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The basic problems facing American health care. Douglas Elmendorf , head of the Congressional Budget Office, says none of the bills he has seen make the fundamental changes needed in how medical care is delivered and paid for. The big issue is the unwilingness of different interests to accept serious changes. THe NYT says the long run solution to the problem of rising costs is to move away from the fee-for-service system that pays hospitals and doctors for each additional service they provide and into anew system that is organized around ways that encourage low-cost and high quality healthcare. The difficulty is that the long run may be too far, considering the seriousness of the crisis. Elmendor also suggests taxing employer provided health benefits, as this will discourage the excessive use of medical care. As the NYT says this is politically risky, even though it believes this may be a way to the new system which has to discourage the use of health care in the manner it is conducted now, with too many tests being conducted. A new system requires an enlightened approach on the part of each interest group in the face of a crisis, and the failure to do that may only end up retaining some of the worst aspects of the old system just mentioned that drive up costs and make universal health care unaffordable....

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This editorial in the WSJ describes the sharp increase in premiums under the Affordable Care Act of president Obama. The average premium increase is about 24.2% according to a Barclay's analysis, and as high as 43.9% in states such as Illinois. Bill Clinton calls it the craziest thing with small business affected, and some premiums doubling. Of the 17 million people in the individual market eight million buy without subsidies. One in five enrollees cannot qualify for subsidies. Democrats say subsidies are too small. Hillary Clinton has proposed to have a Medicare "buy-in" for people ages 55-65, and a "public option" government run plan. Republicans want to rewrite the law. But this depends on which party wins the Senate, with the election in Missouri giving Democrats an opportunity to maintain a Senate majority.

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This view from the Guardian by David Adler from July 8 2019, gives a third perspective on Greece as it goes into elections. It looks at the turbulent period of 2015-2019 when a new leader Alexis Tsipras promised to lead Greece out of the eurozone crisis by standing up to the ECB and Germany, instead of looking at Greece's own responsibility in letting debt buildup till it overwhelmed Greece. Adler says Syriza was too much on one end blaming Germany for strict conditions on a loan bailout, and after this did not work embracing the loan program in a complete reversal causing much anguish to his own support base when this led to callous implementation.  Mitsotakis is careful to say in his interview with Reuters that the vulnerable have to be protected while also committing to a path of economic growth for Greece. It says 50 billion euros was provided to help people with the cost of living crisis, pensions were increased, minimum wage increased by 20%. It also shows the need to judge by looking at the situation not by labels of centre left or center right, are people better off, will people be better off in the future, are all the bases education, healthcare, public services, infrastructure covered? Is the government honest with the people and doing everything it can after listening to the people? ...

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British regulators say they have"absolute confidence" in the Pfizer vaccine after analysis of over 1000 pages of data on the vaccine. The vaccine was approved by the Medicine and Health care products Regulatory Agency. The first vaccines to be shipped to Britain are being packed in Belgium. Britain has secured 40 million doses enough for 20 million people. Vaccination will begin as soon as doses reach Britain. The NHS will prioritize, first care home staff and residents, then healthcare workers, followed by people over 80 years age. Clinically vulnerable people will get a jab alongside people ages 70-74. People with severe obesity and underlying conditions will get jab after people over 60 years, followed by people over 50 years. About 34% of the 66 million population of Britain is over 50 years age, which is about 22 million. This means the Pfizer vaccine ( with doses already secured by Britain enough for 20 million people) covers over 90% of these people or 19 million people and the 1.1 million workers in NHS. Rapid progress in vaccinating these people would make Britain the first country in the world to have done this, a remarkable achievement. By the end of the year the Oxford vaccine should also be available making it possible to proceed with vaccinating the rest of the population of 46 million people. ...

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On September 26 Germany holds a general election to decide who will lead Germany after Merkel. Olaf Scholz of the Social Democrats is seen as personally popular for his work in government with 48% support in recent polls, with Armin Laschet of the Christian Democrats at 24% and Annalena Baerbock at 27%. The Social Democrats poll 24% and are expected to form a government with the Greens at 16% and the FDP party. Baerbock of the Greens and Armin Laschet of the Christian Democrats have lost support in recent weeks with the floods and other events. The figures are from Deutschlandtrend poll by Infratest dimap Institute.  The CDU of Merkel looks less likely to form a government under leadership of Armin Laschet today compared to a few months before. Merkel is still popular with most Germans but this support does not carry over to Armin Laschet. There may also be some sense among Germans that it is time for a change in government after the Merkel years even though she is personally popular. The difficulties imposed by the pandemic on the German people, and the added problems of the floods could lead voters to look for change in government under new leadership more sensitive to the problems of today- infrastructure, employment participation of people held back by the pandemic, and rebuilding healthcare, education, childcare systems, tackling climate change issues. ...

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The exceptional role played by US president Biden in ensuring the recovery of the US economy, reaching both low unemployment and bringing down inflation was made possible by the president's conviction that the bargaining power of labor and its share in the productive wealth of the economy needed to be restored. The chair of the president's Council of Economic Advisers Jared Bernstein points this out in his speech at the Petersen Institute of International Economics. Bernstein points out that the Philips Curve which shows the tradeoff between reducing unemployment and increasing inflation is essentially flat and the president was right to push for full employment at between 3.5-4%. In the post Reagan era America was reduced to trickle down economics as president Biden has said at every State of the Union leading to a situation where workers had lost their bargaining power. See this as a resilience factor R in the economy which if it falls below a certain point leads to the economy operating well below its potential with high unemployment and worker incomes depressed. This strong conviction of the president and the efforts of the Fed chairman Powell have helped America recover from the pandemic faster than Europe, China and other countries, and is opening a path to meet the challenges of the future including infrastructure development and overcoming climate change, and meeting needs in healthcare and education, ease of living. ...

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Once a pioneer in X ray machines and jet engines General Electric fell into disrepute under Jack Welch when the company hid low earnings in industrial businesses by setting up its financial business. The 2009 financial crisis hit GE hard. Years of deleveraging followed after exit of the financial business. In 2018 it exited the Dow Jones Industrial Averages. Larry Culp of Danaher joined GE as new CEO of GE in 2018. He sold the healthcare business to Danaher for $21 billion. After about $100 billion in deleveraging the remaining company was split into two companies GE Aerospace led by Culp and GE Energy called GE Vernova a purpose built company led by Scott Strazik headquartered in Cambridge, Massachusetts. GE Vernova is focused on wind turbines and renewable energy, its purpose to accelerate the energy transition and advance sustainability. The new GE is itself a return to the old days when GE was a pioneer and powered America's industrial base, not the company of deindustrialization of Jack Welch of the 1980's Reagan and post Reagan period when investing in financial and speculative business made GE to lose its purpose and go astray. For Culp and others the realization of the failure of policies that deindustrialized America and shifted factories to China after Thatcher and Reagan was a lesson learned. It is now the story of an America on the move under president Biden. ...

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Uber built up about $30 billion in operating losses and burnt up huge amounts of capital with its access to capital from from financial markets in the US, according to S&P Global Market Intelligence. 2023 is the first year for profits of $1.43 billon of which the larger part of it $1 billion is from equity investments. It went public in 2019. Lyft a competitor of Uber has not yet turned a profit. Contrary to the general impression these kinds of startups have burnt enormous amounts of capital, and diverted capital from essential needs such as education, healthcare services, and public transportation. Consider the case of lack of investment in the New York subway system that lags so far behind that in other cities such as Tokyo to make it incomprehensible. The New York Port Bus Terminal  needed to be replaced- the planning took 10 years and the new terminal building will not be completed till 2032. Essential investments that improve the lives of millions of people in our cities are neglected or delayed. The real crowding out of capital from essential public needs is a feature of the Reagan era economics that have created many of the problems we face today of underfunding where it really counts. The capital allocation system is distorted so that capital does not generate proper returns or benefit the largest part of the population. ...

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Churchill came up with the idea of British restaurants that serve nutritious meals at reasonable cost so that no family would suffer from lack of access to healthy food at moderate prices. This would insulate people from the high prices during the war in the 1940's for food and energy. The Guardian shows these public diners in 1940's Britain. At its peak there were more British restaurants of this kind than McDonalds's or Weatherspoon's exist today. There is a need for this type of government supported food place that serves affordable meals serving quality food ethically produced as a new form of national infrastructure. Nourish Scotland is calling for reviving it today. It tackles health inequality and food insecurity. Abigail McCall, project officer at Nourish Scotland, says- "For other aspects of our wellbeing – water, transport, healthcare, even wifi – we have built the public infrastructure to ensure that everyone has quality, universal access. We are missing that in relation to food,” said Abigail McCall, project officer at Nourish Scotland. “Poor diets have overtaken smoking as the leading cause of preventable ill health for some time now. We need the government to make a bold intervention in our food environment, and invest in delivering what the market doesn’t: healthy, climate-friendly food in a convenient way and at an affordable price."   ...

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The calls for major changes in education and healthcare in a rebellious voter environment in 2016 by Bernie Sanders, represents a struggle for the soul of the Democratic Party between Sanders and Hillary Clinton's more incremental approach. The huge support from younger Americans for Sanders makes this a struggle for the soul of the party after the Obama years. Clinton's message is tempered with a realization that some of the changes in income disparities are a result of technological change and globalization, which does not resonate as well as the Sanders message that this is a result of rules being turned to their advantage by privileged groups. A similiar appeal on the right by Cruz says influential lobbies are writing the rules to their advantage, while also appealing to marginalized Americans, and struggles for the soul of the Republican party against the establishment politicians, governors such as Bush, Christie and Kasich, who have done poorly in Iowa.

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Amazon expands during the pandemic when retail on line delivery has helped people reduce trips to the grocery or retail stores. Amazon hired 427,000 people to expand its workforce to 1.2 million people by November 2020, 9 months into the pandemic. Almost doubling the employee workforce. These workers are mostly at warehouses, with some software engineers and hardware specialists. This includes hiring in India and Italy and is worldwide hiring. This does not include 100,000 temporary workers for the holidays, and 500,000 delivery drivers working for contractors.  Only hiring of 230,000 people by Walmart about 2 decades a ago in one year comes close. Walmart hired 180,000 people during the pandemic. Walmart has 2.2 million employees. With the expansion underway Amazon looks to become the largest private employer in the world in 2 years, say experts.  Amazon pay is $15 an hour after an increase of $2 recently. Its coronavirus safety practices have been upgraded after early criticism in April and May. Recent expansion in Italy and in India are also part of worldwide expansion after Walmart has pulled back from its worldwide expansion. This also shows how quickly major aspects of life are changing during the pandemic as some companies in online business are becoming more prominent than others. Target and Walmart have also increased in size. Best Buy has changed its focus with its conversion into a company that leads with personal service in online plus store hybrid retail and a focus on seniors and older people for healthcare service and product delivery. Companies are changing the way they run or getting a new life in remaking their business. This is also a time when other aspects of business such as social media are becoming evident. Subtle aspects such as reports of higher rates of mental depression through use of social media platforms. There is also the awareness that information technology companies in Silicon Valley generate most of their money in advertising and this advertising of $100 billion is only a small fraction of the $12 trillion U.S. economy. Should Silicon Valley based in California decide priorities on where capital allocation should go through the part it plays in moving startups based less on America's priorities than other considerations. Healthcare, education, cities, and infrastructure have not received funding they need and capital allocation by financial markets has failed the American people, as it has failed in Europe and other parts of the world for similar reasons. This has hit hard communities and people across the U.S. and Europe and also in Latin America, Africa and Asia, with the loss of manufacturing to China and other countries from the U.S. India and Europe. ...

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The tough job President Obama faces as he faces opposition from politicians who have interests to protect, and healthcare businesses with interests to protect. The President has to come up with a plan that is deficit neutral, because financial markets could see a healthcare bill that further widens the deficit as a signal for higher interest rates that would deepen the recession. At the same time each of the three sources of revenue puts him at loggerheads with political leaders in Congress or groups with interests to protect. Limiting income tax deductions for high earners could raise $267 billion in 10 years. It would require taxpayers in the top tax brackets deduct their mortgage interest, state and local taxes, and charitable donations, at the 28% tax rate instead of the 33% and 35% tax rates. The opposition is with democratic leaders that it would hurt charities, universities that depend on tax deductible donations, and taxpayers in high tax cities like New York city that are the home base of Democratic leaders. Yet only 1.4% of households would be affected says the nonpartisan Tax Policy Center. The Center on Philanthropy at Indiana University, says charitable giving would decrease by 2%. The other opposition on this comes from the preference of Senators Baucus and Grassley, who head the Senate Finance Committee, for tax increases or cost savings to come from the health sector. Specifically they want to see the value of workers' employer provided health benefits subject to income taxes. It is a situation in which every sensible person admits the need for healthcare reform and would see the current pace of healthcare costs as unsustainable and dangerous; and after that will just go back to his group and try to preserve as much of the status quo as possible, so as not to disturb by much the benefits or compensation they have secured from the system over the years. Then there are political leaders in Congress with their own preferences, and Congressmen who are the subject of heavy lobbying by these interests. The administration and the Presidents job is to navigate this stream with a workable deficit neutral plan, without any requirement for any group to make sacrifices, and in some situations even small sacrifices for the public interest. Would charitable institutions be hurt that much, what if charitable institutions were exempted, why would other interests the try to obtain the same exemption. Its like the unions trying to keep the old unsustainable goldplated healthcare and other benefits at GM even as the ship was going down. Taxing employer provided employee health benefits as income would raise $2.5 trillion over a decade. The opposition here is from unions which are a force in the Democratic party and which count tax free health benefits as a legacy of the labor movement. Employer provided health insurance covers 160 million American employed and their dependents under the age of 65, so it has a wide impact. Yet most economists favor ending the tax break. They say it mainly goes to upper income taxpayers, and discourages cost consciousness among consumers of health care, thus encouraging excessive spending and surging health care costs. Senior Obama advisors, Peter Orszag, the budget director, and economist Jason Furman favor this approach. So do Republicans in Congress. Senators Baucus and Grassley are not asking for the complete removal of the tax break, what they want to see is capping the value of benefits that go untaxed. If the tax-free limit is $13,000, a policy worth $15,000 would pay income taxes on $2000. A third spource is to spend less on Medicare. About two thirds of the $948 billion in savings Mr Obama has proposed over 10 years comes from a number of reductions in Medicare spending. $177 billion comes from insurance companies bidding for government reimbursements for offering private plans to seniors. $106 billion comes from cutting the subsidies to hospitals serving the uninsured as universal coverage should remove this need. And $110 billion in reduced payments to hospitals and doctors because of productivity gains. A range of industries insurance companies, hospitals, doctors drugmakers, nursing homes, home health care companies and medical device makers, all stand to lose from reduced payments from Medicare and Medicaid. And these groups with interests to protect are another factor in this process of working out a healthcare plan. ...

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The Wall Street Journal looks back at president Trump's first year in office from the inauguration speech to the passage of the new tax law. Race and immigration issues form the background of much of the domestic politics as Democrats prepare to shutdown government by December 2017 over a comment by the president. This happens during a meeting between the two parties on the Dreamer legislation to allow children of people illegally in the U.S. to stay in the country, when the president makes a derogatory remark about immigrants from Haiti and says he prefers immigrants from Norway. Efforts to repeal the Obama healthcare legislation fail during the first year. Democrats win a Senate seat in Alabama. A special counsel, Mr. Mueller, is appointed to investigate the Russian meddling in the U.S. presidential election. The tax law is skewed towards more tax cuts for the wealthy than the middle class, with the increase in the deficit not justifying the cut as infrastructure and other needs in health and education require funding. In international affairs Trump recognizes Jerusalem as the capital of Israel, and takes a strong stand on Iran and North Korea.    ...

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Simo Romero describes the serious self-reflection among Brazilians, as protests against the games and a climate of indifference replaces the euphoria in 2009 of getting to host the Summer Olympics in 2016. About 63 percent of Brazilians believe hosting the Olympics will hurt the country, 51 percent say they are not interested and only 16 percent are enthusiastic about the games, according to polling company Datafolha. The problems Brazil faces now stem from corruption scandals at Petrobras, impeachment proceedings against president Rousseff, and appointment of an interim president Temer, both extremely unpopular. Rio de Janeiro state's finances are in severe condition, and Brazil appears to have wasted the boom years by running up too much debt and not investing in public infrastructure, education, healthcare, and public services. As a result during the Olympics the sailing competition in Guanabara Bay near Rio is faced with the unpleasant problem of raw sewage that has not been cleaned up. Security needs in the Olympics area has led to reduced security in the northeast where prison run gangs operate in some areas against public property. Former president Lula da Silva who was once popular as Brazil experienced the commodities boom is now under investigation related to the corruption at Petrobras.  ...

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In his monthly television address called "Mann Ki Baat" prime minister Modi apologizes to Indians for the complete lockdown of the country. Modi said "for a a country the size of India we need strong measures. Nobody likes to take strong measures, but it is the only option, seeing other countries and learning that the disease must be dealt with at the beginning before it becomes incurable."  He cautioned that social distancing did not mean emotional or human distancing. Sympathy and cooperation are needed. He called frontline healthcare and sanitation workers "warriors" and "soldiers," and promised Rs 50 lakh (5 million) insurance for 20 lakh (2 million) such workers. He also commended the work of shopkeepers, drivers, bank workers and others to keep essential services running. Modi suggested now is time "to not go out, but to look within yourself. Try to know yourself." He gave examples of recovering doctors and workers, and of finding new hobbies. In coming time he said every Indian will try to break barriers for the country's development, once this crisis has passed. ...

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Vaccine mandates are becoming a favored action as companies and governments see the dangers of rapid spread of highly transmissible delta variant. Following the action by the French government to make vaccinations mandatory for all healthcare workers, and require health pass passe sanitaire showing one is fully vaccinated at restaurants, cafes, and trains, more governments are taking up this action. This is supported by French premier Castex showing that 97% of the 18000 average daily cases in France this week, up 150% from prior week, are from unvaccinated people. Similar situation prevails in the US making it critical that governments take action early, and not miss the right time for such action.

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DW.com shows Kashmiris voicing their concerns about their future. The Kashmir economy can get an immediate and significant boost from tourism which creates significant number of jobs and opportunities for young Kashmiris. Spain gets 85 million tourists and its economy is highly dependent on tourism. Kashmir also has the potential for boosting production of fruits and vegetables for export. 

It is this economic force that Kashmir can see building its future and would boost the living standards of the people in this region. By creating a strong economy Kashmir can boost investments in schools, universities and hospitals, healthcare, to improve the quality of life in the region.

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Washington Post editorial on the Obama Georgetown speech of April 13, 2009. It questions whether President Obama has the candour and courage to tackle the tough issues of deficit reduction and entitlement reform. New healthcare spending for coverage itself will add to entitlement, and it says some of the savings mentioned by the President are phony or already needed for new spending for the economic recovery and health care. At the same time the paper gives Obama good marks for his clarity and grasp of the crisis and steps for recovery, and the policy agenda in the areas of health care, energy and education. The questions about courage and candor also raise all the questions about facing upto the facts about insolvent banks that Krugman, Rosenfeld, the Economist and others have raised. Is Obama dodging the hard choices, is he dithering? On the toughest issues like foreclosures, insolvent banks, global regulation pushed by the Europeans, will he end up making inadequate or faulty choices, and when he comes around to making the tough choices, will he have lost so much valuable time as to prolong the crisis and stretch it out to many years....

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A House budget bill passed in Texas would cut an already lean budget- because of years of prudent fiscal policies- by $23 billion from the current level of state and federal spending over the next 2 year budget cycle. This is a reduction of 12.3%. The budget makes large cuts in public education, healthcare for the poor, highways, prisons and state parks. It takes away full day preschool, cuts teacher incentive pay, and reduces scholarships for college students by two-thirds.

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House Democrats in the U.S. see the Republican health care plan making the same mistakes in 2017 that the Democrats made in 2008. With the passage of the bill in the House of Representatives with a vote margin on May 4, 2017, rushed through in the way the Obama bill was also rushed through, the nation remains as divided as ever on the issue of health care. The Republicans favoring limiting subsidies and cutting Medicaid, and using some of the savings for a tax cut. The Democrats favoring mandated coverage for all and large subsidies to reduce the number of uninsured Americans, with expansion of Medicaid for very low incomes. Democrats in the House say the Republican House bill will result in Republicans losing seats in the House in midterm elections.

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For the first time in three decades US economic growth will be much faster than China's. Second quarter 2021 growth in the US was 12.2% compared to 7.9% in China, and will continue to be much higher for five consecutive quarters. This report in the WSJ says it is the result of the US response to the Covid pandemic. The US vaccination drive, massive fiscal stimulus and near zero interest rates have helped, including the confidence generated by the $1 trillion infrastructure investments planned for this decade. Over the longer term Capital Economic estimates China's GDP around 2030 will drop to 2% growth with demographic decline, just as the demographic factors favor Indian growth to levels that China has seen in the last two decades. This was the plan and vision set out by the Indian prime minister for 2047, on the 100th anniversary of independence. For the future government help has helped US households accumulate $2.6 trillion in excess household savings, which Moody's estimates is 7 times that in China.  In the longer term gaps will have narrowed between Asia and Europe, the US, which is a good thing. More will need to be done in Africa and Latin America. Much of the talk about who leads ignores the local needs in cities and towns across all parts of the world for a better quality of life, better education, better nutrition, better healthcare, meeting aspirations of young people, and supporting hope for a better future. ...

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This essay by Hein De Haas in the WSJ says there is a need for honest discussion about immigration in the US, about how best to accomodate the need for workers in certain trades and occupations in an organized way. In fact there is no need for the issue to be politicized this much. It needs to be depoliticized now that the needs for these workers are going to be larger not smaller as the US population ages and there is need for workers in healthcare and support for aging, and in other places such as construction, building infrastructure as US rebuilds aging bridges, roads and airports. In the seventies it was ned for agricultural workers and temporary workers moving back and forth across the border. Only in recent times has the border crossings assumed the scale and dimension it now has with 2.5 million border crossings at the peak. By comparison to the needs for workers only 500,000 are given work permits. And the laws have not been changed since the Reagan administration amnesty and legislation. Haas says workforce enforcement is negligible today in recognition of the fact of worker needs even under Republican administrations showing the need for honest discussion and resolution of this problem. The other problems of rebuilding manufacturing, US competitiveness, education and vocational training, are very different and require different solutions so that letting the immigration issue spill over the way it has is bad for America in deciding the future direction of the country and the economy, and renewing hope for the future. ...

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Americans Save Early and set aside for savings 10% of your pre-tax income, is the advice to ensure a safe and healthy savings retirement. This is absolutely critical. What the government can do is to ensure that incomes keep uo with inflation with fair wages in industry. It also can and should protect Americans from unexpected medical costs by ensuring that all Americans are covered by health care and for catastrophic situations. Then it is the task of Americans to build a culture of careful saving that their ancestors had and considered a essential part of virtue. For this to help build savings for retirement the government and the Federal Reserve together- as Biden and Powell have shown one with capital investments to build a strong economy and the other by protecting savings and cost of living action- must ensure that no financial crises take interest rates to zero or 1-2%. At interest rates of 5-6% for returns this helps build savings for retirement. For this to happen banks have to go back to their traditional work in the economy and no speculation risk, and Silicon Valley go back to inventing and not a culture of capturing capital allocation in capital markets and paying little in taxes. A new culture would put government in its right place to ensure that it plays a significant role in building manufacturing and science and technology in the US as president Biden has done through government investing in infrastructure and renewable energy, chips and science, and in education, healthcare.  ...

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October 1 is a national holiday in China  and the 75th anniversary of the founding of People's Republic of China in 1949. Youth and students in China travel across the country to visit historic sites in the Chinese Revolution in what is called Red Tourism. The perceptions of young people and students on Mao in 2024 is shown in this video in FR24. This is how China wants to remember its past- a century of conflict with European powers and the British Empire after European Powers tried to breakup China following the Opium Wars in the 1850's. This was followed by the Japanese Empire staking its claims over parts of northern China in 1900-1945, and the period in which the US under General Joe Stilwell struggled with the dilemma of China knowing the corruption and failure of leaders to modernize China.  Then followed the decades when hunger and inadequate healthcare was banished from China, yet the industrial revolution that happened in western Europe and the US was elusive. Efforts in the 1960's to do this failed. Only when China showed the spirit of humility to work with Europeans and Americans and the Japanese and opened up its thinking to adopt markets in its own context of state run operations was the industrial revolution accomplished and modernization made to happen in the 1990's onwards. Three decades of rapid industrialization transformed an ancient nation in the heart of Asia. ...