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New York city Mayor Bloomberg, says President Obama and Republicans should stop promising a free lunch, or something for nothing. He points to Obama's reelection strategy of higher taxes for the rich- by taxing those earning over $1 million at minimum of 30% in federal income taxes- as generating $1.1 billion, according to Congress's Joint Committee on Taxation. This would make little difference on a federal government with $1.2 trillion gap in spending and revenue. And he says Republicans who say making the Bush tax cuts permanent while at the same time cutting the deficit are promising a free lunch, with no connection to reality. The answer says Bloomberg should be to eliminate the Bush tax cuts for all groups, for shared sacrifice, and for Congress to pass the Simpson-Bowles deficit reduction plan with $4 trillion in savings on an up or down vote.

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Tyler Cowen, Professor of Economics at George Mason University, points out some basic truths about health care as it is practiced today in the USA, and healthcare spending as it stands today. He questions whether starting out with extra spending plans to provide coverage to all will help solve the basic problems facing American health care. Too many tests and diagnostic procedures used by doctors is not aproblem that will be solved by spending more money to cover everyone. And government taking on more spending to cover all will not address all the other major shortcomings of the American way of practicing medicine, like prescribing a battery of tests, that tend to drive up costs, to just mention one of the problems. And it will not address any of the shortcomings in the way Americans take care of their health, diet, exercize and healthy lifestyles. THese are critical to get good health outcomes for the people, and which combined with careful spending of dollars where it will provide the greatest benefit, is the only way the health care solutions can be found....

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The Congressional Budget Office's Elmendorf says without spending cuts in payments to doctors and hospitals and other providers, providing coverage to the unisured will put the nation deeper into debt. Popular measures such as increasing preventative care, expanding medical records and rewarding doctors for choosing treatments that improve cost and quality have potential but its not proven how much the savings from this would be. The administration and the White House Budget Director, Peter Orszag, say they are in agreement with the CBO that something needs to be done to seriously reduce costs, reducing payments for Medicare and Medicaid to doctors and hospitals, and making other changes.

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The Senate FInance Committee's $829 billion bill, would cut by $113 billion money for America's Health Insurance Plans over ten years, specifically Medicare Advantage, reducing insurer profits. The AHIP is responding with aad campaign to seniors to fight this setting up aconfrontation with the Obama adminsitration.

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Brooks takes a different view about the 1986 Reagan tax reforms providing a way forward in 2013. He says growth is slower now in the U.S. with changes in the global economy and any growth killing tax increases or disincentives for investment are risky changes. He suggests taxing consumption and providing incentives for savings and investment. Closing loopholes will have to tackle the major deductions such as charitable deductions says Brooks.

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The small segment of society in Pakistan that controls business, has large agricultural holdings, and the politicians in parliament, all benefit from a system in which they pay very little in taxes. These groups draw the maximum benefit from their privileged position. According to a transparency promotion organization in Pakistan, the average member of parliament in Pakistan has net worth of over $900,000 and pays little in taxes. A senior tax offical says the tax revenues in 2009 were the lowest in the country's history. According to Pakistan's tax rules income taxes are owed by anyone making more than $3,488 a year. Analysts estimate that of the 10 million who should be paying taxes only 2.5 million are actually paying taxes. And the tax collection is extremely poor, so that less than 2% of the population of 170 million pay taxes, with tax collection as a percent of GDP among the lowest in the world. Pakistan's laws do not allow questioning of money transferred from abroad, so a lot of money can be channeled to Dubai and brought back into Pakistan. This is important becuase the burden of this falls on the poor, in the appalling quality of infrastructure and public services, and the widening gap in the quality of life of most people in the country compared to the affluent few. ...

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A small tax on the $800 trillion foreign exchange industry of 0.005%- with the tax on currencies where the leaders of these countries approve like Merkel of Germany and Sarkozy of France- would generate much needed money to help the word's poorest, says Philippe Jouste-Blazy, a former foreign minister of France. For instance he says tuberculosis killed nearly 1.8 million people in 2007, and caused the GNP of some countries to fall as much as 7 %. THis would bring serious gains to economic growth in the poorest countries. Look at the $1 to $5 tax imposed on airline tickets in France and 10 other countries since 2005.It has raised $700 million and financed three quarters of the AIDS treatment now being received by the world's HIV positive children. Unitaid, is an organization Blazy leads. It manages the money from the airline tax, and has negotiated 50 to 60% reductions in the price of pediatric anti-retroviral drugs in low income countries. The reason why the banking community should support this tax. One it is tiny, 0.005% on a foreign exchange transaction, and should not affect the flow of transactions. It is done automatically by computer systems. The currency trading system right now is untaxed. More importantly the bankers says Blazy have been benficiaries of taxpayer money. Isn't it time to give back to those worst affected by the global crisis the bankers helped create? Does'nt it create more credibility for the global financial, monetary and trading systems? He says the tax money could be managed by the Global FUnd to fight AIDs Tuberculosis and Malaria, with upholds programs in 100 countries to high performance standards....

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Fewer than 2% of Pakistanis pay income taxes and some of the powerful landed elite and industrialists pay little or no income taxes. The result is that the government is short of funds to finance needed healthcare and education. This leaves more of these tasks for the mosques and international donors such as the Saudis, and with it brings support for militant groups. Pakistan is dependent on IMF help for its financing needs and the IMF has offered $11 billion in loans. $7.6 billion of this was transferred. But further loans were held back by the IMF since May 2010 till Pakistan made economic reforms in taxation and other areas such as energy subsidies. The US supports this effort. The government's recent effort to raise fuel prices puts the burden on the poorer sections of society. The result was deeply unpopular and the government was forced to withdraw the price increases. This was the only way to maintain the support of coalition parties in the government

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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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Questions raised by investors following the layoffs at 3G acquired companies and the practice of investing in Coca Cola sugary drinks- does the carefully cultivated folksy image of Warren Buffett match the investing practices and the special rules that apply to Berkshire?

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

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The worst flaw in the health care bill says the Economist is that "fee for service" and doctors billing for each test done continues as before.The whole idea of medical services based on medical necessity and value for money has been left out of the billsin Congress. Alan Meltzer also pointed this out in his discussion of the deficits and debt over the next decade; that the 25% reduction in medical expenditures does not look anywhere closer to reality, worsening the deficits. This is also the view expressed in the discussion of health care reform in the November 2, 2009, issue of Business Week. Never mind said BW that the doctors and hospitals account for one third of medical expenditures and there is waste in Medicare spending. Congress said BW has made no changes in the "fee-for-service" system of medical care that has inflated medical costs, by paying doctors for the volume of services delivered and not the quality of services delivered.

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Wholesale inflation calculated weekly is at 7% in India. And the country's Finance Minister Chidambaram says he is more concerned about inflation than a growth that slows a bit. Experts forecast growth slowing down from 9% to 7% in the next 2 years as the global slowdown affects India. For the US India has been a good export market with sales growing at the rate of 75% a year according to the USA Commerce Department. But a look at the charts shows that China also had periods of a couple of years when growth slowed to 7% in recent years before it gradually went back up to over 10%. And China's growth will also be affected by the global slowdown and fall weel below 10%. And this may be a health y thing for China as it decides what kind of growth it wants to see that is better than the haphazard growth of the last few years with its huge environmental costs and lax regulation and the imbalances in growth between urban and rural as well as wages and benefits without labor law protections to create domestic consumption by a middle class. ...

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Arvind Panagriya, Prof. of Economics at Columbia University, points out the key initiatives of the Modi government in its first four years which will show results in future years for development of the country.  He mentions the Swachh Bharat Mission and cites results that show rural households with toilets are now 84% up from 38%.  By 2019 the whole country will be defecation zone free on the 100th anniversary of the birth of Mahatma Gandhi. The Dhan Jan Yojana DJY accounts opened for rural households are up to 316 million. Aadhar cards for identification are up from 650 million to 1.2 billion. The Aadhar and DJY work together to enable direct transfer of benefits to poor households, eliminating the leaks in benefits transfer and ghost accounts of the period since independence in 1947. Not mentioned by Panagriya is the Health Insurance scheme for lower income households that enable families to survive a sudden medical expense that could put them in dire straits.  These efforts work in a way to change India from the ground up from its villages and rural areas as envisioned by Mahatma Gandhi in the struggle for independence. The land acquisition law amendments were put on hold till farmers concerns could be better accomodated, an area of concern for industrial development cited in an editorial in the Hindu newspaper. Fiscal consolidation and inflation targeting have resulted in an average inflation rate of 4.3% for the 4 years of the Modi government. Inflation was over 9% in the last 2 years of the previous Congress UPA government with GDP growth dropping to 5.9% for the last two years. Average GDP growth for four years for the Modi government is 7.3%, even after the changes to implement GST taxation for one national tax eliminating state barriers in interstate commerce and demonetization to fight corruption and black money. Rate of GDP growth should be higher after the gains from the initiatives and the new GST integration of the country are felt, with increase in investment and FDI, after infrastructure improvements and land acquisition arrangements are made. Transportation infrastructure modernization initiative pushes ahead with the first bullet train in the pilot project for Ahmedabad- Mumbai set to start in 2022. This is a $17 billion project financed for $13 billion by the Japanese government at 0.1% loan for 50 years, moratorium on repayments for 20 years, using E5 Shinkansen series technology. Implementation of this project on a sound financial basis should lead to transformation of the Indian rail network, raising the level of technology implementation across the entire Indian rail system. Such an achievement would rival the first introduction of railways into India in the nineteenth century under the British. A new bankruptcy law is intended to free up capital for investment by putting behind the large number of non performing loans in the Indian banking system. Changes made by the central bank RBI are designed to speed up this process so that loss making enterprises are absorbed, consolidated or shut down, a legacy from the earlier period.     ...

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As Obama faces the situation FDR faced, between political popularity after election in 1932, and loss of some political capital in the first year by 1933, and a lot depends on political will and courage. He has to execute and implement plans for efficient government spending that builds jobs to replace those lost, and to use the investments in really productive ways including projects that provide returns for years into the future. As David Axelrod points out in the Frank Rich column in the NYT, people sometimes live in a parallel universe, which may be completely at odds with what the rest of the country caught in the economic currents of layoffs and collapsing businesses is thinking.

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Timothy Rooks in DW.com points out rightly that it will be how well Macron grasps the opportunity to turnaround the economy within the EU that will make a difference. France needs some of the changes Macron is proposing because it has one of the largest state sectors of western economies, and private industry needs to be revitalized to generate the jobs to reduce youth unemployment. A cut in the corporate tax to 25% from 33% would be in line with Britain, Germany and other countries. Some cuts in spending 60 billion euros over 5 years, and 50 billion euro stimulus package. The wealth tax would be retained, and the 35 hour work week.  He has opposing views on 35 hour week but now will focus on flexibility on overtime, capping severance pay and investing in education, job training, other ways of reviving the labor markets to get hiring started again and cut into 25% unemployment for persons under age 25. He also plans to follow the German model of letting companies deal with unions at the local level, at the company level, not only at a national level. Close cooperation with Germany and the confidence of French industry will be a plus as he works to revive the French economy, with the conviction that this will also be a project to fulfill the hope of young people for jobs, and a way to reduce the number who have turned to extremist parties in France. ...

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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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This editorial in the WSJ tells readers not to confuse the spirit of a pro-growth initiative in the CEO statement of Oct. 2012 with a simple tax increase. The CEO's are doing this as a part of a larger effort for a strong recovery in the U.S. economy and not simply to increase taxes. For the first time CEO's are backing tax increases to break the influence of what the Journal calls Republican deadenders who flatly oppose any tax increases period leading to unacceptable deadlock and uncertainty that prevents business from investing and hiring. This is part of a broader set of tax reforms to lower rates overall, reduce tax expenditures and support the Simpson-Bowles commission recommendations framework to reduce the deficit.

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The influence of the AMA convened Relative Value Scale Update Committee (RUC) on how the Medicare payments to doctors is shared, and on the growth of the Medicare budget. Concern that the interested party is driving the decision making process. Medicare costs went up by 9% in 2009. Fears that doctors have too much control over the dollars in the $500 billion Medicare program. The tendency to focus on more expensive procedures and short change preventive and less costly care. Medicare spends $60 billion on doctors fees. The older codes remain in place even when costs are reduced, leading to higher costs for the Medicare budget each year. And there is little incentive for doctors in RUC to revise overvalued codes.

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Walk in clinics at drug stores like CVS and stores like Walmart now have the cooperation of hospitals. Hospitals are now affiliated with 25 Walmart clinics. THe Cleveland Clinic has lent its name and backup services to a number of CVS clinics in northeastern Ohio. And the Mayo Clinic is operaing ne Express care clinic at asupermarke in Rochester, Minnesota, and asecond one at ashopping mall. This helps clear emergency rooms of people seeking bsic medical care as for astrep throat or flu. About one thousand clincs are operating in the US at drugstores, supermarkets and big stores since the idea took root 4 years ago. Wal-Mart has partnered with hopitals like the Christus Medical Group in Texas, Aurora Health System in Wisconsin and COxHealth in Missouri to setup clinics. Mayo did so after employees and patients said they wanted more convenient treatment for minor medical problems, so there may be a need here that as not been met. The lower costs at these centers compared to primary care doctors offices or emergency rooms make it possible for them to price lower and meet the needs of the 45 million or so uninsured people in the US, numbers growing as jobless rate increases. They are typically staffed by nurse practitioers or physicians asistants. Dr Herman at Mayo Clinic, who supervises its retail store clinics, says rather than fight this trend primary care doctors should learn from it, and work with hospitals around the country to offer more convenient locations and consumer friendly office hours, including periods of walk-in care with no appointment....