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Peter Orszag's role in the healthcare debate and the formulation of health care policy proposals. One proposal of Orszag, who heads the Congressional Budget Office, is to set up a new agency with powers to cut spending and implement changes in Medicare. Says Orszag, "one of the reasons we have such disjointed and skewed incentives is that we have an excessively political process." At a recent meeting with House Democrats, one Congresswoman said her top priority is winning higher payments for oxygen suppliers, and Orszag was taken aback. For years officials have been trying to cut payments to oxygen and medical equipment suppliers, which are said to be inflated. When a new competitive bidding process was set to take effect last year, industry supporters in Congress were able to delay the plan, and these supporters are still fighting to block changes says the WSJ. Here is a 40 year old Orszag, with degrees from Princeton and London School of Economics, who got his early experience in the Clinton adminstration at age 24. He then followed this with a number of policy oriented jobs, ending with appointment to head CBO in 2007. And he faces the whole system of Congressmen from both parties beholden to interests in the healthcare industry, who provide the donations for them to finance their election campaigns. Dan Eggen describes this in the Washington Post, 7/21/2009. Max Baucus of Montana, and to some extent Grassley of Iowa, are senators from both parties who Eggen points out are beholden to the healthcare industry because of large donations they receive from the interests in the healthcare industry. These interests want to see their payments system protected. The further escalation in health care costs, which would make the whole healthcare system unaffordable even as it delivers poor results, can only be prevented by making cost control an exercize that is not influenced by healthcare industry donations. Jackie Calmes describes the huge hurdles in achieving a deficit neutral move to universal health care in the U.S. in the NYT 6/26/2009. See the link. The exchange between Grassley and Orszag on the issue of the $177 billion in savings needed from the payments to health insurers under the Medicare managed care plans- which allow seniors to obtain Medicare coverage outside the government run program -went as follows. These are dubbed overpayments by outside experts and efforts have been made to cut them in Congress. When Mr Grassley raised concerns about the impact of such cuts in a hearing, -and Grassley has opposed the cut for this overpayment to insurers- Orszag responded saying: "I very firmly believe that capitalism is not founded on excessively high subsidies to private firms. This is what this system delivers right now." ...

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Scott Shane of the NYT provides this exceptional account of how the ideology of Wahhabism on which the Saudi monarchy is based has influenced the evolution of Islam, but not in the way other religions have evolved into more moderate and open religions. Christianity evolved from the period of religious conflict, and evolved to the point that the basis of progress was based on education and technology in most of northern and southern Europe. Where the evolution did not take place because of more intolerant behaviours such as in Spain with the Spanish Inquisition and ideas from the medieval period, this development based on education and technology lagged severely behind.  Wahhabism developed as a result of a sect started by a religious cleric Wahhab in a poor desert region around Mecca and Medina, now the Saudi Kingdom, who sought the help of a tribal chief Ibn Saud. They used the religious-political alliance to gain tribal dominance in the region. Wahhabism sought to change Islam by banning worship and religious rites at tombs common in that period. It also as Brookings scholar William McCants cited here says, drew "sharp lines" and intolerance between believers and non-believers- all non-believers including other sects of Islam, Shiites, Christians. The movement spread throughout the region, but was crushed by the Ottoman Empire based in Istanbul, Turkey, by the 1850's, only to be revived in the 1920's following the collapse of the Ottoman Empire. A Norwegian expert Heggenhammer cited here says clearly Islam did not benefit from the evolution that other religions had, and Wahhabism has slowed this evolution into and open, tolerant religion because of its "sharp lines" and intolerance of other faiths and ideas with the Wahhabism from a medieval perod. In India the British rule brought enlightenment thinkers (John Stuart Mill for example was a clerk for the British East India company). But no such change happened under Ottoman rule to inspire leaders like Gandhi and Nehru to setup a new constitution that made changes from medieval Hindu beliefs such as caste and religious practices based on superstition.  The development of an oil rich state in Saudi Arabia with the discovery of oil, and the dependence from 1950-2010 of the global economy, has led say experts to the export of the Wahhabist kind of Islam to other countries in Middle East and South Asia. This they say made the evolution to democracy and peaceful coexistence difficult or impossible in the region. ...

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A look at the graph showing inflation adjusted GDP growth in the South African apartheid years of 1980-1994, show GDP declines in 6 of the 14 years, with 3 years of decline in the last 5 years of apartheid rule. Which shows that the economy was suffering from a combination of world sanctions and the war with the African National Congress to defend apartheid. In 1996 an agreement was reached with the ANC to transfer power and end apartheid in South Africa. Some of the pressures against apartheid came from the business community's perceived interest in maintaining growth. This has been borne out by the graph showing the inflation adjusted growth in the years of ANC rule starting in 1995, which show a striking difference with growth between 4-6% for 1995-2008, high growth rates for 13 of 14 years, and slight decline in only one year 1998. This bears out the policy of business and a democratically elected government with respect for minority rights, and black-white-colored and tribal loyalties being reconciled to goals of economic growth and democracy. For two years Nelson Mandela head of the ANC maintained continuity in economic policies by retaining the white finance minister from the previous apartheid government. In 1996 Trevor Manuel who had little economic experience- who worked as an activist to organize protests against high bus fares and rents under apartheid governments- was made finance minister. He has been finance minister now for 13 years, and only resigned when President Mbeki resigned after losing the leadership election of the ANC. In the early years he controlled government spending to pay off South Africa's tremendous debt. He brought down inflation and built up foreign reserves. After the election of Jacob Zuma, another ANC veteran, supported by young black people, in September 2008, and his likely win in the current election, it appears that Zuma will retain Trevor Manuel. This ensures continuity in the face of the global recession, especially hitting commodity producers like South Africa. South Africa compares favorably with Nigeria in economic growth and modernization, spread of mobile phones, computers, literacy rates, but suffers from high unemployment, and low life expectancy. Pressures are increasing to do more for unemployment, address the crumbling infrastructure, and provide more help to the poor. Zuma has the support of the unions known as Cosatu and the Communist party, and of young blacks, in a country where one third of the population is under 15 years of age and over 40% of the population has mobile phones. South Africa has the largest economy in South Africa, is larger in land mass than Nigeria, has about 45 million people - a third of the population of Nigeria with 127 million population which has fertility rate of 5.6 twice that of South Africa- and GDP of 213 billion compared to $72 billion for Nigeria. Literacy rates are 82% for S. Africa and 68% for Nigeria, showing that higher literacy rates are lowering fertility rates and population growth. The figures are from the 2007 Economist pocketbook World in Figures. A strong press and media provides check on corruption which siphons away development funds in the public sector in commodity dependent countries like Nigeria. The private sector controls commodity exports of South Africa. So even with the relative lack neglect of the poor and unemployed in South Africa, and of health care, South Africa has done better overall than Nigeria. Average annual inflation was 5.1% in South Africa, compared to 15.7% in Nigeria, and this hits the poor the hardest. It goes to show that when it comes to modernization it helps to be inclusive, reconciliation oriented, and bring together all the resources of the country including a vigorous press and media, and business, regardless of color, race, creeds, faith, tribe or caste....

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What oil analysts would like to know about the Khurais oil field in Saudi Arabia is can it deliver. This is the Saudis big effort to sustain and increase oil production as other fields are aging and declining. The Saudis would like to see it add 1.2 million barrels a day to its current production of 11 million barrels a day. no date is set for when this oil field will come on stream and how much of the 1.2 million barrels a day will become reality. The Khurais field has been sitting there for many years while the Saudis tapped the Ghawar field just 60 miles away because of the complexity of the Ghawar field which situated deep within the rocky layers of the earth and dunes. Its been described as a hard sponge compared to the wet sponge that Ghawar is. The natural pressure is not enough to bring the oil up so natural gas or filtered salt water would have to be used. As natural gas is needed for soaring power generation needs filtered salt water will be brought from over 120 miles away from the Persian Gulf through pipes to Khurais and more than 100 injection wells have to be drilled so that 2.3 million barrels a day can be pumped down in a manner that would push the oil up but not kill an oil wellby going through a rocky fissure. All this has to understood through geologic mapping of 2700 square miles down to the microdetail for an area the size of Connecticut so that nothing goes wrong. 2.8 million 3-dimensional images of underground strata to trace any fractures in the rock that might cause trouble and building of models to simulate how the oil field may respond to water injection. The production would have to be monitored from Dhawan where the central monitoring facilites are for Aramco. Aramco the Saudi Oil company brought in for oil field services Foster Wheeler as project manager, Halliburton for drilling wells, Eni SpA's Saipem unit for water injection work, in the plan developed in 2005 with estimated cost of $6 billion. Halliburton is drilling more than 300 wells that go over a mile deep and then branch out horizontally, and 125 water injection wells. Nansen Saleri who heade reservoir management for Aramco and headed the Khurais revitalization effort is now running his own firm in Houston. He described it - the trick is to understand Khurais down to the smallest detail. This is a picture of the complexity and the resulting uncertainties of Khurais. A former head of Aramco oil exploration Mr. Husseini who retired 5 years ago says its quite possible that Aramco may achieve its target of 1.2 million barrels a day but isn't sure that production can be sustained at this level and what it might cost. Khuransiyah project was expected to generate half million barrels a day by 2007 en but is a year off schedule and many projects are running late from a shortage of steel and manpower. It used to cost $4000 to add one barrel of capacity through the 1990's now its estimated by experts to cost closer to $16,000 for a barrel added. So when will Khurais come on stream? And will the even more difficult Manifa field in the Persian Gulf come onstream? Its not certain. meantime oil reached 119 dollars a barrel. But analysts will be sure to watch this one and the new fields in Brazilian offshore waters to bring prices down just as conservation kicks in and global demand slips a bit from the super heated growth of the last few years especially from Asia. ...

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Russian economy is faltering under the strain of the global financial crisis. The stock market is plunging, with the RTS Index down 19% on October 6, 2008, and the market down 60% since the high in May, 2008. Construction spending is winding down. Th economy growth rate was 8.1% in 2007 but its slipping. If oil prices hit $50 and they were already at $78 on October 10, 2008, then says Anders Aslund at the Peterson Institute for International Economics in Washington, there will be a sharp decline in the growth rate. Moscow analysts say the growth rate could drop to 4%. For Americans Russia may seem remote excpt for investors. But in a global economy there are connections to emerging markets and Russia is one big emerging market, next to China, India and Brazil. When General Motors shares dropped 31% and Ford's 22% on one day on October 9, 2008, the news that spooked the markets was ofcourse a credit watch and questions about liquidity from Standard and Poors rating agency, but alsoimportant was that the one bright spot for GM and Ford in Europe and in Russia in particular was disappearing as GM sales declined in Europe and in Russia. In the prior 12 months GM had seen sales jump by 40% in Russia giving it 10% of a car market that passed Germany recently as the largest car market in Europe. Couple of important things about Russia. Russians today are big spenders, savings are small and Russians do not trust their banks so bank deposits are very low. Household deposits are equivalent of 17% of GDP, compared with 45% in the USA. Only 4% of Russians trust commercial banks according to a poll by National Financial Research Agency in Moscow. So Russia depends on the outside world for much odf the cash flowing through its financial system. Foreigners purchased two thirds of the $170 billion in bonds isued by Russian companies and foreign banks put up half of the accumulated $900 billion in bank loans including almost all longterm debt estimates Moscow investment bank Troika Dialog. With global credit markets in a lockdown mode Russia is simply running short of cash. The government has $560 billion in foreign exchange reserves from years of high oil prices plus $160 billion in two sovereign wealth funds with most of this money in fixed income securities abroad as a rainy day cushion should oil prices tumble. On October 7 the governmet announced $36 billion in emergency loans to Russian banks following earlier pledges in September of $150 billion in loans and relief for Russian companies in danger of defaulting on international debts. One danger here is that about 55% of outstanding corporate loan are of maturity less than 1 year. One of Russia's largest developers Mirax Group is putting 50 projects on hold as bank financing for developers has almost ceased. On the other hand Russia's financial sector is relatively small and the credit crisis cannot hurt Russia as much as it will USA ad Europe. Bank loans account for 10% of corporate finance and the bond market is only a decade old, so about half of all capital investment by companies comes from retained earnings. And Russia has huge needs for investments in infrastructure after years of underinvestment, a stable political structure, an educated workforce, and an economy that is just getting started. As Secretary Paulson answered questions after the G7 meeting October 10, this was another point on the minds of the secretary and questoners, the hope that emerging markets like Russia, India, and China would continue to grow though slower than before, even as the US and Europe slipped into a long recession, and provide a little cushion to the global economy....

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New ways to price drugs based on how well they work for patients.

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After the Phase 1 trade deal with China led to cancellation of new tariffs on computers, mobile phones and the remaining products imported from China, tariffs are still in place on $370 billion of imports from China. President Trump says China agreed to import $32 billion of agricultural goods, with the figures reaching $50 billion in 2020. The prior high was $26 billion in 2012. This comes as a big relief for the agricultural farm sector which had 24% more bankruptcies in 2019. Farmers are now more likely to vote for president Trump as they did in the last election. In addition China agreed to buy $200 billion more of American goods over the next 2 years. This combined with the USMCA agreement to replace NAFTA, for North American trade, is good news for president Trump and for the U.S. economy for 2% annual growth. The S&P stock index went up by 29% in 2019. The big concession by China is its agreement to agree to penalties if it does not keep up its part of the bargain.  Intellectual property protection remains a challenge and Mr. Trump may have decided to take a tactical success and shore up his base of farmers and small business people before taking up these issues in the future. China for its part may have decided to make a tactical move of its own as it has nothing to lose in importing more farm products from the U.S. in exchange for being able to continue to make the computers, iPhones and tech products it manufactures, just like before. China has not conceded much in terms of its goals set  in "Made in China 2025." Both sides are taking a much needed pause to consolidate their positions, as the fundamental differences remain to be tackled. Huawei and Chinese technology issue remains as before with the U.S. wary of China's technological gains in 5G telecom equipment and keen on building and protecting America's technological advantage in future trade relations. ...

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This report says fewer jobs alone is not going to reduce inflation, US inflation is propelled by factors beyond economic theory. The Phillip's Curve is a inverse relationship between unemployment and inflation that was a convenient tool for the 1960's to get the economy to do well with low unemployment at 4% with moderate inflation. It was torn apart by high inflationary expectations in the 70's. In today's world Robert Gordon of Northwestern University suggests central banks consider inflationary embedded expectations, supply shocks and cost push as in the pandemic 2021-2022, and demand changes. The job that Mr. Powell at the Fed has is lowering inflationary expectations by reducing private sector investment and job creation by raising the cost of capital through interest rate increases. Yet today the government is a huge partner in capital investment for America in clean energy and infrastructure building which means job creation remains strong as it has in America. President Biden's effort to reduce pharmaceutical costs and for inflation reduction by fighting price increases through stealth fees, has at the same time cut into inflation. So as lower demand and increased supply in 2022 as the government better manages the supplies of energy, including release of oil stocks from the national reserves. Explained- The Phillips curve is an inverse relationship between unemployment and inflation observed by a New Zealand economist William Phillips in a paper in 1958 based on British unemployment and inflation data1861-1957. Economist Robert Samuelson turned it into a textbook concept as a simple tradeoff in 1960 more inflation gets you less unemployment- which fit the period of the 60's- but warned that it could change over time. Milton Friedman and others during the 1970's period of high inflationary expectations setting rejected it. In reality Mr. Phillips never meant for economists like Samuelson to generalize from his statistical observation of data on the British economy before 1958 and apply it to the US for the closing decades of the 20th much less the 21st century. ...

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Millions of people who are first time users for whom affordability is an issue in countries from Nigeria, Ivory Coast to India, Indonesia, are connecting to the internet. This time not with smartphones made by Samsung or cheaper Chinese smartphones made by Xiaomi or Huawei, but by using a new smart feature phone that cuts down the price such as the Jio phone by Reliance Jio in India. This costs only about $25 compared to $100 to about $300 for lower cost smartphones These phones provide basic features, some apps, messaging, internet access at low cost. About 3.4 billion people without the money to buy costlier smartphones are turning to this just like people did 20 years ago with lowcost Nokia basic phones until smartphones appeared. Monthly cost for mobile data access to internet is $2.50 a month for all the mobile data he needs or Rs. 1750. Batteries last for days in countries where electricity is unreliable. A fruit vendor in New Delhi makes $80 a month or  Rs 5600. A Jio phone fo him costs Rs 1400 compared to paying Rs 7000 or $100 for a Chinese smartphone. Reliance partnered with Hong Kong's KaiOS Technologies Inc. which makes the most widely used operating system powering smart feature phones. Jio sold 60 million Jio phones and 370 million such smart feature basic phones are forecast to be sold in 3 years by 2022. Reliance Jio is being imitated by others. Orange SA of France has launched an inexpensive smart feature phone bundled with inexpensive mobile data plans in Ivory Coast, Burkina Fso and Cameroon and plans to put this in other former French colonies in Africa and Arab countries. WizPhone plans to introduce a $7 phone in Indonesia. KaiOS is working with Brazilian manufacturers to roll out cheap phones there.  In advanced countries Nokia is offering revamped versions of its candy bar shaped phones with added web access to enthusiasts. These cost $100. A whole new group of people who could not afford a smart phone are now being connected after Jio's pioneering effort in India. ...

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Jason Zweig interviews John Bogle, founder of the Vanguard Group, in September 2011, after weeks of extreme volatility in the U.S. stock market. He says the index fund concept has been "bastardized" by exchange traded funds and the speculative behaviour in ETF's with insane turnovers approaching 10,000 percent. He considers investing in a balanced portfolio of stocks and bonds a useful way to approach investing even though the last decade has produced medicore results. And predicts a 7% return for the next decade, with money doubling every 10 years. The changes today mean you have to start earlier, save and invest for longer periods, says Bogle, but the returns should still be good. It would be insane to expect the high returns of the 70's and 80's today, says Bogle. In today's market Bogle has 80% of his investments in bonds and 20% in stocks.

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Jean Brunel, chief investment officer at GenSpring, says expect returns of 2-2.5% on bonds and 5% on stocks and not much higher in the next 5 years. He points out that with low rates the whole investment environment has changed. The consensus among investment managers is that it is a good idea to lower expectations and not chase risky returns in the next couple of years.

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Francois Hollande becomes the first Socialist candidate to be elected president of France since Francois Mitterand 17 years ago.