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

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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 officehours of profitmedia.com.

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Or post your question on the Scott Galloway subreddit and we just might feature it in our next episode.

Our 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.

And 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 Procter, we do offer health benefits.

The average worker still pays 19% of single-plan premiums out of pocket.

Deductibles average about $1,800.

It's bad for the economy because losing a job oftentimes means losing health insurance.

You're not able to allocate your human capital to where it would be best served, entrepreneurship or moving or taking time to care for a loved one for fear that you will lose

your

health insurance.

So 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.

The result is a sicker population and a more expensive, less efficient system.

See above 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.

Healthcare 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 7 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%.

And I think the model is the following.

And it's the UK 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% in the last 10 years.

So we have 30% or 40% 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 just not evenly distributed.

So, what you have with NHS is it's nationalized healthcare.

You 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.

People 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 what 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 ChatGPT to saying, where can I get the cheapest MRI?

in Soho.

So 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 bucks of healthcare.

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.

And 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, find 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.

And 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.

Can 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 then boom, better health care, 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.

They say, hi, Scott.

How does a high-net worth individual manage their money and their investments?

I can't imagine that you log into Fidelity or Schwab like the rest of us to sell your covered calls, or maybe you do.

Do you make sure that credit cards and rent are paid on time?

Out of pure nosiness, can you allow allow us to peek behind the curtain of daily money management, tracking your net worth and following your investments at this different scale?

Okay.

I try to be very transparent about my

wealth 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?

How 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 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.

And 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 in 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.

I'm now worth, you know, 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 demographically is going to be an increase in billionaires.

We'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 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.

And if one of my kids is a total fuck up, as long as he's 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'm kind of changing my team.

Anyways, now what you asked intergenerational wealth transfer so uh 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 uh you're gonna lose money and that is

unless you're all over goldman's tax 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 a 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.

Why?

Because the tax code's gone from 400 pages to 4,000.

Why?

So that 3,600 pages just could fuck the middle class and transfer money 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?

All of these things I leverage.

One, because I have 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 discipline.

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 to 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.

Start 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, you're an 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 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 outperforms other asset classes, but it's for savings.

And then also the power of diversification.

Focus equals the product of stoicism and discipline, right?

Time, right?

And then diversification.

Whew,

that was a tour around the world.

Anyways, thanks for the question.

We'll be right back after a quick break.

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Welcome 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.

After 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.

I 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 have never related more to a question

and never known less what to tell you.

These 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 St.

Bart's when a friend said, hey, let's go to St.

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 kind of.

You know, 15 and 18 years on, it's my purpose.

I've never had purpose in my life, or I thought I had goals.

I 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 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.

That is the only time in my life where a box has been checked in 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.

Also, our boys, you know, they're not without their issues, but on the whole, they're super healthy, happy, and like wonderful

boys/slash 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 going to, we're pushing our luck.

Having said that, my biggest regret, my biggest regret now, and I

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.

Specifically, 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.

The 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.

These are my concerns.

How important is this to you?

Let's talk about the logistics, but also looking at through the lens of how you'll think about things in 10 or 15 years, because that 10 or 15 years

is going to be here in a instant.

Literally yesterday, my oldest was coming into bed with me on Sunday mornings and snuggling with me for 10 or 15 minutes and then sitting up and saying, let's make a plan.

I mean, it was like there was a Hallmark movie.

I'm like, where are the cameras?

And then yesterday I'm arguing with him about him taking the ACT

for his college apps.

And he's just rolling his eyes and like trying to avoid me around the house.

It was yesterday he was.

He was saying, Dad, let's make a plan.

It goes really fast.

Again, hugely personal decisions.

But the fact that you're with a loving partner, you have two healthy kids, and you're an issue right now is whether you have three or you just stick with two and you both have jobs and what sounds like healthy careers,

your problems are a function of you being in the most fortunate 99%

and the most fortunate 99.5%.

You know, well done.

Congratulations to you.

And I trust that you're in these conversations, taking pause to realize how lucky you are to be thinking this way about a loving partner and having a healthy family and children and just being in a position to be considering a third.

Such a nice place to be in.

Thanks for the question.

That's all for this episode.

If you'd like to submit a question, please email a voice recording to officehours at propgymedia.com.

Again, that's officehours at propgmedia.com.

Or if you prefer to ask on Reddit, just post your question on the Scott Gallery subreddit and we just might feature it in an upcoming episode.

This episode was produced by Jennifer Sanchez.

Our assistant producer is Laura Jannaire.

Drew Burroughs is our technical director.

Thank you for listening to the PropGPod from PropG Media.

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