Here's a statement of the obvious: The opinions expressed here are those of the participants, not those of the Mutual Fund Observer. We cannot vouch for the accuracy or appropriateness of any of it, though we do encourage civility and good humor.
Agreed with Ted. No one is actually going to sit and solve the underlying problem of why health care costs are spiraling out of control in this country, they're just going to come up with various workarounds and a program that no one can explain clearly and easily. Meanwhile, I think the health care issues being seen in Asia are something that isn't being discussed and will continue to be a theme.
Long-term long HQL (and continue to get paid nicely to wait with that fund's distributions.)
Additionally, I like HQL and HQH's ability to invest pretty significantly in private equity healthcare.
well, that's how they did ytd and for the past three years but if i had a dollar for every time i invested based on glowing past results, i'd be a rich man. sigh. then again, dreams die hard, and at the moment i'm heavily into health. go health!
Reply to @linter: I agree with you in terms of past performance being no guarantee of future results. However, I think it becomes a matter of what is the fundamental reasoning behind performance - and I just don't see the story/theme being over. In fact, if anything, unfortunately the theme continues to be bigger - both here and overseas. Bloomberg article:http://www.bloomberg.com/news/2013-09-03/china-catastrophe-hits-114-million-as-diabetes-spreads.html
I haven't been impressed by anything the government runs and the future of healthcare looks like it is headed in that direction. Past performance may be what we investors look back on and reminisce about as 0-care takes effect.
The whole concept of making investment profit on the healthcare sector is very interesting. I believe that it's fair to say that the main underlying driver of Obamacare and every other proposed reform is the excessive cost and inefficiency of our present system.
The very concept of making an investment profit of any significant magnitude obviously requires that the cost of the underlying medical care be overpriced, so as to provide that profit margin. So how do we rationalize the desire for a lower cost system with the concept of huge profits?
At the risk of being accused (again!) of being either a socialist or worse, I simply raise the question of what it is that we expect from our medical system, without advocating for any particular design change, Obamacare or otherwise. It's pretty well irrefutable that whatever we're pretending is a "system" now is in fact neither logically designed nor even really a system, but rather a clapped-together batch of attempts to provide at least some level of basic service to almost anyone, while also providing an excellent level of care for those few who can afford it.
The result is a "system" that charges the often-quoted "$10 for an aspirin" so that we can provide minimal service to those who show up at the emergency room with serious problems but no cash. Now, the very existance of this situation strongly implies that perhaps medical care should not logically be considered in the same perspective as other financial transactions. For example, no one seriously believes that if you show up at a new-car dealership with no money you should be entitled to "some basic level of new-car ownership". This dichotomy suggests that regardless of whether it is expressed or not, our society does, at some level, make an exception to the normal capitalist model with respect to health care. From Ted's Ritholtz article:
"The Emergency Medical Treatment and Active Labor Act (EMTALA) was signed into law by Ronald Reagan. It mandated that “Hospitals provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay.”
If we accept that as a fact, (realizing that whatever we are doing now is both irrationally expensive and discriminatory to those without adequate insurance coverage) and desire to make our health-delivery system as efficient as possible, how do we expect to do that while providing great amounts of profit for investors who have no skin in the game other than to make money on the deal?
I cannot square this circle: I simply do not understand how to make the health system more efficient and less expensive while simultaneously building in great investment profits at the same time.
I apologize for the length of this... it approaches that typical of others who I have chastised for the same weakness.
Reply to @Ted: I'm not "fighting" anything. I'm asking a serious question that deserves a serious answer.
I'm not much into hypocrisy: do we want a more efficient and cost-effective system or not? If not, let's quit pretending and simply state that the medical-care system is in no way different than buying a new car...no money, no health... too bad... that's life.
Reply to @Old_Joe: This is going to be a jumbled answer.
1. Costs of various medicines and treatments have gone up astronomically. I know a relative who hadn't bought an inhaler (asthma) in ages because they don't need it that often. They knew it was expensive when they got one not that long ago. They were not prepared for a cost about 35-40% higher than expected. I'm sure people here have a million stories from friends, relatives, etc.
2. If you are going to introduce additional customers who could previously not afford various things in the health care industry - whether it be treatments or otherwise, does that fix the underlying costs and other various problems? I'm not going to get into a debate on whether or not everyone should have healthcare, but just making it so that everyone has healthcare (or, well, everyone has to get healthcare or face penalty) doesn't actually take steps to fix the underlying problems.
3. You have a government that cannot agree on anything and a health care plan that was explained early on as: "We have to pass it so that you can find out what is in it." People should have revolted on that statement alone, but all that aside, this is not government working together to create something clear and well thought-out, it's something that I'd guess few senators could actually explain and how many have exempted themselves from it?
The lack of clarity and lack of any sort of cooperation in Washington has resulted in turning an important topic into a "hot button" issue where you have senators going through "Green Eggs and Ham" while talking for nearly 18 hours. As I noted in another thread, the debt debate situation does not concern me. The longer-term, cumulative effect of a government system that appears broken and lacking leadership, as well as any sort of forward-thinking plan, does.
It also means more government involvement in people's lives. Beyond that, this is not a free lunch either and who really benefits most? The little guy at the expense of all those nasty corporations? I don't think so.
Again, the heath care situation in this country needs to be fixed. It, however, needs leadership and cooperation and more time than I think anyone in this country has the patience for. Maybe there is no good answer, but it's an important enough problem that deserves a government that focused on working together on a clear, transparent plan that people can understand.
This isn't being political - it's one of the biggest issues in this country; if you have a government that not only cannot work together on this but turns it into a gigantic mess of a debate, why have confidence in many other various issues being handled? If they are incapable of working together on one of the biggest issues facing this country, when does it become very clear that their interests are focused on their own interests rather than the needs of the populace at large?
All that said, I continue to like healthcare companies because - from all that I can see - the costs of all the various medications probably aren't going to go down and neither,probably, are treatments.
A lot of changes for the people of this country, but what changes for the Pfizers and GSK's of the world? Probably not that much - if anything, more business. Big pharma goes on being big pharma.
I'll continue to invest in heath care. Ethical? I dunno, I try to be somewhat ethical in terms of investments, but own Glencore, which I have to think would be a favorite of Mr. Burns if "The Simpsons" character was real.
Additionally, on another note, the two CNBC anchors were just trying to figure out why college costs have gone up astronomically. Um, if anyone can get a student loan, what happens? Gah.
Reply to @Old_Joe: I'm on the same page with you, OJ. Health care is one of my ethical filters. I know, I know, I know: to some small degree, surely just about all the mutual funds I own invest in some aspect of the industry. But I cannot bring myself to deliberately invest in an earmarked Health Care mutual fund. It seems to me the perfect example of profiting by exploitation. Health Care is not just another marketplace, like all the others. The fact that we still don't have a Single Payer universal system shows me who and what is in charge here in the USA, ultimately: The Almighty Dollar. (One, two, three, now: everyone bow down, all together. Now, repeat after me: "Hail, O Divine Greenback!")
Hi OJ, You noted: The Emergency Medical Treatment and Active Labor Act (EMTALA) was signed into law by Ronald Reagan. It mandated that “Hospitals provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay.”
This is indeed how this currently functions.....
ALSO, ,Big Pharma sues state of Maine This is a google search list.....take your pick of stories; all from the past 2 weeks.
Kinda tangent; as least in regards to gubment stuff. The majority of projects I know about would not take place without Federal grant money. Hugh amounts of grant money goes to many areas each year, in all states. A few years ago a school district was awarded a "loan", not a grant for a project. The loan has about a .62% interest rate for 20 years, for $13 million. The school has great needs to update buildings and especially very poor construction that continues to cause high energy useage. However, the loan could only be approved for new construction (let us call this, make work projects). Folks were and continue to be employed in the work. The project may generate some revenue for the school district into the future, which is good. The project is a 650 seat, state of the art; performing arts center that will be used mainly by the middle and high school bands and drama dept. All well and good, and yet the school's band rooms and related are in terrible condition.
Hi Max, Check the pharma link below in the reply to OJ. One must always determine who is the "screwee and screwor", eh? Yes, we live in a very smelly world of money. While not in the same aspect as you noted about investing in "health"; over the years, when hearing whines from friends and families about the continued rising costs with their phone and cable prices, I always encouraged them to invest in a decent telecom fund to have a return on their own money and hopefully make enough extra to pay for all of their telecom needs. Take care, Catch
Max, Past the fact that the homo sapien is supposedly more evolved than other creatures upon this planet; the species is not very far removed from the survival of the most fit, regardless; as is common in other forms of creatures.
Oh well, as the saying goes....."all is fair in love and war" and humans prove this statement every day of the year. Take care, Catch
Lastly, I'll note that exercise and change in diet needs to be a focus in this country. I'm probably the youngest person on this board, but a couple of years ago I really realized that I needed to make some improvements in exercising more and eating a little better and while I could still stand to make some more changes, the results have been very good. Understandably people are going to need healthcare for many things, but I think some conditions could be prevented or lessened with changes in lifestyle.
.....However, I'm not really confident that people will make those changes en masse, so again, remaining invested in healthcare.
Reply to @MaxBialystock: Max.........I removed the spider comment. The rest to the fact that where the money paths may lay; is where power and related will flow, regardless of ethics, etc. This may be a concern for some, especially when involved with a diverse fund investment. One may have a fund that holds mostly what one may choose to invest into; but may also hold a company that builds components for cruise missles. An investor may not choose to be involved with such a holding. Tough choices, sometimes.
Reply to @MaxBialystock: If it weren't for the Pharma stocks which is the bulk of PRHSX holdings, I along with millions of others wouldn't be alive today. Regards, Ted
Reply to @Ted: Ted, I suspect we will agree, as to Pharma/Biotech; that at least for me, I can not begrudge some of their profits, as these companies seldom know ahead what the outcomes will be from the millions spent on R & D in the hopes a given product is effective and lastly, that the product will be approved by the FDA. There are many other companies that do not provide as much potential good for we humans. I'm with you on Pharma/Biotech and related. Regards, Catch
I missed out on a good discussion here. Time zone warp does that.
The big point is, everyone wants and needs healthcare. Nobody wants to pay for it. To paraphrase Old Joe above, I may be accused of being a Tea Party member here and so be it.
The problem is insurance. When you insert a middle entity that handles the cost of a product without that cost being handled by the customer themselves, prices go up. I can see my doctor in the US for $60 cash. He is not supposed to do that but as a favor to me and my wife he does. Otherwise he bills insurance for $110 for a simple visit and gets whatever the insurance will pay. Medicare will get him about $35 last time we discussed this with large delays. Other insurances pay him around $60-80. So I see we are getting the service for the real cost. As for the $10 aspirin, that money pays for a lot of things since when one looks at the costs of hospital care, there are not many areas they can charge excessive like that. The money pays for labor, upkeep and everything else. I know because I used to be in healthcare in a hospital.
Staying with big pharma, a big issue is doctors prescribing high cost medications when low cost generics will do the job. Why? Insurance. If the patient is not paying for the medication directly then go for the gold. Prescribe the $5 a tablet antibiotic for Fred's sore throat when amoxicillin and 5 cents will do just fine. If Fred has to pay for it, he would surely demand a cheaper alternative. The same applies to all kinds of medications. Some of you here may be taking a expensive med for blood pressure or cholesterol or whatever. In most cases a very cheap alternative would do the job yet you can get the high cost med for the cost of a copay. Kind of like getting a Lexus for $2000.
Do I have any suggestion? Not really because this is a complicated subject. I would go for a plan that covers major medical like in the old days. Let me pay for my annual exams and my medications. But if I am involved in a accident or have a heart attack or get diagnosed with the big C, I would be thankful that my major medical insurance is there for what would cost 5 or 6 figures easily.
Finally to clarify, right now I pay for all my healthcare in cash. I take medication for diabetes and I have to test daily. I get the cheap medicine (metformin) and I am stable now for the past year. I do what I can to stay healthy.
I also wanted to comment that if the government takes over healthcare, be prepared to get much less than what you receive today. Also be prepared to pay for it. The idea that healthcare can be given to you for the cost of cable tv is absurd. I would say a 15% tax on all income would be a start. The only country I know that has a successful socialized health plan is Australia and part of that is they allow citizens to get private insurance on top of government health coverage so that care can be expedited. In most cases, waiting lists and denials are the norm.
Reply to @scott: That is a great point and one I think will evolve in time. More and more people are catching on to a healthier diet and exercise. Nobody needs to force the issue and we don't need bans like the mayor in NYC enacts. I don't mind a quarter pounder now and then but a daily diet of them is surely not healthy at all. Over time we will see people change to healthier diets.
I am having granola and coffee for breakfast while watching Bloomberg West. My usual regimen.
I wonder how much a month's supply of Metformin costs at retail price in The Philippines (Mercury Drugs? Just a guess. I saw them everywhere, over there.) I take that stuff, too.
If I have no responsibility toward anyone else for any reason, then it makes sense to speak of Health Care in a strictly amoral marketplace context. I do hope that someday, we can get from ME to WE in this country. (Michael Moore, "Sicko.") Why? Because (believe it or not) there are some things that are more important even than MONEY. Holy cow, what a radical, commie-pinko concept! Off with his head!
Some years ago, I lived in BC, Canada. There was a provincial car insurance outfit that you had to go to to insure your vehicle. Eventually, BC allowed people to go with other options. OK. That's for cars. Hunks of metal. Fine.
I can see that it makes sense to let the wealthy buy-into additional health insurance plans at their own expense. Those covered right now via Medicare can do that. My mom does that. There is no good reason why Medicare cannot be expanded to cover everyone. So, some other schmuck may need more treatment and prescriptions and surgery than yourself? So what? If you're not chronically ill, why not just count yourself fortunate? There's a big pile of different ailments that hit people with no warning. SOME ailments are actually a result of too much exercise in the attempt to stay healthy! In short, there's no way that this thing can ever be evened-out so that you only pay YOUR fair share. What's holding up a better, TRULY universal plan is selfishness and greed. We have met the enemy, and he is us. But it doesn't have to be this way. We do not HAVE TO operate out of selfishness and greed.
I am about ready to poke my eyes out with a pencil the next time I read the false narrative of the "government take-over of healthcare".
Aside from that....I am long healthcare in the form of large positions in POAGX, VGHCX and VHCOX...along with some individual stock holdings. I also work in the health science industry, working with several big pharma in their efforts to move compounds through the clinical trial process.
Here is a general question which illustrates my long-term affinity for the health science industry from an investment perspective. If more people will be entering the world of healthcare coverage in the US, why would the suppliers for products required by this new market population experience anything other than an increase in demand for their products?
I get metformin for 2 pesos per tablet. Current exchange right now is roughly 43 pesos to the USD. The stuff is dirt cheap and proves my point in a way. If you are paying high prices for cheap drugs, something is wrong. Most people don't know what they are worth however.
Test strips are 647 pesos for #25. I get One Touch simple select. Another scam by pharma as these strips are all the same. They put a different code on the end so you can use them with one kind of meter. My solution, buy the cheapest meter available and the cheapest strips. You don't need a fancy meter with memory and such. There are apps for that and my iPhone is my log for all things diabetic.
I think I am paying real world prices versus inflated prices paid by insurance plans. Also, how many diabetics are prescribed by their endo docs the fanciest meter with the most expensive strips and told to test 6-8 times a day. How many are prescribed the $5 a tablet drug when metformin is so cheap? Big pharma does cross the line with drug reps that push drugs in exchange for freebies and such for the doctors. That has to stop.
Reply to @PRESSmUP: "I am about ready to poke my eyes out with a pencil the next time I read about the false narrative of the "government take-over of healthcare".
Let's get specific and still be civil. Waiting lists, true or false? I say true. I know someone in Australia who had a ruptured disc in his thoracic spine. Very painful. He went to the doctor originally who diagnosed the issue and then he was placed on a list for scheduling for a procedure where they insert a needle and suck out part of the disc. Time to wait, 8 months. In the meantime his productivity went down since he couldn't hardly work. Just one example. Multiply that by population.
There are changes needed for sure. Is the government the one to take over and change? Another idea is for hospital chains and systems to start their own in house plans. You use their services and doctors. Much like Group Health if that plan is familiar but you could have your own doctor. Actually, the stand alone doctor practice is a thing of the past. Most are now joining health systems like above. Costs are being reduced but the big insurers don't like it.
Just curious...what do you mean by "government take-over"?
Not sure how fluent you are with the provisions of the ACA, but all of the carriers who will be providing plans within the state exchanges are non-governmental companies...many of which are traded on the major exchanges. I.E., public companies.
To this point, the cost of the various layers of coverage within each state (gold, silver, bronze) are, not surprisingly, largely driven by the number of companies bidding for these contracts within each state. That would be competition driving down pricing.
But if by a government take-over you mean we all have to have some type of health insurance coverage, then you are indeed correct I suppose.
And as an FYI...I really have no interest in anecdotal descriptions of waiting lines in Australia. Sorry if you don't believe I am being civil, but I bristle at misinformation being distributed helter-skelter.
And I've told myself I would refrain from politics in this forum. So that's about as far as I want to go.
Reply to @JohnChisum: Thanks! I think fitness technology is kinda interesting. Nike is richly valued at this point, but they're an example with their fuel band, as well as shoes that now communicate with your phone. Nike also has a lot going with social media and fitness. Now someone trying to work out more has an app that can graph their run, encourage them to set new goals and compete against friends, among other things.
I do agree with you on not regulating what people eat. While I don't have a ton of confidence that people are going to switch to healthier eating, I guess you do see some positives, such as a decline in soft drink purchases (see Coke, who is seeing declines in carbonated and a rise in things like Vitamin Water.)
Reply to @PRESSmUP: It would be a defacto government takeover. I just do not agree with the idea of forcing everyone to buy insurance. I prefer getting insurance out of the picture entirely and make it more of a free market system. In my example above, the consumer would deal with the hospitals directly.
There has to be a change and it should involve all levels. Doctors have to quit ordering MRI's for when someone bumps their head. Observation first. Start with the cheaper medications first. Is that test really necessary? We have to throttle back on the litigious mindset that we sue whenever something doesn't go the way we wanted it. In dealing with the human body, there are many unexpected variables to deal with. As a doctor once told me, "this is why it is called the "practice" of medicine."
Comments
Long-term long HQL (and continue to get paid nicely to wait with that fund's distributions.)
Additionally, I like HQL and HQH's ability to invest pretty significantly in private equity healthcare.
The very concept of making an investment profit of any significant magnitude obviously requires that the cost of the underlying medical care be overpriced, so as to provide that profit margin. So how do we rationalize the desire for a lower cost system with the concept of huge profits?
At the risk of being accused (again!) of being either a socialist or worse, I simply raise the question of what it is that we expect from our medical system, without advocating for any particular design change, Obamacare or otherwise. It's pretty well irrefutable that whatever we're pretending is a "system" now is in fact neither logically designed nor even really a system, but rather a clapped-together batch of attempts to provide at least some level of basic service to almost anyone, while also providing an excellent level of care for those few who can afford it.
The result is a "system" that charges the often-quoted "$10 for an aspirin" so that we can provide minimal service to those who show up at the emergency room with serious problems but no cash. Now, the very existance of this situation strongly implies that perhaps medical care should not logically be considered in the same perspective as other financial transactions. For example, no one seriously believes that if you show up at a new-car dealership with no money you should be entitled to "some basic level of new-car ownership". This dichotomy suggests that regardless of whether it is expressed or not, our society does, at some level, make an exception to the normal capitalist model with respect to health care. From Ted's Ritholtz article:
"The Emergency Medical Treatment and Active Labor Act (EMTALA) was signed into law by Ronald Reagan. It mandated that “Hospitals provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay.”
If we accept that as a fact, (realizing that whatever we are doing now is both irrationally expensive and discriminatory to those without adequate insurance coverage) and desire to make our health-delivery system as efficient as possible, how do we expect to do that while providing great amounts of profit for investors who have no skin in the game other than to make money on the deal?
I cannot square this circle: I simply do not understand how to make the health system more efficient and less expensive while simultaneously building in great investment profits at the same time.
I apologize for the length of this... it approaches that typical of others who I have chastised for the same weakness.
Regards,
Ted
I'm not much into hypocrisy: do we want a more efficient and cost-effective system or not? If not, let's quit pretending and simply state that the medical-care system is in no way different than buying a new car...no money, no health... too bad... that's life.
1. Costs of various medicines and treatments have gone up astronomically. I know a relative who hadn't bought an inhaler (asthma) in ages because they don't need it that often. They knew it was expensive when they got one not that long ago. They were not prepared for a cost about 35-40% higher than expected. I'm sure people here have a million stories from friends, relatives, etc.
2. If you are going to introduce additional customers who could previously not afford various things in the health care industry - whether it be treatments or otherwise, does that fix the underlying costs and other various problems? I'm not going to get into a debate on whether or not everyone should have healthcare, but just making it so that everyone has healthcare (or, well, everyone has to get healthcare or face penalty) doesn't actually take steps to fix the underlying problems.
3. You have a government that cannot agree on anything and a health care plan that was explained early on as: "We have to pass it so that you can find out what is in it." People should have revolted on that statement alone, but all that aside, this is not government working together to create something clear and well thought-out, it's something that I'd guess few senators could actually explain and how many have exempted themselves from it?
The lack of clarity and lack of any sort of cooperation in Washington has resulted in turning an important topic into a "hot button" issue where you have senators going through "Green Eggs and Ham" while talking for nearly 18 hours. As I noted in another thread, the debt debate situation does not concern me. The longer-term, cumulative effect of a government system that appears broken and lacking leadership, as well as any sort of forward-thinking plan, does.
It also means more government involvement in people's lives. Beyond that, this is not a free lunch either and who really benefits most? The little guy at the expense of all those nasty corporations? I don't think so.
Again, the heath care situation in this country needs to be fixed. It, however, needs leadership and cooperation and more time than I think anyone in this country has the patience for. Maybe there is no good answer, but it's an important enough problem that deserves a government that focused on working together on a clear, transparent plan that people can understand.
This isn't being political - it's one of the biggest issues in this country; if you have a government that not only cannot work together on this but turns it into a gigantic mess of a debate, why have confidence in many other various issues being handled? If they are incapable of working together on one of the biggest issues facing this country, when does it become very clear that their interests are focused on their own interests rather than the needs of the populace at large?
All that said, I continue to like healthcare companies because - from all that I can see - the costs of all the various medications probably aren't going to go down and neither,probably, are treatments.
A lot of changes for the people of this country, but what changes for the Pfizers and GSK's of the world? Probably not that much - if anything, more business. Big pharma goes on being big pharma.
I'll continue to invest in heath care. Ethical? I dunno, I try to be somewhat ethical in terms of investments, but own Glencore, which I have to think would be a favorite of Mr. Burns if "The Simpsons" character was real.
Additionally, on another note, the two CNBC anchors were just trying to figure out why college costs have gone up astronomically. Um, if anyone can get a student loan, what happens? Gah.
You noted: The Emergency Medical Treatment and Active Labor Act (EMTALA) was signed into law by Ronald Reagan. It mandated that “Hospitals provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay.”
This is indeed how this currently functions.....
ALSO, ,Big Pharma sues state of Maine This is a google search list.....take your pick of stories; all from the past 2 weeks.
Kinda tangent; as least in regards to gubment stuff. The majority of projects I know about would not take place without Federal grant money. Hugh amounts of grant money goes to many areas each year, in all states. A few years ago a school district was awarded a "loan", not a grant for a project. The loan has about a .62% interest rate for 20 years, for $13 million. The school has great needs to update buildings and especially very poor construction that continues to cause high energy useage. However, the loan could only be approved for new construction (let us call this, make work projects). Folks were and continue to be employed in the work. The project may generate some revenue for the school district into the future, which is good. The project is a 650 seat, state of the art; performing arts center that will be used mainly by the middle and high school bands and drama dept. All well and good, and yet the school's band rooms and related are in terrible condition.
So it goes, eh?
Take care out there,
Catch
Check the pharma link below in the reply to OJ.
One must always determine who is the "screwee and screwor", eh?
Yes, we live in a very smelly world of money.
While not in the same aspect as you noted about investing in "health"; over the years, when hearing whines from friends and families about the continued rising costs with their phone and cable prices, I always encouraged them to invest in a decent telecom fund to have a return on their own money and hopefully make enough extra to pay for all of their telecom needs.
Take care,
Catch
Conscience-less empty suits are responsible.
Past the fact that the homo sapien is supposedly more evolved than other creatures upon this planet; the species is not very far removed from the survival of the most fit, regardless; as is common in other forms of creatures.
Oh well, as the saying goes....."all is fair in love and war" and humans prove this statement every day of the year.
Take care,
Catch
.....However, I'm not really confident that people will make those changes en masse, so again, remaining invested in healthcare.
Max.........I removed the spider comment.
The rest to the fact that where the money paths may lay; is where power and related will flow, regardless of ethics, etc.
This may be a concern for some, especially when involved with a diverse fund investment. One may have a fund that holds mostly what one may choose to invest into; but may also hold a company that builds components for cruise missles. An investor may not choose to be involved with such a holding.
Tough choices, sometimes.
Catch
Regards,
Ted
Ted, I suspect we will agree, as to Pharma/Biotech; that at least for me, I can not begrudge some of their profits, as these companies seldom know ahead what the outcomes will be from the millions spent on R & D in the hopes a given product is effective and lastly, that the product will be approved by the FDA.
There are many other companies that do not provide as much potential good for we humans.
I'm with you on Pharma/Biotech and related.
Regards,
Catch
The big point is, everyone wants and needs healthcare. Nobody wants to pay for it. To paraphrase Old Joe above, I may be accused of being a Tea Party member here and so be it.
The problem is insurance. When you insert a middle entity that handles the cost of a product without that cost being handled by the customer themselves, prices go up. I can see my doctor in the US for $60 cash. He is not supposed to do that but as a favor to me and my wife he does. Otherwise he bills insurance for $110 for a simple visit and gets whatever the insurance will pay. Medicare will get him about $35 last time we discussed this with large delays. Other insurances pay him around $60-80. So I see we are getting the service for the real cost. As for the $10 aspirin, that money pays for a lot of things since when one looks at the costs of hospital care, there are not many areas they can charge excessive like that. The money pays for labor, upkeep and everything else. I know because I used to be in healthcare in a hospital.
Staying with big pharma, a big issue is doctors prescribing high cost medications when low cost generics will do the job. Why? Insurance. If the patient is not paying for the medication directly then go for the gold. Prescribe the $5 a tablet antibiotic for Fred's sore throat when amoxicillin and 5 cents will do just fine. If Fred has to pay for it, he would surely demand a cheaper alternative. The same applies to all kinds of medications. Some of you here may be taking a expensive med for blood pressure or cholesterol or whatever. In most cases a very cheap alternative would do the job yet you can get the high cost med for the cost of a copay. Kind of like getting a Lexus for $2000.
Do I have any suggestion? Not really because this is a complicated subject. I would go for a plan that covers major medical like in the old days. Let me pay for my annual exams and my medications. But if I am involved in a accident or have a heart attack or get diagnosed with the big C, I would be thankful that my major medical insurance is there for what would cost 5 or 6 figures easily.
Finally to clarify, right now I pay for all my healthcare in cash. I take medication for diabetes and I have to test daily. I get the cheap medicine (metformin) and I am stable now for the past year. I do what I can to stay healthy.
I am having granola and coffee for breakfast while watching Bloomberg West. My usual regimen.
If I have no responsibility toward anyone else for any reason, then it makes sense to speak of Health Care in a strictly amoral marketplace context. I do hope that someday, we can get from ME to WE in this country. (Michael Moore, "Sicko.") Why? Because (believe it or not) there are some things that are more important even than MONEY. Holy cow, what a radical, commie-pinko concept! Off with his head!
Some years ago, I lived in BC, Canada. There was a provincial car insurance outfit that you had to go to to insure your vehicle. Eventually, BC allowed people to go with other options. OK. That's for cars. Hunks of metal. Fine.
I can see that it makes sense to let the wealthy buy-into additional health insurance plans at their own expense. Those covered right now via Medicare can do that. My mom does that. There is no good reason why Medicare cannot be expanded to cover everyone. So, some other schmuck may need more treatment and prescriptions and surgery than yourself? So what? If you're not chronically ill, why not just count yourself fortunate? There's a big pile of different ailments that hit people with no warning. SOME ailments are actually a result of too much exercise in the attempt to stay healthy! In short, there's no way that this thing can ever be evened-out so that you only pay YOUR fair share. What's holding up a better, TRULY universal plan is selfishness and greed. We have met the enemy, and he is us. But it doesn't have to be this way. We do not HAVE TO operate out of selfishness and greed.
http://www.upworthy.com/his-first-4-sentences-are-interesting-the-5th-blew-my-mind-and-made-me-a-little-sick-2?c=ufb1
Aside from that....I am long healthcare in the form of large positions in POAGX, VGHCX and VHCOX...along with some individual stock holdings. I also work in the health science industry, working with several big pharma in their efforts to move compounds through the clinical trial process.
Here is a general question which illustrates my long-term affinity for the health science industry from an investment perspective. If more people will be entering the world of healthcare coverage in the US, why would the suppliers for products required by this new market population experience anything other than an increase in demand for their products?
I get metformin for 2 pesos per tablet. Current exchange right now is roughly 43 pesos to the USD. The stuff is dirt cheap and proves my point in a way. If you are paying high prices for cheap drugs, something is wrong. Most people don't know what they are worth however.
Test strips are 647 pesos for #25. I get One Touch simple select. Another scam by pharma as these strips are all the same. They put a different code on the end so you can use them with one kind of meter. My solution, buy the cheapest meter available and the cheapest strips. You don't need a fancy meter with memory and such. There are apps for that and my iPhone is my log for all things diabetic.
I think I am paying real world prices versus inflated prices paid by insurance plans. Also, how many diabetics are prescribed by their endo docs the fanciest meter with the most expensive strips and told to test 6-8 times a day. How many are prescribed the $5 a tablet drug when metformin is so cheap? Big pharma does cross the line with drug reps that push drugs in exchange for freebies and such for the doctors. That has to stop.
Let's get specific and still be civil. Waiting lists, true or false? I say true. I know someone in Australia who had a ruptured disc in his thoracic spine. Very painful. He went to the doctor originally who diagnosed the issue and then he was placed on a list for scheduling for a procedure where they insert a needle and suck out part of the disc. Time to wait, 8 months. In the meantime his productivity went down since he couldn't hardly work. Just one example. Multiply that by population.
There are changes needed for sure. Is the government the one to take over and change? Another idea is for hospital chains and systems to start their own in house plans. You use their services and doctors. Much like Group Health if that plan is familiar but you could have your own doctor. Actually, the stand alone doctor practice is a thing of the past. Most are now joining health systems like above. Costs are being reduced but the big insurers don't like it.
Just curious...what do you mean by "government take-over"?
Not sure how fluent you are with the provisions of the ACA, but all of the carriers who will be providing plans within the state exchanges are non-governmental companies...many of which are traded on the major exchanges. I.E., public companies.
To this point, the cost of the various layers of coverage within each state (gold, silver, bronze) are, not surprisingly, largely driven by the number of companies bidding for these contracts within each state. That would be competition driving down pricing.
But if by a government take-over you mean we all have to have some type of health insurance coverage, then you are indeed correct I suppose.
And as an FYI...I really have no interest in anecdotal descriptions of waiting lines in Australia. Sorry if you don't believe I am being civil, but I bristle at misinformation being distributed helter-skelter.
And I've told myself I would refrain from politics in this forum. So that's about as far as I want to go.
I do agree with you on not regulating what people eat. While I don't have a ton of confidence that people are going to switch to healthier eating, I guess you do see some positives, such as a decline in soft drink purchases (see Coke, who is seeing declines in carbonated and a rise in things like Vitamin Water.)
I'm also interested in machine-to-machine and healthcare - devices that wirelessly send information from patients to doctors, etc. (Qualcomm, Gemalto - http://www.qualcomm.com/media/documents/files/qualcomm-life-brochure.pdf, http://www.gemalto.com/m2m/markets/mhealth.html)
There has to be a change and it should involve all levels. Doctors have to quit ordering MRI's for when someone bumps their head. Observation first. Start with the cheaper medications first. Is that test really necessary? We have to throttle back on the litigious mindset that we sue whenever something doesn't go the way we wanted it. In dealing with the human body, there are many unexpected variables to deal with. As a doctor once told me, "this is why it is called the "practice" of medicine."
Thank you for the civil discussion.