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Fiat chief Marchionne on a visit to Detroit to do due diligence on its deal with Chrysler, said that no one was lining up to take the deal away from Fiat. He made it clear that the deal, in which for providing its technology in small cars to Chrysler it would get a 35% stake in Chrysler, has to stand on its own two legs. For another $25 million Fiat could raise its stake to 55%. Its only other investment would be in the plant costs for building theses small cars in the USA. Fiat will not use USA government money for Fiat's operations, and only take money from Chrysler after the government is repaid, he said. For the deal to go through everyone has to make concessions, says Marchionne. The logic of the deal may rest on US government help and labor and other stakeholders concessions. In a year Fiat could be importing cars into the USA and in 30 months Fiat could be making cars in the USA.

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900 million eligible voters in India means this is the largest election ever. The election will take place in 7 phases in April and May from April 11 to May 19. Votes will be counted on May 23. The election is for 543 seats in parliament, the Lok Sabha. Turnouts are high with 66% turning out in the last election that brought Mr. Modi and the BJP to power.  Unlike elections in Britain a lot is spent in each election, about $5 billion in the last election and double that this time. The U.S. elections in 2016 had spending of $6.5 billion as a comparison. Women vote at about the same rate as men and more women than men are expected to vote this time. Prime minister Modi won the last election with promises of development and infrastructure. He is delivering on infrastructure but building manufacturing and generating jobs in the formal sector remains a tougher task for any administration in 4 years. During the first term Mr. Modi made needed changes including introducing the GST tax to integrate India's fragmented market and get rid of a patchwork of regional state taxes. He introduced a whole range of projects and yojanas which are setting the stage for widening the middle class, and improving living conditions. Some of the problems such as the bad loans in the banking system date back to previous administrations and the government has taken steps to clean up this problem by refinancing banks and introducing a bankruptcy law. This has slowed GDP growth to about 7%. However this would have happened under any administration.  The brief war with Pakistan in February 2019 has added another dimension to this election with questions about whether this may help Mr. Modi because of his strong stand against terrorism camps in Pakistan.  In the end it all comes down to whether the public still believes the BJP party under Modi is best qualified to develop the infrastructure to modernize the country and improve services, and whether it can create enough of the manufacturing capabilities to generate jobs needed. It may not be that the BJP under Modi has  not made mistakes in the process of learning how best to tackle development, but whether a patchwork of regional parties led by the opposition Congress party is in a position to provide the strong decisive direction to make quick decisions on development. Getting the agreement of a number of regional parties such as the party in West Bengal state or the Uttar Pradesh state when it was under a previous administration of Mrs Mayawati means an even slower rate of decision making as it leads to lack of speedy decision making. Whether voters have short memories and forget the slow rate of infrastructure development under previous administrations or have a willingness to give the BJP a chance to show what it can do under Modi for development can eventually decide this election. An example of what this means is in how the Mumbai Metro is being pushed through to timely delivery- Metro Rail's head Mrs. Ashwini Bhide simply says she feels for the people of Mumbai who have suffered from delays in development of needed infrastructure for so long, with millions doing appalling rides in a creaky old rail system. In her view it should have been done yesterday. It is this attitude that can make or break the current administration, and whether it can get this message through to voters one more time. Most who have this attitude are aware that China is now laying enough concrete every two years than America did in the whole 20th century, as reported in the Guardian newspaper, and are equally passionate about delivery of services and rapid development of badly needed infrastructure.         ...

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Japan is playing an increasingly positive and significant role in stabilizing the international financial system, and in providing new ideas for solution and proactive measures, some of it based on its own experience with a long sustained economic downturn from which it only recently emerged. It has dedicated $100 billion to the IMF for loans to emerging economies, which will be a significant help in preventing a severe downturn in developing countries. Here Prime Minister Aso outlines ideas that Japan will bring to the global talks this weekend November 15-16, 2008. The significant immediate steps are early and thorough disclosure of nonperforming loans based on valuation and reliable standards, and the removal of these loans from their balance sheets as a top priority. Japan was slow to do this prolonging its downturn into a decade or more of no growth. Other two priorities are injecting capital into banks with government money, and supplying ample liquidity from central banks and US dollar liquidity. After the immediate challenge there lie 7 areas to be addressed in the medium term. Improving savings and reducing consumption in countries dependent on external debt and moving to domestic demand led growth in export dependent economies. Bolstering the resources of the International Monetary Fund and the Asian Development Bank. Changing the governance structures of the IMF and the World Bank and other bodies to give proper representation to emerging economies that play an important role in the world economy. Giving the Financial Stability Forum a status above standard setting institutions like the Basel Committee, the Forum reinforced and reorganized to give membership to emerging economies. International Accounting Standards Board, governments, companies and investors in ajoint effort work to come up with a set of standards that have global application. And tightening standards for credit rating agencies through the International Organization of Securities Commissions. Aso proposes giving various countries legal authority over these agencies and the nurturing of credit rating agencies in each region in addition to global agencies, for the development of regional bond markets. Aso is also pushing for regional cooperation like the initiatives in East Asia such as the foreign exchange swap mechanism. ...

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Who is Nandalal Weerasinghe? This report in The Daily News gives some idea about the man chosen to help Sri Lanka negotiate a deal with the IMF.  Dr. Nandalal Weerasinghe was an alternate executive director at the International Monetary Fund before being appointed deputy governor of the Ceylon Central Bank in 2012. Before this he managed several macroeconomic departments at the central bank and was assistant governor of the central bank from 2007 to 2009, He has spent the large part of his career in economic positions at the Central Bank of Ceylon after getting his PhD in economics from the Australian National University. Weerasinghe is the leading expert in macroeconomics from Sri Lanka who has IMF experience. He says "things will get worse before they get better." He retired early from the central bank with a change in government in 2019. He was reappointed as Sri Lanka faced a debt crisis in March 2022 following the two year long pandemic, and the Ukraine war in 2022 that was bad for emerging market economies. Weerasinghe says about the crisis facing Sri Lanka- Recent decisons followed Modern Monetary Theory. This has dire consequences. In recent times the savings brought about by the low tax and interest rate regime passed savings on to the corporate sector and took away spending power from savers and pensioners. Surging inflation made things even worse for the lower income middle class and older parts of society. Years of accumulated debt have brought Ceylon to this point. In Ceylon one is seeing the effects of savings being passed on to the corporate sector in an economy dependent on tourism and remittances from overseas workers, both hit by the two year long pandemic. This is part of  a trend that has hurt emerging market economies from Argentina and Pakistan which also turned to the IMF to Turkey.  In other countries in the European Union savings also passed on to the corporate sector with low tax and low interest rate regime. With high inflation resulting in the cost of living crisis seen today in France and Germany. This type of policy that Weerasinghe calls 'Modern Monetary Theory' is not healthy for the European Union and the US, as these policies led to the neglect of much needed and vital investments in infrastructure, health and education. Only now are these effects being corrected by new administrations of Biden in the US and Scholz in Germany, with Biden's 2 trillion plan for workers and families, and a similar plan from chancellor Scholz. With this come needed investments to tackle climate change, all of which was neglected before. India has taken a different approach. By following good governance, managing vaccination effectively during the pandemic, social emphasis for food, water, electricity, cooking gas, medicine for the vast population of 1.2 billion, and a Master plan for building Made in India manufacturing,  India has avoided such crises and maintained strong economic growth. In this sense it is a model for South Asian, South East Asian, African, and Latin American emerging market economies that face a difficult situation today. Good governance is critical.   ...

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DJT 1.0 was led on the tariffs policy by USTR Robert Lighthizer, who had experience negotiating with the Japanese negotiators in the Reagan era. He is today respected by  Republicans, is seen in an important role in economic policy and to prepare the tariff policy actions of the new DJT administration. Lighthizer prefers to get Congress to take action with legislation. He also believes that domestic manufacturing will make gains with new and higher tariffs on Chinese imports. Lighthizer policy is falsely compared with Hoover Tariffs Act of 1930 when world trade was 9% of world GDP, today it is 63% of world GDP, and where under Hoover in 1930 the tariffs were across the board all countries 20,000 goods. Under Lighthizer on specific products where dumping is happening -steel, aluminium, autos, with Japan in 1960-70 or China 2000-2020 targeting American industries + technologies for takeover. And falsely when it comes to raising costs to each American family on average by $4000 a year by economists. The conventional view for business for 2000-2016 through Bush and Obama favoring free trade did not take into account the unusual experience of China which entered WTO in 1990, then expanded in a way unprecedented in history at 10-12% growth rates for 15 years destroying American manufacturing with dumping, having support of outshoring by companies in the US, and not giving reciprocal treatment for exports from the US to China. China also had unrestricted access to US technologies in this type of trade. Lighthizer's approach was to specifically address this problem not a general across the board tariffs on all goods (20,000 goods) on all countries as with the Hoover Tariffs Act in 1930. Lighthizer's approach adopted by DJT called for reciprocal trade response with China as the US had already done with Japan, not unilateral across the board tariffs, and when world trade had advanced to about zero tariff rates. And falsely compared to Hoover 1930 Act because under Hoover tariffs were 29-40%. raised to 60% when world trade was small, was 9% of GDP. The Biden administration has tacitly agreed with Lighthizer's vision by not reversing DJT tariffs. A new higher tariff will probably be selective based on the industry, country and what goals the US has set under the new administration for that industry. Some of the tariffs revenue may also be used for tax cuts. ...

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Slowdown in drug sales growth in USA and Europe. Top seven emerging markets will account for 34% of global sales growth upfrom 7% in 2000. And the USA accounted for 40 to50% of growth in global pharmaceutical sales each year early in this decade, in 2009 the sales in the USA will account for just 9%. Forecasts and figures are from IMS consulting firm. USA sales will rise only 1-2% if at all, while emerging markets will grow by 4.5% to 5.5%. With the economic troubles American consumers are less likely to fill prescriptions and insurers are not covering new drugs and favoring generics. Intense competition among generics drug makers is reducing prices. IMS predicts that the global generic market will grow by 5 to 7% in 2009 to $68 billion, slowing from double digit growth. This is from total sales forecast for pharmaceuticals globally of $830 billion.

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This is a big desicion by the Obama administration, and has global implications for the amount of oil consumed and the emissions discharged. The Obama administration will introduce one national standard for automile emissions and mileage standards, replacing the patchwork of standards and skipping over the challenges to the California standards by using those standards to set the national rules. The rules take effect in 2012. It will create a new national standard for a car and light truck fleet in the USA, that is 40% cleaner and more fuel efficient by 2016 than it is now, with a new average of 35.5 miles per gallon. The current national standard is 25 miles per gallon, and this standard has fallen way behind the Japanese and the Europeans. The Europeans went through their battles for fuel efficiency a few years ago with auto industry resistance, and this was finally settled with tougher standards, giving the European industry advantages in technology over the Americans. The American car industry stalled higher standards, and what standards were passed were whittled down by heavy lobbying in Congress. As a result a battle raged between those interested in conservation and the environment and the Detroit car industry, especially in a deteriorating global environment for this type of prolific oil consumption on American highways. This lack of foresight on the part of Detroit carmakers, and their management, accelerated their financial collapse in 2008 and 2009, as large car and truck sales collapsed. That this tough new standard of 40% improvement in 2016, would in fact not have been possible without this fiinancial collapse and turning to the government for a bailout - with the entire board of General Motors being replaced- is one of the ironies of this situation. This decision will almost certainly accelerate the development of smaller models, and bring the kind of attention to them that will give them the quality and features and comfort to make them command higher prices and become profitable, as is the case in Europe. For too long the American small car became synonymous with being a lesser car in many dimensions of design, quality, comfort and performance, so that it became a cheap car that you upgraded from to a larger car as you became affluent. It had been that way, but did not have to be that way after the world had changed. And the larger models like the pickup trucks and large cars are more likely to be phased out with the new regulations. This will also bring a `new sanity to oil prices, as the reduced consumption in the US will accomodate the increased consumption in India from the small cars like the Tata Nano which look set to sell in the millions, and still keep oil affordable for tight budgets worldwide. In this sense it is a victory for global good sense. For President Obama this is a personal quest, as he co-sponsored 2 bills in 2006, during this second year in the US Senate, one to raise fuel economy standards, and the other to encourage the use of alternative fuels....

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Copies with slight changes to extend drug life with new brand names- Clarinex for Claritin, Nexium for Prilosec, Paliperidone for Risperdal being the latest in this new marketing strategy of drug companies to extend the life and sales of a successful drug. The drug companies try to market the copy drug as a significant improvement, which is what J&J is doing with Paliperidone. Experts are skeptical. Pricing of the generic versions of Risperdal or its copy will be much less expensive. Cost is a sensitive issue. About 15% of Risperdal's $1.35 billion sales were from Medicaid, generic substitutions offer potentially large savings. Meantime J&J did not do clinical tests between Risperdal and Paliperidone, the tests with 1600 patients compared Risperdal with a sugar pill. A psychiatry Professor at Duke and another professor at NYU are skeptical of J&J claims for Paliperidone. United Health shows savings of $150 million by using generics instead of Nexium, so managed care payors will tread carefully....

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The National Childhood Vaccine Injury Compensation Program protects vaccine makers from much of the litigation risk faced by pharmaceutical manufacturers. It limits compensation for death to $250,000. This special vaccines court is called Office of Special Masters at the U.S. Court of Federal Claims. This may be one reason for Pfizer's willingness to pay $68 billion for Wyeth which is amaker of childhood vaccines. Vaccines will generate $21.5 billion in sales by 2012, according to Sanofi-Aventis. Vaccines are biologic products that can't be copied. Wyeth's Prevnar is designed to protect children against 7 strains of pneumococcal disease. It has sales of $2.7 billion projected to grow to $5.5 billion in 2015 according to Sanford C. Bernstein & Co. Vaccines have driven huge reductions in childhood diseases, and the Act is designed to potect makers of vaccines, who suffered from excessive litigation in the 1980's.

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 This message from Pope Francis is especially relevant today during coronavirus. Francis says of the mistaken priorities of today away from healthcare, education, infrastructure and "coherence" in society and the pain and hardship this is causing in society, there is much that can give people thought to reflect on. Francis  new book, "Let us Dream: The Path To a Better Future" will be out December 1. "If we are to come out of this crisis less selfish than when we went in, we have to let ourselves be touched by others’ pain." He cites a line in Friedrich Hölderlin’s “Hyperion” that speaks to him, about how the danger that threatens in a crisis is never total; there’s always a way out, that where the danger is, also God plants the saving power, a way out. And not simply a way out, God also gives human beings a chance to grasp for and hold onto renewal if only one makes the endeavour. As it says in the Bhagavad Gita God gives man a chance to warm himself near the fire, only those who make the effort to go to the fire can feel the warmth, it is a choice man has to make. And again God says in the Bhagavad Gita that he is not partial to any man. Ever since the global financial crisis hurt working families in the middle and lower classes hard in 2009 because of banks misbehaviour and greed, Pope Francis has called for countries in the western world to heed his warnings about the dangers of greed and corruption to us all. Even George Washington warned of this in his inaugural address, so the warnings are not new. Reminding people once again he says "we cannot return to the false securities of the political and economic systems we had before the pandemic. We need economies that give to all access to the fruits of creation, to the basic needs of life: to land, lodging and labor. We need a politics that can integrate and dialogue with the poor, the excluded and the vulnerable, that gives people a say in the decisions that affect their lives. We need to slow down, take stock and design better ways of living together on this earth." The pandemic has exposed the paradox that while we are more connected, we are also more divided. Francis is never tired of warning that the present political and economic structures and people who staff them have not felt others pain, so he reminds us it is hard to build a culture of encounter in which we meet as people with a shared dignity, within a throwaway culture that regards the well-being of the elderly, the unemployed, the disabled and the unborn as peripheral to our own well-being. Where only self preservation counts. Francis reminds us of the Christian concept that no one is saved alone. This is not just an abstract concept. When Francis was only 18 years and a second year student he was admitted to a Buenos Aires hospital for a severe respiratory disease, so severe that he lost a part of his lungs. He remembers the day August 13, 1957. He understands this pandemic from personal experience. He knows what it is like to be on a ventilator. Surgeons removed the upper right lobe of his lung. Francis struggled to breathe. He was  saved Francis says not even by the doctors, but by a Dominican sister, a senior ward matron, who had been a teacher in Athens before being sent to Buenos Aires. She understood that Francis was dying and after the doctors left asked the nurse to double the prescription dose of penicillin and streptomycin. Sister Cornelia Caraglio, knew better than the doctors from her regular contacts with sick people what they needed, and she had the courage to act on that knowledge.      ...

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Netherlands is well ahead of other countries in remote working. The percentage of employed persons working from home is about three times that of the U.S. or Britain. It is about 15% in Netherlands compared to 4-5% in the U.S. or Britain. A culture of near universal fast internet connections, a culture of trust with companies knowing the work will get done, and companies providing employees with funds to set up a good working environment from home. In some Dutch companies employees can take vacation freely as long as the work gets done. The idea of a whole work day spent at a desk in the office in some office building is not entrenched in Dutch culture. A U.S. poll shows 59% of remote workers would like to continue working remotely after the pandemic. Companies are shifting to a new culture of work done away from the traditional business office as the economy reopens. In the Netherlands the pandemic is only giving more confidence in the idea of working away from a business office. This can now catch on in the U.S. and other countries. ...

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With 5.7 million jobs lost since December 2007 fewer people are paying payroll taxes to support Medicare and Social Security says Labor Secretary Solis. As aresult Medicare will run out of funds by 2017, 2 years earlier than predicted last year. Medicare and Social Security issued their annual report yesterday, suggesting the nation cannot afford the cost of Medicare at the rate of current expenditure growth. Social Security will run out of money by 2037 four years earlier than predicited before. The only way to keep Medicare solvent says Mr Geithner is to reduce the rate of growth of health care costs.

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As Indian pharmaceutical industry sees drug testing in India as an opportunity, conditions for obtaining the best results are being established by taking necessary steps. With ashortage of experienced people to run drug trials, Indian government has stepped up training, setting up partnerships with the U.S. FDA, Health Canada, the World Health Organization, and other similiar organizations, The emphasis should be on credible dat and the safety of subjects says A.K. Pradhan, India's Assistant Drug Controller. After the death of an infant in a Wyeth Pharmaceuticals drug testing effort, the Drug Controller of India though supportive of Wyeth has raised certain issues that Wyeth is addressing.

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No country benefited more than first Japan and then South Korea till 2000, and now China till 2022 from the trade and sharing of industrial technology enabled by the American backed system of trade and industry. Walter Russell Mead says in WSJ that China has chosen to challenge the system through which it developed into an industrialized nation with the US running huge trade deficits, sharing its technology and letting Chinese manufacturing displace American local manufacturing. China is seen as challenging the system. Yet what has happened is that this process of displacing American manufacturing and industry was not sustainable anyway and continued for a decade longer than it would otherwise have lasted because American industry could not easily reverse a course it had set of setting up manufacturing in China, once that manufacturing base had already been transferred from the US to China and American companies had grown accustomed to a new state of affairs of making overseas in China. Not much thought was given to how American workers would react to that situation as companies and industries making that transfer made independent decisions. This led to the election of Trump with wins in midwestern states that had suffered from loss of manufacturing communities.  The Trump tariffs on Chinese goods and the Biden administration lining up completely behind American workers and families for the first time for Democrats has sent the signal to China that it finds the situation of China's dominance in the trade system unacceptable. The document of "China 2030" of the Chinese Government with planned dominance in key sectors and industries was met with alarm across America in all parties. The paradox of Apple as a key sector in Chinese manufacturing and the largest American company is the result of policies pursued by America without realizing the true cost of shipping manufacturing out of the country. That process is now being reversed with change of management starting at Intel Corp. and other companies to bring the manufacturing base back to the US. This policy is being resolutely pursued by the US and will speed up following the pandemic which has further demonstrated how much of a mistake the policy of sending out manufacturing in critical areas such as health could be. This is the reality behind the rhetoric and verbal exchange between China and the US. With the rapid growth of Chinese manufacturing countries such as India were put in a difficult situation  as this was preventing the local industrial base developing in India with Chinese imports in the same way as it had damaged that of the US and the EU. Worse it led to the use of US and European technology in China's defense industrial base including aviation and other sectors that threatened India's borders with repeated Chinese incursions in the Himalayas, from the Pakistan western Himalayas to Ladakh and the eastern Himalayan mountains. That situation existed long before the Trump and Biden administration and the Modi administration called for a return to America of its industrial manufacturing base and its technological leadership. Both the Bush and Obama administrations and the Indian Congress administrations failed to realize the dangers of letting the US, European and Indian industrial base wither. India is not just a country but a culture that extends from the Himalayas all the way across Bangladesh to the Indonesian islands which shares a common cultural history of Buddhism and the Vedanta. This is a region that has a population of about 2 billion people. In a larger sense the cultural history extends to  Vietnam and Japan with its Buddhist culture whose origins go back to India, and also of China itself. In the larger sense this is a population of close to 3 billion people. The economic development of this region and learning from the parliamentary traditions and scientific discoveries of the modern period since 1700 is a task for both the US, Europe and the people of the region.   ...

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Former German chancellor Angela Merkel and foreign minister Steinmeier are singled out for their policies that likely emboldened Russia into its invasion of Ukraine. The DW.com says Merkel's tenure now shows deep seated flaws in leadership with her policies with Russia having gone too far in the other direction and leaving Europe in a vulnerable position. Merkel saw herself as continuing old policies from the period of SPD chancellor Willy Brandt of engaging with Russia, then called the Soviet Union. Yet looking at it closely the policy of Brandt was to reach accomodation with the eastern half of Germany, called the GDR, not to weaken Germany's position. By distancing herself from the US Merkel was in sense out on her own. Consider says DW.com that in 2014 Germany imported 36% of its gas from Moscow, by 2022 when Russia invaded Ukraine it was 55%. The SPD under Gerhard Schroeder and Steinmeier following Schroeder share responsibility with Merkel for this dependence.    A similar integration of the German economy with China's economy happened under the 4 term administration of Angela Merkel. This can be seen in the port of Hamburg. This may have similarly emboldened China in its relations with neighbors in the Indo-Pacific region and with Taiwan. German chancellor Scholz is by one report reading Cambridge historian Brendan Simms- "Europe The Struggle for Supremacy 1453 to the Present." This historical account of the relations of major European states in the 5 centuries before the present period shows the Balance of Power as critical to the liberty and freedom that Britain and Netherlands as well as other countries were able to keep. Sweden was attacked in 1700 with sign of weakness, Britain faced challenges from France in 1700 and in 1800, and allied with the Hapsburgs and German states to maintain its democracy and way of life. Merkel of CSU and Steinmeier of SPD may have failed to realize this when they ignored the history of Europe. The WSJ report on the miscalculations on the German and French side with Sarkozy, Hollande and Macron show that all these leaders failed to grasp that by leaving the issue unsettled of Ukraine's NATO admission they had created the situation that was bad for both Russia and for Ukraine, creating seeds for serious differences that could lead to future conflict and war. By not respecting and giving room to the lessons of history these leaders in Western Europe have created the conditions for the very opposite of what they intended to do.  ...

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All sides joined the President at the White House, as part of his consensus building efforts, and to get aseat at the table in restructuring health care. The insurers and health care providers, including technology providers, all committed to cutting the cost of health care. New social insurance programs to cover 45 million uninsured Americans, and to make health care affordable for businesses and individuals, will be unworkable at currently projected rate of increase in health care costs of 6.2% a year for the next decade. The industry promised to reduce that by 1.5% through voluntary efforts, even though there is skepticism about whether they will deliver. The insurers are against a government sponsored health plan fearing it will drive them out of business. Insurers and health care providers are lobbying against the cuts in their Medicare payments, and insurers are fighting Obama's cuts to their private Medicare Advantage plans by a total of $176 billion over 10 years. Doctors are fighting a 21% cut in their Medicare fees scheduled to take place in January 2010. Pharmacuetical companies and makers of medical devices are concerned that new products will have to pass a cost-benefit test before being approved for coverage under Medicare. Its just that they all see the continued rise in costs as somehow unsustainable, especially in the current economic crisis, and share the feeling with business and the rest of the country that the system is broken. At the same time like the banks and bank executives, health care companies and their executives go on lobbying aggressively and doing things the old way, which raises questions about how well these systems that are broken can be put on the right path....

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Providing health insurance to the roughly 50 million people that are uninsured costs some $120 billion ayear. This will hae to be paid for through limiting the tax deduction on employer provided health insurance (something Obama campaigned against), or cost reduction in the bloated cost structure for health care in the country. But the same health care providers who committed to cost reduction in arecent conference at the White House are lobbying against some measures that reduce cost.

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Questions being addressed to get health care to the uninsured and to all Americans at an affordable level.

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Areas for growth for the Indian drug Industry include the large growing domestic market, the outsourcing by US drug manufacturers, and sales in other developing countries of Asia, Middle East, Latin America and Africa. Analyst estimates are that India will spend $30 billion a year on drugs to improve care for its people in the next 10 years up from $8 billion today. And the distribution network is being developed by drug companies insdie India to reach more people. Also companies like Pfizer plan to double outsourcing of manufacturing drugs from 10% today to 20%.

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During the freeze offs when due to winter storms across the northeast and other parts of the US the gas supplies were down by 7% the supplies of natural gas in the US were 5.2% above the usual average. Natural gas prices are 30% below the price in October at the start of the heating season demand in the US. This plentiful supply will help Americans weather this winter so much better than last winter, and reducing the price of a key input for many products in the industrial economy such as cement, plastic and fertilizer to reduce overall inflation. In this way the US is pursuing climate change action under president Biden with policies that take action on the Cost of Living front that affect ordinary Americans at the same time for a two pronged effort.

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Walgreens is changing its growth model to add the business of Health and Wellness buying two companies I-trax Inc. and Whole Health Management which run 350 health centres at corporate offices. Pharmacies will be added to these centres. Its targeting 7600 office sites with 1000 or more employees that could use a health-care center. Its competitors CVS and Walmart are going into managing employer drug benefit programs, with Walmart's selling point being reducing costs of paying for prescriptions for employers.

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How the French health care system works. France comes in first and the USA 37th in aWHO health care ranking. THe difference in deaths from respiratory disease is half that in the USA, and lower rates of death from heart disease and diabetes. IT has more hospital beds and doctors per capita than the USA. 65% of French people are satisfied with their health system compared to 40% in the USA, and yet France spends 10.7% of GDP on health care and the USA spends 16% for poorer results. THe French system is more generous to its seniors. Unlike Medicare there are no deductibles, just modest co-payments that are often dismissed for chronically ill. And diabetes and critical surgeries are covered 100%. French also buy supplemental insurance like Medigap for extra expenses like dental and eyglasses. Cancer patients are treated free of charge. Avastin treatments costing $48,000 a year are provided at no charge. France's PMI or Protection Maternelle et Infantile, is rated highly. It is anetwork of thousands of healthcare facilities, that ensure that every mother and child in the country receives basic preventive care. Mothers even receive afinancial incentive for attending their pre and post natal visits. France makes this care affordable by reibursing doctors at a much lower rate. The average yearly net income for doctors is around $55,000, about athird of what doctors in the USA make. But French doctors don't have to pay back huge student loans as medical school is paid for by the state and malpractice insurance premiums are only a tiny fraction of that in the USA. And again the French government pays two thirds of the social security tax for most French physicians- which is typically 40% of income. So the $55,000, is more like $92,000 taking that into account and more like $110,000 when student loans and malpractice is taken into account at US levels. Specialists who have 4 or more years experience can charge what they want, but as one gastroenterologist says, there in an unspoken and undefined limit to what you can cahrge or what is socially acceptable. Yet even in France there is inflation in health care costs that the government deals with through price controls and more spending. The French national insurance system is running increased deficits each year and this is now $13.5 billion, and it has led to higher taxes for employers and workers. ...

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This WSJ report shows how the debt ceiling negotiation were conducted and the process that made it possible to reach an agreement since the State of the Union address by president Biden on February 7, 2023. It started with Biden getting unanimity right on the floor of Congress during his speech about protecting Medicare and Social Security. The Republican strategy was to pass the legislation on spending that did not specify where cuts were to be made yet used 2022 spending levels with a 1% increase. The deal was to be for three years and passed the spending bill with an increase inthe debt ceiling. Till that time the Democrats decided to not enter negotiations.  Biden and McCarthy then had to choose who would represent their side in the long negotiation process that lay ahead till June 5. Progressive Democrats called for invoking the 14th Amendment that allows the government to continue functioning and pay its bills. Biden chose not to take that route. Respect for the other side, a prepared script are an important point in negotiations. To get results something even more important is essential flexibility and a plan, Plan B. Trust began to develop between McCarthy and Biden. Biden and McCarthy did not any time engage in acrimonious description of the other side. At one point when Biden was in Hiroshima for the G7 meetings Ricchetti on the Biden side and Graves on the Republican side began to feel the frustration. Biden decided to fly home early from Hiroshima. He was constantly in touch with his negotiators Steve Ricchetti, a trusted aide, and a cabinet official the Budget Director Shalanda Young. Graves a long time trusted adviser of McCarthy headed the negotiations for McCarthy.  Shalanda Young and Garrett Graves are both from Louisiana and Graves says he used to work out with Young's dad in the same area. This had a positive effect. It also reduced the tensions in the negotiations so that it could be said this was the calmest negotiation from either side that has been seen in the US  for a long time and bodes well for America's future and for its people, far beyond any concessions made by either party.  Biden made clear at the outset what he could accept without leaving it hidden- he would agree to some work requirements, he would not agree to work requirements for Medicaid. Others in the Democratic party conveyed how distraught they were with efforts to impose stringent requirements for federal food aid during a cost of living crisis when the Republican positions ruled out any new taxes on the wealthiest Americans. In the end Republicans agreed to keep spending limits for 2023 for two more years into 2025 when they would be increased by 1%. Democrats offered to cut (Income Tax) Internal Revenue Service (IRS) spending to increase IRS staffing from $80 billion to $70 billion. Biden said "nobody got everything they wanted." It would have to be passed in Congress with the support of moderate Democrats and moderate Republicans, with members holding extreme positions among Republicans and Democrats opposing. The two parties coming together after a long time to meet the real challenges ahead for the American people. ...