There have been a few events going on, with all the hustle and bustle from America we are moving towards a possible point that this nation will be officially renamed, when that happens other domino stones will be pushed into a different direction. Yet there is still time, so we can ignore it for now. What was interesting for me, was a Facebook mail that has all the elements of becoming a flame, a wave of emotions, intentionally set in that way. Yet the part that was actually interesting were the facts that it had. Those facts were indeed interesting to look into, yet not by themselves. At this very moment I am digging to confirm certain numbers and see if they hold up.
|Income 2013||Income 2014||Change|
Aetna, Mark Bertolini
|Centene, Michael Neidorf||$14.5M||$28.1M||93%|
|Cigna, David Cordani||$13.5M||$27.2M||101%|
|Humana, Bruce Broussard||$8.8M||$13.1M||48%|
|United Health, Stephen Hemsley||$12.1M||$66.1M||546%|
|Wellpoint Joseph Swedish||$17M||$8.1M||-47%|
These are health insurances and their CEO’s. This group of 6 have in their hands the health options of the bulk of Americans. Now, before we act in outrage, which we might still do, we see that two of them lost half their income, which in the worst situation, that person (Joseph Swedish) makes in 2 days the same I make in a year. In opposition, there is Stephen Hemsley, who makes in a day, the same I would make in 6 years. Now, we can make this about the imbalance, yet that is not what this is about.
Let’s not forget that these are manages health carers. In September 2016 we saw CNN report “A recent report by Kaiser/HRET Employer Health Benefits forecasts that the average family health care plan will cost $18,142, up 3.4% from 2015. That’s faster than wage growth in America“, and “Premiums on the Obamacare exchanges are expected to rise by double-digits this year“. Now, we need to tread carefully here, health care systems require more work and they need to look to what happens in the future, not just what happens now, So when we see Aetna report in 2016 a total revenue of 60 billion, yet an operating earnings of 2.7 billion, we see that there is a margin, yet not an overly exaggerated one. This is part of a system for 23.5 million members. In this on page 7 we see that the revenue is comprised of commercial and governmental premiums totalling 51.5 billion. Yet it goes further, when we see the growth that Aetna has had, the merger deal with Humana, which is interesting as it is set as a 37 billion merger, yet when we see the quarter of quarter growth of 3 years at least, does it make sense to see this as a mere 37 billion dollar merger when the operating revenue has been in excess of 58 billion for well over 3 years? In addition, Aetna reported an operating gain against costs of over 30%, so when we see the CNBC quote on November 10th 2016: “The Affordable Care Act was built on a flawed model that required getting as many people as possible into the insurance system, Bertolini said. And he said he thinks the Republican Party will make good on its promise to repeal it“, we wonder with their operating profits, a managed health care system no less, what are we not seeing? As stated, compared to the revenue, the profits are not outlandish, yet the entire Obamacare issue seems to give another view, one that clashes with the view that we see at Aetna. Now consider another quote, one we see on December 13th 2016, in bizjournals.com. Here we see: “As one of its arguments against the acquisition, the U.S. Justice Department says the deal would drive up prices on health insurance exchanges in 17 counties where Aetna (NYSE: AET) and Louisville-based Humana (NYSE: HUM) now compete“, you see where there is competition, prices are pushed down, so how come I suddenly see an increase in health insurance exchanges? The final part is one that strikes a sting on the violin of chaos too. Consider the quote: “Bertolini also testified that Molina Healthcare Inc., which has agreed to buy Medicare assets from Aetna and Humana for $117 million if the merger is approved“, now let’s be honest that $117 million is nothing to sneer at, yet what are these Medicare assets exactly? Where is the write-off? You see, two companies with a total revenue exceeding $100 billion annually over the last 3 years, in that light $117 million is close to no blip on the radar (0.11%). So why was it mentioned, why put Molina Healthcare Inc. in the picture? Well, like the other two players, they have had quarter on quarter growth for 3 years too, more important, even as their revenue is not as impressive of the two others, we see that annual on quarter, 2015 brought close to 50% growth, whilst 2016 is expected to surpass the 30% mark, those are operating revenue growths nearly unheard of in this day and age. And this is not the adult media sales, this is healthcare, so as we expect that there will always be growth, we need to see where the interests are of these players. Let’s not forget that the picture is changing. Humana Inc. is a for-profit American health insurance company, they clearly state this, so what will become of Aetna when that merger goes through? How will the picture change and how will that impact the members? They are both Managed health care, yet Aetna is not outspoken ‘for profit’, the numbers do bear this out to some degree. Yet in all this is not about the members or patients. This is about the shareholders and both have plenty, the question becomes what direction will Aetna take? Will we see a board of directors that find themselves in agreement with the senate under Emperor Tiberius Claudius Nero, when in 19 AD they proclaimed: ‘Puer Pauper‘ (fuck the poor), which by the way coincided with the expulsion of the Jews from Rome, life is full of irony at times. The reason to make mention of this is because Israel has a health care system not unlike the Netherlands. A compulsory plan where all Israeli citizens are entitled to basic health care as a fundamental right. There a person can sign up with one of four official health insurance organizations which are run as not-for-profit organizations, this is where we see the massive difference. ‘run-for-profit‘ comes at a price and that price is the additional dividends that the members must pay the shareholders. It is not that simple, but you get the idea. In all this the fact that this approach made Israel 4th in terms of efficiency and Israel was ranked 6th healthiest country in the world by Bloomberg rankings. These are numbers any government could be proud of. Neither the US nor the UK make that top 10, according to the article in Bloomberg, the UK doesn’t even make the Top20. So as we realise a few numbers and this all leads to a lot of questions, we can agree that there is nothing against ‘for-profit’, yet who remains in the US with the option to afford this? Perhaps that is why the link to Molina Healthcare Inc., just a small token proclaiming to remain ‘for the people‘, whilst relying on tax deductions and write offs to remain ‘for the shareholders‘. However, let’s face it, these two (Mark Bertolini and Bruce Broussard) are almost the lowest ones on the Health Care CEO list of incomes, still making per day about what I make per year. Yet even as their incomes drew the attention, it is the coverage, the operating profits and the for-profit sides in some of these Managed Health Care groups, whilst we see places like fortune.com inform its upcoming ‘victims’ that the costs will go up: “costs are expected to grow 6.5% through next year. While costs have finally reached a point of equilibrium after years of double-digit growth” as well as “36% of employers are even considering a defined contribution strategy where they would provide a set sum of money to each employee to pay for health care, and if a health care plan exceeds that sum, the employee is on the hook for the remainder of the cost“, so whatever increased quality of life the Americans did not get, there is information that well over 10% of the employers have adopted this strategy. Such plans, especially with the for-profit health care managers will see a shift in costs, from employer to employee. Fortune.com gives as reason: “There’s two primary factors that affect health care costs: how much is being consumed and the price for services and drugs. As it turns out, prices aren’t what’s primarily adding to the rising trend. It comes down to more people consuming more care“. I personally believe that the truth is somewhere in the middle lane. Both the needs of an aging population and the pharmaceutical patents driving up prices as pharmaceutical patents are chomping down on maximised profit per pill. In this Forbes reported two days ago that the pharmaceuticals are not happy. Here we see the quote “Much of Medicare is now run by private sector insurers like Humana or Aetna, who already bid on drugs to get lower prices (this is known as Medicare Advantage)“, Yet President elect Donald Trump stated: “I worry today that the pharmaceutical industry has a very false sense of relief or security because of a Trump administration and a Republican Congress. I think we should recognize that the drug pricing issue is a populist issue. Americans are rightfully angry. The fault is not, surely, on the pharmaceutical industry’s shoulders, but we bear that because we make the drugs. We innovate the drugs, and as a result of that, whether we like it or not, or we want to try to explain it or not, we have to deal with it.” As stated more than once in the past, I do believe in capitalism, yet at what point does capitalism become plain greed? When we look at the top 20 pharmaceuticals, they are hiding behind a 2% growth, yet these 20 companies which include Novartis, Pfizer and Johnson & Johnson were making 547 billion in 2014, whilst we see that 13 of them are turning a profit with one of them 127%, these are only the 2014 numbers, the profits have been steadily increasing, at the expense of those requiring medication, at the expense of a health care system that can afford less and less. In all this we see that places like Pfizer kept a gross profit of well above 38 billion and they weren’t even the best scoring one. Yet, the connection go on a lot further. You see, with Pfizer we see James C. Smith who is also on the public board of Thomson Reuters, Suzanne Nora Johnson is also on the board of American International Group, Inc. (insurances). James M. Kilts serves on the board of MetLife Inc. as well as Nielsen Holdings N.V. The list goes on. A group of board members already on a massive income, adding the incomes from other boards where they serve with incomes most people dare not dream of. What is more interesting is how we see an almost illuminati sized cloud of interaction with media, insurances and other interactions. All essential and profitable for Pfizer. When we look at Novartis that list of directors takes an even more interesting turn. Ann Fudge who also serves on the board of the US Council on Foreign Relations, with additional functions at Unilever as well as the Northrop Grumman Corporation. Pierre Landolt, Ph.D. who is also the chairman of the Swiss private bank Landolt & Cie SA, a Financial Institution in Brazil and a few other enterprises. Andreas von Planta, Ph.D, linked to HSBC, Moller Finance, and the regulation board of the Swiss stock exchange and finally Srikant Datar, Ph.D., who goes beyond mere Novartis, with additional board placement with ICF International Inc., Stryker Corp. and T-Mobile US. The pharmaceutical boards read like a weave of corporate interaction with links all over the Fortune 500. A conspiracy theorists wet dream.
For us it is not about who they are connected to, but how such links could be used to maximise profits. The idea that the Pharmaceutical industry has its representation, and on the other side we see an optional Novartis with its board member Ann Fudge who also serves on the board of the US Council on Foreign Relations, how is that for hedging your bets on both sides of the profit sandwich?
On this Friday 13th we see news in the Guardian mention of the NHS winter crisis, we have been seeing from all directions the Obamacare and how Obamacare Premiums are expected to Increase by ‘Double Digits‘ in 2017, one can only hope that the first digit is a ‘1’. With pharmaceuticals and insurances both on the maximisation of profit, the people in several places are pushed in a corner with no place to go see about any options.
Only the superstitious will think that the health care news will be better tomorrow, it is Friday 13th after all.