Inspired by the monthly Harper's Index, this is 2019's first index on healthcare and finance. The average ratio of Medicaid-to-Medicare payments spending across the US across all services: .72; In CA: .52. The factor by which commercial insurance payments exceed the reimbursements from Medicare: 1.88x The net assets of HCA, the largest publicly-traded hospital in the … Continue reading January’s Healthcare Index
Without Benjamin Graham we may not know the name Warren Buffett. Graham was an investor, professor, and practical philosopher. He wrote the masterpiece Security Analysis during the midst of the Great Depression, as well as The Intelligent Investor, and was a professor, mentor, and employer to Buffett. Graham wrote that the markets in the short … Continue reading Weighing Machines
Volatility in investing can be a great thing. The attraction to Bernie Madoff's scam can be better understood by its lack of volatility. His funds showed annual returns of an eerily consistent 10-12% and at one point reported 72 consecutive months of positive returns. His strategy used a split-strike or collar options strategy (not related … Continue reading On Hidden Risks and Volatility
In 2008 Warren Buffett made a bet against active investing, or more specifically the active-active, triple-fee side of investing, the hedge funds of funds. This group charges fees for placing money with hedge funds, who typically charge their own two types of fees. hedge fund's ability to pick funds that would outperform the S&P 500 … Continue reading Why I’m Betting Against Berkshire
Businesses love metrics. One form or novel way (a 5 on the hack prowess scale) is to find the perfect metric that makes the future a little more predictable. The eager student tells the elderly person, "Teach me to be wealthy, only quicker" to paraphrase C.T. Munger. A year after the financial crisis of 2007-2008, … Continue reading On RVs and Write-Offs
It has taken over 40 years for index investing to reach 20% market share. That's longer and less heft than most people would guess. But it's also a reminder of how a good idea can take generations of incremental awareness and results to move beyond shallow roots. Index investing is a form of passive investing, … Continue reading Passive vs. Active in Investing and in Health
Now known in some circles for something beyond its array of cheesecakes, 2,000 calorie dishes, and cruise ship-meets-Las Vegas décor, The Cheesecake Factory (CAKE) added a second consecutive quarter of negative healthcare news, a cost that’s hidden in most companies' income statements. The impact of this quarter’s negative healthcare surprise was $4,600,000, or 44% of … Continue reading Part 2: Is The Cheesecake Factory in The Healthcare Business?
The 2006 book The Wal-Mart Effect describes the retailer's impact on communities and suppliers. Since it was written, a lot has changed. Amazon has outperformed Walmart in the stock market by 20x. Walmart has also dropped the hyphen from its name. Walmart still does $57,000,000 per hour in sales, or $500B per year, and has 2.3M … Continue reading The Walmart Effect on Healthcare
I just re-read "The Outsiders: Eight Unconventional CEOs and Their Radically Rational Blueprint for Success" by Willam Thorndike. It's an analysis of eight relatively unknown Jack Welch-record-beating CEOs and how they trounced the market and industry peers over 20+ years. Their primary source of value as CEOs was how they allocated capital, or how they invested … Continue reading Corporate Capital Allocation and Healthcare Spending
People who work on the business side of healthcare often wish that companies would think about healthcare more often, or even concede that they are in "the healthcare business." I suppose part of this is the law of the instrument, which even if not said by Mark Twain, sounds like Mark Twain: "To a man … Continue reading Is The Cheesecake Factory in the Healthcare Business?