It’s Time to Build in Healthcare

a16z General Partners David Haber, Alex Rampell, and Erik Torenberg discuss why 19 out of 20 AI startups building the same thing will die - and why the survivor might charge $20,000 for what used to cost $20. They expose the "janitorial services paradox" (why the most boring software is most defensible), explain why OpenAI won't compete with your orthodontic clinic software despite having 800 million weekly users, and reveal how non-lawyers are building the most successful legal AI companies. Plus: the brutal truth about why momentum isn't a moat, but without it, you're already dead.

A16Z co-founder Ben Horowitz joins Shaan Puri and Sam Parr on My First Million to talk about how to be a great leader.

Russ Fradin sold his first company for $300M. He’s back in the arena with Larridin, helping companies measure just how successful their AI actually is. In this episode, Russ sits down with a16z General Partner Alex Rampell to reveal why the measurement infrastructure that unlocked internet advertising's trillion-dollar boom is exactly what's missing from AI, why your most productive employees are hiding their AI usage from management, and the uncomfortable truth that companies desperately buying AI tools have no idea whether anyone's actually using them. The same playbook that built comScore into a billion-dollar measurement empire now determines which AI companies survive the coming shakeout.

In this episode, a16z GP Martin Casado sits down with Sherwin Wu, Head of Engineering for the OpenAI Platform, to break down how OpenAI organizes its platform across models, pricing, and infrastructure, and how it is shifting from a single general-purpose model to a portfolio of specialized systems, custom fine-tuning options, and node-based agent workflows. They get into why developers tend to stick with a trusted model family, what builds that trust, and why the industry moved past the idea of one model that can do everything. Sherwin also explains the evolution from prompt engineering to context design and how companies use OpenAI’s fine-tuning and RFT APIs to shape model behavior with their own data.

Ben Horowitz reveals why the US already lost the AI culture war to China—and it wasn't the technology that failed. While Biden's team played Manhattan Project with closed models, Chinese developers quietly captured the open-source heartbeat of global AI through DeepSeek, now running inside every major US company and university lab. The kicker: Google and OpenAI employ so many Chinese nationals that keeping secrets was always a delusion, but the policy locked American innovation behind walls while handing cultural dominance to Beijing's weights—the encoded values that will shape how billions of devices interpret everything from Tiananmen Square to free speech.