Hawking Dire Projections

The Deficit Scolds' Unsound Logic

One of the most damaging effects of the current deficit hysteria is that it distracts our attention from the more serious problems our elected officials should be trying to solve. A recent New York Times column by David Brooks, titled “Why Hagel Was Picked,” is a good example of this deficit fixation, which has become common not only on the right but among self-described centrists.

Instead of focusing on the important foreign-policy challenges America faces and whether Senator Hagel is qualified to face them as Secretary of Defense, Brooks explains Hagel’s nomination as the natural consequence of the federal government’s unwillingness to rein in expensive entitlement programs. Brooks argues that the defense budget is being “squeezed by the Medicare vise” and that America will cease to be a world power if it has to provide decent medical care and social protection to the elderly and the poor. “Oswald Spengler didn’t get much right,” Brook writes, “but he was certainly correct when he told European leaders that they could either be global military powers or pay for their welfare states, but they couldn’t do both.”

The first problem with Brooks’s analysis is the assumption that Medicare and Medicaid are themselves the cause of our future fiscal problems. While Brooks is right that the rise in Medicare and Medicaid costs is unsustainable, the reason these costs are rising so fast has nothing to do with bureaucratic waste or profligacy. These federal programs are getting too expensive only because health care in general is getting too expensive. If health-care costs were to keep rising as fast as they have over the past two decades, spending on health care would eventually take over the entire economy: we would all be working solely to pay for our insurance. Obviously this can’t happen. Sooner or later, we will have to fix our health-care system so that it won’t.

As a percentage of GDP, the United States pays more than twice as much for health care as most other rich countries do, and most of these countries have better health outcomes. Clearly, we still need to reform our health-care system. By itself, “Obamacare” will not be enough. The goal of the Affordable Care Act is to extend health-care insurance to as many people as possible. It does this partly by expanding Medicaid but mostly by arranging for more Americans to get private insurance. But simply adding more policy-holders to the ranks of the privately insured will do nothing to curb the cost of health care. We currently pay too much, and receive too little, because the health-care industry has been taken over by Wall Street, whose major goal, with health insurance as with banking, is maximal short-term profit. Its goal is not to make the health-care system cheaper, more efficient, or more just. The insurance industry, which is merely a branch of Wall Street, is itself one of the main causes of out-of-control health-care costs. A system that is both affordable and effective will be possible only when we tame the insurance industry, either by regulating it much more like a public utility, or, better, by taking it out of the equation and replacing it with a single-payer system. You don’t have to look far for evidence that a reasonable and efficient (if not very profitable) health-care system is well within the means of a country as affluent as ours. Countries less affluent have already achieved it.

Brooks may be right that most Americans are unwilling to pay for America to remain the world’s policeman. I suspect most Americans are quite willing to pay enough for the country to defend itself. Today the U.S. military budget is bigger thant the twelve next largest military budgets combined. We account for 45 percent of the world’s military spending even though we have only 5 percent of its population. We spend almost five times as much as China or Russia. Budgeting is about choosing what we value most, and, pace Brooks, it is surely a good sign if Americans decide to stop fighting wars we don’t need to fight so that our government can afford to take care of the elderly and the poor. As Dwight Eisenhower (a Republican) put it, “Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed.”

But the biggest problem with Brooks’s analysis is its premise that the federal government’s out-of-control spending will sooner or later cause it to go bankrupt, turning us into the next Greece. It’s true that the aging of our population will require adjustments in how we spend our money (just as the postwar Baby Boom did). But these adjustments will be quite manageable as long as we make intelligent and evidence-based policy decisions. To see what happens when policy-makers disregard evidence in favor of panicked intuition, one need only look at what’s happening right now in the European Union, where harsh austerity programs designed to reduce debt levels have only succeeded in inhibiting economic growth.

Like most deficit hawks, Brooks is worried by dire long-term debt projections. Yet such projections are not a good basis for policy-making, for two reasons. First, they are notoriously inaccurate. Remember the 2000 forecast of federal government surpluses as far as the eye could see? Long-term forecasts are inaccurate because the future is essentially unknowable. All such forecasts are based on the assumption that the future will be just an extension of present trends.

Economists call this the “ergodic axiom.” But all economic history since the advent of capitalism shows that we live in a nonergodic world. This, by the way, is why most economists didn’t foresee the financial meltdown: housing prices had never plunged before, and this was taken to prove they never would. When social scientists make predictions, they often hedge them with the Latin phrase ceteris paribus—“all other things being equal.” But in the long run all other things are not equal. The variables change. Circumstances that are unforeseen and unforeseeable render our old projections moot, or current trends hit a natural limit that the projections disregard.

To give just one example: Most of the long-term projections for federal debt are based on the assumption that health-care spending will continue rising at the rate or near the rate it has in the past twenty years. Yet, as I mentioned before, this is impossible. Frequently the assumptions underlying the projections are chosen to produce a desired outcome, especially for political documents like Paul Ryan’s budget plan. But even if the smartest, best-informed people produce them without any political agenda, long-term forecasts are not very helpful. If people paid more attention to the performance record of past long-term forecasts, they’d take current ones less seriously, or at least more cautiously.

The second reason policy-makers should not allow themselves to be cowed by long-term debt forecasts is that debt does not constrain the U.S. government the way it constrains a business or a household. This is because the U.S. government—unlike, say, the Greek government, which is chained to the euro—pays its bills in its own money and so can always pay for what it wants. The real constraint is future production: Will the economy produce enough goods and services in the future to satisfy the demands of the American people and their government? What government programs we can afford in the future will depend on both demographics and advances in technology—as well as on noneconomic factors like wars, natural disasters, global warming, irrational politicians, and others things beyond the expertise of an economist.

Most analysts look only at demographics when they consider the long-term future of Social Security and Medicare, and this leads them to erroneous conclusions. We are often told that Social Security is unsustainable because the number of workers per retiree is falling. At first glance, this analysis seems to make sense. In 1960 there were 5.1 workers for every retiree; by 2010 that number had fallen to 2. Worse, it is projected to fall to 1.9 in 2086. This looks ominous indeed. But let’s look at another example. In 1940 there was one farmer for every fourteen people. By 1960 the percentage of the population working in agriculture had been cut by more than half, so that each farmer was feeding thirty-four people—more than twice as many as just two decades before. Today each farmer feeds more than 138 people. Yet that fact does not make us worry about a coming food shortage because we all know that, thanks to advances in technology, the average farmer now produces much more food than farmers did in 1960 or 1940.

And what is true of food production is true of economic productivity more generally. The best way to ensure that Social Security will still be around for future generations is to continue supporting government investment in things that will make the economy more productive— above all, in education and research and development.

The budget hawks’ baleful warnings of “unfunded liabilities” is finally meaningless. If we applied the logic of “unfunded liabilities” to food (surely our most important future liability), we’d find that we have an unfunded liability of $359.3 trillion over the next seventy-five years (assuming a modest 3 percent growth rate). Should we then worry that our children are going to starve, as the budget hawks now worry that our children won’t have Social Security? How are we going to pay for all the food people will need? Should we start saving now so we can pay for food in the future? No, of course not: the food we will eat in the future will be food grown in the future, and we will pay for it with future incomes. In the same way, future economic activity will pay for future retirees.

The major economic problems we now face are high unemployment, income inequality, an economy dominated by Wall Street, and a government under its whip. The fact that many House Republicans now appear to be unwilling to let the federal government carry out its basic responsibilities is also a real problem—a real problem based largely on an imaginary one. The irrational fear of debt will become a self-fulfilling prophesy if it leads to austerity policies that make us collectively poorer and therefore less able to produce the goods and services the country will need in the future. The prophets of austerity are like someone who asks us to starve ourselves now so that there will be enough food left for future generations. In fact, the best way to prepare for the future is to take care of the present.

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Thank you for the article Dr. Clark. I generally agree with your assertions about health care and the ACA. I am aware that we spend much more on health care than other first world nations, and that we receive much less for out money. I also believe that the ACA was a step forward in terms of extending health insurance to millions more Americans, yet it fell short in reducing  the rising cost of care. I was disappointed that the ACA did not include the public option, which I believe would have kept insurance rates down. I would have even welcomed the Republican idea of tort reform had it been included in the ACA. I would seriously consider any other ideas from either side of the aisle that might possibly contain the rising cost of care, so long as they don't include the premise that we must abandon our social responsibility to extend health benefits to the greatest number of Americans.

The major economic problems we now face are high unemployment, income inequality, an economy dominated by Wall Street, and a government under its whip. The fact that many House Republicans now appear to be unwilling to let the federal government carry out its basic responsibilities is also a real problem—a real problem based largely on an imaginary one. The irrational fear of debt will become a self-fulfilling prophesy if it leads to austerity policies that make us collectively poorer and therefore less able to produce the goods and services the country will need in the future. The prophets of austerity are like someone who asks us to starve ourselves now so that there will be enough food left for future generations. In fact, the best way to prepare for the future is to take care of the present

 

Well Mr. Clark, once again I'm sorry to say, you are missing the mark.  The debt crisis is real, as too is our demise as one of the greatest nations on planet earth. 

Again I remind you, that what you list are mere "symptoms" of our root problem:  a morally bankrupt and God less nation; unfixable by "politics" and short-lived government entitlements, which BTW, just so happen to be "funded" by the hard working people of America.

Only when, and if,  as a nation we return to God with irrational exuberance, will our solution(s) be found. 

Our problem is not a bunch of Republicans " unwilling to let the federal government carry out its basic responsibilities."  It's a country unwilling to live by God's commandments.

Being that just yesterday was witness to the first US POTUS taking a "not under God" innovocation from laity, elected by a majority of "non God fearing Americans", and elected on a platform of intrinsic evils, my only quesiton is why so many defy basic and historical "logic."

It is simply a question of "guns or butter." We blithely and with almost no detailed questioning or debate approve $660 billion in defense spending and then fight tooth and nail over pennies on the dollar in Agricultural policy, food stamp support, care for the aged, support for the unemployed, repairs to our own infrastructure at home, housing policy and now, the favorite sport, healthcare. This huge disconnect explains all the wastage of public spending for wars and invasion and all the neglect of desperately needed programs at home. Our local National Guard unit is this week returning after a year of assignment to bridges and roads in Afghanistan. Several received purple hearts but thankfully none were killed. Now, what are their prospects for living wage employment here at home? Dang poor, as the local unemployment rate is 13.1%. And that's on the official rate.

This should be treated as the national emergency that it is. Continuing the fight over austerity versus stimulus is just silly and shameful. It only postpones the ultimate collapse of our economy unless we can put people to work building rather than destroying. That would be a vision!

 

Patricia:  If all we have to do as a nation is return to God with "irrational exuberance" and "our solution(s)" will be found, how do you explain the economic collapse of 2008, the unrivalled debt and deficits -- not to mention terrorist attacks -- and wars the nation experienced under the regime of George W. Bush?  After all, it could be argued that Bush 43 exhibited more "irrational exuberance" for God than any US President in history.  Yet, in my humble opinion, what Bush wrought at least throws enough doubt on your theory to make a wise nation search for future solutions well beyond Godly exuberance, irrational or otherwise.  

PS  I guess it would be more precise to qualify what happened in 2008 as a "fiscal collapse."  The whole economy didn't blow up, although it could have.

Hi Beverly

You ask a good question(s) and one that can be answered quite easily, as wars, debts, deficits, and terriorist attacks are all mere symptoms of sin.  None of these could have possibly occured if all involved simply lived by God's commandments.  Wars simply cannot exisit between peaceful hearts.  As for our current debts and deficits, most is a result of greed and and self-power driven agendas, all under the guise of "social justice." 

The Catholic Church has always taught that one of the consequences of sin is war, be it between our brothers (as we see in our current politics), or against nations.  In fact, for the most part, it's what the the (church approved) Fatima Miracle of the Sun is based upon; our need to repent or face another war.  It accurately predicted WW II, and most likely, WWIII.

God has sent many prophets since that time, from CS Lewis to holy Popes to A Huxley to name a few.  A more recent one was nobel prize winner Alexander Solzhenitsyn, once booed after giving the advice to Harvard Grads. 

No one likes to say it, but the truth is, sin is the real enemy.  Today, as one of my business associates proudly twitted, we "celebrate" 40 years of Roe V Wade.  Yet, she far from alone. 

 Forty years today Roe v Wade was passed.  Fifty Five MILLION aborted babies later, we elected a president on an intrinsic evil platform, the National Cathedral proudly announces they will perform same sex 'marriages', and Fifty Shades of Grey, "mommie porn",   not only out sells the bible, but has  relgated women to the same  slavery of pornography as men. 

And we think it's the Republicans?  It's ALL of us.  It's sin!

In conclusion of my response Beverly, I leave you with a quote from A Solzhenitsyn:

Over a half century ago, while I was still a child, I recall hearing a number of old people offer the following explanation for the great disasters that had befallen Russia: "Men have forgotten God; that's why all this has happened." Since then I have spent well-nigh 50 years working on the history of our revolution; in the process I have read hundreds of books, collected hundreds of personal testimonies, and have already contributed eight volumes of my own toward the effort of clearing away the rubble left by that upheaval. But if I were asked today to formulate as concisely as possible the main cause of the ruinous revolution that swallowed up some 60 million of our people, I could not put it more accurately than to repeat: "Men have forgotten God; that's why all this has happened

 

 

Hi Patricia.

I think that we would agree that our country fails to meet many ethical standards. In our previous conversation we both agreed that abortion is a serious problem, and a problem primarily found within the ranks of Democrats. However, I believe you fail to see the immorality and amorality within the ranks of Republicans. There are serious Christian ethical considerations to be made when we choose between global domination and health care, tax cuts for the wealthy and food from the tables of struggling families, weaponry and shelter for those who lack it.

I also think Beverly Bailey makes the point that economic fluctuations have occurred and will continue to occur regardless of where we put God in this country. How we choose to respond to as a nation to those most affected by those fluctuations is a serious moral choice.

Hi Jeff:

If I gave any impression that I was giving the Republicans a pass, well, then I apologize for my poor writing.  Save for " a few good men" on both sides of the aisle, all of congress, for the most part, are dispicable, self-serving cowards.  Trust me, the only reason the "intrinsic evils of the dems" aren't in the Republican platform is that they know they can't win without the social conservatives.   FWIW, I'm not a member of either party.

I really don't want to get into political debates Jeff.  If we could just agree that both sides have plenty to go around, we can then agree that as a nation, we are spiritually bankrupt, "out of wine" as last Sunday's Gospel teaches.  Only God can replenish us at this point.

As for normal "economic fluctuations", that isn't what we are facing, nor, based on yesterday's speech by our president, even a concern worth mentioning. 

We can agree to disagree on social welfare, but as a Catholic, there is no room for disagreement on the intrinsic evils.  And that Jeff, we DID respond to as a nation, and even worse, by a majority of the Catholic Vote.

We reap what we sow.

Patricia You don't want to get into a political debate? You could have fooled me. It seems that your biggest problems with Professor Clark's article are the intrinsic evils within the Democratic Party platform; something he says nothing about. Maybe that's what the problem is - that he doesn't mention them. But, why would he? This article is about the economy, unemployment, the deficit/debt, and the rising cost of health care. Abortion and contraception are far beyond the scope of discussion. The only reason I saw your comments as bearing any relevance to the matter at hand is because you made the claim that the problems Professor Clark mentions are symptoms of a greater underlying problem, namely, the removal of God from the public square and immorality. As of yet, you fail to offer any evidence to make the case for that claim, nor do you point us in the direction of any research that may have already done so. If your problems with Professor Clark's article are that the intrinsic evils of abortion and contraception are the causes of unemployment and inequality then I think you need to make a case for that claim. We can agree that both sides have plenty to go around. However, I strongly disagree with your statement that the current debt level is a result of greed and power driven agendas under the guise of ”social justice”. You make the attachment that America's demise as the greatest nation on the planet is a problem. Would you purport that funding to maintain America's global dominance should take priority over funding for the basic human rights of food, shelter, and health care?

Professor Clark mentions are symptoms of a greater underlying problem, namely, the removal of God from the public square and immorality. As of yet, you fail to offer any evidence to make the case for that claim, nor do you point us in the direction of any research that may have already done so.

Jeff, really? 

 Try studying human history and the bible. 

I digress, except to say,  you just made my case! 

There is some wisdom in Dr. Clark's argument that David Brooks oversimplifies America's budget dilemma as a simple choice between defense cuts and Medicare cuts. But Dr. Clark's central thesis is incorrect: "We currently pay too much [for health care] and receive too little, because the health-care industry has been taken over by Wall Street, whose major goal, with health insurance as with banking, is maximal short-term profit...The insurance industry, which is merely a branch of Wall Street, is itself one of the main causes of out-of-control health-care costs."

A few minutes of research leads to the following: In 2010, the U.S. spent $2.6 trillion on health care. In the same year, profits at the ten largest health insurance companies totalled less than $15 billion. If we eliminated ALL those profits, total ealth care spending would be reduced by one half of one percent. In the same year, Medicare fraud was estimated at $48 billion, and costs of defensive medicine were estimated at $100 billion. In 2009, Peter Orszag, director of the White House Office of Management and Budget, told NPR that as much as $700 billion a year in health care costs do not improve health outcomes. These and other points are brought together in a white paper, Where Can $700 billion in Waste be cut Annually from the U.S. Healthcare System prepared by Thompson Reuters, one of the most respected news agancies in the world. The Henry J. Kaiser Family Foundation report Health Care Costs--A Primer (May, 2012) comments that "Health care experts point to the development and diffusion of medical technology as primary factors in explaining the difference between health spending and overall economic growth...Increases in disease prevalence such as diabetes, asthma, and heart disease, coupled with the growing ability of the health system to treat the chronically ill, contribute to the high and growing levels of health spending."

If we are to make effective policy choices, we must first rely on facts, not popular axioms.

Joseph J. Dunn       Author of After One Hundred Years: Corporate Profits, Wealth, and American Society

Mr Dunn:

I agree we need to rely on facts, but they should be the right ones.

The profits that the healthcare sector generates mostly do not go to healthcare companies, many of which are non-profit hospitals, but instead go to the insurance industry, which is a part of financial services industry (wall street), and which mostly are run by the logic of wall street, as well as to Big Pharma (also run to maximize investor profits and not health. So you are looking in the wrong place.

 If running hospitals was profitable the Church wouldn't be forced to close so many down. 

And of course, profits are an accounting creation, and calculating them in healthcare sector is particularly hard, as the assignment of costs is less than objective (look at a hospital bill and you should be able to see this, or you'll get a headache, but bring your own aspirin, its cheaper).    Having a for profit insurance industry rule over health care means that medical costs are much higher than they need be, just look at how much USA spends on paperwork.  Frontline had a show awhile back that compared a Canadian and a New York hospital that were equal in size and scope.  The Canadian hospital had 12 people taking care of all the billing, the New York Hospital had 800.  None of this would be seen by looking at the profits.  As anyone who has studies the economics of industries learns, when there is an oligopoly (like with health insurance) and the ability to set prices, there will be substantial cost inflation.  Add to this that the health insurance industries incentive to minimze paying out, you get both high costs and poor outcomes.

There are of course many factors that make health cost high in USA and private insurance is only one, but I don't see making it a bigger part will reduce costs.  As for cronic illnesses you mentioned, many public health researchers are finding lots of evidence that income inequality is a ajor contributor to these and early mortalities.  There is lots of evidence that racism and other forms of discrimination make people sick as well. What I almost never see is a public health expert who is not being paid by wall street say we need more profit motive in health care.

 

Peace,

Charley Clark

The numbers I presented above directly respond to the statement that "The insurance industry, which is merely a branch of Wall Street, is itself one of the main causes of out-of-control health-care costs." Addressing the broader issue of other corporations in the health care industry, the return on equity of health insurers, pharmaceutical companies, and device manufacturers measured over five-year averages, does not differ from the ROE typically earned by such firms as Anheuser Busch-InBev, Kellogg, H.J. Heinz, General Mills, etc. Those ROEs are the incentive that draws investors to put money into long-term drug research and production, new medical devices, hospital buildings and management, etc. We rely on the for-profit sector precisely because the capital needed for these ventures is not available elsewhere. As for "Wall Street" influences, such as "maximal short-term profit" let us recall that whatever profits are made are accruing to the benefit of the shareholder-investors. These "Wall Street" investors include union pension funds, charitable foundations, university endowments, and mutual funds that cater to many of the 47% of American households that own stocks or mutual fund shares--obviously including many middle class households. And some of these health care corporations have served their customers and shareholders for over one hundred years. This might just be a system that contributes to the common good.

 Without falling too much into anecdotes, let's also acknowledge that a large number of those 800 billing personnel are dealing with Medicare, and others are dealing with non-profit insurers. The need to convert billing formats, and incentives, away from "pay per treatment" is well known, and for-profit insurers and hospitals have long been active in such movements. All of us can become more knowledgeable consumers of health services, and make better health choices. Insurers are also major providers of programs that reduce costs and improve the health of their customers, including incentives for health club activity, call centers staffed by registered nurses, quit-smoking programs, and on-going review of research into best practices and evidence-based protocols. These, too, serve to advance the common good.

In summary, there are improvements to be made to our health-care system, and all of us have roles to play. But profits and incentives are not the problem--they may be a large part of the solution. Cheers,

Joe Dunn

 

 

 

I'm sorry Patricia, but I don't know what case you think I made.

Mr Dunn:

You wrote:

"Addressing the broader issue of other corporations in the health care industry, the return on equity of health insurers, pharmaceutical companies, and device manufacturers measured over five-year averages, does not differ from the ROE typically earned by such firms as Anheuser Busch-InBev, Kellogg, H.J. Heinz, General Mills, etc"

These are all Large Corporations, the comparison should be with firms that face real competition.

Back in the day I used to teach Industrial Organization, and we did the Pharmacetical Industry as a case study, and the evidence is that the Big Pharma has much higher than average profits for even large corporations.  Just doing a quick google search I found a study that had the Drug companies that are in the Fortune 500 with an average return on equity of 33.2% for 2001, while the rest of the Fortune 500 has a return on equity of 9.8%, over 300% larger. 

A quick look at Yahoo finance shows that the healthcare sector is very profitable, with a net profit margin of 15.6% and only one other sector is above 10%, with the average for all non healthcare sectors (without Healthcare) being just under 8%. 

The increased profits of healthcare have not provided better health outcomes, as USA is consistently at the bottom of most rankings of healthcare outcomes of rich countries.

Maybe some day I will write a post on what a sham the shareholder model is, but don't have time for that now.  Just one quick point.  The Finance Industry's share of all corporate profits has gone from the 8-12% range before deregulation, to 30-40% range.  They haven't made the economy three times more productive.  And at the same time real wages have not risen.  This is a major reason for the rise in income inequality.  James Galbraith has an excellent book on this, "Inequality and Instabiity" which Ihighly recommend.

Charles Clark 

 

Dr. Clark,

Thanks for the recommendation on Galbraith's book. I believe there is a great need to explore our history, to understand our options for the future in terms of promoting the common good, with a preferential option for the poor. Knowing you share my concerns, but not my views, I invite you to read my recent book, After One Hundred Years: Corporate Profits, Wealth, and American Society. The topics we have addressed over the last few days are covered there in 400+ pages. I wrote it to point to the most powerful levers available to those who share our concern for economic justice.

Briefly responding to your points above, "These are Large Corporations, the comparison should be with firms that face real competition." No firm, no matter how large, is exempt from competition. Consider that early in the 1920s Ford Motor Company's market share ranged from 40% to 60%, but by 1929 that share had dropped to 34%. General Motors (organized five ears after Ford Motor Company) had overtaken Ford, and GM went on to acquire the lead market share, which it held throughout the rest of the century. The same process of competiton for customers allowed upstart Wal-Mart to unseat Sears, Roebuck and Company as the leading retailer. It explains the passage of RCA, which once dominated the elecronic entertainment (radio) industry. The greatest threat to any established firm is the new competitor, the innovator, the one who focuses 100% of its resources on meeting the customers' need. 

"I found a study that had the Drug companies in the Fortune 500 with an average return on equity of 33.2% for 2001, while the rest of the Fortune 500 has a return on equity of 9.8%, over 300% larger." I don't have readily at hand statistics for 2001, but in any given year the competitive forces (customers making decisions) produce some Fortune 500 companies with low or negative ROEs and others with high ROEs. In the five year period 2002-2006, General Motors produced a net loss of almost one billion dollars per year, resulting in a negative ROE for the five-year period. In 2007 (before the Great Recession and financial crisis), GM lost another $39 billion. I am confident that the ROE differences you reported for 2001 existed for similar reasons. Since all firms face competition an in any year there are big ROE winners and big ROE losers, I used the five year averages discused earlier.

"A quick look at Yahoo finance..." Profit margin and dollars of profit, and hence ROE, are very different, as you know. Some high-margin products produce low profits and ROE, and the opposite can be true. Not enough space to get into all that here, as you can appreciate. But nothing you write here weakens my position.  

"The increased profits of healthcare have not provided better health outcomes, as USA is consistently at the bottom of most rankings of healthcare outcomes of rich countries." The diparities in healthcare outcomes are documented in numerous studies. They point to differences in infant mortality, some of which sadly results from in utero exposure to illegal drugs and alcohol, and some of which ironically arises from live delivery of very fragile infants who might not have been born alive except for the highly advanced maternity and neo-natal care facilities in the US. As to adults, the US suffers far more than other advanced countries from abundance of calories and insufficiency of exercise, neither of which have much to do with our professional healthcare system, but have a lot to do with our individual lifestyle choices. The Thompson Reuters and Kaiser Foundation reports I pointed to earlier are worth reading, and the Kaiser website has a wealth of information on health issues.

"Maybe some day I will write a post on what a sham the shareholder model is..." One anecdotal bit of information: one of the largest fortunes in America today (and it is funding one of the largest charitable donations of this decade) was built by Warren Buffett buying, on the public market, stocks of companies that any of us could have purchased, at the same price. Every year, he discussed his stategy in his Chairman's Letter to his shareholders. These are available at the Berkshire Hathaway webste. The strategy is simple and anyone could have followed it. But the self-discipline was unique. Much more info on the shareholder model available in After One Hundred Years. 

The research and converstaions that can move us to a more just society are vital. As Paul VI wrote in Populorum Progressio, "...the individual who is animated by true charity labors skillfully to discover the causes of misery, to find the means to combat it, to overcome it resolutely." Let us move forward in that spirit. 

Best regards,

Joe Dunn

 

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About the Author

Charles Michael Andres Clark is a senior fellow at the Vincentian Center for Church and Society and professor of economics at St. John’s University in New York.