Perspective Unlimited

Thursday, February 28, 2008

The Pressures of Excessive Do-Goodness

Even though this year's budget contains many giveaways, there are the predictable complaints that it has not done enough - not enough for the poor, not enough for the middle class, not enough for businesses. The responses from some office holders are also quite predictable. Singapore Angle has two rather good discussions about the budget debate (here and here).

There are always some good causes that the government should spend money on, but has not. There are always some arguments for the government to intervene in the market. There is always pressure for the government to do more. But let me pick on one specific episode in this post. The background to this post is as follows.

Hospital for the Rich

Parkway won the tender to build a hospital at a Novena site. Anyone who has been to the site will know that it is a rather small and narrow site. Parkway bid more than a billion dollars for the land and its share price actually dipped since analysts felt that the company has overpaid. The company later revealed that it had put in a high bid because it had wanted to build a A-class only private hospital. On the face of it, it was a fairly straightforward tendering process, but it prompted Dr Huang's criticism of Parkway's business plans and the tendering process (here).

I believe Dr Huang had written the letter with good intentions. However, good intention itself is hardly a sufficient condition for good public policies, or indeed, raison d'etre for government intervention. Before a policy-maker decides to intervene in the market, this is the number one question he has to answer: where is the market failure?*

Why the Government should not Intervene

A a healthcare provider in the marketplace, Parkway is in a better position than any bureaucrat to understand where the demand is. There is really no compelling reason for the government to dictate to a private company how many class-A or class-B wards it should have. Where does the state end and the market begins? Should the government ban luxury apartments since they are large and ostentatious? Should the government ban first-class air travel because only the rich can afford it? Enough of poor analogies already, I am sure you catch my drift.

Secondly, Novena area is beginning to feel like a prime location - the surrounding condominiums are easily trading above $1000 psf. To have class-C wards there is insane from the opportunity cost perspective**. Good healthcare can be provided to the lower-income group irrespective of location. There is really no need to build a class-C hospital smack in the middle of downtown to show that we are taking care of our poor. It is far better to locate class-C wards on cheaper sites in the heartlands, and also where the need is.

Thirdly, the use of the land is not free - Parkway is not pocketing private profits at the expense of the public. A billion dollars flow into state coffer as a result, money that can be transferred to the poor. If the land had come with strings to build a certain number of lower-class wards, Parkway would obviously have bid a lot less for the land. What is the outcome then? The consumer surplus at the high end market is not captured, and there can be no transfers to the lower-income group as a result. From this perspective, the restrictions proposed by Dr Huang - well intentioned as they are - would in fact be detrimental to the interest of the public.

Common Misery

I could go on and on to rebut the letter from Dr Huang but that is really not the intention of this post. We live in a market economy - despite its many shortcomings, the market economy has proven over the past two centuries to be able to generate the most amount of wealth for the greatest number of people. As Churchill once said, "The inherent vice of capitalism is the unequal sharing of blessings; the inherent virtue of socialism is the equal sharing of miseries". We must not let our good intentions create policy misery for every one.


* Even if the government can pin down the source of market failure, it is still not a sufficient basis for intervention. The government must ensure that its actions do remedy the failure without imposing even more cost the society!

** TTSH and the CDC were built there before that area became expensive.

50 Comments:

  • I have no misgivings about the benefits of market economy and capitalism. But that does not directly translate to better provision of health care or equal distribution of health care resources.

    Black's Report (Sir Douglas Black 1977) has demonstrated the unequal distribution of the burden of disease between social classes, which is further aggravated by a capitalistic approach in management of health care resources (eg. health care cost and spendings). For the professionals, those of higher social strata, whom possess better health, would be at a position of acquiring more health care resources thus benefiting from it. On the other hand, depriving the rest.

    Moreover, a market controlled health care sector in the USA is deem dysfunctional, requires more input per capital while delivering poorer outcomes. (http://jama.ama-assn.org/cgi/content/short
    /295/17/2037)

    If both the Black's Report and medical journal from JAMA are true, they would refute the basis of the argument for an absolute free market economy involving the health sector in Singapore.

    Is there no place for privatised health care? In my humble opinion, there still is. The Scandinavians and most european countries have shown that privatised health care does provide a efficient supplementary service in conjunction to a developed public-funded(government regulated) health care system.

    Further reading:
    http://www.commonwealthfund.org/usr_doc/
    1027_Davis_mirror_mirror_international_update_final
    .pdf?section=4039

    By Anonymous Scylla & Charybdis, at 1:57 am  

  • I completely agree with you that there is a role for both private healthcare provider and also for public healthcare and some degree of government intervention in the healthcare market. But that is not at all the point here.

    The point here is the manner of intervention: whether the government should in fact intervene in a land tender process in a prime and expensive area – to chain the private healthcare company with regulatory strings that it must provide xxx number of lower class bed? It is really quite clear that there are far better ways that the government can intervene to ensure that the lower income groups get access to good quality healthcare.

    By Blogger Bart JP, at 5:17 am  

  • I have seen NUH and TTSH. I want the likes of Khaw be as far away and to have as little influence as possible on private hospitals pls. More private hospitals means more beds and more competition means the middle-class like moi can actually afford decent\quality healthcare when the need arises.

    "The road to hell is paved with good intentions."

    I really prefer the government (by definition not the most efficient) to do as little and as cheaply (in in taxes) as possible. danke.

    NoName

    By Anonymous Anonymous, at 3:11 pm  

  • Bart,

    Have you heard that the direct SIA flights to USA from Singapore has enough demand from Business class passengers, they elimiated the economy class. Now that is the way to maximise profits.

    The Parkway bid is a small matter. It is just a small plot of prime land and a small part of our medical industry. Imagine one day if we attract enough rich middle eastern to get rid of our class "C" & public hospitals to maximise profits. ...I don't think we will get there because the PAP still has a socialist heart.

    The US economy looks like it is going sink into a mess. What's the take of economists in LSE? ...any insight beyond the dooms day scenarios that we won't be getting out of this one without getting bruised and battered....?

    What's your take?

    By Blogger LuckySingaporean, at 11:05 am  

  • Wherever possible, market forces and competition drive economic outcomes. Visiting Disneyland in LA is not a necessity, even if you must go, there are so many flights available. There is really no case to force SIA to provide direct economy class flights. Let the firms decide.

    I have said for some months already, get out of the stockmarket - I made that call when STI was rallying above 3600 points back in Jul/Aug 07.

    Property is really unlike other assets, it affect so many people, so many lives. Credit card debts looming on the horizon, inflation picking up, geopolitical threats rising everywhere.

    I fear not a sharp contraction in the US. What I fear is Japan II - the slow unwinding, a prolonged period of agonisingly low, sub-par growth, forever teetering on the edge of a recession.

    By Blogger Bart JP, at 2:34 pm  

  • If US becomes Japan II, what would be the best investment?

    You reckon it is going to be worse than the 80s recession and the oil-shock of the 70s?

    NoName

    By Anonymous Anonymous, at 2:31 am  

  • Bart,

    ::: I made that call when STI was rallying above 3600 points back in Jul/Aug 07.::::

    Thanks for reminding me for the 3rd time of your wisdom. When the STI touch 2800 - I had to refrain from using certain words....

    :::, even if you must go, there are so many flights available:::
    No problem as long as there are other comfortable ways. That is why I said the Parkway thing is just a small thing as it is only a small part of our healthcare system.

    :::I fear not a sharp contraction in the US. What I fear is Japan II - the slow unwinding, a prolonged:::

    Ah ha...death by a thousand cuts...slowly die. The worst death. I said I'm starting to feel sorry for Americans.

    By Blogger LuckySingaporean, at 3:40 am  

  • Honestly, I am an amateur investor. For a small investor, it is easier to make money on the up, far more difficult to make money on the down (we cannot borrow scripts for example).

    I think for survive the recession, the usual rules probably apply: blue chip, high dividend, stable industries, growing economies. But really, I am also quite lost for direction at moment.

    By Blogger Bart JP, at 2:44 pm  

  • Bart,

    I was counting on the market to be efficient so that I can just buy assets that are properly priced and keep them for the long term.

    What we are seeing in recent weeks/months is the financial markets manufacturing their own bad news. The fear led to mispricing of mortgage backed securities which led to margin calls for financial companies which led to assets being dumped, which depresses prices even more ...causing even more fear.

    I'm glad the Fed stepped in to knock some senses into the market yesterday night. Once the fear goes away, things become more "normal". It is okay for markets to move up or down but the continuous pounding of past 2 weeks was hardly "normal"...it was causing a loss of confidence that might worsen the real economy.

    At this point, I don't think any investor is still holding out for the US to avoid a recession. Stock markets bottom during a recession before a recovery is apparent.

    I was thinking about Japan II. If the US economy goes into a long shallow downturn wouldn't the emerging markets, the BRICs be able to compensate with their high growth. One economist was saying the US is just a giant consumer who cares if it goes down, it is easy to replace, all we need is to get the rest of the world to learn to borrow money and spend more. Decoupling in the works?

    By Blogger LuckySingaporean, at 12:13 am  

  • Decoupling of the real economy may still be possible in our lifetimes.

    Decoupling of stock markets?
    Only when the insiders(otherwise known as market forces) decides to introduce better regulations to level the playing fields. When pigs fly. haha.

    PS: Looks like another bad day in asia. so Bart, we already know that u were rite. So any practical advice as in which asset class will survive Japan II?

    Private hospitals?

    NoName

    By Anonymous Anonymous, at 8:19 am  

  • I don't have the faintest clue how this housing mess in the US will resolve, but the smart money is now on the chindia growth story. They might just rescue the world.

    By Blogger Bart JP, at 2:03 pm  

  • SSE is sadly tanking.

    Good news?
    http://www.telegraph.co.uk/money/main.jhtml?xml=/money/2008/03/13/bcnpaulson11.xml

    sadly -> http://suddendebt.blogspot.com/2008/03/snake-eyes-you-lose.html

    NoName

    By Anonymous Anonymous, at 9:50 am  

  • NoName,

    The A-shares on SSE are tanking simply because they are grossly overvalued.

    In 1993-1996, the Singapore economy grew strongly but stocks peaked in early 1994.

    There are 2 reasons for stocks to tank - over valuation & unanticipated economic slowdown.

    I wrote about the relative strength of the DOW which to date despite the severe crisis is down something like only 17%(?) from the all time high despite certain recession faced by the US economy. The reason is the DOW never became overvalued during the multi-year bull run and the balance sheet of Dow components less the financial companies are solid. It might drop to 11,000 or below nobody can say for sure but so far it has been resilient ...given the US is the center of this crisis, it is quite amazing.

    In the case of the SSE, they were valued at P/E of 30-40, even with the correction, it is down to more reasonable levels of 20-30. This is the P/E level of the STI in our 1993 superbull peak...so SSE might have some distance down...!! But the Chinese govt might softland this until earnings catch up with price.

    As for the STI, our blue chips are now the cheapest in Asia. We are trading at P/E of 10. I'm just waiting for single digits P/E for our blue chips to buy. I'm just watching on high yielding REITs and really undervalued mid-caps.

    Stock prices don't trade in a vacuum. At the end of the day as a long term investor, you're buying part of a business. This business might be adversely affected by the US economy and the current crisis but still it has to have an value and a price which it make sense to buy. Perhaps DBS at $12-15...?...During the Asian Crisis I bought DBS at $5(? some single digit price). It is crisis that distort prices, without crisis you don't get this type of price...you don't get this type of fear and you type of opportunity.
    There might be worse days to come in this whole mess, if anything it looks bigger than the Asian crisis. ..but when the time comes don't be overwhelmed by fear.

    By Blogger LuckySingaporean, at 8:50 am  

  • I mentioned SSE cos many are hoping that chindia will come to the rescue. Working with the chinese on a daily basis ... i am not so sure :-p

    When I was really young I mistook pure luck for genius. Then came 1997 which was a rather expensive lesson. The Asian Crisis + SARS helped paid for my humble apartment with some to spare.

    I exited partially at 3800 and went back in at 3000-3200 thinking myself an old hand ... *ouch* there goes my profit for 2006-7.

    (you know there was this experiment where stocks rise 60% of the time and almost every1 still lost $$$)

    This crisis, however, is by far the scariest. Mainly cos I am in my mid thirties now ... old man and not yet financially secure. One retrenchment and its the white collar version of wiping tables till i retire :-S

    Hi Bart

    sorry to hijack ur thread but no post on Bear Stearns?

    NoName

    By Anonymous Anonymous, at 3:46 pm  

  • Hi Noname,

    I find myself agreeing with many things Lucky said, I think the time to buy will come soon. No, nothing to say about Bear Sterns. Your recommendation Suddendebt is much better than me at tracking the US economy. I better keep my mouth to the local one.

    By Blogger Bart JP, at 10:51 pm  

  • Bart,

    Why no update? Busy with thesis?

    You okay?

    By Blogger LuckySingaporean, at 1:26 am  

  • Thanks Lucky, yes, busy. But back at work, so not fair if I comment on economy and other issues anymore. But me still reading your pearls of wisdom.

    By Blogger Bart JP, at 2:56 am  

  • hi mate, this is the canadin pharmacy you asked me about: the link

    By Blogger bernard n. shull, at 4:01 pm  

  • Bear Stearns gone.
    Lehman gone.
    ML gone.

    Do you still believe in the free market and "trickle down benefits"?

    NoName

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