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Profits and Health Care: A Beneficial Connection

March 17, 2017 4 comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Summary of My Post-CPI Tweets

Below is a summary of my post-CPI tweets. You can (and should!) follow me @inflation_guy or sign up for email updates to my occasional articles here. Investors with interests in this area be sure to stop by Enduring Investments. Plus…buy my book about money and inflation, published in March 2016. The title of the book is What’s Wrong with Money? The Biggest Bubble of All; order from Amazon here.

  • Pretty big market day! Importantly, CPI: remember last month was big upside surprise, and driven by unusual suspects – core goods.
  • There’s a decent base effect hurdle today, as last Feb was 0.25% on core CPI. Consensus today is for a very weak 0.2% (almost 0.1%).
  • The consensus forecast clearly says that most economists see last month’s shocking 0.31% on core as one-offs.
  • Consensus expectation is for core to slip back to 2.2% from 2.3%. But then, last month they thought we’d fall to 2.1%.
  • Hurdles get easier next month: March ’16 saw 0.09% core CPI, and then a series of low 0.2s & 0.1s. So core is going up this summer.
  • Here is what I said about last month’s figures: https://mikeashton.wordpress.com/2017/02/15/summary-of-my-post-cpi-tweets-36/
  • 5 mins to CPI. Sources say the headline number is trading 243.34 (which would be -0.04% on headline) in the CPI derivs mkt.
  • core at 0.21%, higher than consensus expectations of 0.15% or so. Keeps y/y at 2.22%, down from 2.26%. But next month is an easy comp.
  • Monthly core CPI prints.

  • I don’t pay much attention to headline but it was a little high, y/y up to 2.74%. Only matters if it affects tenor of Fed discussion.
  • In major subgroups: Housing rose to 3.18% vs 3.12%. Need to see if that’s energy. Apparel fell back, as did health care.
  • w/in housing, Primary Rents slipped to 3.91% from 3.93%, Owner’s Equiv to 3.53% from 3.54%. So the housing bump was elsewhere.
  • Looks like the housing increase was mostly household energy, 4.46% from 3.51%. So no biggie as the kids say.
  • Apparel 0.42% vs 0.99%. The big jump last month was mostly reversed. Overall core services 3.1% and core goods dropped back to -0.5%
  • Last month the big story was that core goods had caused the jump in core CPI. Looks like these were mostly seasonal issues after all.
  • Transportation 6.3% vs 4.8%. That’s mostly gasoline. New & used cars slipped. But rising: parts, maintenance, insurance, airfares.
  • In Medical Care, big drop in medicinal drugs 4.19% vs 4.85%. Also drop in prof svcs (2.68% v 2.94%). THOSE are the one-offs this month.
  • Here are y/y med care & housing, source of the big upward pressure recently. But remember this month the housing is mostly energy.

  • Four more major subcategories. Recreation is the only one moving higher, but it’s a heterogeneous group & hard to decipher.

  • Quick estimate of Median is 0.21% m/m, 2.52% y/y, not quite a new high. Official figure will be out later.
  • Next month we should have core back over 2.3% and a shot at 2.4%, thanks to easy comp in March.
  • 10y inflation swaps still below current median inflation.

  • Mkt pretty confident in Fed: CPI mkt pricing: 2017 2.0%;2018 2.2%;then 2.2%, 2.1%, 2.2%, 2.2%, 2.3%, 2.4%, 2.5%, 2.7%, & 2027:2.5%.
  • This CPI report takes inflation off the boil, but not off the burner.
  • One more chart: weight of CPI categories over 3% inflation y/y.

Let’s face it. While this month’s CPI held some intrigue because of last month’s surprising spike, nothing about the figure was likely to change the outcome of today’s FOMC meeting and probably not the tenor of the statement or post-meeting presser. So, in that sense, this was a much less-significant report than last month’s release.

At the same time…let’s not lose sight of the fact that this was still an above-consensus CPI report. While the consensus was broadly correct that some of the jumps in core goods categories from last month were one-offs, and at least partially retraced this month, it’s still the case that y/y core inflation is going to keep rising through the summer merely on base effects. If the Fed wants to be hawkish and tighten more than the market currently expects (I think that nothing could be further from the truth, with Yellen at the helm, but she seems to dislike President Trump enough that she might forget some of her dovish leanings), then they will continue to have cover from inflation reports for a while.

Going forward from that, there are two inflation questions that will be resolved: (1) Will core goods recover and rise, indicating a broadening of inflation impulses that could produce a longer-tail upside? And (2) will housing inflation flatten out or decline since rent inflation is currently rising faster than even our most-generous models? If it does, then core inflation might stabilize near the current level, or even decline.

I have trouble figuring out what the mechanism would be for inflation to flatten out at these levels, from the macro-monetary perspective. Money growth remains brisk and higher interest rates should eventually goose velocity. I don’t see much prospect of money growth rolling over while banks are neither capital- nor reserve- constrained. And it’s hard to see interest rates heading back down while central banks shift into less-accommodative stances. I have more confidence in the macro-monetary (“top down”) model at longer time frames, and more confidence in the bottom-up analysis at shorter time frames. And for years they’ve told the same story: inflation should be rising, and it has. But there is a conflict between these perspectives that is coming later this year. How it resolves will be the story of the next 3-6 months.

Good Models and Bad Models

I have recently begun to spend a fair amount of time explaining the difference between a “good model” and a “bad model;” it seemed to me that this was a reasonable topic to put on the blog.

The difference between a good model and a bad model isn’t as obvious as it seems. Many people think that a “good model” is one that makes correct predictions, and a “bad model” is one that makes bad predictions. But that is not the case, and understanding why it isn’t the case is important for economists and econometricians. Frankly, I suspect that many economists can’t articulate the difference between a good model and a bad model…and that’s why we have so many bad models floating around.

The definition is simple. A good model is one which makes good predictions if high-quality inputs are given to the model; a bad model is one in which even the correct inputs doesn’t result in good predictions. At the limit, a model that produces predictions that are insensitive to the quality of the inputs – that is, whose predictions are just as accurate no matter what the inputs are – is pure superstition.

For example, a model of the weather that depends on casting chicken bones and rat entrails is a pretty bad model since the arrangement of such articles is not likely to bear upon the likelihood of rain. On the other hand, a model used to forecast the price of oil in five years as a function of the supply and demand of oil in five years is probably an excellent model, even though it isn’t likely to be accurate because those are difficult inputs to know. One feature of a good model, then, is that the forecaster’s attention should shift to the forecasting of the inputs.

This distinction is relevant to the current state of practical economics because of the enormous difference in the quality of “Keynesian” models (such as the expectations-augmented Phillips curve approach) and of monetarist models. The simplest such monetarist model is shown below. It relates the GDP-adjusted quantity of money to the level of prices.

This chart does not incorporate changes in money velocity (which show up as deviations between the two lines), and yet you can see the quality of the model: if you had known in 1948 the size of the economy in 2008, and the quantity of M2 money there would be in 2008, then you would have had a very accurate prediction of the cumulative rate of inflation over that 60-year period. We can improve further on this model by noting that velocity is not random, but rather is causally related to interest rates. And so we can state the following: if we had known in 2007 that the Fed was going to vastly expand its balance sheet, causing money supply to grow at nearly a 10% rate y/y in mid-2009, but at the same time 5-year interest rates would be forced from 5% to 1.2% in late 2010, then we would have forecast inflation to decline sharply over that period. The chart below shows a forecast of the GDP deflator, based on a simple model of money velocity that was calibrated on 1977-1997 (so that this is all out-of-sample).

That’s a good model. Now, even solid monetarists didn’t forecast that inflation would fall as far as it did – but that’s not a failure of the model but a failure of imagination. In 2007, no one suspected that 5-year interest rates would be scraping 1% before long!

Contrariwise, the E-A-Phillips Curve model has a truly disastrous forecasting history. I wrote an article in 2012 in which I highlighted Goldman Sachs’ massive miss from such a model, and their attempts to resuscitate it. In that article, I quoted these ivory tower economists as saying:

“Economic principles suggest that core inflation is driven by two main factors. First, actual inflation depends on inflation expectations, which might have both a forward-looking and a backward-looking component. Second, inflation depends on the extent of slack (or spare capacity) in the economy. This is most intuitive in the labor market: high unemployment means that many workers are looking for jobs, which in turn tends to weigh on wages and prices. This relationship between inflation, expectations of inflation and slack is called the “Phillips curve.”

You may recognize these two “main factors” as being the two that were thoroughly debunked by the five economists earlier this month, but the article I wrote is worth re-reading because it describes how the economists re-calibrated. Note that the economists were not changing the model inputs, or saying that the forecasted inputs were wrong. The problem was that even with the right inputs, they got the wrong output…and that meant in their minds that the model should be recalibrated.

But that’s the wrong conclusion. It isn’t that a good model gave bad projections; in this case the model is a bad model. Even having the actual data – knowing that the economy had massive slack and there had been sharp declines in inflation expectations – the model completely missed the upturn in inflation that actually happened because that outcome was inconsistent with the model.

It is probably unfair of me to continue to beat on this topic, because the question has been settled. However, I suspect that many economists will continue to resist the conclusion, and will continue to rely on bad, and indeed discredited, models. And that takes the “bad model” issue one step deeper. If the production of bad predictions even given good inputs means the model is bad, then perhaps relying on bad models when better ones are available means the economist is bad?

That Smell in the Fed’s Elevator

March 7, 2017 5 comments

A new paper that was presented last week at the 2017 U.S. Monetary Policy Forum has garnered, rightly, a lot of attention. The paper, entitled “Deflating Inflation Expectations: The Implications of Inflation’s Simple Dynamics,” has spawned news articles such as “Research undercuts Fed’s two favorite U.S. inflation tools”(Reuters) and “Everything the Market Thinks About Inflation Might Be Wrong,”(Wall Street Journal) the titles of which are a pretty decent summary of the impact of the article. I should note, because the WSJ didn’t, that the “five top economists” are Stephen Cecchetti, Michael Feroli, Peter Hooper, Anil Kashyap, and Kermit Schoenholtz, and the authors themselves summarize their work on the FiveThirtyEight blog here.

The main conclusion – but read the FiveThirtyEight summary to get it in their own words – is that the momentum of the inflation process is the most important variable (last year’s core inflation is the best predictor of this year’s core inflation), which is generally known, but after that they say that the exchange rate, M2 money supply growth, total nonfinancial credit growth, and U.S. financial conditions more broadly all matter more than labor market slack and inflation expectations.

Whoops! Who farted in the Fed’s elevator?

The Fed and other central banks have, for many years, relied predominantly on an understanding that inflation was caused by an economy running “too hot,” in that capacity utilization was too high and/or the unemployment rate too low. And, at least since the financial crisis, this understanding has been (like Lehman, actually) utterly bankrupt and obviously so. The chart below is a plain refutation of the notion that slack matters – although much less robust than the argument from the top economists. If slack matters, then why didn’t the greatest slack in a hundred years cause deflation in core prices? Or even get us at least close to deflation?

I’ve been talking about this for a long time. If you’ve been reading this blog for a while, you know that! Chapters 7-10 of my book “What’s Wrong With Money?: The Biggest Bubble of All” concerns the disconnect between models that work and the models the Fed (and most Wall Street economists) insist on using. In fact, the chart above is from page 91. I have talked about this at conferences and in front of clients until I am blue in the face, and have become accustomed to people in the audience staring at me like I have two heads. But the evidence is, and has long been, incontrovertible: the standard “expectations-augmented-Phillips-Curve” makes crappy predictions.[1] And that means that it is a stupid way to manage monetary policy.

I am not alone in having this view, but until this paper came out there weren’t too many reputable people who agreed.

Now, I don’t agree with everything in this paper, and the authors acknowledge that since their analysis covers 1984-present, a period of mostly quiescent inflation, it may essentially overstate the persistence of inflation. I think that’s very likely; inflation seems to have long tails in that once it starts to rise, it tends to rise for some time. This isn’t mysterious if you use a monetary model that incorporates the feedback loop from interest rates to velocity, but the authors of this paper didn’t go that far. However, they went far enough. Hopefully, this stink bomb will at last cause some reflection in the halls of the Eccles building – reflection that has been resisted institutionally for a very long time.

[1] And that, my friends, is the first time I have ever used “crap” and “fart” in the same article – and hopefully the last. But my blood pressure is up, so cut me some slack.

A Short Remark About an Ominous Count

This will be a very short remark, partly because I am certain that someone else must have observed this already.

The Dow Jones Industrial Average declined on Tuesday after having risen in each of the preceding 12 days. I was curious, and the DJIA has data going back more than a century (unlike, for example, the S&P 500, the Russell, or other indices), so I checked to see how often that has happened before.

It turns out that only three times before in history has the Dow advanced in 12 consecutive sessions. The dates of those occurrences are (listed is the last day of advance before the first decline):

July 8, 1929

December 7, 1970

January 20, 1987

The latter of these three was actually a 13-day advance, and the longest in history.

Now, the 1970 occurrence seems to be nothing special. It occurred five years into a 15-year period that saw the Dow go nowhere in nominal terms, but there was nothing special about 1971. However, anyone who invests in the stock market ought to know the significance of 1929 and 1987. It also bears noting that current market valuations are higher (in terms of the Cyclically-Adjusted PE ratio) than on any of those three days – quite a bit higher, in fact.

None of which is to say that we won’t have another 10, 20, or 30-day streak ahead of us. I suspect the bulls will say “see? This same occurrence in 1929 and 1987 happened months before the denouement. We still have time to party!” And they may be right. This isn’t predictive. But it, especially when compared to valuation levels second only to those seen at the peak of the “Internet Bubble,” is ominous. This is a party I wouldn’t mind missing.

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