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More Changes to Medicare for Doctors

More Changes to Medicare

By Ira Nash MD

Conclusion

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Why My Firm Sold Short-Term Bond ETFs and Bought U.S. Treasury Bills

Why My Firm Sold Short-Term Bond ETFs and Bought U.S. Treasury Bills

By Vitaliy Katsenelson, CFA

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

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DOCTORS:

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“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

Questions I’d be Asking If I Owned Tesla Stock

Questions I’d be Asking If I Owned Tesla Stock

By Vitaliy Katsenelson CFA

 What happened to 345,000 reservations?

When Tesla’s Model 3 was released, it was supposed to be a $35,000 car. Four hundred thousand people, including yours truly, put down a $1,000 deposit to reserve their spots in line so they could get their hands on that marvel as soon as it became available. It was a brilliant move by Tesla, as it provided the company $400 million of interest-free financing — the biggest crowdfunding project ever.

Today, after some delays, the Model 3 is being produced. However, $35,000 seems to have been a fiction of CEO Elon Musk’s imagination. Though the car is getting great reviews from auto critics, the price for a bare-bones Model 3 starts at $49,000, and the tax incentives are fading away.

But something interesting happened recently. I received an email from Tesla that said: Model 3 is available to order, and no reservation is required in the U.S. We’re now offering all our best options — including our Long Range and Performance configurations with dual motor all-wheel drive. You can design and order yours today for delivery in approximately 2–4 months.

On the surface this sounds like great news, except that it begs a question: What happened to 345,000 orders? Let me explain. According to Bloomberg, which has been tracking Tesla’s production, to date (as of July 28, 2018) Tesla has produced 55,000 Model 3 cars. Since a $1,000 deposit was supposed to secure buyers a place in line, any car ordered today will only be delivered after orders that were placed years ago are fulfilled — after all, 400,000 people paid Tesla $1,000 to hold their places.

Thus there are only three possible explanations for the email I received. One is that Model 3 production is expected to accelerate at an exponential rate to 40,000 cars a week, starting now. However, Bloomberg estimates that Tesla’s normal production cadence of the Model 3 is closer to 2,825 cars a week, so this is a highly unlikely scenario.

Or two, maybe Tesla has been extremely liberal with its statement of a two-to-four month delivery schedule because it still has 345,000 cars to produce before it can start fulfilling new orders, and the company is using that email to raise additional funds from new customers making deposits. (The required deposit is now $2,500.)

There is a third explanation: The bulk of the original 400,000 orders were for a $35,000 car. When it came time to actually buy the car, consumers may have realized that the out-of-pocket expense was much more than expected and simply canceled their orders, draining Tesla’s balance sheet of $345 million.

How sound is Tesla’s balance sheet?

What Musk has achieved with Tesla and SpaceX is truly astounding. I have incredible respect for him, but he is also a magician playing a confidence game. If Musk can continue to convince the market that Tesla has a bright future, then the market will continue to finance Tesla’s losses, and maybe Musk will figure out how to produce the Model 3 more cheaply and then Tesla will sell hundreds of thousands of Model 3s and the future will be as bright as Musk paints it.

For that to happen, Tesla needs to maintain its high stock price, and investors have to believe that Musk is the Iron Man. Investors have to suspend belief, ignore current problems, and focus on the future. However, if the market loses confidence in Tesla and Musk, Tesla is done. This company is losing billions of dollars a year; it has an over-levered balance sheet. This is where Musk’s confidence game comes in.

If you believe in magic stop reading right now. Okay, you’ve been warned.

There is no magic. Magic is just the art of misdirection. The magician gets you to focus on the shiny object he holds in his left hand and you don’t see what he is doing with his right hand.

Musk has been showing us a lot of shiny objects. Some are real, like the success of SpaceX; some are superfluous, like sending a Tesla Roadster into space, and some are future promises on which Musk may or may not be able to deliver, like his futuristic underground railroad for cars (the hyperloop) and the Tesla truck, which is unlikely to be produced on time and at the promised price. The list is long in this category and never-ending; Musk’s futuristic thinking knows no bounds.

But importantly, these promises are the shiny objects that keep Tesla’s stock price high.

If I was a Tesla investor I’d be seriously worried about the company’s balance sheet. There are some ominous signs that Tesla’s financial situation is deteriorating rapidly. Tesla reportedly recently sent an email to its suppliers asking them to give some money back to help the company with its profitability.

Such requests are made by companies looking for Hail Mary solutions to significant financial problems. If suppliers start questioning Tesla’s financial viability, they’ll start shortening their accounts receivables periods and start requesting letters of credit. This would escalate the company’s problems. Hail Marys are acts of desperation. Putting this in the context of the likely Model 3 cancellations, — Tesla’s cash burn has likely gotten a lot worse.

 How effective is Musk at running Tesla?

Tesla is Elon Musk. He has achieved more than many of us will achieve in a thousand lifetimes. But today Musk is running half a dozen companies (Tesla, SpaceX, Solar City, Boring, OpenAI, Hyperloop). To make matters worse, he is also an incredible micromanager. I read that he interviews (or at least used to) every new employee who joins Tesla and SpaceX.

It is clear that Musk is quite exhausted, and his behavior is becoming more erratic. In a conference call snafu in April, he called the British diver who saved the Thai cave kids a “pedo” on Twitter. This sort of thing undermines Musk’s Iron Man image — if he loses that, the confidence game is lost and Tesla is done.

Another red flag went up recently: Musk started to attack short sellers. A short seller who went under the name of Montana Sceptic posted negative research on Tesla on Twitter and SeekingAlpha. Elon Musk personally called the man’s employer and threatened a lawsuit if the employer didn’t silence Montana Sceptic. Historically, companies that have gone after short sellers have had something to hide or were playing a confidence game. (The short sellers were interfering with the misdirection to shiny objects.)

Assessment

Tesla investors are still fascinated by the shiny objects, but I note that CDS insurance on Tesla’s bonds prices in a 24% risk of default by 2025. I am not long or short the stock. But if I were long Tesla’s shares I’d be asking myself these questions. After all, you’re paying $50 billion for a company that trades completely on the spoils of future dreams.

 Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

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DOCTORS:

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“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

 

On Medicare Bureaucratization

Isn’t limited to governments

By Rick Kahler MS CFP®

A client recently told me about her first medical checkup after becoming eligible for Medicare. “The doctor said things like, ‘They require us to fill out this form,’ and ‘This test is covered every three years, so we can’t do it this year,’ and ‘Medicare will pay for a baseline EKG even though you have no history of heart disease.’ I’ve gone to this doctor for ten years. I’m the same person I was a year ago. Yet it felt as if I had moved to a category where the appointment was all about the paperwork instead of my health. ”

A situation like this, where the paperwork seems more important than the person, demonstrates something I call the Principle of Bureaucratization: the idea that the more layers of decision-making are added to an organization, the less efficient it becomes in delivering its goods or services.

While this phenomenon affects organizations and governments of all sizes, the negative outcomes seem to increase the larger a company becomes or the further away the seat of government is from its constituents. Municipal services seem to be delivered more efficiently than state services. State services tend to be more efficient that those coming from the federal government. There are some exceptions, but not many.

One reason is that the further removed from you the decision-maker is, the less personal the services will be. Moving from the private health care system to the government-run health care system called Medicare is just one example. The same principle seems to apply in other countries. I have visited the UK numerous times, and it seems that every time I’ve read a newspaper article about some specific failing of the NHS (National Health Service). Just recently, at a workshop in Europe, a participant from the UK told me that the waiting list to see a psychiatrist was one year. “The NHS simply works against you,” she said with exasperation.

I think most Americans can agree that our healthcare system is badly flawed. We may disagree on the causes and cures. I see as one major problem that our federal government has created a regulatory structure which allows a select number of health insurance and pharmaceutical companies control over the health care system. These regulations have sent insurance costs soaring by almost eliminating competition. Third-party payment of medical bills means those receiving the services don’t have any incentive to even ask about costs.

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Bureaucratization isn’t limited to governments. It also affects large companies where the policies are made by people many layers away from the customers, and the employees dealing with customers don’t have the authority to make decisions or solve problems. Who hasn’t experienced having a seemingly easy problem to solve with a service provider, calling a customer service representative, and ending up on the phone for 45 minutes being passed from department to department and supervisor to supervisor?

Many employees of large firms and governments are equally frustrated by the bureaucracy created in their organizations. Bureaucratic organizations stagnate innovation and responsiveness. They are especially inefficient when those dealing directly with consumers don’t have any significant consequences riding on the quality of the goods or services provided. This is one reason why many, like Brian Robertson in his book Holacracy, believe the “best practices” governance model for organizations is a self-organizing structure that empowers employees closest to consumers to make decisions.

What’s the bottom line?

You’re ultimately responsible for your own well-being. Ask questions, be the squeaky wheel, and, above all, make connections with those working in the bureaucracies you deal with. Help them keep in mind that their purpose is to serve people, not paperwork. 

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

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Where is the Elon Musk of Healthcare?

SEARCHING FOR … !

By Fred Goldstein

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Advancements

Where is the Elon Musk of Healthcare?

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

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DOCTORS:

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“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

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Transformative Forces in Health Care

Navigating the Forces

By http://www.PublicisHealth.com

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

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DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

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Avoid Costly IRA Mistakes

Avoid These 2 Mistakes

By Rick Kahler CFP®

Investing through an IRA is a foundational method of retirement saving. Opening and contributing to an individual retirement account is not hard. That doesn’t mean IRAs are simple and easy to understand.

National Association of Personal Financial Advisors

I was reminded of this at the 2018 spring conference of the National Association of Personal Financial Advisors, where I attended a workshop by Jeff Levine of Fully Vested Advice, Inc., on “10 Critical IRA Mistakes.”

Top on his list of mistakes was failing to make charitable contributions out of your IRA when you are over 70½. These are called Qualified Charitable Distributions (QCDs). Here is why giving to charity directly from your IRA is a good idea.

For traditional IRAs, at age 70½ you must begin to withdraw required minimum distributions (RMDs) whether you want to or not. An RMD is taxable at ordinary income rates. Further, if you make a charitable donation and you are over age 65, you now must have over $13,300 of itemized deductions per person to get any portion of it deductible. By donating out of your IRA, you can reduce your RMD by an amount equal to your charitable gift. This makes your charitable gift 100% deductible and lowers your adjusted gross income, which can also help lower your Medicare premiums.

Here’s an example

Assume you are age 71, give $9,000 a year to charity, your property taxes on your home are $2,500, you are in the 22% tax bracket, and your RMD is $10,000. Without planning you will take your $10,000 RMD and pay $2,200 of income tax on it. Since you only have $11,500 in itemized deductions you will take the standard deduction of $13,300.

If instead you contribute $9,000 to charity out of your IRA, you reduce your taxable RMD from $10,000 to $1,000, slashing your tax liability on it from $2,200 to $220. The savings of $1,980 would cover most of your property tax.

If you make a QCD like this, it’s essential to inform your tax preparer. There is no required written evidence from your IRA custodian that your RMD needs to be offset by the amount of your gift. It’s your responsibility to tell your accountant so they report the correct reduced amount of the RMD on your tax return.

In Bankruptcy

Another significant source of mistakes is the complex asset protection rules for IRAs and retirement plans. Protection differs between bankruptcy and non-bankruptcy creditor actions.

In bankruptcy, all employer plans (ERISA), SEP and SIMPLE IRAs, and rollovers from retirement plans to IRAs are 100% protected from creditors. Amounts you personally contributed to traditional and Roth IRAs are protected up to a total of $1,283,025. However, inherited IRAs are not covered. You can see why it’s important to keep traditional, rollover and inherited IRAs in separate IRA accounts.

To make it even more complicated, different rules apply if creditors sue in non-bankruptcy proceedings. ERISA plans are 100% protected in all states. All IRAs are 100% protected in most states, except California, Georgia, Maine, Mississippi, Nebraska, South Dakota, and Wyoming, where they have limited to no protection.

Solo 401(k), SEP IRA, and SIMPLE IRA plans are fully protected from non-bankruptcy proceedings in about half of the states. The others, including South Dakota, have limited or no protection. If you live in one of these states and have a Solo 401(k), SEP, or SIMPLE, you want to roll it into an IRA as soon as circumstances allow.

Assessment

Mistakes like the two described here can be costly. To avoid them, especially if your circumstances are at all complex, it’s wise to get tax and IRA withdrawal advice from qualified financial advisors.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

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Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

***

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

Crossing Warren Buffett, Richard Branson and Steve Jobs?

What would you get if you crossed Warren Buffett, Richard Branson and Steve Jobs?

By Vitaliy Katsenelson CFA

Introduction

Masayoshi Son, the Korean-Japanese, University of California, Berkeley-educated founder of one of Japan’s most successful companies, SoftBank Group.

Like Buffett, Son is a tremendous capital allocator with a highly impressive record: Over the past nine and a half years, SoftBank’s investments have delivered a 45% annualized rate of return. A big chunk of this success can be attributed to one stock: Chinese e-commerce giant Alibaba, a $100 million investment SoftBank made in 2001 that is worth about $80 billion today.

Though you may put Alibaba in the (positive) black swan column, Son’s success as an investor goes well beyond it — the list of his investments that have brought multibagger returns is long. The 57-year-old Son is Japan’s richest person, and SoftBank, which he started in 1981 and owns 19% of, has a market capitalization of $72 billion.

Like Apple co-founder Jobs, Son is blessed with clairvoyance. He saw the internet as an transformative force well before that fact became common knowledge. In 1995 he invested in a then-tiny company, Yahoo!, earning six times his investment. But he didn’t stop there; he created a joint venture with Yahoo! by forming Yahoo! Japan, putting about $70 million into a company that today is worth around $8 billion. (Yahoo! Japan is a publicly traded company listed in Japan.)

What is shocking is that Son saw that the iPhone would revolutionize the telecom industry before Apple announced it or even invented it. See for yourself in this excerpt from an interview with Charlie Rose, where Son describes his conversation with Jobs in 2005 — two years before the iPhone was introduced:

“I brought my little drawing of [an] iPod with mobile capabilities. I gave [Jobs] my drawing, and Steve says, “Masa, you don’t give me your drawing. I have my own.” I said, “Well, I don’t need to give you my dirty paper, but once you have your product, give me for Japan.” He said, “Well, Masa, you are crazy. We have not talked to anybody, but you came to see me as the first guy. I give to you.”

Like Virgin Group founder Branson, who created Virgin Atlantic Airways in the U.K. to compete against the state-owned behemoth British Airways, Son started two telecom businesses in Japan — one fixed-line and one wireless — with which he challenged the state-owned NTT monopoly. In 2001, disgusted with Japan’s horrible broadband speeds, he convinced the government to deregulate the telecom industry. When no other companies emerged to rival NTT, Son took it upon himself to start a fixed-line competitor, Yahoo! BB (broadband). Thanks to him, now Japan enjoys one of the highest broadband speeds in the world and Yahoo! BB is a leading fixed-line telecom.

It took Son four years to bring his broadband business to profitability. This is how the Wall Street Journal described that period in 2012: “The problems at the broadband unit contributed to losses for the entire company for four consecutive years. Mr. Son set up an office in a meeting room 13 floors below his executive suite to be closer to the problem unit. He slept in the office at times and routinely summoned executives and partners for meetings late at night. . . . He worked out of the meeting room for 18 months, until the broadband unit had cut enough costs and moved enough customers to more lucrative plans.”

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A normal person might have taken a break and enjoyed the fruits of his labor at that point, but not Son. Just as his broadband business went into the black, Son executed on his vision for the internet and bought Vodafone K.K., a struggling, poorly run wireless telecom in Japan. SoftBank paid about $15 billion, borrowing $10 billion.

Fast-forward eight years, and SoftBank Mobile is a success. It is one of the largest mobile companies in Japan, even faster-growing than DoCoMo (a subsidiary of almighty NTT). Today it spits out about $5 billion in operating profits annually — not bad for a $5 billion equity investment.

Son has a highly ambitious goal for SoftBank: He wants it to become one of the largest companies in the world. Unlike the average Wall Street CEO, whose time horizon has shrunk to quarters, Son thinks in centuries: He has a 300-year vision for SoftBank. Practically speaking, 300 years is a bit challenging even for long-term investors, but at the core of his vision Son is building a company that he wants to last forever (or 300 years, whichever comes first).

Son views SoftBank as an internet company and is committed to investing in internet companies in China and India. He believes that as these countries develop, their GDPs will eclipse those of the U.S. and Europe.

Jobs, Branson, Buffett — it is rare for somebody to embody strengths of each of these business giants. None of them has the qualities of the other two. Buffett is a business builder but does not run the companies in his portfolio. Branson is not a visionary — in his book Losing My Virginity he admits to not seeing analog music (CDs) being destroyed by digital music (iTunes) and demolishing his music store business. Jobs probably came the closest, as both a visionary and a business builder, but he was not known for his investing acumen.

Valuation (updated)

You’d think SoftBank would be priced to reflect Son’s premium. Instead, its stock currently trades at around a 50% discount to the fair value of its known assets (SoftBank has about 1,300 investments, many of them not consolidated on its financials).

The gap between what SoftBank is worth (its fair value) and its stock price has widened substantially over the last few years despite the stock’s appreciation. Our fair-value estimate of SoftBank shares is about $80.

Frustrated with SoftBank’s valuation, Son has begun to make strategic moves to deleverage SoftBank. Last February, SoftBank announced it may take its Japanese telecom business public. SoftBank is expected to sell about 30% of its stake and should raise about $20 billion.

SoftBank owns a large chuck of Didi, the largest Chinese ride-hailing company, a Chinese version of Uber, which in fact bought Uber’s assets in China. Didi is a privately held company. Recently SoftBank announced that it is going to sell its shares of Didi to Vision Fund for $20 billion. Vision Fund is a $100-billion private equity-like investment vehicle created by Son. SoftBank owns one-third of Vision fund and has an even larger economic interest in it.

And then there is Sprint — SoftBank owns 82% of its publicly listed shares. After dating T-Mobile for almost a year, Sprint and T-Mobile finally decided to merge. There is a chance that the government might not approve this merger, but we think the probability of approval is high. The telecom industry requires scale: the cost of a network (cell towers, equipment, and spectrum) is mostly fixed, and profitability of a carrier is for the most part determined by the number of users.

T-Mobile and Sprint are each half the size of giant incumbents Verizon Communications and AT&T, which achieved their size through dozens of acquisitions. The combination of Sprint and T-Mobile would reduce competition in the short run, but in the long run it would create a strong and viable competitor and thus stable prices for consumers. T-Mobile and (especially) Sprint on their own would eventually get marginalized into irrelevance by AT&T and Verizon by the large cost of 5G rollout.

If the merger goes through it would improve the optics of SoftBank’s balance sheet. SoftBank owns 82% of Sprint and thus has to consolidate Sprint’s $30 billion of debt on its balance sheet. Despite SoftBank’s control of Sprint, in the event of bankruptcy SoftBank is not liable for Sprint’s debt. After the merger SoftBank will own around 27% of the combined entity and thus, magically, the debt of the new company will migrate from SoftBank’s balance sheet to the balance sheet of Deutsche Telecom — the majority owner of T-Mobile.

Between the sale of Didi, the Japanese telecom IPO, and the Sprint/T-Mobile merger, SoftBank should see its debt drop by about $70 billion. The current discount between the fair value of SoftBank’s assets and its stock price is caused by the perception of enormous leverage, and as the leverage gets cured so will the perception.

Conclusion

There are many ways to look at SoftBank. You can think of it as buying a stock at a roughly 50% discount to the market value of its assets or as a way to buy Alibaba at less than half its current price. Alibaba is a great play on the Chinese consumer who is spending more and more money shopping online. Alibaba is synonymous with Chinese online shopping, whose growth may accelerate with higher smartphone penetration and, just as important, the ongoing rollout of a fast wireless LTE network.

You can also look at SoftBank as a vehicle through which to invest in emerging markets — not just China but India as well. It is almost like hiring the combination of Buffett, Branson and Jobs to go to work for you investing in markets whose economies in a few decades will surpass that of the U.S., while also investing in a segment of the economy — the internet — that is growing at a much faster rate than the overall economy. And, of course, you have Masayoshi Son, the Buffett-Branson-Jobs fusion, making these investments for you. With SoftBank at this valuation, you can ditch your emerging-markets mutual fund.

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Additional thoughts

Some additional thoughts. I don’t expect every bet Mr. Son makes in Vision Fund to work out. Not at all. I look at Vision Fund as a portfolio of bets. For instance, his investment in WeWork and WeWork’s valuation make me cringe. I am also concerned that he feels the need to spend $100 billion all at once. There will be a time when this money will buy a lot more than it does today.

I feel uneasy that the $100 billion will be like a pig going through the python of Silicon Valley, inflating the prices of technology companies. But a few things let me sleep well owning Softbank: First, Mr. Son owns 20% of the company – every dollar Softbank spends, 20 cents are his. As Nassim Taleb would put it, Mr. Son has skin in the game. Second, the discount of Softbank stock to the fair value of its assets is so huge that it could absorb the blow-up of Vision Fund. And finally, I remind myself that I’d probably have had a similar feeling of uneasiness about Mr. Son’s decisions at any time in his 30-plus-year career (PCs in the ’80s, Internet in the ’90s, telecom Japan and internet in China in the ’00s). And this is when I remember Einstein’s quotes.

P.S.
To understand Mr. Son’s thinking, read my article on exponential growth. To understand the structure of Vision Fund, read this article.

Conclusion

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DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

About Dr. David Edward Marcinko MBA CMP™

At Your Service

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Chief Executive / Education Officer * Speaker * Author * Researcher and Professor of Health Economics, Finance & Policy Management 

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http://www.DavidEdwardMarcinko.com

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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An Introduction to “Micro-Hospitals”

The New Kid on the Block: An Introduction to Micro-Hospitals

By Health Capital Consultants [HCC]; LLC

This Health Capital Topics article, the first installment of a five-part series, will introduce the concept of micro-hospitals and briefly discuss how they have evolved within the current healthcare delivery environment.

The following articles in this series will further examine micro-hospitals in relation to the Four Pillars that influence the value of entities within the healthcare industry, i.e., regulatory; reimbursement; competition; and, technology. (Read more…) 

***

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

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Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

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Understanding the ME-P Knowledge Based Ranking Service

Join Our Mailing List

About Our Professional User-Generated Ratings Interface

From the Contributing Editors

How We Work

The Medical Executive-Post is a professional ranking and educational rating system for the integrated industries, readers and contributors we serve.

We function as an open social utility that allows readers and users to submit and collectively evaluate the quality of blog posts, opinions and essays on any of more than 50 specific topics and related subject matters of collective interest.

Understanding Knowledge Based Ranking Services

Assessment

Conclusion

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Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

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Dr. Marcinko Interviewed on the Physician Credit Crunch

Financial Experts Share Tips on Obtaining Loans to Start or Expand a Medical Practice

By Michael Gibbons

Editor: ADVANCE Newsmagazines

Maybe you’re a young dermatologist or plastic surgeon who dreams of starting your own practice. Or maybe you’re an established professional but want to expand your palette of anti-aging services. Either way, you’ve probably made an unpleasant discovery: Banks are leery about lending today. Global recessions with seemingly no end in sight tend to give loan officers sticky fingers.HO-JFMS-CD-ROM

Dermatologists and Plastic Surgeons

We have it on good authority that dermatologists and plastic surgeons as a group are less affected by this problem than physicians in some other branches of medicine. Still, there’s no better time than now to absorb some sound advice on how to approach banks for loans—whether you’re a fresh-faced newcomer to the fresh-face business or a wrinkled veteran at eliminating wrinkles.

Start Small

There’s no soft-soaping it: Starting a healthy aging practice is much harder than expanding an existing practice, even in the flushest of times.

“For young dermatologists starting out, I recommend you start small,” advises Jerome Potozkin, MD, who offers facial rejuvenation, liposuction, body contouring and dermatological care through his practice in Walnut Creek, CA. “You can always expand. Keep your overhead low. Know what your credit score is and do everything you can to improve it. Pay your bills on time.”

Lasers aren’t cheap. Besides the initial acquisition costs, a service contract can cost $7,000 to $12,000 a year, according to Dr. Potozkin. “Don’t feel you have to buy every new laser under the sun,” he says. “In fact, renting rather than purchasing is an option many companies offer. When your volume is low you can rent and schedule laser days—although the pitfall there is you don’t have lasers available whenever patients come in.”

Also, young dermatologists “will probably have an easier time getting a loan if they go to a relatively underserved area, as opposed to an area that has a large number of dermatologists per capita,” says Dr. Potozkin, who began practicing 10 years ago. “There are two schools of thought on this: Go where you want to live to start a practice or go to where there’s a need and be instantly successful. I chose the former. It took me longer to get started but I’m very happy where I am.”

Patience, Prudence and Passiondem2

Be patient, prudent, passionate—and start with a spare office and as little debt as possible, advises Dr. David E. Marcinko MBA, a financial advisor and Certified Medical Planner™. Marcinko, a health economist,  is CEO of the Institute of Medical Business Advisors Inc., a national physician and medical practice consulting firm based in Norcross, GA www.MedicalBusinessAdvisors.com

“Patients are looking for passion from you, not lavish trappings,” Dr. Marcinko says. “When a banker or a loan officer sees $175,000 or more of debt they are loath to give a loan—and it’s hard to blame them. Purchase a home after you become a private practitioner. You need to be as close to debt-free as you can be.

Exit Strategy

“Another thing bankers want to know is, ‘If we give you a loan and you start a practice and it fails, how will we be paid back?’ They want an exit strategy.”

The good news is dermatology “remains a very lucrative specialty, and in most parts of the country they are in a shortage position, particularly with the aging population,” says Sandra McGraw, JD, MBA, principal and CEO of the Health Care Group, a financial and legal consulting firm based in Plymouth Meeting, PA., that advises the American Academy of Dermatology, among other groups.

“I would start with a realistic business plan for why you think this practice can succeed, in the specific location,” McGraw says. “How many patients do you expect to see? How will they know you are there and available? Remember that banks lend to all kinds of people, so keep your numbers realistic. Overestimating expenses is as bad as underestimating them. Then determine how you want the money—usually a fixed loan for a period of time and then a line of credit as you get your practice going and sometimes need the cash flow.”biz-book

Expanding a Practice

Established dermatologists should have an easier time getting loans to expand their practices. They have, one hopes, a track record of success and assets to put up as collateral.

Mid-career physicians “have cash flow, physician assets and equity to some degree in a house and personal assets,” Dr. Marcinko observes. “Banks can attach loans to personal assets and savings accounts. Ninety-nine percent of times you must sign a personal asset guarantee. Mid-lifers have assets young ones don’t, so mid-lifers aren’t quite the risk. They have businesses that have value and cash flow. Banks like cash flow.”

However, even veterans must do some homework before approaching a bank. “You still want to establish why you want the money and how the expansion will increase your income,” McGraw says.

Another tip: If the bank has loans out with reputable vendors, you might ask the loan officer to recommend them to you as potential contractors. “Sometimes keeping it local and supporting others with loans at the bank can be helpful,” she says.

Assessment

Dr. Marcinko adds, “Bankers today want you to come in with a well-reasoned, well-thought-out and well-written business plan. Give bankers a 30-second elevator speech on why you are different. It’s really important to ask yourself, ‘What can I offer the community as a doctor in my specialty that nobody else can?’ If you bill yourself as the first dermatologist to do laser surgery, that’s a perceived advantage. You purchased the equipment and learned to use it. But anyone can do that. If you can come up with something that nobody else has or can do, that’s how you’re successful in anything.”

Link: Dr. Marcinko Interview

Link: https://medicalexecutivepost.com/wp-content/uploads/2009/08/dr-marcinko-interview.pdf

Conclusion

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Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Global Healthcare Corporate M&A 2018

Global Healthcare Corporate M&A 2018

Global corporate M&A activity in healthcare surged in 2017, fueled by relentless pressure on companies to contain costs and boost returns.

Total deal value rose 27%, to $332 billion, while deal count increased 16%, to 3,099 (see Figure 1).

Three megamergers (that is, deals valued at greater than $20 billion), with a collective value of $126 billion, accounted for more than one-third of the total (see Figure 2).

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http://www.bain.com/publications/articles/global-healthcare-corporate-m-and-a-2018.aspx

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. https://medicalexecutivepost.com/dr-david-marcinkos-bookings/ 

Contact: MarcinkoAdvisors@msn.com

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On Microsoft Health Accelerator, Merck Accelerator and Samsung NEXT

Microsoft Accelerator, Merck Accelerator and Samsung NEXT
have the highest awareness of all corporate health accelerators

By Markus Pohl

Among corporate health accelerators Microsoft Accelerator has the highest awareness level. Merck Accelerator and Samsung NEXT are ranking second and third. 42.8% of the digital health community has heard of Microsoft Accelerator. 26.7% have heard of Merck Accelerator, 26.4% of SAMSUNG Next and 24.8% of Grants4Apps by Bayer. Techstars (Barclays Accelerator, London) (18.2%) follows fifth with some distance behind.

These findings are part of our mHealth Economics program, the biggest survey of its kind with 2,400 answers from the digital global health community. In the ranking of of corporate accelerators’ awareness 21 corporate accelerators investing in healthcare have been included.

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Here is the full ranking:

Microsoft Accelerator, Merck Accelerator and Samsung NEXT have the highest awareness of all corporate health accelerators

Conclusion

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***

APPLE and the iPhone X

Now Apple must show what’s next after iPhone X

By  Vitaliy Katsenelson CFA

The iPhone X is likely to be a phenomenal success for Apple. But its success will not be driven by anything new that the new phone packs inside. Instead, its success will be based on the phone’s screen size. Essentially, iPhone X provides the same screen real-estate as an iPhone Plus, but with the sleeker form factor of the iPhone 7 or 8.

Apple has done a great job at changing the paradigm of our thinking about the iPhone. If you only care about making phone calls, then an iPhone 4 is good enough. Why pay for more? You probably don’t even need to upgrade your phone for years, as long as the battery keeps holding its charge. However, for most, the actual “phone” function is the least important of the iPhone.

Earnings

From an earnings perspective, iPhone X will be a tremendous boost. It will increase the average selling price per unit by a few hundred dollars, which should help not just sales, but profit margins as well. This is actually healthy for both Apple and the entire iPhone ecosystem (including DRAM and solid state drive makers — for example, we still have a large position in Micron Technology). People were also postponing buying new iPhones while waiting for the iPhone X; thus, the number of units sold will probably exceed most optimistic expectations.

What is next?

Then the question becomes, What is next? Higher-priced iPhones will also change the dynamics of the upgrade cycle. Apple is going to have a harder time convincing iFanatics to shell out $1,000-$1,200 every year (or even every two years). The upgrade cycle will likely be elongating to three or four years.

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Thus, any blow-out success of iPhone X in 2017 and early 2018 will be coming at the expense of future years. Even if you are a loyal Apple shareholder, you have to be prepared for this.

Assessment

Absent a new category of products, Apple is turning into a fully ripe stock. Yes, it will look statistically cheap based on 2018 earnings, but that will not be the case if you look at 2019 or 2020 earnings.

As all the excitement subsides, Apple stock will have to answer an extremely important question: What is next? After all, the value of any business is a lot more than the earnings generated next year, but far beyond that.

Conclusion

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Contact: MarcinkoAdvisors@msn.com

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***

On Consumer DNA Testing

Two states still resist consumer DNA testing

[By MIT Technology Review]

Earlier this month, 55,000 football fans were to receive a giveaway at a Baltimore Ravens game: not a T-shirt or a beer koozie, but a free DNA test. Ultimately, though, Maryland laws nixed the stunt.

Ronni Sandroff explains why.

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https://www.consumerreports.org/cro/news/2010/09/who-owns-your-dna/index.htm

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

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***

Machines Playing Doctor?

The Machines Are Getting Ready to Play Doctor

Bert Mesko

[By Bertalan Meskó, MD PhD]

A team of researchers at Stanford University, led by Andrew Ng, a prominent AI researcher and an adjunct professor there, has shown that a machine-learning model can identify heart arrhythmias from an electrocardiogram (ECG) better than an expert.

Read more

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Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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Mid-Year US Markets Investment Update 2017

Second Quarter 2017

[By Rick Kahler MS CFP®]

Most clients I have met with recently show surprise when I tell them the first half of the year was a good one for investors. As one client said,

“How is that possible with all the problems in the world?”

She ticked off the unrest in the Middle East, ISIS, our strained relations with Russia, the instability of North Korea, not to mention the tweeting antics of President Trump and Congress’s inability to fix health care or provide tax relief. To her, all these appear to be good reasons for markets to be going down, not up.

Her response isn’t unusual

Most people mistakenly assume that markets rise when there is good news and do poorly when there is turmoil and pessimism. Actually, it’s often the opposite.

The U.S. stock market has more than tripled in value during the runup that started in March 2009, when the world as we knew it seemed to be ending. The most recent quarter somehow managed to accelerate the upward trend. We have just experienced the third-best first half, in terms of U.S. market returns, of the 2000s.

Still, as good as markets were to investors, economic growth was admittedly meager in the first quarter. The U.S. GDP grew just 1.4% from the beginning of January to the end of March.

Round-up

The S&P 500 index of large company stocks gained 2.41% for the quarter and is up 8.08% in the first half of 2017. International stocks are finally delivering better returns to our portfolios than US stocks. The broad-based EAFE index of companies in developed foreign economies gained 5.03% in the recent quarter and is now up 11.83% for the first half of calendar 2017.

Real estate, as measured by the Wilshire U.S. REIT index, gained 1.78% during the year’s second quarter, posting a meager 1.82% rise for the year so far.

The energy sector, which was a big winner last year, has dragged down returns in 2017. The S&P GSCI index, which measures commodities returns, lost 7.25% for the quarter and is now down 11.94% for the year, due in part to a 20.43% drop in the S&P petroleum index. This proves once again the value of diversification. Just when you start to question the value of holding a certain investment or wonder why the entire portfolio isn’t crowded into one that is outperforming, the tide turns. If only this were predictable.

In the bond markets, longer-term Treasury rates haven’t budged, despite what you might have heard about the Fed raising interest rates. The coupon rates on 10-year Treasury bonds have dropped a bit to stand at 2.30% a year, while 30-year government bond yields have dropped in the last three months from 3.01% to 2.83%.

Some good news

The unemployment rate is at a near-record low of 4.7%, and wages grew at a 2.9% rate in December, the best increase since 2009. The underemployment rate, which combines the unemployment rate with part-time workers who would like to work full-time, has fallen to 9.2%, its lowest rate since 2008.

The current bull market is aging, however. The runup has lasted far longer than anybody would have expected after the 2008 crisis. Inevitably, although it’s impossible to predict exactly when, we are approaching a period when stock prices will go down. It is always good to remember that the stocks in your portfolio will eventually plunge by more than 20% (which is the definition of a bear market).

Assessment

This might be a good time to revisit your stock and bond allocations and be sure you are diversified into five or more asset classes.

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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The Future of Pharma?

The Top 10 Trends Shaping the Future of Pharma

 

 

 

By Bert Mesko MD PhD

The drug sends a message to a caregiver after the patient swallowed it. The doctor prescribes virtual reality treatments for migraines.

Do you think it is science fiction? You are mistaken. Just let me familiarize you with the top 10 trends shaping the future of pharma. Read more.

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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The Need for Antitrust Investigation of Physician Health Programs and their “PHP-Approved” Assessment and Treatment Centers

Monopolies, Self-Referrals and Shell Games

By Michael Langan MD

Monopolies, Self-Referral and Shell Games: The Need for Antitrust Investigation of Physician Health Programs and their “PHP-Approved” Assessment and Treatment Centers

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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Doctors and Drug Addiction

Doctors and Drug Addiction

via Michael Langan MD

This article originally appeared on http://www.DrugRehab.com, a web resource provided and funded by Advanced Recovery Systems (ARS).

Their mission is to equip patients and families with the best information, resources, and tools to overcome addiction and lead a lifelong recovery.

This article has been reproduced with permission. For more information, please visit their site.

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 Doctors and Addiction

Conclusion

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Backward Market Business Research

Experimenting in Business

By Dan Ariely PhD

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 Part of the CAH Startup Lab Experimenting in Business Series

By Rachael Meleney and Aline Holzwarth

Missteps in business are costly—they drain time, energy, and money.

Of course, business leaders never start a project with the intention to fail—whether it’s implementing a new program, launching a new technology, or trying a new marketing campaign.

Yet, new…

Beginning at the End — Dan Ariely

Product DetailsProduct Details

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Finding high-quality companies; TODAY?

At attractive valuations

By Vitaliy Katsenelson, CFA

We are having a hard time finding high-quality companies at attractive valuations.

For us, this is not an academic frustration. We are constantly looking for new stocks by running stock screens, endlessly reading (blogs, research, magazines, newspapers), looking at holdings of investors we respect, talking to our large network of professional investors, attending conferences, scouring through ideas published on value investor networks, and finally, looking with frustration at our large (and growing) watch list of companies we’d like to buy at a significant margin of safety. The median stock on our watch list has to decline by about 35-40% to be an attractive buy.

But – maybe we’re too subjective

Instead of just asking you to take our word for it, in this letter we’ll show you a few charts that not only demonstrate our point but also show the magnitude of the stock market’s overvaluation and, more importantly, put it into historical context. 

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 Finding High-Quality Companies Today

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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10 Breakthrough Technologies 2017

Including in Medicine

By MIT Technology Review

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These breakthrough technologies will affect the economy and our politics, improve medicine, or influence our culture.

Some are here now; others will take a decade to develop. But you should know about all of them right now.

See the List

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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Are you a leader or a manager?

How to tell the difference?

By TrainHR

Are you a leader or a manager?

Conclusion

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How to Give a Great Speech

By Vitaliy N. Katsenelson CFA

Little Moments, or How to Give a Great Speech

Conclusion

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The Warren Buffett & Charlie Munger Show

More on Value Investing

By Vitaliy Katsenelson CFA

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The Warren Buffett & Charlie Munger Show

Conclusion

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The American Dream is Slipping Away?

Is the American Dream slipping away?

By Rick Kahler CFP®

Is the American Dream slipping away? Yes, according to an article by David Leonhardt, The American Dream, Quantified at Last, published in the New York Times in December 2016.

Leonhardt cites research done for The Equality of Opportunity Project and reported as Trends in Absolute Income Mobility Since 1940. It concludes that the ability to attain the American Dream has fallen from 92% in 1940 to 50% today.

For me, this report raised a few questions

First, how do we define the American Dream?

Merriam-Webster calls it a “happy way of living that is thought of by many Americans as something that can be achieved by anyone in the U.S. especially by working hard and becoming successful.”

Wikipedia says it is “the set of ideals (democracy, rights, liberty, opportunity, and equality) in which freedom includes the opportunity for prosperity and success, and an upward social mobility for the family and children, achieved through hard work in a society with few barriers.”

James Truslow Adams, in his 1931 book The American Dream, defines it as life being “better and richer and fuller for everyone, with opportunity for each according to ability or achievement.”

These definitions suggest the American Dream is every person having the opportunity through ingenuity and hard work to achieve financial and emotional well-being.

Interestingly, the study Leonhardt cites chose a definition from Lawrence Samuel’s 2012 book, The American Dream: A Cultural History: “the ideal that children have a higher standard of living than their parents.”

The study found that those born in 1940 had a 92% chance of earning more than their parents at age 30. Those born in 1950 had a 79% chance, in 1960 a 62% chance, in 1970 a 61% chance, and in 1980 a 50% chance.

Leonhardt calls this data “deeply alarming.” He says, “It’s a portrait of an economy that disappoints a huge number of people that have heard that they live in a country where life gets better, only to experience something quite different.” I am guessing the disappointment to which he refers is what most people experience as life getting worse.

Yet defining the American Dream as an economy where children perpetually make more money (adjusted for inflation and taxes) than their parents misses the mark. As an economy improves and matures, that’s not sustainable.

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Indeed, our country is experiencing exponential decreases—decreases in those living in extreme poverty. We are actually experiencing substantial increases in those earning more. Research in 2016 by Stephen J. Rose found that from 1979 through 2014 the number of households becoming affluent (incomes were adjusted for inflation) increased eighteen times, from 0.1% of the population in 1979 to 1.8% in 2014. The upper middle class increased from 12.9% to 29.4%. This, of course, left significantly fewer people in the categories of middle class, lower middle class, and poor.

As more people increase their standard of living, it’s only logical that the relative income growth of future generations will decrease. At some point in time, enough is enough.

Instead of seeing the American Dream solely as out-earning our parents, it may be more useful to go back to the second part of James Truslow Adams’ definition: “It is not a dream of motor cars and high wages merely, but a dream of social order in which each man and each woman shall be able to attain to the fullest stature of which they are innately capable, and be recognized by others for what they are, regardless of the fortuitous circumstances of birth or position.”

Assessment

Once someone achieves financial, physical, and emotional well-being, earning more than one’s parents becomes immaterial.

Conclusion

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About USAFACTS.com

About the Website: USAFACTS.com

By Staff Reporters

Principles

USAFacts is a new data-driven portrait of the American population, our government’s finances, and government’s impact on society. They are a non-partisan, not-for-profit civic initiative and have no political agenda or commercial motive. They provide this information as a free public service and are committed to maintaining and expanding it in the future.

USA FACTS rely exclusively on publicly available government data sources. They don’t make judgments or prescribe specific policies. Whether government money is spent wisely or not, whether our quality of life is improving or getting worse – that’s for you to decide. They hope to spur serious, reasoned, and informed debate on the purpose and functions of government. Such debate is vital to our democracy. They hope that USAFacts will make a modest contribution toward building consensus and finding solutions.

More

There’s more to USAFacts than their website. They also offer an annual report, a summary report, and a “10-K” modeled on the document public companies submit annually to the SEC for transparency and accountability to their investors.

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Innspiration

USAFacts was inspired by a conversation Steve Ballmer [former CEO Microsoft Corporation] had with his wife, Connie. She wanted him to get more involved in philanthropic work. He thought it made sense to first find out what government does with the money it raises.

Assessment

Where does the money come from and where is it spent? Whom does it serve? And most importantly, what are the outcomes?

Visit: http://www.USAFACTS.com

Conclusion

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Ten Fascinating [Medical-Technical-Commercial] Things

Ten Fascinating Things

By MIT Technology Review

  1. Doctors have kept fetal lambs alive in plastic artificial wombs for weeks, a technology that could soon help improve the care of premature babies.
  2. Google is tweaking its search algorithms and adding new reporting tools in order to help tackle fake news and offensive content.
  3. One of the best ways to learn is to ask someone for advice when you’re confused—which is exactly what this robot is able to do.
  4. Uber has ambitiously promised that its flying taxi vision will become a reality by 2020. (Relatedly: is it time we stopped calling these things flying cars?).
  5. By using lasers to identify the distinctive noises made by the beating wings of mosquitos, researchers might be able to find new ways to fight malaria.
  6. Boston Dynamics, the manufacturer of many a nightmarish robot, has been testing its mechanical dog, Spot, for package delivery in Boston.
  7. These tiny finger wearables let people touch what’s not there in virtual reality.
  8. Tiny water droplets in fog scatter light, making it impossible for us to see. But a new trick could overcome that to help lidar work better in extreme weather.
  9. China has built and launched its first ever homegrown aircraft carrier—a very public flex of its increasingly advanced technological muscle.
  10. An artificial intelligence scriptwriter produced every line for David Hasselhoff to act out in this very strange short short film. It’s as surreal as it sounds.

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Digital Apps Make Investing Accessible to Do-It-Yourselfers?

Financial Advisor Grant Moore Speaks

By Savant Capital Management

There’s an app for everything today. Financial advisor Grant Moore spoke about the pros and cons of digital apps for investing in the 815 magazine article, “Digital Apps Make Investing Accessible to Do-It-Yourselfers.”

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 Digital Investing Aps

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The impact of illegitimate authority on regulation of the medical profession

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The overdue need for critical analysis

Langan MD

By Michael Lawrence Langan MD

It is not wisdom but Authority that makes a lawThomas Hobbes

In Questions of science, the authority of a thousand is not worth the humble reasoning of a single individual— Galileo Galilei

Regulatory Decisions and Public Policy Making

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The impact of illegitimate authority on regulation of the medical profession: The overdue need for critical analsysis — Disrupted Physician

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Against the Rising Tide: Looking for Biostatisticians and Epidemiologists to help shape Drug-Testing Policy to be more Evidence-Based

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More on Evidence-Based Medicine

[A Special ME-P Report]

By Michael Lawrence Langan MD

 Pharma

Against the Rising Tide: Looking for Biostatisticians and Epidemiologists to help shape Drug-Testing Policy to be more Evidence-Based.

More:

Integrity and Accountability [The Declining State of Physician Health and the Urgent Need for Ethical and Evidence-Based Leadership]

About the Author

Dr. Langan graduated from Oregon Health Sciences University School Of Medicine, Portland Oregon with an MD 21 years ago. He had his residency training of Geriatric Medicine-Internal Medicine at Beth Israel Deaconess Medicine Center and Internal Medicine at St Vincent Hospital Medicine Center.

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Product Details

A Penny for your Thoughts?

penny

Or, better yet.. would you be willing to help me out for free?

I’ve put together a quick non-academic questionnaire: Click here to take the survey Your response will help me immensely in figuring out which route to take in an upcoming project.

Thanks very much in advance! I appreciate everything you do.

Irrationally Yours,

Dan Ariely PhD

 A penny for your thoughts? — Dan Ariely

***

One Man’s Quest to Hack His Own Genes

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A Repost by Antonio Regalado

When Brian Hanley set out to test a gene therapy, he started with himself

When Brian Hanley set out to test a new gene therapy, he needed a subject. So, he started with … himself.

In a plastic surgeon’s office in Davis, California, Hanley had genes, which he had designed himself, injected into his thigh. The hope: they would make his body produce more of a potent hormone that would hopefully increase his strength, stamina, and life span.

Hanley has a PhD in microbiology, but his experiment is independent, unapproved by the FDA, and funded by savings. He claims to be “informed consent personified,” while ethicists argue that “experimenting with yourself is a very, very deep conflict of interest.”

Our own Antonio Regalado met Hanley to find out why he did it, what he thinks his project could prove—and how he prepared for the possibility of something going wrong.

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The Most Transformational Era in Financial Services Since the 1980s

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A Retro-Spective End-of-Year Look Back

By Dara Albright Media

Epic Infographic Depicting Why 1981 Was a Defining Moment for the Financial Services Industry

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most-transformational-era-in-financial-services-since-the-1980s-final-367x1024

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Conclusion

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A Clever Rap Anthem About Electronic Health Records

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On EHRs

A Re-Post Report by Jaan Sidorov

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broken PC

Clever Rap Anthem About Electronic Health Records

Assessment

ZDoggMD makes some good points, slips in a sly reference about one EHR provider and salutes another.

Ten years that have passed since he wrote this article, and we still have a way to go.

Conclusion

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The Amazing Future of Dentistry and Oral Health

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Bert Mesko

By Bertalan Meskó, MD PhD

The Amazing Future of Dentistry and Oral Health

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A Survey of Top American Fears

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Rick Kahler MS CFP

 

By Rick Kahler MSFS CFP®

Not long ago, one of Americans’ top fears was public speaking. Apparently Toastmasters is working; this fear didn’t even make this year’s Top 10 list.

Survey of American Fears

Chapman University recently completed its third Survey of American Fears, as reported in an October 12 article in Science Daily. Based on responses to questions about 65 potential fears from more than 1,500 adult participants, here are the top 10 things Americans fear:

  1. Corruption of government officials (same top fear as 2015)
  2. Terrorist attacks
  3. Not having enough money for the future
  4. Being a victim of terror
  5. Government restrictions on firearms and ammunition
  6. People I love dying
  7. Economic or financial collapse
  8. Identity theft
  9. People I love becoming seriously ill
  10. The Affordable Health Care Act/”Obamacare”

Four of these top fears (numbers 3, 7, 8, and 10) relate directly to financial health

The survey additionally identified four attitudes essential to motivating ourselves to protect against a fear:

  1. This can happen to me.
  2. This is serious.
  3. I can actually do something to help myself.
  4. Taking action will make a difference.

Let’s apply these attitudes to just one of the top fears: not having enough money for the future.

There’s a good reason this fear made the top ten. Around 70% of all Americans live paycheck to paycheck. Faced with a sudden need for $1,000, 75% would need to sell something or borrow to come up with the money. Around 48% would need to sell something or borrow just to come up with $400. Clearly, many Americans are not saving for emergencies and retirement.

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fear

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Motivation

Let’s look at the first motivator, This can happen to me. We are a nation of optimists. Many have money scripts like “The money will always be there,” and “Social Security and future government programs will provide for me.” We don’t consider realities such as the meager living Social Security would provide or whether taxpayers can or will support expanding aid programs. Thinking happy thoughts won’t create emergency reserves or retirement investments.

Which brings us to This is serious. If you are not investing enough money from each paycheck to continue your standard of living into retirement, it is really serious. If you retire unprepared and underfunded, it will be too late to save. And continuing to work won’t be an option for 8 out of 10 because of health reasons or inability to find a job. This is serious.

I can actually do something to help myself. Today, while you have a job and your health, you can make changes. You can get creative to reduce your standard of living and begin to save and invest. You can change your diet and take better care of your health so you can work longer. You can go back to school and reeducate yourself so you stay relevant in the workforce. You can make double and triple payments on your debts and become debt free. You can relocate to an area with a lower cost of living. You can even focus on rebuilding great relationships with your kids so they may let you move in with them in your last years.

Taking action will make a difference. Indeed it will—and starting now is key. Someday is today. Search online for printed materials, online courses, local classes, or professionals that can help you create spending plans that work, get out of debt, creatively cut expenses, increase your income, and maximize your investment growth.

Assessment

There is a lot you can do to help yourself, and your most important action is to take a first step. 

Conclusion

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 Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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The Importance of Sensitivity, Specificity and Diagnostic Test Accuracy — Disrupted Physician

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Sensitivity, Specificity and Diagnostic Test Accuracy

Langan MD

By Michael Lawrence Langan MD

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The reliability, validity and accuracy of drug test results needs to be known prior to using a test. Specificity and sensitivity must be known prior to using a test on any population.

This should go without saying as to do anything else would be irresponsible and careless. Source: Diagnostic Testing 101.1: The Importance of Sensitivity, […]

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Diagnostic Testing 101.1: The Importance of Sensitivity, Specificity and Diagnostic Test Accuracy — Disrupted Physician

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Conclusion

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Why we cannot assume CFP® equals “Fiduciary”

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Rick Kahler MS CFP

By Rick Kahler MS CFP®

One of the most important ways to find competent and trustworthy investment advisers is to be sure they owe you a fiduciary duty.

This means the advisers’ legal and ethical responsibility is to act in your best interests, not their own or their employer’s.

An ongoing legal case featured in an October 31 article by Ann Marsh in the online Financial Planning magazine highlights both the importance and the difficulty of finding a fiduciary adviser. (Disclosure: I am one of several advisers quoted in the article.)

The whistleblower case against J. P. Morgan involves an adviser and former J. P. Morgan employee, Johnny Burris, who says he was fired after refusing to give in to pressure to sell some of his employer’s high-priced products that he did not believe to be in his clients’ best interest.

Importance?

Here is why this case is important to anyone looking for financial advice: many advisers at investment firms like J. P. Morgan hold the Certified Financial Planner (CFP) designation. According to the website of the CFP Board of Standards, the organization that awards the certification, CFP’s are required “to put your interests ahead of their own at all times and to provide their financial planning services as a ‘fiduciary’—acting in the best interest of their financial planning clients.”

This sounds straightforward enough. Since 2008, the CFP Board has positioned the CFP designation as an indicator that an adviser will put clients’ interest first.

Unfortunately, that isn’t quite accurate.

Here is the tricky part: Advisers who sell financial products are allowed to “wear two hats” in their interaction with consumers. Any time they are giving financial advice and acting as financial planners (as defined by the CFP Board), they are expected to act in the best interest of the client/customer.

Yet if they don’t give any financial advice other than what is ancillary to the sale (a very confusing concept) of financial products to the same client/customer, that fiduciary requirement does not apply. The consumer is apparently expected to have the exceptional discernment and knowledge to know which hat is being worn at any given time.

As a consumer, you can assume that advisers holding the CFP® designation have completed many hours of education and passed tests to assess their professional competence.

However, because of the CFP Board’s hairsplitting, you cannot assume “CFP” equals “fiduciary.”

You still have to ask two essential questions:

The first is “In this engagement with me, who are you primarily responsible to, me or your company?” An adviser employed by a brokerage house or investment bank is very likely to be held most responsible to their company and expected to sell that firm’s financial products. This sets up a conflict of interest, in that the products with the highest fees will make the most money for the firm and the adviser, while those with lower fees may well be in the best interest of the clients.

A CFP® adviser who works for an independent financial planning firm may be less likely to be pressured to sell a given line of products. They also may do enough financial planning to be required to be a fiduciary.

However, you still need to ask the second question: “How do you get paid?” Any adviser who receives income from selling financial products cannot fully represent clients as a fiduciary without first overcoming an inherent conflict of interest.

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stock market

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Assessment

An adviser who doesn’t sell any products, who gives investment advice, and whose income comes solely from client fees is answerable and responsible to those clients as a fiduciary. You can trust that such a fee-only adviser will genuinely put your interests first. 

Conclusion

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10 Reasons Why People Should Not Fear Digital Health Technologies

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Fear NOT!

By  Bertalan Mesko, MD PhD 

10 Reasons Why People Should Not Fear Digital Health Technologies

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e061d80a-6884-4496-b9a9-d910c7d54f15

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HEALTH INSURANCE, MANAGED CARE, ECONOMICS, FINANCE AND HEALTH INFORMATION TECHNOLOGY COMPANION DICTIONARY SET

      Product DetailsProduct DetailsProduct Details

 

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Macro-Economic Mid-Year Update

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Last Week’s Headlines

By Michael Green [TGA Capital Management]

www.tgacapitalmanagement.com

Businesses are paying more for goods and services as the Producer Price Index increased 0.5% in June, the largest increase in a year, according to the Labor Department. Higher energy costs pushed the increase. Since businesses usually pass on increases in the cost of goods and services, it’s likely consumer prices will increase as well, driving inflation upward.

Here is a mid year economic summary:

  • In fact, consumer prices did increase in June–just not at quite the same rate as producer prices. The Consumer Price Index rose 0.2%, following the same increase in May and a 0.4% gain in April. Over the last 12 months, the CPI has increased 1.0%. Excluding the volatile food and energy components, consumer prices still increased 0.2% in June and 2.3% from a year earlier.
  • Consumers continue to spend as retail sales increased in June, jumping 0.6% from the previous month and 2.7% ahead of last June. This follows a 0.2% (downwardly revised) increase in May. Excluding autos and gas, household spending climbed 0.7% from May. Output excluding autos remained the same as the prior month. This report, coupled with increases in consumer and producer prices, provides optimism for the economy over the summer months.
  • The manufacturing sector experienced a noticeable uptick in June, as industrial production increased 0.6% after falling 0.3% in May. Manufacturing output rose 0.4%, largely due to an increase in motor vehicle assemblies. June’s gain is the largest monthly increase since November 2014.
  • The number of job openings decreased by 345,000 to 5.5 million on the last business day of May, according to the Job Openings and Labor Turnover Survey (JOLTS) report from the Bureau of Labor Statistics. April’s rate was 5.8 million. May’s job openings rate is the lowest of the year. The quits rate was unchanged at 2.0% as workers continue to remain at their present jobs. It’s important to remember that June’s employment situation report showed significant improvement on the labor front.
  • U.S. import prices rose 0.2% in June from May, largely due to a spike in petroleum prices. Exports also increased in June, rising 0.8% following increases of 1.2% in May and 0.4% in April. The 2.4% rise in export prices for the second quarter of 2016 was the largest three-month advance in export prices since the index rose 2.7% between February and May 2011.
  • The Treasury Department reported a $6.3 billion budgetary surplus in June, following May’s $52.5 billion deficit. However, over the first nine months of the fiscal year, the deficit is up almost 27%, at $400.9 billion, over the same period last year ($316.4 billion).
  • Largely influenced by the immediate negative impact of the Brexit vote, the Index of Consumer Sentiment fell from 93.5 in June to 89.5 in July.
  • In the week ended July 9, the advance figure for seasonally adjusted initial unemployment insurance claims remained level at 254,000, unchanged from the prior week’s level. The advance seasonally adjusted insured unemployment rate remained at 1.6%. The advance number for seasonally adjusted insured unemployment during the week ended July 2 was 2,149,000, an increase of 32,000 from the previous week’s revised level.

Conclusion

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A Smaller Government is a Peaceful Government

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Erik Hare

[By Erik Hare]

Small is Peaceful

A long weekend needs a repeat – this one from a year ago that leads into some of the reforms that should be talked about through the election cycle much more than candidates wives and mistres…

A Smaller Government is a Peaceful Government

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Why Health Care Costs Exploded After World War II

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By Michel Accad MD

[Editor’s Note: This Q & A Reprint from Michel Accad, MD]

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Hearse

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 Why Health Care Costs Exploded After World War II

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The Myth of Free-Market Healthcare

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By Kel Kelly [A Reprint]

While most people believe that our healthcare industry is one comprised of free markets, it is anything but.

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Surgery

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 The Myth of Free-Market Healthcare 

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The Mayo Clinic and the Free Market

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Source: Michel Accad MD

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pill mill

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The Mayo Clinic and the Free Market

About

Dr. Michel Accad is a practicing cardiologist who blogs for a medical audience at alertandoriented.com

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Penthouse Interviews Murray Rothbard

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Source: A Re-Post by MICHEL ACCAD, MD

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Penthouse Interviews Murray Rothbard

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  [Foreword Dr. Hashem MD PhD] *** [Foreword Dr. Silva MD MBA]

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