In Episode 143 of Hidden Forces, Demetri Kofinas speaks with Vivian Lee, President of Health Platforms at Verily Life Sciences (an Alphabet company) about America’s broken health system, how to fix it, and why it’s been so difficult to do until now.
According to an Institute of Medicine 2012 study, we waste 30 cents of every dollar we spend on health care. That’s over $1 trillion per year. Nearly one-fifth of the US economy goes to pay for health. That’s two to three times more than other high-income OECD nations where health coverage is universal. And yet, our life-expectancy statistics place us 26th out of 35 among those same OECD countries. How is this possible?
What you are going to learn today is that while the solution to America’s broken health system is complicated, the problem is rather simple: our incentives are totally “out-of-whack.” Our fee-for-service system rewards action, not better health outcomes. It encourages overtreatment and specialty care at the expense of prevention and primary care. This is the fundamental flaw of American health care. But this isn’t the entire story. How we pay for healthcare is equally important.
Most Americans don’t buy health care. They buy health insurance. This incentive structure often puts insurers and doctors at odds with patients’ interests. Insurers who pay doctors and hospitals for care are incentivized to spend as little as possible on a patient’s health. The less they payout, the more profit they make. Conversely, in a pay-for-action model, most doctors and hospitals are incentivized to spend as much as possible. This means patients (or more precisely, their premiums) are the rope in an annual trillion-dollar tug of war. Doctors and hospitals pull by ordering more tests and operations; insurers yank back by denying those services or adding restrictions like “prior authorization” paperwork for expensive medication and tests. When hospitals or doctors charge more than insurers are willing to pay, patients can get caught in the middle and be asked to pay the difference, leading to those so-called “surprise bills” that we all love so much. Normally, we could expect market forces to drive costs down in such a highly inefficient system, but the model of buying insurance (not health care) means not only that customers are price inelastic, but that they are actually incentivized to consume as many services as possible since they have already paid for them in the form of a monthly premium. Everyone is shooting in a different direction.
In today’s conversation with Vivian Lee, you are going to learn how America’s health system became so dysfunctional (e.g. defensive medicine, poor primary- and self-care, astronomical end-of-life costs, etc.) and what we can do to fix it.
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Producer & Host: Demetri Kofinas
Editor & Engineer: Stylianos Nicolaou
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Episode Recorded on 06/24/2020
In Episode 142 of Hidden Forces, Demetri Kofinas speaks with Tony Greer, editor of the Morning Navigator and founder of TG Macro.
This episode begins with a clip from David Portnoy (a.k.a Barstool Dave or Davey Daytrader), in what is probably the most epic hype video ever created for stock trading.
Portnoy has come to personify not only the recent rip-roaring retracement in equities, but also, the philosophy that the stock market no longer bears any relationship to the real economy. “It took me a while to figure out that the stock market isn’t connected to the economy,” according to David Portnoy. “I tell people there are two rules to investing: Stocks only go up, and if you have any problems, see rule No. 1.”
Extraordinary monetary interventions remain the single most important causal factor for explaining this phenomenon (what we have referred to on this show as “market nihilism”). Whether investment flows are coming from passive funds or “passive people,” what’s important is that the allocators invest indiscriminately. As the popular fraise goes: “Always buy the fucking dip” (#ABTFD)
In our past episodes with Mike Green, we have explored the role of systematic passive investment vehicles in driving markets higher. With the recent return of the retail investor an additional layer of passivity has been added. Not only are these investors seemingly “price inelastic,” but they also exhibit a disturbing level of indifference to fundamentals that is qualitatively different from anything seen in past generations. Unlike the Gen-X and Boomer cohorts of 1999 who felt that they could see a future that others could not yet perceive, this generation of zoomers and millennials seems to feel that they have figured out something far more fundamental about how things work today. In their view, the notion that the stock market has any relationship to economic reality is laughable. Fundamentals can’t hold a candle to Jay Powell and his money printer. Along with this realization comes a mocking, self-deprecatory celebration of aberrance. Indeed, going through r/WallStreetBets or wojack images on crypto subreddits exposes you to imagery that is reminiscent of a scene from the Island of Dr. Moreau.
In their 90-minute conversation, Tony and Demetri explore all of these themes. They discuss the recent rip-roaring retracement in equities and how the Federal Reserve, with its relentless money-printing has broken the economy, turned the stock market into a casino, and sown the seeds for a political crisis unlike any we have seen in more than a generation.
You can access the episode overtime, as well as the transcript and rundown to this week’s episode through the Hidden Forces Patreon Page. This week’s rundown is particularly helpful for anyone trying to follow along or who has not been properly exposed to the subjects discussed in today’s episode.
All subscribers gain access to our overtime feed, which can be easily added to your favorite podcast application.
Producer & Host: Demetri Kofinas
Editor & Engineer: Stylianos Nicolaou
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Episode Recorded on 06/15/2020
In Episode 141 of Hidden Forces, Demetri Kofinas speaks with Joseph Nye, the co-founder of the international relations theory of neoliberalism who is credited with developing the concept of "soft power."
In his latest book “Do Morals Matter?,” Dr. Nye meticulously weighs the ethics of the foreign policy decisions of American presidents from F.D.R. to Donald Trump. He argues that good moral reasoning should be three-dimensional, weighing and balancing the intentions, the means, and the consequences of a president's decisions. “A moral foreign policy is not a matter of intentions versus consequences but must involve both as well as the means that were used,” professes Joseph Nye.
In this conversation, Demetri and professor Nye discuss the presidencies of Harry Truman, Dwight D. Eisenhower, John F. Kennedy, Lyndon Johnson, Richard Nixon, Ronald Reagan, George H. W. Bush, Bill Clinton, Barack Obama, and Donald Trump. Nye compares and contrasts the various presidents, their tenures, policy challenges & opportunities, as well as the moral dimensions of some of their most consequential decisions.
The second hour of today’s episode, which is available to our premium subscribers, deals primarily with the Obama and Trump presidencies, including a detailed discussion about the contemporary challenges facing the United States in a multi-polar world.
You can access the episode overtime, as well as the transcript and rundown to this week’s episode through the Hidden Forces Patreon Page. All subscribers gain access to our overtime feed, which can be easily added to your favorite podcast application.
Producer & Host: Demetri Kofinas
Editor & Engineer: Stylianos Nicolaou
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Episode Recorded on 06/08/2020
In Episode 140 of Hidden Forces, Demetri Kofinas speaks with Thomas Rid, Professor of Strategic Studies at Johns Hopkins University’s School of Advanced International Studies about active measures, the history of disinformation, and political warfare.
We live in the age of organized deception. Spy agencies pour vast resources into hacking, leaking, and forging data, often with the goal of weakening the very foundation of liberal democracy: trust in facts. As a renowned expert on technology and national security, Thomas Rid was one of the first to sound the alarm. More than four months before the 2016 election, he warned that Russian military intelligence was “carefully planning and timing a high-stakes political campaign" to disrupt the democratic process. But as crafty as such so-called active measures have become, they are not new.
The story of modern disinformation begins with the post-Russian Revolution clash between communism and capitalism, which would come to define the Cold War. In this conversation about active measures, Rid reveals startling intelligence and security secrets from materials written in more than ten languages across several nations, and from interviews with current and former operatives. He exposes the disturbing yet colorful history of professional, organized lying, tracks the rise of leaking, and shows how spies began to exploit emerging internet culture many years before WikiLeaks. Finally, he sheds new light on the 2016 election, especially the role of the infamous “troll farm” in St. Petersburg as well as a much more harmful attack that unfolded in the shadows.
During a period of heightened emotions, extreme politics, and dangerous precedents, this conversation will help listeners to understand how we got here and what we can do in order to make it safely through the other side.
You can access the episode overtime, as well as the transcript and rundown to this week’s episode through the Hidden Forces Patreon Page. All subscribers gain access to our overtime feed, which can be easily added to your favorite podcast application.
Producer & Host: Demetri Kofinas
Editor & Engineer: Stylianos Nicolaou
Subscribe & Support the Podcast at http://patreon.com/hiddenforces
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Episode Recorded on 05/25/2020
In Episode 139 of Hidden Forces, Demetri Kofinas speaks with Matt Stoller, Director of Research at the American Economic Liberties Project and author of Goliath: The Hundred Year War Between Monopoly Power and Democracy. In this nearly two-hour long conversation, we discuss how monopoly, commercial concentration, and regulatory capture drive outcomes in our economy, markets, and political system and what we can do to take that power back.
This episode was recorded on Friday, May 29th, amidst the riots that have been unfolding across the country in response to the death of George Floyd, a 46-year old African American man who appears to have been suffocated by Minneapolis Police officer Derek Chauvin. Neither Matt or Demetri are in any position to provide further insight into what is transpiring in Minneapolis, but they do discuss the response by some members of the media, the White House, as well as the President’s statement that he is going to issue an executive order to roll back Section 230 of the Communications Decency Act with its legal protections for social media companies.
We also discuss the Joe Rogan-Spotify deal in the context of antitrust regulation and concentration in the podcast industry, the arrest of a CNN crew in Minneapolis, private equity and the regulatory capture of government by the financial sector, and perhaps most importantly a conversation about the future of the Democratic and Republican parties and whether we are living through the early stages of a new political consensus forming in American life.
You can access the episode overtime, as well as the transcript and rundown to this week’s episode through the Hidden Forces Patreon Page. All subscribers gain access to our overtime feed, which can be easily added to your favorite podcast application.
Producer & Host: Demetri Kofinas
Editor & Engineer: Stylianos Nicolaou
Subscribe & Support the Podcast at http://patreon.com/hiddenforces
Join the conversation on Facebook, Instagram, and Twitter at @hiddenforcespod
Episode Recorded on 05/29/2020