Raghu Gullapalli

Yes, Prime Minister. That was my keystone. It taught me early that competence and cynicism often walk hand in hand. That real leadership is less about grandstanding and more about managing egos, dodging landmines & occasionally telling the truth on purpose. Everything since has just been a masterclass in how right Sir Humphrey was.

@BitcoinSapiens AI crushes the cost of doing. It doesn’t remove the constraints on getting. The game shifts from labor scarcity to bottleneck control.

Elon Musk said saving for retirement becomes pointless in 10 to 20 years. Not speculation. Math. Musk: “Don’t worry about squirreling money away for retirement in like ten or 20 years. It won’t matter.” We passed the event horizon. Retirement savings assumes scarcity persists. It won’t. AI and robotics collapse labor costs to zero. Living costs follow. You’re not saving for security. You’re saving for a world that stops existing. Musk: “If any of the things that we’ve said are true, saving for retirement will be irrelevant.”

@chamath At least Newsom doesn't confuse himself as either Jesus or a Founding Father, granted Trump is old enough.

Wow. Awesome. Thanks. Please also raise my taxes and destroy my children’s education more than you already have so my family and I can stay impoverished, uneducated and in your indentured servitude while we carry your branding on us.

My framework for who thrives: 1. Manual + cognitive + non repetitive → Resilient (surgeons, nurses) 2. Cognitive + non repetitive → Augmented, not replaced (specialists) 3. Cognitive + repetitive → High risk (claims processors) 4. Manual + repetitive → Robotics risk (labs)

AI doesn't eliminate these jobs. The complexity did. AI just reveals the waste. Simplify the system and a massive number of "jobs" become unnecessary overnight. That's the conversation nobody in Washington like @BernieSanders wants to have.

Insurers weaponize bureaucracy. The AI doctor, hospitals actually would onboard in a minute & pay for: one that argues with the $20/hr claims reviewer so the $500/hr doctor can go back to caring for patients.

@HealthcareAIGuy @CBinsights Incomplete. This map doesn’t share the RWD companiesKaiser sells their data to, nor the vendors they don’t permit to publish data on their novel diagnostics.

Kaiser healthtech and AI strategy map

@wolfejosh 🍩

what odds would you put of Bret Taylor selling Sierra to OpenAI + taking CEO with Sam moving to BoD? a) 0% b) 1-20% c) 20-60% d) 60-99%

@chrissyfarr 💯

Health AI startups are chasing "prestige logos": the 400 big academic medical centers. That's only 7% of the market. Mark Sendak (VegaHealth) on why the other 93% is the real opportunity 👇 * $45B IT market * Faster buying cycles * 18% claim denial rates driving urgent demand

@DrSuneelDhand You’ve got it backwards. Specialists like ophthalmologists won’t be replaced, they’ll be in greater demand. Also, ophthalmologists are surgeons. So your “least likely” category just swallowed one of your “most likely.”

The medical specialties most likely to be replaced by AI next few years: 1. Primary care doctors 2. Radiologists 3. Dermatologists 4. Psychiatrists 5. Ophthalmologists Least likely: Surgeons (although it’s still on the horizon) Did I miss any?

@itsolelehmann This isn't Hiroshima. It’s closer to: The invention of power tools You can build faster You can destroy faster But the world won’t collapse overnight

@chamath What I tell every company I work with, big or small: “AI will standardize what we know. The real opportunity is capturing what we don’t formally know but rely on every day.”

AI is stripping companies down to three key elements: 1) Expert Knowledge - this is the vertical specific understanding of what to do 2) Tribal Knowledge - this is knowledge of the fuzzy grey details that are poorly document and is what creates a dispersion in performance in companies doing roughly the same things 3) Hardware and Software - this is the glue that humans use to stitch Expert and Tribal Knowledge in order to perform If 1 and 2 are documented well, it allows you to rebuild how you do work. This isn't about replacing humans - in fact I think it allows you to grow faster and hire more people because with a great understanding of what to do, it requires more and more people to express judgement. This is why we built Software Factory and its being used by many established and large enterprises.

Ironically, Anthropic's Mythos strengthens Apple’s narrative. When AI increases cyber risk, closed systems become more valuable

@mcuban The cost-to-charge ratio is fiction. CMS-2552 allocates costs via square footage, FTEs and pounds of laundry. The result? A cost per discharge that's directionally useful and operationally useless. No service line leader can run their business on it.

Most hospitals don't know their costs. Things I've asked for that made them roll their eyes : A BOM for surgeries P&L for each insurance carrier P&L for Medicaid or Medicare business Why do they need consultants for everything. Why doesn't their CSuite know how to do any of it Why do they use GPOs when prices are insane Why do they work with carriers that underpay, late pay, deny everything, waste docs time with denial committees run by 97 yr old pediatricians. Why do they make no effort to sell direct to employers (excluding those on costpluswellness.com to avoid all the carrier abuse , and avoid being sub prime lenders for patient OOP Why do they abuse 340b Why do facilities fees exist Why do they abuse site neutrality Why do they abuse patients with charge master based bills Why do they not push for standard contract templates to reduce admin. Why do they accept so many different ins plans Anyone want to add more And for context, remember I think the biggest insurance companies are worse

@pitdesi Next shoe: end subsidies for unhealthy foods that cause metabolic syndrome. Shift them to plant‑forward, high‑protein, high‑fiber whole foods. Fortunately, we know someone on this thread who can help Congress with that.

I’m pretty anti nanny state but at first glance this makes complete sense. Should reduce diet-related chronic disease and have all sorts of benefits. And generally- taxpayer-funded nutrition assistance should fund nutrition! What’s a good counter argument?