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Profits and Health Care: A Beneficial Connection

By: Michael Ashton | Friday, March 17, 2017

I usually try to avoid political commentary in this space, because it has become so personal to so many people. If I point out that a particular program of the "left" is smart, or cleverly put together, then half of my readership is annoyed; if I point out the same about the right, then half of my readership is angry. It doesn't really make sense to waste article space except on those occasions when a policy has a clear effect on inflation over time, such as when the structure of the ACA made it clear that it would put upward pressure on inflation (as I pointed out in 2013) or in response to someone else's flawed analysis of a policy, as I did last year when I tackled the San Francisco Fed for their weak argument about how the ACA would hold down inflation because the government would demand lower prices. Actually, there is no policy I have written about more than the ACA over the years - but again, this was economic commentary and not political commentary.

This article will be short, but different in that I am writing it to express frustration with the absolute lack of intellectual clarity on the part of the Republicans in making a particular argument that immediately impacts the debate over health care but also extends far into other policies. And, because the argument is simple, direct, and has tremendous empirical support, I couldn't restrain myself. I expect this article will not be picked up and syndicated in its usual channels since it isn't directly about economics or markets, but it needed to be said.

I've been stewing about this topic since Tuesday (March 14th), when I happened to catch part of the daily White House press briefing. Press Secretary Sean Spicer was asked a question about the President's health care proposal, and tap danced away from the question:

Q Thanks, Sean. You mentioned the call with the CEO of Anthem Health. Can you tell me what this proposal of the President means for health insurance companies? Will their profits go up or down under the President's proposal?

SPICER: Well, I don't think that's been the focus of the President's proposal. It's not about them, it's about patients. But I think what it means for them is that they finally get to create more choice and more plans and allow people to choose a plan that fits them. Right now, they don't have that choice. And, frankly, in more and more markets, companies like Anthem, UnitedHealth, Signa are pulling out -- Aetna -- because they don't have the choice and because of the government mandate. I think what we want to do is allow competition and choice to exist so that they can offer more options for the American people.

Q But will those companies make more money under the President's plan or less?

SPICER: I don't know the answer to that. That's not been the focus of what we're doing now. And at the end of the day, right now they're pulling out of market after market, leaving the American people with fewer and fewer choices. So right now it's not a question of -- from the last I checked, I think many of them were doing pretty well, but it's the American people and its patients that are losing under the current system. So I think that there's a way you can do a little of both.

Spicer's response was the usual drivel that the Republicans have adopted when they run in fear from any question that includes the word "profits." To summarize, the question was basically, "you're doing this to throw a sop to fat-cat insurance companies, aren't you?" and the answer was "we don't think about that. No idea. Profits? Who said anything about profits? It's about patients and choice. And, if anyone gets more profits, it wasn't on purpose and we didn't have anything to do with it."

But this was actually a softball question, and the answer ought to have been something like this:

Q But will those companies make more money under the President's plan or less?

BIZARRO SPICER: Well, I hope so. After all, the insurance companies want every person in America to have health care - which is the same thing that we want - because the more people they sell their product to, the more money they can make. The insurance companies want to sell insurance to every person in the U.S. The insurance companies also want costs to be lower, and constantly strive to lower the cost of care, because the lower that costs are, the more profit they can make in the short run. But they don't want lower costs at the expense of health - clearly, the best outcome for their profits is that most people covered by insurance are healthy and so don't require the insurance they've paid for. So, if we just get out of the way and let companies strive for better profits, we are likely to get more coverage, lower costs, and a healthier population, and that is the goal of the President's plan.

The reason we don't already have these things is that laws we have previously passed don't allow insurance companies to offer certain plans, to certain people, which both sides want but which politicians think are "unfair" for one reason or another. Trying to create a certain preconceived Utopian outcome while limiting profits of insurance companies is what caused this mess in the first place.

If you want to beautify gardens in this city, does it make sense to limit the amount of money that gardeners can make? If you did, you would find fewer gardens got tended, and gardeners would not strive to make improvements that they didn't get paid for. We can see this clearly with gardeners. Why is it so hard to understand with the companies that tend to the nation's health? Next question.

For some reason, Republicans think that saying "profits are good" is the same thing as saying "greed is good" and leads to caricatures of conservatives as cigar-smoking industrialists. But while at some level it is the desire for a better material outcome - which I suppose is greed, but aren't there degrees of greed? - that drives the desire for profit, we cannot dismiss the power of self-interest as a motive force that has the effect of improving societal outcomes. "It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest," after all.

Of course, Republicans must also remember that profit without competition is a different animal. If an insurance company creates an innovation that lowers medical care costs, but does not face competitive pressure, then the benefit of the innovation accrues to the company alone. There is no pressure in such circumstances for the company to lower the price to the customer. But consider what happened to air fares after the deregulation of 1978, or to the cost of telephone service when the AT&T monopoly was broken up in 1984, as competition was allowed and even encouraged. Competition, and the more brutal the better, is what causes companies to strive for an edge through innovation, and it's also what causes the benefit of that edge to eventually be accrued by the end customer. The government didn't invent cell phones. Motorola did, in order to try and gain an edge against AT&T,[1] but until the telephone monopoly was broken up there were no commercial versions of the cell phone. The first cell phones cost $10,000 in 1983, about $25,000 in today's dollars, but now they are ubiquitous and cost about 2% as much in real terms. But this didn't happen because of a government program to drive down the cost of cell phones. It was the profit motive, combined with competition. All that government did was create the conditions that allowed innovation and competition to happen. And wouldn't we like health care to be as ubiquitous and cheap as cell phones are?

This is not a hard thing to get right. It isn't hard for people to understand. But for some reason, it seems incredibly hard for politicians to believe.

Note that nothing I have written here should be construed as an opinion about the President's health care plan, which I have not read. My remarks are only meant to reflect on the utter inability of Republicans to properly convey the reasons that a different approach - one where the government's involvement is lessened, rather than increased - would make more sense.


[1] The first cell phone call was made by the inventor, Martin Cooper at Motorola, who called his competition with it: the head of the cellular program at AT&T. According to him, he said "Joel, I'm calling you from a cellular phone, a real cellular phone, a handheld, portable, real cellular phone" and he said it got really quiet on the other end of the line.

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Author: Michael Ashton

Michael Ashton, CFA

Michael Ashton

Michael Ashton is Managing Principal at Enduring Investments LLC, a specialty consulting and investment management boutique that offers focused inflation-market expertise. He may be contacted through that site. He is on Twitter at @inflation_guy

Prior to founding Enduring Investments, Mr. Ashton worked as a trader, strategist, and salesman during a 20-year Wall Street career that included tours of duty at Deutsche Bank, Bankers Trust, Barclays Capital, and J.P. Morgan.

Since 2003 he has played an integral role in developing the U.S. inflation derivatives markets and is widely viewed as a premier subject matter expert on inflation products and inflation trading. While at Barclays, he traded the first interbank U.S. CPI swaps. He was primarily responsible for the creation of the CPI Futures contract that the Chicago Mercantile Exchange listed in February 2004 and was the lead market maker for that contract. Mr. Ashton has written extensively about the use of inflation-indexed products for hedging real exposures, including papers and book chapters on "Inflation and Commodities," "The Real-Feel Inflation Rate," "Hedging Post-Retirement Medical Liabilities," and "Liability-Driven Investment For Individuals." He frequently speaks in front of professional and retail audiences, both large and small. He runs the Inflation-Indexed Investing Association.

For many years, Mr. Ashton has written frequent market commentary, sometimes for client distribution and more recently for wider public dissemination. Mr. Ashton received a Bachelor of Arts degree in Economics from Trinity University in 1990 and was awarded his CFA charter in 2001.

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