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The Healthcare Fix

“Let us not seek the Republican answer or the Democratic answer, but the right answer. Let us not seek to fix the blame for the past. Let us accept our own responsibility for the future.”

-John F. Kennedy


Keynesian dogmas are often criticized at Hedgeye.  While fiscal and monetary policy is often the target for critics, health spending is often ignored.   Perhaps it is easier to comment on growth and inflation metrics in the broader economy than it is in the healthcare sector.  But the similarities are apparent.  Over the last 50 years government health spending has coincided with rising medical inflation and slower growth.  Maybe it is time to try something different.


The health reform debate has a long history, but one that has generally ended with rising demands on public financing.  As of today, government payments account for over half of the total medical spending today in the United States.  Medical spending finds itself again as central issue in the current political debate.  


For all of the public support for the health sector, or because of it, affordability and access continue to be the chronic platforms of the debate.   Since 1999, family insurance premiums have risen at over 8% per year and 3X the rate of wage growth, rising from $5,791 in 1999 to $15,073 in 2011 (Kaiser Family Foundation).  At this rate of increase, a family policy will cost $22,000 in 2016 and $32,000 by 2021.  Meanwhile, the employee share of insurance premiums has risen while wage growth has been stagnant. But worst of all, access is shrinking.  Out of pocket expenses and deductibles make it unaffordable for many to seek care, while of those insured by Medicare and Medicaid, physicians refuse these new patients 13.7% and 28.2% of the time, respectively.


We are hopeful that President Obama’s Affordable Care Act will produce all that has been promised by the President and the Congressional Budget Office, namely improvement in access, lower costs, and reduced federal deficit.   For reasons we won’t elaborate on here, we believe The Affordable Care Act, while different in the details, will have the similar outcome as past expansions of government health spending.  We expect the legislation will reduce access, drive medical costs higher, and worsen the deficit. 



It is cliché at to say health spending rises faster than broad measures of inflation such as the Consumer Price Index.  Despite the widespread belief that this is driven by an aging population, the surprise finding far less spoken about is the miniscule contribution an aging population makes to annual medical inflation.  According to a 2006 study of hospital care, the annual contribution to hospital spending from an aging population is 0.74% (Banker et al, Health Affairs 2006).  In other studies of total medical spending, the aging contributes only 0.50%.  Removing the demographic fallacy, the conclusion should be to focus on prices. 


Putting this in the populist context of Apple and its $108B in fiscal 2011 revenue, an annual price increase on the $2.6T Health Economy adds $130B in additional revenue, or cost, to the system, with a corresponding “value” that is impossible to compare.



We find it a shame that the healthcare sector is entering its second decade of decelerating growth and lower multiples yet enjoy more government support, more regulation, while Americans have a profound need than ever before.  We’d love nothing more than see routine 5% annual price increases and $130B in new spending turn itself into a new industry to analyze.  Unfortunately prices are going up, and the system remains broken and ineffectual.



My bookshelf is cluttered with too many books on how to fix healthcare that I have spent too much time reading.  Many offer intelligent alternatives.  Many are diligently researched.  But all of them lack a simple and practical solution.  Here’s my simple solution: create a National Health Score, or a credit score for your health. 



A National Health Score would convert well known patterns of per capita medical spending and creates a national underwriting table.  With a Health Score, creating a price for a health insurance policy for an individual is turned into a function of age and a few simple risk factors.   Additionally, remove the risk of catastrophic event by insuring and caring for those rare events separately.


On an individual basis, the Health Score would focus an individual on factors they can control.  A  42 year old father of 2, who is overweight, has high cholesterol, and is a tobacco user should pay more than a healthier 42 year old.   However, if by his own effort he slims down, quits smoking, and improves his Health Score, he should pay less.  By consolidating the risk factors into a Health Score and using it to set the monthly premium, an individual has the “skin in game” that consumer directed healthcare advocates so desire, but its centered on things the individual has control over. Over time, the system benefits from lower long term costs.



The fact that the existence of a three tier system is accepted so calmly in the United States (private insurance, government, none) while we lead the globe in per capita health spending at close to $8,000 per capita, should be alarming.   With a Health Score in hand, legislators and policy will be allowed to turn to how much support an individual receives and how to improve the aggregate Health Score of the population. 



The reality for the vast majority of people is that a serious episode of care is a rare event.  For a hospitalization, the percentage of people are admitted to a hospital in a given year is in the single digits.  For those between the ages of 18 and 44, the rate is 5.9%.  For those between the ages of 45 and 64, the rate is 6.9%.   The downside of course is when you find yourself in the group that goes to the hospital.  The high cost of the care, which carries a mean expense of $11,433 and $20,252 for these two age groups, can harm many, and bankrupt others, and make health insurance prohibitively expensive after an individual does get sick.   By treating people who find themselves unlucky enough to have a major episode, they should be considered a separate group and insured and cared for that way. 


The prognosis for the Health Sector is not good.  Decades of expanding government spending appears set to continue.   Growth will continue to decelerate, multiples will move lower, while government expenditure rises to new highs.  Consumer trends will continue to rise in importance, and pricing leverage will continue to wane.  I’ll continue to play the game in front of me, but I am hoping for something different.


Our immediate-term support and resistance ranges for Gold, Oil (Brent), US Dollar Index, and the SP500 are now $1, $117.81-120.28, $79.06-79.67, and 1, respectively.


Thomas Tobin

Managing Director


The Healthcare Fix - The Healthcare Dollar 2 EL


The Healthcare Fix - Virtual Portfolio


The Macau Metro Monitor, February 17, 2012



72,000 ENGAGED IN GAMING SECTOR Macau Daily News

Macau’s total labor force stood at 347,000 in Q4 of 2011, employment rate at 97.9%.  The number of employers went up from 10,000 in Q4 2010 to 12,000.  72,000 people were engaged in the gaming industry, accounted for 20% of the total workforce.


TODAY’S S&P 500 SET-UP – February 17, 2012

As we look at today’s set up for the S&P 500, the range is 11 points or -0.74% downside to 1348 and 0.07% upside to 1359. 












  • ADVANCE/DECLINE LINE: 1541 (2009) 
  • VOLUME: NYSE 805.81 (-0.07%)
  • VIX:  19.22 -9.08% YTD PERFORMANCE: -17.86%
  • SPX PUT/CALL RATIO: 1.45 from 2.40 (-39.58%)


  • TED SPREAD: 39.65
  • 3-MONTH T-BILL YIELD: 0.09%
  • 10-Year: 2.00 from 1.98
  • YIELD CURVE: 1.71 from 1.69 

MACRO DATA POINTS (Bloomberg Estimates):

  • 8:30am: CPI, M/m, Jan., est. 0.3% (prior 0.0%)
  • 10am: Leading Indicators, Jan., est. 0.5% (prior 0.4%)
  • 10am: API monthly report
  • 1pm: Baker Hughes rig count 


  • President Obama talks about U.S. manufacturing at Boeing plant in Everett, Wash. 11:25am
  • CFTC holds closed hearing on enforcement matters, 10am
  • Mitt Romney, Ron Paul make campaign appearances in Idaho; Rick Santorum visits Michigan; Newt Gingrich speaks in Georgia
  • House Energy meets to mark up resolution authorizing issuance of subpoenas in probe of federal loans to Solyndra. 9:45am
  • House Appropriations subcommittee hears from Agriculture Secretary Tom Vilsack on the agency’s budget. 10am
  • House Armed Services Committee hears from Army Secretary John McHugh, Army Chief of Staff Raymond Odierno on the budget request. 10am 


  • Germany said to want euro-area finance chiefs to avoid two- step vote on EU130b Greek rescue and a bond swap to cut the nation’s debt load at a meeting next week
  • CME Group has made bid for London Metal Exchange; NYSE Euronext said to also be interested
  • Cost of living in the U.S. may have gained 0.3% in Jan. on higher prices for food and energy, economists est.
  • Networker John Kinnucan arrested by FBI in trading probe
  • CVR Energy said it will review Carl Icahn’s offer of at least $30-shr
  • Alibaba Group Holding said to plan to privatize its Alibaba.com unit close to its IPO price
  • U.S. ITC may rule on whether Apple infringed on a patent owned by smartphone maker HTC
  • U.K. Jan. retail sales rose 0.9%; median forecast 0.3% decline
  • German President Christian Wulff resigned amid the threat of a legal probe into corruption allegations 


    • Amerigroup (AGP) 6:00am, $0.62
    • Encana (ECA CN) 6:00am, $0.10
    • Barnes Group (B) 6:30am, $0.32
    • HJ Heinz (HNZ) 7:00am, $0.85
    • Digital Realty Trust (DLR) 7:00am, $1.01
    • Enbridge (ENB CN) 7:00am, C$0.39
    • LifePoint Hospitals (LPNT) 7:00am, $0.76
    • Pilgrim’s Pride (PPC) 7:00am, $(0.30)
    • Ventas (VTR) 7:01am, $0.89
    • Campbell Soup (CPB) 7:30am, $0.62
    • HMS Holdings (HMSY) 7:30am, $0.15
    • Brookfield Asset Management (BAM/A CN) 8:00am, $0.51
    • Lincoln Electric Holdings (LECO) 8:06am, $0.63 


OIL – never has Oil trading > $100/barrel not slowed both US and Global Consumption Growth. Maybe this time is different. Maybe it isn’t. Brent Oil busting to new highs this morning on a weak US Dollar and institutional performance chasing squarely focused on buying inflation protection. 

  • Gold Bulls Expand as Billionaire Paulson Says Buy: Commodities
  • CME Group Said to Submit Bid to Buy London Metal Exchange
  • Copper Trims Weekly Drop on U.S. Economy, Greece Bailout Outlook
  • Oil Set for Biggest 2012 Weekly Gain on U.S. Economy, Greek Aid
  • Shanghai Copper Stockpiles Rise to Record 217,142 Tons
  • Uganda Coffee Exports May Climb 3.1% as Nation’s Crop Expands
  • Wheat Advances as Egypt Buys From U.S.; Corn, Soybeans Gain
  • Cocoa Falls as Exporters Agree to Ivorian Sales; Coffee Declines
  • Palm Oil Advances to Three-Month High on Optimism Over Recovery
  • World’s Biggest Platinum Mine Under Police Control After Riots
  • Small Hedge Funds Draw Money as Their Bigger Rivals Stumble
  • Timchenko’s Kolmar to Boost Coal Output Fivefold, Eyes Seaport
  • Tullow Seen Beating Peers With $30 Billion Africa Find: Energy
  • Midwest Farmland Prices Rise at Fastest Pace Since ’76, Fed Says
  • Oil Set for Biggest Weekly Gain This Year
  • Copper Climbs Before U.S. Leading Indicators Report: LME Preview
  • Gold May Gain on Speculation Greece Bailout Will Weaken Dollar 













SINGAPORE – when the Prime Minister of Singapore warned of a “rough landing” in China last week, our research team was buzzing about it – they should have been; Singapore is a leading indicator for Global Growth – and Singapore’s Exports for JAN just dropped to negative y/y! (-2.1% vs +9.0% DEC). Chinese Growth is slowing – We sold our China Equities (CAF) long (bought it in DEC) yesterday.


JAPANESE YEN – biggest currency drop not discussed by consensus media, maybe ever – and ever, as you know, is a long time. The Yen is literally straight down for the month of FEB. Down 4% is a monster move for a major currency. We think this is front-running the Sovereign Debt Maturity spike that’s pending in March. When we were saying this about the Euro breaking down hard in April 2011, that was the early signal too…










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