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1 point   posted on 06/24/08
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 9 %
-5.58%
 risk: moderate

How to reform US health care?


Jim Jubak in a recent article argued that the best method to reform health care was to hand it to Walmart.They would cut down on salaries,medicine costs by using generics and eliminate insurance costs because most people will be paying with cash.
This is almost similar to what we have in India.My question is if this is brought about which I think will happen going forward as America gets poorer,what should the investment strategy be? I was considering adding Zimmer holdings in view of the favorable demographics.But would the Baby Boomers be able to pay for it going forward ?That is an open question since we are seeing unprecedented wealth destruction.Another consideration is the effect on medical innovation which is funded by profits.I can't imagine Walmart model companies discovering anything useful.So is it better to buy drug manufacturers and device manufacturers overseas.Is this the reason why Warren Buffett has holdings in European drug makers and no US ones?

  Related to:  
WMT WalMart Stores Inc
UNH UnitedHealth Group Inc
ZMH Zimmer Holdings Inc.
PFE Pfizer Inc


Comments (21)

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traderdrew   51%     1 point   commented 1414 days ago reply

the best way to reform health care would be through a single payer system but that would mean going in the face of all the major insurance companies which is a difficult lobby to confront

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nextfundmanager   N/A     1 point   commented 1414 days ago reply

the first step is for politicians and citizens to realize that we are already paying for the healthcare of the uninsured via emergency room visits and that almost any solution will be better than what we have now

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Toby Lopez    9 %     1 point   commented 1414 days ago reply

Thank you for your comments.I am a doctor myself and one of the reasons why I reconsidered my decision to come the US was the commercial nature of the profession.We get to run our office as a business and not withstanding my high degree of involvement with investing and such,in my real life profession as a doctor I just want to treat people and not worry about billing,salaries and the other aspects of running a business.Although I am libertarian in many of my views,I believe health care should be run as a service by the government paid for by taxes.Health care should not be an industry focused on year on year profit growth.In this respect the single payer system would be the way to go as the first step in reform.And yes the un insured do get treated at public expense.This is very profitable for the insurance companies since they might be high risk and low return anyway and they get foisted on to the public.Besides emergency room consults are usually made late in the course of the disease when they can't take it any more,so the resulting treatment would be much more costlier than it would have been had it been treated promptly.I note with grim fascination India take the first steps down the slippery slope of private medical insurance and high medical costs.I therefore started eating healthy and getting regular exercise because I am sure I won't be able to afford my bills should I fall ill in my old age :)
A website that promotes single payer system
http://www.pnhp.org/facts/what_is_single_payer.php
Physicians for national health program

Thanks once again for your perspectives.

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dressshops   N/A     1 point   commented 361 days ago reply

The high cost of private custom dress Mention of the private custom, we immediately think of high bridesmaid dresses.In fact, because the private floor length bridesmaid dresses sector to ensure the quality of knee length bridesmaid dresses itself decided the cost of all aspects of the cost.

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loneranger   38%     1 point   commented 1413 days ago reply

there is no question that we need to reevaluate the costs of prescription drugs in this country, it really makes you wonder who Washington is looking after. Might as well get your drugs from mexico or canada

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traderdrew   51%     1 point   commented 1407 days ago reply

Thomas thanks for the link, the info, and your perspective.

So are you currently in the US, I wasnt quite sure from your response?

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nextfundmanager   N/A     1 point   commented 1407 days ago reply

I think the real question is whether on not people will be interested in paying a specific amount only for healthcare rather than continue their cognitive dissonance and pretending that they arnt already paying for it

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Toby Lopez    9 %     1 point   commented 1405 days ago reply

I dropped my plans of coming to the US and am staying on in India.During my college days coming to the US was my big dream.Once I got out started working my perspectives and needs changed.I started to understand how different systems work and I didn't really like the working conditions in the States.Health care professionals are going to be squeezed going forward as costs are cut,it won't be pretty.Wal mart isn't known for quality,similarly as the pork is cut out,corporations will squeeze profits out by cutting down on staff (hire less qualified people etc).Hedge funds are already leading the way in the management of nursing homes
http://www.nytimes.com/2007/09/23/business/23nursing.html?_r=1&oref=slogin

http://dealbook.blogs.nytimes.com/2007/10/18/lawmakers-to-examine-nursing-home-buyouts/

The US is bankrupt(I may be a bit paranoid here I admit,I am the guy who thinks there would be a massive sell off in the US Bond and Treasury markets as confidence in the US dollar and inflation control plummets forcing yields up) and will not be able to honor its Medicare bills.So the government will likely dilute what it provides.

I think they would prefer not to know until they find themselves at the receiving end of a faulty health delivery model.

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nextfundmanager   N/A     1 point   commented 1405 days ago reply

wow that hedge fund bit is fascinating. the dilution by the government sounds just like america

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David Caro-Greene   50%     1 point   commented 1404 days ago reply

Health care providers have always suffered from a wicked case of conflict of interest.

From a moral perspective we know that Walmart will not take the appropriate ethical action into consideration when expanding their business in this area.

From an investment perspective its awesome. Walmart sells more health defect causing products than your local nuclear power plant and the customers love to buy the hydrogenated oils and high fructose corn syrup because it is the taste they have grown to love as obese pig like child beasts.

Walmart will keep the snorting hoards in perfect slovenly posture as the dirty dogs they really are as they should be.

So what could a bunch of flouridated prozac and low grade morphine gonna do to make them any more disgusting than they already are?

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Toby Lopez    9 %     1 point   commented 1403 days ago reply

http://articles.moneycentral.msn.com/Investing/JubaksJournal/LetWalMartFixUSHealthCare.aspx?page=1

Jim Jubak is of the view that Walmart should go beyond just providing low cost generics.

http://blogs.newberlinnow.com/conserv_speaking/archive/2007/02/08/Wal_2D00_Mart-to-the-rescue.aspx
this by
"State Senator Mary Lazich (R-New Berlin), whose district includes New Berlin, Franklin, Greendale, Hales Corners, and parts of Greenfield, has been in the Legislature for more than a decade.
She considers herself a tireless crusader for lower taxes, reduced spending and smaller government. " :)

I am a macro person big picture person -my view is this -managed health care is like speciality retailers,they did well when people had money now that they don't (and neither does the government and employers are increasingly bailing out of health care for employees),tough choices would have to be made and they would "trade down" to store clinics.Some of the things I say might seem outlandish :).

Jim Jubak outlines the following benefits
1.generics lower prescription costs
2.people pay cash-eliminates any need for documentation,insurance filing etc.Someone opens the cash register,puts it in and returns the change.Done.
3.walmart will cut cost-if u can't do it at MY price,I would just get someone else.This would adversely affect health professionals,I expect more immigration etc because most medical professionals from the States would have too much debt to work at these salaries.Some people I know are already working in drug addicted riddled neighborhoods no American would want to go.
4.online medical records-although this would cut costs,I am not really sure this is a good idea.This requires good government oversight to prevent misuse and to expect the same from a government that let the credit crisis,FNM and FRE fiasco happen is a bit of a stretch.In the end it will be like the credit score ratings that everyone wants to keep perfect.Similarly everyone would worry about their medical records when they go for a job interview(remote possibility).

As for the obese etc,the recession and free markets would do for them what countless weight loss programs and gurus were not able to do.I am a believer in the gospel of hard asset investing.Agricultural commodities will continue to do well over many years to come.Meat prices are going to increase over the next year as the current herd liquidation exerts its effect.As prices rise people will not be able to eat let alone overeat.The age of "comfort eating" is over.People are already shifting to beans and rice.They are growing vegetables in their own backyard.Of course they might stop midway and try to go back to their old ways during bull market pulbacks(gas prices fall,stocks go up,everybody on CNBC is happy and MSM goes wild).But change is inevitable.In the long run Stampada is right when he says there is no where else that the innovation etc of the West has been surpassed.Kungfu Panda stirred a debate in China regarding this-kungfu is chinese,the Panda is chinese but it took an American to make Kungfu Panda.

http://www.iht.com/articles/2008/07/16/asia/letter.php

The US will be better at the end of this crisis.The people will be fitter,hard working,conservative and frugal.

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stampada   62%     1 point   commented 1397 days ago reply

PART 1 of 2. A major reform of any system in the US will first require reform of the legal system. Attorneys have gained control over everything that matters in this country and any pretense at beneficial change or meaningful reform is merely fodder for a lawsuit or class action movement. Any change that will cap malpractice suits or reduce normal practice of medicine lawsuits will be resisted, fang and claw. This means that peripheral areas will be starved for adequate health care, while health care workers will migrate to the larger population centers that will be able to afford all of the mitigating tests necessary to placate the malpractice boys. The US has far and away the highest per capita concentration of attorneys in the civilized world who bind progressive measures with legalisms and chains of political correctness. Second, supply and demand factors have to be brought into a more equitable equilibrium. Current supply is unable to satisfy the additional demand of 47,000,000 people. Why not increase the supply of services by allowing masters’ level practitioners – physicians’ assistants; nurse practitioners; etc. (I personally do not need someone with 14 years of training to tell me that I have a sinus infection) – to operate in a semi-autonomous manner? (In England, one needs only a four year, Bachelor of Medicine degree to practice medicine.) These practitioners could deliver babies, set broken bones, deal with infections, and other routine work. More involved cases would be referred to higher level practitioners. (Continued in PART 2.)

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stampada   62%     1 point   commented 1397 days ago reply

PART 2 of 2. Third, promote effective wellness and healthy lifestyle programs. If we are to live in an increasingly socialized world, I do not choose to subsidize those folks standing in line at the “Fried Chicken Hut,” or the “I Can’t Believe It’s Not Fish (But I Can Believe That It’s Cholesterol) Shack.” Under socialism, your bad behavior is a direct cost to society, overall, and cannot be tolerated! Fourth, CONTACT YOUR CONGRESSPERSON TODAY ABOUT ALL OF THE CHANGES YOU WOULD LIKE TO SEE LEGISLATED: HEALTH CARE; SOCIAL SECURITY; TAXATION; MILITARY SPENDING; ETC. TELL YOUR CONGRESSPERSON THAT YOU WILL BE WATCHING HIM OR HER AND WILL HOLD HIM/HER ACCOUNTABLE FOR DESIRABLE CHANGE OR LACK THEREOF. IF YOU DO NOT GET DIRECTLY INVOLVED IN THE POLITICAL PROCESSES OF YOUR COUNTRY, THEN DO NOT COMPLAIN ABOUT YOUR STEADY DIET OF “MORE OF THE SAME,” UNDER WHICH THE RICH GET RICHER AND – oh, well, you know the rest.

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i admire your faith in your local representative, but I have little of that in mine

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