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The startling truth about health "reforms," - they won't control spending, and without that the whole system of health care will rapidly become unaffordable and unsustainable. Obama's Council of Economic Advisors points out in new report that since 1975 annual health spending per person, adjusted for inflation has grown 2.1 percentage points faster than overall economic growth per person. At this rate health spending which was 5% of the GDP in 1960, and is 18% of GDP today, would grow to 40% of GDP in 2040. Medicare and Medicaid would increase from 6% of GDP now to 15% in 2040, or equal to three fourths of federal spending. Employer paid insurance premiums for families which grew 85% in inflation adjusted terms from 1996 to $11,941 in 2006, would increase to $25,200 by 2025 and $45,000 in 2040. This would force employers to reduce take home pay. Samuelson says the uncontrolled health spending is singlehandedly determining national priorities, reducing discretionary income, raising taxes, widening budget deficits and squeezing other government programs, while it is producing large amount of waste in medical spending. See the link to Prof. Tyler Cowen of George Mason University in NYT, 6/14/ 2009, who cites the habit of doctors to write many expensive tests as one of the prime culprits in the wasteful spending. And in the process it delivers higher cost for lower overall quality of health for the American people. This at a time when many European countries provide live examples of doing it in a better way- lower cost, better health. The serious problem with the Obama health reforms says Samuelson is that it talks about restraining spending but may end up increasing spending. Its talk about controlling spending he says is good intentions, but based more on hopeful thinking, public realtions and risks becoming cosmetic reform. Because to really control spending will require coming to grips with its fundamental cause- hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, private or governmental. Such a system encourages doctors and hospitals to provide more services, expensive tests, favors heavy use of expensive medical technologies to increase profits, and for patients to expect them. Samuelson puts his finger on the root of the problem - there is no incentive and every disincentive for all the players in this game , doctors, hospitals and patients to seek reform of this system. For doctors and hospitals the hope would be that this cosmetic "reform" would leave the system basically unchanged, and patients to continue with a lifestyle and expectations that do not not acknowledge the fact that a lot of healthcare does not come from spending but from preventative care, education, good eating and exercize habits, and healthy lifestyles. And the uninsured are no exception, they would simply start consuming the expensive care for lower quality of overall health like everyone else. With this kind of situation confronting us, the views of Samuelson, and Professor Tyler Cowen of George Mason University, as welll as a growing chorus of informed public opinion on this subject, is that insuring the uninsured is a good idea, but doing it within the bounds of the present system, can only increase the costs. And too much is at risk, to rely on what Samuelson calls a scattershot of measures to control costs made up by Congress such as "evidence -based guidelines," "electronic record-keeping," "bundled payments to hospitals, to give the illusion of progress that won't make a serious difference. A sweeping restructuring of health care is needed, that would overhaul "fee-for-service" payment and reduce the fragmentation of care. It will also need what has not even be touched on adequately in the debate. This is the massive need for education in the schools about nutrition, eating, exercize, healthy lifestyles. It would also require opinion leaders in each field from sports and other fields to lead by example and with constant public presence, the media, and companies to form a partnership with private institutions to change existing eating habits and lifestyles that encourage obesity, smoking, fast food eating habits, large portions in restaurants....

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The failure of the Supercommitte in the U.S. Congress by the Thanksgiving deadline will not have any immediate consequences. This is because automatic spending cuts that are supposed to go into effect if the Supercommitte fails, do not go into effect till Jan 2013. This gives Congress another year in which to come up with necessary deficit savings. This is a major reason the two sides divided on major issues from the extension of Bush tax cuts and tax increases, and facing pressure from their party's interest groups and voter support groups, have no special incentive to reach a compromise. Such a compromise also means politicians taking the political risk of not being reelected. Another dynamic that is in play in November 2011 is that interest groups in the Republican and Democratic parties both now see the "sequester," as the automatic cuts are described, as a better alternative than any bipartisan agreement that cuts health and retirement programs. For anti-tax groups, the automatic cuts are better than a deal than includes tax increases. Sen. Rand Paul (R-Kentucky) says: "We promised tax cuts. And I think we need to have cuts." For liberal groups, the trigger or sequester for the 2013 automatic cuts is better than a deal that cuts health and retirement programs. The trigger for automatic cuts will cut agency budgets, but spending for the poor and the elderly -including food stamps, Medicaid, Medicare- is exempted. Eric Kinson, co-director of the Strengthen Social Security Campaign, says no deal is better than one that is flawed, the extra time gives the country time to pause and think about the alternatives....

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The Bank of Japan reduced interest rates by 0.2 %, from 0.5 % to 0.3%, lowering the overnight lending rate. Citing higher energy prices and lower export demand it lowered the growth forecast to zero for 2008. This is the first time in 7 years that the Bank of Japan is doing this. Japan has never recovered from the real estate and stock market bubbles of the 1980's and interest rates in Japan have been at levels near zero for many years. With low interest rates and a huge deficit Japn has few options left. The small nature of the rate cut is unlikely to increase borrowing or stimulate the economy say experts, but is more of a symbolic move that Japan will coordinate its efforts with other global economies. Even so half of the governing board voted for and half against this cut with central bank governor Maasaki Shirakawa casting the deciding yes vote. Upto now Japn's significant help has been in the form of suppplying yen and dollars to money markets to ease the global credit crisis. Another move is a $51 billion stimulus package that will give income tax rebates to households. Japan would like to pick up the slack in global growth from USA's weakness but is unable to do so because like other Asian economies its growth is export based with low consumption spending at home. This is true also of China and China's need for infrastructure spending is not as great as it once was leaving imports of machinery at lower levels, which gives less support to export driven growth from Germany or the USA....

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Pearlstein points to the need for the structural changes in the U.S., Europe and China to address the serious imbalances that are at the root of the problem. This process will be painful and mean a short term drag on the economy even if the right actions are taken. The process of unwinding the imbalances will take time. Lower growth in China will be good for the bubble in real estate markets and the reduction in the trade surplus, even though this will reduce imports of European and U.S. machinery. Higher savings in the U.S. and reduction of consumer debt will slow retail sales but this is healthy for longer term growth. The same is true for savings in deficit reduction that will result in more layoffs at the local level. The government needs to have similiar action take place at the banks to end their "extend and pretend" practices and finally write off bad loans in residential and commercial real estate. There is no easy way out, no solutions that can be made without a sharing of the pain. Policy makers around the world have tried to look for painless solutions for years and this may be the end of the road. There is some action that the governments and central banks can take. Pearlstein suggests that the European Central Bank buy up some of the sovereign bonds being dumped on the market even if it means printing money. The Fed, the Bank of Japan and the central bank of China can also swap some of the Treasuries they own for European sovereign bonds. This would give time for the EU leaders to give the European Financial Stability Facility the resources and powers to replace the sovereign bonds with more reliable European bonds. The Fed can take this opportunity to sell some of its huge pile of Treasury bills into the market so that it has more room for action in future years. The U.S. government can move up the spending for infrastructure in years 8, 9, and 10 to the next 2-3 years to give some support to the economy as these changes take place. The spending decisions should be left to an independent Infrastructure Bank. See the related article by Krauthammer in the Washington Post, August 5, 2011, which provides a companion policy prescription for U.S. deficit reduction based on the work done by the Bowles-Simpson Commission and by preserving efficiency and fairness....

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Applebaum describes the accounting errors in the Trump 2017 Budget which makes unrealistic assumptions of 3% growth to show higher revenue generation of $2.1 trillion over ten years, and uses that revenue to fix higher deficits from tax cuts- counting the same number twice. A former Treasury Secretary, Lawrence Summers, calls it the most egregious accounting error he has seen in 40 years.

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David Wessel says there are three hypotheses about the slow recovery with growth of 1.9% in the first quarter of 2011, estimated growth of 1.4-1.5% for the second quarter. The first, is that this is transitory, with gas prices, Japan's tsunami disrupting supply chians, and Europe's poor handling of the financial crisis. This he scores as wishful thinking. The second, that the stimulus was too small, the need for a second stimulus, or the related hypothesis of the large uncertainty hanging over business, including the debt ceiling negotiations, deficit etc. This he scores as more convincing, but one is not sure different policies would have led to a different situation. The third hypothesis is that the underlying diagnosis of the economy itself was hopeful but flawed and wrong. Hope about the housing market- which has been proved wrong. The same for exports, or consumer spending. Wessel cites Ken Rogoff and Carmen Reinhardt's new book on the afterperiod of financial crises and asset bubbles, with data going back to many historical periods showing that the periods following crises are difficult having protracted periods of slow or marginal economic growth....

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Chile is relatively better off than other Latin American economies because of the $20 billion in its sovereign wealth fund. This helps the government carry out astimulus of $4 billion. This includes additional $1 billion in investments for state owned copper company Codelco, $700 million for infrastructure projects, extra benefits for poorer Chileans, temporary tax cuts for small businesses. Government spending will rise by about 11% in 2009. Public debt is minimal at 4% of GDP in December 2008, and the fiscal deficit for 2009 is estimated at 2.9% of GDP. The copper prices have dropped by two thirds, but the decision to save much of the reevenue gained when copper prices rose is now showing up as an extremely wise decision and one that is critical for crisis prone Latin American economies. Inflation that rose to 9.9% for 2008 to October to 7.1% in December, and should fall witin the 2-4% range says one economist by the end of 2009. In addition to the other moves the government has given a$500 million capital boost to BancoEstado, a stateowned bank which is Chile's third largest bank, to support expanded lending for mortgages and small businesses.. ...

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The lack of trust in negotiations on the terms of spending cuts between Greece and EU ministers in February 2011. In difficult exchanges between German finance minister Schauble and Greece's finance minister Venizelos, Schauble criticized the Greek government for not beginning negotiations for reduction in the minimum wage. EU ministers at a meeting with Venizelos on Feb 10, 2012, showed a distrust of Greece's figures on austerity cuts and asked for an additional $428 million in cuts to make up for the refusal of Greece to cut supplemental pensions. In Greece five ministers in the Greek cabinet resigned in protest over the conditions set by the troika of the EC, ECB and the IMF, just as unions launched a 48 hour strike in Athens. Greece is in the fifth year of a recession with unemployment at over 20%, making sharp cuts more painful. A shrinking economy makes achieving budget defict targets even more difficult and worsening the debt situation.

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Brazilian President Lula's interview witht the Economist, just before leaving office. It is not still clear how Lula will be seen, even though his popularity at the moment is helping elect his chief of staff Ms. Rousseff, as his successor. Lula's success in office is seen as a continuation of the policies of President Cardozo, who helped tame Brazil's inflationary crisis. Lula has benefitted from the continuation of the policies of his predecessor, and also from the boom in exports to China for soya, metals and other exports. By helping expand Brazil's middle class and the aid to poorer segments of society with the Bolsa programme, he has earned credibility and wide popular support. The dangers lie in the areas of an extremely overvalued currency- see the link to the Brazilian currency Real- with the Real at 1.7 and analysts with computer models showing the Real really worth 2.65 dollars. Part of the problem is government deficits to finance increased spending which require inflow of foreign capital and higher interest rates. Brazil is very dependent on exports to China for the increased level of growth, this poses risks if China's growth slows as expected from the high growth rates of the past. This poses risks for the level of infrastructure spending the Lula and Ms. Rousseff goverments plan on developing. Brazil's educational system is weak and efforts to improve this under the Lula government have not produced results. So the longer term assessment of the Lula goverment will have a balanced score card of wins and losses, without the euphoria of the moment....

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The moves by the Obama administration and the national feeling and mood, its views as taken in poll of 998 adults by CBS News/New York Times. On taxing those above $250,000 income levels at higher rates- 74% of respondents support it. On populist sentiment - 71% say Obama cares more about ordinary Americans than for large corporations. On the vast expansion of spending and programs 48% prefer smaller government and fewer services and 41% favor bigger government and more services. On spending to stimulate the economy at the risk of higher deficits- 45% support this. On the budget proposal- 56% support it, but 79% of Democrats like the priorities, only 27% of Republicans like them On helping banks recover- 29% supported this in Feb, 47% support this now. In the freedom to use his own judgement at a time when Republicans have rejected almost everything he does- by three to one people say they trust Obama to make better decisions about the economy than Congressional Republicans. This includes one quarter of Republicans, which is significant in giving President Obama the room to use his judgement of what is best and take aggressive action where necessary. This aggressive action may be necessary if taking over some failed or insolvent banks is considered to be the best option, and President Obama's advisors like Mr Axelrod must be taking notes from this poll by CBS News/New York Times. On security, on safety- by tqo to one people say they trust Obama to keep the nation safe. ...

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The European Union Commission says Ireland must recover 13 billion euros in back taxes for giving tax preferences to Apple that are against EU rules. The EU Commission says Ireland allowed Apple to pay a corporate tax rate of 1% on its European profits in 2003, and .005% in 2014. The EU Commissioner says the use of Ireland as the place where Apple pays taxes on operations in Europe has no base in reality, as most profits are earned in other countries outside Ireland. Taxable profits of Apple "did not correspond to economic reality," according to Ms. Vestager, the EU Commissioner.  In the current environment where political upheaval is unsettling the democratic process in the U.S., Britain, Spain, France and Italy, as well as in Brazil and other countries in the developing world- because of deep recessions, and efforts to cut the deficits with deep cuts in state spending including in education and healthcare, basic services- the moves by companies to reduce taxes to these absurdly low levels such as .005% when other companies in the EU are paying 12.5%, is becoming increasingly unpopular. As pointed out in this BBC News article this sounds like the way Carnegie, Rockefeller and Vanderbilt operated during the late 19th century, and were seen as operating in a manner that was above the law. Janet Yellen pointed out at a Boston Fed Conference on inequality in Oct 2014 that the bottom half of the distribution or 62 million households in the U.S. in 2013, had a net worth of about $10,000, One quarter of these households had a net worth of zero dollars. The working class and blue collar workers in the U.S. provide much of the support at Trump rallies. Younger college educated people support Sanders, because of the situation of the working and middle class in the U.S., and a similar situation exists in Europe. It is for the sake of the democratic process and delivering services in education, healthcare, and other basic areas to all, that companies small and large need to pay their fair share of taxes, regardless of size, influence, or technological advantages. Today this is is seen by most leaders who draw public support as the right way forward for the U.S., Latin America, Europe and Asian countries, including proper allocation of resources to best serve the needs of working people. For example the 13 billion euros is equal to all of Ireland's healthcare budget, and 66% of its social welfare budget.    ...

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The U.S. Federal Reserve announced on Dec. 13, 2016, that it would increase its benchmark short term interest rate by 0.25 percentage point, to between 0.50% and 0.75%. The increase will also be reflected in business and household borrowing costs. The Fed also announced its intention to make 0.75% percentage point increase in 2017, possibly in 3 quarter percentage point moves. The Fed's forecast is for the fed-funds rate to reach 2.1% at the end of 2018, and 2.9% at the end of 2019. The Fed's policy is based on a sense of strong labor market with unemployment falling, and says it is based on discussion at a 2 day meeting, and "in view of realized and expected labor-market conditions and inflation." This reflects a view that there is now not that much slack in the labor market, that further improvements could trigger higher inflation. Fed forecasts for inflation are for it to increase from 1.5% in 2016 to 1.9% in 2017 and to the target of 2% in 2018. The unemployment rate of 4.6% in 2016 is forecast to go to 4.5% in 2017 and remain at that level till 2019. Economic growth is forecast at a median annual rate of 1.9% in 2016, 2.1% in 2017, only a slight improvement from last forecast in Sept. 2016. Support for chairwoman Yellen's policy decision was unanimous. See the link on views of NYT's Binyamin Applebaum and Neil Irwin on how Fed rate policy and economic growth under the Trump administration is likely to play out, and Ian Talley's report on impact on exports with a stronger dollar in WSJ. These views also are in line with the Fed's forecasts and policy decision as they reflect the concerns of the Fed about inflation, and also reflect the Fed's view that growth will be close to 2% in 2017-2019, and not the 3-4% stated by Trump and Treasury Secretary Mnuchin. Fed rate policies to keep inflation at about 2% tend to counter stimulus spending by the Trump administration and effect of tax cuts. The size of the stimulus and the tax cuts are also likely to be much smaller than stated because of Republican concerns about the deficit in the U.S. Congress, according to these views. The stronger dollar also has the paradoxical effect of making trade gains more difficult while increasing trade friction in tougher bargaining supported by Trump, making the higher growth targets harder to reach.   ...

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This article in the Economist magazine says Brazil's new president Michel Temer, once impeachment proceedings lead to the resignation of Dilma Rousseff, is only slightly less popular than her. Polls show 58% of Brazilians say Temer should be impeached close to the 61% for Rousseff, and his party is also affected by the Petrobras corruption scandal. Brazil's large trade unions supporting the Worker's Party of Rousseff see it as a "coup" or "golpe" and promise strikes, combined with large street protests, this comes as the country faces a second year of falling GDP at 3.8% according to the IMF. Brazil has a budget deficit of 10.8% and needs changes in public spending, including pension reforms, which are unlikely under Temer or his party the PMDB, or under the PMDB's Mr. Cunha. Some experts see the change in Brazil as part of a broader shift in Latin America, that happened in Argentina recently with the election of Mauricio Macri as president, towards governments that move to the centre in politics and reduce state intervention in the economy to stimulate growth. This is unlikely to happen in the short run, with society deeply divided and the area in front of the Brazilian Congress cordoned off to separate the opposing factions and rallies of political supporters....

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The view of regional Fed presidents indicates that the Fed may take a pause from any further intervention in financial markets. QE 2 was launched at a time when the government was at a deadlock for any further stimulus, and a deflationary trend was setting in. In August of 2010 inflation was on a downward trajectory, from 2.8% to less than 2.2% in a few months. A New York Times article by Paul Krugman pointed out the dangers of deflation. Alan Blinder argued for the need for Fed action with the deadlock in government over further stimulus in another op-ed in the Wall Street Journal at the time. The political deadlock continues with pressure to cut federal spending to reduce the deficit, reducing the chances of government support, and leaving the Fed as the sole source of support. The Fed initiated QE 2 in Novemeber 2010 when consumer prices were up 1.1% from a year earlier, and far below the Fed's 2% goal. In April 2011 consumer prices were up 3.1% over the prior year. Current TIPS prices suggest investor expectations of inflation of 2.8% over 5 years. Another deflationary trend could lead the Fed to take some sort of action in the presence of a political deadlock for government action....

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Many of the achievements of Jindal in the areas of education, and competitiveness and health care and infrastructure for the state of Louisiana are now at risk because of an anticipated deficit of $2 billion in state revenues for 2009 and in the current year the $865 million surplus has evaporated and turned into a$365 million shortfall all in a short time. The state budget used afigure of $84 abarrrel for oil in calculating the state's revenues related to oil revenues generated in the state from offshore drilling but with oil at $40 a barrel things are not lookin good. The total intake from oil and gas from royalties and leases accounts for 17% of the Louisiana state budget. The state rolled back atax increase and increased expenditures on much needed higher education and health care and infrastructure spending. Louisiana needed these programs because it continues to lose people to migration and is the only southern state to do so. The expected cuts are $109 for education and an additional $160 million for health care cuts much from Medicaid. It also shows how quickly things can change for states that are overdependent on natural resource revenues and in this deep downturn for a range of states from California, to New York to Louisiana....

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The shift away from Iranian oil with U.S. pressure and sanctions, and higher oil prices, could pose challenges for the Indian macroeconomic outlook in 2020.

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According to U.S. Senate investigators Apple recorded $26 billion, 65% of its income worldwide for 2012, in Ireland. Ireland Operations International is based in County Cork, Ireland. Ireland has about 4% of Apple's worldwide workforce. Laws in the European Union allow digital companies such as Apple and Google and other large companies to pay little in taxes through such arrangements. Apple CEO Cook says Apple is not using any tax gimmicks. Apple negotiated a low 2% tax rate with the Irish government. The Senate hearings in the U.S. and a meeting of EU leaders has raised concern about this practice being allowed at a time when much needed infrastructure investments are being shelved in the U.S. and Europe because of budget deficits. Spending cuts in education and in R&D hurt long term economic growth. Government statistics show the average Ireland tax rate on gross income of companies in 2010 was 6%. Ireland has a low corporate tax rate for companies of 12.5% which it retained after EU pressures to change the rate when the Irish bailout was provided. Ireland has 4000 Apple workers, and 600 American companies employ 100,000 Irish workers....

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Krugman says voters in France, Greece, the UK and other countries are protesting against austerity measures imposed in the EU countries. The policies were based on the assumption made by the Chrisitian Democrats in Germany that the German model if applied in other countries would generate the kind of recovery Germany made in the last decade from the high unemployment under chancellor Gerhard Schroeder. German wage restraint agreement between unions, industry and government made this possible under the Hartz reforms, and France is already embarking on wage restraint, with the two major parties, unions and industry backing the plan. But for this to work France and other countries such as Spain and Italy have to be able to export to Germany or other countries. German workers are suffering from stagnant wages for many years, stemming from concessions made to reduce unemployment. Allowing wages to rise in Germany when there is a shortage of workers in industry, would benefit workers in Germany and help France and other EU countries increase exports. German industry is failing to make this normal adjustment in markets by insisting on smaller concessions, even though there is support within the government for higher wages. German growth was possible because of demand outside for its exporters. The "austerity measures" Germany supports would depress demand inside the domestic economies of France, Spain, Italy and other EU countries, and without the wage and inflation adjustments with Germany leave demand weak outside. Without needed demand output falls, unemployment rises and tax revenues decline, leaving deficits worse than before, and a dangerous downward spiral. Better management of finances as Germany has insisted has ceased to become the issue, as both Hollande in France and Rajoy in Spain, and Monti in Italy, are keen on getting control of finances, especially regional spending in Spain....