Almost exactly two years have gone by since I posted
about the Medical Devices Tax (Obamacare, Jobs, and Global Competitiveness,
November 22, 2011). In that post I worried about the negative impacts of the
new tax on US employment. Two years later there is evidence that the worries
were well founded even though the tax has not yet begun to bite. Since Congress
may have the chance to save the day for the Medical Device Tax yet in 2013 and
since there are some who would not repeal this part of Obamacare, I thought I
would wade into this topic one more time.
This time I am spouting about an article
written by Kent Gardner, chief economist for the Center for Governmental
Research (Rochester Business Journal,
November 15, 2013). Gardner alleges that
“Joint replacement earns a whopping profit for the implant
manufacturers and a very good living for the surgeons and hospitals involved.
And private insurers, Medicare, Medicaid and the Veterans Administration pay
most of the bills.” He thinks these firms are doing just fine and uses three
arguments to explain why the tax won’t have negative effects”:
1. These firms are cartels and therefore medical device firms won’t pass the tax along to higher prices
2.
The tax will not cause US jobs to go
overseas
3.
The tax will not cause any reductions
in innovation and competitiveness
So let’s take a closer look at Gardner’s arguments. He says
medical device firms are like cartel members. Wikipedia offers this definition
of a cartel,
a
formal (explicit) "agreement" among competing firms.
It is a formal organization of producers and manufacturers that agree to fix
prices, marketing, and production.[1] Cartels usually occur in an oligopolistic
industry, where the number of sellers
is small (usually because barriers to entry, most notably start-up costs, are
high) and the products being traded are usually homogeneous.
Implicit in this
definition is that the cartel brings the members high or excessive profits.
So
Gardner is wrong on a lot of counts. First, there is no formal agreement among
medical devices companies as there is in OPEC. Second, if there is an informal
agreement to do all this bad stuff, then this is against the law – and these
guys must be pretty good to have eluded the regulators for so long.
Third, these companies
are not homogeneous. There is a relatively large number of medical device companies,
and there is plenty of entry and exit, especially among the smaller innovative
firms. . While there might be small numbers of companies in very specific
segments of the industry, this is what one should expect when advanced science
is behind specialization, continuous invention, and innovation. A company that
leads in a particular kind of product, for example, may enjoy a monopoly
position for a little while. But this is also true for cellular phones and many
other electronic products – do we want to put additional taxes on Apple and
Samsung because they lead their industry? Probably not. A small number of firms
doing everything they can to take leadership is good for product price and
quality and, of course, the consumer. Think Nokia if you want evidence that even a
small number of firms can produce real competition.
Fourth, most of
the data I am finding does not support the notion that these companies are
making obscene or even risqué profits. I looked at rankings of profit measures
by industry –published by Yahoo Finance and a consulting company, Analyxit .
These rankings generally show that the Healthcare and Medical Devices sectors
make very reasonable net profits as a percentage of revenue. For example Yahoo
Finance found Medical Devices had a net profit ratio of about 13%, ranking it
42nd among industries. In contrast Finance sectors had returns
ranging from 36% to 81%. The return on
equity ranking showed Medical Devices at 14% with a ranking of 82nd.
Analyxit ranked Healthcare, including Medical Devices, as eighth among nine
sectors based on net profits as a percentage of revenue. Again financial
companies led the list with returns averaging 17%. Healthcare’s percentage was
4%. In the middle of the pack were utility companies with a ratio of 8%.
Gardner says these firms will not pass the
extra cost of the tax onto consumers. He reasons… “When firms hold significant market power – as they do in
this industry – the connection between cost and price has been weakened. Price
is largely driven by demand factors, not cost: Monopolists already charge what
the market will bear.” Gardner’s argument flies in the face of what we teach
freshmen in economics every year. Market power translates into an inelastic
demand curve -- which means that firms without much competition do not have to
worry much about losing customers when they increase prices – and would as a
matter of fact pass the extra costs caused by the tax into higher prices.
I
would agree that these firms will eat the tax as a reduction in profits and not
pass the cost along to medical consumers in the short-run. But this is not
because these firms have market power. The main reason that profits will fall
is that medical device manufacturers have long term contracts with hospitals
and other health providers and cannot easily increase revenues to offset rising
costs from the new tax. Won’t these firms
benefit from a tidal wave of new enrollees in Obamacare? Probably not. Many of
the newly insured will be younger and not require medical devices like new hips
and knees.
What I showed two
years ago is that while a 2.3% tax on revenue sounds trivial, the result is
that the tax is a much larger percent of a company’s profits. While some people
think profit is a dirty word, the fact is that profits are used to invest in
research, product development, safety, and other critical outlays that invent
and improve products. The more the government takes of these profits the less
is available for increasing product quality and being competitive. Large
for-profit firms are already seeking foreign locations and will be followed by
private companies. And the negative impact on smaller entrepreneurial firms is
disproportionate because in the early years a company often makes small or no profits
despite having rising revenues. The upshot is that a 2.3% revenue tax will mean
business losses and an end to these small businesses. Inasmuch, the bigger
firms will gobble their assets and this will lead to less, not more,
competition. A correlated worry is that all these firms will turn away from
devices that cannot promise immediate returns or serve smaller markets. This
bodes ill for future important improvements in the device industry.
But aren’t corporate
taxes low? The answer is that despite some loopholes, US corporate income taxes
are among the highest in the world. Domestic companies are already reducing
employment and globalization means many are seeking production and market opportunities
globally. The medical device news is full of stories about layoffs and new
joint ventures, both domestic and foreign. Combining a high corporate tax with
another 10-30% of income going to a medical device tax makes it more desirable for medical devices companies
to find locations and markets where better profits can be made. China, India, Ireland,
Costa Rica, Singapore and a growing list of countries are quite willing to
compete on corporate profits as a way of winning production as well as R&D
facilities.
The upshot is that
this tax is not good for US employment nor US-based innovation and
competitiveness. The US should be happy to have the world’s leading medical
device companies and it should be fighting to keep it that way. Worse yet is
the misleading contention that this tax increase will break up this medical
devices cartel and lead to more competition. It will do just the opposite as
large US companies get larger by combining with suppliers and competitors – and
as they move more and more operations abroad.








