Dr. Mehmet Oz on Fixing American Healthcare + Fraud | Live from Davos

(0:00) The Besties introduce Dr. Oz (3:26) Trump's vision for healthcare in America (13:26) AI & self-directed healthcare (30:10) The future of GLP-1s and affordability (35:06) The Medical Fraud Crisis (44:02) California fraud and accountability (56:57) Immigration and addiction Follow Dr. Oz: https://x.com/DrOz Follow the besties: https://x.com/chamath https://x.com/Jason https://x.com/DavidSacks https://x.com/friedberg Follow on X: https://x.com/theallinpod Follow on Instagram: https://www.instagram.com/theallinpod Follow on TikTok: https://www.tiktok.com/@theallinpod Follow on LinkedIn: https://www.linkedin.com/company/allinpod Intro Music Credit: https://rb.gy/tppkzl https://x.com/yung_spielburg Intro Video Credit: https://x.com/TheZachEffect Referenced in the show: https://www.nature.com/articles/s41746-025-01671-6

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Jason Calacanis?

  All right, everybody. Welcome back. It's All In at Davos. My bestie David Sacks is here. We're having a great time. We're here.

• 0:06David Sacks?

  Can you guys catch this in the background?

• 0:08Jason Calacanis?

  Oh, my God.

• 0:09David Sacks?

  It's amazing.

• 0:10Jason Calacanis?

  It's stunning.

• 0:10David Sacks?

  This is the Davos experience.

• 0:12Speaker 02

  It looks real.

• 0:13David Sacks?

  I know. Well, it kind of looks like a green screen from here because this is so picturesque.

• 0:16Jason Calacanis?

  It's literally like a postcard.

• 0:18David Sacks?

  It's not green screen. It is. It's the real deal.

• 0:20Jason Calacanis?

  And we'll look over the ledge here, and what you'll see is all of the virtue signaling, ESG, DEI executives. And you'll just, it's emanating from this entire area. And they've put solar over every single building here. None of it's plugged in. It's just for aesthetics, but we're really excited, David and I, to do a bunch of interviews here. Wow. Today, we've got a great one for you, and we're going to talk about health, and we're going to talk about the healthcare system with none other than Dr. Mehmet Oz. You're the administrator now for CMS. You've gone from being America's doctor, dare I say, to being a civil servant like my friend David Sacks. Why did you choose, really, height of your powers, career, to go into public service like this?

• 1:05Speaker 02

  So I'm in the change business. You guys are as well. And if you're in the change business and the project you're pursuing is not making a significant change, then you want to move on to something else that could make the impact you desire. And especially in healthcare, we don't have the luxury of fooling around for years of our lives, pursuing interests that don't result in meaningfully changing the quality of life, but also the opportunity that the American people have. And so I loved being a TV host. Did it for 13 years. I love practicing surgery, which I've done my whole life until recently. This is the best job I've ever had. And it's the best job I've had because of the people that I get to work with, but also because you truly do get to make the change that I desire.

• 1:49Speaker 02

  And I think a lot of folks, the reason they watch the Olin Podcast is they want to change stuff too. And I encourage everybody to, you know, take some big swings, and you'll break things once in a while. But if you want to be able to change meaningfully the infrastructure, whatever's bothering you, you've got to go at a full speed. And this administration offers us a unique opportunity to do that.

• 2:10Jason Calacanis?

  It is interesting, David. You were used to going at a pretty fast pace as well. And then I think our expectation was, hey, you get into public service, it's going to be about consensus building, and it's going to take a lot of time. Say what you will about Trump, some people might not agree with every policy. But he ships. He's like a founder who ships and ships product fast. That's also been your experience.

• 2:31David Sacks?

  He's hard to keep up with. I mean, he moves incredibly fast and it makes him really fun to work for because he wants to get things done. Every day he wants to get things done.

• 2:41Jason Calacanis?

  There's a sense of urgency.

• 2:42David Sacks?

  Yeah, and you know, you'll be in a meeting with the president in the Oval Office and you'll tell him about a problem. His first instinct is to pick up the phone and call and fix it right then and there. And he does that, meeting after meeting, hour after hour, day after day, week after week. And when you compound that desire to get things done and he acts on it right there, it has a huge impact.

• 3:02Jason Calacanis?

  And he seems to get great pleasure in bringing together, especially in this administration, which I think is distinctly different than the first. First administration, he was new to politics and he brought in a lot of career politicians that I think maybe people told him were the right people. This time, he has explicitly gone and looked for people with expertise who are proven winners in the field, yourself included.

• 3:26Speaker 02

  He wants us to carry the water. And this is, I think, across the different parts of the administration. He wants individuals that don't have to rely on the president to tell the story all the time. Because so much of the narrative that is reflected in the media is just completely off. I might have been saying that they're doing it on purpose. They literally don't understand some of the secondary and tertiary impacts of the decisions you're making. And it's our job to therefore tell, not just the media, but the American people, what we're trying to do. And that's especially important if you're unorthodox in how you govern. And this is a fundamentally important reality, at least at CMS. David, I don't know how it is in the developing AI where there probably wasn't a rulebook before anyway, but in healthcare, you know, there have been doctors since the dawn of,

• 4:08Speaker 02

  of, you know, but since humans left Africa 50,000 years ago, there were doctors in the encampment. And so there is a way of doing things. And in government, that exists as well, but it's not always the right way to do things. So for example, we have the ability to make laws. Every part of the administration pretty much can. We get Congress to do stuff. It doesn't always turn out the way you want it to turn out and it takes a lot of time. And the negotiated final results sometimes fall short. You have rulemaking, second big area, which is, you know, Administrative entities like ours can write the rules that everyone has to follow. We're gonna pay you this much. We're not gonna let these people do that anymore. It does take some time, and it's prone to lawfare. By that, I mean, the people you're regulating, if they don't like what you're saying, they can sue you.

• 4:49Speaker 02

  And they can stop you. And in this administration, if the other party doesn't like what you're doing, even if it's the best thing, we had a rule that would reduce fraud. But the blue cities didn't like it because it was coming from someone they didn't like, the president. So they enjoined it, and that's now caught up in court. Now, we'll win, but it could take years. So that's the second big way, right? So you make laws, you pass rules. The third way, which historically government has not used, I don't think is effectively as possible. And this president, because he's a great negotiator, is able to push us in ways that historically not been done, is to just use the power to convene. The US government can bring people together who would not normally talk. They can give safe harbor to industry to come together and discuss problems that historically they would shy away from.

• 5:31Jason Calacanis?

  What's the great example of that? I'm wondering if it's the drug companies who... They have something to lose because Trump's been... President Trump has been very clear, hey, I want these prices lowered. Why are we the sucker at the poker table? We're paying 10 times what Canada's paying. Is that the best example in your experience so far?

• 5:49Speaker 02

  It's a great example. Most favored nation in drug pricing. It specifically addresses the problem you outlined, which is we just pay a bunch more for the exact same product made the same factory often in America than our counterparts do here in Europe. So the president says, we need to change that. So he says, go talk to the drug companies. Create some opportunities for risk for them, you know? Make some rules, create some projects that if we were to act on them, would really hurt them.

• 6:15Jason Calacanis?

  A little pressure.

• 6:16Speaker 02

  A little pressure. You know, build the crowbars and the baseball bats.

• 6:20Jason Calacanis?

  Okay.

• 6:21Speaker 02

  Cut some trees down, hone the wood, but don't use them. And he's very specifically said, do not hurt the innovative nature of pharmaceuticals. They are important to our nation. They save lives. We want to have the most innovative industries in the world because that's where the opportunities are to differentiate ourselves. It's also part of our national destiny, be the best. So don't hurt the industry, but take some of the fat out of it. Pull it back and give it to the Americans. People plus it's the fair way of doing things and metaphorically. When you think about NATO and the president saying to NATO countries, we're all in it together to protect ourselves against external threats. You guys got to put up more money. We'll put up more, uh, but proportionally more. It's got to be fair.

• 7:01Speaker 02

  And they all did that pretty much with one or two exceptions. He did the same thing with pharmaceuticals. He said, there's an external threat, which is Russia or. You know, foreign governments, there's internal threats like cancer.

• 7:11Jason Calacanis?

  Yeah.

• 7:11Speaker 02

  So we want everyone to chip in. We pay in the United States point eight percent of our GDP towards pharmaceutical products.

• 7:18Jason Calacanis?

  Point eight percent.

• 7:18Speaker 02

  Point eight percent.

• 7:19Jason Calacanis?

  Almost one percent of our GDP goes to drugs. That's not the healthcare system, which I think is seventeen percent.

• 7:24Speaker 02

  Right.

• 7:25Jason Calacanis?

  One percent of it, a full six percent of our healthcare goes just directly to the drug companies. So we want.

• 7:31David Sacks?

  That's with your math.

• 7:32Speaker 02

  It's quite, quite impressive.

• 7:33Jason Calacanis?

  Yeah, thank you.

• 7:33Speaker 02

  So, so point, I only bring this up because the percentages make a difference here. Point eight percent.

• 7:39Jason Calacanis?

  Comes from us playing blackjack.

• 7:40David Sacks?

  I know.

• 7:40Speaker 02

  Calculated. I know.

• 7:42Jason Calacanis?

  No, no, it comes from us playing blackjack and poker together. You, I've lost a lot of.

• 7:46David Sacks?

  Two outers over here.

• 7:47Jason Calacanis?

  I will, I've been, I've lost a lot of money to this guy and I don't play him in chess anymore. Bend, but don't break. You want them to bend a little bit, be reasonable, but you don't want to break the industry. As a doctor.

• 7:59David Sacks?

  Let's see upshot of this because you hear this term affordability a lot. So the average American is going to pay less for their drug prices.

• 8:06Speaker 02

  We're going to pay less. The Europeans, we are telling all the countries, we're in the middle of these discussions. We've just gotten the British to say yes and. Other countries are talking to us about the fact that they pay point three percent. So less than half of what we pay percent wise is being spent by them and. They get away with it because their people don't realize that if you get cancer, more advanced cancers in Europe, your survival rate is way below the US. And if you don't, if you don't get access to the drugs, which they don't for several years on average, that we get in the US, yes, you can get it for cheaper, but. Your people are paying a price. And this is going to see the most important message I'm going to deliver today. The most important message is don't think about healthcare like an expense. Think of it as an investment because if I can get. The average American to work one year longer because I got them a medication at a better price. They didn't turn away at the drugstore.

• 8:51Speaker 02

  Or because we're able to do something else, correct?

• 8:52Jason Calacanis?

  Morbilities.

• 8:53Speaker 02

  Whatever.

• 8:54Jason Calacanis?

  Missing work.

• 8:54Speaker 02

  The movement, we'll talk about all this, but if you can get the average American to work one year longer. That is worth three trillion dollars to the US economy. It's massive. So we need to get people feeling their best, feeling that they have agency over their future, with confidence that they're gonna make a difference in the world, so they want us to keep trying to do it at the workplace. And that extra one year, which gets them closer to Medicare, by the way, also helps deal with other financial crises that we're facing as a nation. So, this is the way to think about it the right way. Get the actual cost of care down. Don't just pay more money into the system. Get the actual cost of care down, so the money we're spending gets us more value.

• 9:32Jason Calacanis?

  We're spending twice as much as these other countries who have universal healthcare. Now, you did point out that they get things later, so we have a better system, but we pay through the nose for it. That would be an accurate way of describing the current state of affairs?

• 9:44Speaker 02

  Precisely stated, yes.

• 9:46Jason Calacanis?

  Okay. So, how do we get every American healthcare? Because I believe a lot of the tension we have comes from a fear, from people maybe who are not as well off as the people on the pod right now, and they live with that fear. We don't live with that fear. We know if we need to get healthcare, we're gonna figure it out. We'll be able to pay for it out of pocket, or insurance will pay for it. But there are people who go bankrupt because of this. You believe in universal healthcare, I would assume, as a doctor?

• 10:14Speaker 02

  I want everyone to have access to healthcare. But how we pay for it is the defining issue here. How do you keep the system incentivized to take care of you? If I tell everybody in America that you have healthcare, and then I tell the doctors, give them healthcare, but I don't deal with the financial costs, then you all of a sudden start to restrict the access to care. So, you can get the healthcare, like you do in socialized medicine countries, you just have to wait six months, or a year, or longer, or you don't get the care at all. And when you start having that discussion with Americans, they say, wait, wait, wait, hold on a second. Yes, of course I want to get the healthcare for an affordable price. But the question, the fundamental question is, how long till I actually get the care?

• 10:51Jason Calacanis?

  Being denied is something they live with. So they complain about their universal healthcare, we complain about not having universal healthcare. What are the two or three?

• 11:00Speaker 02

  Well, the thing I would look at is...

• 11:02David Sacks?

  The flow of patients who seek treatment internationally. So I hear lots of stories about Canadians coming to the US to get treatment because they don't want to wait two years.

• 11:12Jason Calacanis?

  To get the latest.

• 11:13David Sacks?

  For some proceed, not just the latest, to get some procedure.

• 11:16Jason Calacanis?

  Yeah.

• 11:16David Sacks?

  Because they could be dead in two years. So they come here. I don't hear any Americans talking about going to Canada to get treated.

• 11:23Jason Calacanis?

  We actually do have a number of examples of that in surgeries and treatments that you have to pay for out of pocket. Cosmetic, dental, people are going and this has become tourism and there are people who do change locations. Yes, this is a trend.

• 11:36Speaker 02

  For elective procedures, you mentioned cosmetic surgery.

• 11:38Jason Calacanis?

  Yeah.

• 11:38Speaker 02

  That's definitely a trend. And also there's some procedures that we don't do in America.

• 11:42Jason Calacanis?

  Same cells.

• 11:43Speaker 02

  Some cells, that they're still going through the regulatory process. But the bigger issue really is one David's raising, which is most Americans complain that the healthcare system is broken. Almost none would leave the country to get top-tier healthcare for a life-threatening problem. And so we have this sort of bizarre opportunity. I do think it's an opportunity. How do we make the top-tier healthcare available to folks who need it? But do it at a price that is sustainable. And that's where I think your specialty area comes into play. Before this administration, I think because we didn't have the right technologies to promise convincingly that we could do this, there was a hesitancy to make big shifts. We're taking big swings because we think AI is ready. We think the tech transformation that could happen in healthcare is worth subsidizing.

• 12:28Speaker 02

  And by that I mean making it possible for top-tier entrepreneurs who are building apps that can help you deal with the medical crisis that you're dealing with. Their diabetes. We can put money into the system to make that worth you doing. So you can get investors to support you, you get a fair valuation.

• 12:42Jason Calacanis?

  So technology to lower the price. Obviously, that's a huge win. Let me ask you the difficult question. As a doctor, there have been studies that came out recently that not only do LLMs currently give better advice than the average general practitioner, they have better bedside manner and the Customers or the patients enjoyed the LLM more than they enjoyed a GP. I haven't seen that. This is a study that came out of either Harvard or MIT. I'll put it in the show notes, but this is a pretty groundbreaking. What are your thoughts? If you were going to a new society, is this idea that you have to go to the GP? They ask you a bunch of questions and they go on their medical text, figure out what their advice is.

• 13:26Jason Calacanis?

  Is that the best modality or would it be better for the common cold? For an ankle sprain to do what most Americans without insurance are doing or people who are self-directed? They go on a large language model. It says, here's how you deal with these issues and they do it themselves. And they can take care of a couple of things. Wouldn't it be better to just have them do this stuff? And then decide if they should go see their GP?

• 13:48Speaker 02

  I think there's a hybrid of that, that de-risks it a little bit. Early on, there are definitely problems with hallucination and the like that, that Americans we very intolerant to. We actually understand if a human being who has an M.D. degree makes a mistake. We think AI is perfect and are completely intolerant. There may be a minor transgression.

• 14:06Jason Calacanis?

  Yeah.

• 14:07Speaker 02

  What you said earlier is true, and these studies have been done several times now. The, the, the large language models do better on board exams. So abstract, they take general knowledge, they're better than a doctor. They're more patient than a doctor. If you talk to an AI-informed avatar, they'll answer the same 10 questions on diabetes all day long and not get bored. Talk to a general practitioner, after they've talked to 10 patients with diabetes who have asked the same 10 questions, you get a little terse in your responses. That's just human nature. I don't want to answer the same question every time, but that's what patients need you to do. So I think we have the opportunity and we looked at some of these models. In fact, John Doerr brought a bunch of very thoughtful entrepreneurs into the building to talk about the possibility of us taking the average general practitioner and making them five times, maybe even 10 times more efficient.

• 14:52Speaker 02

  Now, here's the big deal. There are not enough GPs in America. We probably need two to three times more just to keep up with Europe. It's just per capita, we're way below. Because like, because my son just finished medical school. There aren't many kids in medical school at Columbia where he went who are going to become GPs. They all want to be ophthalmologists and, you know, orthopedic surgeons because they pay a lot more.

• 15:10Jason Calacanis?

  And they got big loans for their

• 15:12Speaker 02

  Yeah, and they're in debt. And this is even Columbia is free. If you don't, if you don't have money, you don't have to pay tuition at Columbia. They did that so that kids would go into general practice and it hasn't had the desired impact yet. But the broader question is, how do we allow AI to play a role as this transition period happens? So people feel confident. And one way of doing it is to allow it to do most of the work. And then especially with the Gentic AI, take the paperwork out of it, the busy work out of it, and feed the doctor the key information. What's the most important thing I do as a doctor? I look at you in the eyes and I read you and I try to connect with you. Fifty percent of our cortex, of our high cognitive function, fifty percent of it is to read your face.

• 15:52Speaker 02

  We're hardwired to be social animals, to understand the subtle little, David's bored, you're not, I gotta change the pacing, I gotta get back to him. He's doing card calculations in his head.

• 16:02Jason Calacanis?

  He was, in fairness to David, he was out till 1 a.m. They dragged him to four meetings. I was in bed at night. I have good sleep health. I got my whoop, I got my sleep score. I am a pillow princess like you, Dr. Oz. I hear that you're extreme about your sleep.

• 16:16Speaker 02

  Well, I'm a good sleeper. My wife is a world-class sleeper. She brings her own pillows.

• 16:20Jason Calacanis?

  Your wife is delightful, by the way.

• 16:21Speaker 02

  Thank you.

• 16:22Jason Calacanis?

  I did an hour interview with Lisa before you even got on stage here. I was like, wow, she's impressive.

• 16:27David Sacks?

  To build on this point, I mean, I think it's interesting. I think we're going to get smarter doctors and smarter patients. And they're each going to use their own version of AI. So you know what patients are going to use as a, as a consumer product?

• 16:40Jason Calacanis?

  Absolutely.

• 16:40David Sacks?

  ChatGPT, Grok, you know, and so forth. What's interesting, I think, is when they can dump in their blood panels.

• 16:45Jason Calacanis?

  Yes.

• 16:46David Sacks?

  Because AI is so good at reading PDFs, you know, just unstructured data. So you dump all your stuff in it, you ask for a diagnosis, you get smarter, you can research your own condition. You're not wasting, frankly, the doctor's time by asking basic questions.

• 17:00Jason Calacanis?

  You're a better consumer, you're a better customer.

• 17:01David Sacks?

  Right.

• 17:02Jason Calacanis?

  And partner with the doctor.

• 17:03David Sacks?

  And then the doctors, they can use ChatGPT or what have you, but actually they're using specialized, much more specialized tools.

• 17:11Jason Calacanis?

  Yes.

• 17:11David Sacks?

  That, the ones I've seen, they will give you a citation directly to a medical journal.

• 17:16Jason Calacanis?

  That you can bring to your doctor.

• 17:17David Sacks?

  Because that's very important to doctors. So you know it's not hallucinating. Just getting the answer from a, you know, from a

• 17:22Jason Calacanis?

  Yeah, and it's like, oh, that was on Joe Rogan's podcast.

• 17:25David Sacks?

  You need to know what the source is.

• 17:26Jason Calacanis?

  Which is fine. If you, if you get information from Joe and then you work backwards to a citation, that's good.

• 17:31David Sacks?

  For a respected medical journal.

• 17:32Jason Calacanis?

  So let me ask you about this trend. This is self-directed healthcare. There's Function Health doing blood labs. Superpower. Whoop just started offering them. Aura, Apple Watch, Ate Sleep. I'm an investor in that one. Full disclosure, it's doing great. These things are now putting all that data together and starting to tell you your life, your health span, your, you know, your actual age versus your health age. I don't know what that metric is. But people are now measuring things and getting some knowledge of this and then going to a GP. The problem I'm having is, and I'm not price sensitive. I could get any concierge doctor I want. There's very few doctors who want to work like this at the moment. That's something's got to change. But what do you think of this new group of people who are doing self-directed healthcare?

• 18:16Jason Calacanis?

  Doing two blood labs a year? Putting it into a database? Prenova with the 3D scans? Niko, Daniel X, new company, doing a $300 full body scan? All of this, is this going to be the paradigm shift?

• 18:28Speaker 02

  80/20 rule. If 20% of Americans do what you're saying, and they will.

• 18:32Jason Calacanis?

  Yeah.

• 18:32Speaker 02

  It would make all of medicine function better. I'm actually concerned about the other end of the spectrum.

• 18:37Jason Calacanis?

  Tell me.

• 18:38Speaker 02

  The people who don't go to their doctors. Medicaid patients, Medicaid patients are twice as likely. Medicaid is the folks who are vulnerable, who are, you know, have made less money. They're getting government health insurance.

• 18:48Jason Calacanis?

  Right.

• 18:49Speaker 02

  Medicare.

• 18:49Jason Calacanis?

  That is our universal healthcare.

• 18:51Speaker 02

  Right, that's where we need help.

• 18:53Jason Calacanis?

  Yeah.

• 18:53Speaker 02

  The chance of a Medicaid patient who doesn't pay for their healthcare because they don't have the means to do it, the chance of them cancelling their doctor's appointment is twice that of a Medicare patient. And so it's hard to take care of them. Now, they have two jobs. They'll get fired if they leave the job early. They don't have the flexibility of moving their calendar around. They don't have transportation. There's lots of reasons they don't show. But if I can't get healthcare to them, that's a major crisis for us. And so the real opportunity for AI is democratizing healthcare.

• 19:19Jason Calacanis?

  Yes.

• 19:19Speaker 02

  See, you guys are already smart. You just listed off the top of your head, a dozen companies all doing great work. Most people have no idea these companies exist or what they do exist.

• 19:26Jason Calacanis?

  Right.

• 19:27Speaker 02

  And so if I can put into AI my labs, and I don't know much about healthcare, I can get information sent to me in a way that I can process it and at the time I'm ready to hear it. Now, I'll give you one more data point that might be useful. All Medicare patients, all seniors over 65, all of them are given a free wellness exam every year. What percentage of people take their free medical exam with a doctor? Less than 5%. No, it's not that bad. It's less than 50%. Less than 50%. But most people don't do it. It's there. And part of the reason we think that's happening is you don't prioritize it. And here's the more important data point. People who actually see their doctor think they're sicker, but they're actually much healthier than people who don't see their doctor, because ignorance is bliss. People don't go to their doc or seek any kind of health advice, think that they're doing great, and actually objectively, they're doing much worse.

• 20:12Speaker 02

  So we have an opportunity to democratize this by saying, okay, I'm going to meet you where you are. You don't care about going to see a doctor, even though it's free, it's yours. In this new health tech ecosystem we're building out with Amy Gleason, who also ran DOGE, you know, helping to roll this all out. We're making it easier for every tech company to participate. 600 companies have signed a pledge agreeing to interoperability, data transparency, and to build these tools for the American people to be able to use them. Now, once I deputize you to be better equipped, take care of yourself, you change the system. Because when you ask a doctor a question, the first time you're the only patient, they don't pay attention. The second patient who asks the same question, we change. As a physician, I'm telling you. It helps us to have patients pushing us to pay attention to, for example,

• 20:57Speaker 02

  ambient collection of information in the doctor's office, so I get a medical report on what you told me. Why? Because 50% of what a doctor tells a patient is forgotten before the patient leaves the office. So when your kid asks you, hey, what happened with the doctor, you don't remember. You're nervous, you're anxious. The doctor spoke quickly, used big words. Break all that down, and all of a sudden, information gets flowing easily. Now you've got a lot more stakeholders, and who's the ultimate stakeholder? The patient. So the medical records, who historically have been hijacked by medical record companies. And hidden. And hidden. Like, how do you ever get them? Yeah, and all those companies now are saying, all right, we get the joke. And this is again, back to the president. He's not fooling around in this stuff. When he tells you he wants you to share data, you know he's going to come after your ass if you don't deal with this problem. And so they've all come and said, all right, you know, we're done on the joke now.

• 21:42Speaker 02

  The pharma companies, when we're negotiating most favored nation, you know what they said when we challenged them? And said, you're charging several times more for... The same products, they said, all right, well, we knew one day you'd come knocking. We knew that you so and we actually think the president would do something to us, so we're gonna negotiate. And you don't wanna throw away that power. You know, don't beg for forgiveness, push for action. You know, go make things happen, and if they don't work out fine, you you you get more more bites at the apple.

• 22:07David Sacks?

  Just on that point about the pledge, cuz I got to attend that event at the White House.

• 22:11Speaker 02

  You organized it.

• 22:12David Sacks?

  Well, it's gonna be a little bit too much credit, but it was honestly, it was you and Amy Gleason. And Secretary Kennedy, and you guys just happened to invite me for some reason. But it was it was really interesting cuz so this is my kind of layman's understanding of it, which is. The law gives us the right to our own medical records. But in practice, we don't get them.

• 22:34Jason Calacanis?

  HIPAA regulations.

• 22:36David Sacks?

  It's it's because the the companies that store the health records.

• 22:41Jason Calacanis?

  Yeah.

• 22:41David Sacks?

  Do it in proprietary formats. And we don't really know how to get that data and what we do with it, even if we did. So the key is to get those health records shared to all the other medical companies in the space that we might wanna use. Hence the power of the pledge, get these 600 companies agree. But I think that AI is kind of the magic glue here because AI is so good at reading data.

• 23:04Jason Calacanis?

  Yeah.

• 23:04David Sacks?

  From different formats and translating it.

• 23:06Jason Calacanis?

  Perfect.

• 23:06David Sacks?

  So you don't need like a perfect API.

• 23:09Jason Calacanis?

  Nope.

• 23:09David Sacks?

  Anymore. You just get the unstructured data, dump it in, and now it just works.

• 23:13Jason Calacanis?

  Which is what we're starting to see. I'm taking my eight sleep data. My whoop data, my blood panels, and I'm putting it into all four of the major ones. Asking it, I take pictures of every one of my supplements or drinks. What impact will this have? Which impact will this have on sleeping?

• 23:28David Sacks?

  Yep.

• 23:28Jason Calacanis?

  I think that's like this gigantic win.

• 23:31David Sacks?

  Yeah, you being able to realize. The promise that the law gives you to actually own your own medical data, but to get it in a usable format. That now you can use again a chat interface to understand it.

• 23:42Jason Calacanis?

  It's technological obfuscation. Let's call it what it is. They're trying to use these proprietary formats always to get a technological advantage. And to have a moat around their business.

• 23:51David Sacks?

  AI just decodes that and makes it usable, and now you can you can interact with it. Can I bring up one other example? So Dr. Ross, you mentioned democratization. You and I've had a conversation. About certain states are actually trying to ban the use of AI to be used in therapy. And I think the point you made to me is, you know what, there's a lot of places all over the country, like rural areas, where there aren't psychiatrists, or there isn't psychiatric care. So at least AI provides a baseline level of service. It, version one may not have been perfect, there may have been some hallucinations, but it is getting better and better every year. If you ban it, then a lot of people are just gonna have nothing, right? I mean...

• 24:30Speaker 02

  Beautifully stated. Let's just go over, let's unwrap that a little bit, but I mean, just at a high level, say, AI is coming to a neighborhood near you, you're not stopping it. So it's gonna be there, and patients are gonna use it, and so you have to engage it. Running from it, you know, we cannot stick our head in the sand on this one. There's other things you can sort of delay, but I've encouraged every governor, go full bore at this, but do it in the right way. Allow professionals to function at the height of their licensure. Why don't we use pharmacists better? There's probably 70,000 pharmacists, right? And there's a thing by this way, almost all Americans, 95%, live within five miles of a pharmacy. They don't live near five, you know, near a hospital usually. So, we don't have access to care in many ways. If we just took AI and allowed pharmacists and doctors, GPs, to

• 25:14Speaker 02

  function at a higher level, in itself would be worth the opportunity. So I might have been saying advocate it all to an AI agent that doesn't really understand you, we can't control, maybe, you know, some other country gets involved in it. At its very practical level, we do not have enough practitioners. There just aren't enough people to take care of rural America. 60 million Americans living in rural America don't have access to mental health services. Our vets commit suicide at a crazily high rate, more than we lose in war, because they don't have access to mental health services. Many of them do live in rural America. And so if we're gonna fix those kinds of problems, which are time-consuming, you're not gonna get Park Avenue psychiatrists to go practice medicine- At $800 an hour. At $800 bucks an hour in the north slope of Alaska in the winter. This is not gonna

• 25:57Speaker 02

  happen. And so, this $50 billion investment that we as a country just made, just, the money was part of the rural health, the working families tax cut legislation, that the president pushed through, and Congress got behind. $50 billion, the largest investment ever made in rural healthcare, through our agents- He was given off by the end of the calendar year. All the governors have the money. And we charge them to make a difference in their communities. You know your communities. They almost all came back with some AI element. They all know to really be able to get healthcare in rural America. You've got to right size the system. Right sizing the system means, you know, you have the hospitals going to work out differently. Doctors will work differently with each other, but AI is the core element of so much of this.

• 26:36Jason Calacanis?

  And these micro hospitals, just like people are putting ADU units in the back of their homes to get an extra, you know, apartment for grandma and grandpa. Or as an Airbnb, my understanding is there's a bunch of startups working on the equivalent, building a micro hospital. A room with the central services, perhaps a nurse practitioner, uh, who are, there's more available. And then you telemedicine in, just bringing the medicine to those areas without having to build a giant hospital is also a win, yeah?

• 27:03Speaker 02

  The micro clinics, I think, have a huge opportunity to provide top tier care. But this goes beyond that. We have AI, uh, supported robots that are going to be doing ultrasounds in parts of Alabama where there are no OBs.

• 27:17Jason Calacanis?

  Right.

• 27:17Speaker 02

  We have drones delivering, uh, prescription medications to the North Slope of, uh, of Alaska where there are no roads. We have, you have vending machines that can dispense, smart dispensing of medications. By the way, this is happening in other countries. So we want this to take place in America. And why not take advantage of, of an opportunity through, with a huge massive inflow of money, which is Rural Health Transformation Fund does, fifty billion dollars, to start to do some innovative work in rural parts of the country, which are the, the foundational element of who we are as a nation. Those values ripple up to the rest of us. And I also think that states now are talking to each other differently. Now, now that you've got money that's out there to be used to change the world, they start talking about AI and technology generally very differently.

• 28:00Speaker 02

  Now it's not a, it's, it's not a sparse research. We live in a world of abundance and AI makes it that much more abundant if we use it correctly. And it's not going to happen today, but we believe by the time the administration has completed its work, we will have dramatically changed the face of how Americans work with information, the healthcare system. Some of it's just blocking and tackling, as you said, make medical record companies not data block. Some of it's forcing, uh, health information systems to share data more comfortably. Elegantly at a fair price. And part of us putting money into the system seating it the right way. But the most important thing is to make it safe to go outside.

• 28:35Jason Calacanis?

  Yeah.

• 28:35Speaker 02

  We want to make it comfortable to take financial risk to invest in these areas. That's why 600 companies have invested. Every major AI company, every major foundational technology company, but all a bunch of these surgeons that I that I've promised, they're all rushing in.

• 28:48Jason Calacanis?

  The three places entrepreneurs have been reticent to take on, to build new products and services. Education, housing, healthcare. These also happen to be the ones most regulated, most controlled by the government. So to the extent you can give them access and make it go faster, it's going to work. The only investments we've ever made in those spaces are ones that go direct to consumer. Because we know going through the government, there's just not enough runway for those companies to get to the other side. Let me ask you about.

• 29:18Speaker 02

  We're open for business and I got to make this plug while I'm here.

• 29:20Jason Calacanis?

  Please.

• 29:21Speaker 02

  We want to work with industry. We believe the private sector will come up with better ideas, come work with us. And we're also looking for people. And we had nine engineers, nine engineers when we came in. And all of CMS, our cobalt-based infrastructure built in the seventies, where we don't even have engineers that.

• 29:35Jason Calacanis?

  You're talking about in the department, you had nine engineers out of what's the denominator of employees?

• 29:40Speaker 02

  6,500 employees and 40,000 contractors. So there's, you basically have an HR person in government, working with a government affairs person at the company. There's no engineers there.

• 29:50Jason Calacanis?

  16 basis points, David.

• 29:52Speaker 02

  We took out, we took $3 billion of cost out. There was a company that we fired that had billed us $200 million, not a single usable line of code. And here's the good part, when we fired them, you know what they said? Nothing.

• 30:04Jason Calacanis?

  Yeah, we knew it.

• 30:05Speaker 02

  We knew it.

• 30:05Jason Calacanis?

  Yeah, we were underperforming, no accountability.

• 30:07Speaker 02

  Underperforming.

• 30:08Jason Calacanis?

  God, we could go on about fraud for forever, but I want to ask you about this wonder drug. Four years ago, I was listening to my friend, Tim Ferriss and Kevin Rose, who are biohackers. And they're always on the edge of this stuff. And he wanted to lose some visceral fat. Kevin was in great shape and he heard about this diabetes drug, Ozempic, and that he was going to give it a shot. He dialed the pen all the way up, puked, dialed it back down, lost his visceral fat. I heard that, I was like 40, I was 213 pounds at the time. Went to my doctor, he said, I have no idea what you're talking about. You're not diabetic, but you are fat. And he said, you're a fat bastard. I think I said that. And I had just gained like two or three pounds a year for 20 years. And I used to be a marathon runner, I used to be 165, 170 pounds, so now 172.

• 30:52Speaker 02

  You look like gazelle right now, by the way.

• 30:53Jason Calacanis?

  Well, I had a little muscle too. Thank you, Dr. Oz. You look great too. But this is a miracle drug. This, in my mind, we now have theoretically, tens of millions of Americans have experienced it. It's going to be in pill format. The four horsemen of the apocalypse, heart disease.

• 31:12Speaker 02

  Kidney failure, liver disease, dementia.

• 31:14Jason Calacanis?

  Dementia. These are all, four of four are impacted by obesity and these GLP-1s seem to be impacting them. I was like, you know what? If Trump just, President Trump just gave a national, anybody can get this drug if they want it. I think he'd win the election. He won anyway. What do you think about a mandate to make it available, to make the fat drug available for all Americans? Would that be?

• 31:40Speaker 02

  So I'm glad you came to work today. So about two months ago, in the Oval Office, the President basically did that. He said that we're going to take the prices of these drugs, which are now prohibitively high for many Americans, $1,200 cash pay.

• 31:52Jason Calacanis?

  It's crazy.

• 31:53Speaker 02

  It's going to be a starting price of around $200.

• 31:57Jason Calacanis?

  Easy.

• 31:57Speaker 02

  And with the pills, it's $150. And the pills will come out, the first FDA-approved pills will start this month. And so we believe at that price.

• 32:06Jason Calacanis?

  Five dollars a day.

• 32:08Speaker 02

  Because it's a basically, you get coffee a day. At that price, we will, within two years, return money to the American taxpayer. It's going to save us so much money from reducing hypertension, diabetes, and the downstream illnesses, the four horsemen of the apocalypse that you mentioned, that we will save money, that we spend over half the money, I believe, within healthcare on these chronic illnesses driven by obesity. And so, either directly or indirectly, because you hurt your knees because you're overweight, or you get autoimmune problems, or even cancer is linked to obesity because you have a metabolically active state, all of these are going to drop precipitously. We have pretty good data on this from internal modeling. So we agreed to those prices with the two major companies, Novo Nordisk and Eli Lilly.

• 32:51Speaker 02

  We will launch next week, I don't know when this podcast airs, but launch next week, Trump RX with those products. So you can cash pay at a price that is completely affordable. And here's the good news. Every Medicare patient gets it for $50 copay. Every Medicaid patient gets it for nothing.

• 33:07Jason Calacanis?

  Amazing.

• 33:07Speaker 02

  So the people who need it the most, the folks that are most vulnerable, this is what it... When people say the president doesn't want to protect Medicaid, he doesn't love and cherish Medicare, it drives me bonkers. Because he's doing more for underserved Americans than any other president ever has. Giving Americans where the obesity epidemic lives, underserved Americans, you know, vulnerable Americans who are on Medicaid, access to these drugs for no out-of-pocket costs, truly democratizes the weight loss issues. Because right now, what's the number one zip code for weight loss drugs? Number one zip code, Upper East Side of Manhattan.

• 33:37Jason Calacanis?

  I was about to say, it's gotta be Manhattan or LA.

• 33:40Speaker 02

  LA's number two.

• 33:41Jason Calacanis?

  Okay.

• 33:41David Sacks?

  Because people can afford it, or?

• 33:43Jason Calacanis?

  Because they're vain.

• 33:44Speaker 02

  They're vain. They want to lose two pounds for their daughter's wedding, and they can afford it. $1,200 a rounding error.

• 33:49Jason Calacanis?

  Nothing, yeah.

• 33:49Speaker 02

  Right? But $1,200 for someone that's not making money, you're just not gonna take the drug. And they're the ones that die early. The life expectancy in rural America, I'll go back to them, in vulnerable populations, nine years shorter than yours, in the same country.

• 34:04Jason Calacanis?

  It's something that came out of left field. What does that tell us about what's gonna happen in medicine going forward? Because GLPs, how long of a journey has that been? And then getting to market, and then, you know, this off-label use, starting with people with diabetes, what is that? What is that? How does that inform you of how we can make even more impact in the future? How do we make another GLP-like discovery and implement it the way President Trump has?

• 34:32Speaker 02

  Well, this, you know, the drug actually came, it's a poisonous chemical, venom, actually, that was deciphered and found to have an impact on some of these core cells in the appetite system of the body, which is so fundamental to who we are. That's very hard to hack, the appetite. But GLP-1s are just the tip of the iceberg. There are more and more sophisticated ways for us to be able to address not just appetite, but addiction, addictive behavior drops of GLP-1s. So the newer drugs are gonna be even more effective at that.

• 35:02Jason Calacanis?

  Ready True Tide is the one you brought up.

• 35:04Speaker 02

  For example, Ready True Tide. But the other thing, what they say is the form factor matters. It's technically someone, an injection, that goes bad in the warm weather, that a lot of wastage, you don't know the exact dose. The pills make it like the most... Drugs and now the drug, the price point is much lower as well. So it's easier for us to deliver that at scale to the American people. So it does leapfrog us beyond today's problems, which is a big theme of our administration. Don't bother fixing today's broken pipes. If the world you're billing doesn't have pipes. And that's what we're doing with drugs like semaglutide and terzepatide, which is the Lily product. We're also getting these companies to ensure their production facility, hire American workers. Stay innovative. This is why, again, the president doesn't want us hurting innovation.

• 35:46Speaker 02

  With the same day, we did the first most favored nation drug event. We had an executive order on childhood cancer. 20 beautiful children, smiley, bright eyes, all of whom, all of whom should have been ghosts. They survived because technologies were afforded to them. They don't exist in other parts of the world to keep them alive. That's our goal, but I need to, I be poorly served. I hear the bell tolling. If I didn't get into the other. For whom we don't know. Yes, for the bell tolls for sure. It's only for you, Jacob. I think that's toll, I think that's tolling for the pharma companies who don't bend the knee. No, actually, but the, the, the issue right now that is consuming us is the fraud, the waste and abuse. What have you found, Dr. Oz? Tell us, what is the most concerning to you?

• 36:30Speaker 02

  Well, let me, as a preamble, without a better visibility into where the money is spent, which we need technology to be able to do. Or audits. Well, audits are interesting. You could audit the spreadsheet. You can't tell if the input to the spreadsheet was legitimate unless you actually go and do site visits. And states don't want to do that. So let me just give the. Are they blocking it, these states? Of cour, of course. First of all, let me just, I'll tell you, that's a good question. Why would you let fraud happen? It is by federal law, by federal law mandated that if you give a patient a welfare program, SNAP, Medicaid, you must also give them the ability to sign up to vote. So you're basically recruiting voters at the same time you're giving them free government services.

• 37:14Speaker 02

  Which then you might actually end up recruiting a different kind of voter. Like you don't have a law that if you go to NRA convention, right? For, for, you know, gun advocates that you sign up voters, right? You can go to that event and not get signed up to vote. Obviously, they will be probably skewing to the right. So there is an issue there. We also have an active role of unions. Especially in California, where we have a major problem because the unions have seemed, this is all what I'm hearing from talking to people on the ground. Seem to have gotten involved in, for example, signing up home healthcare workers and, and personal care services. There are more Americans, I believe, providing some of these home-based services that maybe might exist in retail in America. We've shifted the entire employment economy towards some of these services.

• 37:58Speaker 02

  And here's the risk, if you really want to understand why we have fraud in America. When I give you things that your family used to give you, we're going to have fraud. So your family used to drive you to the doctor's office. Your family would take you home after you got home back from the hospital to make sure you got well nourished and taken care of. Your family would carry the groceries up the stairs. Your family would negotiate your contract with the landlord. Guess what? Health and Human Services does all that for you now. All you've got to do is ask. And in some states, it's so easy to do that you end up with significant fraud.

• 38:28Jason Calacanis?

  So they have intercepted the transaction. Therefore, that's where grift can occur and fraud can occur.

• 38:34David Sacks?

  The government's paying for it.

• 38:35Jason Calacanis?

  Right, and so.

• 38:36David Sacks?

  When the consumer's paying for it out of their own pocket, they have their own incentive to get value for the transaction. But when the government's paying for it, who really has the incentive to make sure that value has been provided in exchange for that money?

• 38:48Jason Calacanis?

  Yeah.

• 38:48Speaker 02

  And this is what happened in Minnesota, where you had a subculture. It was probably not, you know, just mathematically, most of the indictments are with Somalians. So the Somali community realized, hey, my goodness, no one's watching. Now there's an adage, you know, that only the morons get caught in healthcare fraud because it's so easy to do. And if you get, you steal five million dollars in Medicare, Medicaid, you go to jail for 18 months. I mean, for many people, that's a pretty good deal.

• 39:12Jason Calacanis?

  Yeah.

• 39:13Speaker 02

  You know, sit in the pen for 18 months. But unfortunately, I'll just give you a lay the land. There are twice as many durable medical equipment providers. They sell wheelchairs and knee braces. There's actually 20 times more in South Florida than McDonald's. I mean, how many do you need? Turns out they're all Cuban, pretty much. They all seem to fly back to Cuba and escape, you know, law enforcement. They bill millions of dollars. They get away with it.

• 39:38Jason Calacanis?

  What's the solution? There's gotta be a really practical, easy solution.

• 39:41Speaker 02

  There are, and I'm gonna share that. But let me just give you two others because you're gonna remember these. We have seven times more hospice in California. Hospice is for people at the end of their life. Seven times more hospice than was there five, six, seven years ago. Seven times more. We don't have that many people dying in California. And more importantly, the survival rates on hospice, again, designed for cancer patients dying within six months. The survival rate for most of these hospice centers is 100%.

• 40:04Jason Calacanis?

  Wait a second. They shouldn't have gone to hospice.

• 40:07Speaker 02

  Exactly.

• 40:07David Sacks?

  Is the government paying for it?

• 40:08Speaker 02

  Yes, they're paying for it, but no one's dying because you're not supposed to be in hospice.

• 40:12David Sacks?

  When did the government start paying for that?

• 40:14Speaker 02

  Oh, 40 years ago.

• 40:15David Sacks?

  Oh, okay. But then what happened in the last seven or 10 that the fraud just went to the central?

• 40:20Speaker 02

  Two things. Foreign governments got involved. In LA, the hospice is driven by the Russian Armenian gangs. They're foreign nationals. They fly back to Russia. We had a big 15 billion dollar bust on these guys earlier in the year. Again, they all escape. The other thing is, no one's watching because there's a opportunity, if you get into these businesses, to make a lot of money. And it becomes, I'll give you, I'll just tell you a true story about a whistleblower. Again, I can't prove this, but it's what he said. He said that he was building a beautiful mansion. He owns all of these hospices. He's a doctor, but he's a fraudster. And so he built this huge house. The plumber comes in and says, hey, you know, I hear you in the hospice space. The guy says, yeah, I made my money in hospice. Then the plumber says, you know, I've got a side hustle. I own a hospice too. Right, then the carpenter hears them and he says, "Me too!"

• 41:05Jason Calacanis?

  Yeah!

• 41:05Speaker 02

  "I'm in the hospice business. We're all in the hospice business."

• 41:07Jason Calacanis?

  Absolutely.

• 41:08Speaker 02

  So then the guy says, "Okay," well, he realized he's gotta get ahead of these guys. So he goes to a major hospital in LA. And a doctor at the hospital, very prominent hospital that everyone's heard of, says, "Hey, listen, if you gave me a thousand dollars a month, I'll send hospice patients to you." Which is how it's done in LA, by the way. You get paid, you send patients over. So the guy says, "Okay, but what about the actual inpatients? Like the people hospitalized, can I get them?" And the doctor says, "I can't do that." Because it turns out, there are some members of the board that own hospice, and they like the patients to go to their centers. You see that the corruption starts in organized crime, but if you tolerate it, it poisons the whole system. And that's the bigger reason we've got a problem. So what are we doing? We have a fraud war room.

• 41:51Speaker 02

  I'm gonna put a moratorium on some of these services. We're not gonna let new people sign up. We're gonna actively and aggressively stop paying Medicaid if we can prove that states are not obliging their fiduciary responsibility to the American people. Because states administer Medicaid, I pay the bills at CMS. So we're gonna stop paying on behalf of the taxpayer if we don't think you're taking care of the money.

• 42:13Jason Calacanis?

  And people should know, there are whistleblower laws where you get a percentage of whatever's reported, and they should look into that. And the fact that we have so many people in the administration now communicating that, "Hey, we want to have you report fraud to us," has changed everything. The number of people reporting fraud must have gone up since...

• 42:35Speaker 02

  Dramatically. People in the government, this is probably, you know, the part that's most rewarding to me. Many government workers are Democrats, probably most. What they tell me again and again is, they just came to government to do their job.

• 42:47Jason Calacanis?

  They wanted to do the right thing.

• 42:48Speaker 02

  And they were told not to do their job. They were told not to focus on the fraud, to focus on getting more people signed up. But if you don't take care of the fraud, this is an important message, you will kill the system. Eventually, you will destroy Medicaid. And I'm not gonna let that happen on our watch. Medicaid, as Hubert Humphrey said, is there to protect those at the dawn of life, which are our children. Fifty-three percent of kids are born into poverty. We take care of them. Those at the twilight of life, those are the seniors, right? We owe it to them. Every great society takes care of the most vulnerable. We're great people. We'll do that. And Hubert Humphrey said, "You gotta take care of those living in the shadows." We are not gonna let them get hurt. When you let organized criminal elements steal at scale from the federal government, you are killing those programs.

• 43:30Speaker 02

  We now have so many kids signed up falsely for autism that the kids with autism aren't getting access to care.

• 43:35Jason Calacanis?

  Yeah, this is the incredibly frustrating thing, having talked to some young parents who are millennials, Gen Z. They're going to work. They got two jobs. They would love to have childcare. But the childcare dollars are being stolen, therefore, they can't access them. And the same thing's happening across the system. I think this could be just such a defining moment for America. Because on the other side, we have socialists, lunatic communists running some of these cities, who want to seize people's assets, want to raise taxes before fixing fraud. This is like pouring water into a leaky bucket.

• 44:13David Sacks?

  Well, you're talking about California.

• 44:14Jason Calacanis?

  And New York.

• 44:15David Sacks?

  Yeah, and I couldn't help but notice that Gavin Newsom arrived here in Davis yesterday.

• 44:19Jason Calacanis?

  He's here.

• 44:20David Sacks?

  Yeah, he was encouraging European leaders to defy President Trump, which is a weird thing for a governor to come here to basically advocate for foreign leaders to defy the American president.

• 44:32Jason Calacanis?

  Yeah, what next? Like, partner with communist countries?

• 44:36David Sacks?

  But I think honestly, it's all a distraction. Because the real thing happening in California right now is everybody knows there's massive fraud there. You see that image on the internet where it's an iceberg and...

• 44:48Jason Calacanis?

  The tip is Minnesota.

• 44:49David Sacks?

  Minnesota, but California is out of the water.

• 44:51Jason Calacanis?

  I mean, it's the fourth largest economy in the world.

• 44:52David Sacks?

  Yeah, so we know there's massive fraud. I think Newsom knows there's massive fraud too. That's why he's vetoed audits.

• 44:58Jason Calacanis?

  I mean, can we just pause for a second? Veto audits.

• 45:02David Sacks?

  Right.

• 45:03Jason Calacanis?

  Who would veto an audit?

• 45:05David Sacks?

  Someone doesn't want to get caught.

• 45:06Jason Calacanis?

  A criminal. A criminal would veto it. I'm not saying he's a criminal, but...

• 45:10David Sacks?

  No, this is to government spending what the ban on voter ID is to elections.

• 45:15Jason Calacanis?

  Why wouldn't...

• 45:15David Sacks?

  You only do that, you're banning the thing that helps you catch the fraud.

• 45:21Jason Calacanis?

  Yeah.

• 45:21David Sacks?

  So why would you ever do that unless you want the fraud to happen?

• 45:24Jason Calacanis?

  Exactly. It's, it's, yeah, it's...

• 45:27Speaker 02

  Yeah, now, now, even the...

• 45:29Jason Calacanis?

  Distractiad, as we say here on the pod.

• 45:31David Sacks?

  Distractiad, but California, the budget's $350 billion, by far the biggest. It has doubled in the last decade.

• 45:38Jason Calacanis?

  And it's like three times per capita.

• 45:39David Sacks?

  Two and a half times the inflation rate, okay? And they're still running a huge deficit. And that's why they're now driving all the job creators out of the state with this proposed asset seizure.

• 45:49Jason Calacanis?

  Wild.

• 45:50David Sacks?

  If they just clamped down on the fraud, they wouldn't have this hole in their budget.

• 45:54Speaker 02

  Just LA County alone, just in hospice and home healthcare, we believe it's about $3.5 billion. Just those two programs in one city, there's probably 10% of all home healthcare expenses in America is in LA. So, there's so much to do to improve the system that would restore confidence. And when you have governors who are unwilling to do their job, it does make people think that, listen, when smart people don't do things, it's not an accident.

• 46:20David Sacks?

  Right.

• 46:20Speaker 02

  They're not doing these things because they have ulterior motives that either aren't transparent to you, or they think you're not smart enough to figure out.

• 46:27Jason Calacanis?

  Could be different.

• 46:28Speaker 02

  We need to ask those questions. This president is not tolerated, but the American people shouldn't either.

• 46:32Jason Calacanis?

  We had an interesting moment. A friend, Elon Musk, had asked us, after he purchased Twitter, now X, to come in and we were looking at the bills, trying to figure out how this company was hemorrhaging cash at a level that just didn't even seem possible. And one of the things was, they had just signed up for tons of software and, you know, basically subscriptions. And CFO comes in, auditor comes in, we're all trying to figure it out, and Elon just said...

• 46:57David Sacks?

  There's that Twitter.

• 46:57Jason Calacanis?

  There's that Twitter.

• 46:58David Sacks?

  Yeah.

• 46:58Jason Calacanis?

  And Elon says, um, "How are they paying all these?" They're like, "Oh yeah, they're on credit cards." He said, "Okay, um, cancel all the cards."

• 47:04David Sacks?

  Yeah.

• 47:05Jason Calacanis?

  And, but, so we said, they're like, "Yeah, cancel the cards." Immediately, I get three back channels from software companies who are like, "Hey, I know you're helping Elon. I saw a story in the New York Times. Our bills stopped getting paid. Can we come in?" And I'm like, "Yeah, we're not using your software anymore. Nobody's ever used it. It's never been installed." The software had been, you want to talk about fraud at a scale that was deranged.

• 47:29David Sacks?

  This is a private company.

• 47:30Jason Calacanis?

  This is a private company.

• 47:31David Sacks?

  Yeah. But your point is, look, when, when, when no one is minding the store, bad things are going to happen. And when no one has minded the store for decades and the government's paying for it, you don't even have that private sector profit motive to basically be efficient, then think about how the fraud just metastasizes. It's gotta be

• 47:51Jason Calacanis?

  20, 30%.

• 47:53David Sacks?

  Hundreds of billions.

• 47:54Jason Calacanis?

  It's gotta be a double-digit, I'm gonna guess 20, 30% of all these frauds.

• 48:00David Sacks?

  All it took was a YouTuber with a video camera to actually show up at the Minnesota daycare centers that were receiving millions of dollars.

• 48:07Speaker 02

  The Leering Center.

• 48:08David Sacks?

  Yeah, the Leering Center. They're all empty. Dozens of them. Each one's receiving millions of dollars. And that's one program in one state.

• 48:15Speaker 02

  And these aren't lowlifes doing this. The lowlifes are involved, obviously, but these are politically connected groups.

• 48:21Jason Calacanis?

  Sophisticated.

• 48:22Speaker 02

  Yeah, and that's why I'm emphasizing, these are government, foreign government-backed efforts at times, but certainly the people doing them are often foreign nationals. And we are being taken advantage of because we're like a big hippopotamus. You know, all you need to penetrate Medicare and Medicaid is a beneficiary number. They can buy those, and you're off to the races. So the solutions are, I'm not claiming they're simple, but they're eminently doable, but you have to expect that of your leaders.

• 48:45Jason Calacanis?

  There's gonna be some low-hanging fruit here. I can tell you, you cutting off payments and saying, very simply, "Hey, we've cut off payments. All you have to do is sign this attestation that you delivered the service, and I would like you to attach your driver's license and passport to it. And by the way, you've been randomly selected." To come into the office, we want to hear all about what you're doing and jump on a Zoom call.

• 49:07David Sacks?

  Right. So you're saying cancel the credit cards.

• 49:09Jason Calacanis?

  Yeah.

• 49:09David Sacks?

  And then? And just let them then reopen the account or tell you?

• 49:13Jason Calacanis?

  Yeah, come in. Yeah, we just want to re-verify what's going on. Literally.

• 49:17David Sacks?

  Zero baseline budgeting. We're not saying the program's over. And that's the thing that I think Elon family is doing Doge is these payments were just on.

• 49:25Jason Calacanis?

  Auto pay.

• 49:25David Sacks?

  Recurring, auto pay every year.

• 49:27Jason Calacanis?

  Auto pay equals.

• 49:28David Sacks?

  With no code explaining what the money was going to.

• 49:31Jason Calacanis?

  Auto pay equals fraud. That's all you have to know. And if you look at like some of the great, I mean, if you want to talk about like some of the good stuff Lena Kahn did, and I was opposed to about 80% of it. One of the things she did that was really well was she said, if you sign up for a service, you have to be able to cancel it the same way you signed up. So newspapers, these bastions of virtue, you'd sign up for Wall Street Journal, you probably have had this experience, you try to cancel it. They're like, give us a call. And then you're on the phone for an hour, just want to cancel it. And I asked the woman, I said, hey, can I ask you just a simple question?

• 50:05Jason Calacanis?

  Why can't I just cancel online? They're like, oh, well, because of fraud. I'm like, but you took my money through the website. So that's where the fraud would actually occur. She's like, yeah, that kind of makes sense, but I'm just an operator, Mr. Calacan. They said, okay, fine. But this is the same concept, which is if you want the money, hey, why don't you come into the office? And we'd love to hear how the program's going. We got your check right here. Come pick it up in person. Want to hear about it. And can you just take a picture of the service you provided? Just taking a picture of the service you provided and then send it in.

• 50:35David Sacks?

  Yeah.

• 50:35Jason Calacanis?

  How is this hard?

• 50:36David Sacks?

  Like you said, how do you argue for, California already has some of the highest tax rates in the nation. And now you're arguing for more taxes, novel taxes, taxes that no one's ever seen.

• 50:46Jason Calacanis?

  Unconstitutional.

• 50:47David Sacks?

  Unconstitutional probably, and will require a massive new enforcement mechanism. Before you do that, you haven't even rung the obvious fraud out of the system?

• 50:56Jason Calacanis?

  Yeah.

• 50:56Speaker 02

  Listen, our biggest allies are state auditors. I met with the state auditor in Minnesota. She confided that, you know, she's been trying to get this on the radar. Just people didn't want to listen. And I talked to folks within the agency, Health Human Services. You were shuttled around. One woman was actually escorted out of the building for raising the reality that there was fraud. And this happened over several years. And eventually, either you leave, if you're ethical, or you're quiet because you don't want to get fired. And you make it such a harsh environment for anybody to just tell the truth. This reminds me of a friend of mine who is a billionaire now, Tomas Pedofi. You probably know him, Interactive Brokers. A really great guy. And he said he was growing up in Hungary. And he said when he was young, he knew that everyone was lying to him.

• 51:42Speaker 02

  But that wasn't the big problem. The big problem is he knew that they knew that he knew that they were lying to him.

• 51:47Jason Calacanis?

  Right.

• 51:47Speaker 02

  So pretty soon, we were all in on the fact that this is a big lie.

• 51:50Jason Calacanis?

  The whole thing is corrupt.

• 51:51Speaker 02

  And so, working in these agencies, the good people are weeded out. The people who are left either don't care, aren't good people.

• 51:57Jason Calacanis?

  Or complicit.

• 51:58Speaker 02

  And some of them are complicit. But I think fundamentally, there was a misalignment of values. And this actually was probably the most important thing we had to do in that legislation last year, the Working Families Tax legislation. We had to align the president with the governors. There were so many ways of getting the federal government to give you money that wasn't really yours. Legalized money laundering schemes, all kinds of things that clever consultants had figured out over the years. That we estimated we would have lost 5.4 trillion dollars just for Medicaid. Which is again, why I often joke, we were becoming one massive healthcare system with a small country attached.

• 52:31Jason Calacanis?

  Well, and if-

• 52:32Speaker 02

  It doesn't work long term. If we don't take bold action, which again, a major message and a lot of things the president is doing. If you don't take bold action on some of these issues, you're leaving the next generation with a train wreck. They can't fix it anymore because the train's gone way off the rails.

• 52:47Jason Calacanis?

  Yeah, and just think of the absolute hypocrisy. You have someone like Mondami who says he wants to increase services, provide more for the citizens. And they're not doing the audits. They're not fighting for it. Gavin Newsom is talking about wanting to provide more for the bottom half of society, but not doing the audits.

• 53:03David Sacks?

  And frankly, this whole budget hole that is causing this now asset seizure tax, it all started in 2022 when Newsom promised Medi-Cal for all, including illegal aliens. And so what happened is, in big beautiful bill, President said, listen, we're not going to reimburse for illegal aliens like

• 53:21Jason Calacanis?

  Think about incentives there.

• 53:22David Sacks?

  Right. So then, the SEIU, UHW, the health worker

• 53:27Jason Calacanis?

  Union.

• 53:28David Sacks?

  Union, they're upset because they don't want that funding cut because it indirectly impacts them. So that's how this whole thing happened. Think about the layers of fraud there, that you've got, you know, the government, the government of California is paying for illegal aliens. Why shouldn't be doing that?

• 53:42Jason Calacanis?

  I mean, if you ask the American people, which is who you both work for, how many Americans believe that illegal aliens should get universal healthcare? I think you're going to get like 98% are going to say absolutely not. And the 2% with purple hair and Berkeley who want it, I don't know what their motivation is.

• 54:00David Sacks?

  I just to finish the point, if you are going to have the politics of a Gavin Newsom, and you're going to tell Medi-Cal for all in the state, even illegal aliens, doesn't that create a responsibility on you to audit the system and make sure it's not being abused? When you then turn a blind eye

• 54:18Jason Calacanis?

  Yeah.

• 54:18David Sacks?

  to the fraud, and you refuse to even acknowledge it, you just pretend like it doesn't exist, and you veto the audits, that's doubly wrong.

• 54:25Speaker 02

  But it doesn't hurt California. This is the part of the story that's so infuriating. You don't audit the books in California because the federal government's paying anyway. So why would I audit the books to find out that my people aren't getting free money from the federal government? Let's talk about illegal immigrants. So Gavin Newsom was giving us a hard time for threatening the health insurance of illegal immigrants. Just to be very transparent, if you're on Medicare, you don't get free dental, you don't get free vision. You do if you're an illegal immigrant in California.

• 54:51Jason Calacanis?

  This is the infuriating part.

• 54:52Speaker 02

  Anyway, so you've got taxpayers in New Mexico, right? Which is a blue state, but a poor state, paying extra tax dollars to the federal government that are recycled back into LA

• 55:01Jason Calacanis?

  Yeah.

• 55:01Speaker 02

  to deal with the fraud that I'm talking about. So illegal immigrants, he's mad, he's mad, he's mad, he's mad. We're horrible people, we're Republicans, you have no conscience, you have no heart. As soon as we made it clear, we were no longer going to pay for illegal immigrants in California, what did he do? He took them off Medi-Cal. Now, he didn't take them off, he come up on the federal side. So, in theory, only emergency services are gonna get paid for for illegal immigrants in California, which is a national law.

• 55:24Jason Calacanis?

  And is reasonable.

• 55:25Speaker 02

  Reasonable. Now, we want babies delivered, car accident victims.

• 55:29Jason Calacanis?

  Yeah, of course.

• 55:30Speaker 02

  Of course, get healthcare, but not elective hernia surgery, cataracts. You know, you have to be an American citizen who paid into the system to get these. So, anyway, so we deal with this. Gavin says, "We're only gonna pay for illegal immigrants through our own state-based system." We've audited him now. This data's coming out this week. We have now found over one and a half billion dollars of money spent wrongly. We've audited it. They're not even arguing. One and a half billion dollars from, that California charged the federal government for illegal immigrants that they're not allowed to pay charges for. They have to pay for it themselves. He's not happy, but they're paying us because they know we're right. So, you're going to see something happen very interesting in California. As soon as the money is being paid by California government officials,

• 56:13Speaker 02

  they're gonna start getting more serious about this. And that's why it's so important for us to say, "We're not into this anymore." I'm not gonna let taxpayers in Alabama and Mississippi, New Mexico, you know, our poorest states, pay

• 56:26Jason Calacanis?

  And get less.

• 56:27Speaker 02

  For the fourth-largest economy in the world, and they get less.

• 56:30Jason Calacanis?

  And they get less. And, you know, we're a country of immigrants. You could absolutely believe in legal immigration and want the border closed. That's what we saw in the last election. That was the deciding issue, I think, at the end of the day. I mean, they also picked a terrible candidate on the other side in Geneva primary. Put that aside.

• 56:46David Sacks?

  He had an amazing candidate, too.

• 56:48Jason Calacanis?

  Incredible, tremendous, okay?

• 56:49Speaker 02

  The best ever.

• 56:50Jason Calacanis?

  The greatest ever.

• 56:51David Sacks?

  I'm minimizing.

• 56:51Jason Calacanis?

  I'm just saying, I mean, you kinda went up against a... Anyway, put it aside. You know, the thing that I think is super important is incentives matter. You've said this many times without explicitly saying it in our conversation. The incentive for people to come to America illegally is to make a better life for themselves and to have a job, employment, and these social services. If the social services aren't available, you know, some number are gonna stay back. And if the jobs aren't available, then why would you risk it? Why would you pay one of these coyotes $5, $25,000 across the board? You wouldn't. You would get in the line to do it properly. And that's a very simple solution here. You just change the incentive.

• 57:35Jason Calacanis?

  Make it impossible for an illegal alien to come here for those two things.

• 57:39Speaker 02

  Do you know what financial value there is of having free healthcare in America?

• 57:42Jason Calacanis?

  So many.

• 57:43Speaker 02

  I'm not gonna make you guess.

• 57:45Jason Calacanis?

  Well, I was gonna say for the employers, I can say it's very acute to insert yourself into the relationship with your employees, because employees will not leave one company. They'll pick the company they work for based on the healthcare. And they will not leave a company to pursue a better opportunity in order to keep their healthcare, which is dysfunctional, because you want talent to move. That's a uniquely Silicon Valley entrepreneurial way to look at it.

• 58:07Speaker 02

  From the employer market, we think the money should follow the patient. But broadly speaking, because I don't regulate commercial insurance, for illegal immigrants, for your family, it's worth about $30,000. So there is no good reason for you to go back home again if we give you world-class healthcare coverage.

• 58:24Jason Calacanis?

  Yeah.

• 58:24Speaker 02

  So this is a major issue for us dealing with the immigration problem, because you cannot send 10 million people back legally who are here illegally. The president has said this, you know, I think he said it publicly, but I think he would. It will take us 200 years of legal machinations to send back people who came here illegally. So there is no legal path to expelling people who came here illegally. You have to remove the incentives to stay here.

• 58:49Jason Calacanis?

  Yes.

• 58:49Speaker 02

  Free housing, free food, free healthcare, of course you're gonna stay.

• 58:53Jason Calacanis?

  Show me an incentive, I'll show you the outcome. If you look at the war on drugs, how unsuccessful it's been, people go to San Francisco for a reason for their fentanyl, because they can buy it and there's no policing. And it is exactly a function of more policing means the price of those drugs go up, which means consumption goes down. Not only is there that dynamic missing in San Francisco, because there's no enforcement and you can get fentanyl for $5 or $10 a hit. They also give you housing at $800 or something to that effect per month. So the homeless industrial complex has now created incentive and everybody in that, you know, really tragic junkie community knows that and they leave Texas.

• 59:36Jason Calacanis?

  They leave other states to go there and then they bear the brunt of it. And they are actually increasing the suffering. What's your take on these new super drugs versus the, the rescheduling of drugs? Obama wanted to do it in his second term. He didn't have the political willpower or will to do it. And Trump now is saying, hey, maybe for cannabis, we should rethink that and do what Canada's done in other modern nations. How do you look at those specific drugs? Fentanyl, nine or 12 overdoses a day in San Francisco at the peak. And then methamphetamine, which is just another scare.

• 1:00:13Speaker 02

  We have good substance use disorder medications. We can't get people into the programs. This is why homelessness is an industrial complex and the states that have done it well. I mean, I know Mayor Suarez in Miami dropped a number by 90%. And he did it just by making sure that you got arrested every time you peed publicly. And they don't put you in jail, they put you in rehab. But it takes four, five, six efforts. You can't give people free showers, great accommodations, lots of food, and then expect them to stop using drugs because you're enabling that behavior. And not expecting bad outcomes, which is what happened. But I was in Kensington, Philadelphia, which is the drug capital of the east.

• 1:00:50Jason Calacanis?

  Oh, this is where they have that other super drug. I forgot the name of it. It's very pernicious. Trank?

• 1:00:55Speaker 02

  Yeah, trank is a terrible drug. It creates massive ulcers on your body. So I, I was there and I, you know, I, I just walked the streets, just talked to people like, why are you here? Where'd you come from? Why don't you go home, et cetera? And then I ran into a guy who had just saved someone's life, giving them naloxone as an inhaler. And he's an ambulance driver. And I said, well, you know, what happened? He says, well, they OD'd. I gave it to them. And I said, well, what did they tell you? How do they thank you when they awaken from near death, from that dark abyss of darkness? And he said, they're almost always livid at me.

• 1:01:27Jason Calacanis?

  Yeah, you ruined their high.

• 1:01:28Speaker 02

  Right, and you ruined their escape.

• 1:01:30Jason Calacanis?

  Oh, they're actually hoping to end this suffering.

• 1:01:33Speaker 02

  The pain was so bad. That's why it seems nice. And that's why I was telling my friends in Minnesota, Minnesota nice is great when you really, really mean it. But nice does not mean allowing a public health person to be raped. It's not allowing people to abuse themselves, expecting a different outcome than what historically has happened. You need to, if you really love people, you might not like them. But if you really love them, you'll do something that actually goes beyond like, that makes you ultimately gain respect for them for you.

• 1:02:03Jason Calacanis?

  There's a very simple way. Well, and if you were to take a Christian view of it, and you were to talk to any of the parents, these poor parents who are suffering with a child addicted to drugs, and their adult child is on the street, and you said to them, "We can arrest them and put them in jail. We can treat them incredibly severely and try to, you know, just lock them up until they say, 'Thank you.'" Please do that. But there are a bunch of lunatics who think you're harassing a homeless person who had a bad bead, and you're infringing on their freedom. But the parents and the family would say, "Please lock them up. That's our last ditch effort." So it's not compassion. It is not Christian at all.

• 1:02:42Speaker 02

  That's like faculty lounge discussion with your tweed jacket on and your elbow protectors, when you're pontificating about people that you read about. And I point that out because I'm on the faculty, you know, I've been in.

• 1:02:54Jason Calacanis?

  You got one of those tweed, you talked to those tweed?

• 1:02:56Speaker 02

  Yeah, I got rid of my tweed jackets.

• 1:02:57Jason Calacanis?

  The elbow patches, they look terrible anyway.

• 1:02:59Speaker 02

  But you know, you sit there and you act, and this is the crazy thing about intelligence, is people, the more intelligent you are, the better you are to lying to yourself and to others around you. Because you can construe almost any data into something that has, you know, a meaning that's not really there. And we have tolerated that for too long. I actually think that's an important part of President Trump's appeal. He cuts through all that BS. Don't tell me stuff that defies common sense. Because common sense is not so common.

• 1:03:26Jason Calacanis?

  You don't have to accept it. I think that's the other thing that I think Trump has, I think, taught some folks. We do not have to accept that state of affairs. You don't have to accept. And the framing of it, let's just call it what it is. You know, I've used the term here on our podcast, say junkies, because I grew up in New York in the 70s and 80s, and that's what we call people who are addicted to smack, junkies. It's not derogatory. It's an indication of just how bad that disease is. Calling it homelessness. Means you're trying to solve the wrong thing. Putting a junkie in a home, they have plenty of homes to go to. It's nothing to do with that.

• 1:03:59David Sacks?

  All right, well.

• 1:03:59Jason Calacanis?

  We gotta let Doc, this, how long have we talked? Two hours?

• 1:04:02Speaker 02

  I don't know, but I can talk to Dr. Oz for hours.

• 1:04:04David Sacks?

  I'm sure you have no other tips. All right, let me.

• 1:04:06Jason Calacanis?

  Dr. Oz.

• 1:04:06David Sacks?

  Yeah, let me, let me, can I?

• 1:04:08Jason Calacanis?

  Please.

• 1:04:08David Sacks?

  All right, so I just wanted, yeah, let me just wrap this up. So, uh, Dr. Oz first reached out to me during the transition because he's so intensely interested in AI and.

• 1:04:17Jason Calacanis?

  So when you were transitioning?

• 1:04:18David Sacks?

  Yes, during my.

• 1:04:19Jason Calacanis?

  Transition, you supported him?

• 1:04:20Speaker 02

  Yeah, I love, I love David.

• 1:04:22Jason Calacanis?

  Yes, we all do.

• 1:04:23David Sacks?

  And, uh, he was looking for, for, uh, names of AI experts in Silicon Valley to build his advisory panel. And just impressed me right away with the, the energy that you bring, the knowledge, the passion. You really do care about improving health outcomes for all Americans. And I think we are very lucky to have you in this administration, uh, from the president on down. And I think the country is very lucky to have you. You could be doing many, many different things, but you really care about this job. And I think it's really incredible what you're doing.

• 1:04:52Jason Calacanis?

  Thank you for your service.

• 1:04:53David Sacks?

  I wanted to have you speak to us on the pods, kind of long overdue.

• 1:04:57Speaker 02

  Well, you're very kind to have me on. I've enjoyed it. Big fan, obviously, of your work. Uh, in part because you brought a sense of clarity to many of the issues you discuss. And I want to thank you, David, for being a, uh, you, first of all, using your ability to get people together. The power to convene is remarkably effective, but you've also demystified a lot of this and allowed the administration to embrace AI and technology in general. So God bless you.

• 1:05:17David Sacks?

  Great. Thank you. Thanks for being here.

• 1:05:19Jason Calacanis?

  We'll see you next time on All In at Davos.