Episode summary
GLP-1s Are a Bigger Business Than AI
Invest Like the Best
· · 1 hr 25 min · Hosts: Patrick O'Shaughnessy · Guests: Zach Reitano
Summary
Zach Reitano argues that American healthcare is broken because the patient usually is not the customer. In his view, the industry is organized around whoever controls payment at the point of purchase, which leads to opaque pricing, misaligned incentives, and mediocre experiences. He contrasts that with cash-pay markets like LASIK, cosmetic surgery, and GLP-1s, where prices fell, quality improved, and convenience improved once patients could choose directly.
He also makes a broader case that healthcare should be a much larger part of GDP, not a smaller one, because health is the foundation of every other form of progress. Zach says the U.S. already has strong acute-care outcomes, but chronic disease is the bigger problem, and GLP-1s are beginning to rewire both demand and pricing across the system. He expects GLP-1 use to keep spreading, potentially to more than half of Americans over time.
The conversation also covers Ro’s turnaround. Zach says the company refounded itself in 2022, cut staff, narrowed its focus, and rebuilt around a strong attract/strong repel culture, sequential execution, and vertically integrated software. He frames Ro less as a point solution than as a patient-first distribution platform for treatments that are becoming more effective and more accessible.
Key takeaways
- Zach Reitano says the core flaw in U.S. healthcare is that patients are usually not the customer, which creates opaque prices and weak accountability.
- He argues that GLP-1s show what happens when patients pay directly: prices can fall from $1,300 to $149 while the manufacturers still make more money.
- Zach says Ro has grown from about a $250 million run rate to over a $3 billion run rate while using fewer people than in 2021.
- He expects GLP-1 adoption to rise sharply over time, eventually reaching 50% plus of people, because the drugs address multiple chronic-disease pathways.
- Zach says Ro’s turnaround came from a strong attract/strong repel culture, sequential execution, and more explicit operating principles.
Notable quotes
“If I had to say like what is the problem with our healthare system, it is that the patient is not the customer”
“What happens when those go direct to consumer that list to neck gets entirely eliminated”
“I think the majority of people will be on it”
“We should not and we cannot prioritize jobs over lives”
How the episode opens
If I had to say like what is the problem with our healthare system, it is that the patient is not the customer. Whoever controls the flow of money at the point of purchase. That's the customer.
That's the stakeholder that everyone builds around. We just are not the customer in the majority of the interactions. Right?
You have like $1,300 drugs that people are paying behind the scenes $3, $400 for. No industry could survive with its prices not being public. I've got a first question based on our last phone call which was something you told me which just really stood out.
What percent of GDP do you think healthc care could or should be 10 15 years from now?
I think it should be as high as possible. 50 70
Everyone's always complaining it's too high. Everyone's always complaining it's too high and I think that uh it's missing the forest for the trees. If you think about healthcare, I think it's the sinquon of life.
It's without which there is none. And it's actually depends how AI pilled you are, but your audience is probably pretty AIDS. If you imagine a life of pure abundance and you imagine Jeban's paradox does its thing, then the only good in our lives that does not have any diminishing marginal return uh is another healthy year.
And so to me, at the limit, you should be spending every single dollar towards the health of your society. And so when we look at uh the US and say, oh, we spend 18% of our GDP, that's a problem. My question is like, well, why?
We've never used absolute numbers like that as a problem.
From the episode’s captions: roughly the first two minutes, lightly cleaned. Keep watching on YouTube →
Topics
- glp-1s
- healthcare pricing
- telehealth
- healthcare outcomes
- digital health marketing
Companies and tickers mentioned
- Ro
Watch the episode
Watch “GLP-1s Are a Bigger Business Than AI” on YouTube
Summary, takeaways and quote selection by Octagon. Quotes are short excerpts; the full conversation is in the episode.
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