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Boosting vaccine production for the Indo-Pacific region that includes Bangladesh, Indonesia, Malaysia, Thailand, Philippines, Vietnam with production done through Biological E in Hyderabad will be discussed at the meeting with Biden. Japan will fund the project, and Australia will handle the distribution. This will be part of a followup to a March 12 virtual meeting of Quad leaders. This effort to meet the vaccine supplies challenge for the Asian region covering south east Asia and its population of 600 million will be one of the major outcomes of Quad countries collaboration, making it a peacetime collaboration that supports development in the region without burdening the financial position of any country.  The other part of US- Indian collaboration and Quad collaboration centers on two related themes after healthcare and pandemic. The immediate challenge is to tackle the breakdown in the supply chain for semiconductors. The US and Europe can no longer depend entirely on a supply chain based in Taiwan. The narrowest part of the Taiwan Straits which separates Taiwan from the Chinese mainland is only 81 miles wide, which makes continued dependence on chip production on Taiwan an unreliable option and the need to build a new supply chain for Japan, EU and US. Plans will be made to address this in the talks. The Biden administration has already taken action with Intel Corp making a U turn and bringing chip manufacturing back home to the US with $50 billion investment planned. India and other Asian countries may form additional options for semiconductor manufacturing. The third part of the Quad effort will center on US and Japan ramping up infrastructure building capabilities with India to build infrastructure across Asian countries and in Africa that will be financed in a way that will not have some of the liabilities of the Chinese initiative called Belt and Road. Loans given by Chinese state banks and contracts including manpower from Chinese contractors are now seen as not meeting the needs of Asian and African countries. These loans most of the time cannot be repaid as in Zambia, and other parts of Africa, and in Pakistan, leading to interest accumulating on debt and making future infrastructure development extremely difficult. The use of manpower from China also means no learning curve for infrastructure is formed for local companies and infrastructure comes without new jobs jobs being created.  For most of the period 1900 -1950 the British built Asian and African infrastructure. During the period 1950 onwards the US assumed a major role, as did the Soviets. This changed after belligerent Reagan administration policies and wars in the Middle East sapped the funds that could have gone to infrastructure building that would improved living standards in Asia and Africa. Mr Biden wants to see this change and this is what he meant when he said at the UN General Assembly today- " we want relentless diplomacy to take the place of relentless wars." He means every word of this and the diplomacy is between allies and also adversaries, but mostly with allies such as Japan, the EU and India to build a better world. That he has to do this quickly Biden is aware of that, which is why he said "the next 10 years will determine our future."   ...

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It is not a story that most people grasp or understand- the long term effects of the US immigration surge of 2023 and its source mostly from Venezuela. The  US Congressional Budget Office says labor force in 2033 ten years from now will be larger by 5.2 million people and younger as a result of the immigration surge in 2023 from about 1 million immigrants each year in the 2010's to 3.3 million. About 2.5 million crossed the southwestern border in 2023. Much of it the result of the collapse of the Venezuelan economy and its middle and upper classes leaving the country. This was worsened by the US sanctions on the Maduro government including under president Trump, say experts in an adjoining NYT article on the 7 million people who left Venezuela to go to Colombia, Peru, Ecuador and Chile since 2012, then making their way up the Darien Gap to the US. Something that could have happened under a Republican president if the US Congress could not reach bipartisan agreement on correcting asylum and parole policy. As a result of this surge US Gross Domestic Product  in 2033 will be 3% larger. When the large Asian economies are seeing a aging workforce, Japan for the last decade and China now following Japan, the US labor force will be younger than it would be without this unusual surge in immigration of the last 2 years. The federal deficit will be smaller at 6.4% instead of 7.3% in 2033 as immigrants will pay taxes on income. Another aspect of this larger infusion of immigrants is that after the pandemic shut down immigration entirely there were severe shortages in the hospitality and restaurant, construction, healthcare industries. And with the trillions of dollars in investment that the Biden administration is making with more factories - this will absorb most of the immigrant surge by 2033. With some positive effects in the competition with rising Asian economies China and India. Particularly consider with the younger demographic India of 1.4 billion people. It will mean more factories can be built in the US and there will be workers for these factories in the US at wages that keep the US economy competitive years from now in 2033. This is a sobering aspect of the current situation viewed from what will be seen by America's younger generation. And under the bipartisan compromise in Congress correcting asylum and parole policy that was shut down by the former president, Republican senators understood very well that the immigration surge of 2023 would have some constructive effects for the long term, while its effects on the short term would be mitigated by Biden's commitment to close the border in 2024. This did not happen, yet the future for America's younger generation is bright under the Biden plan for massive investment in manufacturing and jobs in the US, and with the millions of immigrants needed to fill the jobs that investment will create by 2033. It will make America with a younger work force than Europe or China, only India having a younger workforce in 2033. ...

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This is a story of missteps in retailing that can lead to loss of as many jobs as when large automobile plants close-about 65000 jobs in retail at big box store Bed Bath & Beyond in 2019 down to 32,000 by 2022, and with all stores closing in 2023 all jobs lost. Some of these jobs were replaced with the growth of Amazon in online retailing and warehousing shipment, others permanently lost. Jordyn Holman and Lauren Hirsch of the NYT explain how a major retailer collapses into bankruptcy in 2023. This retail chain started in 1971 thrived on its two founder's concept of building a customer base around a store that piled high the volume of merchandise selection for bedsheets, towels, pillows, kitchen appliances, and offered 20% coupons on brand items. It survived the 2009 crisis and by 2012 its stores were up to 1100 from 350 ten years earlier in 2000. This was a result of 4 acquisitions including Buy Buy Baby and Harmon Stores Its collapse is a textbook case of what can happen. Its financial foundations were weakened by a bond offering $1.5 billion, going into the debt market for the first time.   From its success attracting activist investors and the company according to analysts trying to fend them off. The bond offering was the first step to impending disaster. In 2019 three activist investors won a fight to appoint 4 new board members and hire a new CEO Mr. Tritton from Target.  The big change happening just before the pandemic was the complete change of management with the new CEO. Stores that had made the decisions on what merchandise to buy based on location were no longer allowed to do so. Some stores were closed and there were layoffs reducing employee morale. The big change came to the 20% coupons which was the unique feature of the store getting people back into the store. Coupons were cut back as profits declined. The pandemic introduced new elements of surprise. The supply chains were disrupted, and just at that time new management decided to shift to private labels to increase margins and sales. Kitchen Aid was replaced with private labels. As a result of supply chain disruptions the stores could not be stocked leading to customers moving away, a crisis was brewing. At that very time something concealed the crisis from view. The Biden administration checks to support people during the pandemic led to a sudden increase in sales, a one time spurt. Then as suddenly as the spurt months later a complete dropoff in sales. Management closed more stores, suppliers who were not paid demanded to be prepaid leading to stores being only partly stocked. Bed Bath & Beyond collapsed as its coupons were dropped, its stores poorly stocked, no brand merchandise such as Kitchen Aid, and decisions made at the wrong time including the debt load all taking a toll at once. By the end of 2022 bankruptcy loomed. In April 2023 the company declared bankruptcy after failed efforts to raise additional financing. The same changes also hit Best Buy, another big box retailer, which managed the changes to internet buying by shifting sales to the healthcare sector, and continuing to build on it strengths as a retailer of motivated employees with knowledge of the electronic merchandise. It made it right through the pandemic without the changes in management that happened at Bed Bath & Beyond. ...

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Having an adequate supply of N95 masks is critical for each hospital tackling the coronavirus pandemic. The lack of enough masks leaves health care personnel without the basic protection and is a grave emergency. Hospitals are resorting to reuse of the masks in this crisis and this is not a good practice as it increases the chances of infection. President Trump has invoked the Defense Production Act on April 2 against 3M. This gives the federal government more control over 3M's operations to ensure that it goes all out to make the healthcare N95 masks that the hospitals need in this grave emergency. This report in the WSJ covers the situation as of April 3 on the supply of M95 masks for health workers and others. N95 masks block 95% of very small particles. Supply in the U.S. is for 50 million N95 masks. Demand in the U.S. is for 300 million N95 masks as estimated by the Department of Health and Human Services. in March- this is how many are needed by health care workers to fight this pandemic in the U.S. The principal manufacturer is 3M. 3M company has doubled its production since January 2020. The trend before this pandemic was to send production over to China and other countries. This is changing now with the pandemic and the U.S. policy shifting to be self sufficient in medical supplies in the event of an emergency. A policy Peter Navarro, who heads the agency in charge of getting medical supplies, says President Trump is insisting be implemented. Hospital buyers supported the earlier trend to keep costs down, but this appears to be a costly mistake, putting health care workers in hospitals across the U.S. without the basic protection they need. Minnesota based 3M invented the first modern disposable masks in the 1960's. Interestingly 3M continued to make millions of masks in the U.S. even though competitors moved manufacturing overseas. The 50 million disposable masks 3M made globally went to workers in industries where it provided extra safety from metal shavings or other substances, and medical workers. Now 90% of masks go to medical workers. 3M ramped up production globally since January 11 when the pandemic first hit to 100 million masks a month globally, and 35 million a month in the U.S. at plants in South Dakota and Nebraska. 3M says that it will import 10 million masks from its factory in China, which earlier this year was restricted from shipping it outside China as China needed masks for the pandemic. About 10 million more masks are made by two other manufacturers Alpha Pro and Louis Gerson Co.  U.S. Department of Health and Human Services ordered 600 million N95 masks from 5 companies to distribute to hospitals and build up the national medical supply stockpile. 190 million each of this is from 3M and Honeywell and 130 million Owens & Minor Inc.  3M says it will make 50 million a month in the U.S. by June. Honeywell which had moved production overseas, plans to bring back production to the U.S. by making 10 million masks by May at its Rhode Island and Phoenix plants. There is a company in Singapore that makes one million masks a day in China and other Asian countries, Pasture Pharma Pte, but most of it is committed to government agencies in China.   ...

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This is the higher education equivalent of the moonshot says one education expert. The community college initiative of President Obama would double the numbe of people graduating out of community colleges. About six million students a year enroll for credit at America's 1200 community colleges, but only about 555,000 earn a two year degree, and another 295,000 a year earn a vocational certificate. The administration is putting a big emphasis on community colleges. Martha Kanter, the former chancellor of the Foothill-De ANza Community college district in California, has been appointed to the No.2 position in the Education Department. Arne Duncan made his first official visit to Miami community college, and Joseph BIden's wife teaches at acommunity college. The way community colleges have functioned in the American system of higher education, is that they provide post-secondary schooling for low-income studetns who have few other options. This works through open admissions. And most students are employed adults attending parttime; and according to some studies more than half need remedial courses before tackling college level work. The Obama effort is to require community colleges to work harder to retain students until graduation, and to encourage partnerships between community colleges and employers to offer workforce training. Without the access to the additional funding community colleges would actually find themselves in a bind, with rising enrollment rates just as their funding access deteriorates with state spending budget cuts. Debra Bragg, co-director of the Forum on the Future of Public Education at the University of Illinois, says that most new graduates produced under the Obama proposal would complete certificate programs, usually lasting 6 months to ayear , offering specific credentials for middle skill jobs. These jobs could be in healthcare, information technology, or other growing areas. See the article in BW showing the problem that is growing of unfilled jobs in many growing fields during a period of high joblessness, because of amismathc between the qualifications of jobless people and the requirements in the new fields. An example id autoworkers in Michigan taking up new skills for jobs in other fields. In this sense this program can be immensely useful in closing the gap. Results will take time as these resources take effect and graduation rates increase over time. ...

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The publisher of the Wall Street Journal, Dow Jones & Co., is working to overturn a court injunction that prevents the public from seeing the Medicare billing records of individual doctors. Dow Jones & Co., filed court papers in January 2011, to overturn the court injunction. The American Medical Association has fought to keep secret the amounts of money individual doctors get paid by Medicare. The AMA filed a lawsuit against the government to keep secret these Medicare records, on the grounds of privacy rights, and won a court ruling in 1979. This court ruling still stands. The position of Dow Jones in its efforts to change this situation, is that giving the public access to the records is essential to the monitoring of so large a public expense as Medicare. These records would then be available to state medical boards, nonprofit organizations, universities and newspapers who can act as watchdogs over the $500 billion Medicare program. Such transparency and monitoring is an essential feature for the proper functioning of such programs and to prevent misuse of public money. For a program like Medicare, fraud and waste has enormous implications, as it adds to the spiralling cost of healthcare and to the unsustainable budget deficits. In one of the largest cases so far, the FBI, Justice Department, 700 state, federal and local agents, worked together to charge 114 defendents nationwide with Medicare fraud in February 2011. A senior law enforcemet official says Medicare fraud is so rampant, "there's no way in hell you can prosecute your way out of this problem, no way." He says the the answer is more effective monitoring of the money that goes out. And a key part of that is transparency and public access to how the money in Medicare is spent, what individual doctors and healthcare providers are getting paid by Medicare. The lack of this transparency for a program the size of Medicare can only lead to a lack of monitoring as the Dow Jones suit asserts, and make it difficult for the government to check abuses in the way money goes out. At a time when teachers and public workers and seniors are expected to make their share of the sacrifices to fix the budget deficits, it is incomprehensible that money should then be allowed to go out of the Medicare system through fraud and waste, because of a lack of transparency....

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The basic outlines of new health care legislation takes shape as Senators Dodd and Kenedy come up with a plan that scales down subsidies to low-income people to buy insurance. Attached to their revised outline is a budget office analysis thatprojects the plan costing $611 billion over 10 years and with expected changes from the Senate Finance Committee would cover 97 percent of all Americans. And earlier plan received much criticism because the Congressional Budget Office estimated its cost at $1 trillion over 10 years and left 37 million Americans uninsured. In addition there is the revised Medicaid expansions for aid to the poor that would add a couple of humndred billion dollars to the total tab. The administration's goal is to keep the cost down to $1 trillion over 10 years. The legislation as it stands includes the public option which is designed to control insurance costs. Mr. Obama said this week that "the public option would keep insurance companies honest." Employer mandated insurance is part of the Kennedy-Dodd legislation proposal. Employers with 25 or more workerswould have to provide coverage or pay the government an annual fee of $750 for each full-time worker and $375 for each part-time worker. The government pays the startup costs for the public insurance option as a loan to be repaid, and premiums would make the option self-sufficient....

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Comparative effectiveness research will be conducted to evaluate what is the best treatment for any ailment or disease or health problem under the $1.1 billion allocated for this in the Stimulus Plan. What are the alternative methods of treatment, what is the effectiveness of each treatment, what are the comparative costs and so on. Is it better to treat neck pain with surgery or acombination ofphysical therapy, exercize and medications? If there is ablockage of arteries in the lower leg and leg pain, how does drugs and watchful waiting compare with surgery? For chronic heart failure how does home monitoring of blood pressure and weight and exercise in addition to medications provide an alternative route as opposed to just medications. Dr Fisher of Dartmouth Medical School cites these as examples of questions that can be asked in comparitive effectiveness research. The money will be available to the Health and Human Services Department and will be used over several years. About 15 federal employees will form a council to coordinate the research and advise President Obama and Congress on how to use the money. In 2007 the US spent $2.2 trillion, or 16% of GDP, on health care, and the Congressional Budget Office says it will grow to 25% of GDP at the rate its growing by 2025 if left to its own devices. ...

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Of the people asked the question "what issue do you see as the most important for health care" 44% in a NBC/WSJ poll said they considered Cost as the biggest issue, and 37% said that they considered the Uninsured as the biggest issue, 11% said quality of care was the biggest issue. The President is focussing on cost as he develops the health care plan. He is also saying that to provide health care for all and cover the uninsured without controlling costs would break the bank. Another thing that the White House shows it has learned from previous failed attempts, is that it is doing this with an open Health Care Forum with participation of different sides in the health care discussion. Clinton's effort in 1993 ran into problems because it was developed secretively, and without much discussion, and little effort to get different people's views. The previous attempt also waited too long after the election, and this time the President is moving quickly when he enjoys large popular support. Its also true now that there is serious concern especially in this downturn of what a threat spiralling costs of health care are becoming to the future prosperity of the American people. This time the leaders in Congress are setting an aggressive schedule to get health care palns legislation on the floor by June and get a floor vote in August 2009....

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Business Week's Chad Terhune points out that the health reform bill that passed Congress will do little to restrain the overbilling by pharmaceutical companies, medical device and equipment makers. Chad cites numbers from the U.S. Health and Human Services Department that shows $47 billion in Medicare spending went to dubious claims in the year ending Sept 30, 2009. This is 10% of the $440 billion Medicare program. And 10% of the Medicaid program also goes to dubious claims. Consider then that Congres allocated $10 million annual increase to fight fraud. A suit filed by a former Siemens manager at the federal court in Philadelphia states that Siemens routinely overbilled the Veterans Affairs Department and other governmental agencies by humndreds of millions of dollars for MRI and CT scan machines.

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S. Jaishankar is one of India's most experienced diplomats. The Indian Express shows work he did in Sri Lanka during another crisis. He called the Indian High Commission in Sri Lanka when he learned about hospitals in Sri Lanka that had shortage of supplies and could not conduct surgeries for this reason. He asked that arrangements be made for these healthcare supplies.

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The Labor department reported that unemployment surged to 10.2 % in October 2009. 190,000 jobs were lost in October 2009. Ther breakdown lokks like this. Construction lost 62,000 jobs, manufacturing lost 61,000 jobs forming the bulk of the job losses. Its interesting to note that only 16,000 jobs were gained in the federal government and 16,000 jobs were lost at the local government level making the net gain zero at the government level. And what was gained in the health care sector 28,700 jobs and in educational services 10,700 jobs for a total of 39,400 jobs was completely offset by 39,800 jobs lost in retail sector. The useful point here is that local governments are hurting and retail sector is hurting and little is going to change this as long as job losses continue and the gains at the government level and healthcare and educational services are simply offset by losses inretail and local government. This situation will likely ocntinue into 2010. The losses in manufacturing are likely to continue. A sample of companies like Eaton, Boeing and John Deere shows that 2010 will not generate many jobs. Eaton has decided to have its 55,000 employees take aweek of each quarter, so there is one twelfth work capacity unused which is where Eaton will turn to before hiring. At Boeing there are layoffs of 10,000 planned but its also hiring 3800 workers for anew factory in South Carolina, and at John Deere 452 workers will be recalled in November but in December there is aplanned shutdown. A September Survey by Business Roundtable found that 13% of firms planned to increase employment in the next 6 months, but 40% planned to cut payrolls. So manufacturing looks to go on like this in 2010 with slowing but continued job losses. The numbers show that in October the median number of weeks it takes to find ajob up to 18.7 weeks which is the highest number since the sixties. What gets ignored by the small print you find it in the Wall Street Journal is the broader unemployment rate which is 17.5% when you include those who have stopped looking, those who work part time but need full time work and the marginally unemployed. The rates jump for younger workers here and in Europe also. ...

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As the related article in The Washington Post points out the narrative inside India relates more to the the sense that terrorism has been a persistent problem for India and the public's sense that action was needed. Most of the issues in South Asia relate to development, roads, dams, bridges, airports and housing that need to be built, healthcare, sanitation and education on a massive scale. This is an area where India can show the way forward for South Asia, and be the real test for Mr. Modi after the many projects that he has initiated in India in the first term. It is only ordinary Indians, Pakistanis, Bangladeshis, Sri Lankans, and other people in South Asia that are paying the price for neglect of development and infrastructure as China, South Korea and other nations have forged ahead. A focus on development is the right sphere for competition both for Mr. Modi and for people in the region.

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Doctors face a 21% cut in the amount of Medicare payments for treating seniors having Medicare, though this cut will be delayed till 2011 under legislation in Congress. This issue goes back to 1997, when a budget law set spending targets, and stated that if they were exceeded formulas to reduce doctors payments would go into effect. The formulas seriously cut into doctor payments by Medicare in 2002, so the formula was put off. The result of this is that the cuts based on the formula now amount to 21%. The cuts are not expected to go through, but at the same time Congress has an headache on its hands with the growing deficit. In the Senate there is opposition to a $120 billion bill to extend long term unemployment benefits which lapsed in June 2010, for tax breaks, and other expenses. Senators want to pare down the bill's price tag, as $80 billon of this is unfunded and will be added to the budget deficit. For a primary care doctor in Washington state, Medicare pays about $95 compared to private insurers payment of $129, and a plan for state workers that pays $140....

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Dan Maffei won his Congressional seat from an incumbent Republican from Syracuse. Others of the 35 first term Congressmen represent a rural, small town and suburban areas like Maffei. And they are not about to lose their seats after tough congressional campaigns, they say, by voting the wrong way on health care reform. As one from Maryland put it he is not willing to foloow the lead just to follow the lead. These are the Congressmen that Steny Hoyer, Rep. from Maryland, who leads the Democrats in the House, wants to give more time as this is what they wanted. And these Congressmen are making themselves heard and making changes in the health care legislation where they disagreed.

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Difficulties facing a Obama administration, taking over in the middle of a huge economic crisis, with so many high expectations aroused by the lofty rhetoric that a letdown would occur for the faithful and young people energized by his candidacy were these expectations to remain unfulfilled. Two wars and their conduct could raise controversy as they cannot be abruptly be wound down and the Afghan war could present surprises as it has for all foreigners. And there are no easy solutions to the economic crisis which could be stubborn and prolonged like the one faced by Japan and its lost decade. Japan had a leader in Koizumi who energized the Japanese during their economic crisis years, some changes ocurred but Japan still labors on and its a different country now without the same hardworking ethic and cando spirit among the young. And there are no easy solutions like investing heavily in infrastructure and energy and providing healthcare to all working people, because with the one trillion dollars going to shore up the financial system and the banks there is only so much Obama and Democrats can do with public spending without much higher deficits and other difficulties. Not delivering on these promises or delivering inadequately could lead to a letdown for supporters. And for black people and Hispanics in the working class, and workers who have lost jobs as unemployment rises especially in the auto industry in the midwest where he got much of his crucial support, the conditions are tough with jobs scarce and rising home foreclosures, for which the government may be able to help but only in a limited way as the economic crisis may take a long time to unwind. ...

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Public opinion in the district of Steve King, a Republican in the House of Representatives favoring defunding of Obamacare healthcare law.