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Plus: Amazon’s Prime football bet

On Thursday, Sonali Basak, Bloomberg Television’s global finance correspondent, interviewed Citadel’s Ken Griffin about the incoming Republican administration and was struck by his thoughts about the deficit. Plus: What happens when hospitals rely on ill-trained nurse practitioners, and why Amazon.com is pitching a new Black Friday football tradition. If this email was forwarded to you, click here to sign up.

I asked Ken Griffin, simply, what’s most on his mind. Because the billionaire oversees the world’s most profitable hedge fund and donated more than $100 million toward down-ballot races this election cycle, it wasn’t clear to me whether he’d choose a market matter or a personal one. He didn’t donate to Donald Trump’s campaign, so I wasn’t sure how open Griffin would be about politics just two weeks after the president-elect’s victory.

In some ways, Griffin’s response was both personal and practical. Addressing the crowd of hundreds at the Economic Club of New York, he answered me with what worries him most: the posturing around immigration policy and the direction of inflation. He also raised what’s probably the most abundant frustration among investors: the national deficit.

“You asked what I worry about? Will Team Trump, will this administration, be able to find a path to put America’s fiscal house back in order?” Griffin said. “We cannot continue to run this level of profligate spending, and that’s a big issue.”

Griffin, founder of Citadel, in conversation with Basak on Thursday at the Economic Club of New York. Photographer: Yuki Iwamura/Bloomberg

I had the numbers in my back pocket because it’s an issue I’ve been following closely. Investors who are worried about the US fiscal situation have been selling off in a frustrating manner, often sending the 10-year yield beyond 4.5%.

When bond prices fall, yields rise—and interest rates on other types of debt such as mortgages are more closely tied to those long-term yields. That’s one reason home loan rates keep rising even as the Federal Reserve has started to cut interest rates. It’s also why corporations can still borrow from banks at extremely low levels, but it’s hard for the average American to go out and get a loan.

The crowd at the Economic Club has had time to consider fiscal disorder. In early September, Trump outlined his economic plan there. He pitched cutting corporate taxes to 15% for companies manufacturing in the US. According to the Committee for a Responsible Federal Budget, that would increase the deficit by $200 billion over 10 years.

Such tax reductions and another set of similar plans would contribute $7.5 trillion to the deficit over a decade, the CRFB estimated. Extending and modifying the Tax Cuts and Jobs Act from Trump’s first term would be the biggest contributor to those losses: roughly $5.4 trillion.

By comparison, “reducing waste, fraud and abuse” would save the federal budget only $100 billion, according to the CRFB. That’s one big task now largely in the hands of Vivek Ramaswamy and Elon Musk, who are overseeing a proposed department of government efficiency. They said in a Wall Street Journal opinion article that they’ll target five times that amount. Even if Musk and Ramaswamy achieve their goal, it’s still cutting into a very small portion of the estimated shortfalls.

The math is grim.

“I don’t think we have the fiscal room to cut taxes from where they are today,” Griffin said, “and I think there’s a real question about where do we need to raise taxes to start to put our house in order.”

He said Trump in his first term made a bet that cutting taxes would contribute to productivity gains, but it’s hard to know whether that bet paid off, given the regulatory constraints on corporate America’s growth during President Joe Biden’s administration. Griffin thinks that made businesses less productive.

Other Trump policies pose risks to the economy, markets and the direction of interest rates as well. A crackdown on immigration, for example, could spur inflation, especially when immigrants populate jobs everywhere from restaurant kitchens to the C-suite in Silicon Valley.

The issue is quite circular. Higher inflation can lead to higher interest rates, and the US government’s borrowing costs are one of the biggest expenses in the national budget. I asked Griffin whether the bond market would face problems as the national debt load swelled. He said the country clearly can’t sustain this deficit for the next 20 years.

Related: Ken Griffin Open to Citadel Stake Sale, Warns of Tariff Risks

In Brief

Hospitals’ Nurse Practitioner Predicament

Illustration: Manshen Lo for Bloomberg Businessweek

Dale Collier had never attended medical school. But as a nurse practitioner she was empowered to oversee patient care the same way medical doctors do. She was assigned to the overnight shift at Chippenham Hospital, a facility with more than 460 beds in Richmond, Virginia, where workers say staffing is light and pressure on providers is intense.

Chippenham is owned by HCA Healthcare Inc., the $84 billion company that runs America’s largest hospital chain. Like a growing number of hospitals across the country, HCA has begun placing NPs in higher-stakes roles. For Collier, who had an acute-care license, that meant tackling some of Chippenham’s sickest patients.

It proved too much for her. Virginia regulators later found that patients died after she failed to properly care for them. In January 2022, a 69-year-old man with rapidly dropping blood pressure suffered what was likely a gastrointestinal bleed after she failed to assess him and order testing. In March of that year, Collier gave an agitated woman three doses of a medication that wasn’t recommended for her condition, then another drug, until she became unconscious. Collier didn’t complete a bedside evaluation or consult a physician. The patient died two days later.

Less than a decade ago, almost everyone with Collier’s responsibilities at Chippenham was a medical doctor, rather than a nurse with an advanced degree. At the time of the deaths, NPs like Collier made up a fifth of such staff, one former HCA physician estimated, as the company’s hospitals came to operate with some of the nation’s most razor-thin staffing levels. In effect, she was part of an industry experiment testing whether nurse practitioners can do a physician’s job caring for acutely ill patients. The experiment failed.

Faster to train and cheaper to employ than doctors, NPs help American health-care companies’ bottom line—but can risk patient safety. Read more from Caleb Melby and Noah Buhayar in the second part of a series: What Happens When US Hospitals Go Big on Nurse Practitioners

All-American Holiday: Turkey, Football, Amazon

Illustration: Nathan McKee for Bloomberg Businessweek

On Black Friday, Amazon’s Prime Video streaming service will carry an NFL game between the Las Vegas Raiders and Kansas City Chiefs. It will be the second edition in what the league and Amazon want to make into a new holiday tradition. Both the NFL and the tech giant are hoping the Raiders and Chiefs can put on a better show than the Miami Dolphins and New York Jets did last year, when the Dolphins pounded the Jets 34-13 in front of 80,000 hushed fans at MetLife Stadium. Amazon.com Inc. paid the league about $100 million for the rights to that sad spectacle, an eye-popping figure for three hours of programming—about what it cost Prime to produce two seasons of the detective series Bosch.

For the world’s largest online retailer, however, the NFL on Black Friday isn’t just another show: It’s a way to insinuate itself in the life of millions of Americans on one of the biggest shopping days of the year. The Black Friday game is a showcase for Amazon’s broader strategy in sports and its leading laboratory in a long-term project to meld content and commerce in a way that will shape the viewing experience for fans—and the financial fate of leagues—for decades to come.

Ira Boudway, in the latest Field Day column, writes about how Amazon hopes a good game makes its annual fee seem worth it: Amazon’s Black Friday NFL Game Is a Play to Keep You Paying for Prime

Sign up for Bloomberg’s Business of Sports newsletter for the context you need on the collision of power, money and sports, from the latest deals to the newest stakeholders

HODL

$100,000
Bitcoin is quickly closing in on six figures, buoyed by expectations of friendly US regulations and expanding investor interest, courtesy of President-elect Donald Trump’s support for crypto. The value of the crypto market as a whole has increased by about $1 trillion since Election Day.

Empire Rocked

“Modi ji, your friend has defamed the country’s name all over the world.”
Sanjay Singh
Senior leader in the Aam Aadmi Party
US Justice Department bribery charges against the Indian tycoon Gautam Adani have sent his conglomerate’s stocks and bonds tumbling. The implications for US-India relations stretch much further.

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