Don't mess with (this) BILL

In an appearance on Capitol Hill Thursday, Federal Reserve Board Chair Janet Yellen delivered her verdict on the suggestion: bad idea. Yellen was delivering regularly scheduled testimony before the Joint Economic Committee when she was asked by Rep. Carolyn Maloney (D-NY) for her thoughts on the law that placed new restrictions on the financial services industry in the wake of the financial crisis that led to the Great Recession. “We lived through a devastating financial crisis and a high priority for all Americans I think should be we that want to see put in place safeguards through supervision and regulation that result in a safer and sounder financial system,” Yellen said. “And I think we have been doing that and our financial system as a consequence is safer and sounder and many of the appropriate reforms are embodied in Dodd-Frank.” She cited a number of beneficial effects she believes the law has had, with regard to the stability of both individual financial institutions and on the broader financial system itself. Among other things she noted that banks now carry more capital to cushion against losses and have much more stringent liquidity requirements. Derivatives trading has been centralized and more closely regulated, and regulators have far more authority than they used to when it comes to liquidating the assets of a failing bank. She said that the requirement that the largest banks create so-called “living wills” to assist in an orderly liquidation of their assets in the event of failure has not only reduced the perception that some banks are “too big to fail” but is also “really changing the mindset of large financial firms about how they need to run their businesses and making them safer and sounder.” The Dodd-Frank Act implements a large variety of financial reforms, explains CNBC, including the Volcker Rule, regulation of derivatives, creation the Consumer Financial Protection Bureau and creation of the Office of Credit Ratings. The act also includes a large number of other reforms. The act's authors based these reforms on the causes of the 2008 financial crisis to prevent similar future crises. The Volcker rule stops banks from owning hedge funds for their own profit, states About.com. Dodd-Frank allows the Securities Exchange Commission the power to regulate risky derivatives, such as credit default swaps, which were partially to blame for the 2008 financial crisis. Dodd-Frank creates the Consumer Financial Protection Bureau to regulate consumer banking products, such as credit cards, payday loans and mortgage rules, in an attempt to stop predatory lending. The new Office of Credit Ratings regulates the credit rating industry, which is accused of providing inflated ratings to bad derivatives before 2008. Many Wall-Street investors feel that Dodd-Frank hurts economic growth with overly strict new rules, reports CNBC. However, many other commentators feel that the new regulations do not go far enough to stop further financial crises. One of the agencies that the Dodd-Frank Act created was the Financial Stability Oversight Council and the Orderly Liquidation Authority which tracks the financial stability of firms large enough to cause significant harm to the economy if they do not survive. If those companies become too weak, the law as it stands, in 2015, sets the stage for orderly liquidation, keeping tax dollars from supporting those types of firms. If banks become so large that they represent a risk to the financial system, the council can break those banks up and elevate reserve requirements, as stated by Investopedia. The Consumer Financial Protection Bureau was set up to stop predatory mortgage practices and make mortgage paperwork simpler for customers to understand before they sign contracts at closing. The Bureau also keeps mortgage brokers from elevating their commissions by boosting fees and interest rates, and it prevents loan originators from pushing borrowers to the loan that gives the originator the highest commission.

A little birdie

These 2 ladies taught me that "fat meat was greasy" but sometimes things are a little subtle this was lifted from WSJ Am briefing The stocks of companies with small market capitalizations have burst higher since the U.S. presidential election. The small-cap Russell 2000 Index has climbed 9% since Nov. 8, far outperforming the S&P 500's 1.8% rise. Smaller growth companies are jumping, the reasoning goes, because their revenues are more exposed to the U.S. economy, and less to the global economy. That puts them in better position to benefit if Donald Trump's statements on trade and fiscal stimulus become policies. "The strong small cap performance appears justified, as they are best positioned to benefit from the president-elect's pro-growth policies while being less exposed to the risks of protectionism and increased foreign taxation," said Bank of America Merrill Lynch analysts Dan Suzuki and Jimmy Bonilla, in a Wednesday note. A number of trades -- such as selling Treasurys or buying bank stocks -- have quickly gained momentum since the election. Some investors are skeptical of this sharp reversal of fortune post-election, and have warned that such trades could revert once there's more clarity about Mr. Trump's policy proposals. But unlike some other post-election trades, small-caps have been looking up for a while now. Through election day, the Russell 2000 was up 5.2% this year, outpacing the S&P 500's 4.7% rise. That's after underperforming large-caps by 15 percentage points during the three years through August, according to money manager Alger. An early-November survey of financial advisers, conducted by Alger before the election, found that 76% were bullish on small caps. Even without the election shift, small-caps may yet have the wind at their backs.

Loan Interest each day keeps Prmary care Doctor Away

Lifted from the NYT Many people have to wait too long to see a doctor. And it could get worse. If, as many people believe, we have a shortage of doctors in the United States, then it follows that we can fix this only by training and hiring more physicians. As with almost everything in our health care system, though, it’s complicated. Some people think there’s no shortage at all — just a poor distribution of the doctors we have. The main argument for a physician shortage is that we aren’t adding enough new doctors to keep up with changing demographics. The Association of American Medical Colleges has projected that by 2025 there will be a shortfall of between 46,100 and 90,400 doctors. In primary care, it projects a shortfall of between 12,500 and 31,100 doctors. The baby boomers are getting older and sicker, and they have more complex conditions than they did when they were younger, including arthritis, high blood pressure, pulmonary disease, diabetes and cancer. The Affordable Care Act is expected to accelerate the need for additional medical care. Increased insurance coverage increases demand, and Obamacare alone is projected to require about 16,000 to 17,000 more physicians than would have been required without it. Adding data to this argument, the United States has fewer practicing physicians per 1,000 people than 23 of the 28 countries that reported data in 2013 (among nations in the Organization for Economic Cooperation and Development). The United States had 2.56 doctors per 1,000 people, which is more than Canada (2.46), Poland (2.24), South Korea and Mexico (both 2.17). But we were way behind countries like Austria (4.99), Norway (4.31), Sweden (4.12), Germany and Switzerland (both 4.04). Based on these metrics, it would seem that we need more physicians. It would also seem that we’re not training them. When it comes to medical graduates, the United States ranks 30th of 35 countries. But there is strong evidence that we are thinking about this the wrong way. In 2014, the Institute of Medicine released a thorough analysis on graduate medical education that argued there was no doctor shortage, and that we didn’t really need to invest more in new physicians. The system isn’t undermanned, it said: It’s inefficient. We rely too heavily on physicians and not enough on midlevel practitioners, like physician assistants and nurse practitioners, especially because evidence supports they are just as effective in primary care settings. We don’t account for advances in technology, like telehealth and new drugs and devices that lessen the burden on physician visits to maintain health. Sign-up for free NYT Newsletters Morning Briefing News to start your day, weekdays Opinion TodaySubscribed Thought-provoking commentary, weekdays CookingSubscribed Delicious recipes and more, 5 times a week Race/Related A provocative exploration of race, biweekly Enter your email address Sign Up Receive occasional updates and special offers for The New York Times's products and services. MANAGE EMAIL PREFERENCES NOT YOU? PRIVACY POLICY And we fail to recognize that what we really have is a distribution problem. Parts of this country have lots of doctors, perhaps too many. These are mostly in cities, especially in cities where it seems desirable to live. The problem is made worse by the ways we reimburse for care. Medicare, for instance, pays more to doctors who live in places that are more expensive. The argument for this is that the cost of living is higher, so reimbursements must be, too. But that also means that doctors can earn more in places where they already might want to live. A result is that many rural areas, and less popular cities, experience more of a doctor shortage than others. The other distribution issue is in specialization. When it comes to generalists, we ranked 24th of 28 countries in doctors per 1,000 people. Specialists are a different story. There, we were 11th. This is an important fact about the American health care system. We sometimes hear that we have too many specialists and too few generalists. That’s not necessarily the case. We have an average number of specialists compared with other advanced countries, and even shortages in some specialties. It’s the ratio of specialists to generalists that’s the problem. When you compare the percentage of physicians who are generalists with those who are specialists, the United States beats only Greece among developed economies. Here, financial drivers play a role. Doctors who choose to specialize can make much more money, millions more dollars over a career, than primary care physicians. Money isn’t the only reason that medical graduates choose to specialize. But it’s certainly a factor. The average student debt for someone finishing medical school in 2015 was more than $180,000. Twelve percent of graduates had debt totaling more than $300,000. The median starting salary for a resident physician (and some residencies go for seven years or more) was just over $52,000. So by the time you’re in your 30s, you are hundreds of thousands of dollars in the hole, and you’ve just spent years making too little to pay it back while interest accrued. A specialty that might offer you a lot more money is enticing. None of this should be taken as a cry for sympathy for the financial plight of doctors in general. They are more likely to be in the top 1 percent of earners than any other profession. Still, it’s important to recognize that financial drivers are at play, and that they do matter. 131 COMMENTS What no one seems to be debating is that we have a shortage of services. We could fix that by increasing the number of physicians, either by training more or allowing more to immigrate into the country. We could fix that by improving the ratios at which physicians enter specialties or primary care, through changes in training slots or in how we pay physicians. We could fix that by making the health care system more efficient, by distributing the resources we have more effectively, or by increasing our willingness to use midlevel practitioners through changes in regulations or licensing. None of these approaches are easy, and all would most likely require governments to act. As the next administration takes power, choosing at least one of these paths seems necessary to improve access in the health care system. Correction: November 7, 2016 An earlier version of this article rendered the name of a health care group incorrectly. It is the Association of American Medical Colleges, not the American Association of Medical Colleges. Aaron E. Carroll is a professor of pediatrics at Indiana University School of Medicine who blogs on health research and policy at The Incidental Economist and makes videos at Healthcare Triage. Follow him on Twitter at @aaronecarroll. The Upshot provides news, analysis and graphics about politics,

From the Horses Mouth

goo.gl/UcxVKl

From the Horses mouth

goo.gl/UcxVKl

Post Brexit Reconsiderations

Lifted from Fierce but commented on here: Why sell at a Fire Sale, when operating costs have diminished and new products may come out . Would you sale the kitchen sink when you make kitchen sinks Pfizer has decided not to split up, abandoning a plan the company has been working toward for 5 years. Though the Big No isn't a complete surprise, it's a big course change for the drug giant, and for CEO Ian Read himself, who made the idea a centerpiece of his reign. The news is likely to disappoint many analysts and investors, who’ve been following the will-they-or-won’t-they question ever since Read first opened it up. Quarter by quarter, Read and his team have fielded analyst questions about when, how and why. Now, they’ll have to explain why not--and what's next. Read has some nitty-gritty financial reasons for the choice--including cash flow that's easier to tap as one company--and analysts figure taxes played a role. But there's another obvious reason: M&A. The company bought Hospira last year, adding a suite of biosimilars to its portfolio, and recently agreed to pay $14 billion for Medivation, the maker of the blockbuster prostate cancer med Xtandi. And more dealmaking could well be the answer to what's next. M&A has always been Pfizer's M.O., Bernstein analyst Tim Anderson pointed out in a Monday investor note. "A critic could argue that Pfizer is back to being the same old Pfizer as before, relying on M&A to grow and to refill its pipeline," Anderson said, "but at the expense of growing larger in the process, depending on the size of deals it chases." The essential question has always been whether Pfizer execs believe the company’s individual pieces could perform better on their own. Back when Read first proposed a breakup--which would leave Pfizer in two separate chunks, one focused on developing and selling new drug brands, the other on older brands, generics and biosimilars--the idea was that each business could be worth more as standalone companies than they would be together. Not so today, CFO Frank D’Amelio said Monday. When the split idea first came up, “market valuations of other companies suggested that our two businesses could potentially be worth more as separate companies than they are together in a single company.” But since then, “any potential gap between Pfizer’s market valuation” and a sum-of-the-parts estimate “has closed,” D’Amelio said. Meanwhile, Pfizer’s overall long-term growth prospects are now stronger than market watchers might have thought previously--and certainly stronger than estimates back in 2011, Anderson said earlier this year. Then, when EPS growth was projected at 2.6% through 2015, “dividing the company into a ‘good bank’ and ‘bad bank’ made sense,” Anderson said in July--and not so much now that projected annual growth sits at an estimated 6.9%. In announcing the decision Monday, Read said as much: “We believe that by operating two separate and autonomous units within Pfizer we are already accessing many of the potential benefits of a split--sharper focus, increased accountability, and a greater sense of urgency--while also retaining the operational strength, efficiency and financial flexibility of operating as a single company,” the CEO said in a statement. Meanwhile, as Anderson pointed out Monday, without the tax benefits of an inversion, splitting up would likely create a bigger tax burden on each piece than Pfizer could manage as a single company. "[O]ne of the drivers for pulling the plug on this plan likely related to the tax dis-synergies splitting up would create," he figures. Yes, other pharma industry hive-offs have done well; JP Morgan analyst Chris Schott pointed out Pfizer’s own animal health spinoff, Zoetis, on the call. Read himself mentioned AbbVie, the pharma unit that Abbott Laboratories split off in 2014. But those increases in value say as much about what was happening before the spinoff as they do about what happened after, Read suggested. “You have to question, number one, were the separate parts all being invested in equally? I don't think they were,” he said. “Were they getting the same amount of management attention? I don't think they were.” Pfizer has certainly made some deals on both sides of its business. The company’s Hospira buyout has already yielded one biosimilar approval--a knockoff version of Johnson & Johnson's anti-inflammatory blockbuster Remicade, which could launch next month--and added a large portfolio of injectable generic drugs to its essential health division. For the innovative products side of the company, the planned acquisition of Medivation will deliver not only Xtandi but also a couple of promising oncology candidates. The long-awaited decision doesn’t mean Pfizer is saying never, however. Read also suggested on the Q2 call that it might be an option down the road if the circumstances warrant. “I don't think that optionality necessarily has an expiration date,” he said. And in discussing the money Pfizer has spent so far to set up for and evaluate a potential split--$600 million over several years--D’Amelio noted that the investment lays the groundwork whether a split were to happen now or later: “[I]f we were to make a decision soon or sometime in the future, that work remains completed. We don't basically lose any of the work that we've completed to date.” And Read was careful to leave the door open in Monday’s statement. “We will continue to generate the financial information necessary to preserve our option to split our businesses,” he said, “should factors materially change at some point in the future.” As for upcoming M&A, Anderson points out that an entire range of Big Pharma and Big Biotech companies are shopping right now. "Pfizer is certainly not alone in looking for things to buy--many other companies claim to be doing the same," he said.

A tisket a tasket a Tesla option in my Basket

TESLA-SOLARCITY TIE-UP COULD BE DELAYED BY LAWSUITS Shareholder lawsuits could slow the closing of electric automaker Tesla’s planned $2.3 billion merger with solar-power company SolarCity, The Wall Street Journal’s Cassandra Sweet and Susan Pulliam report. Four investor lawsuits–two filed by individual shareholders and two by pension funds–claim that Tesla’s board failed to fulfill its fiduciary duties when considering the merger. Tesla Chief Executive Elon Musk is chairman of SolarCIty. The solar-power company has been trying to raise cash to keep operating on its own pending the merger by selling more solar panels for cash (rather than pursuing its traditional plan of leasing them out) and raising money from a hedge fund. It has also laid off employees and closed sales offices.