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My perspectives as an investor and consumer

Understanding the PPIP

davidellis-flow1-07sOn March 23, 2009, the Treasury Department released details of the Public-Private Investment Program (PPIP), which is one of the programs under the TARP aimed at restoring financial stability.

The details of the program were complicated enough to elicit a standalone post.

The Problem. According to the Treasury, one of the problems plaguing the financial system is that of legacy assets – real estate loans held directly by the banks (“legacy loans”) and securities, or tradable financial instruments, backed by loan portfolios (“legacy securities”).  The true value of these assets has been brought to question. As a result, there is uncertainty surrounding the balance sheets of the institutions holding these assets.  Markets don’t like uncertainty as is evident from their performance, especially that of bank stocks, over the last 12 months.

Proposed Solution. The program’s intent is to repair the balance sheets of these institutions by moving the legacy assets off the hands of banking institutions and into the hands of investors.  Cleaner balance sheets could make it easier for banks to raise capital and increase their willingness to lend.

Principles of the Proposal. Treasury will use $75 – $100 billion in TARP money to become co-investors with the private sector, with backing provided by the FDIC and the Federal Reserve.  The “investment partnership” will, thus, be able to purchase $500 billion to $1 trillion of toxic mortgage assets (both residential and commercial) from banking institutions that currently carry them.

There are two separate approaches, one for legacy loans and the other for legacy securities.  Initially, Treasury will share its $75 – $100 billion equity stake equally between the two programs with the option of shifting the allocation towards the option with the greater promise of success with market participants.

  1. Legacy Loans Program: Suppose a bank has a pool of mortgages with $100 face value that it wants off its hands.  It approaches the FDIC, which determines whether it wants to leverage the pool at a 6-to1 debt-to-equity ratio.  If it decides to go ahead, the pool is auctioned by the FDIC.  Several private sector investors are hoped will bid.  The private sector bidder with the highest bid would be the winner and would form a Public-Private Investment Fund to purchase the pool of mortgages.  Let’s say the highest bid is $84.  Of this purchase price, the FDIC would guarantee $6 of every $7 in investment, or in this example, $72.  This is debt financing.  The remaining $12 is equity financing, which is shared equally by the private investor ($6) and the Treasury ($6).  The private investor would then manage the servicing of the pool of purchased assets.  The private investor and the Treasury would each be able to purchase $14 worth of assets for every $1 of their own money (14-to-1 leverage).
  2. Legacy Securities Program: Treasury will approve up to five fund managers for this program.  A fund manager, for example, submits a proposal and is pre-qualified to raise private capital.  The Treasury plans on being a joint-venture partner.  Let’s say a fund manager is able to raise $100 of private capital for the fund.  The Treasury will co-invest $100 in equity financing along side the private investor and will provide an additional loan of $100 (debt financing) to the “partnership” fund.  Additional requests for loans up to $100 will also be considered by the Treasury.  As a result, the fund manager has $300 – $400 in total capital for purchase of securities.  The fund manager has full discretion in investment decisions.  This program will be incorporated into the previously announced Term Asset-Backed Securities Loan Facility (TALF) whose original goal was to provide debt financing (non-recourse loans) to buyers of newly created consumer and small business loans.

The PPIP program has thus far met with lukewarm reception from the private sector, which is noteworthy given the necessity of their participation.  On a conference call to analysts and investors last Thursday, Jamie Dimon, the CEO of JP Morgan and, currently, the go-to guy for the US government on financial mergers/takeovers, said that they will not take part in the PPIP.  “We’re certainly not going to borrow from the federal government because we’ve learned our lesson about that,” said the Chief Executive.  Wells Fargo and US Bancorp are noncommittal.

It remains to be seen whether the Public-Private Investment Program will succeed in getting credit flowing again or further reveal corporate fear of business decisions driven a government that’s looking solely in the rearview mirror.

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Filed under: Business, Economy, Government, , , ,

Take a look under that TARP

barsness_bigbluemountainIntimidated and confused by all the programs initiated by the government within the past 12 months?  Don’t beat yourself up.  We are in the majority.  Let’s try and shed some light on these programs and gain some understanding into the allocation of our taxpayer dollars.

On October 3, 2008, the Emergency Economic Stabilization Act of 2008 (EESA) was signed into law amidst a tailspin in the financial markets.  The Troubled Assets Relief Program (TARP) was established under the EESA with the goal of stabilizing the financial system of the country and, hopefully, preventing a systemic collapse.  Under this law, the Treasury was granted authorization to spend up to $700 billion towards the purchase of troubled assets and the injection of capital into banking institutions.

The TARP has several programs under it:

  • Capital Assistance Program (CAP): to promote confidence in the financial system by ensuring that the nation’s largest banks have sufficient capital cushion against larger than expected future losses.  Financial institutions have to undergo a supervised stress test to be deemed eligible.  The stress test requires these institutions to make some assumptions. The banks would have to assume that the economy shrinks by 3.3 percent in 2009 and remains flat in 2010.  Assumptions will also have to include a decline in house prices by 22 percent this yearUnemployment should rise to 8.9 percent this year and reach 10.3 percent in 2010.  Big banks – those with consolidated assets greater than $100 billion – are required to carry out the test by the end of April.  If regulators assess that an institution does not have enough capital under these assumptions, they would have to raise the required capital either in the private markets or from the government.
  • Consumer and Business Lending Initiative (CBLI): a joint initiative with the Federal Reserve.  The goal of this program is to unfreeze consumer and business credit markets by providing financing to private investors willing to purchase assets backed by auto, student, small business, and credit card loans.  Under this plan the Federal Reserve will provide $200 billion in lending and the Treasury will support it with $20 billion in credit protection.
  • Making Home Affordable Program: an effort to stem the tide of foreclosures and declining home values through the employment of three initiatives:
    1. A refinance for 4 to 5 million people who took out loans owned or guaranteed by Freddie Mac and Fannie Mae
    2. A $75 billion loan modification program aimed at preventing foreclosures by targeting 3 to 4 million at-risk homeowners
    3. Support low mortgage rates by strengthening confidence in Fannie Mae and Freddie Mac through increased funding commitments to the two entities
  • Public-Private Investment Program (PPIP): to repair balance sheets throughout the financial system through the Legacy Loan Program and the Legacy Securities Program.  The loan program will facilitate the purchase of troubled loans from banks while the securities program will attempt to move the highly illiquid securities (such as mortgage-backed securities and collateralized debt obligations) off the balance sheets of banks and into the hands of investors.  The PPIP is conducted in conjunction with the FDIC and the Federal Reserve.  $75 to $100 billion in TARP capital is combined with private capital.  FDIC and the Federal Reserve will provide leverage for the private capital thereby increasing purchasing power to $500 billion-$1 trillion.  Remember how excessive leverage was our financial system’s undoing?  Looks like we’re going back to the same well in order to rescue the selfsame.  I may have to post another article just on the intricacies of the PPIP.
  • Capital Purchase Program (CPP): created in October 2008 to provide immediate capital to stabilize the financial and banking system, and to support the economy.  It is a voluntary program in which the US Government, through the Department of Treasury, invests in preferred equity securities issued by qualified financial institutions.  The goal is to invest up to $250 billion.  As of the April 10th report by the Treasury, $198.8 billion has been invested.
  • Asset Guarantee Program (AGP): under this program, Treasury will guarantee certain assets held by systemically significant financial institutions. Assets to be insured are selected by the Treasury and must have been originated before March 14, 2008.  In return for this assurance, the government collects a premium from the financial institution, the value of which is determined through actuarial analysis.  Citigroup seems to be the only institution so far to have qualified, and tapped into, this program or forced to do so.  It has received a guarantee on up to $5 billion of its assets to date.
  • Targeted Investment Program (TIP): the goal here is to stabilize the financial system by reducing the chance that one firm’s distress will threaten other financially sound businesses, institutions, and municipalities.  The program is implemented through investments in these unstable institutions.  Citigroup and Bank of America are the lucky ones chosen for this program, each receiving $20 billion through investments in preferred stock with warrants.
  • Automotive Industry Financing Program (AIFP): instituted to prevent a significant disruption of the American auto industry.  Most of the aid has been through the issue of loans, which have so far totaled $24.7 billion.  $5.5 billion has gone to Chrysler Holding and Chrysler Financial.  $19.2 billion has gone to General Motors and GMAC.  The notable exception is Ford Motor, which stayed away from government support and has taken this opportunity to separate itself from the other two.  New York Times has an article on how this company managed to stay independent.
  • Systemically Significant Failing Institution Program (SSFI): to prevent disruptions to financial markets from the failure of institutions that are critical to the functioning of the nation’s financial system.  This domain is reserved for those rarest of institutions – ones that made the worst business decisions of, at least, the past decade, and threaten to cut us all off at our knees.  The lone inhabitant of this realm is American International Group, Inc. or fondly referred to as AIG.  The taxpayers have used $40 billion from this program to prop up this company.  This is in addition to the ~$90 billion it has drawn from the credit-liquidity facility created for it by the Federal Reserve.

Now that you’ve taken a look under the TARP what impressions are you left with?

Filed under: Economy, Government, , , , , ,

Use leverage to transform health care in the US

ailing_healthcare_by_frantzwahWe all understand to some extent that our health care system is in dire need of reform.  Do we know what its condition really is?  Allow me to paint a picture.

What is the current and projected state of health care in the US?

National Health Expenditure (NHE) is defined as the total health care spending in the United States.  According to Centers for Medicare & Medicaid Services (CMMS), which quantifies health spending on an annual basis, the NHE grew 6.1% to $2.2 trillion in 2007, or $7,421 per person.  In comparison, this cost was $75 billion or $356 per person in 1970.  Health care spending currently accounts for 16% of our Gross Domestic Product (GDP) and is projected to grow by an average of 6.2% per year between 2008 and 2018.  At that rate the NHE will have reached $4.5 trillion in ten years and account for 20% of our GDP.  Healthcare spending has exceeded overall economic growth (GDP) annually by an average of 2.5 percentage points since 1970.

80% of health care spending goes to hospital care (37%), physician and other professional services (29%), and drugs (14%).  Many doctors complain that the system is now turned on its head where more and more of each healthcare dollar goes to cover administrative costs associated with the first two categories than to pay professional fees.  The facilitator of the doctor-patient relationship has become the principal entity.  Meanwhile, the doctor-patient relationship is now there to support the facilitator.

Private health insurance and out-of-pocket payments accounted for the largest part of health spending (55%) in 2007.  Public programs like Medicare, Medicaid, etc., comprised 45% of NHE.  While worker’s earnings and overall inflation has increased ~30% since 1999, health insurance premiums have grown 119% during the same period.  This usually means that workers have to spend more of their income each year on health care to maintain coverage.  These effects may either be direct – through increased worker contributions for premiums or reduced benefits, or indirect – such as when employers forgo wage increases to offset increases in premiums.  I gather you’ll agree with me that neither of these options is ideal.

Due to the influence of the recession and the leading edge of the Baby Boom generation becoming eligible for Medicare, average annual spending growth by public payers is expected to outpace that of private payers.  As a result, CMMS projects that public programs will overtake private insurance and reach 51% of NHE by 2018.  Not only will it be necessary for us to allocate greater portions of our income to employer-covered insurance premiums and Medicare, there is no guarantee that it will be sufficient to bear the imminent burden on our health care system.

How can this problem be addressed?

Victor Fuchs, Professor of Economics and of Health Research and Policy at Stanford University, proposes tackling health care reform around four essential principles: coverage for the uninsured, cost control, coordinated care, and choice1.  According to him, any reform which does not cover these essentials is doomed to fail.  In addition, any reform plan that is not controversial is certain to be inconsequential.

Dr. Benjamin Carson has one such controversial and ambitious plan.  Dr. Carson, who has served in a medical advisory role for both President Clinton and President Bush, suggests the idea of a medical endowment where ten percent of the cost of health care be set aside annually in an endowment fund2.  The interest from the endowment would be used initially to cover health care expenses for the uninsured and underinsured, the first C of Prof. Fuchs principles.  He envisions growing the fund to such a size in 15-20 years that it can cover most of the country.  He has initiated a pilot program at Johns Hopkins Medicine.  The fund, called the Benevolent Endowment Network fund, will be started off in pediatric neurosurgery, expanded to all of neurosurgery with the hope of eventually covering the entire hospital.

On the corporate side, Wal-Mart is slowly positioning itself to be a force in health care through a controversial plan for tackling the second C – cost control.  I call it controversial because Wal-Mart tends to elicit a visceral reaction from many people, who view the company as “pure evil.”  I merely present the company as one of the potential forces necessary for true health care reform to be accomplished.  In September 2006, the company introduced $4 30-day prescription pricing for 291 generics in the Tampa Bay, FL area, which was available to the uninsured.  It has since expanded the program to 49 states covering 350 generics and 1000 over-the-counter medications.  Pricing now includes an option for a 90-day prescription for $10.  Several pharmacy chains, including Target and K-Mart, were forced to follow suit.  Anecdotal evidence from my pharmacist friends, who work for other chains, suggests anger at this move.  Meanwhile, many consumers applauded the move.

The company is now looking to shake up Pharmacy Benefits Management (PBM).  It announced a pilot with Caterpillar to provide 2500 prescription drugs to 70,000 of its employees, spouses, and retirees.  If successful, it is sure to try expanding the deal with other employers.  This, in turn, could help employers cut their costs related to prescription drug coverage.

The third leg in Wal-Mart’s stool is electronic medical records (EMR).  According to an article in the New York Times, Wal-Mart has decided to team its Sam’s Club division with Dell and eClinicalWorks to market hardware, software, installation,maintenance, and training to physicians’ offices.  They will be mainly targeting small physician groups where 75% of the nation’s physicians practice.  Another initiative in the works for Wal-Mart is telemedicine in collaboration with NuPhysicia, LLC.

Michael Porter, University Professor at Harvard Business School and Director of the Institute for Strategy and Competitiveness, has a plan for tackling the third and fourth C’s – coordinated care and choice.  He proposes a value-based health care delivery system where players strive to create value for patients rather than capturing more revenue, shifting costs, and restricting services.  The centerpiece of this strategy involves bundled reimbursement for an entire care cycle instead of individual services like doctor visits, MRI scan, radiologist consultation, biopsies, etc.  He provides examples of institutions such as The Cleveland Clinic and MD Anderson Cancer Center where disease-based integrated practice is bearing fruit.

Despite the various forces working to address the four C’s, one important issue that I see missing is that of preventive medicine.  I proffer this as the most important piece for the long term viability of any health care reform that’s implemented.  Most reform ideas center around the reduction of current health care burden which are all remedial in nature.  In fact, our entire nation’s health care focus seems to be on treating the disease.  Even the preventive measures mainly target regular screenings.  The assumption here is that some type of disease is inevitable; so let’s try to nip it in the bud through screenings.  What about the notion that many diseases may be prevented if we actively engage in a lifestyle that’s healthier this year than it was the last?  A friend of mine (hat tip CJC) made a statement recently which I believe to be true:

No health care reform or plan in the world can bear the burden of overweight and obesity and the complications that arise from it.”

According to the National Institutes of Health, two-thirds of us are overweight and one-third are obese.  Overweight and obesity are known risk factors for several diseases.  Certain diseases can trigger other complications and multiply the cost associated with treating them all.  For example, people with diabetes spent $190 billion for health care in 2004, nearly seven times the $28 billion they spent specifically to treat diabetes.  A sizeable portion of the total spending for these people went to the treatment of conditions that are common complications of diabetes3.  So leverage, in this case, works against us and multiplies the burden on the health care system.

However, leverage may be employed to our advantage, as well.  What if we take personal responsibility for our long term health through healthier eating and more physical activity?  We may be able to reduce conditions of overweight, and obesity and diseases like diabetes, heart attack, stroke and other related disorders.  As a result, we will find ourselves making fewer doctor visits outside our regular check-ups.  Fewer complimentary services are ordered by our primary physician.  All of this reduces the burden on our health care system.  Health care providers can, in turn, focus on patients with diseases that are out of their control and provide better value.  Meanwhile, consumers may be willing to apply some of the savings from their reduced insurance premiums to cover the uninsured and underinsured.  The four C’s have a better chance of success in providing coverage for all of us because less strain is put on by each of us.  And the best part: this leverage monetarily costs us next to nothing.

All it requires is one question and small steps to answer it: How can I live healthier this year than I did last year?

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1 Health Reform: Getting the Essentials Right by Victor R. Fuchs

2 The vision of the Benevolent Endowment Network fund by Dr. Ben Carson

3 Roehrig C., et al. National Health Spending by Medical Condition, 1995-2005.  Health Affairs.  Volume 28, Number 2 (2009): pp 358-367.

Filed under: Business, Economy, Government, Health, , , , , , , , , ,