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Elon’s Power Play, Ozempic Insurance Costs, and the Future of ESG

It’s the first-ever Pivot call-in show! Kara and Scott talk to Pivot listeners and answer questions on Elon, AI, Ozempic, and more. Plus, Apple’s new app store policy is facing backlash, CNN’s CEO maps out his plans for the future, and Bill Ackman is embroiled in yet another controversy. Follow us o

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Episode Summary

Executive Summary: The episode centers on a live listener call-in format covering four major themes: Apple’s App Store fee changes and antitrust optics, CNN’s strategy under Mark Thompson, the power of billionaire influence in politics and governance (especially Elon Musk and Bill Ackman), and the future of AI, healthcare, and ESG. Across topics, the hosts argue for competition, clearer regulation, and business models that align with consumer value rather than extraction or hype.

Main Topics: Apple App Store fees and antitrust backlash (Priority: 5/5): The hosts debate Apple’s new 27% commission on alternative payments in the App Store after the Supreme Court declined to hear the Epic appeal. They argue Apple is trying to preserve control while appearing compliant, but the policy looks anti-competitive and could disadvantage rivals like Spotify versus Apple Music. CNN’s strategy under Mark Thompson (Priority: 5/5): They discuss Thompson’s plan to reorient CNN around subscriptions, better mobile video, and a more integrated structure. The hosts say the strategy is right—monetize premium news—but execution matters, and the product should be tighter, more news-focused, and built for direct paid consumption. Billionaires, politics, and influence buying (Priority: 5/5): A discussion of Dean Phillips, Bill Ackman, Citizens United, and the broader shift of power from government to wealthy individuals. The hosts argue political access is cheap for rich donors, and that billionaire attention-seeking can distort democratic and institutional decision-making. Elon Musk, shareholder governance, and fiduciary duty (Priority: 5/5): In response to a listener question, they analyze why Musk’s public tweeting and demands for more voting control have not triggered more shareholder action. The hosts emphasize that X is private, investors are aligned with Musk’s ecosystem, and his governance behavior is unprecedented but tolerated because of his value creation. Healthcare, insurance, and GLP-1 drug access (Priority: 4/5): A doctor caller prompts a conversation about Ozempic/GLP-1 affordability and the broader insurance industrial complex. The hosts argue U.S. healthcare is structurally unfair, over-relies on costly middlemen, and needs reform so effective drugs and care are more accessible, especially for lower-income patients. AI in education, business, and regulation (Priority: 5/5): Multiple callers ask about AI’s effects in schools, startups, and public policy. The hosts present AI as a powerful but disruptive tool that should be embraced in education while also regulated through transparency, safety testing, and perhaps a new agency with real enforcement powers. ESG and DEI as business strategy versus branding (Priority: 4/5): They argue ESG and DEI have been politicized and often weaponized, but the underlying concepts—climate risk, workforce quality, fairness, and inclusion—are legitimate shareholder concerns. The hosts criticize greenwashing and ideological fights while supporting practical, risk-based corporate decision-making.

Key Arguments: Apple’s 27% alternative payment commission looks like anti-competitive self-preferencing, especially because Apple can advantage its own apps while charging rivals. CNN’s future should be subscription-led and news-first; premium, tight news loops would be more valuable than filler programming or personality-driven spinoffs. Billions of dollars and weak legislative action have shifted influence from democratic institutions to wealthy donors and activist billionaires. Musk’s public threats and demands for 25% voting control may be a governance nightmare, but shareholders tolerate it because he has created enormous value. OpenAI and other AI companies should not be trusted solely on mission statements; profit incentives will dominate unless government and media create real checks. AI can improve education if used as a tool for research, drafting, and prompting—but educators should teach students how to use it critically rather than treating it only as cheating. Healthcare costs are inflated by insurance intermediaries and poor regulatory design; GLP-1 drugs could become transformative if pricing and distribution barriers fall. ESG/DEI are useful when treated as business risk management, but the labels have been hijacked by both activists and political opponents, making them easier to dismiss. A new regulatory framework for AI should focus on transparency, safety, and externalities rather than trying to pause innovation outright. Companies should be able to define their own values, but businesses that genuinely align with climate, workforce, and inclusion goals often perform better over time.

Data Points: Apple App Store alternative payment commission: 27% - New fee Apple will charge developers using an alternative payment method in the App Store. Credit card company fee range: 1.5%–3% - Used as a comparison point for Apple’s commission structure. CNN/NYT subscription shift: from about 25% to over 50% of revenue - Referenced as Mark Thompson’s success at The New York Times in moving toward subscriptions. Musk voting-control target: 25% - Elon Musk publicly demanded 25% voting control. Musk current stake/options range: 13% to 17% - Described as what his options could take him to if exercised now. Ackman political contribution: $1 million - Bill Ackman gave Dean Phillips money and publicly discussed influencing his DEI stance. Thiel political spending: $30 million - Cited as an example of how little money can buy significant political influence. Apollo-era federal spending: 3.5% of GDP - Used to illustrate how national priorities and public investment once enabled moon-shot-scale projects. Top U.S. marginal tax rate: 37% current income; 22% long-term capital gains - Referenced in a discussion of the shift from public to private capital power. OpenAI valuation: $90 billion - Used to illustrate how shareholder value can overwhelm altruistic mission language. Harvard freshman class non-white share: 51% - Referenced in a discussion of DEI and whether elite reshuffling counts as diversity progress. Healthcare coverage observation: top 10% vs bottom 90% - Used to argue the U.S. healthcare system is optimized for the wealthy while the rest subsidize it. Insurance affordability example: $400 emergency - Used as an example of a cost many households cannot absorb. Average car payment: $1,000 - Used to illustrate household financial strain and drug affordability concerns. GLP-1 drug monthly cost example: $1,200 - Referenced as a potential out-of-pocket price for Ozempic-like medications. OpenAI internal split: accelerationists vs decelerationists - Described as a major governance tension in the company.

Pivotal Quotes: "Competition is the only way to handle this." — Scott Galloway: On Apple’s App Store payment rules and the lack of real market competition. "With for-profit companies, they should be trusted to do nothing else. That's what they do." — Scott Galloway: On OpenAI and the limits of mission-driven rhetoric once huge capital enters the picture. "He's an adult toddler and they're giving him sugar." — Kara Swisher: On Elon Musk’s behavior and why his board and investors keep enabling him.

Implications: Listeners are left with a consistent thesis: major tech, media, and healthcare institutions need real competition, transparency, and regulation or they will keep exploiting structural power. AI, ESG, and billionaire influence will likely remain contentious until governments create enforceable guardrails.

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About Pivot

With great power, comes great scrutiny. Every Tuesday and Friday, journalist Kara Swisher and NYU Professor Scott Galloway offer sharp, unfiltered insights into the biggest stories in tech, business, and politics. They make bold predictions, pick winners and losers, and bicker and banter like no one else. From New York Magazine and the Vox Media Podcast Network.

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