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Senators Mike Lee of Utah and Jerry Moran of Kansas declare their opposition to the Republican Health Care bill proposed by Senator McConnell. This decision by the two senators makes it impossible to begin debate on the bill. Earlier two other senators, Susan Collins of Maine and Rand Paul of Kentucky announced their opposition. This means the Republican health care bill has no chance in the Senate even after changes to the bill passed by the House of Representatives. Republicans have a thin majority in the Senate make it difficult to pass legislation. Collins met with residents in Maine and Moran with people in his home state of Kansas, and both senators heard a lot about the negative effects of the Republican bill on people in their state. The bill is seen as hurting people in rural areas, elderly, and not likely to do enough to bring down premiums. Its plan to slash Medicaid spending has drawn strong opposition from all Democrats.

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Not since the days of the Vietnam War has Madison, Wisconsin seen the kinds of demonstrations that were seen last week. This raises a question whether this creates an awakening of the progressive movement. Wisconsin, New Jersey, Ohio, seem to suggest that whats happening in the states will become more important in shaping public opinion as the U.S. elections of 2012 approach. Ohio also has a plan by Governor John Kasich that restricts collective bargaining rights of public workers. A key question is how much public support there is for reduction of pension and health benefits of public employees. Even though the favorable ratings of unions are at a low, according to a survey by the Pew Research Center, the public is divided over whether it supports unions or state governments in disputes about benefits, with slightly more support for the unions. And other states such as Michigan with new Republican governors and majorities in state legislatures say they are not taking the path of Wisconsin in limiting collective bargaining rights, suggesting caution in this respect, even as they plan cuts in benefits. Because of the intensity and passion that has been aroused something more than the calculations of the politicians, including the President, may be at play. President Obama, says the Washington Post, is playing a longer game on the budget, with a measured response, but also saying that teachers, firefighters and police officers were being vilified. The demonstrations in Wisconsin were more bottom up than top down, and have the potential to affect the political dynamic and the way the U.S. addresses its problems in unpredictable ways....

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This WSJ article provides a detailed account of the positions of Clinton and Trump on Wall Street, the financial industry, banks, Dodd-Frank, regulatory reform, 6 weeks before the U.S. presidential election.

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Are there costs or are there savings from the Obama health care bill? Does it affect jobs and how? The Congressional Budget Office says the health care law will save $230 billion in ten years based on a whole set of calculations and assumptions. Commonsense and basic math leads others to question how spending $930 billion on insuring 32 million Americans could end up with significant savings. The different view argues that the Budget Office erred in making some calculations, by counting $70 billion in premiums from long term care because they would be used to pay benefits later, omitted $115 billion in spending to adminster the law, and omitted $208 billion needed to prevent scheduled reductions in Medicare payments to doctors. The money needed on the Stimulus, on two wars in Iraq and Afghanistan, and the uncertain prospects of the US economy in the longer term till debt and other issues are resolved, injects the critical element of difficult choices and priorities. If state and local budgets are severely strained in 2011-2012 would that require federal help and will there be other needs that will have to be met by the federal government that are critical such as another unexpected downturn, or a resolution of unresolved bad debt at the large US banks There is also a sense that the health care law does not do enough to reduce the cost of health care that will be needed over the next decade so that other priorities are not neglected. Both parties are not up to the task in this respect for running the country's finances withot using the numbers to tell different stories....

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China bans smoking in public places in June 2015. The authorites say unlike previous bans before the Olympics this one will be enforced. The damage to public health is immense, with about one third of smokers in the world in China. Public spaces include restaurants, offices, bars, nightclubs, airports and trains. Included also are areas around schools and hospitals. There are 301 million smokers in China, according to the World Health Organization. About 53% of men and 2.4% of women smoke regularly, and this contributes to 1 million deaths from heart disease, cancer and other diseases. WHO estimates about 100,000 deaths from second hand smoke. About 28.1% of the population are smokers, based on the 2010 survey. The survey was organized by the WHO and China's Center for Disease Prevention and Control. The figure of 2.4% shows women are less affected than men by the damage done to public health. Women also are leading the way to fight smoking and effects of second hand smoke. People in Beijing already have to deal with the effects of pollution in the air they breathe, and are keen on eliminating the additional harmful effects of secondhand smoke added to this....

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Alan Blinder, Princeton University professor and former vice chairman of the Federal Reserve, says the biggest reason for the growing deficit in the years out to 2040 is because of increases in health care spending. Its not that there is runaway spending in other areas. He cites CBO projections that show other costs stable relative to GDP from 2015 to 2035 and declining. This is why healthcare spending is at the heart of the problem. And why tackling the deficit has a lot to do with reducing healthcare cost increases.

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ECM President Trichet described the euro's as sharp and abrupt and moves like that not being healthy. He said "brutal" moves like this were never welcome. He will hold ECB's rate steady at 4%. rising European rate and lowering rates by the Fed may have exaggerated the dollar's decline. The ECB will continue to inject credit to steady the credit markets with injection of 115 billion euros inlate November and early December are planned.The euro is now at $1.45.

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Samuelson points to the risks to the American economic growth from excessive health care costs. This is hurting take home pay and shows up in consumer spending. It is hurting government spending in other areas such as needed infrastructure spending and efforts to reduce the deficit. This hurts private capital investment to create jobs because of lower demand from constricted consumer spending. The U.S. budget has as its largest single expense 27% on health care compared to 20% on defense the next largest expense, with growth in health care spending taking this to one third of the budget in coming years. Without addressing health care, says Samuelson, the Supercommitte in Congress even if successful at deficit reduction will basically have failed to do its job, and it did not have the time, resources or conviction to do this. According to a new study from the Organization for Economic Cooperation and Development (OECD), U.S. healthcare spending per person is $7,960 per person in 2009. This compares with Norway $5,352, Britain $3,487, France $3, 978, an OECD average of $3,233. Life expectancy in the U.S. is 78.2 years, compared to Japan 83 years, OECD average of 79.5 years. Chile and the Czech Republic have life expectancy equal to the U.S. Except for cancer care where the five year survival rate is 89.3% in the U.S. and the OECD average is 83.5%, the U.S. lags far behind in much needed critical areas such as diabetes and asthma. Rates of emergency hospitalization for asthma are 3 times that in France and 6 times that in Germany and Italy. The U.S. has fewer doctors per thousand population and higher cost per medical procedure- with more frequent use of the costliest procedures- creating a supply shortage that induces higher prices, and less preventive and early action care through physician visits. The number of practicing U.S. doctors is 2.4 per thousand population in the U.S. compared to 3.1 per thousand for the OECD average; and number of annual doctor consultations 3.9 per capita in the U.S. versus 6.5 for the OECD average. Appendectomy cost $7,962 in the U.S., $5,004 in Canada and $2,943 in Germany. Coronary angioplasty cost $14,378 in the U.S., compared to $9,296 in Sweden, and $7,027 in France. Knee replacement cost $14,946 in the U.S., $12,424 in France, and $9,910 in Canada. Knee replacements, angioplasties and MRI exams are twice as common in the U.S. compared to the OECD countries. ...

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The view from Germany on Trump's economic plan and the need for changes by his advisors. DW.com's Wenkel says Trump needs to understand that 80% of job losses in recent years have come from not from globalization, but automation and higher productivity, rationalization. He says higher tariffs on Mexico could backfire.

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Andy Grove of Intel teaches a class at Stanford- he taught aclass earlier this year- and talks about his experiences. Some see Grove's disciplined management style as areflection of his experience escaping the Nazis from Czechoslovakia. Dr Grove says it comes from his experience at the CIty COllege of New York He recounts this in one of his books, where aparticular Professor helped mentor him but who was in the beginning very tough on the young Grove. Grove says that what impressed him most in those early years at City College was the way hard work and talent were rewarded and where students challenged their Professors without any attention to rank. Interestingly this is still true at many universities, and meritocracy prevails there. The opposite is true when one thinks of this at many corporations which gradually fall into astultifying mode where senior managers are not challenged and politics prevails. GM is a good example. Grove says he experienced this at Fairchild -where he worked with computer chip pioneers Moore and Noyce -with its elitist, back-stabbing and lax corporate culture. Senior executives at Fairchild walked in whenever they felt like, and younger employees were penalized or fired for similiar behaviour. When he took charge at Intel Grove imposed a strict arrival time of 8 am with latecomers forced to sign asheet. He also did not go along with trends like flexi-time and teleworking. He became known as ablunt and demanding manager, but afairminded boss who rewarded good ideas whatever the source. Asked about the strict arrival time Grove says that people don't understand that he was never that disciplined himself and he was not even amorning person. His view is that he wanted to avoid what he saw as aoutrageous double standard at Fairchild. With a better culture he was able to attract the best talent to Intel, and he used the strong discipline to improve the lousy manufacturing at Intel. Three decisions shaped Intel. The first, is the recognition of the strategic inflection point when current strategy is no longer viable, because unanticipated external forces make an existing business strategy obsolete. This happened when Intel got clobbered by the Japanese in the memory chip field it had dominated. And at such moments there are internal forces and inhibitions to overcome that make starting over or doing something totally different extremely difficult. For Intel this was the habit forming tendencies from having done one thing so well- the companies roots and the founders and engineering staff's knowledge and preferences lay in memory chips- such that that it became an emotionally stormy thing to break from this past. Grove made a complete U turn to go in another direction which he describes so well in his book -Only the Paranoid Survive. Timing is critical, and instinct and judgement is all that you have got to rely on. Its like a group of hikers in the woods and after suspecting that they are on the wrong track one of them says, "Hey guys I think were lost." Grove even describes the scene with acomparison to a scene in the World War II movie Twelve O'Clock High, where a new commander is called in to straighten out an unruly and undisciplined squadron of fliers in sel-destruct mode. The commander on his way to take charge, stops his car, steps out smokes acigarette while gazing into the distance. Then he he throws the cigarette down, grinds it with his heel and tell his driver "Okay Sergeant, lets go." Grove says he related to this scene in this decision at Intel, with every fiber of his being experienced this crisis personally, and learned what it takes to claw your way through a strategic inflection point, inch by excruciating inch. He says it takes objectivity, the willingness to act on your convictions, and the passion mobilize people into supporting those convictions. The second and third decisions was less gruelling but also courageous. The Intel Inside advertising campaign meant building abrand with customers even though Intel had never done this before. The decision to not have secondary suppliers and press the issue of manufacturing quality within Intel till Intel got it right also had never been done before. Andy Grove's strategic inflection point is what GM missed and set the process in motion towards bankruptcy. See the links in Intelilinks. The management style is also relevant to that discussion. Grove also provides insights in the Cross-Industry Insight Mechanism. He sees strategic inflectionpoints in autos and health care industries. He says the auto industry is going to be increasingly divorced from oil and the next big company will come in the auto battery technology field. He also believes health care and the pharmaceutical industry can learn from chipmaking. The clinical trials in pharmaceuticals take way too long, are slow-moving and bureaucratic. The pharmaceutical firms can learn from the fast "knowledge turns" in chipmaking, so that cycles of learning are accelerated....

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The party congress of the Communist party does not look like its going to lead to any changes in the system, only to make sure it runs better by getting public input through pollsters on public officials, and on web sites on new legislation. The pollster, including a firm, Horizon Group, describes his role as working out a mechanism for people to express themselves as there is very real frustration in society. Websites airing public opinion helped introduce nondiscriminatory clauses in the new employment legislation. But otherwise there is actually a tightening of the control of dissent, as the party is worried that once it starts it will get out of control and jeopardize the economic progress However this leaves the future quite uncertain as there is still not enough room for airing the very real frustrations and concerns such as for the environment, health and services, the prevailing corruption, and the problems in the countryside of the poorer regions in the interior of the country. These concerns are being pushed into the future. For instance without a free press its hard to air corruption cases, as in India. Only two of the several thousand petitions under the system of letters and complaints xinfang are resolved. About 12 million are received each year by the government. Because of the obsession with tight control many activists end up in prison even though the causes such as the environment are popular. Like the activist who called attention to the Lake Tai pollution, and the rural blind activist mentioned who argued on behalf of women that were forced into late term abortions. Here the government actually stepped in to announce plans to cleanup Lake Tai, but the system continues its inexorable push to drive out any dissent even if it does not relate to political issues. This may be one of the severe distortions of the present system. ...

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How Phillips is changing itself to focus on new areas such as elderly health care. The acquisition of Lifeline which is a call service for elderly patients that helps them for independent living. products are being redesigned for consumer health care. One such product is a HeartStart Home Defibrillator which costs $1200 without prescription at drug stores. Ivo Lurvink heads the consumer healthcare division formed in 2004 with the goal of tapping opportunities outside of hospitals. As Phillips new CEO sees it hospitals care is expensive and more and more people are becoming savvy and smart about taking care of themselves with products available and more products need to be designed with them in mind. In targeting needs of elderly Phillips has identified independent living as an important market and has developed a "senior solutions sweet spot" as the kind of customers in this group it would like to target. to get an idea what Phillips is trying to dream up in redesigned or new products, Ivo Lurvink is looking at the broken bones that 350,000 Americans who fall and break bones have to struggle with. Could Philipps come up with a product that detects motion and balance? Philips CEO Gerard Kleisterlee sees the trend as being health care is being increasingly pushed out of hospitals which are expensive and into homes and clinics, and patients are behaving more like consumers and asking smart questions of what will be best for them. Philips has closed most of its electronics factories, its components division, and sold its seminconductor business to private equity firms for $7.4 billion. Its a big shift for a technology company but lower priced Asian imports have convinced Philips that it must make a shift, especially after losses in 2001 of over 2 billion euros and in 2002 of 3 billion euros. The professional medical products division was a bright spot in a recovery with earnings growth of 40%. It sells large equipment to hospitals. Gerard Kleisterlee who took over as CEO of Phillips in 2001 is making a change that is also being made at GE and Siemens as health care becomes increasingly important. Kleisterlee is himself an engineer an after the post tech bubble asked himself "what is the hand of cards that I have and how do I playthem?" Changing its orientation and moving into new products with better margins and less competition in high growth markets such as elderly care is the result of this reassessment. ...

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Elizabeth Rosenthal looks at Obamacare's contribution to cost containment in 2013-2014. Rosenthal says its is a kind of delicate maneuvring at the edges, because serious work needs to be done. The fee-for-service and many of the drivers for increases in medical costs, the old system of pricing, are still in place. In 20 years at the current rate and after Obamacare health care will still take 25% of the U.S. budget if nothing is done. Healthcare costs are about half that of the U.S. in some of the advanced European countries. She calls Obamacare a trickle down theory of cost containment becaue it leaves most of the drivers for cost increase in place and works at the margins. Princeton economist Uwe Reinhardt calls it an ugly patch on a somewhat ugly system. Rosenthal cites the armies of consultants anticipating every move to reduce prices, and working on "strategic billing'' to increase revenues for hospitals and doctors. For those who say the prices are now up more slowly than in the past, Michael Chernew of the Harvard Medical School, has this to say- its like a diet, reminding us that that we haven't even lost weight, just gaining weight slower than before. ...

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The German people offer a warm welcome to refugees from Syria and North Africa suffering enormous hardships to make their way across seas and overland through Eastern Europe to Germany's borders. Germany of its own accord waived the right to deport Syrians back to the first European nation entered, and supported Syrian refugees right to stay with an 87% acceptance rate for Syrians seeking asylum. In August 2015 alone 100,000 refugees were accepted. Chancellor Merkel and Germany lead the European Union by example, and what an example it has been. Faiola of the Washington Post tells the story of Abed Almoen Alalie, a civil servant from Syria who fled with his family, and after being roughly treated in Budapest, Hungary, cannot believe his eyes seeing the welcoming crowds as he gets off the train in Munich. Never has a nation in such a short time made its way into the hearts of so many as Germany has done in 2015. The crisis found Germany, or Germany found the crisis, either way Germany embraced it and the people who came with it in a way hard to imagine. With chancellor Merkel leading the way using strong words and courage of her Lutheran convictions- "The fundamental right to asylum does not have a limitation. As a strong, economically healthy country, we have the strength to do what is necessary." Many Germans have responded in a degree and manner that is hard to imagine . They say this was Germany's effort at redemption after the war. In a poll by ARD released September 3, 2015, 88% of Germans said they would donate money or clothes to refugees or have done so, and 67% say they will volunteer to help. ...

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Actually some of this is a healthy development as more nations and people have a stake in the world economy. Take the Brazil situation for example . Clearly the Brazilian people are more favorable to globalization and its benefits than they were a decade ago at the height of the Asian crisis and the contagion effect on Brazil. Actually the advantages of free trade and a global trading system that benefits Brazil as well as China and India and other countries that buy its commodities such as iron ore is more now than ever because these nationas are benefitting from this trade. Because of the high prices of commodities and the agricultural products of Brazil, it has a currrent account surplus and its currency is strengthening. Instead of having to go to the IMF for assistance Brazil has large foreign exchange reserves that support its currency and which help it push up its investments as a share of GDP from 19% to closer to 25%, which should enable it to sustain about 5% growth year after year., according to Sergio Vale of MB Associados. A strong real, lower interest rates, and consumer credit have boosted the purchasing power of the middle class and the antipoverty programs of the Lula government have helped the poorer classes have a stake in the development. According to a recent Observador/Ipsos survey 23 million Brazilians have left social classes D and E and joined class C whose distinctive markings are a rented apartment, a car and some new gadgets. Actually quite to the contrary of the impression created by this article Brazil according to a former central bank governor is now showing a new enthusiasm for this kind of development which encompasses free trade and markets, a feeling that the stockmarket is not a casino and being part of the world economy is a good thing. The big discoveries of oil at Tupi and Carioca-Sugar Loaf in Atlantic offshore waters by Petrobras even though they are in miles deep waters and require special expertise must only have reinforced this mood. The danger to Brazil's enthusiasm comes not from nationalism of different countries trying to find better ways of meeting the aspirations of their people but from the risks in a global slowdown that started with the US subprime and mortgage crisis, the resulting credit tightening, and fall in consumption thats expected after years of overspending by the American consumer. Its now upto these individual countries, like Brazil, China, India and Russia, Japan as well as Germany France and other countries that are not directly part of the housing bubble and subprime and mortgage securitization mess affecting the USA, and the UK and Ireland and Spain to a lesser extent, to find ways of maintaining more modest but still substantial growth to meet the growing aspirations of people in these countries. In this sense the policy errors and regulatory errors made during this last decade in the US will actually have hurt the world economy and markets in a serious manner, and it is this that has now to be managed in a better way by these countries with the close cooperation between them and the USA. The situation in Brazil is repeated in the experience of India, China and Russia where for the first time there is enthusiasm for being part of the world economy. In the light of this development there is more reason for hope and more need for careful navigation mechanisms for these and other countries to weather the difficulties from a global slowdown and still sustain development that itself could help the USA work its way out of the current crisis through its exports....

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Daniel Bell at Tsinghua University in Beijing, Andy Xie, economist in Shanghai, Zhang Habin, professor at Peking University, and Michael Meyer, author and hutong expert, talk about what issues are important. Bell says Obama mania is absent among the young in China, though they respect his intellectual abilities, and Chinese are not looking to the USA for ideals. They are looking to Chinese culture and characteristics, and democracy is seen in this light with emphasis on Chinese characteristics. This means the US has to engage at a deeper level with China. Treat China as an equal with something positive to offer, says Bell. Andy Xie is concerned about the US-China relationship, based as it is today on tenuous grounds, where what happens in Florida and California can have a significant and immediate effect on what happens in Guangdong. With 70% of the furniture sold in the US made in China, the effects are immediate when housing slumps. So he says the US lost 3 million jobs since the subprime crisis, and China lost 20 million jobs. And for the 5 million college graduates coming out in 2009, they will be adding to the 5 million college graduates from previous years who are seeking jobs. Ten million unemployed college graduates mean China is seeing whole new conditions as the backdrop of US-China relations. Habin says its important for the US to set an example in climate change and emissions of greenhouse gases. The US should sign an agreement with China with binding targets, make its technology available to China, and provide development aid to make this technology and other assistance accessible to China. Cooperation on this issue is vital to future relations says Habin. Meyer says the hutong, small enclaves of old Beijing with lanes and small homes, that the city officials call neighborhood slums, but actually have a sense of community and a vibrant life, are worth preserving. He questions the Walmart and Pepsi commercial culture, and questions building of the American car culture urban plan that generates pollution, lacks community feeling, and is not energy efficient. In fact he has a point here, because the US is shifting away from its own older urban planning design that encourages urban sprawl, as in California. The new Sacramento urban plan that is being adopted for the future in America has energy efficiency, more community and easy interaction, less urban sprawl in mind. See the link to this. But Meyer says Chinese planners insist on their right to make the same mistakes American urban planners made. And Meyer quotes the head of the first Chinese environmental NGO, who says, "if the Chinese want to live the American way of life we need 7 earths to support them". Which raises a disturbing question of the US postwar way of life with its large SUV's, urban sprawl, and less sense of community. Wouldn't the US have to join India and China in the worldwide scramble for resources to preserve this way of life? Just this week China signed $51 billion of deals for natural resources, see the link. And is the rapid decline of the SUV, just the first sign of changes that are taking place, with the economic changes in coming years leading to grappling with issues of better quality of life, smaller quantity of things, health and obesity and lifestyles, community, all coming to the fore. ...

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India's plans to use its increasing production of wheat to fill the gap created by Ukraine and Russia not being able to meet the need of countries such as Turkey, Egypt, Arab countries, Africa and the Middle East. Stabilizing the price of wheat will be a great help for meeting the needs of people in these countries who are severely affected first by Covid and now by the increasing prices of essential supplies of wheat for their growing populations. Prudent agricultural policies and carefully meeting the needs of farmers should enable India to do this.

In this sense India could do what it has done with its vaccine supplies to countries in Africa and Asia- help meet essential needs during a health crisis and economic crisis for Asia and Africa.

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Dubai's sewage system is not keeping up with the rest of the sewage system. For homes not connected to the sewage system the sewage is transferred by tanker trucks and sometimes tanker trucks will unload the sewage on desolate streets outside of town. Also treated sewage water is used in sprinklers in public parks in Dubai but this water may ot be healthy or have a bad odor so some residents ask their children to stay inside when the sprinklers go on. So where is the $300 billion thats supposedly going to be spent in the next 10 yeas and where is the money thats being spent now going for something as basic as sewage systems to be inadequately funded and tackled? It also shows the imbalances in development that go on side by side in the developig countries. In the rush for western style living a lot of other things may be happening or neglected. In China basic labor rights, food and drug safety, and pollution of the nation's water system, and contamination hazards were left untackled or ignored as a lot of money went into new infrastructure and western style living for those able to acquire it in the cities. Thus the substandard housing with neglect of safety inspections, supply of shoddy materials for building and the corruption which made a lot of this possible, especially painful when it came to collapsed school buildings in the Sichuan earthquake, is a recent reminder of these imbalances in the developing countries middle classes making a rush to acquire western standards of living. In Dubai sewage is rising by 25% a year and one sewage plant that is 30 years old is all that Dubai has to meet its expanding sewage needs!!!...

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Estimates show the 50 million Americans enrolled in Medicare today will increase to 80 million by 2030, according to the program's actuaries. Simple demographics as the baby boom generation ages is making controlling the deficit without controlling increase in health care costs as both sides in the fiscal cliff negotiations are attempting to do can only lead to defunding critical areas such as education, R&D and infrastructure, and breaching the safety net for lower income Americans. Health care spending took up 7% of GDP in 1960, increasing to 17.9% of GDP in 2010. Federal spending on healthcare has grown to about 25% in 2012 from 10% in 1960, and is projected to increase to about 33% in ten years by the Congressional Budget Office.