Analyzing Healthcare through the Lens of the Eurozone Crisis

Overview

Global Data and others have written various reports that outline the effects of monetary policy and the healthcare systems of Ireland, Portugal, Cyprus, Italy, Spain and Greece. This particular market sector has been heavily hit in the analysis by Global Data and several reasons for this are attributed since these countries are at the heart of the Eurozone Sovereign Debt Crisis. However, there are some underlying economic causes not explored by Global Data that have tremendous impact for policy makers, economists, and investors of these countries which are teetering on insolvency. At the center of this crisis is the Greek economy. The anomalies attributed to massive debt and spending by a socialized government does not tell the complete story. This includes the building of infrastructure by foreign multi-nationals in the 1980’s and 1990’s and a financing package that was initially offered by the International Monetary Fund to finance these upgrades. There was a restructuring of debt which allowed the Greeks to hide 2% of their debt off-books and a large American banking firm helped create this illiquidity. It is suggested that further inquiry be made into these multi-nationals, their financiers and their roles in bribery and extortion of the Greek government officials leading up to the crash.

 

Introduction

Global Data, a premier source of actionable insight into the energy and healthcare industries, published a report detailing the impact of the monetary crisis in Europe on the healthcare industry (“About Us,” 2015). Following the American financial crisis of 2007-2008, several European governments had difficulty securing additional credit for operating their governments. Unlike the American financial crisis around the same time, the debt was not informed from corporations or persons, but by governments and coined as “sovereign debt,” (Li, 2011). When Greece held elections and a new government was instated in 2009, regulators discovered their income to debt requirements failed to meet the guidelines for the European Union (“Evidence mounts that Greece cooked the books,” 2010). As audits across the continent spread, other states discovered similar problems in Ireland, Portugal, Cyprus, Italy, and Spain. State acquired illiquidity placed pressure on lending institutions and governments who were headed toward insolvency, created a credit crunch and caused runs on banks. To stave off bankruptcy, these governments solicited the European Central Bank, the International Monetary Fund, and the European Financial Stability Facility. Through an agreement of austerity in cutting programs and raising taxes, these states restructured some of their debt and averted insolvency. These were not total or comprehensive solutions and even prolonged the misery for some as Greece eventually defaulted on a $1.7 billion payment in June of 2015 (Harrison & Laikos, 2015). The problems CBS Moneywatch reporter Jill Schlesinger called the European sovereign-debt crisis, “the Energizer Bunny of financial catastrophes,” (Schlesinger, 2012).

The healthcare systems in Ireland, Portugal, Cyprus, Italy, Spain and Greece are funded heavily by the government. The Social Insurance Institute (IKA) is the largest insurance body in Greece and covers more than half the population. According to an on-line resource for expats moving to Greece, it provides health care for 5.55 million insured persons, including family members, and paid pensions to 845,000 pensioners (“The National Health System,” 2015). Portugal as well has government subsidized health care system managed by the Serviço Nacional de Saúde. The Portuguese government spent approximately 11% of $216.5 Billion GDP in 2012 towards healthcare. Ireland’s government also heavily subsidizes the healthcare sector but only for poor patients. It spent approximately 9.2% of its $221.1 Billion GDP on healthcare in 2012 (“GDP by Country 1980-2014,” 2015; S. Rogers, 2012). Spain’s central government continuing with this pattern finances a significant portion of the country’s healthcare services via the Sistema Nacional de Salud. In 2012, it spent approximately 9.5% of $1356.5 billion GDP toward healthcare (“GDP by Country 1980-2014,” 2015; S. Rogers, 2012). The central government of Cyprus also funds the healthcare system for many people in the country via their National Health System in which all workers and residents must apply for state-sponsored insurance. In 2012, it spent approximately $1.5 billion on healthcare for its citizens (“GDP by Country 1980-2014,” 2015; S. Rogers, 2012). By comparison the US in this same time frame spent 17.9% of its GDP and amassed more expenditures than all those governments combined. While the US system is partially funded by public tax dollars, larger amounts of private dollars go its the health care system since it is not a single payer or a socialized system.

The financial problems of the European economic system have made headlines in the United States with some trumpeting the end of the European Union (O’Brien, 2015). Harvard political science professor, Dani Rodrik echoed similar sentiments while adding a further critique in noting, “the real problem is that Europe has not created the union-wide institutions that an integrated financial market requires,” (Rodrik, 2015). Reporter Hugo Duncan noted that an exit of the Greek Government from the Eurozone because of this debt crisis, would be the beginning of the end for the European Union (Duncan, 2015). The New York Times called for reforms to transform the European Union away from a centralized state (Dixon, 2015) and reporter Sivy noted in Time Magazine detailed four different scenarios of failure for the European Union (Sivy, 2012). Sivy reported Greek frustration from the European Union’s Central Bank and its requirements to guarantee payment in the event of a Greek exit from the European Union (Sivy, 2012).

For the average European citizen of Greece, Portugal, Ireland, Spain or Cyprus, economic ignorance has contributed to the problem of politicians promising access to free services of the state when these programs were financed by debt. An anti-austerity and communist party in Spain called Podemos has won several large local elections and continues to lead in the polls for the 2015 national elections (Burridge, 2015) with promises of universal healthcare and education (Cencela-Kieffer, 2015). This has investors from the rest of the world, who have money invested in the Spanish economy, scared that the central government may nationalize businesses in reaction to the austerity measures imposed on Spain as a result of the Eurozone Crisis (Gonzalez, 2015). In the Spring of 2015, amidst a national election between various Portuguese candidates, healthcare workers joined garbage collectors, educators, and court system employees in a strike of protest toward the EU imposed austerity (Ames, 2015). Portuguese nurses remained unable to get jobs and many leave the country to find work (Kassam, 2015). Of all the austerity measures in Greece, healthcare has been hit the hardest (Chrisafis, 2015) as fascist neo-nazi parties like Golden Dawn gain popularity in a political climate that demands austerity (Wheeler, 2012). An estimated 5000 doctors have left Greece since the crisis began and most left for Germany (Olsen, 2015). In Cyprus, young people facing the burden of austerity over their national debt and reduced wages, have at least a third considering working abroad (Gavos, 2013). This island struggles with unification issues over predominantly Turkish and Greek split with many Turkish nationals burdening the better southern Cypriot system. It is a tinderbox of political intrigue.

Conditions surrounding these events have the general citizens of these countries struggling to understand the debt their countries have burdened them with. A 2014 Pew Research Center poll showed that most Europeans believe the EU Parliament in Brussels is out of touch with average Europeans and most remained dissatisfied with their economic conditions (Stokes, 2014). A 2013 poll showed that Europeans have no idea what inflation is (Sumner, 2013) and prior to the Eurozone Crisis several leading economists viewed the rising Euro as a threat to the US Dollar as the world’s reserve currency (Heard, 2003). This may be the latest chapter in a currency war as informed by Clark, who noted only six months after Saddam Hussein had begun trading his oil for Euros the US military invaded Iraq (Clark, 2003). Clark further supported this thesis by the failure of the Iranian Oil Bourse which was dominated by Euros (Clark, 2004).

Against this political and economic background the research team at Global Data provided executive insight into the Impact of Eurozone Crisis on Healthcare Economics (Global Data Ltd, 2012). The purpose of this report will be to argue in favor of the methodologies used to aggregate reporting on macroeconomic principles and its effects on health care market sectors in the Eurozone.

Research Overview

A review of the Global Data report notes that GDP spent on the healthcare sector has increased over the past few decades. More recently the Eurozone Crisis has caused a realignment of capital and lending practices within Europe that has affected various states and the kinds of governments they wish to have. This means that rather than a redistribution of wealth or complete confiscation of wealth by the state these territories have had to increase taxes, cut public spending and decrease wages and salaries across the board. This has been done to balance the budgets of these governments and has brought tremendous pressure on the healthcare systems of the Eurozone Governments. The austerity imposed by these governments has directly impacted the governments of Portugal, Italy, Ireland, Greece and Spain throughout this crisis (Global Data Ltd, 2012).

Overall the findings of this report found there were several factors connecting the monetary policy of the Eurozone and its connection with austerity in the healthcare sector. Two approaches were found in describing the situation. One group of factors involved looking at reasons why the cost of doing business as a government had increased. The second group looked at what states had done to restrain spending. In essence it was a tale of consumption versus conservation.

One finding included an aging population. As citizens age and rely more on social systems, pensions and fixed incomes, the drain on public treasury funds may exceed revenues generated by taxation. This in turn causes excessive public debt and an inability to make payments on that debt when the number of people using resources in the system exceeds those putting resources into the system.

The report also cited increased expenditures in the pharmaceutical field as a leading reason for factors connecting the monetary policy of the Eurozone and austerity within these countries. The report noted, “The expenditure incurred on pharmaceutical sector is directly proportional to the price of the pharmaceutical drugs,” (p. 3). When capital is extended to big business in a trade zone like the European Union, dollars across a wide variety of economic strata enters the economy. When these drugs are taken by more people across a larger swath of a population, the public expenditure on health care is greater. This increase cost drains public coffers as a social burden to the society’s most vulnerable members who require these medicines and may not be in a position to purchase them or because of lifestyle choices are unwilling given that the state offers this as a benefit of citizenship (p. 3). Another challenge noted in the report was the absence of generics on the market. Brand name drugs and their life saving intellectual property limit the ability of generics to enter a marketplace that may find more value in thrift. This additional pressure creates additional opportunity for austerity.

In addition to an increased cost of use by big pharmaceuticals, the report suggested that a large amount of capital is set aside for research and development. Companies are under increased pressure to secure greater breakthroughs for more disease than ever before and this investment in systems that are largely single payer places a considerable burden on the states whose constituents vote for their treasuries to be spent toward medical research. These high expenses create further opportunity for austerity (p. 3).

The report cited inflation as a reason for the need for austerity. The views of inflation in this regard focused on the Keynesian view that rising wages and prices cause rising prices of goods. The study notes, “The annual cost of therapy associated with branded drugs has been increasing considerably year on year owing to the rise in inflation,” (p.3).

The report also cited unemployment and decreasingly productive populations as reasons for the need for these austerity measures. As these populations age, as businesses move out of areas to find greater profit, sources of revenues and business are more difficult to obtain. These governments lose tax revenue and try to tax the remaining businesses to make up the difference. Unable to secure these revenues they often resort to public borrowing to meet the need for those services and in doing so move their national governments toward insolvency.

The conservation approaches to reduce spending noted that private insurance within the Eurozone developed higher co-payments from individual consumers (p. 4). This reduced the overall burden to nation states. Another approach negotiated for better prices on goods and services which also decreased the overall spending limits (p. 4). Lastly, these groups tried harder to get generics into their formularies (p. 4).

The report followed these generalities with some specific instances in each of the countries with an appendix that focused on the methodologies. The methods employed in this research paper addressed secondary and primary research via some 56 members (p.6) and then used an expert panel to validate the information.

Analysis and Findings

The approach of the researchers at Global Data analysed, “the impact of the Eurozone Crisis on the healthcare economy and analyses the various measures employed by Portugal, Italy, Ireland, Greece and Spain in order to overcome their deficits,” (p. 1). It appears that this report accomplished that end. In addressing some of the cost demand aspects of health capital the marginal efficiency of investment and rates of return were not explored through the lens of the state (Folland, Goodman, & Stano, 2010c). Secondary investment across these economies was not measured or considered where resources in one of the more well to do countries was explored, such as MRI machines more readily available in Germany over Greece, and thus the rates of return for these investments were not considered. Consideration of age and wages were included in the perspectives of Global Data’s report. Folland, Goodman and Stano note, “The pure investment model generates the prediction that optimal health will decline as the person ages,” and that reduced wages in the Eurozone decrease overall health and may compound the problem by deceasing capital investment in healthcare stocks (Folland, Goodman, & Stano, 2010a).

The published methodology did not include another appendix containing the data to validate the conclusions of the report (Trochim, 2006). Furthermore, the idea an expert panel reviewed the data leaves the research open to an ad verecundiam fallacy without the potential to review (LaBossiere, 2012). This perspective complicated the discussion regarding big pharmaceuticals in the highly regulated single payer markets of Greece, Spain, Portugal, Ireland, Italy and Cyprus. When government was responsible for the investment as well as the service it is not as sensitive to the market demands as a free market and thus the highly regulated nature of pharmaceuticals in this case limited access to those markets by competitive products. The result is higher prices and reduced supply. This adds burden to socialized system since it prohibits competition. The report noted that generic markets were limited but did not articulate the reasoning for this. Folland, Goodman and Stano attribute this economic phenomenon to externalities which consistently reflect the prices of the goods and services to which they are associated (Folland, Goodman, & Stano, 2010b).

The economic impact of state-sponsored monopolies must be considered given the single payer aspects of these governments and their domestic healthcare markets. Folland, Goodman, and Stano noted that, “When the marginal revenue lies beneath the demand curve, the monopolist will reduce production below competitive levels and the changed price will exceed the marginal cost of production,” (Folland, Goodman, & Stano, 2010d) States often attempt to solve the very problem they create by interfering in markets. They are the ultimate monopolists. Esteemed free-market economist Ludwig Von Mises noted:

If the government provides the funds required by taxing the citizens or by borrowing from the public, it abolishes on the one hand as many jobs as it creates on the other. If government spending is financed by borrowing from the commercial banks, it means credit expansion and inflation. If in the course of such inflation the rise in commodity prices exceeds the rise in nominal wage rates, unemployment will drop. But what makes unemployment shrink is precisely the fact that real wage rates are falling (Mises, 1947).

In Europe companies facing international competition will find it more difficult to make a profit in the face of increased taxation as a matter of austerity. Furthermore, these companies will be unable to hire more workers based upon the same circumstances or become leaner and more competitive in the marketplace without innovation or capital coming into the market. Unemployment will remain higher than free markets would otherwise produce and national monetization of debt will continue (Schultz & Grenke, 2013). This socialist appeal toward public spending the name of taking from productive entities in the European economy will only serve to move more business offshore and ultimately will harm the economy. Health care services will continue to decline in this same perspective of monetary policy and the inability of these firms, who without the burden of public debt were profitable, will become assets of foreign corporations.

Missing completely however, was the socialized baiting that occurred through derivatives in the bond markets by the central banks of Greece, Italy, Spain, Portugal, Ireland and Cyprus. As each of these governments utilized the Euro to hide their debt, an American bank, Goldman Sachs sought to assist them in this fraud, which at present is claimed to be legal in both the United States and Greece. Global Data failed to mention this.

Goldman Sachs helped to create the crisis in Greece in a similar fashion as the bank insolvency issues over the sub-prime lending in the United States (Balzli, 2010). In 2002 Greek debt managers in order to maintain compliance with the EU guidelines for a country’s debt masked their debt with the help of a massive deal from Goldman Sachs used contracts relating to an underlying entity called derivatives. Goldman Sach’s benefited from this arrangement securing $300 million in fees. The Independent reported that under the guidance of Antigone (Addy) Loudiadis at Goldman Sachs, “[They] swapped debt issued by Greece in dollars and yen for euros which were priced at a historical exchange rate that made the debt look smaller than it actually was. The swaps reportedly made about 2 per cent of Greece’s debt disappear from its national accounts,” (Armitage, 2015). The New York Times critiqued the Greek government’s medical problems on high numbers of pensioners and universal “free” socialized medicine (Markary, 2015) but failed to mention that the same fees given to Goldman Sach’s could have paid the Greek debt to Rouche Pharmaceuticals who continue to report a severe shortage of drugs in Greece (Smith, 2013).

The fallout from this has been a bail out by these countries from the International Monetary Fund, another American institution gaining interest. The Jubilee Debt Campaign noted that the IMF has made €2.5 billion profit out of Greece loans (“IMF has made €2.5 billion profit out of Greece loans,” 2015). When Greece defaulted on the IMF loans in June of 2015, it caused a run on Greek banks making many of them insolvent (Laura Wright, 2015). The result of this illiquidity was the buy out of many private sector businesses by German companies including some $800 million in the healthcare sector (“German companies have bought up the most Greek businesses,” 2015). Shipping giant Maersk placed a bid in the summer of 2015 to purchase Greek’s two largest ports (Wienberg, 2015) and pieces of this deal became the focus of several multi-national business interests. Newsweek reported that 14 of Greece’s 37 regional airports which include those on popular holiday islands Kos, Mykonos and Corfu are being sold in this fire-sale (Draper, 2015).

While this isn’t illegal, it remained informed from a perspective offered by a former economist and self-described economic hit man, John Perkins (Perkins, 2005). In his riveting tale of economic intrigue he described how American interests are served by banks being able to sell large amounts of debt and infrastructure to countries all over the world. If these countries do not comply by taking the IMF funds and then using them on American infrastructure suggestions, then countries like the US send Jackals and then the military (Perkins, 2007). Anecdotal evidence for some of this can be found in the massive infrastructure projects Greece endured when building for the Olympics to include a multi-billion dollar airport renovation project that had to be rushed. Multi-national Siemens was contracted and a Greek transport minister was charged with money laundering after he told the inquiry that he had received more than $123,000 from Siemens in 1998 as a campaign donation (Gatopoulos, 2010). The Greek government agreed to halt an official inquiry and Siemens agreed to pay the city of Athens a fee over the bribery case involving traffic lights (Mavraka & Papatheodorou, 2012). There was more and evidence remains informed from a review of Siemens accounts in 2006. The sealed report, which has not been made public, allegedly contained the names of 20 leading Greek politicians who have together received more than €100 million in recent years to “promote” Siemens. This supports Perkin’s thesis that these infrastructure contracts ensnare populations with public debt they cannot repay for ‘shovel ready’ infrastructure while lining the pockets of a political class on the take and making a few businessmen wealthy in securing the deals (Mavraka & Papatheodorou, 2012). As of late no American businesses-men have been prosecuted under The Foreign Corrupt Practices Act (15 U.S.C. § 78dd-1).

Conclusion

Global Data’s review of the Eurozone Crisis surrounding the sovereign debt of Greece, Cyprus, Italy, Portugal, Ireland, and Spain informed readers about several key relationships between monetary policy in these countries and that healthcare markets in each county have been hit hard as a result of austerity measures imposed by banking and financial interests of foreign central banks, the European Central Bank and the International Monetary Fund. These factors will continue to affect investment and financial decisions as well as public service policies in the near future with no end in sight to the hardship that must be endured by the Greek people. Notably, the methods used to explore this relationship within the report did not include the potential for validation through the implementation of an appendix but within the scope of the document also failed to document several key relationships between money and a market that explain how many private interests in Greece now are targets for a hostile takeover by multi-nationals in the fire-sale. This remains a critical perspective in understanding credit markets and financing in Greece today. Given that much of the economic conditions were preceded by special structured borrowing for infrastructure spending enabled by Wall-street banks and a controversial view of US foreign policy espoused by self-described economic hit men, the crisis may be more than coincidental and in fact engineered to transfer large sums of wealth away from Greece. It may be the latest chapter in a currency war over Dollars, ¥uan, and uros and these perspectives continue to be something any investor, policy-wonk, or pundit would be interested in knowing.

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