Will Quist

@iamjakestream YC is amazing for, in this order... 1. YC 2. Megafunds 3. Folks who want entry from outside the valley into the 'game'

@iamjakestream 100%, no notes

This is downstream of the YC uncapped note terms. Founders rationally push for highest price possible after DD, so that the YC MFN converts for the least dilution possible. However sets the bar *very high* for subsequent funding and results in a lot of seed extension attempts

Most healthcare “innovation” is zero-sum at best, negative-sum at worst. I want to see more more positive sum HC ideas that grows the surplus rather than shifting it around

spiritually, it feels inevitable that AGI is born in California as a uneconomic carnival gizmo, and then dragged to New York, caged and put to work by men in grey tall towers that poke and prod it until it spills trillions out filtering through PDFs

Master of Bots for Slow? I am interested in hiring a 'master of bots' to work on software and bot stack at slow / build internal (and maybe external apps, etc) with me. This isn't a for sure role, but I am for sure interested -- application below...

@credistick @MosesSternstein They are too short term focused.

@MosesSternstein @wquist When the cost of private capital is low, and VCs are telling you stuff like “public markets are myopic”, “public life is bad for innovation”, etc — why would you go public?

"Companies have been going public later (and larger) because VCs wanted to extract rents on private market growth when interest rates were low. Not because it was better for founders." 👀

The number one place AI is really giving leverage? to creators in our creator fund who can now build software on their own and are optimizing the sh*t out of their busiesses with Cluade. So much so we are hosting a 2 day bootcamp for our creators & friends on bots for creators

@packyM I don't think alfred is gonna like that but amen.

@wquist I'm saying let a million Metropolises bloom

been saying this

@packyM Ok. Yes. Though take rates of the surplus generated matters - as do valuations paradigms. Everything trades at 20x EBITDA at some point, these net new industries just tend to faster. Which change the 'value' captured. Anyways, I'll go back to my small AUM corner...

ah i see what you're saying. not exactly the argument i was making but get your point. i don't really care what you call it. i wish more of the companies valued at $95b were just public. what i mean is that if more big industries can be attacked by companies that are VC investable (i.e. we're doing power and mining etc... now), there's more VC investable value up for grabs at whatever stage.

@packyM Venture capital is funding unproven ideas to find out if they’re true—where being right matters more than being likely. Investing in things already working, working more seems to have more in common with other jobs.

admitting that nothing / everything is venture capital is the next best alternative to actually being honest about what is / isn't venture capital trying to put $1b investments at $95b in the venture capital bucket is a terrible option (unless you are an LP who needs to put a lot of money into something called venture capital no matter what the risk / reward is)

@packyM but i would rather that be the approach than this

@wquist why is anything when you think about it

@packyM well, i can tell you

@gothburz coming here to be the 1000 lucky person to tag @tjparker

I am Sam Hazen, CEO of HCA Healthcare. The largest for-profit hospital system in the United States. One hundred and eighty-two hospitals. Twenty states. I oversee a spreadsheet called the chargemaster. It has 42,000 line items. Each line item is a price. The prices are not real. I need to be precise about that. They are not estimates. Not approximations. Not market rates. They are anchors. An anchor is a number you set high so that every negotiated discount feels like a victory. No relationship to cost. No relationship to value. A relationship to leverage. My team sets the anchors. That is the job. The price is correct. Take a drug. Keytruda. Immunotherapy. Treats sixteen types of cancer. The manufacturer charges approximately $11,000 per dose. That is the acquisition cost. What the hospital pays. My team enters it into the chargemaster. They do not enter $11,000. They enter $43,000. That is the gross charge. The gross charge is a fiction. No one pays it. No one is expected to pay it. The gross charge exists so that when Blue Cross negotiates a 68% discount, they pay $13,760, and the contract says "68% discount" and both parties feel the transaction was rigorous. A 68% discount on a fictional price produces a real price that is 25% above acquisition cost. That margin is where I live. My 2025 compensation was $26.5 million. Eighty percent of my bonus is tied to EBITDA. Earnings Before Interest, Taxes, Depreciation, and Amortization. It is also earnings before the patient opens the bill. Same dose of Keytruda at the hospital across town. Gross charge: $12,000. Blue Cross rate: $10,200. Same drug. Same dose. Same needle. Same cancer. Different spreadsheet. The CMS transparency data showed the ratio between the highest and lowest negotiated price for the same drug at the same hospital can reach 2,347 to one. Not 2x. Not 10x. Not 100x. Two thousand three hundred and forty-seven to one. For the same thing. In the same building. On the same Tuesday. The price is correct. Every drug in the chargemaster has twelve prices. Twelve. Gross charge. Medicare rate. Medicaid rate. Blue Cross. Aetna. Cigna. UnitedHealth. Humana. Workers' comp. Tricare. Auto insurance. And the self-pay rate. The self-pay rate is for the person without insurance. It is the gross charge. The fictional number. The anchor. The person without insurance pays the number that was designed to be negotiated down from. They pay the ceiling because they have no one to negotiate on their behalf. Same drug. Same chair. Same nurse. They pay the price that no insurer in the country would accept. I maintain a file. CDM line item 637-4892-PKB. Saline flush. Sodium chloride 0.9%. Acquisition cost: $0.47. We charge $87. That is an 18,410% markup. The saline flush is used before and after every IV infusion. A chemo patient receiving twelve cycles will be charged $87 for saline fourteen times per visit. I know the math. My team built the math. The math is the job. The price is correct. In 2021, the federal government required hospitals to publish their prices. The Hospital Price Transparency Rule. Machine-readable file. Gross charges. Discounted cash prices. Payer-specific negotiated rates. We complied. We posted the file. The file is a 9,400-row CSV on our website under "Patient Financial Resources." Four clicks from the homepage. Column F: "CDM_GROSS_CHG." Column J: "DERV_PAYERID_NEGRATE." My team designed the column headers. They designed them to comply. They did not design them to communicate. CMS reported 93% of hospitals now post a file. Compliance. But only 62% of the posted data is usable. That gap is where we operate. We are compliant. The data is published. The data is incomprehensible. A researcher downloaded our file. She spent three weeks cleaning it. She called the billing department for clarification on 340 line items. They transferred her four times. The fourth transfer was to a voicemail box that was full. She published her analysis anyway. Cardiac catheterization lab charges: $8,200 to $71,000 for the same procedure depending on the payer. The report received eleven views on our press monitoring dashboard. I saw it. I did not forward it. On April 1, a new CMS rule takes effect. Hospital CEOs must personally attest — by name, encoded in the machine-readable file — that the pricing data is "true, accurate, and complete." My name. Sam Hazen. In the file. Attesting that 42,000 fictional anchors are true, accurate, and complete. They are complete. I will give them that. Forty-two thousand line items is nothing if not complete. A new analyst read the transparency data. She asked why the same MRI costs $450 for Medicare and $4,200 for Aetna in the same building on the same machine. I told her the rates reflect negotiated contractual agreements between the payer and the facility. She said that doesn't explain the difference. I told her the difference IS the contractual agreement. She said that sounds like the price is arbitrary. I told her the price is the result of a rigorous, multi-variable analysis that accounts for acuity, case mix, regional market dynamics, and payer contract terms. She asked if I could show her the analysis. I told her the analysis is proprietary. The analysis does not exist. The analysis is my team, in Q4, adjusting the chargemaster upward by the percentage the CFO wrote on a sticky note. The sticky note this year said "6-8%." They chose 7.4% because it is between six and eight and it has a decimal, which makes it look calculated. She stopped asking. The price is correct. My insurance. The executive health plan. Not in the chargemaster. Administered separately. I do not pay the gross charge. I do not pay the negotiated rate. I pay a $20 copay for services at our own facilities. Gross charge for my treatment: $14,200. Insured rate for our largest commercial payer: $8,600. I pay $20. The executive health plan was designed by the Chief Human Resources Officer and approved by the compensation committee. I was not on the compensation committee. I was a beneficiary of it. That is a different thing. I benefit from the system I price. I price the system I benefit from. These are two separate facts that happen to involve the same person. HCA Healthcare was named the Most Admired Company in our industry by Fortune magazine for the twelfth consecutive year. That was February. The same month I sold $21.5 million in company stock and purchased zero shares. Fortune did not ask about the chargemaster. I am Sam Hazen, CEO of HCA Healthcare. I have 42,000 prices in a spreadsheet across 182 hospitals. None of them are real. All of them are charged. Same drug: $12,000 or $43,000. Depends on which spreadsheet. Which building. Which contract. Which page of which PDF. The patient who has no contract pays the most. The researcher who found the discrepancy got a voicemail box that was full. The analyst who asked why stopped asking. The executive who prices the system pays $20. On April 1, I will personally attest that this is true, accurate, and complete. The price is correct. The price has always been correct. I am the price.

@_truthseeking_ Isnt that the point here?

@wquist effectively meaningless statement

Automation of the physical world is a systems problem, not a robotics problem.

@davidlee @EricNewcomer Maybe I am the one using the wrong word. ;-)

@davidlee @EricNewcomer I 1000% agree. But I guess I don’t equate introspection and a pursuit of balance. I would characterize the greats I have been around as EXTREMELY introspective - just in a super narrow way.

Re introspection After I graduated from college and did not get offered a full-time job at the NYT where I was an intern, I decided to spend a month hiking on the Appalachian Trail to do some reflecting on what I wanted from life. Just three days in I remember journaling that I definitely still wanted to be a reporter. I spent the rest of the 200+ miles getting over a breakup, unplugging from technology, and reading Game of Thrones. If you know what you want to do and just pursue that goal, it is much easier to achieve than constantly reassessing and introspecting. But perhaps Andreessen thinks I should have introspected more given the career I chose. To some degree the need for introspection is about whether you are getting major things wrong or not. Obviously having some internal check-ins is one way to try to see. Avoiding introspecting fastidiously would seem to me to be a sign that your subconscious thinks you might be bothered by your actions if you introspected. Andreessen’s anti-introspection posture is particularly eyebrow raising given he also seems to avoid tough external questions. So we have someone with a penchant for nihilism and lust for power who is setting up every wall he can to avoid interrogating his drives.