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Issues raised by the huge mismatch between revenues and investment for AI. $400 billion estimated investment by 5 Tech firms in 2025 alone with revenue of about $40 billion and huge uncertainty about when AI will produce returns. Articles seen this week of November 17 in the WSJ and NYT on this issue, podcasts, discussions in other media outlets. Could this lead to a dot com bubble type economic crisis? Could that lead to a recession? Alongside these articles another article in the WSJ on Nov 17 shows the benefits small firms get by using AI, benefits which are on the fringes of their business, not essential but with some experimenting firm owners/managers able to tweak AI information for use in business. Nothing significant which firms will pay much money for. The uncertainty is a major factor. Should geopolitics trump all these concerns? Is the competition with China require this scale of investment, and is China following a more utilitarian approach as reported in a WSJ article this month, of investing in AI in a utilitarian way targeting its use in improving manufacturing, improving infrastructure, and not wildly throwing money at experimental uses that are unlikely to yield much result. In geopolitical sense would the country that not only promoted AI but used it efficiently and cost effectively, used it in ways that promote the overall public good, get the WIN. In short it behooves everyone of us to ask hard questions of AI, to dehype the hype, to look for the public good that comes out of this from it's efficient use. To ask the tough questions when $400 billion generates only $40 billion in 2025 and the $3 trillion planned investment over 5 years is half unfunded, is it going to crowd out energy needs for homes and business, push renewable energy targets back, crowd out essential investments in the crumbling aging infrastructure of the US and Europe, crowd out essential investments in education, healthcare, pharmaceuticals, and manufacturing, that hold better promise for our People. Will it also put retirees at risk when corporate bonds from retirees money fund the unfunded portion of AI? This means making the political dimension not about migration, settling the illegal migration issue that was meant to be settled a long time back, or about cultural issues that have little day to day impact on our lives which are about groceries, childcare, housing that are non ideological. Making the political dimension not about remote countries that one knows little about except when it affects public safety and health as with fentanyl. Capital allocation decisions to the vital needs of America can then be free of politically induced error, so that it can be subjected to the test of how best it serves the public interest and the people of the Nation. ...

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Large food and beverage companies are seeing established brands sales decline as newer organic and health conscious brands increase market share. The 25 largest food company sales declined to 45.1% of food industry sales of $418 billion in 2014, declining by 4.3% since 2009. Smaller brands increased share from 32.1% to 35.3%. The more health conscious brands have seen tremendous growth, Granola bar company KindLLC increased share from 0.5% share of the snack bar market to about 6% in 2015, according to Bernstein Research. Chobani Inc. reached $1 billion in sales in 5 years. Kroger and other big supermarket chains are responding to consumer demand for buying local, buying from boutique producers, and buying from health conscious producers, by supporting these brands with marketing strategy, flavor selection, package size, and other ways, so that Kroger can carry their products on its shelves. FlapJacked pancake mix from a small Colorado company was introduced at Kroger's King Soopers chain in that state, and then taken to 500 Kroger stores in the U.S. For chains such as Kroger and Winn-Dixie in the southern U.S., it is critical to stay ahead of changing consumer preferences, especially now that eating right and eating healthy, and looking for alternatives, is changing the marketplace. ...

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A study published in the British journal Lancet shows that the number of people suffering from diabetes went from 153 million in 1980 to 353 million in 2008. The study shows the U.S. having 24.7 millon diabetics in 2008, which is three times the number from 1980. About 70% of this is from population growth and aging, and the rest from obesity, lack of exercize, changing diet. The American Diabetes Association estimated the cost of treating diabetes in the U.S. at $174 billion for 2007. About 138 million diabetics live in China and India. In India there is an additional cause- malnutrition in early childhood years for the poorer segment of the population. European countries have done better than the U.S., Mexico, India and China. S. Korea and Thailand have done better than other Asian countries. And this is attributed to healthier lifestyles, diet and less obesity in these countries.

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Paul Peterson, a professor who heads the Program on Education Policy at Harvard, says that public school education has not done as well as private or charter school education. In two areas character or values, and school discipline, public schools lag far behind private schools or charter schools. Private schools score 59% and 46% in these two areas, public schools lag far behind at 21% and 17%, in the 2016 Education Next Survey, says Peterson. He says by appointing Betsy DeVos as Education Secretary, the Trump administration sees the need to think how public schools can benefit from improvement in these areas.

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Short time work programs, paid leave, aid to small business for employee retention with the government paying a big percentage of wages, and unemployment benefits till companies rehire employees with government paying for this, are all different ways in which the U.S. and Europe are coping with the coronavirus crisis.  In the U.S. 22 million have applied for unemployment benefits with the U.S. government picking up a substantial part of the wages till companies rehire these employees. In the UK the government has launched a program that gives 2500 pounds or $3100 to each worker each month upto 80% of the worker's pay. The money is sent to businesses for retaining employees. This could cover estimated 8.3 million workers in the UK at a cost of $52 billion. The U.S. has a similar program with the first phase $377 billion already distributed to small businesses which requires retention of employees for government forgiveness of these loans. The basic idea is retain employees who could stay at home or be in short work programs or work from home. The French government is paying the wages of 9.6 million workers, almost half of workers in the private sector by sending the money to 785,000 small businesses. In Germany the Kurzarbeit program covers 725,000 companies which supports the wages of employees in a downturn and is financed from a special fund. The cost for Germany, France and Spain is about $147 billion or 135 billion euros for such programs. The European Union will step in with a 100 billion euros loan package. ...

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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.

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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.

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U.S. health insurance company WellPoint Inc. will offer higher payments to primary care physicians. This is part of new strategy to reduce emergency room visits and costs after deterioration in a patients condition by relying on primary care physicians for better care at the outset. Payments to primary care physicians will be increased by 10%, with higher payments when the results show better quality and preventive care. WellPoint has a network of 100,000 primary care doctors. Physicians who meet certain goals such as lowering the overall cost of a patient's health care costs will be given an incentive of 20-30% of the savings realized. The new effort will add 1-2 percentage points to the 6-8% of the $100 billion that Wellpoint pays for claims processed each year. WellPoint's management sees a reduction in medical costs of about 20% by 2015 as a result of such efforts.

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Generic version of Zocor by Merck to reduce bad cholesterol is now available and can substitute for Lipitor which costs $2 to $3 per day. This generic can be bought at Costco at 10 cents per day. Generics can have a huge impact on cost for patients and for the country's medical bill and for affordable health care its very important to achieve affordable health care.

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As a BBC reporter O'Connell interviewed Adam Neumann during the its highflying days when its share value today at $1.22 was $400. The company was about to do in office space rental what Amazon had done to retail and Neumann talked the talk, yet only a few years later the company is filing for bankruptcy.  Money went into valuation at $47 billion it is now $64 million. Billions of dollars wasted. Another example of how capital allocation in the American economy is failing and billions of dollars that are wasted could have been used to rebuild America's crumbling infrastructure and public needs in health and education, fighting climate change.

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Chile, Mexico and the U.S. rank high in the diabetes rate for top soda consuming countries. In the U.S. the diabetes rate is at 7.7% of the population, in Chile 9.6% and Mexico 9%. Soda consumption per capita was at 165 litres in the U.S., 146 litres in Mexico and 134 litres in Chile, and 145 litres in Argentina where the diabetes rate is at 3.9%, for 2012. A new public service ad in Mexico City subway stations says it all, showing an ad with a soda bottle and the words- "Would you take 12 teaspoonfuls of sugar? Soda is sweet, diabetes isn't." The new Pacto de Mexico agreed to by all major political parties includes the soaring diabetes rate in Mexico as a problem to be tackled, including lunches at public schools and the consumption of coke and sodas by children. A particular acute problem in Mexico is the lack of clean drinking water in many areas and the dependence on coke and sodas for liquids. But bottled water could be used in its place if available at lower prices. One proposal is for a soda tax which could generate $2 billion and be used for setting up clean drinking water fountains in schools and other places. Elected officals in Mexico are firm about the need for action, as Mexico recently became the first country over 100 million inhabitants with the highest obesity rates at 7 adults out of 10 over the age of 20 obese or overweight, and the consequently high diabetes rate. Diabetes is the No. 2 killer in Mexico, and a serious health danger. Coca Cola gets its second highest revenues from Mexico after Europe, and the situation has evolved after years of heavy coke advertising to the point where Coca Cola is taken at every meal by some Mexican families, and is a sign of prestige. The company's response is to fight the public service ads with ads showing people burning off 149 calories by walking. The country now faces a long and uphill fight. Russia is one of the countries which is also conducting a similiar fight against soda drinks. The Bloomberg Philanthropy is financing efforts against soda drinks in Mexico, as part of its campaign against smoking and sodas as health hazards, and this maybe Bloomberg's bigger contribution to society than his service to New York City. Developing middle income countries such as Mexico, Chile, India, China, Brazil, are the hardest hit by soaring diabetes. And the costs to their health systems in 10-20 years from uncontrolled obesity and diabetes will be enormous. The U.S. is a developed country with similiar high rates of obesity and diabetes, with soaring medical costs, and serious problems that strangely have not received the public awareness and efforts that one should expect. ...

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The health care system is designed to encourage procedure based specialist practices and discourages the patient understanding education and monitoring that occurs with a well designed preventive family physician practice. As a result a patient only spends 30 minutes ayear on average with family physician compared to one hour in other developed nations. In the USA there has been a steady decline in the level and quality and extent of family care and the close one on one rapport with well trained family physicians who enjoyed their work and understood their patients and kept up with their health conditions and provided good and regular advice on these conditions. There is no money in this care as a result first you provide an environment where a whole range of medical conditions can flourish and expand, and then you hit them with a whole series of tests to rule out specific medical conditions. It is a perfect way to expand the testing and let testing flourish, so it would appear that if someone had wanted to start with a goal of letting testing proliferate unhindered then this would be the perfect way to design it. ...

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This WSJ report looks at the situation in American cities where black people suffer disproportionately from the lack of resources to build better lives. Detroit, Milwaukee, St. Paul and St Louis are some of the worst hit cities in the lack of decent housing in the cities. Lenders once used redlining during the Depression era when most of the white population was still in the city so that the areas with black people were burdened with more restrictions and higher rates on loans. This report shows that the situation has changed little after the 1950's after 70 years of alternating Republican and Democratic administrations.   Now that most of the wealth and the white population has left the city of Detroit the population has declined from about 1.8 million to about 700,000. Only 1700 mortgages were made in the city because banks do not make money on tiny mortgages with the declining value of houses in black areas of the city. Black residents are largely shut out of financing, making home ownership harder, says this WSJ report.. Banks made subprime loans in the city and other cities in the U.S. before 2008 with politicians in both political parties supporting this in the name of home ownership. But these loans lacked financial due diligence as loans were made without attention to lender ability to pay off mortgages. After 2008 a financial crisis and higher unemployment hit the U.S. economy from the impact of these bad mortgages packaged and sold as assets. These loans ended up with foreclosure on homes leading to a drop in home ownership from 50% to 40% after a slight increase from 50%. Lacking genuine good intentions with sound financial sense these intentions of improving home ownership fell by the way side, worsening instead of improving things. The pandemic has hit black people and cities particularly hard. With the situation in Detroit continuing to languish from a lack of resources and a system that is failing, says this report in the WSJ.  The loss of manufacturing jobs has hurt black Americans particularly hard and a reversal of the manufacturing decline in the U.S. of the past three decades is needed for the situation to improve. This loss of manufacturing jobs has only increased the gap between the white and black unemployment rates in urban areas of the U.S., as it has also increased the gap in unemployment rates between white professionals with college degrees and whites lacking college education.  This ripping apart of the social fabric is a problem also seen in Europe with decline in manufacturing and other  problems leading to economic decay, coupled with housing and other issues inside cities.      ...

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How the French health care system works. France comes in first and the USA 37th in aWHO health care ranking. THe difference in deaths from respiratory disease is half that in the USA, and lower rates of death from heart disease and diabetes. IT has more hospital beds and doctors per capita than the USA. 65% of French people are satisfied with their health system compared to 40% in the USA, and yet France spends 10.7% of GDP on health care and the USA spends 16% for poorer results. THe French system is more generous to its seniors. Unlike Medicare there are no deductibles, just modest co-payments that are often dismissed for chronically ill. And diabetes and critical surgeries are covered 100%. French also buy supplemental insurance like Medigap for extra expenses like dental and eyglasses. Cancer patients are treated free of charge. Avastin treatments costing $48,000 a year are provided at no charge. France's PMI or Protection Maternelle et Infantile, is rated highly. It is anetwork of thousands of healthcare facilities, that ensure that every mother and child in the country receives basic preventive care. Mothers even receive afinancial incentive for attending their pre and post natal visits. France makes this care affordable by reibursing doctors at a much lower rate. The average yearly net income for doctors is around $55,000, about athird of what doctors in the USA make. But French doctors don't have to pay back huge student loans as medical school is paid for by the state and malpractice insurance premiums are only a tiny fraction of that in the USA. And again the French government pays two thirds of the social security tax for most French physicians- which is typically 40% of income. So the $55,000, is more like $92,000 taking that into account and more like $110,000 when student loans and malpractice is taken into account at US levels. Specialists who have 4 or more years experience can charge what they want, but as one gastroenterologist says, there in an unspoken and undefined limit to what you can cahrge or what is socially acceptable. Yet even in France there is inflation in health care costs that the government deals with through price controls and more spending. The French national insurance system is running increased deficits each year and this is now $13.5 billion, and it has led to higher taxes for employers and workers. ...

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The EU's competition commissioner to crackdown on pharmaceutical companies that are delaying the entry of generics drugs with various tactics that are anticompetitive. EU has raided the offices of several marge drug companies and retrieved documents that show this activity was going on. About 5% of medical bills or 3 billion euros coud have been saved from 2000 to 2007, if companies had allowed generics to enter the market earlier and not resorted to these antitcompeitive strategies. Like paying off generics companies or having so many patents on the ingredients of the drug, in one case 1300 patents on one single drug, and then suing the generics companies to tie up the case in the courts.

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Bayer CEO, Marijn Dekkers, plans to divest its plastics business, called Material Science. The plastics division requires large investments with lower returns than can be made in health care or the agricultural crop science business. Crop Science generated earnings before interest and taxes of 1.81 billion euros in 2014, and Health Care helped by 5 new prescription drugs reported EBIT of 3.58 billion euros, compared to poor returns of 555 million euros on the polyurethane and polymers used for laptops to soccer balls in the Materials Science division. CEO Dekkers is a Dutch born executive who worked for 25 years in the U.S. Since taking over in 2010 he has brought a significant culture change to Bayer, by insisting on speed and agility from executives. Division heads with marketing backgrounds are preferred to science degrees, and the planning orientation of the company is being changed to one where the company executives are not afraid to take risks based on incomplete information. Dekkers prefers an IPO for the $10 billion plastics business to generate more cash and reduce the debt of 20 billion euros. He acquired the over the counter drug business of Merck for $14.2 billion, and has boosted drug sales with the introduction of Xarelto in partnership with J&J, eye treatment Eylea, cancer drugs Stivarga and Xofigo, pulmonary hypertension drug Adempas. Sales of these 5 drugs are expected to go up from 2.9 billion euros in 2014 to 4 billion euros in 2015, contributing significantly to Bayer's profits. Dekker's venture capitalist type focus on profit margins is showing results in share price performance- Bayer's share price has advanced 60% in 2015 mid-March price of 145.85 euros compared to the prior year month. In the small town of Leverkusen, Germany, where Bayer is located, there were initially fears that Dekkers was "too American" and too focussed on shareholder value to understand the need to respect tradition. Since then Germans have realized that Dekkers understands tradition and is only bringing necessary change- the transition to being a life sciences company makes sense to shareholders in Germany, for employee representatives on the supervisory board the guarantee of current level of 17,000 jobs in the plastics division for a few years shows his concern for job protection during the transition period. For Dekkers who left Holland in 1985, and has a U.S. passport with an American wife and kids who speak no Dutch or German, the important thing is to get the right balance- he says the system of 99-1 where 99% of the information had to be in before a decision could be made is making the change to 90-10 where only 90% of the information is now necessary to go ahead, even if he would like to see it at 80-20. Bayer still sponsors the local soccer team known as Bayer Leverkausen, and 26 other clubs. Dekkers steps down at the end of 2016....

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Feldstein says that for the 85% of the people who have healthcare the Obama proposals are not a good deal. The Obama proposals mean higher taxes in the long run to pay for the $1 trillion cost of healthcare for the uninsured group over 10 years. This lower income group has no coverage despite the $300 billion Medicaid program. Feldstein says there surely must be better and less costly ways of getting this lowincome group healthcare. Raising the top income tax rate to 45% from 35%- as a result of letting the Bush tax cuts expire and adding aproposed health surcharge on higher income individuals- would actually lower revenues for the government, as it would change behavior of high income individuals in ways that lower their taxable inome. The result is higher deficits and higher taxes when even without this large deficits are projected for the future. How to slow the rapid growth in healthcare spending? The Obama plan is to cut spending on Medicare. Feldstein sees the govenment's effort aimed at reducing the amount of medical services, as reduced spending comes from fewer services, not reduced payments to providers. Will this result in enough of acost reduction to make the system work. And if the cost reductions are too heavily weighted towards reduced services and not reduced payments to providers would this result in large cuts to services to affect the quality of healthcare for the 85% who are accustomed to a different pattern of healthcare, even though it is structured to allow cost escalation. Feldstein offers no solutions to the problems of cost escalation except to suggest that the Obama plan does not really tackle the cost escalation issues directly with providers, and instead burdens the national finances to an extraordinary degree. And the need for apause and reflection....

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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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The former Surgeon General of the U.S., Vivek Murthy, has tackled issues such as the opioid crisis, obesity and poor health outcomes. In his new book "Together: The Healing Power of Human Connection in a Sometimes Lonely World," Murthy looks at the loneliness he says is pervasive in the new culture of iphones and social media that have perversely reduced not increased social connection and the feelings coming from good relationships and social concerns.  A 2020 Cigna survey shows 61% of American adults are lonely, up from 54% in the 2019 survey. It is not about having a lot of people around you, it is about feeling a genuine connection and the quality of relationships. Murthy finds this lack of genuine social concerns and social connection as fairly pervasive from his conversations with people all across the country. Normally it is felt in the fifties as life changes, and in the eighties with loss of mobility. Today the tech devices and what is called scoal media that appear to have increased communication have actually reduced the level of quality connections and interactions. Dr. Murthy suggests volunteering, and service in the community or larger communities worldwide as a way of breaking this. Capitalizing on informal day to day contacts, including with people one has not known before, is another way. This shifts the focus to the people around us and brings a new dimension and quality to our lives.  Saying hello often and smiling genuinely, says Murthy. Improving the  quality of time in day to relationships is another. This can also give us the confidence to connect with people on a regular basis.  ...

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The costs of fraud in medical care from spurious Medicare claims to kickbacks for unecessary services is estimated at $125 to 175 billion. Costs of unnecessary care from overuse to unnecessary lab tests are between $250-325 billion. The amount wasted for on treatment for preventable conditions such as heart disease and diabetes. is $25-50 billion. This number is much higher when all the complications from obesity are figured in. These amounts alone add up to $500 billion. Add to it the problems and the costs of medical errors leading to bad drug reactions or other misdiagnosed procedures which cost an estimated $75-100 billion and the the total is upto $600 billion. These amounts are not going to be tackled by computerization of medical records. The whole manner and ways in which medicine is practiced today and the manner in which the public takes care of its health would have to change for an impact to be made in these numbers.

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

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How companies like United Health are lobbying aggressively to shape the new helathcare legislation to their benefit. BW says the health insurers like United Health, Aetna and Wellpoint are already winning through clever and effective lobbying of Congress. Former Senator Tom Daschle works as aconsultant for United Health. Senator Conrad who has led aeffort to replace the public plan with nonprofit medical cooperatives, which would be a weaker competitive threat to insurers, is also influened by the insurers. United Health's CEO Helmsley and its person working with Congress on healthcare Simon Stevens met with Conrad on June 4. When lawmakers in Congress cite consulting group Lewin Group, that 88 million or 56% of those with employer provided coverage would desert private insurance for a government run program, they are quoting acompany owned by United Health. The Congressional Budget Ofice says these numbers are too high. United Health has used savy presentations on how to cut costs, and help Blue Dog and other Democrats articulate their positions, to gain influence in shaping the plan to their interests. United Health thus counts a lot with Matheson, and Mike Ross of Arkansas, who are prominent with the 52 Blue Dog Democrats. and with Senator Mark Warner of Virginia. And United Health put together an effective lobbbying group, even hiring the chief of staff of House Democratic leader Steny Hoyer. ...