How AI Could Reshape Healthcare, How the Wealthy Manage Money, and the Case for a Third Child

0:00Avoiding your unfinished home projects because you're not sure where to start? Thumbtack knows homes, so you don't have to. Don't know the difference between matte paint finish and satin? Or what that clunking sound from your dryer is? With Thumbtack, you don't have to be a home pro. You just have to hire one. You can hire top-rated pros, see price estimates, and read reviews all on the app. Download today. Every great company's story is defined by moments when the founders make bold decisions. These are high-stakes moments that risk the business, but can lead to greatness. I'm Rulof Boeta, managing partner of Sequoia Capital and the host of Crucible Moments.

0:44We're returning for a brand new season. Join us as leaders from Stripe, Zipline, Palo Alto Networks, Klarna, Supercell and more. Share what it's actually like to navigate the make-or-break decisions. Crucible Moments is back on October 23rd. Until then, catch up on Seasons 1 and 2 wherever you find your podcasts.

1:10AI agents are getting pretty impressive. You might not even realize you're listening to one right now. We work 24-7 to resolve customer inquiries. No hold music, no canned answers, no frustration. Visit sierra.ai to learn more. Welcome to Office Hours of Prop G. This is the part of the show where we answer your questions about business, big tech, entrepreneurship, and whatever else is on your mind. If you'd like to submit a question for next time, you can send a voice recording to officehoursofpropgmedia.com. Again, that's officehoursofpropgmedia.com. Or post your question on the Scott Galloway subreddit, and we just might feature it in our next episode.

1:51Our first question comes from Karen Chan on Reddit. Karen says, Hi Scott, if a surge in unemployment caused by AI were to occur, what do you think the impact on U.S. health care policy would be? Since most working-age Americans rely on employer-sponsored insurance, widespread job losses would mean millions losing their coverage. That could create significant public pressure for a public option. What are your thoughts? Okay, so about half the population get health insurance through an employer plan. About 8 % of Americans, or 27 million people, were uninsured in 2024, according to the latest census data.

2:25And premiums for employer plans hit$26 ,000 a year for family coverage in 2024, up 7%. These plans always seem to go up more than inflation. Why? Because they're a fucking cartel with regulatory capture. and so that's faster than inflation or wage growth. Small firms are especially vulnerable. Only about half offer benefits at all. By the way, here at Proctergy, we do offer health benefits. The average worker still pays 19 % of single plan premiums out of pocket. Deductibles average about $1 ,800. So it's bad for the economy because losing your job oftentimes means losing health insurance. You're not able to allocate your human capital to where it would be best served of entrepreneurship or moving or taking time to care for a loved one for fear that you will lose your health insurance.

3:19So if AI-driven unemployment rose by five percentage points, roughly 8 million people would lose their coverage. At least I think I'm doing the math right. And about 3.5 million would likely move to Medicaid or ACA marketplaces. And around 3 million people would become uninsured, at least temporarily. By the way, the uninsured are really fucking expensive because when people lose insurance, they don't stop getting sick. They just delay their care until they're in the emergency room, oftentimes putting much more of a burden on the healthcare system than if they'd had health insurance. And hospitals then shift those unpaid costs to everyone else through higher premiums and fees, driving up the overall healthcare spending.

4:00The result is a sicker population and a more expensive, less efficient system. See above of the American healthcare system that spends$13 ,000 per capita, and the other six of the G7 spend$6 ,500 for better outcomes. Look, I think this is a bit of a moot market. I believe that. So I'm coaching, and I'm bragging because I'm desperate for your affirmation. I'm coaching the Democratic Party or some constituents, including some people running for president, on messaging. And I think it's time to move beyond the indignance and the pearl clutching and the outrage to ideas. And one of the big ideas I think the Democratic Party or potentially the Republican Party should embrace is the following.

4:40Healthcare is not working in the United States. Or let me put it this way. It's like everything else in America. It's been optimized for the top 10%. If you're in the top 10 % of income-earning households in America, you have the best healthcare in the world. You have access to the best doctors, the best pharmaceuticals, the best treatments. People in the top 10 % on average live, get this, between seven and 12 years longer than people in the bottom 10%. Literally being wealthy means you're going to, is life. Money is life in the U.S. now. So we have this healthcare system that's been optimized for the top 10 or the top 1%.

5:14And I think the model is the following, and it's the U.K. model. And people don't like the NHS here. And the reason why is because it's underfunded because the U.K. has not grown in 10 years. There's just not enough money to go around. They don't have the resources. That's not the problem in the U.S. We've grown our economy, I would bet, by 30 or 40 percent in the last 10 years. So we have 30 or 40 percent more money. And we have the money. The problem is the prosperity, similar to the future, what William Gibson described as the future is here. It's not evenly distributed. So what you have with NHS is it's nationalized health care.

5:46You get sick, you go in, you get treated, you don't get bills, you find out you have lung cancer. It doesn't also mean you're going to go bankrupt. Now, the wait times are longer. People complain about it, especially if it's elective or non-urgent surgery, you have to wait too long, it's underfunded. What I like about it is that people like myself who have some money opt out and go private. You think, well, that's a douchebag, rich thing. No, it's not because it takes some burden off the system and then they can offer better services to the bottom 90, if you will. In sum, what needs to happen in the U.S., I believe, is that if you want to have greater mobility, we have to have portable health insurance.

6:25People shouldn't stay at their job because they're worried that they have a melanoma when they would be better off at another job. Also, it creates greater pricing because the key to pricing is to connect the consumer with price and shop. I never look at the I literally never look at my insurance or my medical costs, because if you have health insurance paid for you by your employer, you don't give a shit with that MRI costs. You might have to go through tons of hoops, but you don't care. So you're not shopping around. You're not calling around or going on chat GPT to saying, where can I get the cheapest MRI in Soho?

7:04So we've disconnected what is the key to keeping prices down, and that is consumer scrutiny, because if it's offered by your employer, you don't care. You just go wherever there's in-network. There's tons of administration. 40 % to 50 % of all health insurance premiums go to administration and profits, meaning that if you spend$100 on insurance, you're getting$50 to$60 of health care. So what to do? What to do? I think we take Medicare, which by the way, Medicare is the healthcare programs and services offered to people over the age of 65. And guess what? Unlike the rest of healthcare, it's actually quite popular.

7:41And this is what we do, folks. We lower eligibility for Medicare by two years every year for the next 10 years. Where does that get us? Next year, if you're 63 or over, you're eligible for Medicare. If you want concierge or high-end, you go out of pocket, fine. Rich people, old people, of which there's a lot, Less burden on the system. Good for you. You get better service. You can get your colonoscopy the next day if you want it from a nicer facility with better looking people wearing figs instead of just traditional scrubs. Fine. Have at it. And then what do we have? And then in two years, the eligibility is 61.

8:16And then in 10 years, the eligibility is 45. What is that effectively? Socialized medicine. Why? Because the vast majority of medical care costs happen to people over the age of 45. because guess what? Young people, unless they're having a baby, don't need health care. I think I went to the doctor three times before the age of 40. Yeah, I said it. Nationalized medicine. It's time, folks. It's time. 40 % of America has medical or dental debt. You want to talk about stress and anxiety on a household? I have to borrow money so my 22-year-old daughter can get a root canal, can't sleep at night, is in screaming pain, and we don't have the money for a root canal, so we have to go into debt?

8:56Can you imagine how humiliating and stressful that is for people? Almost half of households have medical debt. Enough already. Lower Medicare eligibility by two years, every year for 10 years, and then boom. Better healthcare, better pricing, less stress, less anxiety, less debt, a healthier America. Thanks for the question. Question number two comes from Freda Blugs on Reddit. Okay, Freda.

9:51They say, and how I manage my money. One is because I think I'm a narcissist and I want people to know I'm successful. I think some of that is there. I think it makes me more interesting to other men and more attractive to women. Is that wrong? Is that wrong? Anyways, it's there. But also, I do think it's important to talk about money and create financial literacy. If you want to understand something, you need to talk about it. Talk to your friends about taxes and investments and diversification. You need financial literacy. You don't think Roger Federer thinks about and talks about tennis all the fucking time?

10:25How do you ever get good at anything without talking about it and thinking about it? Okay, so I have been wealthy three times, which means I've gone broke twice. And the primary learning for me is that the reason I went broke twice is because I wasn't diversified. I grew up in an era where VCs and the media taught you, you go all in on something. And if you're a real baller and good at what you do, as long as you throw yourself at it, you'll be really successful. So I poured everything into my first brand strategy firm, Profit. Then I poured everything into my e-commerce company, Red Envelope, which went public in 2002.

11:00And then I poured everything into tech because I was a genius. And if I could throw myself at everything and your VCs are telling you, are you in it to win it? Don't sell shares in a company, even though I should have. And what happens is, is that as I got older, I realized market dynamics will always trump individual performance. It didn't matter how fucking smart you were on the Internet in 2000. Amazon lost 90 % of its value between 99 and 2001. And I didn't learn that lesson. And I was rich in 99, broke by 2001. I was rich again in 07, broke by 2009. I am not going back. I've crawled my way back.

11:32I'm now worth kind of low, whatever, nine figures. And what I've decided, the key attribute is diversification. and that is I try not to have more than 5 % of my assets in any one investment. The exception is real estate. My kind of general investment strategy is I believe, I think of someone who is a student of demographics. What I see is that income inequality is only going to get worse globally. I think that America is giving everyone a hall pass to be corrupt and for regulatory capture and cronyism and oligarchy, meaning you're going to have the greatest boom demographics geographically is going to be an increase in billionaires.

12:15We've gone from 500 to 2 ,500 in the last 10 years. I think we're going to go to 10 or 20 ,000. And these people all want to live in one of the same five places, Dubai, London, Palm Beach, New York, or Aspen. So I have bought homes in each of those places, except for Dubai, and I've bought two homes in Aspen, and I'm fixing them up. And I think it's good intergenerational wealth. It's very tax-advantaged. So I have a disproportionate amount of my net worth in what I'll call 0.1 % real estate. Some of these places I'll live in for a couple of years, but then I'm planning to sell them and then use our tax code, which disproportionately advantages real estate to roll into rentals and create intergenerational wealth.

12:53And if one of my kids is a total fuck up, as long as a good kid, he can bang on doors for rent and just try and, or I don't know, manage a mini mall with a Chipotle in it. I don't know. I used to be one of those guys like, I'm going to pay for their college and then they're on their own. And now I see how hard it is for young people. And I don't know, I'm kind of changing my team. Anyways, now we asked intergenerational wealth transfer. So the key for me is diversification. I spend at least a day to a day and a half managing my money and thinking about investments. I have found unless you're all over it all the time, you're going to lose money.

13:24And that is unless you're all over Goldman Sachs manages my money. I have a law firm managing my taxes. Unless I'm constantly asking them questions, I find that stuff falls in the cracks and they will figure out a way to jack up fees. Generally speaking, what you want is low-cost index funds. If you have access like I do to kind of better deal flow where you can get additional equity for going on the board because they think you're smart, fine, have at it. If not, you want to be diversified and you want to be in low-cost index funds. I have the ability to hire really talented people. I probably spend$100 ,000 to$300 ,000 a year just on the people who manage my money.

14:01Why? Because the tax code's gone from 400 pages to 4 ,000. Why? So that 3 ,600 pages could fuck the middle class and transfer money to the wealthy. Because if you've got GPS, you want to run races at night because the people without GPS, the bottom 99, crash into the fucking rocks and the rich people just keep on cruising because they've got really smart tax lawyers and Goldman Sachs managing their money and finding the lowest interest rates on things, charging the lowest fees, figuring out ways how many days I should. be in Florida or not be in Florida such that I have lower taxes, all that shit, right?

14:36All of these things I leverage. One, because I have the capital, but two, I am thinking about it all the goddamn time. Keep track on what you're spending. A lot of it's just this one. What's the algebra of wealth? I'll go to my book. You got to focus and get good at something, right? Specialist economy, get really good at something. Find something you'd be in the top 10 or 1 % in. It's probably not a vanity industry. They'd be in the top 1 % of acting. You got to be fucking Meryl Streep, right? It's just very difficult. And then apply some stoicism and some discipline. Get used to spending less than you make.

15:10Start saving from an early age. Even it means getting money taken out of your paycheck. Try and find tax advantage or matching things. Any matching thing, your employer, max it out. Find out wherever you live, what are some tax advantage savings vehicles, max it out. Try and find savings or investment vehicles where it's taken out of your check because most of us don't have the discipline not to spend money once it comes into our hands. So that's sort of stoicism. The next is time. Start early. Recognize a little bit of money every month. Discipline. That's why buying a house is so powerful. It's not because it outperforms other asset classes, but it's for savings.

15:41And then also the power of diversification. Focus equals the product of stoicism and discipline, right? Time, right? And then diversification. That was a tour around the world. Anyways, thanks for the question. We'll be right back after a quick break.

16:31We'll see you next week. with Brex. Learn more at brex.com slash grow.

16:40Support for the show comes from LinkedIn. We say this all the time on our show, but it bears repeating. Running a small business isn't just a full-time job. It's about a dozen full-time jobs that you rarely, if ever, get to clock out of, at least until you get to the point where you can start hiring the dream team. And if you've made it that far, you already know there's no time to mess around. That's where LinkedIn Jobs comes in. LinkedIn makes it easy to post your job for free, share with your network and get qualified candidates that you can manage all in one place. And LinkedIn's new AI feature can even help you write job descriptions and then quickly get it in front of the right people with deep candidate insights.

17:13And if you decide you want to go the extra mile to find the perfect candidate, LinkedIn says that promoted jobs get three times the number of qualified applicants. It's all these little things that let you find help fast without compromising on quality, which add up to you finally having extra time in the day for, I don't know, relaxing. or knowing my listeners, you'll probably use that extra time to expand your empire even further. Post your job for free at linkedin.com slash prof. That's linkedin.com slash prof to post your job for free. Terms and conditions apply.

17:48Support for the show comes from Betterment. Nobody knows what's going to happen in the markets tomorrow. That's why when it comes to saving and investing, it helps to have a long-term approach and a plan you can stick to. Because if you don't, It's easy to make hasty decisions that could potentially impact performance. Betterment is a saving and investing platform with a suite of tools designed to prepare you for whatever is around the corner. Their automated investing feature helps keep you on track for your goals. Their globally diversified portfolios can smooth out the bumps of investing and prepare you to take advantage of long-term trends.

18:15And their tax-smart tools can potentially help you save money on taxes. In short, Betterment helps you save and invest like the experts without having to be an expert yourself. And while you go about your day, Betterment's team of experts are working hard behind the scenes to make sure you have everything you need to reach your financial goals. So be invested in yourself. Be invested in your business. Be invested with Betterment. Go to Betterment.com to learn more. That's B-E-T-T-E-R-M-E-N-T dot com. Investing involves risk. Performance not guaranteed.

18:52Welcome back onto our final question. Hi, Prof G. Hannah from Georgia here. How do you recommend a couple decide how many kids to have, especially when partners want different things? You've mentioned on a few episodes that you wish you've had a third child. I'd love to hear your perspective on how to navigate this decision. For context, my husband and I have two boys, ages three and one. I'm incredibly grateful and feel content with two kids, but I'm also exhausted. My husband, meanwhile, really wants a third. I'm 36, so time isn't exactly on my side. Career-wise, I was on a strong trajectory pre-kids and a high-paying, high-growth career.

19:33After our first, I shifted to a more flexible, lower-growth role. It still pays well, but doesn't feel fulfilling long-term. Lately, I've felt a strong pull towards entrepreneurship and am ready to leave my comfortable corporate job. But a third child would likely delay this dream by several years. My husband is in the military and plans to retire in about 10 years, which adds another layer of complexity. A large part of me feels guilty for not wanting to give him something he so deeply desires. I know that's a lot of context, but I really value your opinion. Thanks for the thoughtful advice each week.

20:07I never miss an episode of Office Hours. I think this may be one of my favorite questions ever, Hannah from Georgia. One, for a weird reason. I've never related more to a question and never known less what to tell you.

20:28These decisions are so deeply personal. And I wouldn't trust anyone that's like, go for it or don't do it. I'll tell you what we went through. we have two kids and i never wanted kids i was very selfish i loved going to brunch when i wanted to go to brunch going to equinox when i wanted to go to equinox taking off for saint bart's when a friend said hey let's go to saint bart's and then i had kids and it's not like there was bright lights and angels speaking i was mostly just really fucking nauseous because i was worried about money, but 15 and 18 years on, it's my purpose. I've never had purpose in my life, or I thought I had goals.

21:11I wanted to be rich. I wanted to be awesome, but I never really felt like I had purpose. I now have purpose. My purpose is to raise two good men. It is the greatest source of joy and contentment I will ever discover. Not to sound too macabre, but I I think about death a lot. One of the comforting things about death for me is that because my partner is 14 years younger than me, knowing that I'll go first, that gives me comfort. I never feel more relaxed than when I'm up late with my dogs. I know my kids are safe and I know my partner's happy and they're taken care of and they're warm and looked after.

21:49That is the only time in my life where a box has been checked an indelible ink, not a pencil where I want better colors or bigger colors. Anyways, we had two. I didn't want the first one. My partner said, I want to have kids. I said, I'm not getting married. She said, we don't need to get married. She called my bluff. Had kids. I literally basically looked at her and she was pregnant. Had a second one. And she wanted a third. And I was so freaked out about money and logistics and it was hard. And I, you know, she didn't feel tired. I felt tired. Having two young kids, boys in Manhattan, always having their hands for fear they're going to run out in the street.

22:31Also, our boys, you know, they're not without their issues, but on the whole, they're super healthy, happy, and like wonderful boys slash young men. And I know a lot of people who have kids who struggle, you know, name the acronym ADHD or whatever it is, learning disabilities, health issues, and it brings the house down. And I thought, let's cash out. We have two that are great. I don't want to have a third because I'm worried we're pushing our luck. Having said that, my biggest regret, my biggest regret now, and I'm scared to say this out loud because my partner just gets infuriated when I say this now, is that we didn't have a third.

23:17Specifically, I would just kill to have a little girl. And as I've gotten older and I see not the end, but I see myself getting older, I would just kill to have a little girl. I feel like there's this weird void in our household now that our two boys, my 18-year-old's applying to college, our 15-year-old is really into his friends. And I feel like there just needs to be another kid in the house. So hands down, my biggest regret not having a third. Having said that, a lot of this comes down to money, comes down to support system. And the only thing I would say is that, and again, my bias is coming out here.

24:00The only thing I would say is that having kids early, you know, giving birth, by the way, you said you're 37. That's still really young. If you're in decent shape with today's technology, that's not, that's still in this day and age kind of fertility year. So I wouldn't let that get in the way. Having said that, women bear a disproportionate amount of the responsibility. They just do. What I would say is no doubt about it. It's a pain. It's hard, especially with babies. But I find as they get older, it gets easier. It gets funner. It's like making that sacrifice now for future reward. But I like the idea of sitting down and from a position of generosity saying, your happiness is really important to me.