CEO Of Giant Corporation Tells US Government He's The Boss Of Them

Are We the People the boss of giant multinational corporations, or are they the boss of us?

Imagine, if you will, going to the IRS and saying, "I don't think the tax rate is fair so I'm not going to pay it." Regular Americans can't do that. But Apple just did.

Apple's CEO Tim Cook was interviewed by the Washington Post early this month. He was asked about the vast sums of profits that Apple has shifted into overseas tax havens thanks to a loophole in US tax law that lets them "defer" paying taxes on those profits as long as the money technically stays outside the country. Cook said (emphasis added, for emphasis):

And when we bring it back, we will pay 35 percent federal tax and then a weighted average across the states that we're in, which is about 5 percent, so think of it as 40 percent. We've said at 40 percent, we're not going to bring it back until there's a fair rate. There's no debate about it.

What would happen to any regular American if they did what Cook did, and said they they aren't going to pay taxes because they don't think the tax rate is "fair"? (Hint: Jail. And maybe 2 or 3 years added to the sentence for the contempt of saying, "There's no debate about it.")

But Apple is a huge multinational corporation, and these days huge multinational corporations are the boss of our Congress. So, CEO Cook gets away with it -- and with keeping $181 billion in tax havens to dodge paying $59 billion in taxes. Cook knows he can just come out and say they are not going to pay their taxes until there is a "fair rate."

Of course, huge multinational corporations will tell you a "fair rate" would be zero. Or better yet, how about We the People just bow down and pay taxes to them. The corporate tax rate used to be 50%. CEOs complained it was "unfair" so it was lowered to 35%. Also, by the way, Apple can deduct taxes it pays elsewhere, including to states, from its federal tax bill.

Think about what We the People could do with that $59 billion Apple owes us.

In all multinational corporations have more than $2.4 trillion stashed in tax havens, dodging maybe $700 billion in taxes.

Think about what We the People could do with that $700 or so billion they owe us.

Meanwhile

Americans for Tax Fairness released a new investigative report showing that Gilead Sciences exorbitantly priced hepatitis C medications -- price gouging ill American patients -- then shifted billions of dollars of the resulting profits to offshore tax havens to dodge taxes.

An August 21 news story in FORA, an Irish business publication, confirmed key findings of the report:

Company filings show that one of the firm's main Irish subsidiaries had revenues of $2 billion in 2012 and made a full-year profit of $1.3 billion but paid nothing to the Irish exchequer as the firm was tax resident in the Bahamas - where zero corporate taxes apply.

At the end of the year, after which the subsidiaries finances are not publicly accessible, the Irish subsidiary had accumulated profits of just under $7 billion.

The company also transferred the ownership of one of its most valuable money-makers, which it acquired for $11 billion, to a separate Irish subsidiary.

So, this company gouges sick Americans and shifts the profits out of the country to dodge taxes. Are We the People the boss of these giant corporations, or are they the boss of us? Whose government is this, anyway? Who is our economy for?

"The Little People Pay Taxes"

Times have changed. People and companies didn't used to get away with snubbing their nose at We the People, and doing things like dodging taxes.

In the 1980s Leona Helmsley was known as the "Hotel Queen." Helmsley and her husband Harry were known for buying apartment buildings, forcing out the tenants, and converting them into condominiums. The Helmsley real estate empire included the Empire State Building.

They also owned hotels. Leona ran as many as 30 Helmsley hotels, with the luxurious Helmsley Palace at the peak, and became famous after she was featured in advertisements.

But Helmsley became known as "the Queen of Mean," because she was notorious for doing things like abusing employees, firing them at Christmas, even evicting her son's widow a few days after he died. Eventually a dissatisfied employee turned her in for various tax crimes and she was indicted on 235 state and federal counts.

The Helmsleys were charged with using hotel money to buy personal items to evade income taxes. Helmsley famously said of the charges, "We don't pay taxes. Only the little people pay taxes."

We the Little People sentenced Helmsley to 12 years in jail for evading $1.7 million in taxes (eventually resulting in 19 months in jail and 2 years of home arrest.) At her sentencing the judge said:

'There is a community that needs to be served by the enforcement of the law. . . . It is my judgment the motion for sentence reduction should be denied.'

Griesa said that Helmsley's conduct had been 'deliberate, fraudulent, directed against the United States government. It involved evasion of taxes.'

Helmsley was sentenced to jail for evading a pittance of $1.7 million in taxes. Today Apple owes $59 billion. In this age of "mass incarceration" for regular people, imagine a wealthy Wall Street banker or corporate CEO going to jail for something. Actually, you can't even imagine it.

No, instead this is today's reality: Lawmakers Overseeing Wall Street Given Bigger, More Favorable Loans Than Others: Study.

Senator Wyden Says End Deferral Loophole

Some people are trying to restore our democracy, and make We the People the boss of the giant corporations and wealthy CEOs again.

Senator Bernie Sanders has been calling for ending this deferral loophole for a long time. His residential campaign platform called for using the resulting revenue to pay for $1 trillion of infrastructure repair. Senator Elizabeth Warren has also called for ending this loophole.

Last week Oregon Senator Ron Wyden penned an op-ed calling for an end to this corporate tax haven "deferral" loophole, titled "Ending the Biggest Tax Rip-Off -- Tax Deferral." In it Wyden wrote:

...[Tax deferral] is the rule that encourages American multinational corporations to keep their profits overseas instead of investing them here at home, and it does so by granting them $80 billion a year in tax breaks. This policy is as foolish as it is unfair. It simply defies common sense.

Most Americans probably aren't familiar with deferral ...but ... some of the most profitable companies in the world can put off paying taxes indefinitely while hardworking Americans must pay their taxes every year.

Unfortunately, Wyden resorts to offering to bargain with the corporations, offering lower tax rates if they would please invest in the US. Like so many others, Wyden has forgotten that Congress is supposed to be the boss of the corporations.

Sign The Petition

SIGN THE PETITION: Stand with Americans for Tax Fairness and Public Citizen and demand that U.S. Treasury Secretary Jack Lew investigate Gilead's multi-billion-dollar tax dodging scheme and make Gilead pay the taxes it owes U.S. taxpayers.

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This post originally appeared at Campaign for America's Future (CAF) at their Blog for OurFuture. I am a Fellow with CAF. Sign up here for the CAF daily summary and/or for the Progressive Breakfast.

Are Tesla Investors Getting A Raw Deal In SolarCity Merger?

On August 1, Tesla Motors, whose chief executive officer is Elon Musk, announced the acquisition of another Musk brainchild, SolarCity, a rooftop solar panel company for which he servers as chairman, in a $2.6-billion all-stock deal. “It’s really all part of solving the sustainable energy problem,” Musk said when the merger was announced. “That’s why we are all doing this — to accelerate the advent of a sustainable energy world.” Maybe, but was that the real reason for the merger?

Started in 2006 by Musk’s cousins Peter and Lyndon Rive at Musk’s suggestion, SolarCity had a simple plan: Lease solar panels to homeowners on a long-term basis but retain ownership of the panels, allowing the company to rake in hefty incentives from state and federal governments. At first, hyped by Musk, whose showmanship skills rival those of P.T. Barnum, SolarCity flourished. Its stock peaked in February 2014 at $85 a share. Investors who bought the initial public offering at $8 a share 14 months earlier were ecstatic.

But things changed dramatically. The first sure sign of trouble came in August 2015 when Jim Chanos of Kynikos Associates revealed he had shorted SolarCity because its business plan made it a “subprime financing company.” Later that year, SolarCity suffered another blow when the Nevada Public Utility Commission passed rules ending net metering, which allowed a homeowner with solar panels to sell unused electricity back to the power company. The decision prompted Lyndon Rive to admit that without net metering rooftop solar “makes no financial sense for a consumer.” If other states followed Nevada’s lead, SolarCity would be hit hard.

In early 2016, SolarCity stock was downgraded by Barclay’s, then JP Morgan. In May, CNBC’s Jim Cramer declared: “This is a company that I regard in a first-class crisis that acts as if everything is fine.” That same month, after the stock price had plunged more than 60 percent from its peak, Chanos became even more vocal in his criticism, saying, “They’re losing money on every installation and making it up on volume, and that’s a problem when you have a levered balance sheet.”

By June, there was talk of bankruptcy, so Musk had to act. The solution: Tesla, a company with a promising future, would buy SolarCity, a company in precipitous decline. Once again, Chanos warned of problems: “[SolarCity] is burning hundreds of millions in cash every quarter, a burden that now Tesla shareholders will have to bear, at a cost of over $8 billion.” Even so, the boards of directors of both companies approved the deal; now the shareholders of both companies must consent to the merger, a vote that will likely occur during the fourth quarter.

In the press, the deal has been described as more of a bailout than a purchase. Consider The Motley Fool’s commentary: “Maybe SolarCity was in need of a bailout more than investors thought. If that’s the case, it could be a terrible merger for Tesla if SolarCity was in such dire straits in the first place. [I]t could destroy a lot of shareholder value [at Tesla].” And this from The Los Angeles Times: “The deal has been fraught with criticism since it was first proposed….with critics calling the move a bailout.”

Tesla stockholders, then, know they are assuming SolarCity’s financial woes, but what else? For one thing, they may be inheriting regulatory liability. Over the last year or so, the Federal Trade Commission has received complaints from consumers about unscrupulous business practices carried out by solar panel companies. It has also been pressured by the United States Congress. “As a very new industry with a limited track record and little regulatory oversight,” a group of congressmen from Arizona and Texas wrote to the FTC, “the solar leasing market may pose a considerable risk to the increasingly large numbers of American consumers that commit to the leasing product (not to mention the American taxpayer, who heavily subsidizes each rooftop solar project).” As a result, the FTC recently announced its intention to expand its reach over the solar panel industry. Because SolarCity is the nation’s largest provider of solar panels, it is clearly in the FTC’s sites.

There will also be increased scrutiny of SolarCity on the state level. “The recent proliferation of new solar projects brings the potential for a new kind of deception,” Attorney General William Sorrell of Vermont has said, echoing a growing sentiment shared by attorneys general across the country. Indeed, six attorneys general have publicly expressed concerns about the solar industry’s unethical business procedures, among them predatory sales practices and providing consumers with inaccurate leasing information and false promises of lower energy bills. This could potentially lead to a class action case similar to the one filed by attorneys general against Big Tobacco in the 1990s. That would be devastating for an industry already bleeding money.

In short, SolarCity shareholders know what they’re getting with this merger — an unexpected bailout. Tesla shareholders are not so fortunate, and SolarCity’s bad balance sheet may be the least of what they have to deal with. 

A Call For Mylan CEO Heather Bresch To Reduce EpiPen Price And Resign

It was one year ago, August 25, 2015, when my one-year-old daughter Cecelia almost died of anaphylaxis. She had asked for a banana but we wanted her to eat more than just fruit. My wife served her a peanut butter substitute and jam on bread. We were cooking dinner for ourselves when we first saw the tell-tale red blotches and hives.

In thirty seconds, a rash of angry red hives had covered her body. She was uncomfortable but unaware of what was happening. There was a look of extreme fear in her eyes. Another minute passed and her airway began to close as her body fought the allergic reaction. I quickly laid my daughter down and plunged an EpiPen into her left thigh as my wife called 911. The symptoms continued to get worse as she struggled to breathe in my arms, before the epinephrine kicked in and she finally was able to open her throat enough to draw in air. Within ten minutes of the first signs of anaphylaxis, she was shaken but excited to see the emergency vehicles and the firemen who had come to save her.

A trip to the hospital confirmed that she had a near-fatal anaphylactic reaction. To what? We suspect it might have been sesame or sunflower ingredients in either the bread or the “safe” peanut butter substitute. We’ll never know for sure what almost took our daughter’s life.

This is the reality for the fifteen million people living with food allergies and their families. Cecelia has life threatening food allergies to milk, eggs, peanuts, tree nuts, shellfish, garlic, sesame, sunflower, coconut, and kiwi. She is two years old.

Mylan’s EpiPen saved her life just one year ago. I will forever be grateful for the people who have developed the life-saving drug and accompanying technology that are the reason that my daughter is alive and well today.

The EpiPen’s only legitimate U.S. competitor, Sanofi’s Auvi-Q, was voluntarily recalled nationwide in October 2015 after dangerous issues of inaccurate dosage delivery arose that could include a failure to administer the life-saving epinephrine. Immediately, millions of families with life threatening allergies turned to Mylan to secure EpiPens.

The result was a de facto monopoly for Mylan. Since Mylan secured the rights to the EpiPen in 2007, they have steadily raised prices over 460 percent (from an average wholesale of $56.64 to $317.82). CEO Heather Bresch – daughter of U.S. Senator Joe Manchin of West Virginia – increased her own compensation by more than 670 percent from $2.5M to $18.9M during the same time.

With no other competitors in the United States, families are forced to pay extortionate rates for what amounts to $1.00 worth of epinephrine per EpiPen.

I cringe every time I go to pick up Cecelia’s EpiPens at the pharmacy. To say this medicine is expensive is an understatement. Yet, we are lucky to have great insurance and have never had to think twice about paying whatever it costs to keep our daughter safe. This is our privilege.

Jim Bourg / Reuters

EpiPen auto-injection epinephrine pens manufactured by Mylan NV pharmaceutical company for use by severe allergy sufferers are seen in Washington, U.S. August 24, 2016.

I cannot stop thinking about the families of other children with food allergies – who love their children just as much as we love Cecelia – who are forced to go without this life-saving drug. Putting aside Mylan’s massive price hikes, there are families that go hungry and skip monthly bills just so they can provide safe food for their children with food allergies. These families cannot begin to consider paying for an EpiPen. Their children deserve to be just as safe as my children. They deserve to live healthy lives just as much as Heather Bresch’s four children do.

Heather Bresch has cut corners before. She received her first job at Mylan when her father, a West Virginia state senator at the time, personally reached out to Mylan’s then-CEO in 1992.  In 2008, West Virginia University’s president – a family friend and former business associate of Bresch – resigned in disgrace after granting the Mylan CEO an MBA, despite the fact that she had only achieved half of the required credits. 

I know that the world is not fair. I understand that rich children with powerful politicians for parents will continue to be born on second base thinking that they hit a double. I hold no illusions that large pharmaceutical companies will shift their primary focus from profits to public good. While all of this is true, Mylan’s reckless and selfish price hikes under CEO Heather Bresch have crossed a line that she cannot return from. 

Heather Bresch has enriched herself and her fellow Mylan executives at the risk of hard-working American families who are already saddled with great economic and health concerns. They don’t need or deserve a rich narcissist kicking them while they are down.

On behalf of these families and all families living with life-threatening allergies, I ask that Mylan CEO Heather Bresch immediately reduce the price of Mylan’s EpiPen and then resign as CEO. While Bresch may not worry about my family or the millions of others like us in this country, I hope she will consider her own family and the example that she is setting for her children. 

Top GOP Congressman Tells Trump To Release His Taxes

Donald Trump should release his tax returns and full medical records, Republican Chairman of the House Oversight Committee Jason Chaffetz (Utah) said Wednesday.

“You’re just going to have to do that, it’s too important,” Chaffetz said on CNN. “If you’re going to run and try to become the president of the United States, you’re going to have to open up your kimono and show everything, your tax returns, your medical records.”

Chaffetz said that the standard applies to both candidates. Clinton has released her 2015 tax return and medical history. Trump has only released a cursory, bombastic letter from his doctor.

Trump said in May that he hoped to release his tax returns, but has since refused to, saying he can’t because he’s under audit by the IRS. However, IRS Commissioner John Koskinen said that being under audit does not prevent a person from releasing returns. “If you’re being audited, and you want to do something else, share that information with your returns, you can do that,” Koskinen told CSPAN in February. 

In July, Trump’s then-campaign chairman was adamant that the Republican nominee would not release his tax returns. Earlier this week, Eric Trump said it would be “foolish” for his father to release his taxes. “You learn a lot more when you look at a person’s assets,” Eric said. “You know how many hotels we have around the world? You know how many golf courses we have around the world?”

The value of Trump’s assets, however, is not the simple matter Eric Trump implies it is. In his personal financial disclosure detailing those assets, Donald Trump says he is worth $10 billion. Bloomberg and Forbes, however, estimate his wealth at $2.9 billion and $4.5 billion, respectively. And Tim O’Brien wrote in his 2005 biography of Trump that “three people with direct knowledge of Donald’s finances, people who had worked closely with him for years, told me that they thought his net worth was somewhere between $150 million and $250 million.”

The New York Times reported last week that Trump’s debt totaled $650 million, about twice as much as the candidate had disclosed. The discrepancy, the Times said, arises from the fact that the financial disclosure forms for candidates are not designed for a person with business dealings as complex as Trump’s are.

Editor’s note: Donald Trump regularly incites political violence and is a serial liar, rampant xenophobe, racist, misogynist and birther who has repeatedly pledged to ban all Muslims — 1.6 billion members of an entire religion — from entering the U.S.

Arielle Answers: What Can I Do If My 401(k) Is Expensive?

Q: My company's 401(k) plan charges high administrative fees, and the expense ratios on the investments offered are too high. How do I maximize my retirement savings?

You know those GIFs of people wildly and aggressively clapping? That's me right now.

Not because your 401(k) is lousy, but because you know it's lousy. Over half of workers don't even realize that investing in their retirement plan comes at a cost, according to nonprofit The National Association of Retirement Plan Participants. Of those who do, only a quarter understand how the fees they're paying are calculated.

So let me start by saying this: Any readers who are thinking, "Wait, what?" please get out your plan statement or call your plan administrator, and get a handle on how much you're paying in fees and expenses. You can also run your plan through a 401(k) fee calculator. I'd do both; this is that important, and I'll let the money tell you why: The less you can pay in fees, the more money you will have at retirement. This chart shows how much various fees would cost a pretty typical 401(k) investor by retirement age. It's scary stuff.

These fees come from two directions: Administrative expenses -- over which you have little control, though some kind employers will cover the cost -- and investment expense ratios. Added up, it's not unheard of for the total cost to fall toward the right side of that chart, though the typical 401(k) participant pays a median 0.67%, according to 2013 data from the Investment Company Institute, a fund trade group. I'd consider your own plan expensive if you're paying more than 1%.

There's some misconception that the mutual funds in 401(k)s are by definition expensive; in fact, their asset-weighted average expense ratios are lower than the average for all mutual funds. But that doesn't mean the plan you're in will offer enough cheap options -- there's a reason we've recently seen a string of lawsuits against 401(k) providers. A 401(k) limits you to 20 or so investment options in the plan, so you might have only one fund choice for each investment category. If the expenses on those funds are high, you can't shop for a lower-cost fund; you're stuck with those choices. Smaller plans tend to be most expensive, as the administrative costs are spread among fewer people, and they don't have the leverage to bring down fund fees.

So what to do?

Expenses aside, get the match
I don't care if you're in the most expensive 401(k) plan in the world; until those fees reach the value of your employer's matching dollars -- and they never will -- the plan is well worth that cost. It's safe to assume you'd gladly pay $1 or $2 in fees to get $50 or $100 back from your employer.

That's essentially how an employer match works: Many companies kick in 50% or 100% of every dollar you contribute, up to a limit. Sure, it hurts when you lose a portion of your contribution -- and of that employer contribution -- to fees, but I've found that free money is pretty effective at stopping the burn.

To be clear, I'm not saying you have to suck it up. If you feel like your plan's fees are grossly unfair, you should: 1) Do what you can to keep your investment fees low, by choosing low-cost investments like index funds over expensive managed options like target-date funds, and 2) raise the issue with HR. If you rally enough of your co-workers, your company might be willing to shop around for better options.

»MORE: How a 1% fee could cost millennials $590,000 in retirement savings

Then take your money elsewhere
In the chart above, note that the investor is contributing enough to the plan to get the match, but no more. That's by design: You can -- and in many cases, especially if you're in an expensive plan, you should -- contribute to both a 401(k) and an IRA.

The way to go: Contribute until you get the full match, then put any additional money you can save for the year into an IRA, which has a contribution limit of $5,500 in 2016 (if you're 50 or older, you get to throw in another $1,000). If your 401(k) doesn't offer a match, skip it and start with the IRA. IRA account providers frequently charge no fees (assuming you're not working with a financial advisor) and give you access to a huge pool of investments; you can easily find low-cost funds.

»MORE: How to invest your IRA

And if you're lucky -- or let's say strategic -- enough to max out that IRA for the year, and you want to save more? Your 401(k), even if a total dud, is worth revisiting at that point, for one big reason: It has an $18,000 contribution limit ($24,000 if you're 50 or older), which makes it the single best way to get a lot of tax-deferred money put away for retirement.

Finally, if you leave this job, please take the balance in that plan with you by rolling it into an IRA (or into your new employer's plan, if it's a step up from the old one).

Arielle O'Shea is a staff writer at NerdWallet, a personal finance website. Email: aoshea@nerdwallet.com. Twitter: @arioshea.

Can Insurtech Make Miracles Happen in US Healthcare?

As an American and the de facto administrator of my family's health insurance, I am reminded routinely of some of the complexities of the methods we employ to maximize health and pay for care in this country. Forces are driving individuals, providers, insurers and employers to change their approaches or suffer the consequences.

InsurTech companies who take aim at the US health care industry by using software and data to improve efficiency and outcomes can benefit from this opportunity. Depending on whether you are an optimist or pessimist, the health care sector is the land of endless opportunity or unsolvable problems. Since the scale is huge, even small steps forward, aimed at opportunity pockets, can translate into significant wins.

Let's view the situation through four lenses: the health of the American people, marketplace trends, the role of regulation, and the players. You can unpack any one of these and understand why Venture Scanner has identified over $26BN in funding that is being poured into 1,300 health-technology companies across 21 categories and 48 countries. The issues and implications arising from any of these categories are intertwined, so even startups focusing on health insurers cannot disconnect from what is happening in the rest of the ecosystem. This post focuses on health insurance in the US, not the broader health care space or other geographies, because US is a) a massive market and b) a different structure from markets in Europe and Asia).

Americans, overall, do not live a healthy lifestyle

The United States came in last place in a 2013 ranking of affluent countries' health in a Mayo Clinic Proceedings study which included four factors in its definition of "healthy lifestyle": diet, exercise, weight and smoking.

Americans are getting fatter. Over one-third of the adult population is obese. Every single state has an obesity rate over 20%, adding an estimated $200BN to the national health care tab.

A piece of good news from the Centers for Disease Control is that the percent of adult smokers has dropped steadily from 42.4% in 1965 to 16.8% in 2014. The trend amongst students has been less stable, but generally downward, peaking at 36.4% in 1997 and dropping to 15.7% in 2013.

This is a huge and shifting marketplace

Consider just a few dimensions:

Healthcare spending represents 17.5% of the US Gross Domestic Product, $3.2 trillion, or about $10,000 per person. As the population ages, government spending in the sector is expected to increase. Also consider that 30% of Medicare dollars go towards the 5% of beneficiaries who become very ill and then die each year.

Employers are taking action to shift costs to employees, and slow down spending. Employers provide coverage to 150MM Americans. And, according to the 2015 Kaiser Family Foundation total average annual premium per employee has increased from $5,791 to $17,545 since 1999. Employees are being asked to pay more, or to avoid doing so by trading down to high deductible plans. This creates near-term savings back to healthy families who don't run into any medical surprises. What is rarely highlighted, however, is how many families are effectively assuming the financial risk of facing a large deductible in the event of, say, an unanticipated hospitalization. Since 62% of Americans have less than $1000 in savings and 21% have no savings, the potential is real for individual families to face serious financial consequences as a result of this choice.

Only one in seven Americans understand the insurance plans selected yet are held increasingly responsible to manage decisions that could have implications not only for cost, but also for quality of life.

Insurance carriers have benefited from ACA (Affordable Care Act aka Obama care, formally named the Patient Protection and Affordable Care Act) because of how the statute has expanded the market and provided premium subsidies for lower-income households. At the same time, insurance companies remain the least trusted of the health care subsectors.

Regulations focus on changing behavior, protecting patient data, and stimulating innovation

ACA, signed into law in 2010 and upheld by the Supreme Court in 2012, is watershed legislation that set the sector up for reinvention. ACA takes both a carrot and stick approach to increase coverage and care effectiveness while lowering costs, e.g.,

• If as a user you don't purchase coverage, you face penalties.
• If as an employer of 50+ people you don't offer coverage, you face penalties.
• Health care providers are being incentivized to make 'meaningful use' of electronic health records to create efficiencies and improve care decisions, and face penalties if they fail to use such tools
• Primary care providers and general surgeons are being incentivized to move to low-coverage geographies.

These are just a few examples of how ACA is attempting to get people to change how they select, use and administer health care payments and services.

Two other regulations impact Health Insurers:

• The Health Information Privacy and Protection Act, better known as HIPAA, the privacy, portability and security rule designed to protect patient health information, while improving data portability. HIPAA impacts how data is stored, protected, used and transferred.
• The HITECH Act (Health Information Technology for Economic and Clinical Health) was enacted to support the development of a nationwide health IT infrastructure, as well as define and maintain standards for health information technology products and how they interact with each other.

Any health care player -- incumbent, startup, or investor -- must understand how the regulations work

For those who question the likelihood that ACA is repealed, consider that while this year's election suggests anything can happen in politics, keep in mind that there have been over 50 failed attempts by Republicans in Congress to undo the legislation. So, better to understand how the incentives and disincentives relate to any potential new business model, and appreciate how big a departure ACA's core principles are from the traditional way in which the US health care system has operated. The latter is vital to understand the dynamics of the new playing field and how individuals, providers, insurers and employers are responding.

The winning business models will be those that:

• Link to the regulatory levers - carrots and sticks for individuals and providers - and move them. This is where the commercial value lies.
• Prove they can deliver better outcomes at lower cost.
• Demonstrate potential to scale, by itself, via B2B partnerships, or via exit to a scale incumbent.
• Have a viable basis for underwriting and risk management.

Success will be a function of software + data + tactical knowledge of the levers - both the regulations and how to motivate behavioral change where people are being asked to make radical changes.

Amy Radin partners with people who want to transform and grow businesses, bringing a combination of insight, vision, and pragmatism to realize the opportunities arising from change. She links marketing, big data, client experience and digital technologies for impact. Amy serves on Advisory Boards, is an angel investor, keynote speaker, author and consultant. She works with companies from startups to Fortune 500 applying her Framework for New Growth (c) to help companies attract new clients and expand client relationships.

This post was originally published in Daily Fintech and is syndicated in Amy's columns which also appear on LinkedIn, Insurance Thought Leadership, and Medium.

photo credit: Clever Cogs! via photopin (license)

11 Brilliant Pieces of Business Wisdom I Learned From My Dad

What is the best advice your father ever gave you? originally appeared on Quora - the knowledge sharing network where compelling questions are answered by people with unique insights.

Answer by David S. Rose, angel investor, father of three, on Quora:

It is safe to say that my father has been, by far, the most important influence on my life as an entrepreneur. Back in the days of the dotcom boom, when I was in my 30s, I was delighted to be named a finalist for the prestigious Ernst & Young "Entrepreneur of the Year" Award in New York. It was no surprise at all; however, when my father actually won the award just a few years ago, he was in his late 70s!

For as far back as I can remember, my father has served as my primary role model, showing by example the importance of impeccable integrity, hard work and dedication, creative business thinking, and the need for maintaining a long-term perspective. Today, in his mid-80s, he is as energetic and engaged in the entrepreneurial life as anyone I know, creating new business and social ventures and mentoring yet another generation of entrepreneurs.

While my siblings and I have had the privilege of growing up under his direct tutelage, many other people have had the benefit of his distilled life experience, because one thing he is not shy about is sharing advice. Indeed, his seemingly endless store of one-line advisories has served as the soundtrack for the lives of his children, his grandchildren, his employees, his protégés, and anyone who has ever come within his orbit. Here is a selection of his timeless advice for entrepreneurs; some original, others relayed from heroes of his such as Twain, Churchill, Plato, Shakespeare, Santayana, and Montaigne, as well as his own father and brothers:

You can get anything done if you're willing to give away the credit. This was driven home to me when I was a teenager. I watched from a ring-side seat as he single-handedly conceived, implemented, and succeeded at pulling off a brilliant, entrepreneurial, off-the-wall solution to a problem that saved an otherwise-doomed $100 million project. But at the ribbon cutting ceremony, a dozen other people, including the mayor, were showered with credit while my father's name was not even mentioned. I was absolutely devastated, but he was quietly and calmly proud, pointing out that...

Plato's definition of "beauty" is "fitness to the end in view." ...And his end game had been to save the project, not be honored by the mayor. The moral of this is to have a clear idea of what you are trying to do, and then focus on getting that done. In many ways this is a precursor of the Lean Methodology concept of the Minimum Viable Product: don't be distracted by surface appearances or unnecessary features; start by solving the immediate problem with a "beautiful" solution.

Your actions shout so loud I can't hear what you're saying. One of his many admonishments on the subject of integrity, the point is that one can talk a good game, but at the end of the day it is what you do, and only what you do, that actually counts. Integrity means practicing what you preach, saying what you mean, and living up to your promises and exhortations with your own actions.

You only get one chance to make a first impression. He first told me this in seventh grade when I moved to a new school, and I have come to realize how important (even though it seems ridiculously obvious) this is in virtually every business environment. When people meet you for the first time, whether investors, customers, or potential partners, you are in control of what they begin to think of you. Once that first impression has clicked, it is damnably difficult to get people to change their mind. This is now a standard part of my presentation training seminars for entrepreneurs, because in a venture pitch your target investor will likely start making up his or her mind about your opportunity before you are two or three minutes into the presentation.

Negotiate iron-clad contracts ... and then put them in a drawer and forget them. I have relied on this one virtually every day of my entrepreneurial and investing career, and preach this to all of my own protégés. My father is one of the sharpest businesspeople I have ever met, but also the straightest shooter. He stresses over and over how critical it is to ensure that the underlying paperwork in any deal is in your favor and gives you negotiating leverage when the chips are down, but then points out that "with great power comes great responsibility," and you will always do much better by using the power to dictate fair terms for everyone rather than taking advantage for yourself.

Trust everyone, but cut the cards. The corollary, from Finley Peter Dunne, suggests going into every discussion and negotiation assuming good intentions on everyone's part, but not being naïve about it. In my own entrepreneurial career I've taken this even one step further. My corporate motto has always been "everyone gets one chance to screw us," because if I limit my exposure on the first interaction, it will be the cheapest money I ever spend to find out who plays fair and who doesn't.

It's one thing to piss on my back, but don't try to tell me I'm sweating. This one comes from an old-time construction superintendent with whom my father himself apprenticed, and it again boils down to honesty and integrity. Whatever you do (or whatever someone else does to you) should be done clearly and with no obfuscation. Own your actions, and don't try to fool yourself or anyone else with false rationalizations. (As in "it's perfectly ok to pirate music and movies against the express wishes of the copyright owner, because I'm actually helping them by giving them added exposure...").

Every tub should sit on its own bottom. That is, examine each action or relationship independently, and don't mix yourself up by conflating unrelated activities. For example, if you are considering taking in a strategic investment, analyze the equity investment independently as one piece, and the strategic contract as a separate one. Similarly, when considering a problem, break it down into the smallest possible components and figure out how to solve each one on its own. Quite often a seemingly intractable problem can be handled with two or three simple actions.

Nice guys don't always finish first, but you should act as if they do. History has shown that bad things happen to good people, and if one runs around maintaining "nice guys always finish first", you will (a) be disappointed, and (b) convince people that you're hopelessly naïve. But the fact is that if the "nice" is combined with other characteristics such as "effective", "smart", and "hardworking", nice guys often do finish first, and have an easier time and more support from those around them.

If three people tell you you're drunk, lie down anyway. Mark Twain's advice about having a decent respect for the opinions of others is something that I remind myself about nearly every day. Entrepreneurs are almost universally convinced that they are bearing the Word of God, and that anyone who disagrees with them must therefore be either an idiot or invincibly ignorant. I am certainly no exception to this belief, but after nearly four decades in business I have come to realize how true Twain's words ring. While it is critical for entrepreneurs to have faith in their own visions, it is equally critical to listen to what the market and other smart people are saying. Coachability, flexibility, and a willingness to listen to (if not heed) good advice are some of the key things that I look for an as an investor.

Happiness is the exercise of one's vital powers along lines of excellence. Last but not least, George Santayana's perceptive view of personal fulfillment (what Abraham Maslow discussed as "self actualization") pre-dated by decades the concept of "flow". Exercising my 'vital powers' as an entrepreneur, an investor and a mentor makes me one of the happiest people I know, just as it has for my life role model.

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