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The Modern US Monetary System

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On Modern Monetary Realism

By Rick Kahler MS CFP® ChFC CCIM www.KahlerFinancial.com

In a previous ME-P column I explained why any currency-issuing country, like the US, will never default on its obligations or run out of money with which to purchase goods and services priced in its own currency. Sovereign nations that are currency issuers have no solvency constraints, unlike currency users such as individuals, corporations, and government entities that don’t issue currency.

Why the Government is Not-Like Medical Professionals

On Modern Monetary Realism

To follow up, let’s look at what has become known as Modern Monetary Realism (MMR).  Economist Cullen O. Roche describes it in a 2011 article on his Pragmatic Capitalism website titled “Understanding the Monetary System.”

This theory came into existence in 1971 when President Nixon eliminated the gold standard and allowed the government to print money at will. This was a paradigm shift in our monetary policy that’s gone largely unnoticed for decades by many educators, economists, and politicians.

Guiding MMR Principles

The principles of MMR are:

  • The Federal Reserve works in partnership with the US Treasury to issue currency. All other units of government, private entities, and individuals are users of the currency.
  • The government creates money by minting coins, printing cash, and issuing reserves. The private banking sector creates money by creating loans and bank deposits.
  • The Federal Government cannot “go broke.” It is inaccurate to compare it to households, companies, and local governments, which all are users of money and can go bankrupt.
  • The major constraint on currency issuers (sovereign governments like the US) is inflation. It behooves governments to manage the money supply prudently in order to avoid impoverishing their citizens through devaluing the currency.
  • Floating exchange rates between countries are a necessity to help maintain equilibrium and flexibility in the global economy. Nations that unduly inflate their currency suffer the consequences of devalued currency, shrinking purchasing power, and contracting lifestyles.
  • The debt of a sovereign currency issuer is default-free. The issuer can always meet debt obligations in the currency which it issues.

Cullen O. Roche Speaks

Roche suggests that a functional government supports the country’s financial system in four ways:

  1. The US government was created by the people, for the people. “It exists to further the prosperity of the private sector—not to benefit at its expense.” Roche argues that when government becomes corrupt by obtaining too much power or issuing too much currency that results in high inflation, it then becomes susceptible to a revolt and dissolution.
  2. Government’s role is to be actively involved in regulating and helping to build an infrastructure within which the private sector can generate economic growth. Roche views regulation as not only beneficial, but necessary to temper the inevitable irrationality that can disrupt markets. Still, he emphasizes that it is the private sector, not the public sector, which drives innovation, productivity, and economic growth.
  3. Money, while a creation of law, must be accepted by the private sector while prudently regulated by the federal government, keeping in mind that the purpose of the regulation is to maximize private sector prosperity.
  4. “Because the Federal government is not a business or a household it should not manage its balance sheet for its own benefit,” notes Roche, “but in a way that most benefits the private sector and encourages private sector prosperity, productivity, innovation and growth.”

Assessment

Like me, you may need to re-read this a couple of times to begin to grasp the concepts. Once you throw off the outdated pre-1971 model of the monetary system, understanding the basics of MMR isn’t difficult. Knowing the basics of how our monetary system works will help physicians, and all of us, frame the important issues in the turmoil unfolding in Europe and in our own upcoming elections. 

Conclusion

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How Do We Improve Collaboration between Physicians and Hospital Administrators?

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By Jennifer Tomasik MS [Principal: www.CFAR.com]

“It is the long history of humankind (and animal kind, too) those who learned to collaborate and improvise most effectively have prevailed.”

– Charles Darwin

Beyond institutional mergers and joint ventures, collaboration in healthcare is being driven by other factors; there is a need to move from a healthcare system driven by volume and characterized by fragmentation, waste, high cost, and inconsistent quality to a system where care is coordinated, costs are lower, and quality is higher.

Merger Mania

Merger mania in the 1990’s was driven by similar concerns, including the fear of for-profit competition and the rise of managed care. The results of this earlier round of mergers were unexpected. The 1990s ‘consolidation fever’ raised hospital prices by at least 5%, and did not measurably improve quality.[i] Hospitals purchased physician practices without a great deal of thought about expectations and mutual accountability, and many of those relationships failed—usually with significant financial implications.

Of Savvy Healthcare Leaders

Fearful of history repeating itself, savvy healthcare leaders are thinking differently about how to develop the collaborative relationships they need to succeed today. They see Accountable Care Organizations [ACOs] and Global Payments—where institutions will take on greater risk for the cost and quality of the services a patient requires—as an opportunity to get clear about how they can best position themselves across the full continuum of care. They believe potentials gains are not likely to show up simply as a result of mergers and acquisitions or consolidation per se. Rather than just integrating the bottom lines of their institutions, they are focused on ensuring that those individuals and teams who actually care for patients can productively collaborate with each other, and that they understand the clear and compelling rationale for why that collaboration is necessary.

Nowhere is this relationship more important than between hospital administrators and the medical staff.

What is “Collaboration” Anyway?

Merriam-Webster defines collaboration as “to work jointly with others or together especially in an intellectual endeavor.” While true, we find this definition insufficient for our purposes. Our colleagues at The Rhythm of Business, a consulting firm focused exclusively on collaboration, provide a more productive way to think about collaboration:

“Collaboration is a purposeful, strategic way of working that leverages the resources of each party for the benefit of all by coordinating activities and communicating information within an environment of trust and transparency.”

We add to this definition one additional, yet critical dimension. Collaboration also means working with, and through, differences. Any highly functioning team will, by its very nature, have differences – team members are ideally bringing innovative ideas that compete for “idea space” at the table.

Effective collaboration requires that teams not only value differences, but in fact encourage them to be surfaced. Viewed in this way, collaboration is not an event or an idea. It’s not “agreeing to get along.” Effective collaboration is an ongoing, systematic, strategic process. It is also, we believe, a business imperative – and nowhere more so than in healthcare.

Assessment

Given the often difficult nature of relationships between hospital administrators and medical staff, how do you improve collaboration to increase productivity and performance?


NOTE: [i] Vogt, William B and Robert Town. “How has hospital consolidation affected the price and quality of hospital care?” Robert Wood Johnson Foundation: Policy Brief No. 9. 2006.

Conclusion

And so, how do we improve collaboration between Physicians and Hospital Administrators?

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About the Author

Jennifer Tomasik, Principal,  leads CFAR’s Health and Hospital Systems practice. She works with her clients to solve complex strategic and organizational challenges. Her approach to consulting emphasizes communication and collaboration, supported by a blend of quantitative and qualitative analytics. Jennifer has worked in the health care sector for nearly 15 years, with expertise in public health, clinical quality measurement, strategic management, and organizational change. Her clients include some of the most prestigious hospitals, health systems and academic medical centers in the country. She has a Master’s in Health Policy and Management from the Harvard School of Public Health.

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