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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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The Rivlin-Domenici Deficit Report recommends freezing US defense spending from 2012 to 2016 at its current level of over $700 billion a year. This means the Defense department budget would not be adjusted for inflation, and the military would not have the $431 billon in additional spending that the Congressional Budget Office had projected. By contrast Defense Secretary Gates has sought to keep the Defense departmet budget growing at 1% a year after inflation, plus the costs of the war in Afghanistan. And the Bowles -Simpson Deficit Commisssion chairmen have recommended $100 billion in savings by 2015 be used to reduce the deficit. The way Gates sees it the savings of 2-3% annually in department contracts would be used for other military purposes. Rivlin-Domenici and Bowles-Simpson do not see it that way, they want to use the money for deficit reduction and improving the economic prospects for the US.

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Britain's Tax Service reports the number of taxpayers reporting incomes of 1 million pounds a year declined by over 60% in fiscal 2010-2011 from the prior year. In 2010 the Labor government of Gordon Brown introduced a 50% income tax rate for this income group, up from 40%. The number of million dollar incomes filed declined to 6000 from 16000 in 2009-2010, and revenues declined from 13.4 billion pounds or 9% of total taxes from taxpayers to 6.5 billion pounds or 4.4% or about half. The Labor government had hoped for additional 2.5 billion pounds in revenue, showig unintended consequences and surprises in economic policies.

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Estimates by the Congresssional Budget Office in January 2011 show the federal budget deficit in the US at nearly $1.5 trillion in 2011. The deficit would equal 9.8% of the US gross domestic product. In 2009 the budget deficit was $1.4 trillion or 10% of GDP. The CBO estimates show the debt held by the public increasing from 40% of GDP at the end of fiscal year 2008 to about 70% at the end of fiscal year 2011. Republican senators Orrin Hatch of Utah and John Cornyn of Texas called for a constitutional balanced budget amendment in an op-ed published in Politico.

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In a new WSJ/NBC New poll, conducted July 24-27, 2009, 42% called the Obama health plan a bad idea, and 36% called it a good idea. In mid June the poll showed Americans evenly divided on this question. It reflects rising anxiety over the costs of the health plan and what it will do to the deficit, and also shows public anxiety about the ways in which Obama and Congress are reaching compromises to pay for it and to control costs. Added to this are the anxieties raised about government involvement in healthcare and medical decisions about care. Noteworthy are two differing pieces of evidence. In the WSJ/NBC News poll, only two in ten people thought the quality of their own care would improve, only 15% of those with private insurance thought that it would improve the quality of their care. And 4 in ten people thought quality of care would get worse, and 45% of those with private insurance thought quality of care would get worse. By focussing on the cost of health care, the administration seems to have ignored or missed the concerns of people about the quality of care if government focussed on cutting costs. These concerns are real as a vast majority of the public, or about 85% of the people, as Martin Feldstein points out in a recent Washington Post column, are insured. The question is what cost would they be willing to pay for the admittedly worthy cause of insuring the uninsured? And even with the unisured, it seems likely with the current Obama reform plan that immigrants and other people may still remain uninsured, at least for some time. Would a huge burden of $1 trillion make this worthwhile, and is there some better way to do this without the prospect of higher taxes further down the road to pay for this. These are points Feldstein makes. The other piece of evidence is that at the same time that there are reservations about what is coming out of Congress today, there is general support for making constructive changes to healthcare. The WSJ poll showed 56% of respondents favoring the basic ideas in the reforms being considered in Congress, with 38% opposing it....

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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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Laffer says there is a big gap between the cost of health care and what people actually pay, which keeps cost escalating as there are no pressures from users of services to economize or bring reductions in the prices. But Laffer offers no effective solutions either his patient centred approach to health care reform does not address the problem that employers are paying for health care for the large part and these are not taxed as benefits leaving the employee free to load up on services and ignore the cost, which works just fine for the health care providers who increase revenues and profits- also called cost escalation upto the point now reached where the nation can no longer afford it.

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As health care markets are slowing in western countries and price pressures are increasing Phillips is moving aggressively in emerging market countries like Brazil and India. It s market share in emerging market countries is 18.5% and it wants to push this upto 25%. And health care is becoming more important to Phillips as it scales back from consumer electronics. To understand and meet the different needs of these countries Phillips is acquiring local companies and redesigning its products so that they meet basic functions at a much lower price than the same product sold in western countries.

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Mayo Clinics 18 month long effort with 400 health policy experts working on the panel has a set of recommendations for the Presidential candidates. It suggests a private system with private insurance companies offering many options and nobody can be turned down. Those least able to afford it would get government help, individuals would pay for the insurance with some help from employers. Since once insured its not dependent on employer its permanent, changing a job would make no difference at all. Interestingly most of the panel experts cited here from Verizon, the Heritage Foundation and others all agree that the present system is coming to a close and a new one has to replace it with coverage for all Americans and a privately based system with contributions made by society and government, by all individuals, and also by employers. Mayo's study, the breadth of the number of experts participating (400 experts), the length of time to understand and come up recommendations (18 months), the respect the institution has among all sectors and groups, should give the consensus view of experts in the US, so that any future health plans do not simply get derailed by partisan opinion, controversy and lobbying....

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Figures on costs for the uninsured and total spending on health care by researches at George Mason University.

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As remedies for the $1.6 trillion federal budget deficit for 2010, which says Hubbard threatens to compromise Americas economic future, set agggressive targets for reducing discretionary spending limiting growth to 2%. Hubbard also wants to see 1% reduction in projected entitlement spending growth for Social Security and Medicare. This can be done progressively, he says, by lowering the growth in spending for middle and upper income households and strengthening the safey net for lower income people. And third he would have a broad based consumption tax to pay for added social spending. Hubbard was adviser to president George W. Bush and is Dean at Columbia Business School.

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The Obama tax deal pushes tough decisions on spending into the future. It will put more money in people's pockets and as a result give a short term boost. Experts do not see long term benefits to the economy. It does not do what spending on much needed infrastructure and investment in other parts of the economy would do to give a long term lift to the economy.

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Martin Feldstein on the U.S. economy in 2014 and the risks of the U.S. Federal Reserve tackling the economy on its own with monetary policy, without Congress taking on the task of policies to promote economic growth. Feldstein points out the 3.6% GDP growth estimate for the third quarter 2013 does not look that good considering that half of this is from buildup of inventory. GDP growth is about 2% as net result. With paralysis of Congress and the Executive branch the Fed's policy of huge buildup of long term bonds to reduce short term interest rates to zero and stimulate stock and home prices, he describes as the only game in town. The problem is that the size of the effect of increase in consumer spending from this increase in household wealth is small and not enough to contribute to significant GDP growth. The risks of this approach are that it contributes to destabilizing the economy as investors buy risky securities and bid up prices. He suggests a five year $1 trillion infrastructure development program, including defense, as a stimulus Congress should consider. Not the kind of stimulus that happened after the 2008 crisis. If not enough investment ready projects are available as in 2008 that will contribute to future growth, Congress should take another one year to prepare for this before moving forward. Debt reduction is key, and debt as a percentage of GDP should be reduced and set on a path to go where it was before 2008 to about 40%, deficits to below 2% of GDP. This should be done by slowing growth of Social Security and Medicare, and increasing revenues by limiting subsidies in the tax code that Feldstein as pushed for since 2010....

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Leonhardt argues that rationing is rational allocation of limited resources, health care budgets are limited resources even in rich countries like the USA, and if you overpay here you cut somewhere else. Now the cuts that are not noticed he says are in take home pay as employers face increased premiums from insurers. Rationing is taking place all the time with poor health outcomes relative to the cost for poor allocation of resources as survival rate for many diseases are not that much better than other countries. Rationing takes place everyday when patients see doctors only for a few minutes as doctors race to see more patients, and when diseases are not caught early on in the process as doctors do not know their patients well enough. And rationing is taking place as patients simply delay or forego treatments based on the extra cost, or as uninsured get no care. There are so many buzzwords like this thrown around, with doctors, hospitals and insurers and other groups trying to preserve the status quo, even as it is becoming rapidly unaffordable fort the US to be spending so much on health care....

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A cross-referencing initiative by the new government of Mario Monti in Italy called the "income-o-meter," will be setup in the next few months. Under this initiative the government will cross reference different transactions and compare bank accounts with declared income to take action against tax evasion. Tax evasion is so widespread in Italy that an estimated $150 billion is lost in uncollected taxes. This would help Italy bring down its defict and reduce the debt burden in the current crisis. Attilio Befera, director of Agenzia delle Entrate, Italy's internal revenue service, says that the new cross-referencing initiative will prevent someone from declaring income of $26,000 and buying real estate worth $1.3 million. Tax officials say that in a country with 2.5 million luxury cars, only 2% of 41 million taxpayers showed an annual income of more than $260,000.

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A couple of things have taken Obama ahead given he is a candidate who the electorate is not so familiar with and his relative lack of experience, and they relate to McCain as candidate and Obama as candidate. McCain comes across as impulsive and casual, Obama has more composure and steadiness and is thorough. In the selection of candidate Obama filled in for experience, and McCain's selection handicapped his experience argument. McCain campaign's higher taxes from Obama argument is also blunted by his poorly thought out plan to tax health insurance benefits, which neutralized his claims of higher taxes from Demmocrats. And Obama's grassroots organization and fundraising maakes it possible to run a stronger better campaign and his focus has been consistent and steady on the economy, all of which add up to another advantage. And all this is happening against the background of 8 years of Republicans and unpopularity of Bush. To that is added the sudden deterioration of the economy in September 2008 and a global financial crisis, in which McCain's impulsiveness in going to Washington which led to Republicans voting down the first bailout plan in the House was set against steadiness of Obama on these economic issues, with advice from an experienced man like Paul Volcker, former Fed chairman. The worst hit economically are midwest states where the auto industry is near collapse needing its own bailout, and this has led to an astonishing lead in some polls of 25 points for Obama, quite unheard of for a fresh candidate....

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President Obama has 63% job approval rating in a New York Times/CBS News poll. His backing is among Democrats and independents alike which is very useful for Obama.But the poll shows more American having faith in the President than in the handling of specific issues. He gets good approval on foreign policy initiatives at 59%, but in the handling of the Auto bankruptcy, or of health care his ratings are below his personal ratings as President. A majority of those polled were concerned about the rising budget deficits. BUt his ratings among Republicans has fallen from 44% in February to 23%. Republicans were viewed favorably by only 285 of those polled, the lowest ever.

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This may be the most important work of the DJT administration by 2027 into 2028 elections.  WSJ calls it the soda wars, when it is the slow destruction of America. As JFK and RFK well knew when they made fitness a goal for America in 1960- health is not built on sodas. Today with such high obesity, sodas and its likes, it is about the slow destruction of America.  MALA make America Live Again starts here. “When a taxpayer is putting money into SNAP, are they OK with us using their tax dollars to feed really bad food and sugary drinks to children, who perhaps need something more nutritious?” Right now it is the biggest item for schools in most states for the Supplemental Nutrition Assistance Plan. Passed by Congress in 1964 the original bill for SNAP excluded sodas and luxury drinks, but had Sodas added back in by the Senate. By lobbyists even in 1964? SNAP schools program falls under the Agriculture Department. Democrats as well as Republicans appointed Agriculture Secretaries and not one took the action to get sodas excluded, to let states request sodas be excluded and approve it, not the Democrat a Carter, a Clinton, or an Obama, or a Republican a Reagan, a Bush, or a Trump (first term) took the necessary action. In 2025 Brooke Rollins is Agriculture Department Secretary. Arkansas Governor Sarah Huckabee has seen the damage sodas can cause in her family. Rollins on her first day in office has finally acted- after 61 years when the original intentions of the SNAP bill's creators were confounded in the Senate.  On her first full day in office, urging them to propose pilot programs testing changes to food aid. Rollins sent governors a letter to ask for the removal of sodas from schools food aid program.   ...

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Medical device makers for heart like the stent and hip like replacement hips have margins of over 70%. THese and other medical devices may come under pressure from the changes that are anticipatd in the way Medicare reimburses hospitals for these devices, which are largely used by older patients under Medicare coverage. Stocks of these device makers like Boston Scientific, Stryker, and Zimmer, have fallen in recent weeeks

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Paul Ryan, chairman of the House Budget Committee, explains his U.S. budget proposal to bring down the deficit. Ryan's Republican budget proposal is a bold effort to make a break from a status quo which is leading to higher levels of U.S. debt as a percentage of GDP. It envisions changes to Medicare, Medicaid, and the tax code. It is built on the idea that sustainable finances will lead to a better economic future for America, compared to small changes to the staus quo envisioned in Democratic proposals and the 2012 budge proposal of the Obama administration. It is also bold in its effort to tackle Medicare with a "premium-support" system, and Medicaid by turning it into a block grant system. It also incorporates the Bowles -Simpson President's Deficit Commission's ideas for simplifying the tax code.