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Ingram says Obama's 2015 budget is more of a wish list for Democrats, because 2015 spending levels are already set and House Republicans will put together their own budget putting forward the Republican views. Obama's budget includes new taxes on busiess and the wealthy to reduce the deficit. Other ideas- raise tobacco taxes to pay for universal pre-K education, a "Fianncial Crisis Responsibility Fee" on big banks, overhaul immigraion laws to increase tax revenues, limit itemized deductions for the rich, force drug companies to give large rebates on Medicare prescriptions. Another proposal is a $56 billion "Opportunity, Growth and Security" Initiative, for spending on early childhood education, job training, and medical research. To pay for this he would cut the amount wealthy people can save tax free for retirement, cut crop insurance and raise airline security fees.

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Germany faces the possibility of a pandemic surge of the unvaccinated, something that is happening today in the southern United States.  For days the percentage of people that are fully vaccinated remains at 62%. Some vaccination centers are closed. A vaccination center outside the train station in Cologne offers passersby free vaccinations. Berlin's Social Democrat mayor Michael Muller is very frustrated. He says "I am now coming to a point where I think we have exhausted what we can do in politics."  At 62% the rate of fully vaccinated people in Germany is too low to prevent a surge of the Delta variant in the way that it has hit the southern US, and California. Vaccination rates of close to 85% are needed to tackle the risk of another surge in highly contagious delta variant. Not everyone remaining is die hard opposed to vaccines. The Robert Koch Institute estimate is that 5 to 10% of people are in that die hard category. The remaining 20-30 % are people who have various other concerns and fears, hesitancy, that may be changed.  The chairman of the World Medical Association Frank Ulrich Montgomery favors a vaccine mandate, what he calls a 2G rule, that should be introduced in Germany requiring vaccination to attend events, sports, restaurant visits, adopted nationwide. German government has rejected idea of mandatory vaccination of health personnel, that was adopted in France. Vaccination drives are regionally based. Some are ineffective such as the Deutsche Bahn train system vaccination drive for commuters that only had a few hundred doses of J&J vaccine and ran out quickly in Berlin. One prick J&J some say is better for vaccine skeptics. Vaccine skeptics think they may get away without getting covid infection. How does one get over this misconception? Others including members of the Greens party say vaccine needs to be delivered where people are- transit points, bus stops, doses offered in evening and early morning hours, trying new ways to reach people and inspire confidence. Germany now ranks behind France but ahead of Bulgaria in terms of vaccination percentage in September 2021, not a good situation. ...

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What happens to the 70,000 residents of Anacostia, near the Capitol in Washington DC where a third of the people live in poverty and there is a 40% dropout rate, and only 8% of all students there attend college. Vacant homes, drug use and crime sap the neighborhood here. Obama said he would bring 20 cities an antipoverty program successful in Harlem, New York that would include parenting and infant care classes, as well as early childhopod education and free medical care for children. An investment of $1 billion for 5 years for a transitional jobs program, to place the unemployed in temporary jobs. The Obama transition team did not return requests seeking comment on the 20 city plan or the $1 billion for transitional jobs, says the WSJ on January 20, 2008, the day of the inauguration. Its incredible that right in the nation's capital there exists another Washington DC of such neighborhood decline within sight of the Capitol.

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A major British and Indian collaboration and scientific achievement of both countries is not given the recognition it should get because of mismanaged communication of the results of clinical trials. Tom Whipple science editor of The Times says do not make the mistake of thinking oh Pfizer vaccine scores a 9 out of 10 and Oxford's a 7 or 8 out of 10. Pfizer vaccine says it 94% effective. But this is only part of the story. It is the first exam paper in a long number of exam papers and the final score will require scoring them all. "Oxford vaccine is complex, and we are happy with the complexity," says Adrian Hill, Oxford researcher and head of the Jenner Institute. It is not highly unusual in this complex field for a half first dose to work better than a full first dose in a two dose vaccine treatment. This happened with the Oxford vaccine. As a result the study results were harder to communicate. This happened by accident. Much of medical research and much of medicine's biggest breakthroughs in the last 200 years happened by accident, as one researcher looked for something and accidentally discovered something else profoundly useful. Whipple's points are turning out to be true now that Britain's medicine regulator has asked that Pfizer vaccine not be given to people with history of allergic reactions after 2 NHS workers had strong allergic reactions. A lot of questions remain for all vaccines. How long will the protection last? WIll it prevent transmission of coronavirus? Are there any other complications? Which vaccines can work without ultralow refrigeration storage? Ahead lie the prospect of billions of doses. Two are in final stages in India including Bharat Biotech request for emergency authorization. Johnson & Johnson has a competing one to Pfizer's in the U.S. As many as 30 are being developed in India and 100 around the world. Countries like South Korea say they will wait to find out which one works best and where cost overall combined with benefit is attractive. Some of the vaccines are coming out only weeks apart. The early ones could stumble, if something was missed. ...

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 South Korea has run about 300,000 coronavirus tests, double that in Italy and ten times that in the U.S., says this report in the WSJ. This report shows how the South Korean testing works and the workday of Lee Hyuk-min, a clinical microbiologist at a testing lab of Yonsei University Health System Severance Hospital in Seoul, who is working from 4.45 am to 11 pm. South Korea's effectiveness in controlling the spread is based on a strategy of efficient testing that enables isolating quickly people and areas. South Korea's testing network is a legacy of the MERS coronavirus outbreak in 2015, and the government failure at that time to control it.  It brings together doctors, medical staff, labs, and political leaders in roles following the protocols established since then. Dr Lee and others are the final checkpoint in the system which coordinates a diagnostic operation that combines together 633 test sites and 100 labs. The protocol includes a uniform setup- same testing equipment, same training, same decision making process. At 8 am each day all labs upload results to a shared database, which allows public and private hospitals to monitor patient results and report them to Korea Centers for Disease Prevention and Control. Hospitals upload testing details to an online directory. This surveillance allows South Korea to predict where to concentrate its efforts for controlling spread, says Dr Lee who advises the South Korean government on lab testing issues. Action plan took 2 years for the new rules to be implemented following MERS in 2015. The plan included accelerated bio testing company approval for tests. The first company got approval on Feb 4, followed by 4 other firms. Dr Lee says testing is only part of the equation as labs are needed to process and confirm results. Another key is innovation. South Korea setup testing in drive thru locations, that limit contact and speed up testing, which the U.S. is adopting. Dr Lee says early identification is key, and identifying the first coronavirus patient which was done in South Korea on January 20. Other countries including the U.S. took too long to identify the first patient, says Dr. Lee. ...

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Kerala state of 35 million people who speak the language Malayalam, is one of the rare places today that has only 4 deaths from coronavirus, 524 cases confirmed and no community transmission. Here the Guardian looks at the reasons why. The Health minister KK Shailaja started very early on January 23, with a meeting of her rapid response team when the virus was still in China.  She setup a control room and instructed Kerala's 14 districts to do this on Jan. 24. When the first case arrived on Jan. 27 on a plane from Wuhan, Kerala had already adopted the WHO  protocol of test, trace, isolate and support. These passengers were checked for temperature, tested and quarantined. With some at a nearby hospital and others in home isolation. This is all the more amazing considering that Kerala is a state in southern India on the west coast that has a large number of people living and working overseas. Many are in the Gulf countries and the arrival of these refugees could have triggered a second outbreak. This was prevented by careful testing, and contact tracing of clusters.  When one group was evasive and concealed information from an airport surveillance team -arriving from Venice, Italy,  in late Feb- a case was detected back to them.  Contact tracers tracked down all of the hundreds whom they had been in contact with and quarantined them.  By 23 March all flights to 4 Kerala airports from overseas were stopped, including Cochin and Trivandrum. On March 25 India went into lockdown.  Some of the achievements in Kerala include quarantining 170,000 people early. with strict surveillance, which is now down to 21,000. Accomodating and feeding 150,000 migrant workers from other states, before returning them on charter trains to their home areas. A big reason for the success is the high literacy rate in the state. A big emphasis on education and healthcare is a part of the Kerala model. Shailaja is a secondary school teacher, and Health minister. From the days since independence of India in 1947 the state has a strong socialist tradition of taking care of the basics- health, education and public services. It also generates a part of its GDP with income from workers who are overseas.  Another reason for the success in dealing with coronavirus is experience. The state had a virus epidemic called Nipah in 2018 which has become the story for a movie called Virus in Malayalam. There is decentralized public health system in the state and people value their health care facilities, understand and trust the health care authorites. There are hospitals at every level of administration and 10 medical colleges. But trust and education, experience tackling the virus before, are key. Kerala is showing that poor countries can deal effectively with the virus, and create a better life by adopting the right model of creating good societies that value education, healthcare services, better economic structures and distribution of wealth, and  a degree of trust and responsibility found in a state that values public spiritedness. ...

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European Union countries, Britain and the US face the risk of a resurgence of coronavirus through the Delta variant and other variants. The Delta variant detected in India is 40% to 80% more transmissible than the Alpha variant detected in the UK, with the Alpha variant 50% more transmissible than the original coronavirus that originated in Wuhan.    Virologists in Italy feel they are flying blind at this time because of the lack of genetic sequencing in Italy, Spain, France and across most European Union countries. The UK has done genetic sequencing on 27% of recent covid positive tests. The figure drops to 1% for Italy and is tiny for most of the EU countries including Spain and France. Without genetic sequencing it is hard to predict and take steps. Another problem in the EU is that the southern economies Spain, Portugal, Greece, Italy, Croatia are dependent on summer tourism for the economy. The UK economy can handle a delay to a full opening for 6 weeks without serious impact to the economy, says WSJ. Southern European economies can afford only short delays to full reopening. Croatia acted as a door to spread of coronavirus into central Europe when Germans and Austrians went to vacation spots in Croatia in summer 2020. This situation could be happening again in 2020 with British and other tourists visiting vacation areas in Portugal, and Germans visiting Greece and other summer tourism spots. Portugal's national health institute says the Delta variant represents 60% of new cases in the area around Lisbon based on early data. The government of Portugal is facing criticism for letting a Champions League soccer final to take place in Porto, Portugal between two English teams. Thousands of English fans watched the game at the stadium. Other problems are in relaxing of mask rules in France and Italy, last week in France and in the coming week in Italy. French nightclubs open July 9 without mask requirement. Germany is maintaining some social distancing measures and this includes mandating medical masks in closed public spaces and on public transport. Half of French, Italians, Germans are vaccinated and quarter fully vaccinated. Yet the gaps of unvaccinated people is large enough to cause serious concern of another wave. The relaxation of mask rules- the entire stadium in Budapest was packed for a recent game between Hungary and Italy for a soccer Euro 2021 game with no masks to be seen. Stadiums played a key role for the spread of the original coronavirus in Italy with a game in Bergamo, Italy, in the area near Milan. All this makes health officials concerned about the risks of still another wave of the coronavirus.   ...

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David Brooks says the Paul Ryan Budget proposal is a bold step forward that is badly needed in this debate on health care, even though it has some grave weaknesses which need to be corrected. It is a bold step forward because he says Democrats say they want no middle class tax increases, or are not willing to say what kinds of tax increases they support, and yet they believe the Medicare and Medicaid and Social Security programs are worth preserving. This is'nt based on reality. He cites the weaknesses, beginning with the one discussed in David Leonhardt's column in the New York Times on April 7, 2011. Too many Americans pay too little into Medicare taxes and expect to collect several hundred thousand dollars more in Medicare benefits. The example given in Leonhardt's column is from a study that shows 56 year olds with average earnings pay about $140,000 in dedicated Medicare taxes over a lifetime, and then go on to collect $430,000 in benefits. Middle class and affluent boomers can't get off paying their share like everybody else. Its just the right way for their children and the nation's children. Ryan's plan excludes older people reaching retirement in ten years. The other major weakness is that the cuts are too deep. Things like the Pell grants which Ryan proposes to cut back to 2008 levels need to be preserved, and more money has to go into science, education and research and early childhood education for the U.S. to be competitive with China and India. The Ryan proposal places cuts that would be required so that tax revenues need to be at 18% of GDP. The number where a larger consensus exists is for tax revenues at 20% of GDP (also supported by business and the Wall Street Journal's editorial columns). This would preserve programs that are most productive for the economic future of the U.S. Ryan's proposal lets the hope for reducing costs of medical care rest entirely on future retirees deciding how much medical care (tests, procedures etc) they consume through larger cost sharing. Yet a structure and framework is needed to manage these costs effectively, and some combination of incentives to retirees to control costs and an effective structural framework is needed. ...

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At 79 years, Wilbur Ross will be one of the oldest people serving in any administration, as he serves as Commerce Secretary in the Trump administration. Wilbur Ross is best known for the turnaround efforts in the steel industry. In 2002 he acquired LTV Corp, a third largest steel producer in the U.S. facing tough times and legacy costs, for $125 million in cash and $200 million in environmental liabilities. In 2005 he sold his International Steel Group to Arcelor Mittal for $4.5 billion, and is still an independent director on the Arcelor board. Ross's earlier experience was as a bankruptcy specialist at Rothschild Inc. in the 1970's working on restructurings at Texaco, TWA and Continental Airlines. Analyst Charles Bradford is cited in this report by WSJ's John Miller, who competed with Ross in restructuring proposals for failing assets, and describes Ross as working harder and being tougher to make the deals. Some of these restructurings involved cutting pensions and large layoffs. The entire U.S. steel industry faced problems from foreign competition and legacy costs at the time. This included representing bondholders for Taj Mahal Casino in Atlantic City. At the time Ross told creditors considering seizing the asset for a possible missed payment that it would be better to keep Trump in charge for Trump properties as they would be worth more with Trump inside. This led to Ross later providing critical backing for the Trump campaign and raising money from the business community. Mitt Romney had similiar work at Bain Capital in turnaround of failing companies, later turning to politics as Governor of Massachusetts, and 2012 Republican nominee for president. Both Romney and Ross have come under criticism for their role in cost cuts at companies involving layoffs and cutting worker benefits. ...

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Questions about the true cost of the Obama health care legislation and the assumption that the legislation cuts the deficit by billions of dollars. This WSJ editorial says one has to look at this closely, and not merely look at CBO projections, which may be based in a certain context and not reflect the true costs, especially because many accounting gimmicks and use of numbers to present a particular picture is taking place. The information this editorial cites is that: it uses 10 years of taxes to fund six years of subsidies, Social Security and Medicare revenues are double-counted to the tune of $398 billion, a new program funding long-tem care frontloads taxes but backloads spending, and the assumption of an automatic 25% cut to physician payments that Congress is unwilling to authorize. Rep. Rand Paul has tried to present an alternative view which needs to be studied just as closely, because of the enormous impact of a jump in spending at a time when the public finances are fragile. WSJ also cites the work of Richard Foster, the chief Medicare actuary, as an alternate perspective of how things could turn out, Doug Holtz-Eakin, and Eugene Steuerle. It calls for common sense in evaluating programs, entitlements, defense or other government spending. They not only cost money, but costs escalate over time as history has shown over decades, till they eventually are discovered to be not affordable unless the middle class is willing to dig deeper into its finances to pay for them. Alternate perspectives from a range of informed opinion, Howard Dean, Martin Feldstein, and the head of Harvard's Medical School show that the issue needs to be looked at closely and carefully and cannot be something in which CBO numbers can be trusted to tell the whole story. Especially when common sense, history, and informed opinion across a spectrum of thought advises caution, and fragile public finances also suggest caution. Howard Dean, former Governor of Vermont, says the health care bill is not real reform, and may do more harm than good. He says in a Washington Post article, December 17, 2009, the Obama health care bill does not insert competition into insurance markets, does not significantly reduce costs, and does not improve the delivery and use of health services. It was he says done with a political calculus and crafted for votes not real reform. Jeffrey S. Flier, Dean of the Harvard Medical School, gave the Obama health reform bill an "F" grade, saying in a Nov 18, 2009, WSJ article, that it was disingenuous to call this reform, Congress and the White House were simply deceiving the public. He said the bill will accelerate US health care spending, postpone most of the major health care problems, expecially the ones that drive cost, including the "fee for service" system and delivery of health care. He says in his discussions with economists and other health care leaders the opinion was unanimous that the bill will accelerate health care spending. He cites Massachusetts as an example, where access to care was expanded under the same dysfunctional system, and spending went up, and it doesn't work. Feldstein, who in early 2008 suggested proactive solutions to the mortgage debt crisis which were never adopted, says that the Obama health care law means higher taxes in the long run to pay for the $1 trillion cost of health care for the uninsured group over 10 years. Feldstein says that the Obama plan is to cut Medicare to cut spending, and will reduce the amount of medical services, as reduced spending comes from fewer services, not reducing payments to providers. And he asks if the cost reductions are weighted too heavily 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% of the American people who are accustomed to a different pattern of healthcare. ...

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As the deadline of July 22 approaches for the 160,000 members of the UK Conservative Party to elect a leader, former Foreign Secretary Boris Johnson and the current Foreign Secretary Jeremy Hunt are running for the leadership position. Boris Johnson has 68% member support with Hunt at 23%, according to YouGov survey. Both candidates are in favor of Britain leaving the European Union without an agreement. Hunt has stated he would cancel leave for Britain's 16,000 civil servants in August to prepare for the departure of Britain from the EU by October 31.  Only 27% of Conservative Party members believe Mr. Hunt can do the preparation needed for an abrupt exit after 45 years of economic integration with the European Union. By contrast 90% of members think Johnson would do the preparation needed. Preparation is needed because of food and medical supplies trucks and in flights awaiting customs at border points. The result could be chaotic without adequate preparation. Under a Johnson government many ministers would leave the government including Mr. Hammond who runs the finance ministry. He is expected to join rebel ranks in the Conservative Party that does not think an abrupt exit like this is good for Britain. If these members in the House of Commons join Labour party members they could vote to block this from happening. Britain's opposition Labour Party led by Jeremy Corbyn has finally decided to call for a second referendum if Johnson pushes to leave the EU abruptly, and to campaign wholeheartedly this time for staying inside the EU. During the last referendum Labour leaders did not push hard for Remain, and David Cameron as prime minister and head of the Conservatives proved to be a weak and ineffective leader using the promise of a referendum as a ploy to win votes for the Conservatives in an earlier election and then finding himself stuck with promises made in the election with his party's right wing led by Johnson. Years of austerity policies promoted by Germany in the EU after a flawed entry of southern European countries with faulty not transparent finances such as Greece too early  into the eurozone had soured Britons on the EU. The friendly migration policies of German leader Merkel for economic as well as war torn country migrants from North Africa finally not just soured Germans on Merkel policies but also soured British working class families struggling to make ends meet and seeing migration as taking British resources that were needed at home. This has split most of Europe including Britain along lines of the major cities and the rural areas plus smaller towns, and in Eastern Europe, East Germany region along the lines of the old Soviet bloc countries which with deeply conservative thinking do not favor such migration policies. These divisive changes have taken place over along period of decades and will take time to heal through economic recovery and a fairer distribution of wealth, better investment in infrastructure, health, education, public services, neglected during the Tech driven flawed investment diversion of economic resources. Yet the hope of this type of change if grasped by Britons as well as Europeans could bring new life and revive the vision of a Europe with shared benefits for all Europeans, not just a French-German project. For this to happen new leaders have to rise to the challenge inside Britain and the rest of Europe.      ...

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The issues China faces as it plans the next phase of massive urbanization. Urbanization is a major priority of prime minister Li Keqiang, which was also the focus of his postgraduate work in his student days. In the early 1980's about 20% of China was urbanized, this has changed over three decades to where the figure is 47%, plus 17% for workers working in the cities but classified as rural, a total of 64%. China's plan is to fully integrate 70% of the population or 900 millon into cities by 2025. In 2013 only 35% of the population has a urban residency permit, or hukou. The permit is needed for residents to register their children in local schools or qualify for medical programs in urban locations. One of the problems is the huge cost of doing this which it is feared could lead to inflation and higher debt levels. Currently local governments bear these costs using land sales, and central government transfer payments, but without added financing and unable to issue their own bonds, the local governments strictly limit the use of local school and health services to their own residents keeping out rural newcomers. Local government taking over farmer plots, often without enough compensation is highly unpopular in China. Other problems are- providing a steady stream of earnings for new urban residents from farms, if no employment can be found. So they can sustain themselves- especially as they get past 40 years of age when factory employment is harder to find. The government planners see the larger urban population as a way to shift from a largely export based economy and slowing growth, to a consumption based economy. But critics say the risk is that for this to happen new residents from the farming villages have to find jobs, something the government will have difficulty accomplishing. A permanent underclass of unemployed and other financially strapped citydwellers living around major cities, as has happened with the progress of urbanization in Brazil and Mexico, is something the government would want to avoid. ...

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Novartis is taking a new approach to drug research and drug discovery. The old one which was popular in the drug industry was to go directly for blockbuster drugs for large numbers of users, with a long time in the research pipeline because the area of research was largely an unknown. This was costly and becoming less and less productive. Dan Vasella who heads Novartis, is taking a different approach which comes from his understanding of medical science as a physician, in an industry run by accountants, lawyers and business people. This is to go after wellknown molecular pathways identified by Dr Fishman at Harvard in his research, and do this by taking on problems in diseases that afflict small numbers of people. These drugs have some established medical science to work with, and the research work takes a shorter period. Once the drug proves its effectiveness in one illness, it is tested for other illnesses that afflict a large number of people but which shares some of the same underlying phenomena that cause the disease in the two situations. Dr Vasella stumbled on this approach after the development of the drug Gleevec by Novartis. Gleevec was originally approved for a rare blood cancer, but has now shown to be effective against six other dieases. Gleevec brought 3.7 billion in revenues in 2008 for Novartis. In 2002 Vasella made a bold move to discard the old drug development model. The basis of this approach was to go after new drugs that were desperately needed and where the genetics of the illness were well understood. Whereas pursuing rare dieases is considered foolhardy by most drug company leaders, Vasella's idea is to use the common genetic underlying arrangements for that drug to go after other diseases that would be good prospects for the now proven drug. The known genetics makes it possible to complete the research in a shorter time. In 2009 Novartis has 93 drug candidates in the pipeline, 40% more than 3 years ago and 80% of Novartis' drugs last year made it from early testing to late stage development. This was a 60% improvement over 2005. The new approach fits the current regulatory climate, with regulators concerned more about safety, and Medicare and Medicaid and other payor less willing to pay for treatment with modest benefits or with uncertain outcomes. The approach had to be executed in terms of organization and staffing. Vasella moved the R&D global research operation from Basel to Cambridge, Massachusetts, and spent $4 billion on the move. He recruited a renowed researcher and cardiologist at Harvard University, Dr Mark Fishman, who had done research on the genetic mutations in the cardiovascular systems, to run the center and set the new direction for global research. Fishman convinced Vasella that medical research should focus on a small number of molecular pathways- the complex suquences of interactions among chemicals, proteins, and larger cell structures in the body that are behind all illnesses. Says Fishman, there are 24,000 genes in the genome, but only a few dozen pathways conserved through evolution. Fishman's theory is that you find all the links in a pathway and then locate the signals that can turn the genes on or off to develop medicines for illnesses. Bercause disease after disease share a common pathway, the knowledge gathered can then be applied across that region with more accuracy and directly, to address a range of illnesses. Fishman's approach means marketing and sales no longer make the decisions. There is a new method for doing things. Fishman focusses on clinical data and insists that commercial analysis comes after sufficient clinical data. A major restructuring in 2007 led to shedding 1260 sales and marketing jobs, as clinical science now takes precedence and medically trained scientists take senior leadership positions. The new approach is being used for a drug developed for Muckle-Wells syndrome. Computer simulations are shortening the time to late stage trials. The drug has applications for Type 2 diabetes and severe arthritis. The whole process will take many years, as its a sea change for the industry and for Novartis, a fresh approach when the approach used by the pharmaceutical industry for so long is failing. An oral drug treatment for multiple sclerosis is being developed along these lines. Afinitor. approved by the FDA for kidney cancer in March shows potential in six other diseases, including lymphoma where Afintor shrank tumors by 50% in one third of the patients in a trial. ...

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Israel vaccination drive has now reached 2 million people for the first dose and 400,000 for the second dose. What do early results show? As the effectiveness is only 52% after the first dose, according to Pfizer for its vaccine, vaccination drive is only one part of the solution. The number of cases in Israel are high at 10,000 a day. There is concern about the ultra-Orthodox community following the protocols and rules for prevention. Ben Gurion International Airport may be restricted to only essential flights. A mutation variant of the coronavirus, a UK detected variant, is seen as making up about 30% of the cases and could make up the bulk of cases in the future. Lessons being learned are that Pfizer vaccine is effective at about 52% for the first dose. Only after the second dose are enough antibodies triggered to resist the virus effectively. This can be as much as 6 to 12 times the increase in antibodies for second dose, compared to what happens after the first dose says the Sheba Medical Centre at Tel Hashomer, Israel.   ...

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Samuelson points to the risks to the American economic growth from excessive health care costs. This is hurting take home pay and shows up in consumer spending. It is hurting government spending in other areas such as needed infrastructure spending and efforts to reduce the deficit. This hurts private capital investment to create jobs because of lower demand from constricted consumer spending. The U.S. budget has as its largest single expense 27% on health care compared to 20% on defense the next largest expense, with growth in health care spending taking this to one third of the budget in coming years. Without addressing health care, says Samuelson, the Supercommitte in Congress even if successful at deficit reduction will basically have failed to do its job, and it did not have the time, resources or conviction to do this. According to a new study from the Organization for Economic Cooperation and Development (OECD), U.S. healthcare spending per person is $7,960 per person in 2009. This compares with Norway $5,352, Britain $3,487, France $3, 978, an OECD average of $3,233. Life expectancy in the U.S. is 78.2 years, compared to Japan 83 years, OECD average of 79.5 years. Chile and the Czech Republic have life expectancy equal to the U.S. Except for cancer care where the five year survival rate is 89.3% in the U.S. and the OECD average is 83.5%, the U.S. lags far behind in much needed critical areas such as diabetes and asthma. Rates of emergency hospitalization for asthma are 3 times that in France and 6 times that in Germany and Italy. The U.S. has fewer doctors per thousand population and higher cost per medical procedure- with more frequent use of the costliest procedures- creating a supply shortage that induces higher prices, and less preventive and early action care through physician visits. The number of practicing U.S. doctors is 2.4 per thousand population in the U.S. compared to 3.1 per thousand for the OECD average; and number of annual doctor consultations 3.9 per capita in the U.S. versus 6.5 for the OECD average. Appendectomy cost $7,962 in the U.S., $5,004 in Canada and $2,943 in Germany. Coronary angioplasty cost $14,378 in the U.S., compared to $9,296 in Sweden, and $7,027 in France. Knee replacement cost $14,946 in the U.S., $12,424 in France, and $9,910 in Canada. Knee replacements, angioplasties and MRI exams are twice as common in the U.S. compared to the OECD countries. ...

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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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Bruni expresses cynicism about the lack of conviction and authenticity in Romney's claims.

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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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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. ...

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The Wall Street Journal has examined 77 businesses in which Bain Capital invested during 1984-1999, the period in which Mitt Romney headed the firm. Its findings show that 22% of the firms filed for bankruptcy by the eighth year after Bain first made its investment, some with large job losses. Additional 8% of the firms were in such bad shape that Bain lost all of its invested capital. Only a small number of firms produced most of the returns- 70% of the gains come from 10 firms. Of these 10 firms, four were later found in bankruptcy court. Another aspect mostly overlooked is that where large job gains were made they were mostly in lower wage retail jobs at Domino's Pizza, Staples and Sport's Authority, and did not involve the kind of innovation that produces sustained advantages.

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Milbank describes Romney's problem as similiar to that of Al Gore- the feeling one gets that he is just not authentic. He tries to be a regular guy but he is not. He campaigns on his business experience, giving little attention to his record and experience as governor of Massachusetts.