wideout paper change welcome to another episode of the hyper chat I'm here with Nikita we have a really special episode today we're gonna talk about Oscar health and hyper change in the healthcare system and why aligning incentives could be make a huge difference for the healthcare industry which in the u.s. is super bloated and you also have you work for Oscar and you also have a blog called negotiating the terms about women in VC so we're gonna cover all this startups tech healthcare really excited to have you on thanks for coming of course anytime so yeah so maybe we could start before jumping into everything like maybe just give us a little bit of your background and how you got to you working at Oscar yeah of course um I basically studied statistics in history and I think those two combos kind of guided why I got interested in technology so history certainly repeats itself but you're like why do we keep making the same mistakes over and over again and one of the pinnacle foundations of how things change is certainly technology so that's the history part and then when I think about statistics data is one of the most foundational pieces have been foundational sources of information that helps you bring insights to why you're making or why you should make certain types of decisions so I think the two things together has got very much guided my path and when I think about healthcare healthcare is a little bit different to me that's more personal I got interested in it my aunt is mentally disabled and health care has always been really important to like how she has lived her life and I was born and raised in Australia the health care system there is very different from the health care system in India where she is first as the health care system in the US and it's there needs to be radical change in the US healthcare system so something that has always been something important to me that incremental change is not going to do anything for health care if we're gonna really fix things so to me it's like Barnstorm let's do something different and seeing how her life has panned out has dropped really drew me to health care and being able to use some of the skills I have definitely in terms of like data science to hopefully change things yeah it's awesome and one of my favorite sayings is the bigger the problem the bigger the opportunity and so I'd like there's a huge problem maybe you could elaborate you know the u.s. is spending so much more per on GDP per capita on health care that every other countries you know what what's wrong with the system like could do you summarize I don't know if that's too complicated of a question but is there way to pinpoint like why are we so inefficient I mean I think part of it is kind of a political answer so not talking about my employer how my employer sees things but I can talk definitely about how I see things yeah so much in the u.s. is fee-for-service so it's done based on procedure not based on what people's health care outcomes end up looking like so yeah that to me is one of the most screwed up parts of the US healthcare system and the origins are very interesting it came about during after World War Two there were freezes on wages instituted by FDR and in order for I guess in for companies to be competitive they had to offer something to employees that wasn't related to their wages that ended up being health insurance so that was like our origin which is very different from most health insurance in other countries that came from the state yes it was like enterprises wanting to make themselves more attractive to employees and that's what sparked the innovation not exactly exactly and before that there wasn't really health insurance there was more hospitals that offered care so you had you can even see this in the names of big hospital systems Detroit Mercy Mount Sinai these are all religious because it was basically the Catholic Church and a lot of religious institutions that started hospitals so that's very different right from now where we have non profit or not-for-profit or for-profit like hospital Corporation of America HCA hospitals but in other countries of the world it was the government helped drive health care or like universal health care that was not the case in the u.s. so when you think about what could a new health care system look like we would be changing almost a hundred years of how health insurance had looked like the Miss country that is crazy right so you already have all of these inside you already have an industry that it's not in their favor to change the but it's not hasn't been in their favor for like a hundred years so you had BlueCross BlueShield one of the biggest insurance companies in America when ended up happening in like the late eighties nineties etc was that they were one of the only hospitals that was still like truly nonprofit in the sense that they would take anyone they still they covered pre-existing conditions most places as you know that's why we had the Affordable Care Act and all of that most most insurance companies did not blue cross dead so what you ended up happening or what ended up happening was all the sickest people in the US we're like okay I know I can't get covered but I mean by anyone else but I can get covered by Blue Cross and so Blue Cross couldn't shoulder that burden and so they had the board actually voted to make it to not cover pre-existing conditions so all of a sudden you had all these people that I originally had blue cross the floor fell out from underneath for a lot of them yeah so that's a place I'm his historical background on on why things are really screwed up and I can go into near the ACA and Care Act but well what I really wanted to let me mention is is the fee for a procedure and I think that's the root of the issue is the incentives are not aligned in the health care system and so it seems like that is the real change that Oscar is bringing is they're putting consume I think the mission is to make our health care system work for our consumers so aligning the incentives and so it seems like that is a total 180 from how the system works okay I mean everyone says we can fix it by aligning incentives and people have been tried tried to I think Oscar is definitely tried to do that and almost everything we do I can try I can speak to some of the things that my team works on that I think aligns incentives and has made us or have that kind of member experience that has been really core to what Oscar does one I'll start with like one of the most because one of the crazy things about health care which is that no one knows how much anything costs right right yeah you can't like get a quote you cannot whole I've tried to do that and I was like what kind of business is that we were running like you don't know the price for what I'm I've never heard of this I know no other industry is like that you have set prices for the most part but if you if you let's say you do insurance so your insurance company and the doctor you go to or like that facility they have a pre-existing contract that says this is probably how much things are gonna cost this is how much Oscar is gonna cover of it but it means that you're on the hook for everything else you as an individual that your insurance doesn't cover based on that based on my contract so that goes back to the procedural thing the doctor and the facility knows that they're gonna get paid if you do this if you do this if you do this because they have a contract that says with its insurance company that they will cover this that has nothing to do with you know golly is feeling better this time around or he know he's let's say you were there for diabetes your diabetes level dropped from 10.0 a one-seat glucose a1c dropped from 10 which is bad dangerous level to 6 which is pretty good you're not no one in the healthcare system gets rewarded for that if anything the doctor gets rewarded if you keep going back to the doctor and you're almost incentivized for them to keep you sick I like doing more tests on you not to give you the best care exactly like they they don't they actually like make less money if they cure you items are completely around my odds yeah so there's some systems like Kaiser for example where Kaiser has insurance tied in with the hospital system so or with all the doctors there's and then the cost Center is connected with the insurance company and that starts okay this is what they're trying to do right so if if I'm the insurance company I don't want to be paying for you go to the doctor I make more money if you're healthy right so Kaiser their doctors make more money as well and all the people there if you are healthy so the insists they are the incentives are aligned I'm not saying Kaiser is perfect there are still plenty of issues and how Kaiser does things but to me that really goes to what you were saying let's align incentives as much as we can and if your doctors are in line with your insurance company it's a lot better than insurance butting heads with the hospital system awesome and then maybe you could tell us about what your role is Oscar and then that may be a couple examples of those aligning incentives yeah I can do that so I'm on the population health team and broadly speaking population health in any insurance company or any company or really will healthcare company well look at all of the 300,000 members let's say for Oscar and we look at the data that we have on these members demographics etc to say there are some really big cost centers and really big pain points and how certain people are experiencing their health care what can we do given Oscars positionality as a very high touch insurance company to make a change there to make some kind of difference whether that's hey we need to change some features on the mobile desktop tablet app or it might be let's stand up an analog solution for our most chronic members so say we know someone's going to the hospital or let's say they're taking an ambulance 20 times a month because they're obese and that's the only vehicle that can take them there can we partner with say an uber or lyft or some other company that can do it at a farm or at a cheaper cost for that member and for us but we'll still get the job done because ambulances are very expensive so there that's why I'm saying there's technology solutions as well as analog solutions so the goal ultimate goal for our team is to improve outcomes people's healthcare outcomes to reduce cost for the member and for Oscar and to create an experience that makes health care much better or makes their healthcare experience better it's so cool that you're saving Oscar money but you're also saving the patient money that's like Kim yeah and going back to what you're saying earlier 1/5 and that number you know 1/5 of the u.s. GDP is related to healthcare costs that is insane no other country in the world is like that you can even point to England it's around like 11 12 percent that's still way less than the u.s. there are places like Sri not talking Japan and Germany it's about 9 percent 8 percent that's so they essentially have socialized health care there but it's way cheaper so what are some of the things that they do that's very different is that they the state sets the prices so unlike having these backdoor negotiations where a United Healthcare or some insurance company makes an agreement with Mount Sinai or one of the big hospital systems that no one else knows about Wow everyone has everyone knows because the government has says this is the most that the government will let anyone pay or cost for this procedure so well Medicare does that but not everyone's on Medicare right you have to be above a certain age in your 60s to get government insurance to get Medicare so their costs cost is one of the biggest biggest problems so it sounds like transparency is also a huge like the pricing transparency so is that something that Oscar tries to give its members like if you're gonna go for this appointment well you tell me exactly how much it costs yes you have now done that Wow okay pretty cute yes so one of the save it was kind of controversial almost to to roll out this feature because we don't want to make any promises like going back to it we were saying earlier you have no idea how much a procedure or how much it's gonna cost for you to go to the doctor we didn't want to put on the app it's gonna cost you $300 and then surprise actually you got billed $600 for whatever which is like what always happens yeah so we try to be very clear that the cost that we put on there so say you are going to an ob/gyn or you want to go to an ob/gyn so pull up on the app ob/gyn based on your location etc it'll give you a list of OBGYNs to go to and we'll put on there a cost estimate like a range so you can clearly tell like okay there's a difference between obg ran that cost $200 one worse is $500 probably gonna go to the $200 one even if it's 20 minutes further away then the other one we saw we moved away what we originally had was like a yelp dollar sign symbol so you could see like ob/gyn two dollar sign is un four dollar sign but that's not helpful when you reflect it on two different specialties like it's clearly different if you're a $2.00 primary care physician versus a $2 endocrinologist like a very serious national team and like I know like a two-star pasta should cost me like 18 or 20 bucks but I don't know well like a two dollar sign or like you know so we work on like some things like that some other stuff we've done is mail-order so pharmacy it's people the medication adherence is a big problem like people forget to pick up their meds or if they're and the other big thing is that if you're going into CVS there's also a markup because you're going into a pharmacist physical pharmacy so we looked at what our different interesting solutions that hopefully we can do to make people adhere to their medication plan because if you don't take your medication far likelihood that your something's gonna go out of whack and you're gonna end up in an even worse condition than you were in before so we've looked mail-order pharmacy is a big one so if you are let's say have certain types of chronic conditions and you keep going in every 30 days to CVS can we actually put you on a 90 day mail order so instead you'd get it to your home so you don't have to keep remembering to go in yeah I should just come to you it just comes to me wow that's like another thing we also do a lot of research so we talked to members about problems that they're facing which has been really interesting so going back to medication adherence we noticed we're able to tell from our data right if you don't we can see if you go and pick up a prescription from CVS if you don't pick it up we can tell so you're clearly not adhering to your medication but then we want to know why aren't you adhering to your medication are you just forgetting or is it something even more serious is it related to some kind of social determinant is it because you can't leave your home because you're bedridden right it could be something like that or is it too expensive for you and if it's too expensive is there things that we can do and how we price our drugs on our negotiation or what we call the farm like our pharmacy with CVS to make it more affordable for people so we asked these like larger questions and we funnel it funnel it funnel it down hopefully to get to some kind of answer or some kind of solution really helpful and so maybe taking a step back like this whole trend software is eating the world I think Oscar really plays well into this and I've heard a quote or like some sort of line from your CEO when I was watching an interview to research for this that said faxes are more useful than mobile phones in the medical industry today so just with that kind of lens I'm curious if you could describe like what's is Oscar's business approach here like what's the game plan to basically start tackling this huge problem yeah I mean digitizing is a big thing Mario do I don't think talked about this in not interview but the company that prints the most paper in the United States is a medical records retrieval company by far more than any they're so wasteful yeah that's because that's crazy it's crazy right because there's it's papered still I mean than it was before but it's still like an order for any insurance company to receive medical records we have to ask you know retrieval company to get it for us that's thousands and thousands and thousands of paper if we can even move from that from paper to digital or at least more of it that would be so much more helpful and then when you move it to digital you're actually you can use that data that's really another big thing as samples health data doesn't really seemingly follow them around which seems super like archaic that that's not you know there's not one repository for our health data yeah so yeah there's um this is one of the most interesting parts right if you go from Oscar to United at nod to Cigna you start as a blank slate tabula rasa every single time you go to a different place so say you have four major conditions Cigna has no idea so they can't put you on the care plan from the get-go versus if you were able to carry your data with you and you sign up for a Cigna and you give signature health care data so you can go okay great I know that gali has these these these conditions what can we do to make sure we start addressing them from the get-go we know we're able to cover them properly right now you just go to a new insurance company and the insurance companies like alright I know nothing about him let's see what happens this year yeah so what's the why is that so difficult what's the roadblock between not sharing this data like aggregating it is there something Oscars tackling we're like I'm I guess I wouldn't ever want to leave Oscar if I signed up but like I'm guessing you're doing a much better job at digitizing like a cloud of my personal health data yeah there are ways to move your your data but no one really does it and I wish there was a way to let's say like you know Apple I think it's super appealing that you would be able to maybe not just through your Apple watch but through other means have a place that stores your data so that it is easy for you if you do move insurance companies to say hate for the last like four years this is all my healthcare data mm-hmm but we don't have that right now I don't know I think part of it is how siloed every insurance company is they don't really work together right in many ways it's not in their business interest to share data when remember when I was saying like no one knows how much anything costs it is secret how much it costs Oscar to contract with hospital and how much it costs United to contract with Ospital no one really has any idea so the less data sharing I think some certain individuals and some certain institutions have said that's great we should actually share data less because it makes us stickier it makes you less likely to move – yeah no because you're not gonna nose sorry let's say sign up for Oscar want any of them they have all of your information and they have earned that you've shared with them and your experiences on healthcare it makes it if you know it's a lot harder to transfer that to someone else and you have a lot of different conditions why would you move even if it gets a little bit more expensive you know I've spent a year on this they know the doctors I like to go to I can't move because if I had to start from scratch every single time it's really hard it's hard to you know be with doctors that know you then know not just your actual health data but think about like when you go on if you go on a trip you go on a vacation you come back sick a lot of doctors won't even ask you did you go on vacation like it's not it's not it's not there it's not programmed up there so if you go to the same doctor though for the last two years they'll at least have an idea of like who you are and so if you do get sick they ask you different types of questions that doctor you're saying if at first I might not ask you so I think like one of the other big questions is how do we make health care actually about your health not just your healthcare data but you know why are you feeling sleepy this morning have you changed your sleeping patterns did you go on vacation is there something psychological I think there are so many more questions that aren't just reflected in your health data that really impact your health mm-hmm and something really cool that I saw that Oscar is doing is these kind of programs where like I don't know if this is something that is live now but where you can walk and let's say you take more steps you'll actually pay less or these kind of you know incentives to make me healthier and then Oscar is has my back for health so you know I'm reducing the liability and so I'm curious if you could touch on you know is that the future where I'm gonna want to get up every morning and like take a mile walk because I'm gonna save five or ten bucks on my health insurance it's funny we actually got people that like complain they're like oh I'm meeting my steps but every single time you like increase it which do it's like kind of a tiered you know if you're walking more that's great but then if you're always hitting your milestone we're gonna move that mouths down a little bit I think it depends like sometimes I used to because I have you know the eye of Oscar as my insurance I had to do like seven thousand nine thousand steps every day and you've got a dollar for every time you do that so I was doing it every single day and then I got to the pro pros like I'm only getting a dollar does that even matter but it is things like that that actually make people inside it and excited and engaged about their health care like when you look at the way people share their Strava data like I just read about straw that yeah cool it's cool it's like you can win a bike share exactly what you share you share like wait you ran where you went on your bike and people like to see you wear each other's out like MyFitnessPal that was later acquired by Under Armour a lot of that was about let me share my health with other people I think like making it a collaborative experience gamifying your health you know without being too technocratic about it I actually think like that is really fun and people are game of finding their finances people game or find their health people that game I think so many different things if you can bring I think fun as well to how people do their healthcare I think you've got something on there so like game of flying or what how you walk or game I find that Fitness part I think that's something that we're you know we're trying to do so yeah and just the fact that your health insurance company is paying attention seems to me like even though it's a tiny amount of money like they're paying attention they want they're on my side yeah I just think that's such a cool reversal of the industry psychology previous let me let me ask you a question as someone who's like thinking about how getting on health insurance right now Oscar could be or insurance could be two types of things insurance could be very active very involved in your care calling you sending you messages public bla that's one type of insurance company or it could be an insurance company that looks very very much in the background you know they they process things like if you need help you can ask for it but they're not like super active in your care I think that's two different types of insurance companies and some prefer one over the other is number four like I just want to live my life and have my insurance and when I need it I want it I don't really want it to be like super active and like really involved so I'm just I'm personally curious how people feel about how they want insurance to play a role in their life I almost think a hybrid approach it's like what I want where it's like don't bother me but like when something's wrong like I need you there and I need you to be super involved because it's my health yeah that's kind of in the back and like I'm thinking once every six months like I should get a push notification for my phone that's like you should go to the dentist and get your teeth clean once every six months get a check-up I don't even know how often I'm supposed to do that like yeah you know but these are things that are just so simple to like time right now there's no one telling me to go do these things so then I would want my insurance company to reach out to me like hey it's covered it's free here's like five appointments in the next week like just pick one and we'll like super easy coming to you so I think they could take a lot of the stress out of it yeah I like being a little proactive yeah I mean we do that so if we want you to get your annual physical every year yeah and for certain people will even say like there's certain like higher let's say high-risk individuals that we need to get them to a doctor this year we really want them to go to a doctor this year you might throw in a like hey here's a $20 Amazon gift card or $50 Amazon gift card Wow why would you not want to do that and what and one of the reason I'm so excited for this episode is just to give a little backstory like I'm personally trying to get health insurance or like I just got off my parents health insurance and so I'm deciding which new health insurance to get for the first time it's like a really overwhelming process and so confusing I don't know I just feel so over my head and then when I found Oscar I was like even today I was playing around looking at the plans like it's so simple as like a millennial who's used to dealing with like these well design like working software platforms that explain it for me it was just miles ahead of anything else I'd experienced in the industry and so moving into Oscar the company like what gets at me so excited is I I was looking at the last funding round like you're only 7 years old as a company it looks like it's founded in 2012 just reads 375 million out of 3 billion valuation or so from alphabet like under nine months ago and so I'm I'm so so excited about the opportunity here because I think once you get all these young people signed up like they're potentially customers for life and you're you know transforming the way that they can interact with their data the way that you guys aren't how to reduce costs in the system like I think this is building like the exact future that we need for out like this is hyper change in the healthcare space and it's exactly what we need and it's like so overdue and it was probably so so hard to get to this point because of like regulation is kind of what I'm thinking and a lot of other companies have probably tried this but Oscar seems like one of the only one that's really executing so I don't know this is a really question but I guess I'm just kind of curious of like I'm so excited about the pinnacle of this you know I'm just no I wasn't you know like but but it's it's an industry that I don't think like I hadn't thought much about but when I think about investing like one of my mantra is like I want to invest in the future I believe in yeah and like it's honestly very hard to find companies often that are really to their core building something that I'm like the future means this this is good when I look at Oscar it really like fits into that perfectly yeah and so that's what gets me so excited about you know like you're actually building a future that's gonna save the US healthcare system a tonymont ton of money which means taxpayers could save a ton of money which means you know people have faster care it's more affordable it's cheaper it's you know we're digitizing that whole process so I guess I'm just really really excited Oscar health and like I would be investing in at 3 billion if I could personally I guess my that ship has sailed but like I just think it's a it's such a fascinating company to watch and I don't know if you have any comments the long-term like sort of from like your investor brain perspective about about what you think of the company so you know Oscar originally not at this point but he had a very specific focus which was around filling this gap when the Affordable Care Act passed to say hey we're an ACA plan so that means you signed up when the exchange is opened and the exchanges are open you don't like that November to December range and it was for you know people who don't get you know insurance traditionally from an employer it might be someone so when some kind of catastrophic event happens or like let's say you get you become unemployed so you can join at any point for some of those plans that was a very specific niche and so the case had to be made that this was still going to be successful even though it was an employer-based insurance and most people like more than 50% of people that have insurance is from their employer so I think at the beginning it was perhaps a little nebulous you didn't know if Oscar was gonna do well because you still had big players in a lot of places so you met like let's say uncle Orlando there were still insurance companies that were offering Affordable Care Act plants but it became so expensive for whatever reason an Oscar has been able to fight that battle and be an affordable plan we were one of the most affordable plans in Texas so that's why we have so many San Antonio members but what's really interesting about San Antonio is that unlike New York where a lot of people are drawn to Oscar because of technology people joined Oscar because it was the cheapest plan Wow was a lot of people who are Hispanic so we needed to you know make sure that our service our app and our futures could support spanish-speaking population so it's just like very interesting to see like in different states why they chose Oscar and I think that actually dictates like when I think about my team and how we want to actually move the needle on people's care we need to know why they were on Oscar in the first place because someone who's technology forward and cares about the additional experience that's a very different person that's gonna react to some of our pilot programs and interventions versus someone in San Antonio who just signed up because like Oscar that she was playing never heard of Oscar don't care I just need you know my insurance covered yeah yes that's like that's one interesting thing now we're offering or going into the next year we'll be on Medicare so we'll be offering Oscar to people above the age you know 60 plus that's a very another thing that's gonna be very different for Oscar but I'm based on this type of on the political environment the current one not saying what's gonna happen you know after the next presidential election but the fact that we have the Affordable Care Act there is always going to be a need for an Oscar and I'm excited because in spite of the current way that Oscar is built the way that we're thinking about incentives the way that we're thinking about our technology no other insurance company is doing that if you ever looked at the like the website for any of these other insurance companies really this is garbage this is garbage I don't understand like as a millennial in the taxi it's like giving me anxiety you know like man I don't trust these guys Danu why would you right so what I think when we the origin story of Oscar it's like Mario and his wife she became pregnant and then you know they got their hospital bill after everything and he was like I can't read this I have no idea what I'm paying for and I you know went to Harvard and I worked at Bridgewater if I can't understand that truly like if he can't understand that how can anyone else and to be quite honest before I joined Oscar I had no idea what a deductible was I stole you want me I couldn't I grew playing explain like copay coinsurance and deductibles everyone probably needs to know like everyone's been faking that they know everyone does kind of fake it because it seems very scary at the beginning early what is deductible I've never heard that term use other than health care right yeah we what are we deducted what did we do but it's like most plans especially for young people are high deductible so it means that before insurance kicks in you have to pay this amount of money so every time you go to the doctor you were paying the full amount so let's say your deductible is $5,000 you have to pay for that year five thousand dollars throughout your various different various different like encounters with a doctor and after that that's when insurance kicks in so once you cross that five thousand Wow it's like we only have you covered if you spend more than five g's this year whatever are you in certain ways but yeah it's really that but get to that five thousand for families it's like twelve thousand it really really changes so but that's an important thing to know like if you're someone who you know goes to the doctor all the time and you want to you know the insurance to kick in faster maybe you should get a low deductible plan right like you so you only pay $3,000 and then all of a sudden your insurance is coming in and paying for you mmm it's helpful um copay so copay is when you go to the doctor insurance covers some of it and then you are responsible for acting like let's say $30 that's your coping you just pay $30 every time you go but your insurance is covered a lot of it that's fun then coinsurance or things like this is when you are let's New York conducted was done so you got to that 5,000 okay your insurance is actually only gonna cover 70% so you're still on the hook for a lot of it I know right I shouldn't about something welcome to market-based insurance so you know there's an argument I think a valid one to be made about Medicare for all or something like it because potentially that could be cheaper than you know that then the system that we have now which is all kinds of messed up can I ask a crazy moonshot question because one of the things that I don't my brain doesn't wrap around is this concept the million dollar treatments you know this whole concept of like humans are gonna live longer like I feel like the one thing I would pay infinite capital for is time and so that's really what Oscars like core businesses you're selling time then people can add to their lives and I wonder how the system as we technology advances and you get more and more expensive treatments like you know where's the end of like where does insurance play into that if when I'm 90 years old there's a 700 million dollar treatment for to cure my disease and make me live one more year like I don't know this is always something I think of because it's like people will there's the you know the question is do you want that when you're 90 years old do you want to spend X thousands of dollars on a procedure that's gonna keep you alive for another six months versus your old make your quality of life when you're 50 then I think it makes a lot more sense to get a very expensive procedure once you're a lot older I think that you you know you should think about your other life options out there it's actually interesting most of people's in health care costs ever will be in that last few years of their life right because this is your body's deteriorating how all I never throwing everything at it you can't exactly exactly and there's beautiful book Atul Gawande z– book being mortal where he asked these questions about mortality he asks you when you're older how do you how do you think the people actually feel do they want to be do do they want to spend their years or months in a hospital and a very anesthetized cold environment or do they want to be at home surrounded by their family where the focus is not how do I extend my life but how do I decrease my pain so I make it as painless as possible live the rest of my life surrounded by my loved ones and it's I mean not that the cost thing is as important when you're asking questions about mortality but it is technically cheaper to go through like hospice care than it is to be at a hospital but it's a beautiful book so I definitely recommend it to people because he was a doctor so he is thoughts for always how can I make sure that this person is gonna live longer yeah and I guess that that the burden I'm trying to get to is this deep moral question of like what is the bathe baseline health care so like we you know technologies answers this certain level what it seems like there's some standard we have to cut off of like every person is entitled to healthcare up to this point because after that it just gets too expensive and then like all taxpayers are paying for that yeah you know so things I think there's weird skewed incentives at the end in all sorts of ways when you think about this industry that are so so unique and that's why I think like biotech in general it's like an investing category is really interesting because you know people will spend years and years on these treatments that people will pay millions of dollars for just because they don't have anything else yeah I like like the demand elasticity is insane you know oh yeah I'm glad you brought a biotech because I'm so excited about the future of like just longevity and in general and I think there's so many ways that biotech can help in the immediacy not even thinking about like you know when we are a hundred what can happen how things might change think about how expensive it is to get an intravenous procedure or to go into basically and you know you have to go in plug you know they have to put a needle in you you have to be in the hospital for 3-4 hours how many people can do that how many people can take three to four hours out of there like work day and just go and get you know certain drugs running through their body that's expensive and that's also like a lot of like capital loss on the system like if you're just having be leaving work to go get procedures done so there's a good there's an interesting company called Ronnie therapeutics that's what they're trying to do is take common intravenous procedures and make it a pill whoa right even possible there there are some that they're working on that I think like it will get close to being possible but you have to think about like sure drugs metabolize very differently in your system but like that to me is amazing are there ways that we could bring thing procedures or things that are locked up by the hospital to the masses in a way that's more affordable so I think this like intravenous to drug is one thing another thing is um this is pregnancy so it's very very expensive to get you know to have a birth and then c-sections are a way that make that are even more costly like a doctor might say or there are also a hospitals and are incentivized for someone to have a c-section because that makes it you cuz the natural birth exactly sure for fear exactly exactly and a natural birth is like you know eight eight hours plus if you see someone going through a three hour pregnancy who's never been pregnant before and she's just like get it get it get it out of me because I heard so much you know you you know a doctor or the hospital wants kind of wants you to get your baby out because then they can rotate more people in so there's more babies coming out more money to be made but a natural birth does take eight to nine hours so that whole process is really expensive so now they're these alternative options called freestanding birthing centers that have midwives and the original if the original women when you're back in your villages etc that helps you give birth or do natural births that way so they're I think there are really interesting alternative ways to make care more affordable there's they like the what they call them healthcare anarchists it's kind of like this self given yeah there's a bunch of like you know fringe movements to make health care more expensive and more affordable sorry one of them is like the these $30 EpiPen kits so usually and you know unfortunately died you know getting insulin it's like $700 a month a lot of people can't afford that that's insane and that's it you have insurance as well so I know it's really expensive so then these people were working on how can we just create a kit in your home or that you can assemble – that's $30 the that's what these guys are working on it's amazing um then there's an initiative counter culture lab out in Berkeley to create open-source insulin so like stuff that you could make with a 3d printer or like in your kitchen because technically insulin is generic it's not owned by anyone mm-hmm so it's crazy it's something off patent yeah that's generic is costing so much money yep that's insane because I think think about it if I know that you know yours your generic or your insulin costs you that you're creating is $500 so I know there's willingness to pay that's five at $500 so if I want to create a competitor why would I also just why wouldn't I be like 499 dollars because I know you know I don't know how much people would change from one to the other but you know that people are willing to pay those high prices and you see this in the way that drugs that you think you see this all the time and it's really unfortunate but there's you know this plays out a lot with generics so say my patent is about to expire I you know created a drug a while ago and the generic company says hey we're gonna build that you know we're gonna create this in our factories you can pay them to not create the generic like you just sign it Wow you just sign a contract you're like I will pay you 60 million dollars a year to not create the drug you're a generic you're like 60 million that's a lot more okay you want to give us 60 million dollars a year and maybe that will continue in perpetuity Wow and you're not making anything great though it's not a little Wow yeah that's crazy yeah I mean I feel like we gotta switch gears to because I want to get there's so much I want to cover but this is it makes me optimistic about capitalism honestly that we Oscar exists and that we have super smart people like you and everyone working at Oscar tackling systems because that's one of the the real issues is like the distribution of intelligence tackling these hard problems that and so the fact that Oscar is enabling that and like incentivizing them with equity I hope or whatever like that gets me the capitalism is working hopefully you know like but anyway so the other big thing that you do I guess is a blog sort of interview series called negotiating the terms where you interview different women in the VC industry yep so I'm really curious you know how did you start that and like what was the idea behind launching that so I started me and start from why I wanted to do it I guess when I started getting interested in venture you know there were resources but they were very distributed I couldn't find one place that had here are other than Harry Stubbings amazing interviews which you know pot and podcasts are awesome I was like where can I go to find you know people that will take me and people who are jr. talking about their experiences in VC how they broke in etc I think Harry's podcast has been an amazing resource but he interviews partners he interviews CEOs that is a very specific type of individual versus who are other young people who are in this industry who I can relate to and my experiences are it's more like I'm two or three years behind them that's who I really wanted to see those perspectives and I wasn't getting that through some of the other resources that I found and I've always been the kind of person where if I don't if I don't see it there's clearly other people are probably also looking for it so let me just create it myself like scratch your own itch exactly exactly so I just decided this is the idea that I have I bought the domain there was nothing on there negotiating the terms Joe calm yeah if you if you type it in my name will pop up is the like suggested thing right after it looks pretty cool so I just went out and I asked people hey this is this is why I think people want to hear the perspectives of other young women in VC it's that there are so many of us that are thinking about this now yeah would you be interested in doing this and it was a bunch of like seven to eight women who said yes I don't care that you have nothing up there yet I believe in this idea and I this was also around the time that holler A's was getting started which was the female funders female founders focused organization that kind of what is that all arrays have I heard of it they're like a they're basically a big group for all women in venture and they're supposed to be um you know they also addressed the funding gap for women entrepreneurs so a big organization nonprofit that got started around the same time I was working on this website so it was really great to get support from individuals that were part of all raised as well to be like do this this is awesome yeah it was really just people who believed in it and said yeah I'll do it for you I'll do let's do an interview and then I did eight of them then went live and I've been posting ever will almost one every week ever since so I started August of 2018 and now it's a you know April and I've posted 54 interviews wow that's crazy yeah and what what have you you know across all those interviews is there anything that surprised you from you know learning as much about the VC industry I mean I think there are I think things get less and less surprising the morning you talked of you okay I heard that from this person I heard that for that bridge yeah but I think that I went into it thinking very much romanticizing venture and then I realized like everybody our age I feel like that's a problem everyone's like oh I'm gonna get an adventure yeah yeah I realized that's very very much not how I feel happens I feel like that's gonna be last cool like because everyone who works at Buber is like great now I have millions of dollars I'm gonna start my own fund like that's that's definitely gonna happen I was thinking when uber crashes they'll be the whole like well it depends on they're like locking right like you there how long you have to hold your share for mm-hmm we'll see you really know much more about this no I'm just I'm just watching the optics and I'm like any time I see an IPO and they're like a hundred and twenty billion then the New York Times like well thinking we're gonna do a hundred billion and then now it's coming out 90 billion and then I think actually just today like looking like 80 to 90 and I'm like man that is that not you're not IPO you we want IPO for a position of strength yep you know this is not writing down your value forty percent before officially pricing is not the last IPO reminds me I was blue apron to be honest but like when I was like reading all these articles like oh they're cutting the size like yeah I mean we can talk about the IPO as well multiple IPO things as a one of the things you know I do randomly is just read a swatch you're a great person to fall on Twitter because I read your s1 hot takes my hot takes I try to make there's so many like here's the thing I read the s-1 this is the revenue this is the ball I'm like no one cares about that I want your actual opinion on you read the s-1 you notice some weird thing in it talk about that that's what excited about like people who do analysis is now analyses the best ones I mean as phones are like the coolest thing as a finance or an investment or like the s-1 for the people who are watching it's like this the the filing of companies make before they go public 300 pages outlining their entire business model yeah so if you're a nerd investing nerd like you are an or mean you're like what's the business model like whether you need economics of uber yeah it's like the veil just got lifted yeah and you can get as deep as you want and so I just think people don't realize how exciting that is of like you're literally getting a look under the hood at the world's most exciting disruptive companies the slack one went live today like go click yeah it's a race to see you can read a fast yeah I'm so excited it's awesome and you can see how this company the companies actually think of themselves yeah like the yeah sorry I just gonna say the mission like that overview part is so informative like worth it you know lift consumers owning cars transportation of the service society's changing we're gonna reinvent the way cities work and you're like wow that's a vision yes yes that's a great thing it's like you see the vision of these companies we were talking about slack I think a lot of people think of slack because as communications tool but slack is envisioning itself as like the connective tissue between all the things that an enterprise needs Wow right like so you read the slack that's why I read some of the slack that's one I think it's like I take I think I need to take a few days before I like can really process those ones cuz like he's got three under pages something like that it's a lot of information baked in there and I think it takes a while for you to like actually analyze it so what I posted today it was very much just hey I took a quick look this is some stuff that stuck out to me but yeah like thinking of yourself as a communication error not just communicated about your really this connective tissue for every cloud-based SAS tool that an enterprise uses and they get slack included in there that partnerships chart right the partnership wrote was super interesting because the average I think they were saying they were looking at enterprises the average utter pliers will use like more than a thousand saspa tools yeah crazy right like there just so many you end up using right if you're a big company right if you're like a IBM our next entry or whatever you're using thousands because your business is that big and like per country you're probably using a bunch of different SAS tools so when you think about slacks means of integrating all of those into its platform that makes slack so much more sticky as a product so it's not just hey dude what's up oh I worked on this today Beauvoir which is the derivative slack what's what's an example of those integrations because I'm not thinking of one like Salesforce where's is one Twilio is another there are plenty of things that you can put into the Google is another integration that they have Atlassian that they have a partnership with so they now take over try and make it made a HIPAA compliant there if you hit hip shot as well so they have a partnership with Atlassian out because they basically bun sunsetted hip shop yeah okay yeah but their I mean their partnerships are increasing over time but I think it's so smart if you want to call your CRM like right Salesforce a prime example how can I just pull that up immediately I want to know cut in the customer information right like plug it right in and they have over 500,000 developers that are creating slack apps third-party apps so that to me is another thing if you're able to get other developers to buy into your tool and want to use it and create for it that's awesome I think I remember I know we talked about eighteen thousand documents daily are downloaded so share it amongst each other and downloaded through slack there are also over a thousand applications third-party apps that are downloaded every day on slack and integrated which goes to show that those apps are really being used it's not just developers creating something that goes in the ether they're clearly helpful in many different ways whether that's like you know one of the ones that me and my friends have used is like if a little gift like if the integrations or I'm having you know the emojis I've customized because yeah exactly that's awesome things from that to far more sophisticated integrations I think yeah if I could have invested in slack I would have done it for sure and what do you think about the that I don't know if you're you get too into this but like the valuation of slack like 8 billion let's say I appeal at 8 billion they're doing like 400 million in revenue yep growing 77% losing a hundred million in operating income or whatever yep like how do you when you're when you're talking up to value one of these companies how do you think about that I'm thinking about customer acquisition and my 10 value I think about how are you a are you doing a good enough job of getting those customers varied by cohort and keeping those customers I want you to show me that it's not just the big enterprise customers right so like I don't know Google that has over X hundred thousand employees yes it's great if you get you know those enterprises to sign up can you keep those enterprises then SMBs people who have between 10,000 to 50,000 employees are you able to keep them if you're a business that can prove to me that various price points you're able to acquire and keep those customers and maybe your sales and marketing I hope you know if you can keep it as low as possible so you're really product lead growth that you're virality the ability of your product to be the best on the market that's what gets people to sign up that's really appealing to me especially yes like Tesla's another perfect example of this I've never used a Tesla before most people haven't but you look at the product you see its vision it look having the climate change of vision being one of the biggest ones out there it makes Tesla's such an appealing product I think one of the same things is there with lack it's such a cool product and the cool thing about like SAS based products is that you can share it very easily with other people and they use it and once you use slack for the first time you're like this is cool and they're a bunch of products I think that are like this calendly is another one if you want people to you know sign up for calendars oh yeah it sends you you get that for the first time and you're like I've never added time on someone's calendar like this but this makes so much sense product lead growth is really cool and I think slack is doing it very well so and it's you're almost like really honing in on these leading indicators you know that first customer are they still spending money and then that's kind of how you're looking at you know the overall aggregate financials are kind of like lagging indicators are really how the business is doing in your kind of that's how I think I think if your product is at the forefront and you're answering customer pain points then and you're acquiring and keeping those customers that matters to me I can exhume is this not a moonshot Monday it's not like a match made in heaven yeah I mean I know that zoom has a bunch of other features other than video that maybe are slack adjacent but honestly that would be beautiful like I don't want if I have slack and zoom great but if I had slack with soon right game-changer and so switching gears a little bit but back to Tesla because that one thing they're working on is an insurance product and so you're kind of in the insurance space and their unique angle is that they have so much data on the individual driver and their driving habits and they can like what Oscars doing incentivize you to drive safer you actually decrease your rates and so it's they're almost like now insurance is a two-way street yeah that's what I see Oscar doing that's what I see Tesla doing with driving and so I'm curious like do you think about you know this Tesla insurance product just at face value like does that excite you because to me it seems like the same kind of innovation that Oscar is bringing to this that's super smart when I was talking about Kaiser earlier when you have your insurance company and your your health system being one in the same there is nothing more aligned incentive alignment than that so to me having tells to do that that is awesome and it makes so much sense I'm surprised honestly that other car companies have never done that I don't know if they have but you have you know coasts are not the astrology app but there's like co-star that's built into cars that helps you do your nav like a satin and they're tracking you or like if you get in a car crash you can call you know click co-star call for help I'm sure that that that using that already to create an insurance product makes sense but of course dozens gonna be one of the first to do that because they aren't actually thinking about these questions they're thinking about how to move forward whereas most car companies are like we have a car and the car does the thing that the car is supposed to do here's another car that's a different color those to me are very uninteresting pedestrian changes like I think one of the things I think about a lot in technology healthcare I can go back to health care with this there are very few companies that are so innovative and different that they actually move the needle on people's care I think there's a lot of these like d2c brands right there like here we make it easy as possible for you to get this drug or that drug that to me is is you know interesting but how are you actually changing healthcare for people I think that's really hard to find when you find those companies that just gets me so excited and so Oscar is one of them you think yeah for sure definitely and it's such an interesting because what Oscar is doing t align the incentives they want to make you healthier yeah and with this Tesla insurance like they want to make you safer yeah their incentives are aligned to make you safer and that's why one of my favorite things about Tesla's like safest cars on the road even without the self-driving software yeah the number one reason people buy a car you want to be safe yeah like so I just think that's actually last Tesla then we'll leave it and you know that's that's live I'm just curious what's your opinion on Tesla I mean everyone watching is probably you know Tesla shareholders you on fans some curious like what do you think of the Elon Empire and Tesla well I mean Elon Grimes truly the couple of the century right I think they broke up but they no followed her back on Twitter I'm holding out hope I thought they broke I know they got back together because they both had those anime emojis did they change I mean a dual switch to anime emoji profile pics is a pretty strong sign I feel like that's like handing a ring to someone you're like basically the same thing um I mean do we want honest I don't know all too much about Tesla I'm not a test like I I would say I'm a fan I'm not Stan like thank you but that's mostly because I don't know that all that much about it but to me there is no question in my mind that Elon Empire particularly Tesla has done more to impact climate change than almost any other Enterprise like private enterprise and that takes guts that takes balls to be like I'm gonna do something that no one else has done and go all in all in on you know only non Tesla and that that vision comes around no there is one in a million to get an entrepreneur like that so regardless of like all the little weird things that Elon does because he's truly only human and I actually admire a lot of his weirdness because I think people should be more weird and care a lot less about building the walls and having certain personas just like be yourself and be weird and awesome right accessible that that plus like his so this genius that he has plus his vision and his ability to like yeah things don't go perfectly all the time for Tesla but he's still executed so well and it takes you know you have to execute consistently he's done that so that's kind of my perspective on Tesla it's awesome and segue that into what if there's any company in the world you could invest in today like you could easily get on the cap table and invest at the fair you know last round or whatever what would it be and why could be a startup it could be not a startup it could be anything could be a crypto asset I I mean yeah I definitely invest putting on the spot here told you at a time but any company you know like even if the cap tail was impossible to get on like I'm thinking I would probably you coinbase or Oscar honestly is up there if I'm getting in at three bill I don't look at the financial side of your bro I mean if there's another round even getting a secondary now is still like ideal um who probably like SpaceX honestly doesn't matter now just buy shares um like or maybe like a cool n equal startups on your radar Center you're into the startup scene yeah um I think there's a lot of augmented reality I'm in a lot of virtual reality company is that I'd want to invest in also VR is one that does I'm going to be a rented reality for healthcare I think it's super interesting um because I think there's so much more you could do with augmented reality then then just healthcare right like there's certain high-pressure situations where you can't really practice yes for certain parts of healthcare when you're going being a doctor when you're going through training you're doing your residency etc you try on dead bodies or you get to you know practice by being in surgery with a leading position but what about military how do you practice being in the military in actual high-intensity scenarios you can do that in augmented reality or if you are a police officer you know we talk you know there's police shootings happen there's but you know did black men get shot is there ways that you can train beforehand so your gut reaction isn't just shoot or your gut reason isn't just like you know if there is there ways that we can use technology to make things safer and I think are indeed reality is certainly one of them there are lots of players right now so it's kind of hard to tell but also things one of the coolest ones because it's working in healthcare which is of course my area of interest and like I kind of want to push back on this because one thing I always hear is like oh the gut like we're practicing guns and shooting and that's a great use case for VR I'm like and it's not a big exciting market and AI think robots are gonna be on the battlefields and like robots are gonna be policing soon anyway so he doesn't get me excited about like this is a huge change in like the way Humanity works but I think a lot of people hype up a are VR you know this convergence of you know even more of a digital layer overlaying on our lives but there's so much like I think that's such a vague thing of how do you know which company puts out what product that actually moves the needle on how digitized our lives are with augmented reality or VR yeah I mean I think that there was certainly like honestly if Google glass have been done better think about how interesting and cool that would have been like something so seamless I can just wear glasses that says walking down the street ping three blocks away my friend ghali is over there wouldn't that be cool like instead of on your phone something where you can actually see more about your how to you know increase your engagement with the world through your vision I think that that's really exciting other than like putting on a phone on my face and like you know being in a virtual world I think that I think that you can definitely do it and whether that means like you know through Google glass or that means hey we're gonna have you know like black mirror style we're gonna be able to have them on our island you know on our actual irises which would be way cooler I think it's gonna happen whether it happens in the next 50 years or whatever did I think minded realities is already a thing and advertising like have you seen like how or Vocaloids the avatars that are becoming super popular well Mikayla like Brad yeah video and then there yeah low Michaela she's like dropping a mixtape obviously and she's starting to launch her own podcast she's competing with hyper change before you know yeah yeah so there's there's avatars there like the Vocaloids they're like Coachella who they always bring out these uh what are they called June I'm talking about Holograms like imagine going through an entire holographic god-like conference or in concert or when marshmallow went on fortnight like these are really cool different might well like the DJ he he basically did a concert on for tonight so he actually DJed four thousand you know however many tens of thousands hundreds of thousands of fortinet users I think there are ways we're gonna live out our lives in the digital world and I think the the in all the entree into the digital world will happen through augmented reality I don't think people are willing to go all-in yet into virtual reality so that's why I'm excited about a are I don't know you know it's kind of hard to say what is going to be the company that does that but we're so where we are in or with generation now like Gen Z who lives their entire life online right everything's online so they're super willing to engage with this world whereas previous generations I think a little more hesitant mmm-hmm and a good rule of thumb I always think of is like I'm actually stealing this from Elon Musk but his terminal is limbic resonance it's like the kind of rule of how these social networks and sort of this social interaction with technology gets pushed like you want to be able to have as much data transmitted from your brain onto the internet or this digital network as fast as possible that need a flow and so that's what you said reducing the latency essentially yeah and what you said about Google glass to me is so fascinating because you think about all the things I could do with my eye like take a picture of that send it to Nikita like instead about taking out my phone and you know like it's so much it's pushing on that limbic resonance and like that's why I give snap a lot of props for trying their spectacles product because I'm like okay you know Apple apparently wants to go into glasses they're they acquired like this Israeli holographic sort of like Google glass company they you know they everyone's saying that that could be their next form factor and snaps already putting theirs out so I think glasses is you know just to hone in on like product of how I think this really gets in the mainstream is like one area I'm looking at and Siri or not sorry the air pods I think are really interesting of the more functionality that that kind of brings as a wearable tech like a wearable device yeah no definitely I think everybody to are honestly so exciting I don't know if they're going to be as game-changing as some people have said like added really adding a new social layer or anything like that but I think it's very similar almost to the glasses but in a very different way ike imagine being able to just hey i want us to send a quick note to golly i just want to be like i'm walking on the street hey scent in a way that's very different than you know sending a text on your phone i think it's just different you know it's so it's it's funny i feel like sometimes i'm living in two different worlds I see people tweet things like haven't had a phone call in the last like three years and I love phone calls and I think that there are so many other types of Millennials that prefer to make phone calls and that's why the air pods are so interesting and so exciting for them whereas this is there's an entire feels like half of other people that almost want to retract and only engage in the photo world the Instagram world or you know the the text world in a way that's not that same kind of auditory experience last thing if I could pick your brain on the lift IPOs what do you think about that cuz I'm biased I think the Anthony level and outski or something that way no guy just came out and said lidar is not needed which is a validation of Elon Musk and so the way I'm biased but I'm like wow Tesla solved the autonomy thing uber and lyft now that we looked at their ass ones are losing so much money like yeah I I just think this is like a slow-motion train wreck for uber and lyft I don't know and I'm curious you know what's your what's your take on these companies do they have a chance you see the vision I mean they have a chance but they have a chance if the unit economics make sense I think right now they're still living in this world where if we're able to be the cheapest on the market then people use us because it's cheaper than and a better experience let's say then taking public transit or whatever my other options are but it gets to a point where they have to increase prices to be profitable and you only have that profitability if you make everything autonomous or at least you're moving towards that and you increase prices at the same time and I don't know how satisfied people are gonna be when it costs as much to take an uber as it does to take a taxi I mean even in New York taxi an uber yes they're selling a dollar for seventy cents so it's like of course people are pumped you know taking market share like exactly but how sustainable is that over time sorry how sustainable is something like that over time we'll see and I think one of the biggest things like uber didn't do and I highlighted in my tweets they never talked about their cohorts because there are people that sign up for uber right and like taking a bus I never take it again but there are people who take it all the time and they unlike well I suppose lyft didn't exactly do this either but at least they shared a bit of their cohort data they were able to say there are very high-value users that based on some research that other funds have done that are net profitable so the amount of money that takes acquired them is lower than the amount of money that they give back to lift but that's only like the highest category everyone else is a money loser but because this the amount of money that these super users make or generate is so much higher it said that they had a very low customer acquisition cost versus how much that how much money generated per new user and per sustained user over time because it was so much higher than everyone else that was losing money that to me is like crazy that it wasn't more transparent than that I have no idea what the case is for uber because uber actually has a decent number of competitors in different countries and when you think about like what lifts future looks like and even uber you have to dominate the entire globe if you want this to work and work well or at least you know do as much as you can for that to work but uber has already given up in certain giant China basically yeah it's India is like Ola is a popular one didi in China grab in Southeast Asia that's almost half of the world's population right there Europe there's a you know Europe doesn't need Eber as much as because they have great public transit and everything isn't quite walkable so what do you have left you have a lot of the US and maybe Africa and I don't really know the case in South America but I think that I'm less excited by uber than other people have been because I think there's far more things that are constraining them than enabling them yeah interesting and I know you probably follow a ton of amazing blogs and podcasts that are then this hyper change startup world so I wanted to get some recommendations on that and I'm sure all the hyper trainers would love like to hear those as well so you mentioned a couple of them Harry stubbing Harry stabbings he does 20 min of ECE oh that's the 20 minutes yeah yeah okay he's pretty good let's see in terms of blogs I think everyone recommends Ben Thompson of course like strata cherry yeah yeah I don't know I almost don't need to recommend him there's a really interesting one called penny fractions that you probably never heard out but it's this guy who talks about music and the streaming industry and he has really interesting takes on Spotify Apple music any changes that happen in terms not so it's not just okay added new artists it's really looking at the economics of the music and music streaming industry so that one's a really good one there's some other good ones movement that's one on public transit and mobility let's just like an interesting one that I like to read lene Lux is probably the I guess the last one I'll recommend it's all things modern luxury so when you think about your Casper war Bea's way exactly the tech Millennials everything in there lean luxe and lean luxe community so Paul Mumford runs it and there's hundreds of people in the slack group but they're they really bring all things consumer to that newsletter and then because there's a really active slack channel you're also seeing what's going on in the actual community that's building so you have investors like hunter walk etc in there you have actual creators like the founder and Roman or something like that they'll be in there you'll have operators product managers people just talking about all things consumer so I find that to be very interesting but one of the things I really try and practice is getting diverse perspectives or interesting thought on almost every single vertical that I can so I subscribe to like inside AI because I want to know what's happening in the AI world I subscribed to this music newsletter not because I really know that much about music but because it's interesting to hear why Spotify is mad at Apple the day and run see he runs this one on hip hop and capitalism like that super interesting so trap it all trap it already yeah so whatever you can do to find these like gold nuggets I try to cuz yes Ben Thompson is great but everyone else is reading them so how are you thinking any differently than what Ben is saying that's a big thing that's a big problem that I have in general and this in the startup and BC world we all read each other's content but there's a difference between bringing someone else's argument to the table and synthesizing it with your own to have your own own opinion and own independent thought I don't and I think because part part of it is people aren't rewarded for having independent thought it's riskier and there's no you when you have 90,000 followers or you know a lot of these people do you feel scared to put something new out there because maybe it's not gonna be received very well so something that I've tried to think about and how I do all things tech is just like to be as true to myself and how I you know tweet things there also aren't that many and then not to say that I have that many followers on Twitter or anything but there aren't that many like female figures in tech Twitter there really aren't there are handful yeah like Ravi and Devin there's like the biggest ones but they're kind of if you're a woman and intact and you have true opinions on things you're kind of a controversial figure and I think you have to decide like are you willing to be that controversial figure because maybe we're not gonna be liked by everyone else so I think that's something I try to do I'm like you don't like what I have to say I don't care this is my opinion on things and I put it out there and I hope that people engage with it I hope that I meet new people that way and it's definitely for me it's definitely it feels like I've done that that's like that's a great place to end everyone should follow Nikita on Twitter a thousand make it like saying oh it's my last name cigarette E&M so my initial name first I'll put on this yeah that's cool they can check it out yeah do you have any last you know comments moonshot predictions for the hyper changers or anything like that like read as much science fiction as possible I think like that's been to me one of the thing that's like opened up my brain and how I think about what could be the future of technology like if you've never read Gibson's Neuromancer this idea of literally living in the cyber space it's like being able to plug your body into a computer like living in the wires and living in what a dick a disk is like that is so interesting and know obviously like right now you can't build that but I think like even paying attention or imagining a vision like that gives you hope and optimism for what technology can do so if you read Snow Crash even if these sound like yes some of them are a little bit dystopian they're so fascinating to think about there's a really famous book called folding Beijing that's about like you know China in the future where the world folds up on itself so you have multiple societies and classes living in Beijing for certain periods of the day and it's just like yeah literally like Beijing will fold upon itself and then the other class gets to live for X number of hours and then it folds up again another class of people get to live well and it's just like these people who are just science fiction writers are more innovative than like 90% of them like 90% of population so to do whatever you can read more sci-fi and the whole concept of like invest in the future you believe in the future is sort of this open book that's whatever we want it to be yeah like I feel like for young people to when there's so much possibilities with software with us going to space reusable rockets AI like all of these sci-fi II things are becoming you know around the corner of like feasibility yep and so it's I think it's like that's a great starting point for the imagination of like what business is is technical actually enabled enabling us to create yes I think we're already cyborgs like we're yeah every time you like pick up a phone you're a cyborg yeah but you just have like what I was saying the limbic resonance your latency is super low the data flow is super tiny like Elon Musk its I'm calming him but his analogies incredible is like a straw yep you know and the second we can unlock that data like magnitudes more yes you know tens hundreds of thousands of times more you know people get scared about technology and they're like oh everyone's on their phone everyone's on Twitter and it's like this is so this is just if you think this is bad I'm pumped that I'm spending like 30 percent of my life not looking at a screen maybe but I think that is decreasing like the average top you know every year it's probably decreasing by a meaningful percentage so I don't know crazy to think about yeah but anyway I had so much fun scheme on technology thank you so much for taking the time and yeah good luck with everything I wrote everyone's gonna follow you on twitter yeah everyone should follow you up all right peace out thanks for tuning in

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Methew Wade

29 thoughts on “How Oscar Is HyperChanging Healthcare w/ Nikita Singareddy”


    2:10 What's the Problem w/ US Healthcare?/History of US Healthcare
    5:54 Aligning Incentives in Healthcare
    23:40 Business Model + Vision of Oscar
    40:20 Negotiating The Terms
    44:29 IPOs & S-1 filings
    45:55 Slack S-1 Analysis
    51:41 Tesla Insurance Product
    54:52 Thoughts on Elon's Empire?
    57:13 Augmented Reality + The Future of the Internet
    1:01:28 Wearable Technology
    1:03:40 Uber/Lyft IPOs + Robotaxi's
    1:07:22 Podcast + Blog recommendations
    1:12:00 Why You Should Read Sci-Fi

    Follow Nikita on Twitter! https://twitter.com/singareddynm

    🎙️ All these longer HyperChat episodes (and more) are available on your favorite podcasting platforms as well: https://anchor.fm/hyperchange

  2. Nikita is an extremely intelligent person. It's instantly noticeable in the way she talks. And such a calm and likeable demeanor. Great interview Gali.

  3. Hopefully Tesla insurance succeeds amazingly and screws up those other car insurance guys that keep taking our money and not innovating. I also want to try metro mile. That looks interesting also.

  4. Here is the "Introduction" that appears in a book that I am preparing to publish. Anyone interested in purchasing the book can communicate with me via my website: www.stressmechanism.com


    “Not only will men of science have to grapple with the sciences that deal with man, but—and this is a far more difficult matter—they will have to persuade the world to listen to what they have discovered. If they cannot succeed in this difficult enterprise, man will destroy himself by his halfway cleverness.”—Bertrand Russell

    The purpose of this book is to introduce the discovery of the mammalian stress mechanism (MSM) to the lay public in hopes of accelerating its acceptance and inspiring medical reform despite the opposition of politically potent private corporations that profit at the price of public health.

    In the words of Stanley Kubrick, something wonderful has happened. The long-sought “mammalian stress mechanism” (MSM) predicted by Hans Selye has been discovered and described. This was the objective of intense international medical research for some 30 years, but was abandoned more than 40 years ago for lack of success. However, powerful scientific theories typically appear long before evidence becomes available to confirm them. That is what has happened. Fresh information from unrelated research has belatedly enabled the first crude description of the MSM. It enables Selye’s revolutionary “unified theory of medicine.”

    The implications are staggering. The MSM is the missing cog in the machinery of mammalian life. It enables embryological development, regulates blood flow that delivers oxygen and nutrients to cells, maintains and repairs tissues, and otherwise sustains the internal environment that optimizes cell survival and function.

    It can now be understood that all disease is the same, because all disease represents MSM hyperactivity induced by environmental stress. What appears to be distinctly different diseases is actually the characteristic ways the mechanism becomes hyperactivated by combinations of tissue disruption and nervous activity.

    MSM hyperactivity is inherently harmful. It wastes the body’s energy, damages tissues, disrupts blood flow that delivers oxygen and nutrients to cells, and derails the body’s ability to repair itself. The greater the degree and duration of disease, the greater the risk of damage, dysfunction, and death. Therefore, the primary objective of medical treatment should be restoration of optimal (normal) MSM function. It means that physicians can employ powerful treatments using presently available machines, monitors, and medications that quickly, efficiently, safely, and comfortably control and cure all forms of disease, including cancer, communicable diseases, epidemics, critical illnesses, and rheumatoid disease. It will optimize surgical outcome and recovery, and enable surgical repairs that are presently impossible. It will enhance medical efficiency and alleviate the cost of health care. It means that medicine is now poised at the threshold of the most dramatic advance in its venerable history. Most modern physicians will be startled by these ideas, as I was.

    Stress theory is now poised to resume its rightful role as the prevailing paradigm of medical and biological research, restore research productivity, guide efficient and effective pharmaceutical development, and introduce an era of health, longevity, prosperity, and freedom from the eternal scourge of disease, disability, and premature death. In addition, it confers a unified theory of biology with implications that presently reside in the realm of science fiction. Before these blessings can be realized, the newly discovered mechanism must gain the recognition needed to enable its testing, confirmation, acceptance, and application. Given present circumstances, this might not happen for years to come. How many fatalities must occur at a dangerous intersection before government erects a stop sign? How many must unnecessarily suffer and die? Must the blessings of stress theory await the arrival of our great, great grandchildren? Why not us? Why not now? The answer lies with the hands of the power, politics and privilege that dominates all forms of human activity.

    This book will explain why stress theory was abandoned after it dominated medical research for 30 years, and how the subsequent accumulation of relevant information from unrelated research belatedly enabled the MSM discovery. It will strive to explain MSM operation and its implications in a way that can be comprehended by intelligent laymen. This won’t be easy, for the MSM is complex, confusing, counterintuitive, and at odds with entrenched beliefs. To assist with the task, I have prepared a website where MSM functions can be explored, www.stressmechanism.com. It provides links to copies of published papers and YouTube slide shows, each of which lasts about 15 minutes. A fully detailed and referenced book entitled “Recent Advances in the Stress Theory of Hans Selye” will be published simultaneously.

  5. As soon as she said Medicare for All could be cheaper, I tuned out. There are no incentives based on a transparent price system for efficiency and therefore the only viable approach is rationing.

  6. The health care system like the post office and dmv needs competition and open pricing. Just like restaurants and services through rating services and star ratings. But the insurance companies have destroyed this. And big pharma is with big insurance. We know the big government cannot fix it. We need to all have catastrophic care for cancer or major surgeries a and health savings account for the rest. This will create open competition and drive down prices and help eliminate insurance companies. Check out medishare.

  7. gali i don't like you taking the notes while interviewing people, coz they will get distracted and also they might not be able to explain everything in detail. I would appreciate if you could takes the notes after —-apart from that you are fantastic and i keep following you

  8. Gali, this was a very educational Interview. One of your best ones. Nikita is very smart young woman, she has broad and deep scope of knowledge in multiple disciplines. She is one to watch, maybe a future ceo or a social/political leader.

  9. I have been saying this a long time, healthcare is a simple fix. Drop the tax break that pushes health insurance on employers and forces them to cover any private behavior that doesn't cause a person to get fired. Private insurance will find a way to incentivize people eating plants and avoiding animal products, oils, smoking, alchohol. All atherosclerosis related heart disease will basically be gone. Basically all Diabetes, type 1 and 2, most cancer….

  10. OK wow. This was a fantastic podcast. I learned so much. Been getting more and more interested in investing over the last several months listening to videos. Niketa sounds very intelligent and inspiring. I guess I have become a hyperchanger. Well done Gali rooting for you bro

  11. Mail order medication has one big problem. Temperature control. I stopped using the mail order with my insurance because my mail box regularly was at 120 degrees. And I live in western Washington. When I called the insurance company all they said was don’t worry about it.

    So I’m paying twice as much for my meds locally to make sure the potency is correct.

    Yes I checked with the manufacturer and they said they can’t guarantee potency on any drug unless it is kept under 86 degrees.

  12. Great video as always.
    Unrelated, but I want to know technical data about the Roadster already. 620 mile range was what was first announced. Been a little bit since then. I wonder how much specs could vary by the time it is produced and if Maxwell tech could have any effect on it when it releases. You would think that the big release of their groundbreaking tech would be in their $200,000 Roadster 2. I also feel like tesla missed the ball by not having an automatic convertible hardtop roof on the roadster. The miata RF has one and it's msrp is 32,000. Would have been sick.

  13. Great chat! Definitely going to check our Oscar for my health insurance.

    To expand on something you mentioned, fax machines aren’t the only archaic technology used extensively in hospitals. It’s pagers too. Crazy backwards! If you had to guess where in the world pagers would be used in time critical, life on the line processes, you would think it would be somewhere in the developing world. Nope. Right down the road in your local ER there is a nurse who is literally sending pages try to assemble/coordinate all of the different people on the team that needs to respond to your care when you roll into the ER bay with a heart attack, a stroke, or some form of major life threatening trauma. Insane! When the difference between life and death could literally be measured in minutes or even seconds, that’s a process that shouldn’t be reliant on phone calls, pages, and human memory. It should be digital and automatic.

    My wife actually works for a startup named Pulsara which is addressing this very issue, and it’s amazing to see how their technology platform is dramatically reducing the amount of time it takes for patients in critical condition to receive life saving interventions.

  14. Exciting times to fix the incentive structure and people needing to care about the price like they do in the free market. Should be higher cost insurance if you’re not on a plant based diet like kaiser promotes similar to smoking. Please watch the upvoice for non question sentences, even multiple times in one sentence… it’s an epidemic!

  15. Please avoid writing while your interviewer talks, keep eye contact. It's awkward to talk to someone who is looking down 🙂

  16. The biggest trap that health care has fallen into in USA is the cultural assumption that capitalism is a panacea for anything and everything. Adam Smith would emphatically disagree with that assumption. Health care in all other developed countries is based on a non-profit methodology, and USA needs to do the same. Salaries can be whatever they will be, but the focus of health care itself needs to be on those who need care, not investors who expect a profit. Insurance, hospitals, pharmaceuticals, all need to be based on a non-pofit methodology. Especially egregious is the price gouging by Big Pharma in recent years – that is totally unacceptable; again, the focus must be on patient care, on the deliverables, not on profit or even on the corporation. Also, a group insurance policy for all of society, for whatever medical care might be appropriate or required, is the most sensible approach (which is not unlike the universal health care provided for all military members and their families, or for all those in Congress) – a simple group coverage for all of the above is the easiest, most economical, most reasonable variant of health insurance available, using a non-profit format. We must do that. (Also, will someone please tell Big Pharma to stop the annoying and ridiculous TV ads? That is not allowed in Canada, but in USA the nunger is for profit – not for sensibility or for societal health. That must change.)

  17. Pretty cool.

    I would also suggest mobile nurses, as in nurses show up at your door. Maybe only roll this out if your whole neighborhood is signed up for oscar so you can do it more efficiently. Like once a year check up.

  18. Brother 🙂 love everything you put out.
    but pleace make the room , more enjoyable, sofas, colours etc

  19. Enough with the Healthcare we don't care, we want to know what is going on with Tesla, got it??

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