The Business of Design—and the Design of the Future

Jury duty.

I think it's an incredibly important civic responsibility.

I'm totally serious. One of my amazing life experiences was I was selected to be on a jury for someone who was accused of rape, and it was an amazing — there should be a movie about that experience. But in all seriousness, I try to get on juries, but they don't want me anymore. But back then they took me, so.

So Neri was like, 'Oh, well, this is a waste of time.' I said, 'No, it's going to be like one of the most important things you do.' And by the way, why? Because someday you may find yourself accused of a crime you didn't commit. And having people who take this seriously is like one of the most important things. So, you know, next time you get jury duty, it's really a good thing.

She's hot.

So I've always — you know, Neri makes fun and she says, 'Bill, you're a better architect than I am.' I always cared a lot about architecture. I focus less on design, but obviously in the last nine years of knowing Neri, it's something I've spent a lot of time on. Design is unbelievably important and powerful and a huge driver of our reputation, perception. So I think it's really, really important and we're, you know, we're building something right now and we're just in the process of like everything from a logo to, you know, presenting ourselves to the world and it makes a huge difference. So I probably under-appreciated the importance of design in the pre-Neri world. Yeah.

You know, I think she's doing well. You know, it's certainly compared to where she started. So her story is a massive brain hemorrhage due to a congenital weakness we were unaware of. She lived alone in Williamsburg, you know, a few years out of college. You know, the really unfortunate part is that we didn't find her for, you know, 15 to 19 hours after the incident took place before we could release the pressure on her brain. And most people who start in that circumstance, they either don't do the surgery because they think you're too far gone, or if they do the surgery, you know, you don't survive, or you survive three months in a nursing home and you die of pneumonia. So it was not a great place to start. And I can tell you today she's the same old person that she was before. Cognitively she's, I think, fine. She has the same sense of humor. Yeah.

But she's learning to walk again. She's learning to speak again. And she's hopefully learning to see again. So, you know, she's got a long way to go. But we make progress almost every day. We have a call with her doctors every day and her care team. And we do that at 4:00. So it was on the way here. And she had a great day. So every time she has a great day — it's not a perfect, it's not a straight line. But, you know, as I tell her, and, you know, for years I've been like talking to, you know, college students, whatever, I go and speak on campus about, you know, here's, you know, the nature of life is it's not a straight line up. You're going to have some kind of event. It could be you get fired, your startup crashes from a billion-dollar valuation to zero, you get divorced, your girlfriend leaves you, you have a major health incident, something like this happens. And the key is just as you work your way out of it, just make a little progress every day. Progress compounds. Well, she's a classic example of how important that is because if, you know, she — the good news about, you know, cognition is that she's coming back. The bad news is she understands her circumstance. And so emotionally, this is an unbelievably challenging thing and it just seems like the road's incredibly far and you're so close to it, you don't see the improvements. But people who didn't see her for a week or two weeks and they come back, you know, they notice, you know, the progress. So we just know the power of compounding. The way compounding works is it's a — I'll do it, you know, it's a line that you don't see much progress until eventually it goes vertical. Just like, you know, kind of the COVID thing where you don't notice it until it's everywhere. And she's still in this phase. She's not yet here. But she's going to get there. And, you know, we're in the fortunate position to be able to throw everything at her. And this is the best time in history to have a brain injury because of technology, brain-computer interfaces, AI, all these things are going to be very helpful to her recovery and to other people similarly situated.

Two things. It's not a pledge. We've already invested the money in the institute. And two, we've acquired about $300 million in real estate. So we're in now for about $700 million. And, you know, I feel very fortunate to be able to be, you know, whatever it takes with respect to this project.

Sure. I'm sure everyone here has had some experience with the health care system — a parent, a challenge, a child. And, you know, the problem: many health care systems are nonprofit. While philanthropy, nonprofit sounds like good, I'm a big believer if there's a for-profit solution to a problem, that's a much better solution. Now, for-profit health care also has its own sort of challenges, but, you know, the system is completely broken. The incentives are a disaster. The way reimbursement works, you know, like crazy stuff like, 'Well, we won't pay for the fMRI scan unless she's an outpatient.' Because — or we can't, you know, if you do the surgery and then you have this follow-on procedure, they'll only reimburse one number for the whole thing. So, you know, you have to wait a month between the two things or she has to check out of the hospital to get — I mean, it's crazy. The approach we've taken is, you know, we don't care about insurance reimbursement. We'll deal with that later. But very few people can be in that circumstance. So the system is fundamentally broken. The incentives are poorly designed. There's enormous waste. Now, on the other side of it, you have a lot of incredibly well-meaning, hardworking, intelligent people doing their best to deliver care in that environment. I could not be more effusively positive about, you know, the nurses, the doctors. You know, so you've got all these great people in a completely effed-up system. That's what we're — that's the state of health care in the United States.

So the solution is a complete reboot. You know, what we're doing here is, one, New York City happens to be a really good place to build a health care — you know, to redefine health care. And the benefit of having independent financing coming from one source is we can make decisions like a startup. You know, imagine a startup where you've got one big investor, you're not worried about having to raise money. You can focus on recruiting the best people. And, you know, I'm a business person. You know, I come to this with a bunch of skills that are helpful: recruiting, picking talent, designing incentives, real estate, business formation, all those things we're applying here. And, you know, I've been very fortunate in identifying a couple of super talented senior leaders here that are inspired by what's possible. We haven't announced them yet, so I'll keep their names confidential. We then — you know, I've got a good Twitter platform. So instead of hiring a search firm...

What's that? Okay. See, there's still opportunities for more followers.

By the way, I'm just shy of three million, so if we get grouped together, you know. The way we're doing it, you know, I basically put out a tweet saying, 'Here's what we're doing. If you're interested, let us know.' You know, I don't know what the number is, but we've got 1,500 incredibly high-quality expressions of interest. We're going through every one of them. We're getting back to everyone. This is something inspiring because almost everyone's had someone in the family with Alzheimer's, MS, a brain injury, a stroke, you know, a need for rehabilitation and have been dissatisfied with, you know, what's available. And we were kind of lucky in terms of timing or divine intervention. An incredible piece of real estate. You know, it's hard in New York City to get good real estate. We have a 3.4-acre campus on 65th, 66th on 11th Avenue. How about with views of the water? I mean, it's an incredible piece of real estate. Bought it for nothing. It was a — no, seriously, they spent $650 million building a 400,000-square-foot biotechnology building. We paid $191 million for the building. We bought it from Apollo, who was the first mortgage lender. The rest of the site we have under contract. It's the Saturday Night Live studio building, which we're — you know, don't tell Saturday Night Live yet, but we're going to tear that down. They'll probably do an episode about me when we tear down the building. And then we have, you know, a couple of additional acres. We do need the city to upzone it, which they've been doing for sites along 11th Avenue as part of the City of Yes program. But we have potentially two and a half million square feet of buildable area where we're going to bring a ton of jobs. And the other thing that's kind of cool is in addition to inbound from people who want to work there, we've had, you know, every brain-computer interface company, everyone adjacent in the rehabilitation space, you know, Columbia, NYU, Northwell, Mount Sinai have all reached out, want to collocate with us. And, you know, there are real synergies to be created kind of by doing this. So we're kind of, I think, optimizing from the best of nonprofit finance to, you know, kind of for-profit. We're going to have, you know, a Y Combinator-type accelerator. We're going to have a venture fund to help, you know, back these companies. We're going to help them succeed. We may have a for-profit AI affiliate. You know, if you think about AI, what do they need? They need training data. The brain is an unbelievable generator of data. We have not yet tapped that source of training data. These various hospitals have amazing scanning and patient and sample data that we can, you know, consolidate and leverage. And we're going to learn a lot and we're going to do it in a, you know, a Fast Company, you know, approach to business building. So, you know, super excited about it.

And they are. I mean, Neuralink has like a $42 billion valuation in the secondary market. We were leading a round of financing for a company called Precision Neuroscience. You know, they just — we'll let them make their own announcement, which they're going to do shortly, but they raised, you know, $250 million, you know, billion-plus post-money valuation. This is the era of brain-computer interfaces. It's not just Neuralink. There are a dozen companies doing super interesting stuff. Neuralink is one of the more invasive technologies. I'm particularly interested in the sort of less invasive technologies, but just recording what's going on in the brain. There's just a lot of really cool stuff kind of going on. The benefit here of nonprofit is the nonprofit institutions get a little squeamish about doing business with a for-profit enterprise. So I think it's just easier for us to do business with Columbia and NYU and these others in the context of, you know, so we're going to do our best to get the best of nonprofit-for-profit. Obviously, any profits that are made here — and by the way, we have a big profit on the real estate. You know, with an upzoning we can see the site is worth, you know, approaching a billion and a half dollars and we're paying — we paid a fraction of that. Any profits, you know, part of it's going to be a high-rise residential condominium. God bless. And the profits from the land sale, you know, we will reinvest obviously in the institute. So we're — you know, one of the things, you know, I hope no one in the room has had a child with a health issue. Unfortunately, I suspect that some of you have. Unless none of you have children because this is that generation. But you should, you know, go and copulate. It's a really important thing. Without birth control.

We need another generation. Now, what was my point? Once I got to copulate, I lost my train of thought.

But the profit, nonprofit — no, we did that already. Wow, interesting. Maybe I need to check into the brain institute. That's true. But how did I get to children and sex? I'm not sure exactly where that got in there.

All these things are true.

is a very complicated thing. Okay, go ahead.

I'll take more than a couple.