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Alan Blinder, Princeton University professor and former vice chairman of the Federal Reserve, says the biggest reason for the growing deficit in the years out to 2040 is because of increases in health care spending. Its not that there is runaway spending in other areas. He cites CBO projections that show other costs stable relative to GDP from 2015 to 2035 and declining. This is why healthcare spending is at the heart of the problem. And why tackling the deficit has a lot to do with reducing healthcare cost increases.

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A new CBS-New York Times opinion poll in June 2012 shows 44% of those polled approve the job the Supreme Court is performing and about three fourths say the decisions of justices of the court are influenced by their political and personal views. By comparison only 15% approve of the job done by the U.S. Congress in the most recent poll. Only one in eight say the justices make decisions based solely on legal analysis. About 60% say they agree that life tenure for justices is bad because it gives too much power to justices. On the health care law two thirds of those polled say they hope some or all of the 2010 Obama health care law is overturned.

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This review of Acemoglu and Robinson in the MIT News is relevant to the situation faced today. The two professors at MIT and University of Chicago, have provided two books relevant to today's crises, the first "When Nations Fail" in 2012 about the need for inclusive nations, and the second "The Narrow Corridor" about the importance of the role of individual and society in sustaining democracy. Their point in the first book "When Nations Fail" in 2012 coming after the financial crisis caused by banking excesses stated that the nations fail when they are not inclusive.  In practice it is about " the system being rigged" to favor some groups as the Republican party and Mr. Trump say has happened. The banks and lobbyists, pharmaceutical industry and lobbyists, tech industry and lobbyists, leading to a system where individual and society are pushed into a corner. Social theorist and economists fail to look at things in practice such as profit seeking behaviours and unethical behaviour that goes unchecked, which continued after the financial crisis into the election of 2016, with charges of rigged systems.  This week Germany's DW.com oped pages covered New York with the statement that treatment in New York costs $15,000 for coronavirus infection illness yet many New York residents in the worst affected neighborhoods would find a $500 expense difficult to bear. Early closing of schools to control infection rate was resisted by Mayor De Blasio of New York because many parents depended on schools for lunches for their kids. The situation had been allowed to deteriorate to that level.  In their second book the MIT authors are saying that the role of the individual and society are important to check that of the state (for example if it is perceived as being rigged by the influence of lobbying of legislators and politicians as the Republican party and Mr. Trump have maintained). It is only when it is checked and there is some tension is there the possibility of democracy and democratic processes, say the two MIT authors. In the absence of this the states and elites of politicians and business interests supporting the leaders and their common behaviours, become a perpetual state, in effect a one party rule of two parties with similar behaviours and interests in the state. A situation that allowed the outshoring of American manufacturing and European manufacturing to China including critical infrastructure, essential infrastructure over 2 decades even over the protests of Mr. Lighthizer since 2010. As the twin crises evolved in Europe of austerity policies after banking excesses in Europe, and the migration crisis of migrants coming from North Africa and the wars in the Middle East, a similar situation began to develop in Europe as the political elites entrenched in Germany, France, and Spain faced new voices. The tensions that arose were constructive bringing in the role of society and individual that the MIT authors say are so necessary for the narrow corridor of democratic process to function. New parties emerged in France with Macron's La Republique En Marche, Podemos and Ciudadanos in Spain, and in Germany with the SPD and CDU shrinking till the revival of Merkel for her handling of the pandemic. Coming from an intuitive way born from experience in East Germany, Germany's recent president Joachim Gauck, civil rights activist  came up with the same ideas. He is a Lutheran pastor in former East Germany who struggled against the government of the German Democratic Republic (former communist East Germany) for a role for individual and society against the state. We profiled and quoted him in "The Way Forward"  column in Lyrarc.com. Gauck's point was that  having diverse groups in the conversation is important, not excluding others from outside in the conversation is important. Gauck called  debate "the oxygen of democracy,"  that needed to be maintained.  Genuine democratic process is hard to sustain, it happens only when the role of individual and society is given prominence, so that only a narrow corridor exists for democracy, a narrow space in which can be sustained only if the effort is there, the goodwill is there, and the grace of Divine Providence.  It is fragile and it is critical to sustain.   In this sense the sometimes heated debate in the U.S. and Europe, Asia and Latin America about words such as- austerity, community, solidarity, migration, New York Mayor De Blasio's choice between school lunches and infections, about infrastructure, pharmaceutical prices, infrastructure, outshoring, jobs sent overseas, manufacturing locally, made in USA or made in India or made in France, Atmannirbhar Bharat, misallocation of capital starving health and public services, are all relevant and essential for democracy. This includes the discussion to avoid use of the military in protests in American cities in the middle of a pandemic which just crossed the 2 million mark in cases in the U.S., that was taken up by Defense Secretary Esper. In it lies the hope for democracy and many voices. Der Spiegel recent look at the pandemic how it happened in China, closes with the line- you need more than one voice in society. A constant reminder that many voices be heard, counseling patience, but also that wise choices be made with divine providence.           ...

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

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

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The House Energy and Commerce Committee passes ahealthcare plan with 31 to 28 vote. The Senate version takes adifferent approach. The Senate version has moved away from the employer requirements in the House bills. The Senate committee is moving towards aproposal to require employers to contribute if their workers are getting government assisted insurance coverage. It has also moved away from the surtax on the wealthy in the House bills which is expected to raise $500 billion. Instead the Senate version proposes an excise tax on insurers for health plans that offer generous benefits. Under the current bill being considered in the Senate such a insurance policy tax could raise $180 billion. The Senate Finance Committee is also different in that instead of the public insurance option it offers nonprofit health insurance cooperatives as an alternative. There is agreement between the two parties on anumber of things so the debate will center on the public insurance option, surtax on the wealthy to pay for the plan, and the requirement for an employer mandated coverage for all employees....

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The rarely mentioned origins of the U.S. Medicare reform proposal of Rep. Paul Ryan and Rep. Ron Wyden, which includes work done at the Hoover Institution and liberal think tanks, in a debate subject to distortions on all sides.

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The discussion on whether it is feasible to achieve any significant cost savings as long as middle class consumers are not cost conscious about their employer provided health insurance. This would be so as long as their health insurance benefits are not taxed as income. America suffers from a particularly strong case of not minding the price increases imposed by the health care industry as long as its not out of pocket cost. But Obama seems stuck on his insistence that the middle class not take on any burden, that there be no middle class tax in the form of this tax on health care benefits. Critics say even FDR did this by having the middle class pay with payroll contributions for Medicare and Social Security. And even if the 5% of Americans who make more than $280,000 are taxed it will not generate by itself the money to pay for the $1 trillion cost of the plan, as the prospects of cost reduction are uncertain- especially when the basic nature of America's health care system are not changed, like the lack of cost consciousness of consumers of health care when its perceived to be free and employer provided....

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Krugman talks about the misunderstandings and the whole lot of misinformation that comes from advertising and political commentary. With one man telling a Congressman at a town hall meeting: "keep your government hands off my Medicare." In apolitically charged atmosphere this makes rational decisions in acalm thoughful environment difficult or impossible- when the influence of lobbying by the health care industry and the influence of interests on behalf of patients and other interests have already created a difficult situation.

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Senator Schumer calls it a "momentous 24 hours here in the US Congress, a legislative one two punch that you rarely see." Schumer negotiated a major climate change action bill for $369 billion in the Senate, that also covers tax changes to cover costs, and helps cut drug and health care expenses of Americans. The second quarter shows healthy job gains of average 375,000 a month and unemployment at 3.6%. The economy declined by 1.1% but much of this was from a slowdown in home and business construction sectors sensitive to higher interest rates and from higher inventory. Consumer spending increased by 1% during the quarter. The Fed's series of 0.75 percentage points interest rate increases had softened inflation expectations before they get entrenched in the economy. This makes it possible for Democrats to present a message to ordinary Americans that president Biden is getting things done with 2 legislative achievements. A $280 billion bill for investment in the semiconductor industry in the US. And a huge win on climate change with the $269 billion Schumer is negotiating in the US Congress. It is the opposite of what Republicans are saying is Biden's failure to tackle inflation. Appropriately Biden and Schumer are calling this the bill the Inflation Reduction Act of 2022. How did Schumer get this done? After the Ukraine war and EU decision to shut down Russian oil supplies, cut oil and gas use by 15%, and the climate change action inducing fires and floods, there is increasing awareness about climate change action as vital for our future all over the world. This gives more confidence to Democrats to negotiate a temporary continuation of oil and gas, with increased exports of US LNG to Europe. Senator Manchin from an energy producing state of West Virginia was brought over to Schumer's side with this idea. What Biden gets is a 40% reduction of US carbon emissions over 2005 levels, enough to get within reach of the 50% he promised at COP26 in Glasgow. It is a win-win for all sides and for the American people, and shows that patience and hard work, and persistence in the face of adversity can bring results. ...

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Two of three obese people live in developing countries. About 29% of the global population is obese in 2013, according to the Institute for Health Metrics and Evaluation at the University of Washington. Between 1980 and 2013, obesity increased by 47% for kids and 27% for adults in the global population. Dr Murray of IHME says no country was the exception. Diet and inactivity are the principal culprits. About 37% of world's men and 38% of women are obese. Obesity increased rapidly first in developed countries, becoming noticeable by 1980 and slowing since 2006, and now is growing fast in developing countries. Germany is a surprise No. 8 on the list. The U.S. No. 1 ranking tells a lot about the misguided priorities of living in the U.S., lack of education on healthy eating and healthy living, and not putting healthy habits at the top of things to do above making more money. An extreme case is South Africa where 42% of women are obese. The most obese countries are by rank - U.S., China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan, Indonesia. Middle Eastern and North African countries have high obesity rates for children. The study is funded by the Bill and Melinda Gates Foundation....

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John Cochrane, professor at the Booth School of Business, University of Chicago points to the simple truths about U.S. healthcare- out of control pricing because of the pathologies created by previous laws and regulations. He points out that costs are high in healthcare because regulations keep them high. Supply of new doctors is controlled because Congress and the AMA made it that way with a cap on residency programs and AMA opposing the expansion of medical schools. In a system of open competition new hospitals and health care businesses would challenge old ones which is not happening in a regulated market with regulations working to limit competition for the firms already in the business and with the influence to limit competition. Insurance costs for major expenses in an open and deregulated competitive market without the regulations would be so much lower than todays costs that its likely we would not even need a mandate such as the one the Obama healthcare law imposes.

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Elizabeth Rosenthal looks at Obamacare's contribution to cost containment in 2013-2014. Rosenthal says its is a kind of delicate maneuvring at the edges, because serious work needs to be done. The fee-for-service and many of the drivers for increases in medical costs, the old system of pricing, are still in place. In 20 years at the current rate and after Obamacare health care will still take 25% of the U.S. budget if nothing is done. Healthcare costs are about half that of the U.S. in some of the advanced European countries. She calls Obamacare a trickle down theory of cost containment becaue it leaves most of the drivers for cost increase in place and works at the margins. Princeton economist Uwe Reinhardt calls it an ugly patch on a somewhat ugly system. Rosenthal cites the armies of consultants anticipating every move to reduce prices, and working on "strategic billing'' to increase revenues for hospitals and doctors. For those who say the prices are now up more slowly than in the past, Michael Chernew of the Harvard Medical School, has this to say- its like a diet, reminding us that that we haven't even lost weight, just gaining weight slower than before. ...

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Krauthammer cites Congressional Budget Office numbers that show the Obama U.S. health care law continues the spiralling costs of health care with new government mandates at a time of severe budget cuts in education and other areas- for 2013-2022 the costs come to $1.76 trillion. The initial Obama administration figures of 10 year costs of $938 billion announced in 2010 reflected the fact that the new U.S. health care law would take 4 years to fully go into effect. Costs after 2021 are shown to be $250 billion each year in the CBO figures. The law is now before the Supreme Court in 2012, which has to decide on the basis of the limits of the Commerce Clause.

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Danny Hakim's gives this indepth account on the U.S. Chamber of Commerce's connections to the tobacco industry, with reporting from Ukraine, Nepal, the Philippines and other poorer nations struggling with the public health implications of widespread smoking. Since 1997 the Chamber of Commerce, which is viewed in foreign countries as an outpost of the U.S. government, has taken some controversial positions. In the U.S. the chamber has as it members the tech industry leaders such as Google and Microsoft. Yet it is increasingly at odds with these companies. In 2009 the chamber under Mr. Donahue opposed greenhouse gas emissions regulation by the EPA, leading to the departure of Apple from the group and Nike stepping down from the board. In 2013 the American subsidiary of Sweden's construction company Skanska left the group, in protest against the chamber's opposition to green building codes. Michael Bloomberg and Bill Gates have set up an international fund to fight law suits challenging international anti-smoking laws by tobacco companies. The TPP's provision for companies being able to sue foreign governments for violation of trade agreements has no exception for tobacco companies. Similiar concerns are raised about pharmaceutical companies suiing foreign governments where the governments are working to increase access to medicine for poorer sections of the population....

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This WSJ article provides a detailed account of the positions of Clinton and Trump on Wall Street, the financial industry, banks, Dodd-Frank, regulatory reform, 6 weeks before the U.S. presidential election.

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Under a plan called "premium support" Paul Ryan's U.S. budget proposal would have seniors choose a private insurance plan from a federally operated exchange. Each year the government would pay private insurers a specific amount to cover the cost of premiums with the rest borne by seniors. The total amount paid by the government would go up only at the rate of overall inflation, it would not go up at the higher rate of health care inflation. By doing this the government would take off the trillions of dollars of projected spending on health care that are largely the result of the higher inflation rate in health care costs. This higher inflation rate on health care costs is something that both parties have failed to control, and remains a major weakness in all health care proposals to date, including the Obama health care legislation. Allowed to continue growing at this rate when U.S. debt to GDP is nearing 100%, health care inflation costs pose major risks to the nation's finances.

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Rising costs in the French health care system.

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A study by ITEP, Institute for Taxes and Economic Policy shows the top 1% pay less in taxes on income than every other group in 42 American states. The poorest fifth pay taxes 60% higher than top 1%. The most regressive states are Florida, Washington, Tennessee, Pennsylvania and Nevada. The tax systems seen as reducing inequality are D.C. Minnesota, New York, Vermont, New Jersey. This happens at a time of growing inequality, high cost of living, and the aftereffects of the pandemic on health and mental health, with high cost of pharmaceuticals with entrenched lobbies, low enrollment of men in colleges with increasing dropouts, the huge burden of student debt on young people.

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Under the Volcker Rule setup during the global financial crisis of 2008-2009, banks total investments in private equity, hedge funds and similar higher risk funds cannot exceed 3% of high quality capital. During the financial crisis investment banks were highly leveraged leading to the collapse of Bear Stearns and Lehman Brothers, and the precarious financial condition of other banks. Goldman has pared down about 60% of such investments. Remaining are $4.8 billion in private equity investments, $1.2 billion in real estate, and about $1.1 billion in both credit and hedge funds. Regulators have given the bank till July 2017 to comply. As banks recovered from the impact of the crisis, the tearing of the social fabric that happened with high unemployment in some groups especially older white men, has remained six years after the crisis- as evident in the U.S. election campaigns this year. As a result the mood has shifted for tighter regulation and both party platforms, Republican and Democratic, now call for reinstatement of the Glass Steagall Act, which separated commercial banking from investment banking as part of the lessons learned from the Great Depression. Volcker, was chairman of the U.S. Federal Reserve during the Carter administration, known for taking a tough line against inflation. He was the principal driver of the move to restrict banks from risky activity, and faced considerable opposition from banks during the 2009-2013 period when the rule was being formulated.  ...

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The House bill on health care cleared the House Committee on Energy and Commerce with a vote of 31 to 28. Five Democrats joined all 23 Republicans. Compromises were reached with Blue Dog Democrats, centrist Democrats who had concerns about the cost of the health care overhaul. The bill will be taken up again in September after the August recess, when Congress will be faced with the task of recociling the House and Senate versions and reaching common ground on a number of proposals. Some common ground has already been achieved between centris and Blue Dog Democrats and Democratic members who support Obama's proposals. Among the changes on which consensus was reached in the House version: 1. Access Insurers will have to accept all applicants and will not be able to charge higher premiums because of medical history or current illness. All insurers will have to offer a minimum package of benefits, to be defined by the federal government, and nearly all Americans will be required to have insurance. Insurers will have to get prior approval from the government before increasing premiums over a certain amount. About 95% of Americans will be covered this time. The cost will still be approaching $ 1trillion over 10 years. Federal subsidies will be given to those who cannot afford health insurance and Medicaid coverage will be expanded. And the insurance will be made more affordable for the uninsured. Democrats also reached a consensus on creating some sort of government insurance plan or nonprofit cooperative to compete with private insurers. 2. Mobility And under this new plan it will be easier to change jobs as one would retains one's health insurance. This should actually help the job market, and help promote the mobility that is needed, now that jobs are shifting out of sectors like autos to sectors like energy. 3. Cost The Energy and Commerce Committee voted 47 to 11 to set aprocedure for the government to give federal approval of generic versions of expensive biotechnology drugs. By one estimate this saves $9 billion over 10 years. The Democratic proposals from the Energy and Commerce Committee would authorize the Health and Human Services Secretary to negotiate prescription drug prices for Medicare benificiaries. The agreement and consensus among the conservative, liberal and centrist Democrats, and Democrats with ties and connections to the health care industry was reached after intensive negotiations, and adoption of a package of amendments that helped bridge the differences they had. ...