--- author: a16z date: '2026-10-28' guest: '' layout: post.njk source: https://www.youtube.com/watch?v=5UWDUD6qaM4 speaker: a16z tags: - healthcare-market - ai-entrepreneurship - competitive-dynamics - agent-economy title: 医疗市场失灵与AI时代的创业机遇 summary: Mark Cuban指出医疗市场缺乏竞争，Cost Plus Drugs迫使巨头改变。他认为现在是创业最佳时机，AI将改变一切，创业者应利用AI解决未被解决的问题。 insight: '' draft: true series: '' category: ai-application area: tech-engineering project: [] people: - Mark Cuban companies_orgs: - Cost Plus Drugs - UnitedHealth products_models: - Team Cuban Card - agentfeeds.dev media_books: [] status: evergreen --- ### 医疗市场的失灵与竞争缺失 我们并不是处在一个高效的医疗市场中。这里的经济机制已经崩溃了。
Original English We are not in an efficient healthcare market. The economics are broken.
>> 医疗体系的诸多弊病之一，就是它完全缺乏竞争动态。仅仅凭借 Cost Plus Drugs 的存在，你们实际上就已经迫使现有的行业巨头发生改变了。
Original English >> 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 [music] the incumbents.
>> 联合健康（UnitedHealth）拥有 3000 多家子公司，每年在内部公司间转移的资金高达 1500 亿美元。他们常常一方面提高保费、提高免赔额，同时又迫使你与一家他们旗下的公司建立业务往来，而你甚至根本不知道那家公司是属于他们的。最终的使命就是去颠覆医疗行业，让医疗重新变得负担得起。
Original English >> 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.
>> 是否有某个领域让你觉得，“为什么没有人在这个方向创业呢”？
Original English >> Is there like some area where you're like, why is no one building here?
>> 现在就是创业者最好的时代。最大的挑战所在，以及我认为 AI 将产生最大影响的领域是——
Original English >> 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
### 创立 Cost Plus Drugs 的初衷与市场反响 好的，Mark，欢迎来到本期播客。非常感谢你能来。
Original English Well, Mark, welcome to the podcast. Thanks so much for joining.
>> 谢谢你们邀请我，各位。
Original English >> Thanks for having me on, guys.
>> Julie，对于 Mark 在这个领域的贡献，最触动你的是什么？关于 Mark 在 Cost Plus Drugs 以及整体上的所作所为，你一直觉得最吸引人的是什么？你为什么会邀请他来上节目？
Original English >> Julie, what has struck you about Mark's contributions in 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，Mark 首先是拥有踏入医疗这个泥潭的勇气，而且是以一种掀起如此轩然大波的方式进来的。许多同样处于 Mark 这种拥有庞大受众特权地位的人，几十年来对此都望而生畏。因此，我非常喜欢看市场对 Mark 在医疗领域所做事情的反应。我想，Mark，我知道你和我过去也讨论过这个问题，医疗就是这样一种行业——医疗的诸多弊病之一就是它完全缺乏竞争动态、缺乏竞争力量和自由市场动态等等。而令人着迷的是，仅仅凭借 Cost Plus Drugs 的存在——这只是一个例子，稍后我们还会谈到你做的其他事情——但仅仅凭借那个实体的存在、你所代表的理念以及你正在做的事情，你实际上迫使现有巨头做出了改变，而在过去几十年的时间里，即便有政策推动，即便有各种其他力量，这些巨头也从未改变过。所以这是其中一个……
Original English 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
对，因为我自己看不到那些内情，毕竟我不和那些家伙打交道。
Original English Yeah, cuz I don't get to see that stuff cuz I don't talk to those guys.
>> 而且我认为正如你所说的，即使在没有合同的情况下，人们从市场的需求端也开始意识到，他们需要向外界表明存在某种让大家能买到你们产品的途径，对吧？因此，也许即便在没有直接合同的情况下，我也确实听到有人在谈论把你们的方案纳入他们网络的一部分。
Original English >> 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.
>> 说实话，当三大或者六大巨头在讨论定价时拿我们的名字来当作某种应对请求的方式，我一点都不感到惊讶。因为他们知道我们的价格是公开的，任何人都可以调取我们的 API，而且任何稍微聪明一点的大公司每天都在抓取那些数据，并对他们说：“你们必须比这个价格更低。”所以我是能理解这一点的。但是，至少有一家甚至可能更多的公司曾对我说：“哦，对啊，三大巨头中的某一家告诉我们，你们是他们网络的一部分，在你们价格更便宜的地方我们能拿到你们的价格，但我们跟那三大巨头根本没有任何协议。”
Original English >> 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 I can see that. 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."
### 业务布局：从线上药房到实体网络与模块化生产 >> Mark，让我们把视野拉远，盘点一下你目前的业务进展。你在 2022 年启动，当时只有几十种药品。今年 4 月，你说品种已经增加到了大约 4000 种。你们正在进入生产制造、医院合同，未来可能还会进入基于 AI 的护理。你何不全面盘点一下目前的业务状况？
Original English >> Mark, let's zoom out and take stock about where where you're at with the business. You 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. Why don't you take stock a little bit of where the business?
>> 我来给你梳理一下。我们是在 2022 年 6 月 19 日——我是说 1 月 19 日——上线了 costplusdrugs.com。当时上线了 111 种药物，纯仿制药。你知道，当时我们完全不知道会发生什么。我出去开始公开宣传它，它立刻就爆火了，对吧？然后，我们在那里的销售量促使制药厂商扩大了与我们的合作产品组合，我们也得以引入更多的制药厂商。所以现在正如你所说，我们大约有 4000 个 SKU，而且我们的业务每周都在持续增长。因此，我们最大的挑战就是跟上这种增长节奏。这是第一大业务板块。
Original English >> 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. 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. So our biggest challenge is just keeping up with it. So that's segment number one.
接下来，针对邮购药房最显而易见的反馈就是：“我今天就急需拿到药。”于是我们推出了所谓的 teamcubancard.com。这个名字不是我起的。它基本上就是一张折扣卡，让你能够前往与我们合作的 17000 家药店中的任意一家，在本地取走我们的大部分药品——不是全部，但大部分都可以。因为我们向——我非常坚定地支持独立药店——所以我们向合作药店支付 12 美元的配药费。这意味着对于成本最低的药品，我们的价格会更高一些，因为如果是 5 美元的他汀类药物再加上 12 美元，你在别处能买到更便宜的。但另一方面，如果你真的想支持本地的独立药店，你可以在那里取低价药。而在更昂贵的药品上，比如特药仿制药和生物类似药，我们实际上要便宜得多。对于像生物类似药、胰岛素以及需要冷链运输的物品，通过我们的 Team Cuban Card 在本地购买和自取实际上更便宜。这是我们业务中的第二大支柱。
Original English 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. 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. 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 in what we offer.
第三部分是 Cost Plus Marketplace。在讲 Cost Plus Marketplace 之前，让我先回过头讲讲我们在达拉斯的生产制造。我的联合创始人 Alex Oshmyansky 博士最初给我发来的冷邮件中，很大一部分内容就是他想生产那些处于 FDA 短缺名单上的仿制药，因为其中包括儿童抗癌药，以及在医院广泛使用的药物——去氧肾上腺素、催产素、肾上腺素，长长的一串药品清单。我们成功利用 AI 和机器人技术，将原本需要一个足球场甚至更大面积的生产线，浓缩到了 5000 平方英尺以内。不仅如此，我们还能够每四小时切换一次药品种类。因此，我们可以生产六个月的供应量，然后切换产线转向下一种药继续生产，我们将这些产品销售给医院和诊所。
Original English 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. 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.
作为这一模式的延伸——因为我们做这件事情已经有……我们是五年前开始着手的。我们已经能够利用相同的机器人技术和 AI，将其缩减为一个可以说是拖挂卡车大小的制造工厂。我们称之为“舱”（pods）。这些舱可以用于生产任何东西，并运往任何地方。政府是我们的第一个客户。我们最近刚运出了第一个舱，刚刚又收到了第二个舱的订单，他们告诉我们后续还会有更多。因为如果发生生态灾难，我们可以把它运送给 FEMA（如果 FEMA 还在的话）。如果发生气象灾难，或者天灾人祸发生军事灾难，我们可以将它们运送到现场，并通过配置让它们生产任何特定类型的药物。
Original English an extension of that because we've been doing that for you, we started working on that five years ago. 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. 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，我们可以配置一个舱用于生产无菌注射剂；可以将多个舱串联在一起以便进行扩容；或者你可以让一个舱作为无菌室，另一个舱负责仿制药的片剂压片工作。我不是这方面的专家，Alex 可以对此进行精确详尽的阐述。但我最感到自豪的一点——实际上《Stat News》前天还是大前天刚刚报道了这件事——就是我们可以配置这些舱来进行 N=1 的个体化疗法，这样我们就可以把舱运送到研究型医院。这些舱的成本约为 2000 万美元。运送到研究型医院后，如果他们专门研究针对那些属于 N=1 类别的患者的某种疗法，他们就可以直接在现场生产并实现极快的迭代。现在我们在达拉斯的第一家生产设施里也在生产这些 ASO 药物，别问我 ASO 代表什么，因为我都发不准那个词的音。这就是第二部分。
Original English 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 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 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. So that's part two.
从这个制造业务出发，我们创建了 costplusmarketplace.com——抱歉，是 Cost Plus Marketplace。Cost Plus Marketplace 汇集了我们生产的那些无菌注射剂，以及我们从其他供应商或其他制造商采购的其他药品，我们……
Original English 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
以成本加成 10% 或成本加成 12% 的价格卖给诊所、医院、医疗服务提供者，卖给任何想以最便宜价格购买它们的人。我们实际上每年能为医院节省数百万美元。嗯，但我们在那里面临的最大挑战是，我们能说服首席执行官们，但并不总能说服采购人员去这么做。
Original English sell them at a cost plus 10 or cost plus 12 to clinics, hospitals, providers, whoever want to buy them at the cheapest price. 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.
嗯，然后最后，嗯，因为我自己作为自保雇主的经历，以及到处去和医院的首席执行官和首席财务官交谈，了解他们与大型承保商、大型纵向一体化承保商的关系，以及所有他们喜欢和不喜欢——主要是非常不喜欢的事情。我去找他们并说：“听着，我知道你们讨厌那些拖延、拒赔、预先授权，还有，你知道的，拖欠付款、资金追索，以及，你知道的，你们的计划或者承保商的计划一直在增加免赔额，把医疗服务提供者变成了次级贷款机构，因为他们必须在提供护理之前，或者在拿到保险金之前收齐免赔额。
Original English 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. 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.
了解所有这些事情后，我想达成一份直接合同，但我想要两样东西。我来告诉你我打算提供什么来换取那两样东西。第一，我会信任医生。除非是非常离谱的事情，否则信任医生。所以，你们不需要预先授权。不会有拒赔。话说我们曾遇到过一个患有孟乔森综合征的人，那需要拒赔。但是，你知道，除那之外，除非是离谱的事情，我会按时支付我们合同约定的价格。我来承担患者自掏腰包费用的责任。要么由我来支付，要么由我来承担患者本身的信用风险。这样你们就不用、你们就不是次级贷款机构了，你知道的。而作为这一切的交换，我想要两样东西。我想要一个更优惠的价格，因为你们相关的管理和间接费用以及医生时间都要少得多。你们的收益率会更高。而且我希望能够将我们签署的合同，即我们之间的这份直接合同，发布在 costpluswwellness.com 上。
Original English 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. 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. 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. 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. And I want the ability to take the contract we signed, this direct contract between us, and publish it on costpluswwellness.com.
这样它就可以充当所有这些合同的开源资源，以便任何雇主都可以使用它们，任何医疗服务提供者都可以发布他们的合同，即使你不想发布或使用，你也可以在自己的谈判中将它们用作模板。”
Original English 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.
### 雇主自保与承保商垄断 >> 嗯，我喜欢最后这一点，马克，因为我认为那就是我们来回交流的起因，当时我在几周前发表了一篇文章，关于我所谓的健康计划的巨大更替周期。而且长期以来——所以，你知道，雇主赞助的健康福利是我国最大的一类保险，如果你这样考虑的话。所以，你知道，大概有我想 1.55 亿或更多的美国人享有雇主赞助的福利覆盖。
Original English >> 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 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.
>> 是的，更多。但不管怎样，它是全美一半以上，全美的 60%。而且，嗯，从历史上看，它完全，你知道，被这些全国性承保商等 BUAS 垄断了。而且，嗯，从初创公司的角度来看，它一直是一个无法切入的市场，对吧？就像它那些关系根深蒂固。你需要这些全国性网络才能，你知道，在这个局里玩下去。所以进入这个领域的起始成本对于初创公司来说太高了而无法涉足，而且那些关系就是太根深蒂固了。现在，保费上涨简直太荒谬了，对吧？就像今年我们甚至在我们的初创公司中看到，一些 BUAS 正在强推同比高达 60% 左右的保费上涨。这简直——
Original English >> Yeah, more. 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? Like it's the 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 and the relationships were just too entrenched. 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
>> 情况比你想象的还要糟糕，朱莉。你知道，不是要插话，但是——
Original English >> it's even worse than you think, Julie. You know, not not to step in, but
>> 因为它们是纵向一体化的。比如联合健康（UnitedHealth）拥有 3000 多家子公司，每年内部公司间转移支付达 1500 亿美元。如果算作美国各州，这能让它们在 GDP 上排到全美第 14 位。
Original English >> 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.
>> 这就告诉你它们有多庞大了。而 CVS、信诺（Cigna）也相差不远。所以经常会出现这样的情况：他们会提高保费、提高免赔额、增加自掏腰包费用，同时将你重新导向甚至强迫你与一家他们已经拥有的公司建立合作，而你却不知道他们拥有这些公司。你谈到，你知道的，基于雇主的保险，特别是那些自保的雇主。从公司获得医疗保障的人中有 60% 是来自自保雇主。那些雇主需要有人来处理所有的医疗理赔。暂且撇开药房不谈，医疗理赔方面，那些机构被称为第三方管理员（TPA）。如果它们被大型 BUAS 拥有，它们就被称为 ASO，即仅行政服务。而那些管理员，你知道，我们一直听到关于 PBM 及其如何进行差价定价的问题。嗯，在医疗方面，情况要糟糕一百万倍，因为——
Original English >> 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. 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. 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
>> 它也是市场中更大的一块份额。
Original English >> it's also chunk of market.
>> 什么？
Original English >> What's that?
>> 相比之下，它也是市场中更大的一块份额。
Original English >> It's also the bigger chunk of the market relative to
>> 当然。是的，医疗方面要大得多。你知道，10% 且在增长对比其余的 90%。他们所做的是，计划和医院有它们自己的合同。而医院，除非它们具有市场主导地位，否则都讨厌 BUAS 和那些合同，但更重要的是，无论那种关系是什么，自保雇主根本不知道那种关系的条款是什么。对吧？即使有可能你可以去医院查阅 tick 文件，也就是那种关系和那个计划的透明度文件，它们也不总是正确的。它们并不总是对的。但最终发生的情况是，雇主支付的价格，自保雇主支付的价格，很少与收取的金额或支付给医院的金额相匹配。所以那里存在差价定价。更糟糕的是，那些由 BUAS 拥有的 ASO 让对账变得不可能，以至于你无法看清自己是多付了还是少付了。他们还会做一些事情，你知道，有叫做 835 和 837 文件的东西，即发送给医院的数据以及针对这些理赔支付的金额。而雇主根本无法访问它。在很多情况下，他们甚至无法访问自己的理赔数据。这完全是被操纵的，正如朱莉你所指出的，试图，你知道，剔除它们并消除中间商，是当前医疗领域正在发生的事情的关键，是终极追求。
Original English >> of course. 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. 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. 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. 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，我是说我们超级兴奋地看到，一大批初创公司现在能够进入这个市场。除了所有这些市场力量以及经济学再次达到崩溃点之外，一个很大的原因在于人工智能可以在赋能全栈健康计划产品的构建方面发挥重要作用，并在极短时间内减少你所描述的所有那些冗余低效。
Original English >> 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.
### 人工智能在破碎体系中的局限 >> 但这一切归结于谁来承担风险。
Original English >> But this all comes down to who takes the risk.
>> 尽管 AI——我是个狂热的 AI 粉丝。切身实践它，热爱它。我认为它在临床方面很重要。我认为它在运营方面很重要。我认为短期内它在合同方面最重要。但现实是，在一个破碎的金融体系中，即使你将 AI 引入经济模型、运营和流程中，当它本身就已经破碎时，你是无法修复它的，因为正如你在最开始提出的观点那样，朱利安，你百分之百正确。我们身处一个低效的医疗市场。经济模型已经破碎了。
Original English >> 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. 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 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.
>> 你能看到这一点，因为如果你没有价格发现机制，那是保护你的一件事，它让你无法拥有一个高效的市场。但更糟糕的是，这也正是市场、经济机制真正开始分崩离析的地方。这也是短期内在运营上给 AI 带来困难的地方，而在临床上程度稍轻一些。这些合同体量如此庞大、篇幅如此冗长，BUAS 通过其 ASO 俨然成了合同恐怖分子。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——有 1335 页。嗯。
Original English 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 and less so clinically, the contracts are so big and so long, the buas through their ASOS get to be contractual terrorists. 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.
>> 地球上没有任何一群喝了足够咖啡的人类能够抓住他们试图偷偷塞过去的全部东西。
Original English >> There's no group of humans with enough coffee on the planet to be able to catch everything they try to squeeze by.
>> 所以结果就是，无论什么 AI，一旦你签了合同——现在但愿你能用 AI 来防止自己签下糟糕的合同。我认为那是对每个人来说唾手可得的成果，但一旦你签下了包含你未完全理解的条款和未完全你甚至无法——的条件的合同
Original English >> 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
保护自己，他们就赢了。这颗星球上没有任何 AI 能够保护得了你。当你试图在方案上同他们竞争时——没错，听起来不错，我也完全支持，对吧？Sidecar 在做的事情以及许多其他人正在做的事情确实非常聪明，但他们正遇到困难，因为，你懂的，确实需要包装型网络（wraparound networks），而且确实，搭建一个网络非常困难。但那些大型保险公司（BUAs）拥有如此多的子公司，他们在某个地方搞你一把，你甚至都意识不到。而这才是终极挑战。这也是为什么我如此支持分拆大型医疗机构法案（break up big medicine bill），并要去追究这些公司，因为我希望——我希望这对每一位创业者来说都是一个开放的市场，你知道的，能够以各种可能的方式去使用 AI。
Original English protect yourself against, they win. There's no AI in the planet that can protect you. 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 [ __ ] with you somewhere and you don't even realize it. 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.
>> 所以你——你的切入点完全就是我打算问的方向，Mark。这就是 AI 无论带来好还是坏、正在发挥作用的领域之一，它只是揭示了人类所设计的底层系统到底有多破碎，对吧。所以现在支付方和医疗服务提供方之间发生的整个所谓的机器人大战（bot war）局面，就是大家都在指责 AI，但实际上不是的，这就像是 AI 只是在将现有的按服务收费（fee for service）计费系统彻底执行到位，并向我们展示了那个系统到底有多破烂。所以我很好奇想了解，关于这件事情的终局，你的看法是什么？比如很显然，你的直接签约方法听起来能够大幅减少信息不对称、提升合同清晰度等等诸如此类的事情。要解决这个问题，靠的会是这个吗？还是说——
Original English >> And so you you were you 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 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 and things of that sort. Is that what it's going to take or
### 机器人大战与企业合同审查 >> 所以关于理赔、向上编码（upcoding）和向下编码（downcoding）层面的机器人大战，那是短期的东西，对吧？那就像是——你懂的，好吧，我需要减点肥，我不再吃米饭了，我不每天吃我的磨砂玉米片（frosted flakes）了，对吧？在外围做做挺好的，这也是很好的短期策略，但这并没有真正改变一切，因为 AI 是一个伟大的平衡器。你的 AI，我的 AI；你的 OpenAI，你知道的，OpenAI，我的 Anthropic，管它是什么，我们彼此之间会斗个你死我活，你可能赢几局，我赢几局，但它们最终在某种程度上会互相抵消。所以，从长远来看，我并没有看到剧烈的变革。也许如果你是率先入局的，你可以捞到一些好处，而且你也会看到一些诉讼，看到一些挑战，比如当一方拥有它而另一方没有的时候；但在医院那一方，其收入周期管理（revenue cycle management）相当厉害。
Original English >> so the bot wars in terms of claims and up coding and down coding that's short-term stuff right that 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 is pretty darn good.
而在我看来，大型保险公司存在一个大问题，因为它们是通过并购发展起来的。我们提到了这 3,000 家子公司。那存在着大量的数据孤岛。即使你可以尝试寻找途径去获取理赔信息和特定数据来进行向上编码，而且他们也正在这么做，但在大型保险公司这一侧，他们很难转型成为 AI 原生公司。我认为从长远来看，他们会面临严峻挑战。但这所有的一切——我怎么强调都不为过——所有这一切都始于那些雇主签署合同之前。如果你们投资组合里的每一家公司都说：“你知道吗？我要把我现有的福利合同审一遍。如果我有经纪人，如果我有顾问，如果我有第三方管理机构（TPA），如果我有药品福利管理（PBM）合同，我就把我现有的合同放到 AI 里跑一遍，我只用一个提示词，问一个简单的问题：他们在哪里坑了我？我应该做些什么来应对？”在 30 秒之内，你就会看到：砰、砰、砰、砰、砰、砰、砰、砰、砰。还有我通过跑合同看到的事情——因为我得告诉你我有多么喜欢 AI Agent。
Original English 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. 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? 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 [ __ ] me over? what should I do about it? 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.
我都用。我用 GrokBot。我用——Eric 和我都是 NBA 球迷，所以我订了 Luka Dončić 方案，因为只要 77.69 美元之类的。我觉得，这太棒了。GrokBot，77 美元，Luka 方案。我买了。然后我还有 Gemini 方案。然后我还有 OpenAI 的方案，等等等等。而且我使用这些 Agent，还有 Instinct 2、Dot，我使用这些 Agent，我对它们说：你去把每一个有信息公开申请机会的州立实体、组织、机构找出来，我希望你从这些实体中找出你能找到的每一份合同、RFP（招标书）或者不管什么东西，我要你写一封申请函去索取它。把它放进邮件里。放到我的草稿箱里。让我做一些个性化调整。准备好了告诉我，我就点发送。这太神了，对吧？那些过去总是在任务清单最底部、我一直想去碰却从来抽不出时间的事情，现在就这么源源不断地过来了。于是我把它上传到 Google Drive，每一个不同的大语言模型都可以访问它。我就统一告诉它们，每当 Drive 里上传了新内容，你们就去过一遍，然后告诉我，给我列出好消息，给我列出坏消息，给我列出应该采取的行动，然后给我一个简化版，这样我就可以发送给那家公司，或者学校，管它是哪里。然后砰、砰、砰、砰、砰。
Original English So, I use them all. I use Grockbot. 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. 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. 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. And so I put it up on Google Drive and each of the 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.
正是在那里，我看到了大型 PBM 巨头三大巨头以及大型保险公司在 ASO（仅提供行政管理服务）层面所签署的所有这些合同。因此，我得以具体看到所有这些企业机构是如何被宰的——这些学区，天呐，从丹佛到达拉斯再到沃思堡的各个城市，工会。我是说，如果你仔细想想，再次回到你那个极其精准的观点上，Julie，如果占 67% 的雇主、代表着 1.6 亿多美国人的雇主，真正去做了一件事——就一件事：在他们签署合同之前，把合同放进 AI 跑一遍，并在此基础上进行谈判，那么大型保险公司、大型 PBM 巨头及其所有子公司的整套体系都会崩塌。这个国家的医疗保健成本将一落千丈。因此，每当我去找雇主沟通，找投资人聊他们投资组合里的公司时，他们总会问：“我们需要立法吗？我们需要这个那个吗？”我的回答是：“不，你们只需要学聪明点，做好你们的工作，请一个我称之为‘医疗保健 CEO 或 CFO’的人，其唯一职责就是管理这些合同以及与之相关的一切。”然后你就会发现你的医疗成本降下来了。
Original English 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. 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? 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.
一旦我们帮你做到了这一点，那我们就可以立刻去谈剥离出来进行直接签约，以及做所有这些其他事情。比如有几家上市公司，我告诉他们去这么做，他们回过头来对我说：“天哪，我们根本不知道自己被宰得有多惨。”我央求他们在季度财报电话会议上提一下这事，但他们不肯，因为即便由于某种原因离开，他们仍然不得不和那些大型保险公司做生意。是的。所以，如果我们只要做那一件事——把合同梳理一遍。毫不夸张地说，如果你们有超过 1,500 名员工——或者更确切地说是参保会员（members）——对于那家初创公司、那家科技公司来说，最快的方式，可能取决于你被坑得有多惨，能省下几百万美元甚至更多，就是去做我刚才说的事：把你的合同放进 AI 里跑一遍。
Original English 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. 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.
### Cost Plus Drugs 的长远愿景与信任根基 >> 是的。Mark，也许退一步从宏观来看，你能不能多分享一下关于未来几年这项业务的宏伟愿景，以及你对达成目标的实施路径（sequencing）是怎么考虑的？
Original English >> Yeah. Mo Mark, maybe maybe zooming out, c can you share more about sort of the the grand vision for for the business a few years out and maybe how you think about sequencing to to get there?
>> 那么，有几点。第一，我的意思是，终极使命是颠覆医疗保健行业，让它重新变得可负担得起。我支持全民医保，但在你拥有正确的数据、人们能够基于真实数据做出决策之前，你是无法实现全民医保的。所以，这是一个更大的系统。无论它最终走向何方，我只是想颠覆医疗保健，以至于当人们考虑经济账时，它会变成：好吧，我完全清楚这是怎么一回事；而我们走向那里的方式，更多是依靠普及教育，胜过其他任何手段。就像我之前在 Cost Plus Drugs 商业模式方面提到的那样。听着，对于零售端，可能会有人跑过来说：“我们要按成本加成 1% 来做。”好吧，信任依然是我们的核心产品。那就是我的努力方向。我们在市场营销或广告上不花一分钱。而当我们刚开始做的时候，所有来自制药业的人都说：“哦，你们会被干掉的。”我的回答是：“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。而这正是整个行业所缺失的那样东西
Original English >> So, a couple things. One, I mean, the ultimate mission is to disrupt health care so that it's affordable again. 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. 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. And that's the one thing missing in all of
医疗经济学，信任。因此，一旦我们通过完全说到做到、通过完全透明、只收取固定的 15% 加价来赢得他们的信任，就会获得人们的信任。所以这会在某种程度上为我们提供保护。但宏大的愿景，我之前告诉过你的那些售价 2000 万美元的生产舱（pods），那些东西有很不错的利润率。我们认为我们可以在两年内每年卖出几百个，五年内每年卖出几千个。所以你想想，给我一千个生产舱，每个卖 2000 万美元，我们就会做得非常、非常、非常出色。
Original English 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. 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.
这会彻底改变医疗保健，因为我们可以把那些东西串联起来。实际上，我们完全可以在德克萨斯州达拉斯用这些设备制造片剂仿制药，而且制造成本比我们支付给印度——我们合作的印度制造商——的还要低。我们现在追求的不是最便宜的价格，我们找的是最好的制造商，所以我们付的钱要稍多一点。但即便如此，我们也能以更低的成本生产出来。唯一阻碍我们的是，针对每一种仿制药，我们都必须填写——我们必须去申请一种叫做另一种新药申请（another new drug application）的东西。而且那其中的每一项都花费 365,000 美元加上其他费用。所以如果你想做一千种，那就是 3.65 亿美元，再加上生产舱的所有成本。我们试图说的是，看，如果我们真的想把药物制造带回本土，我们随时准备着，而且我们能做到。你们已经在其他领域与我们合作了，所以我们认为我们会达到目标，成为我们工作的一大组成部分。我们已经做好了规划，在 costplusdrugs.com 上，当某种药物是由我们在美国本土制造时，我们会放上一面小小的美国国旗。不过那大概还要等两年，仅仅是因为我们必须与 FDA 一起完成所有那些工作。但这就是宏伟图景，如果我们每年能卖出价值 200 亿美元的生产舱，埃隆可得当心了。
Original English 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. 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. 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 costplusddrugs.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
>> 那么你的观点是否是，如果你展望未来几年，无论技术变得多么优秀，它自身都不会去颠覆医疗保健，而是需要发生其他更多结构性的改变？
Original English >> and 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。存在监管俘获，也存在规模俘获。目前在经济层面，全都是规模俘获。当你收听那些大型垂直整合公司的财报电话会议或阅读文字记录时，他们会谈论技术，但他们绝不会说的一点是“这将转化为雇主和患者更低的成本”。他们总是说“这将提高我们的收益。你知道，我们将向股东返还更多回报。我们将回购股票”。
Original English >> 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. 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.
但在我能够教育好所有这些雇主之前，他们会继续让这件事情变得几乎不可能。这就是为什么，你看，早些时候朱莉谈到 CVS 时，为什么我提到我们不与他们中的任何一家直接打交道，因为我们必须在他们体系之外运作，否则你就会掉进他们的陷阱，他们会用合同来拿捏我。
Original English But until I'm able to educate all these employers, right, they're going to keep on making it nearly impossible. 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.
Mark，在这一切之中，你在很多方面谈到了结构性的问题，但确实存在一个你之前所描述的现实，比如 AI 将会相当大程度地改变这个行业中人们的工作性质。你觉得——我常听你谈起，你知道，我们该如何让我们年轻的人才储备应对未来的变化，以及在这个时代，所谓的“做好职业准备”究竟是什么样子？你认为这对医疗保健领域来说意味着什么？未来 5 年医疗保健的劳动力队伍会是什么样子？
Original English 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 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? Like what does the the workforce of healthcare look like in the next 5 years?
### AI 对劳动力与企业管理层的影响 >> 我的意思是，它看起来与其他任何行业都一样。你仍然必须雇佣初级员工，
Original English >> I mean, it looks the same as any other industry. you have to still hire entry-level people
>> 因为无论模型是什么，发布的瞬间它就已经到头了，对吧，它就落后了，它就滞后了。因此每个模型都伴随着延迟，所以你需要能够了解正在发生的一切、能够构建上下文并与模型打交道、充当人机闭环中的人（human in the loop）、理解后果等诸如此类的人，而且你需要这些人随着时间的推移与组织一同成长，这样在所有这些事情变化的过程中，他们见证了实施的历程，从而能够为组织带来价值。这是第一部分。你不能直接砍掉所有的初级岗位。第二部分，你必须让这些人以及所有其他从事白领工作的人学会如何使用 AI，因为 AI 不会取代工作，懂得如何使用 AI 的人会取代那些不懂如何使用 AI 的人的工作。这是第二部分。然后第三部分是更宏观层面的事情。第一步是尝试让高管团队（C-suite）了解 AI 究竟是如何运作的。教他们智能体是如何运作的。教他们如何使用模型。教他们开源模型与闭源模型之间的差异，以及你必须去做的各种不同的事情。帮助他们理解模型的延迟——我们三个人正在进行的这场精彩对话，在任何地方的模型里都不存在，直到它被公开发布之后才会有。所以，如果我们说了什么大家都可以拿去用的东西，模型全都是落后的，AI 全都是落后的。所以这是必然的，当然你也知道大语言模型处理的是文本和一些图片，并不处理视频中正在发生的所有真实世界的事情。所以作为 CEO 和高管团队的一员，你必须能够理解所有这些事情会对你的公司产生怎样的影响。一旦你对这一点有了很好的把握，然后你就可以开始摸索尝试了，对吧，因为到那时你就能发现实现目标的新方法，从而让你的客户受益，或者创造出新的机会。而这正是 AI 的出彩之处，对吧？AI 并不聪明。它也许是有书本智慧，但它缺乏市井智慧。它缺乏企业家的那种精明。你必须有人在那里引导它、帮助它。但直到你拥有一个理解其运作方式的高管层之前，对那个组织来说都会非常艰难。
Original English >> because no matter what the 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. 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. 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. 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. 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 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.
我是说，我前几个月真的和一家消费食品公司的负责人坐在一起，他跟我聊起了收购，他说：“对啊，因为 GLP-1 诸如此类的事情。”我说：“好，那我们这样做。我们拿你最主打的产品，你的饼干，对吧？然后我让 ChatGPT 去创造一个更适合 GLP-1 使用者、而且定价更低的竞争产品。我要一份完整的物料清单。我要原材料来源、制造方面的一切，以及我需要做些什么。”大约 3 分钟后我们回复了他，他整个人都懵了，他完全一无所知。
Original English I mean, I literally sat with the head of a 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. 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 [ __ ] he had no idea
>> 如果你对此一无所知，那是一个你可以去向大语言模型请教的问题；你并非对如何让自己的公司运用 AI 一无所知，而对我来说，这才是大多数组织面临的更大困境。现在对于提出那个问题并尝试去落地实施的创业者来说，无论做什么，现在都是成为创业者的最好时代。地下室里将会走出万亿富翁。将会有人推出他们自己的智能体群（agent swarm），并以创业的形式来运作。
Original English >> 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. You know,
不过现在依然存在挑战，特别是对于智能体而言。智能体看不到社交媒体上的帖子。它们无法去审阅那些内容，对吧？而且很难获取其中任何实质性数量的文字记录。它们无法观看广告或看到广告。所以，如果我们正在转向面向个人的智能体驱动型经济，那么我们在如何向那些智能体传递商业信息的方式上，就必须发生很多改变。真的，我当时和我公司里的一个小伙子在一起摆弄，我们做出了这么一个东西，你可以去看看。它现在还没真正上线。它叫 agentfeeds.dev。整个想法就是你把帖子的文本内容拿出来，直接放进 agentfeeds.dev，然后你复制粘贴，任何人都可以复制粘贴你关注的任何人的内容到他们的智能体里。“嘿，关注这个的所有动态”，它就会获取所有的广告并为你提供所需的所有信息，这样你的智能体在那些类别或任何方面就能够保持更新。你会看到这类事物呈现出爆发式增长，但我们仍然必须跨越信任这道坎，以及我们大家都心知肚明的关于 AI 的所有事情和关于 AI 的所有问题。但在机会方面
Original English 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. 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. 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. 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
回到医疗保健领域，我认为除了临床之外，AI 最大的挑战以及将产生最大影响的地方，是在患者端、在消费者端，对吧？能够查看你在经济层面拿到的那些东西，比如你知道的，福利账单，对吧？EOB，对吧？福利说明书（explanation of benefits），对吧？这就是我认为消费者将获得最大好处的地方。
Original English 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? The EOB, right? The explanation of benefits, right? And here's where I think um consumers will get the greatest benefit.
所以现在，大概半个国家都处于恐慌之中，对吧？全美有 40% 的人拿不出 400 美元的急诊账单。因此我总是告诉大家，在发生任何事情之前，先去打开你最喜欢的 AI 模型，对它说：帮我列出所有的非营利性医院。去找到它们，问问它们的财务支持服务是什么，因为所有的非营利性医院都必须提供经济援助计划，而且其中一些计划非常不错。对某些人来说，你的处境会更好——我不想替别人做决定，但你可以向 AI 提问并说：不管我原本要交的保险计划保费是多少，我都要把它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沟通了我的情况，而且我对他们的经济援助计划了如指掌。
Original English 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. 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.
这些经济援助计划的制定，在大多数情况下定价都是参考联邦贫困线标准的，但它可以高达联邦贫困线的 600%，这在某些州的某些家庭可能超过 10 万美元。因此，让患者/消费者/家庭了解他们的选择是什么，以及如何获取这些选择（尤其是来自非营利医院的选择），将具有极其重大的意义。
Original English 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办一家公司，我会去每一家非营利医院，建立一个方案，发布我让人们使用的智能体（agents）。“嘿，你知道的，如果你担心自己该如何支付自己的账单或家人的账单，而且你知道，你在银行里没有多少积蓄，无论你挣多少钱，只要低于 X 美元，就把这段内容复制并粘贴到你的 Muse 里，或者粘贴到你的 DOT 里，或者你知道的，你的 Claude Co-work 里，不管是什么，它就会知道来找我们并提出问题。”
Original English 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.
所以当我教那些医院负责人时，我说：“你们根本不懂。你们这帮人在营销上烂透了。你们依赖那些保险公司（BUCAs）及其方案，依赖成为其网络的一部分来给你们输送患者。这太荒唐了，对吧？如果你让人们很容易使用你们的经济援助计划，也许去联系当地银行，也许去向人们展示如何学习使用针对中小企业的止损策略。他们有太多的选择可以用来为患者改善情况，因为那才是真正脱节的地方。”
Original English And so when I taught the heads of hospitals, I'm like, you don't understand. 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 for smaller medium-sized companies. So many options for them to use it to make things better for patients because that's really where the big disconnect is.
你可以提供更好的方案。你可以利用技术来降低价格，并在构建网络或谈判直接合同方面提高效率。但直到最终用户真正接纳它并懂得如何使用它之前，挑战都将一直存在。但我们所有人都在某种程度上经历过这个，就像我们当年学会使用电子表格一样，那时我们还觉得它太复杂了。我的年纪足以记得人们觉得电子表格很难的时代，你知道的，你得向他们解释，他们还得花 500 美元买 Lotus 1-2-3。但现在随着我们经历这种转变，同样的事情正在发生。人们——是的，有很多人反 AI，但也有很多人反计算器，反一切新事物。这只是时间问题。但是一旦你让——你让他们克服对 AI 恐惧的方法，就是向他们展示这些东西能如何真正让你受益、保护你，并减少万一发生大麻烦时你内心固有的恐惧。
Original English 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. 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. 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.
### 前沿模型与个性化医疗的前景 >> 是的。多年前 Aaron Swartz 有句名言，你知道的，“信息渴望自由”。是的。而且我知道在医疗保健领域，在之前的对话中，你对这能否发生有点持怀疑态度，因为正如你所提到的，有大量孤立的数据，而且你知道，有许多战略原因表明为什么这些数据在某种程度上是他们的优势。所以我提这个是想问你，你认为前沿实验室——比如 OpenAI、Anthropic 在这个领域都有非常大的野心——无论是他们还是其他人，在重塑医疗保健方面最终会产生什么影响，或者可以说……
Original English >> 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 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 is you know that that is their their advantage to some degree and 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 in re reshaping uh healthcare or sort of you know
>> 我来确切告诉你，我来确切告诉你。这里我稍微带点自己的私心。 随着模型能力的提升，在审查了你的 DNA 并掌握了它所知道的一切之后，为你量身定制设计药物的成本将开始趋近于零。对吧？我们总在谈论 GPU 以及它们会变得多快、背后的网络、所需的电力，但彻底改变一切并使其更加高效的将是算法。对吧？我们甚至都不知道算法的改进速度会有多快。在未来的某个时间点，无论是 5 年、10 年还是 20 年，他们都会从 Eric、Julie 和 Mark 那里获取样本，然后他们会说——从非处方药开始，因为如果你仔细想想，对吧，你走进药房，拿到了，你知道的，抱歉，不管是 Advil、泰诺（Tylenol），对吧，布洛芬（ibuprofen），我们都以为它对我们每个人的作用是完全一样的。而我们必须亲自去尝试才能看到它对我们的身体有什么影响。人体根本就完全不讲道理。
Original English >> 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. 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. And we have to experiment to see how it impacts our body. the body makes no sense whatsoever.
因此，随着这些前沿模型的处理能力和分析能力越来越强，他们将能够真正做到非处方药的个性化，而不需要经历许多你为了摸清这些情况而不得不经历的繁琐麻烦（mishagos），对吧？现在突然之间，如果这是我专属的布洛芬，这是我专属的剂量或无论这些非处方药的混合配方，砰的一下，你就开始改变它了。然后你就可以进阶到，你知道的，制造为你量身定制的其他药物，因为同样地，我们都去服用艾乐妥（Eliquis），并在 Eliquis、拜瑞妥（Xarelto）或华法林（Warfarin）之间做选择，从宏观角度来看根本毫无道理可言。所以能够把这些东西拿过来并将药物个性化。我曾对两名前沿模型公司的人说过，我说：“如果你真想聪明一点，你就利用你 20 美元或 200 美元的订阅，并在该服务可用时把它包含进去，因为在那个时间点你做这件事的边际成本——瞧，今天仅仅为了响应这样一个请求所必须进行的推理和所有计算是昂贵的，对吧？成本正在迅速下降。但对于这种个性化医疗，同样的事情也会发生。”
Original English 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. 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? Coming down very quickly. But the same thing is going to happen for this type of personalized medicine.
起初它的成本会是极其巨大的。但随着我们对人体有了更多的了解，对我们体内的所有变量以及我们的大脑等有了更多的了解，并弄清了药物，想明白了如何为每个人做到“N=1”（个体化医疗）。它就会成为常规订阅的一部分，因为没有理由不这样做。23andMe 能有多贵呢？你现在花 99 美元或更少就能做 DNA 检测。所以也许我先付 99 美元。如果我愿意的话，我把我的 DNA 交给他们。显然出于隐私考虑，他们会将其存储起来。他们会持续不断地进行分析。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 知道可能会出什么问题。但如果真的出了问题，
Original English 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 the medications and figure out how to do the end of one for everybody. 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. 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. But if something does go wrong,
>> 他们就能获取所有这些药物、所有这些机会，以及实时制造它们的能力。这关乎我自己的利益。我们希望我们的分离舱/制造舱（pods）能直接部署在那里并能够生产它们，因为我们是唯一有能力做到这一点的人。而且我认为在很长一段时间内这都不会改变。
Original English >> 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.
>> 我认为在这个背景下，Mark，人们可能没有给予足够重视的事情之一就是，随着那种情况的发生，随着你刚才描述的情况发生，随着药物对于这个国家或世界上的每一个个体来说变得仅仅是更好的产品。那实际上是对医疗护理交付最颠覆性的力量之一，对吧？就像医疗保健中有多少工作实际上是医生在帮助患者弄清为什么某种药物对他们不起作用……
Original English >> 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
### 医生角色的未来演变与医疗大模型 并且校准，以及进行剂量滴定，还要改变行为，让你的生活去适应药物，而不是让药物来适应生活。所以，我认为那是……
Original English 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
>> 但别忘了，正因为我刚才提到的那种延迟，你依然需要医生。如果马克走进医院说“我刚试了这种新的个性化药物，然后就开始吐得翻江倒海”。
Original English >> 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.
>> 是的，你依然需要远程医疗。
Original English >> Yeah, you still need tele.
>> 你可以通过视频看诊，对吧？然后你可以放个机器人在那儿问：“马克，你感觉怎么样？”对吧？然后终结者可能、可能会走进来说：“你的大限到了。”我不知道。但我宁愿那里有一个拥有全部五种感官的人类，能够观察、提问，看到哭泣的妈妈，或者哭泣的儿子、孩子等等，并能将这些纳入背景信息考量中。所以我不认为那会取代医生，我们甚至都不应该去尝试，因为……而且你们也知道技术的普及采纳过程是怎样的，尤其是对于这个领域。你仍然必须知道该问什么问题。
Original English >> 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. And so I don't think ever that will replace doctors and we shouldn't even try because and and you know, you guys know how adoption of technology is particularly for this. You still have to know the questions to ask.
>> 你仍然必须知道哪些变量重要，哪些变量不重要。你仍然必须意识到，即使处理成本有望在未来的某个时刻降至接近零，其背后也依然存在成本，哪怕那仅仅是时间成本。所以，你需要一个在所有这些方面受过教育的人在那里。茱莉（Julie），对于你的观点，我认为当涉及到医生的角色时，可能发生巨大变化的是他们在医学院受训的方式。他们学到的东西将不会完全一样。他们必须学习如何利用公开证据（open evidence）或市面上可用的任何其他资源，学习如何提取信息——哪怕仅仅是 DNA 信息，理解其中的内容以及模型对其的看法，并能够将其解释给患者。因为，在某种程度上，为了让这一切完美运作，每个人都必须拥有自己的模型，而这对每个人来说都会很困难，尽管在未来的几年里，会创建并支持数以百万计、甚至数以亿计或数十亿计的模型。 而且在此之上，知识产权（IP）会成为引入到这个等式和过程中的一个完全不同的难题。因为你知道，直到最近，学术界一直都是“不发表就出局”（publish or perish）。如果你是一名医生，你创造了某种东西，你希望大家都能用上，也许你甚至可以对其进行授权许可并从中赚取一些收益。但现在，如果你试图为某项成果申请专利，每个 12 岁的孩子都会说：“嘿，看这个专利，只要稍微改动一点点，就能做成我自己的专利。”对吧？或者如果在医疗领域这是一套新的医疗程序，你可能会说：“不行，你必须使用我的模型，而且每次访问你都得付给我 9,999 美元，对吧？或者为了进行推理，你必须使用我指定的软件，因为没人会免费交出那个 IP。”这引发了更多的问题。 我认为许多 AI 创业者的一个潜在认知是——回到埃里卡（Erica）所说的——“信息渴望自由”。信息或许渴望自由，但拥有该 IP 的人可不这么认为。因此，这将改变我们与模型交互的方式。我们可以去争论那些选择用最便宜的模型来回答问题的前端，但我们还没有讨论过：如果拥有者不愿公开提供，我们该从哪里获取训练该模型、对该模型进行后训练、或者用于该模型检索增强生成（RAG）等所需的 IP，而这些数据是绝对必需的。大家觉得这有道理吗，还是觉得我像个傻瓜？
Original English >> You still have to know what the variables are that matter versus the ones that don't. 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 the role of the doctor is how they'll be trained in medical school. 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. 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. 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?
>> 我觉得这非常有意思，因为这也引出了一个问题：未来医生的角色究竟是什么？首先，我同意实际上未来我们将需要更多的医生，因为随着护理建议变得更加充裕，更多的人会要求获得医疗服务，真正现实生活中的医疗服务。所以我们会发现自己实际上需要更多的医生。 而且，关于你所描述的也有一定道理：今天医生的角色是非常死板机械的，对吧？就像是“这些是你必须完成的任务，这些是质量考核指标”。老实说，在传统医疗环境中要求医生做的许多事情，几乎都不需要动脑筋。而你所描述的情景就像是：如果范式发生转变，医生实际上更像是“医生科学家”，对吧？就好像他们的工作实际上是掌握我们在人群规模上可能尚未知晓的前沿信息，但在个体层面上，他们处于最前沿，去收集新颖数据，并针对人们的反应生成全新的见解。
Original English >> 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? 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? It's kind of like the these are the tasks you got to do these quality measures. It's like you 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? 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.
>> 新颖数据在定义上……在我听来这是一份令人兴奋的职位描述。
Original English >> Novel data by definition stimulating job description to me.
>> 是的。
Original English >> Yes.
>> 是的。因为根据定义，你说的完全正确。对。新颖数据就等于个人。
Original English >> Yes. Because by definition, you're exactly right. Right. Novel data equals person.
>> 嗯。
Original English >> Mhm.
>> 没错。伴随着这类数据，
Original English >> Exactly. And with like data,
### 持续监测与 EHR 现有巨头的壁垒 >> 我们将拥有纵向监测。就像我们经常讨论的血压监测一样，这和你说的是同一个原理。事实上我们每年大概就测一次血压，这有点可笑，因为它是不断变化的。
Original English >> 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. The fact that we take our blood pressure like once a year is kind of ridiculous because it changes.
>> 我可不是。
Original English >> Not me.
>> 我手上就带着这玩意儿。
Original English >> I got this [ __ ] right here.
>> 你是……对，[笑声] 你走在前沿。而且很快我们将拥有可穿戴设备，能够每天实时监测这些数据。这样你就能更加精准地了解自己对不同治疗干预措施、甚至是饮食和运动等各类举措的反应。 茱莉，你提到了关于新颖信息的一个很好的观点，而就找工作而言，这关乎所有人，对吧？对于那些可能跟不上这些事物的人，你将需要 AI 翻译员。比如在这个国家或世界上任何地方的普通人，他们只是想过上自己富足的生活，不管那意味着什么。你将需要有人来翻译针对特定情况或个人而言什么是新颖的，以及你该如何让这些对 AI 有效，又如何将 AI 的输出以新颖有效的方式传达给个人。这将会是一份工作，而且要从一个人身上提取 AI 所需的全部内容将是非常困难的，我认为你必须要有一个人在那里来做这件事。也许有人设想会有一个人形机器人来问你那些问题，而某人会感到适应。我不认为……我不认为那会发生。
Original English >> You're Yeah, [laughter] 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. 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. 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. I don't I don't think I don't think that's going to happen.
>> 是的。
Original English >> Yeah.
>> 顺便问一下，马克，我想我从来没听你谈论过另一群根深蒂固的行业巨头，那就是 EHR（电子健康档案）公司。
Original English >> 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.
>> 嗯哼。对于在 AI 时代那个市场会如何变化、演变或不发生变化，以及未来几年会是什么格局，你的基本研判是什么？
Original English >> Uhhuh. What what's your what's your theory of the case there on how that that market changes or evolves or doesn't um in the age of AI and what that looks like in the next few years?
>> 老实说，我不知道。EHR 领域由 Epic 主导，那是他们的天下，所以我基本上就是听从他们的安排，并尽量坚守在我能产生影响的领域，因为我们与他们有合作。我们认为在处方开具环节——也就是医生在场的时候——提供定价（特别是药品价格），并为他们提供不同的选择，是一种……
Original English >> 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 the point of um script where the doctor is there offering them different options is a
>> 是他们刚刚发布的那个新声明的一部分吗，关于……
Original English >> part of that new announcement that they just made about the
>> 对，没错。正是。与 Epic 和亚马逊等的合作。所以我觉得那是一个很大的加分项，我也认为那是必需的，但就他们实际的业务模式以及在哪些方面可能被颠覆而言，我确实没有资格去评判。
Original English >> Yeah, exactly. 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.
>> 好吧。顺便说一下，我对那个声明的不满之处在于，我很高兴他们宣布了这件事，但随后他们却说要到明年五月才能上线，我就觉得，为什么要拖这么久？
Original English >> 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?
>> 那可跟我一点关系都没有。[笑声]
Original English >> I had nothing to do with that. [laughter]
>> 好吧，
Original English >> Okay,
>> 这在这个行业里很普遍，对吧？
Original English >> that's typical in this industry, right?
>> 是的。你们觉得在 10 年后，医疗保健支出是否仍会占到现在占 GDP 五分之一或六分之一的水平，而且仍然存在着这种……
Original English >> 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
某种终末状态……需求量远大于我们能够供应的水平，哪怕效率越来越高、变得更容易，哪怕 GDP 每年还能增长 5%，在某个节点上，我们的需求仍会被限制在经济总量的五分之一左右。
Original English 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.
>> 我也这么觉得。
Original English >> I do.
>> 是的。但我们从这笔支出中获得的价值应该……
Original English >> Yeah. But the value that we get out of that spend should be
>> 应该说，你从人身上获得的价值会提升。
Original English >> well the value you get out of the people will increase.
>> 是的。
Original English >> Yeah.
>> 因为他们会更健康。是的。
Original English >> Because they'll be healthier. Yeah.
### 医疗政策与全民储蓄构想 >> 所以这和“病后照护”（很多人所谓的sick care）是有区别的，相对的是让人保持健康、让他们更有生产力、减少停工时间、而且你知道他们会更聪明因为更容易学习等等。所以我认为我们会获得远超其成本的更高生产力，而这是我们目前所没有的。稍微把视野拉远一点，马克，我们俩有一位共同的朋友，是一位非常有名的民意测验专家。我不会在这里透露他是谁，但他认为，或者他做过的一些研究显示，如果你出来竞选公职，他认为你能赢。当然，你一直说你绝不会参选。所以我们现在只是做假设性的讨论，但如果你当了总统，或者如果你给下一任总统当顾问，我很好奇你会怎么考虑最能解决我们医疗困境的杠杆是什么？接着我还想听听你更广泛的一些政策立场。
Original English >> 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. Um so I think we'll get greater productivity that'll more than account for it which we don't get now. 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 you've said you never you you'll never run. Um, so but so we're just speaking hypothetically now, but I if if you were president or if you were advising the 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.
>> 这其实非常简单。这和我去作证时对各州说的一模一样。第一，将所有拿纳税人钱的机构所签的合同全部公开，不得删减。因为一旦这么做，你就会开始拥有一个高效的市场，成本就会降下来。第二，任何人如果能找到比当前医保方案自付费用更低的价格，就允许计入他们的免赔额。目前已经有八个州在某种程度上实行了这项举措。第三，对于非营利性医院，要求它们公开完整的总分类账，细化到每一笔明细分录，并公开所有的采购发票和采购需求，对吧？这样所有人都能看到。这是我们的钱，我们是纳税人，对吧？第四，取代我们现有的保险方案——那些大型保险公司72%的收入都来自纳税人。他们不再承担风险，而是把风险转嫁出去。对他们而言一切都是套利。所以，考虑到这一点，我们还必须认识到，我们在生命终结之前永远还不清的一笔债务就是保险费。
Original English >> It's really easy. It's the same thing I tell states, you know, that I've testified for. 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. 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 and requirements, right? 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. 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.
好好想想吧。不管是 Medicare，除非你在享受 Medicaid，对吧？你得一直付到去世的那一天，而当你需要它时，在目前的体系以及大概可预见的未来体系中，你都得去争取。在我看来，如果我们能建立这样一个项目：你只需要存入一笔钱，比方说相当于你在所在州参加平价医疗法案（ACA）银级计划所要支付的保费，我们直接去和银行达成协议，规定好在得克萨斯州，一个五口之家按照你的收入水平是2100美元对吧，那么你就一直存入这2100美元，它会累积增长，而且所有权属于你，但如果你想参加这个项目就必须存入这笔钱；然后如果你遇到了医疗事件或用药事件，对吧？你可以动用这笔钱。如果不够，我们和银行达成的协议会实现两点：第一，银行会向你提供贷款，直到达到止损线生效为止，这意味着我们会从你存入的资金中拿出一部分用于购买止损保险；第二，联邦政府或州政府将为你的这笔贷款提供担保，这样医疗服务提供者不会蒙受损失，并且我们仍会从你的工资中扣除这笔钱以便你偿还。而如果你很幸运，从未发生过意外，并且省下了所有这些钱，等到你65岁进入联邦医疗保险（Medicare）时，你就可以拿走所有这笔钱以及全部累计利息。因为你想想看，
Original English Think about that. whether it's Medicare, unless you're on Medicaid, right? 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. One, the bank will loan you money up until a 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,
联邦政府会……
Original English the federal government will, you know,
>> 就像我们的互联网……
Original English >> like our internet
>> 承保或担保你的助学贷款。他们会担保小企业管理局（SBA）贷款。他们会担保住房贷款或为你提供首付，对吧？
Original English >> cover or um guarantee your student loans. They'll guarantee SBA loans. They'll guarantee home loans or give you a down payment, right?
>> 第三世界国家。
Original English >> Third world country.
>> 我们会为所有这些东西提供担保，甚至包括农业项目。但最重要的事情——覆盖我们的医疗保健——祝你好运。如果你遭遇了严重事故，祝你好运，我们也许就把包袱甩给医院，医院不得不收治你。因此，我会建立这样一个计划：规定你必须存入这笔钱；银行会获得担保，就像抵押贷款一样；我们会把钱贷给你，然后设立联邦止损机制，超过某个额度，比如4万美元或其他金额，就由它覆盖。这样一来，保险公司突然就被淘汰出局了。这样一来，你也不用再去抗争，因为那是属于你自己的钱，你可以随意支配。当然，我们必须对你在哪里以及如何花这笔钱设立门槛，这样你才不会直接把钱拿给声称能治好你骨折脚趾的比利表哥，对吧？但在这些约束之内，我认为整个系统一下就改善了。这就是如果让我提供建议，在医疗保健方面我会做的事情。
Original English >> 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. 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. 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? 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.
### AI 行业的宣传困境与应对 >> 那么关于……你知道，你的天赋之一就是讲故事，以及更广泛意义上的营销。那么对于 AI 行业呢？显然 AI 在美国有着特别普遍的负面声誉。如果你要向 OpenAI 或 Anthropic 提出建议，指导他们如何去扭转这些数字，再加上现在整个数据中心的风波，我很好奇你对更广泛的 AI 行业会有什么建议。
Original English >> What what about u you know one of your gifts is is storytelling and and marketing more generally. What about the AI industry in terms of you obviously AI is you know uniquely unpopular in in 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.
我和他们有过这样的对话，我直接跟他们说他们太蠢了。因为你知道现在控制这个国家几乎所有人想法的是什么吗？是社交媒体的算法。
Original English 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? Social media algorithms.
真的，我前几天和一位一起工作的23岁年轻朋友聊天，我们在谈论政治。我们在讨论昨天把票投给了谁、是怎么投的以及为什么这么投。然后我问：“你的朋友们呢？其他那些23、24岁的人呢？”对方说，住在得克萨斯的这帮朋友甚至都不知道肯·帕克斯顿（Ken Paxton）或詹姆斯·塔里科（James Talarico）是谁。
Original English 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
>> 或者说现在是谁，对吧。这在我看来简直不可思议，在这个人看来也很不可思议，但这也印证了一个事实：你通过算法寻找什么，就会得到更多什么。如果你真拥有最好的 AI，你不仅应该能够逆向工程这些算法，还应该能够组织起一套营销方案，因为你们肯定到处宣称能通过自己的机器人、Bot 或者 Dot 之类的东西来执行营销方案，那就真正从那里开始做营销。因为这适用于政治，适用于 AI，也适用于这个国家的一切分歧。在我们使用的社交媒体平台上，我们每个人都有属于自己的独特 AI 推送流，而那些平台在某些极其微小的限制之外，根本不在乎给你推送什么垃圾内容。所以每个人看待世界的方式都不同。那种以为只要多买广告、毁掉我们的橄榄球赛和篮球赛转播就能万事大吉的想法已经过时了，尤其是对年轻人而言。也许年纪大的人投票更积极，这可能就是原因，但在试图改变人们对 AI 本身的看法时，这种做法毫无用处。尽管具有讽刺意味的是，正是这些算法背后的 AI 毁了一切。但只要《第230条》还在，局面就只能维持现状。而且只要……除非我们采取澳大利亚式的做法，或者某些州针对16岁及以下人群的做法。所以我具体告诉他们的是：你们需要利用自己的 AI 去进行全方位的人群细分，找出构建营销、推广以及其他任何手段的最佳方式。就像俄罗斯人那样去做。这没关系，对吧？因为对你们而言事关生死。而人们对数据中心的敌意，只是对无法理解 AI 的一种转嫁投射罢了。
Original English >> 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 [ __ ] what it feeds you within some minimal constraints and So everybody looks at the world differently. 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 the algorithms that's ruining everything. 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. 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.
>> 是的。
Original English >> Yeah.
>> 而且并不了解其中的全貌。我一点也不怪大家。是的。正如雇主们在员工医疗福利方面一直表现得很愚蠢一样，
Original English >> And not all know all the pieces there. And I don't blame people at all. Right. And just like employers have been really dumb with their healthc care benefits, a
许多社区在为数据中心谈判达成的协议上真的非常愚蠢，你知道的，而且在很多很多情况下，他们都屈服于那种合同层面的恐吓。但对我来说，要让他们了解社交媒体，教育我们的立法者以及无论谁当选总统去了解社交媒体，因为我认为他们并没有真正理解这种影响——即我们并不是所有人都在读同一份报纸、同一本杂志、看同一个网站、看同一个新闻节目。我们每个人都有属于自己独特 TikTok 信息流。你的信息流和我的不一样。比如了解你孩子的最好方式，就是看一眼他们的社交媒体信息流。像我 17 岁的儿子，里面全是篮球、篮球、篮球。现在我开始看到冒出了一点点政治内容，但紧接着就是美女、美女、美女、篮球、篮球、汽车、汽车。我心里就想：好嘛，
Original Englishlot of communities have been really dumb with the 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. 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. 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,
>> 典型的 17 岁男生，对吧？不过，在那些顶尖的前沿模型彻底明白它们必须想方设法成为每个人信息流的一部分之前，它们所发布的这一切立场文件都将是毫无用处的。
Original English>> typical 17-year-old guy, right? Um but until the the big um frontier models understand completely that they have to figure out how to become part of everybody's feed. They're going to be putting out all these position papers that are useless.
### 人工智能时代的创业空白与机遇 >> 是的。确实，我是说，马克，我们很赞同你之前说过的，现在就如同活着并且成为一名创业者的最好时代。而且你知道，许多在历史上曾经棘手的事情，突然之间全都可以解决了。市场上是否存在某个领域——你接触过许多创业者，看到人们在全世界各个领域进行建设——是否存在某个领域让你觉得“为什么没人在这个方向做东西”，让你认为它仍然是属于创业者的空白机遇？
Original English>> 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 and an entrepreneur. Um and you know, so many things that again were intractable uh historically are now all of a sudden addressable. Is 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?
>> 所有领域，说真的。你知道，每当我去跟年轻孩子们交谈时，我总是告诉他们，未来将会有两类公司：那些精通 AI 的公司，以及那些已经倒闭的公司。而如果你花时间去学习……接着还有两类人以及他们使用 AI 的方式：那些利用 AI 去学习任何事物的人，以及那些为了自己什么都不必学而使用 AI 的人。如果你是属于那些为了能学到任何东西而使用 AI 的人，并且你意识到了哪些类型的公司和问题目前还没有被 AI 解决，那就不要害羞，尽管去跟你的 AI 对话。你知道，我不仅对年轻孩子们这么说，也对 50 岁、60 岁、70 岁的创业者这么说。现在人们以及创业者使用 AI 时面临的最大挑战，就是与你的 AI 交流时的自如程度，无论是通过语音还是打字，不管是什么形式，因为这里面仍然有大量的犹豫。你知道，就像当年最早的电子表格出现时，人们手里仍然拿着带 10 键的小键盘加法机，他们会去核对以确保电子表格是正确的。你确实依然需要去核对输出结果，但你拥有了把 Grok 的输出拿去放进 ChatGPT 的机会，就像当我查阅我刚才跟你们讲过的所有这些合同时，我先从一个开始，然后说：“嘿，你的一个同行给出了这个结果，对这份合同发表了这样的看法，你怎么看？”接着花上几个小时，年轻创业者们，这就是全部了。所以当你问我是否存在某一件事情时，我由衷相信那就是一切，一切都将被改变。这是我们所见过的最伟大的过渡性技术，我经历过所有的技术浪潮，对吧？而这项技术彻底超越了以往所有。最难的部分仅仅在于放手去干。这就是硅谷以及旧金山湾区年轻人我认为稍微拥有的一点优势所在，因为他们看到自己的父母和朋友，以及那里的文化氛围就是放手去做。
Original English>> 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. 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. 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. 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. And that's where Silicon Valley and, you know, kids from the 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.
但我认为全美其余地区以及全世界其余地方一旦建立起了那种信心水平，你就会开始看到我们从未想象过的业务不断涌现，因为我们现在还没看到那些。你知道，我们还没看到这种令人发出“噢，那是什么？”感叹的公司。你知道，“他们为什么要做那个？那里的机遇究竟是什么？”然后他们比我们更早意识到这一点，对吧？这有点像当年最早的 Friendster，大家会觉得：“哇，那是什么东西？”所以我认为，如果你在寻找方向，最需要聚焦的事情就是：去问任何问题。我是说，我一直都在这么做。就像问：“你对此怎么看？你对这个怎么看？你对这个又怎么看？”你知道，我甚至把两部手机贴在一起放着，获取它们的输出，让它们彼此对话，这样我就能在一旁倾听。对于在那些让人感觉非常不适和奇怪的事情上使用 AI，千万不要感到害羞，因为那种不适感，很可能正是通往具有开创性和改变游戏规则之物的路径。
Original EnglishBut 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? 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. 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. 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.
>> 这是一个极佳的收尾总结。马克，非常感谢你来到我们的播客节目。
Original English>> That's a great note to to wrap on. Mark, thank you so much for coming on the podcast.
>> 非常愉快。谢谢各位，谢谢朱莉，谢谢埃里克。
Original English>> It was fun. Thanks, guys. Thanks, Julie. Thanks, Eric.