Cost is not always about size. That is an inconvenient sentence for anyone trying to sell a larger medical foundation model by waving parameter counts like a hospital procurement trophy. In ECG modeling, the expensive question is not simply whether one can pretrain on more recordings. The harder question is whether the model architecture and pretraining task actually match the structure of the signal. ...
Budget meetings have a useful cruelty. They make vague AI strategy sound ridiculous. A team may begin with the familiar story: the model is not reasoning well enough, so the company needs a larger model, a longer context window, more inference-time search, and probably a procurement conversation involving GPUs. Very modern. Very expensive. Also not always the right diagnosis. ...
Budget. That is where the benchmark story usually becomes less elegant. A vendor shows a model card with better reasoning scores, stronger multi-task accuracy, and a leaderboard position polished to a mirror finish. Then someone in operations asks the rude question: what does this improvement cost per customer case, per analyst hour, per compliance review, or per failed escalation? ...