A Different Perspective on Health Care
"Using the Economists World in Figures I think there is a very interesting and maybe appalling story to tell. In its simplest terms a healthcare system is there to extend the longevity of live of the population. It is the single best and simplest way to judge it because we can all find examples of where one country is better than another but the longevity stats don't lie. When we use that framework the picture is incredibly different. The US has many of the best doctors and medical care in the world but it doesn't work for the population as a whole and therein lies the problem.
"According to the Economist the total US spend on healthcare is 15.4% of GDP including both state and private . With that it gets 2.6 doctors per 1,000 people, 3.3 hospital beds and its people live to an average age of 78.2
"UK - spends 8.1% of GDP, gets 2.3 doctors, 4.2 hospital beds and live to an average age of 79.4. So for roughly half the cost their citizens overall get about the same benefit in terms of longevity of life.
"Canada - spends 9.8% of GDP on healthcare, gets 2.1 doctors, 3.6 hospital beds and live until they are 80.6 yrs
"Now if we look at the more social model in Europe the results become even more surprising:
"France - spends 10.5%, 3.4 docs, 7.5 beds and live until they are 80.6
"Spain - spends 8.1% , 3.3 docs , 3.8 beds and live until they are 81
"As a whole Europe spends 9.6% of GDP on healthcare, has 3.9 doctors per 1,000 people, 6.6 hospital beds and live until they are 81.15 years old.
"The list goes on. The truth is that in many cases as is pointed out the healthcare system is better in the US than in some other countries BUT US citizens must therefore get ill more often than any other country in the West in order to achieve the truly appalling statistic that they are the 41 longest living nation on earth with France, Spain, Norway, Switzerland, Italy, Austria, Andorra, Holland, Greece and Sweden all featuring in the top 20 longest living nations and the UK and Germany at 22.
"This is the big failure of the US system. It is unforgivable. You may get a better chance of recovering from certain diseases but as a whole you will die younger in the US than most developed countries. ... Something is severely broken."
I had many letters from all over the world on this issue both pro and con. And some very lively discussions with health professionals. One pointed out to me that the uninsured in the US when they need a doctor often go to an emergency room for what should be a $50 office visit and end up with a $5,000 bill, which does not get paid and runs up insurance costs for those who do have it. As Dr. Mike Roizen points out in his many books, simply eating right, exercising and other common sense things would cut out much of our health care costs. When one-third of children in elementary schools are overweight, we need to get a grip on what we are doing to the next generation.
In the US, many of us are worried about government rationed health care. Others are worried that they have no access to health care at all. It is a very complicated issue. Let's hope that whatever Congress does really does help. And that the coming revolution in new medicines and procedures gets here as soon as it can for all of us. And now to this week's main story.
The New, New Normal
Last week I outlined three possible paths for the economy based upon the political choices we make about the budget deficits.
First, there is the benign path, where we more or less roll back the Bush tax cuts, and do not increase spending for new programs. The fiscal deficit falls into a manageable range. We repeat the Clinton years where spending is help below increase in revenue so that over time the budget gets balanced. While a large tax increase would have negative consequences for the overall economy, it is far better than the other two paths strictly from the perspective of growing the economy as much as possible. This path also has a very small probability.
The second path is that the Obama budget is passed, the Bush tax cuts go away and we have a decade of projected trillion dollar deficits. By the way, those deficits assume 3% growth rates, low unemployment, low interest rates and very large health care savings, and a withdrawal from Iraq and Afghanistan. The deficits are likely to be MUCH larger then the CBO forecasts. This on top of exploding entitlement expenditures in the middle of the next decade, which are underscored in the opinion of more conservative analysts (including me).
The third path is the same as above expect that large new taxes are passed in order to bring the deficit to a manageable size relative to the growth of GDP. This means that a tax increase over and above those projected by the Obama administration of around $700 billion a year (about 5% of GDP!). Deficits would still be in the $3-400 billion range, but from a funding perspective, it could be done.
The second path is one that will end in heart ache. I do not think that the world or even US investors can buy multiple trillions of dollars of debt for more than a few years without rates rising significantly. That, as Gross points out, will affect both businesses and mortgage borrowers. It is a disastrous train wreck.
The third path is the more likely. I think (hope?) there are enough economically conservative Democratic that will realize the problems of trillion dollar deficits. But they do want a fully nationalized health care, and thus they will pass enough in taxes to pay for it. If they are going to do it, this is their one chance, as Republicans are likely to do better in the 2010 elections and get enough votes to push back any real tax increases other than letting the Bush tax cuts expire.
As outlined last week, it will be a combination of a VAT and taxes on health benefits. There is no other real source for the massive amounts of money needed. It will be a disguised tax on the middle class.
I do not believe they will want to wait until 2010 and an election year. Passing such a huge tax increase is very problematical from the standpoint of a growing economy. It will almost surely put us back into a recession. But it will not be a train wreck. As investors and businesses, we can survive and figure out how to deal with the realities of the new, new normal economy. It will be one in which growth is lower than what we are used to and unemployment is higher. Think Europe.
It will be difficult to ever go back. Perhaps new technologies and industries can develop and help get us back on a path to higher growth later in the next decade. We did survive the 70s, after all.
Now, let's turn to this latest column from Bill Gross, Managing Director of PIMCO. Next week I hope to be back to full speed.
Staying Rich in the New Normal
By Bill Gross
"Behind every great fortune lies a great crime."
Balzac was on to something 200 years ago, but to be fair to modern day multi-millionaires, the only real way to accumulate wealth prior to the 18th century
I remember as a child my parents telling me, perhaps resentfully, that only a doctor, airline pilot, or a car dealer could afford to join a country club. My how things have changed. Now, as I write this overlooking the 16th hole on the Vintage Club near Palm Springs, the only golfers who shank seven irons into the lake are real estate developers, investment bankers, or heads of investment management companies. The rich
Readers who are interested in such things as the Forbes annual list of hoity-toities will have noticed that more and more of them are
The potential downgrade, while still far off in the future in PIMCO's opinion, seemed dubious at first blush. While country ratings factor in numerous subjective qualifications such as contract rights, military might, and advanced secondary education, the primary focus has always been on the objective measurement of debt levels, in this case sovereign debt, as a percentage of GDP. Yet, as shown in Table 1, both the U.S. and the U.K. entered the Great Recession with attractive ratios compared to such grievous offenders (and AA rated) as Japan.
Yet as the markets recognized rather abruptly last week, both countries seem to be closing the gap in record time. To zero in on the U.S. of A., its annual deficit of nearly $1.5 trillion is 10% of GDP alone, a number never approached since the 1930s Depression. While policymakers, including the President and Treasury Secretary Geithner, assure voters and financial markets alike that such a path is unsustainable and that a return to fiscal conservatism is just around the recovery's corner, it is hard to comprehend exactly how that more balanced rabbit can be pulled out of Washington's hat.
Private sector deleveraging, reregulation and reduced consumption all argue for a real growth rate in the U.S. that requires a government checkbook for years to come just to keep its head above the 1% required to stabilize unemployment. Five more years of those 10% of GDP deficits will quickly raise America's debt to GDP level to over 100%, a level that the rating services - and more importantly the markets - recognize as a point of no return. At 100% debt to GDP, the interest on the debt might amount to 5% or 6% of annual output alone, and it quickly compounds as the interest upon interest becomes as heavy as those "sixteen tons" in Tennessee Ernie Ford's famous song of a West Virginia coal miner. "You load sixteen tons and whattaya get? Another day older and deeper in debt." Pretty soon you need 17, 18, 19 tons just to stay even and that describes the potential fate of the United States as the deficits string out into the Obama and other future Administrations. The fact is that supply-side economics was a partial con job from the get-go. Granted, from the 80% marginal tax rate that existed in the U.S. and the U.K. into the late 60s and 70s, lower taxes
The current annual deficit of $1.5 trillion does not even address the "pig in the python," baby boomer, demographic squeeze on resources that looms straight ahead. Private think tanks such as The Blackstone Group and even studies by government agencies, such as the Congressional Budget Office, promise that Federal spending for Social Security, Medicare, and Medicaid will collectively increase by 6% of GDP over the next 20 years, leading to even larger deficits unless taxes are increased proportionately. Collectively these three programs represent an approximate $40 trillion liability that will have to be paid. If not, you can add that present value figure to the current $10 trillion deficit and reach a 300% of GDP figure - a number that resembles Latin American economies such as Argentina and Brazil over the past century.
So the rather conservative U.S. government debt ratio shown in Table 1 will likely be anything
The obvious solution to both dollar weakness and higher yields is to move quickly towards a more balanced budget once a sustained recovery is assured, but don't count on the former
I want to emphasize that we will get through all this, one way or another. Some paths will make it easier than others. But it is very important that you understand what the options are, and build a game plan to deal with them. Over the next few months, I will spend some writing time going into some ideas.
Eastern Europe, Maine and Tulsa
For the next month I will actually be home, then in mid-July off to London and I think Eastern Europe. I am reading through some old International Living issues to help me decide where to actually go. For those with an interest in living in another country, or just like to dream, you should check it out. It is a lot of inexpensive fun. To learn more click here: https://www.web-purchases.com/ILV/LILVK5E1/landing.html
Then Maine in August with my youngest son, and of course Tulsa for Amanda's wedding August 22.
As noted above, I am a little out of sorts, but expect to be back in full swing soon. Have a great week.
Your hoping we can at least Muddle Through analyst,
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