，因为这适用于政治，适用于 AI，也适用于这个国家的一切。我们彼此之间的分裂如此严重；我们在使用的社交媒体平台上，都有各自独特的 AI 信息流，而这些平台根本不在乎它给你推送什么，只受一些最低限度的限制。所以每个人看到的世界都不一样。Social media algorithms. Literally, I was having a conversation with a 20 23-year-old friend that I work with and we're talking politics. We're discussing who we voted for yesterday and how and why. And I said, "What about your friends, the other 23 24 year olds?" and they said that their friends didn't even know living in Texas didn't even know who Ken Paxton or James Terico were or are right which is insane in my mind right insane in this person's mind but it reinforces the fact that you get more of what you seek via algorithms and if you really have the best AI you should be able to not only reverse engineer those algorithms but put together a marketing marketing program because you sure tell everybody you can do marketing programs through you know your your bots your bot or dot or whatever and really start marketing there because this applies to politics it applies to AI it applies to everything in this country the divisiveness we all have our unique AI feed in the social media platforms we use and those platforms don't give a [expletive] what it feeds you within some minimal constraints and So everybody looks at the world differently.

那种觉得多买点广告、毁掉我们的足球赛、篮球赛什么的就万事大吉的想法，尤其是对年轻人来说，已经行不通了。你知道，也许年纪大的人投票更多，这可能就是原因。但如果你想改变人们对人工智能的看法，那就毫无用处。尽管讽刺的是，毁掉这一切的正是那些算法背后的人工智能。The days particularly for younger people of thinking, you know, just buy more ads and ruin our football games and our basketball games and everything's fine. You know, maybe older people vote more and that's maybe why, but it's useless when you're trying to change hearts and minds about AI specifically. Even though the irony of it all is that the it's the AI behind the algorithms that's ruining everything.

但只要第230条还在，我们就只能接受现状。你知道，除非我们采取澳大利亚那种做法，或者一些州那种针对16岁及以下人群的做法，否则，我明确告诉他们的是：你们得用AI对所有内容进行细分，并找出整合营销、推广以及其他任何你们想做的事情的最佳方式。照俄罗斯人的做法去做。But as long as section 230 is there, we are where we are at. And as long as you know, unless we take a Australia type approach or some states type approach of 16 and under, then my what I told them specifically, you need to use your AI to segment everything and figure out the best way to put together marketing, promotion, and however else you want to do it. Do it like the Russians do it.

这不重要，对吧？因为这才是你面临的利害所在。但你知道，人们对数据中心的反感，只不过是因为他们无法理解 AI。是啊，也不是每个人都了解其中的所有环节。我一点也不怪大家。It doesn't matter, right? Because that's what's at stake for you. But people, you know, data center hate is just a proxy for not being able to understand AI. Yeah. And not all know all the pieces there. And I don't blame people at all.

对。就像雇主在医疗福利方面做了很多蠢事一样，很多社区在谈判数据中心交易时也很蠢，你知道，在很多很多情况下，他们都中了合同恐怖主义的圈套。不过，你知道，在我看来，应该让他们了解社交媒体，也应该让我们的立法者以及无论谁担任总统的人了解社交媒体，因为我不认为他们真正理解这种影响：我们并不是所有人都读同一份报纸、同一批杂志，浏览同样的网站，收看同样的新闻节目。Right. And just like employers have been really dumb with their healthc care benefits, a lot of communities have been really dumb with the deals they've negotiated for data centers, you know, and they've fallen for the contractual terrorism in a lot of a lot of cases. But, you know, to me, educating them about social media and educa and educating our legislators and whoever's president about social media because I don't think they truly understand the impact that we don't all read the same newspaper, the same magazines, look at the same websites, watch the same news shows.

我们每个人的 TikTok 推荐内容都不一样。你的推荐流和我的不一样。比如，了解孩子最好的办法就是看看他们的社交媒体动态。就拿我17岁的儿子来说吧，他刷到的全是篮球、篮球、篮球。We all have our own unique TikTok feed. Your feed is not like mine. Like the best way to find out about your kids is to just look at their social media feed. Like my 17-year-old son, it's basketball, basketball, basketball.

现在我开始看到一点政治内容冒出来了，但接着就是辣妹、辣妹、辣妹，篮球、篮球，车、车。我就想，好吧，典型的17岁男生，对吧？嗯，不过大型前沿模型还得完全明白，它们必须想办法成为每个人信息流的一部分。Now I'm starting to see a little bit of politics pop up, but then hot girl, hot girl, hot girl, basketball, basketball, car car. And I'm like, okay, typical 17-year-old guy, right? Um but until the big um frontier models understand completely that they have to figure out how to become part of everybody's feed.

他们会发布所有这些毫无用处的立场文件。They're going to be putting out all these position papers that are useless.

创业与人工智能学习Entrepreneurship and learning with AI

是啊。不，我是说，马克，我们同意你之前说的，现在是活着并成为一名企业家的最佳时代。嗯，你知道，过去许多历史上难以解决的问题，如今突然都变得可以解决了。Yeah. No, I mean Mark, we agree with you that what you said earlier about this is like the best time to be alive and an entrepreneur. Um and you know, so many things that again were intractable uh historically are now all of a sudden addressable.

有没有哪个市场领域——你会见到很多创业者，也会看到各种各样的人在世界各地创业——会让你觉得：“怎么没人涉足这里？”你觉得还有哪些领域是创业者尚未开发的空白机会？嗯，所有领域都是。说真的，你知道，我去和年轻人交流时，总会告诉他们，未来会有两类公司。Is there an area of the market and you meet a lot of entrepreneurs and see you know sort of people building in all sorts of areas of the world. Um are is there like some area where you're like why is no one building here like that you think is still a whites space opportunity for entrepreneurs? Um all of them you know seriously you know when I go talk to kids um and I always tell them there's going to be two types of companies.

那些精通 AI 的人，以及那些已经倒闭的人。如果你愿意花时间去学习，那么人就分为两类，取决于他们如何使用 AI：一类人用 AI 学习任何东西，另一类人用 AI 让自己什么都不用学。Those who are great at AI and those who have gone out of business. And if you take the time to learn and then there's two types of people and how they use AI. Those who use AI to learn anything and those who use AI so they don't have to learn anything.

如果你是那种会借助 AI 学习各种知识的人，而且你也意识到哪些类型的公司和问题还没有得到 AI 的解决，那就别不好意思，尽管和你的 AI 交流。你知道，我这么说不仅是对孩子们说的，也是对五十岁、六十岁、七十岁的创业者说的。如今，人们使用 AI 时面临的最大挑战，是能不能自在地和 AI 交谈——无论是语音交流还是打字，什么方式都行——因为大家仍然有很多顾虑。你知道，这就像当年刚有电子表格的时候，人们手边还放着十键加法机，会再用它核对一遍，确保电子表格算得没错。And if you're one of those people who uses AI so that you can learn anything and you realize what type of companies and problems aren't being solved by AI, don't be shy to just talk to your AI, you know, and I say this not just to kids to 50 year old, 60, 70 year old entrepreneurs. The biggest challenge right now with people, entrepreneurs using AI is the comfort level of talking to your AI, whether it's by voice or typing, whatever it is, because it's there's still a lot of hesitancy. You know, just like back in the day, those first spreadsheets, people still had their 10 key adding machine and they would check it to make sure the spreadsheets were right.

你还是得检查输出结果，不过你有机会把 Gro 的输出放进 ChatGPT。比如我跟你说过，我审阅这些合同的时候，会先拿一份出来，然后问：“你的一位同行看了这份合同后提出了这个看法，你怎么看？”然后花上几个小时。这就是年轻创业者的做法。所以你问我，有没有一件事是我真正坚信的？我相信一切都会改变。这是我们见过最伟大的变革性技术，而我一路见证了它们的发展，对吧？但这项技术远远胜过它们。最难的就是放手去做。You still you do have to check the output but you have the opportunity to take the output of gro and put it into chat GPT and the output of like when I go through all these contracts I was telling you about I start with one and said hey one of your peers came out and said this about this contract what do you think and spend a couple hours that's all young entrepreneurs so when you ask me is there one thing I truly believe it's everything everything will change this is the greatest transitional technology we have ever seen and I'm on I've been around for all of them, right? And this blows them all away. The hardest part is just going for it.

我觉得，这就是硅谷和湾区的孩子稍微占点优势的地方，因为他们看到父母和朋友都在创业，当地文化也鼓励创业。但我认为，等美国其他地区和世界其他地方的人也建立起这种信心后，我们就会开始看到一些我们从未想象过的企业冒出来，因为现在还没看到这种情况。你知道，我们还没看到那种让人惊叹地问“这是什么？”的公司。And that's where Silicon Valley and, you know, kids from the Bay Area, I think, have a little bit of an advantage because they see their parents and friends and the culture there as little go. But I think the rest of the country and the rest of the world once they get that confidence level, you're going to start to see businesses we never imagined pop up because we're not seeing that yet. You know, we're not seeing companies where it's like, oh, what is that?

你知道，他们为什么要这么做？你知道，这里面有什么机会？后来他们比我们先意识到了，对吧？这有点像 Fster，一开始就让人觉得，哇，那是什么？所以我觉得，如果你在寻找什么，最重要的是尽管提问。You know, why are they doing that? You know, what is the opportunity there? And then they realized it before we did, right? It's kind of like Fster, you know, first like, whoa, what was that? And so I think the biggest thing to focus on if you're, you know, looking for something is ask anything.

你——我是说，我一直都这么做。就像，“你觉得这个怎么样？你觉得这个怎么样？你觉得这个怎么样？”你知道，我把手机并排举着，把它们的输出拿来，让它们互相对话，这样我就能在旁边听。You I mean, I do it all the time. It's just like, "What do you think about this? What do you think about this? What do you think about this?" You know, I've held phones up next to each other and take the output and had them have a conversation with each other so I could listen in.

不要害怕在那些让人觉得非常不自在、很奇怪的事情中使用 AI，因为这种不自在很可能正是通往突破性、改变游戏规则的创新之路。用这句话收尾真是太好了。Mark，非常感谢你来参加这期播客。Don't be shy about using AI in things that feel really uncomfortable and weird because that uncomfortableness is probably the path to something that is groundbreaking and gamechanging. That's a great note to wrap on. Mark, thank you so much for coming on the podcast.

很开心。谢谢大家。谢谢你，朱莉。谢谢你，埃里克。It was fun. Thanks, guys. Thanks, Julie. Thanks, Eric.