Why are Health Care Costs Rising So Fast?

Everywhere you go Americans are concerned with health care costs. It seems like every few months insurance companies raise rates and providers raise prices. What's going on?

Since the late 1960s, increases in health care costs have steadily accelerated to a present rate of 2.5 times that of inflation. This out-of-proportion increase began with the establishment of Medicare and Medicaid in 1965, and with the massive amount of money they began to channel into the health care market.

Why is this? There is one central reason. Economics 101 says when money chases a market, the price of that market rises. This is called demand-push inflation. Since the introduction of Medicare and Medicaid, the huge amounts of money forced into the health care market by the US government has caused health care costs to skyrocket.

Think of it this way. Imagine the US government decided to initiate a major spending program to buy, say, lots of pinwheels for every American. Now you might not want a pinwheel and I might not, but that doesn't matter because the government is creating the market. Say it earmarks $10 billion for pinwheels and increases that amount every year. What do you think would happen to the price of pinwheels? If you said "go up" give yourself a Ben Bernanke gold inflation star. That's exactly what would happen. And that's what has happened with health care costs.

Massive government spending on health care is the main cause of its severe inflation, and all other causes depend on or are related to this main cause.

What are some other reasons? One is the amazing advances in health care technology. Health care is just a lot better than it was fifty years ago. That jump in technology is in part due the profit potential companies see in the health care market. You can bet the one thing every health care company and entrepreneur counts on is that the government is going to be channeling a lot of money into health care. So they go after it. This is a great incentive for innovation. Unfortunately it also wasteful, because companies come up with all kinds of medical technology that is superfluous but that doctors use just because it's there. In fact, doctors feel compelled to use any technology that exists because they feel the need to protect themselves from lawsuits, which, ironically, are also a product of too much money being in play.

Another cause of high costs is inflated physician compensation, particularly for specialists. The Center for Medicare and Medicaid Services, the government body which sets Medicare and Medicaid rates, pays much more to specialists than they are paid in peer countries. This is done, purportedly, to attract top people into specialization. But most likely, in a freer market, specialists would be paid less than they are. The physicians, knowing a good thing when they see it, take full advantage of this arrangement by demanding the wages the market will artificially bear. Are they greedy? You could say that. But they wouldn't have had the opportunity to fulfill that greed if government hadn't thrown so much money at them.

There are other reasons for high health care costs: pharmaceutical pricing, higher administrative costs due to single-payer model paperwork, and hyper-litigiousness and resulting defensive medicine. But all these things have their root in too much money being artificially channeled into health care.

It may seem strange that the more money you throw at a problem the more expensive it gets. But that's the way economics works sometimes.

Dispelling Urban Myths About Income Taxes

Tax season is in full force. So now is probably a good time to dispel some myths about US income taxes. These myths are so regularly deployed by certain political segments that they've become part of the common dialogue. But that doesn't make them any less false.


Myth #1
Americans pay too much in income taxes.

Fact #1
"Too much" is a relative term. But Americans pay an average overall income tax rate of only 11%. It's hard to make the case that is "too much."


Myth #2
The rich don't pay their fair share in income taxes.

Fact #2
"Fair" is a judgement call. But the US income tax is very progressive. The top 1% of taxpayers pay an average overall tax rate of 24%. The other 99% of taxpayers pay an average overall tax rate of only 8.4%. Hardly "unfair."


Myth #3
The rich make out like bandits exploiting loopholes and end up paying less in taxes than the average taxpayer.

Fact #3
Even after credits and deductions the tax system is very progressive. Those who earn over $250k pay an overall rate of over 23%. Those who earn between $100k and $250k average about 13%. From $50k to $100k it's about 8%. From $30k to $50k it's about 3%. Below that people actually pay negative taxes--they get refunds (credits) for taxes they didn't pay

Myth #4
Every year the rich pay less of the tax burden. It's an example of the rich getting richer and the poor getting poorer.

Fact #4
Actually the reverse is true. Since 1986, the rich have paid a progressively higher and higher percentage of the tax burden. In 1986, the top 10% of taxpayers paid 54.7% of the taxes. In 2010 they paid 70.5%. In 1986, the bottom 50% of taxpayers paid 6.5% of the taxes. In 2010, they paid only 2.3%.


Myth #5
More and more people have to pay taxes because the rich aren't paying as much.

Fact #5
Actually the percentage of income tax filers who end up paying no tax is higher than it has ever been. In 2010 42% of income tax filers paid either no tax or got money back for taxes they didn't pay.


Myth #6
The gains of the rich come at the expense of other Americans.

Fact #6
The truth is the fortunes of the rich and those of more modest incomes have risen and fallen together. In booming years, all averages of incomes rise. In bust years, all averages fall.


Myth #7
If we just taxed the richest Americans more we could solve the budget deficit problem

Fact #7
Even if we taxed those who make $1 million a year or more at a 100% tax rate, the budget would still not balance.


Myth #8
US income taxes punish investment and reward consumption.

Fact #8
Unfortunately, this is true.


Source: The Tax Foundation

"Capitalism Without Bankruptcy is Like Christianity Without Hell" (and other financial facts you may not have known)

Most politicians have less understanding about money, finance and economics than the average undergraduate business major. Yet these are the people making laws that affect your financial future.

The prices of oil and gasoline are NOT set by oil companies. They are set by the buying and selling of future contracts by traders in the open commodities market. When gas prices go up it is in reaction to speculators believing that they will continue to go up. When gas prices go down it is in reaction to their believing that they will continue to go down. Speculators cannot manipulate the market--they can simply place bets based on what they think the market will do in the future. Those bets themselves drive the market. However, no speculator can be sure that any bet he or she places will be profitable. The idea that speculators can manipulate the market to make a profit is a myth perpetuated by politicians looking for scapegoats.


Five reasons health care has become more expensive:

1. It’s a lot better than it used to be. Medical technology has made incredible advances in the last thirty years. Those advances cost money. 
2. Prices go up when something is in demand and/or when a lot of money is allocated to be spent on it. The rise of aging baby boomers and the government allocating huge amounts of money to Medicare and Medicaid have increased the demand for health care and thus driven prices up. If less money was allocated for health care, prices would drop. It’s simple economics.
3. Doctors regularly prescribe needless procedures in order to avoid lawsuits and boost profits, because...
4. The health care system is being crushed by required government procedures, paperwork and other inefficiencies. 
5. Somewhere along the line we got the idea that others are obligated to try to keep us alive for as long as possible. Apparently we think it’s okay to bankrupt the nation in order to make this happen.

Ever since governments have coined or printed money, they have found ways to debase (decrease the value of) that money. The word “debase” itself comes from the practice of ancient governments adding base metals to gold and silver coins in order to make more coins—thus lowering their value and creating inflation. Why do governments do this? One reason is because inflation is an invisible tax. It’s a way governments transfer money from people that have it (savers) to people that don’t (debtors). With the development of central banks and fiat (non-backed) currency, governments have perfected the efficiency of creating inflation.


Inflation is not a fact of nature. It is a deliberate practice by governments which control the money supply. In the one hundred years before the creation of the Federal Reserve Bank, the U.S. dollar actually increased in buying power. What cost $100 in 1812 only cost $56 in 1912! But since the creation of the Federal Reserve Bank in 1913, what cost $100 in 1912 would cost $2342 in 2012, a 95% loss of buying power.


Despite what hysterical politicians and central bankers tell you, sometimes deflation is the best thing for an economy. Politicians don’t like deflation because it makes it hard for them to get re-elected.


Fat cat executives should be held accountable when they drive their businesses into the ground. They should not be allowed to escape with golden parachutes. Aside from the rank injustice of it, it’s a matter of applying the proper incentives. Executives convicted of fraud or malfeasance should be allowed to keep a modest retirement, while the bulk of their wealth should be used to reimburse defrauded investors. Those who caused the failure should have to start over like everyone else.


The housing bubble and the ensuing credit crisis was created by banks, financial companies, but mostly the US government. Banks and mortgage companies gave home loans to people who had no business qualifying for them. These lenders did this because they could package these loans into investments and pass the risk onto to clueless investors. However, although the financial community bear some responsibility, the government and the Federal Reserve Bank bear the most responsibility because (1) they encouraged lending to unqualified borrowers (“everyone deserves a piece of the American dream”) and (2), most importantly, they held interest rates artificially low, allowing buyers to buy more house than they could really afford, spurring demand for home loans, driving up prices, and inflating the bubble. When unqualified buyers began defaulting on loans, the bubble collapsed.


As I said, the Federal Reserve’s holding interest rates too low for too long produced the housing bubble and credit crisis. The Fed's proposed solution is to... keep interest rates even lower indefinitely! Got that? This is what Japan has done for over twenty years and it has produced a zombie economy there, a twilight realm where little fails but little grows too.  Japan’s suicide rate is one of the highest in the world.


So what should the US do? Simply put we should allow capitalism to take its course—we should allow failing businesses to fail.  When businesses fail, the losers are cleared out, someone else steps in, acquires the assets and has a fighting chance of doing something better the next time. But by propping up failed businesses, the government is ensuring that the same mistakes will continue to be made and that resources will continue to be misallocated. As former astronaut Frank Borman said, “Capitalism without bankruptcy is like Christianity without hell.” As I noted, it's a matter of incentives.


Motivated people will always find a way to profit from circumstances. This includes the unlikely circumstance of capitalism being dead--and just about any other you can think of. That is the genius of human nature, and an expression of people's right to act in their own interest.

Who Does the U.S. Owe Money To?

The United States of America is in more debt than any country in the history of the world.

There are two basic ways to measure this debt. One is to measure the actual amount of money the US has already borrowed. The other way is to measure that amount plus the amount the US is committed to borrow because of future mandated entitlements.

As of today the US in hock for $16.7 trillion dollars. That’s money we owe. But if you project US mandated entitlements over the next 75 years and subtract the projected tax revenues for that period, you come up with an $87 trillion dollar shortfall. In other words, if we continue the way we are going for the next 75 years the US will be over $100 trillion in debt, not counting interest.

Of course, that’s not going to happen--if only because the US will be crushed by bankruptcy long before that point. But the important thing to remember is we are running larger and larger deficits every year. It took us 20 years to go from $1 trillion to $6 trillion in debt. It took us 12 years to add another $10 trillion. Now we are adding more than $1 trillion a year, and there is no projected end to it.

What is going on? Several factors are contributing. Baby boomers are aging and producing less, but consuming more, particularly healthcare, which they expect to be world class. US citizens are demanding more and more benefits from government, but seem to think these things can be bought on the cheap, or for nothing. The US cannot compete with overseas manufacturing, where workers can be paid a fraction of what they would demand here. So we don’t export much anymore. Cargo ships from overseas come to US ports loaded with imports, then leave empty. So instead of exporting products, we export dollars, which we’ve borrowed. All of these together are a prescription for unsustainable debt.

So who do we owe the almost $17 trillion we’ve already borrowed? The answer may surprise you.

One third of US debt is owned by foreign governments and investors. China is our largest creditor, owning about $1.16 trillion. Japan is second with $1.13 trillion. Oil exporting countries own about $250 billion. Brazil, Taiwan, Switzerland, Russia, Hong Kong and the United Kingdom round out the largest holders. This is a big change from the past when we owed the vast majority our debt "to ourselves." Now foreigners have us over a barrel for a third of our debt.

Another third of our debt is held by domestic government entities and domestic investors. The Federal Reserve owns $1.66 trillion (and growing). Mutual funds and private pension funds own $1.4 trillion. State and local governments own $710 billion. Banks own $300 billion. Insurance companies own $260 billion. US saving bonds account for another $185 billion. Another trillion is held by various domestic investors--individuals, brokers and dealers, trusts, and businesses.

The last third of our debt is owned by US federal government agencies. Does that sound strange? US agencies that run a surplus, like Social Security (which owns $2.7 trillion of our debt), buy US Treasuries and basically loan their surpluses to other parts of the government. The good news is we loan the money to ourselves. The bad news is money that was meant for the future gets spent immediately. So taxpayers now owe money plus interest--over and above future contributions--to Social Security and other agency programs, such as the Federal Employees Retirement Fund and Federal Supplementary Medical Insurance Trust Fund. In essence we've raided our federal trust funds to pay for things we want now.

So, roughly speaking, one-third of our debt is owned by foreigners, and one-third by domestic governments and investors (including the Federal Reserve Bank) and one-third by US federal agencies.

The portion owed to foreigners means that we are that much more at the whim of foreigners who might not want to finance our debt anymore, and could throw our economy into a tailspin by refusing to buy it or demanding higher interest rates.

The portion owed to domestic entities means that if the US defaults, we will be shafting ourselves. The portion of this third owed to the Federal Reserve means that more and more the Fed is simply printing money with which to buy our debt, a practice known as “monetizing the debt,” a potentially highly inflationary course of action.

The portion owed to government agencies means that going forward taxpayers have to pay not only for future entitlements, but also for ones that have already been consumed.

No wonder Shakespeare wrote:

    Neither a borrower nor a lender be;
    For loan oft loses both itself and friend,
    And borrowing dulls the edge of husbandry.*

* Hamlet, Act I, Scene 3