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Will ResMed’s share price continue to rise long-term?

ResMed (ASX:RMD) is an Aussie-grown international success story. Now based in San Diego, it’s the world leader in the Sleep Disordered Breathing market,…

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ResMed (ASX:RMD) is an Aussie-grown international success story. Now based in San Diego, it’s the world leader in the Sleep Disordered Breathing market, providing devices for treating sleep apnea, chronic obstructive pulmonary disease, and other respiratory conditions. RMD’s share price has grown a whopping 3,800 per cent since listing in 1999, and we’re confident there’s more growth to come.

Sean, Alan and Daniel from Australian Eagle Asset Management have a long history of investing in ResMed. Their current positive view dates back to 2008 and is the result of the change in its growth trajectory following the rectification of a product recall and growth in home testing of Sleep Disordered Breathing (SDB) as well as new mask releases. Fast forward to today and ResMed has cemented itself as the world leader in the still-growing SDB treatment market, and in Connected Health Software as a Service (SaaS). 

In 2016, ResMed began acquiring digital health assets including Brightree for US$800 million, and out-of-hospital software platforms such as Propeller Health. These acquisitions are integrated to form ResMed’s Connected Health SaaS (Software as a Service) division, which has been instrumental in building a healthcare ecosystem and in creating cross-selling opportunities for both the Connected Health division and the existing SDB products business.

Aside from the build-out of the health ecosystem, the last 2.5 years have been an interesting time for ResMed. The company was one of the ventilator suppliers contracted by the U.S. government for COVID-19 patients in hospitals during the height of the pandemic, thereby providing a temporary boost to revenue. As the COVID-19 ventilator tailwind started to subside in June 2021, one of ResMed’s main competitors in SDB, Philips, issued an urgent product recall. This promoted ResMed as the most reliable CPAP flow generator provider in the world. 

The attributes built by management over the past decade, along with a consistently growing core SDB market that has links to the growing obesity rates in the western world, support above-average earnings growth for the medium term as well as a wide and growing competitive advantage. 

The Montgomery Funds own shares in ResMed. This article was prepared 21 November 2022 with the information we have today, and our view may change. It does not constitute formal advice or professional investment advice. If you wish to trade ResMed you should seek financial advice.

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International

Call For Investigation Into Mortality Rates As Australia Sees Death-Rate Spike

Call For Investigation Into Mortality Rates As Australia Sees Death-Rate Spike

Authored by Victoria Kelly-Clark via The Epoch Times,

Australia has…

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Call For Investigation Into Mortality Rates As Australia Sees Death-Rate Spike

Authored by Victoria Kelly-Clark via The Epoch Times,

Australia has seen a spike in its mortality rates in 2022, with the Australian Bureau of Statistics (ABS) stating that by the end of August 2022, 128,797 deaths had been registered, which is 18,671 deaths, or 17 percent, more than the historical average.

In the data release on Nov. 25, the ABS noted that of registered deaths; there had been a rise in the number of Australians dying from dementia (18.9 percent above the baseline average), diabetes (20.8 percent higher than the baseline average), cancer, and COVID-19.

Karen Cutter, a spokesperson for the Actuaries Institute of Australia (AIA) said in a media release (pdf) that even after the Institute’s COVID-19 Mortality Working Group removed all “from” and “with” COVID-19 deaths, it was not clear why Australians were dying in larger numbers from other diseases such as ischaemic heart disease, cancer, and cerebrovascular disease in 2021 and 2022.

In an analysis (pdf) from Nov. 3, the AIA noted that 1,200 more Australians had died from ischaemic heart disease than expected, while cerebrovascular disease had 450 more deaths than normal. Meanwhile, mortality rates from diabetes increased by 400 deaths, and dementia saw an extra 800 deaths.

According to the ABS, between January and August this year, 7,727 Australians died from COVID-19.

“It is not clear what might be driving this, although we expect that at least part of the excess will be in respect of people who otherwise may have succumbed to respiratory disease in 2020 and 2021,” said Cutter.

They also said that diabetes deaths have generally been higher than expected throughout the pandemic.

Cutter noted that the AIA had also noticed that of the excess deaths in the 0-44 and 45-64 age bands were small, and the number of women dying was higher than expected.

She has called on the federal government to launch an inquiry into the cause of the spike.

“The differences are worth investigation, although the small numbers mean that there is considerable natural variation,” she said.

Spiking Mortality Rates a Global Phenomenon

The spike in mortality rates is being experienced globally, with the UK’s Chief Medical Officer, Sir Chris Whitty, as well as Sir Patrick Vallance, the country’s Chief Scientific Adviser, declaring the country is facing a “prolonged period” of excess deaths after people differed treatment during the initial stages of the pandemic.

Meanwhile, the UK’s health secretary Steve Barclay said that the government needed to come clean about the excess deaths.

In a speech to the Spectator Health Summit in London on Nov. 28, Barclay said that the government must share the scale of the COVID backlog, which he estimated was now “around now 7.1 million patients.”

We know from the data that there are more 50-to 64-year olds with cardiovascular issues. It’s the result of delays in that age group seeing a GP because of the pandemic and, in some cases, not getting statins for hypertension in time,” he said.

“When coupled with delays in ambulance times, we see this reflected in the excess death numbers. In time, we may well see a similar challenge in cancer data,” Barclay said.

COVID-19 Lingering Effects

The AIA agrees that delayed medical treatment may be a cause behind Australia’s rising death rate.

In an analysis of the pandemic in 2022, they said that it was highly likely that delays in medical care was a contributing factor to the excess death rates from other diseases.

“Pressure on the health, hospital and aged care systems, including ambulance ramping and bed block, could lead to people not getting the care they require, either as they avoid seeking help, or their care is not as timely as it might have been in pre-pandemic times,” they said.

“There is some evidence that this may be affecting cancer deaths. It may also be a factor in higher deaths from other causes, such as ischaemic heart disease, diabetes, and the large ‘other’ category.”

They also noted that COVID-19 lingering health effects could also be contributing to the increased rates.

Studies show that coronavirus is associated with increased mortality risks from heart disease and other causes. However, because doctors certifying the death would not necessarily know of the infection if it had occurred months prior, this could demonstrate a causative link several months after recovery from COVID-19.

Tyler Durden Thu, 12/08/2022 - 21:00

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Government

Federal Pandemic Program Forgave $809 Million In PPP Loans To White-Shoe Law Firms: Watchdog

Federal Pandemic Program Forgave $809 Million In PPP Loans To White-Shoe Law Firms: Watchdog

Authored by Mark Tapscott via The Epoch Times…

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Federal Pandemic Program Forgave $809 Million In PPP Loans To White-Shoe Law Firms: Watchdog

Authored by Mark Tapscott via The Epoch Times (emphasis ours),

Federal officials forgave $809 million in Paycheck Protection Program (PPP) loans handed out during the COVID-19 pandemic in 2020 to more than 100 of the nation’s top law firms and another $635 million given to hundreds of elite accounting offices, according to a new analysis of government spending to be made public on Dec. 2.

A worker protests outside the closed Four Points by Sheraton LAX hotel as they call for an investigation by the U.S. Small Business Administration (SBA) into the use of Paycheck Protection Program (PPP) loan funds in Los Angeles, Calif., on April 7, 2021. (Patrick T. Fallon/AFP via Getty Images)

As described by the Department of Treasury, the PPP was established in 2020 to provide “small businesses with the resources they need to maintain their payroll, hire back employees who may have been laid off, and cover applicable overhead.”

The program was administered by the federal Small Business Administration, which made $787 billion in federal loans to companies and firms spanning all industries. The vast majority of the “loans” were subsequently turned into grants, which didn’t require repayment.

An investigation by Open the Books found that hundreds of millions of federal tax dollars went to top law and accounting firms even though most of them didn’t qualify as small businesses and didn’t have to lay off employees.

Open the Books is a nonprofit watchdog that uses public information laws such as the federal Freedom of Information Act to make government spending public, including “every dime online, in real time.”

The Epoch Times obtained an advance copy of the investigative report.

Auditors “found an astonishing $1.4 billion in forgiven PPP loans that flowed to the largest and most successful law and accounting firms across America,” the report stated.

Today, it is an open question whether many of the firms needed a taxpayer subsidy to ‘save’ any jobs during the Covid-pandemic. Many racked up record revenues while their equity partners made millions of dollars.

“For example, in the years 2020 and 2021, we found equity partners individually received $7 million in profits while their law firms received $10 million in forgiven PPP ‘loans.’ The Guam office of Ernst & Young, a Big Three accounting firm with 365,000 employees, took a $750,000 forgiven loan.

“In 2020, millions of mom and pop businesses on Main Street had to shut down during the forced economic lockdown [occasioned by the pandemic]. So, Congress created the Paycheck Protection Plan (PPP) to compensate those businesses for their economic losses.

“Firms with 500 employees or fewer met eligibility requirements. However, Congress didn’t anticipate that Biglaw and the largest accounting firms would cash in so profitably.”

Among the biggest winners was Boies Schiller Flexner LLP, the New York City-based law firm of Democratic superlawyer David Boies, which received a forgiven $10.14 million PPP loan.

Boies first came into national prominence in 2000, when he headed Vice President Al Gore’s legal team during the Florida presidential election recount. The election wasn’t decided until the Supreme Court’s Bush v. Gore decision, which put Texas Gov. George W. Bush in the Oval Office.

Boies also gained national notoriety by representing the Department of Justice in its successful prosecution of Microsoft, and he headed a legal team that challenged California’s Proposition 8, which banned same-sex marriages. The proposition was approved in 2008 by voters, but the Supreme Court effectively nullified it in a 2013 decision.

His firm’s PPP debt was forgiven in October 2021 under the Biden administration, even though during the period covered by the loan “the firm’s equity partners earned $4.5 million each in profit compensation—receiving $2.219 million (2021) and $2.283 million (2020). The firm billed clients $480 million during this two-year period,” Open the Books found.

The second-biggest law firm beneficiary of PPP loans was the Birmingham, Alabama-based Maynard Cooper & Gale, which received $10.13 million under the pandemic relief program. Even so, the firm’s workforce increased from 247 in 2019 before the pandemic, to 260 in 2020 during the pandemic, and 283 in 2021.

No. 3 among the white-shoe law firms getting tax dollars via the PPP program was the New York-based Kasowitz Benson Torres. The firm’s “revenues grew from $216.8 million (2019), to $219.4 million (2020) and then $238.4 million (2021). In April 2020, the firm received a $10.13 million PPP loan that was forgiven in July 2021—while profit per equity partner averaged $2.418 million (2021),” according to Open the Books.

Among the big accounting firms getting tax dollars, Prager Metis CPAs in New York City received $10.2 million, which was forgiven in June. Revenues for 2021 reached $139 million, an increase from 2020’s total of $123.9 million.

Withum’s of Princeton, New Jersey, was next, getting a PPP loan worth $10.1 million that was forgiven in June 2021. Withum’s revenues were $425.3 million in 2021, up significantly from its 2020 total of $257 million, according to Open the Books.

Tyler Durden Thu, 12/08/2022 - 20:20

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International

Chinese Health Official Admits 80-90% Of Population May End Up With COVID

Chinese Health Official Admits 80-90% Of Population May End Up With COVID

After just within the past week China’s government dramatically…

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Chinese Health Official Admits 80-90% Of Population May End Up With COVID

After just within the past week China's government dramatically pivoted from its ultra-harsh 'zero Covid' policy - a policy which had triggered unprecedented widespread protests against communist authorities and health officials as in some instances they barricaded whole neighborhoods into strictly controlled quarantine zones - toward what appears a full embrace of a more lax 'Swedish model' type approach, national health authorities are prepping the population for the coming Covid wave, which could impact an estimated 80 to 90% of the Chinese population, according to a fresh projection by Feng Zijian, a former deputy chief at China’s Centers for Disease Control and Prevention. 

"It’s going to be inevitable for most of us to get infected once, regardless of how the Covid-fighting measures are adjusted," Feng said Tuesday during a virtual conference discussing the zero Covid offramp at Tsinghua University in Beijing. As a senior health official, Feng is part of the central government's task force in implementing new policies which has moved away from the 'one size fits all' mentality that guided Beijing's health response since the pandemic began.

"Some 60% of Chinese people may be infected in the first wave, before the curve flattens, Feng predicted," as cited in Bloomberg. "By comparison, about 58% of the US population had been infected by February this year, according to a US Centers for Disease Control and Prevention analysis released in April. That was up from 33.5% in December."

Via Associated Press

So it seems two years too late, China is learning the lessons of a number of countries that embraced a more flexible stance based on understanding herd immunity early, also centered on protecting the most vulnerable demographic, the elderly and the infirm, while not shuttering the economy wholesale.

Further, as of Thursday morning in China (local time), health authorities are reporting "more than 20,000 new cases a day at the moment, as outbreaks flare from Beijing to the southern manufacturing hub of Guangzhou. That’s up from less than 100 a day in June, and zero for long periods of 2020."

But China says it's ready amid its more localized approach which will seek to prep hospitals, civic authorities, and the citizenry on "proper protective measures" - such as greater deployment of at home rapid antigen test kits. "It is better to direct the flood than block it," Lu Jiahai, a senior expert at the state drug regulator National Medical Products Administration (NMPA), said.

As for this approach looking more like a Swedish model policy (though don't expect anyone in Beijing to call it that), Caixin Global recently captured the following quotes which illustrate an astounding about-face in thinking on the pandemic among Chinese officials

Although there are challenges in the implementation of home quarantine, the infection risks should not be exaggerated, said University of Hong Kong’s Jin.

"Scientific guidelines should be provided for everyone to follow with a clear accountability mechanism, as there have been many examples that even couples in the same room didn’t infect each other," said Jin, citing the experience in Hong Kong, where home isolation has been widely adopted after the worst outbreaks hit in the spring.

One resident in Beijing agreed. "I think it is more important to eliminate the irrational fear of being infected, and at the same time learn how to reduce the risk of cross-infection," Ma Qiao, who has studied preventative medicine, told Caixin.

Some of the new measures from the communist government call for isolating asymptomatic or mild Covid cases at home rather than in quarantine camps or hospitals for seven days. Anyone in contact with the infected would have to quarantine at home for five days instead of eight days at a camp and then at home.

The State Council further disbanded the rule for people to show negative Covid tests before entering public places. As the SCMP summarized of the new approach this week: "The new policy stressed that basic social and medical services need to be provided. People's movements, work and production should not be restricted in low-risk areas." 

Tyler Durden Thu, 12/08/2022 - 20:40

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