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The U.S. House of Representatives votes to repeal and replace the Affordable care Act 217-213. Moderates were won over by an addition of $8 billion  to add coverage for a popular feature of the ACA that covered people for pre-existing conditions.  The bill that passed gives credits of $2000 to $4000 a year, depending mostly on age, upto $14,000 for a family. Credits are reduced for individuals making over $75,000 a year or families making over $150,000. There is no mandated insurance coverage. This trims the federal budget deficit, yet also is expected to keep 24 million more Americans without health coverage after 10 years. The bill now goes to the Senate where moderate Republicans are worried that this may increase premiums for older people, one of the drawbacks of the earlier version of the House Republican bill.

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The Republican House health care bill AHCA  keeps some some of the more popular parts of the Affordable Care Act such as not taking pre-existing conditions to deny insurance, keeping children covered on parents insurance till age 26, and increase contributions to Health Savings accounts. It is different in that the expansion of Medicaid at 138% of poverty rate threshold is rolled back. Age is used for tax credits instead of income, hitting those approaching Medicare age harder. The maximum charged to older people is now set at  5 times compared to 3 times what young have to pay. In general the Republican bill is seen as targeting the elderly to keep premiums down. The elderly on low incomes are hit hardest. Fox News O'Reilly Show showed the host questioning House Republicans, citing the CBO estimates that elderly on low incomes may have to pay as much as $14,000 a year for insurance making it basically unaffordable, and 52 million Americans would be affected adversely. Large companies are no longer required to offer mandatory health insurance under the new bill. Conservatives from Freedom Caucus wanted to see the essential areas of benefits covered by the law limited to fewer than the ten areas in the Affordable Care Act. The ACHA Republican bill leaves to states to determine what are required essential benefits. At one point maternity benefits were to be dropped but this was changed to let states decide. As a result the bill is 33 votes short of the number needed for passing the house in March 2017.   Neither the Democrats Affordable Care Act or the Republican House bill of Speaker Ryan do much to tackle the real problem- the absolute amount and increases for health care dollars for treating each disease in the U.S. compared to European and other countries. As a result health care has become more of a partisan struggle between the two parties than a real effort by all to overcome the problems that have to be tackled. Republicans want to see premiums drop and keep the burden on the deficit down- but with the level of U.S. health care costs disproportionately high compared to Europe and the rest of the world the arithmetic is tough and ends up leaving out vulnerable groups such as the elderly on low incomes, thus making the whole proposition prone to fail. For the same reason the Democrats failed to keep premiums down with a wider safety net leading to calls for repeal of their version.   ...

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The NYT covers the GAESA tourism enterprise of Cuba (that operates independent of the government of Cuba) that overinvested in Tourism at the expense of agriculture industry and infrastructure during the Obama administration, leading to collapse with Trump's 2014 embargo on Cuba. GAESA controls about 50% of Cuba's economy, run by military and people from Castro's family.  That left 121 hotels built in the boom years of tourism at 30 percent occupancy. The Iberostar high rise hotel is one of these hotels that rises over dilapidated housing in Havana, the Cuban capital. The investment in tourism by the GAESA enterprise that runs about 50% of the Cuban economy is 13 times what is spent on healthcare and education, says the NYT. The Castro family, Raul Castro family, runs this business venture that was started when the Soviet Union as sponsor of Cuba had collapsed by 1991. The NYT says this 'devolved' the ideas and promise of the revolution. "Devolved?" What kind of word to describe a complete loss of faith, and enormous failure with severe hardship for the Cuban people? It means the whole idea of communism or Marxist revolution has been proven false, even as it survives in Mexico and parts of Latin America. One can be against the Batista regime- similarly against corrupt regimes in Latin America or Asia- that ruled Cuba before the Castro Cuban revolution and still look for better choices and alternatives than what Castro came up with as an answer to Cuba's needs. Much of Latin America is suffering from the same problems of dictatorships and turning to Marxist alternatives - particularly the alternative put forward by Castro in Cuba- that has also destroyed the Venezuelan economy with Chavez's turn to Castro's Cuban revolutionary slogans and ideology. That came up with temporary solutions for the poorer sections of society, yet failed badly for all sections of society in the long term. How else can one explain one fourth of Venezuela's population and about the same of Cuba's leaving the country, some of those who left the critical human capital that would form the core of the human input to combine with capital and technology for advancing the economy. If Cuba were like the Dominican Republic or other parts of the Caribbean to depend on tourism for its national income then would it not be better to have friendly relations with the US, the main source of tourism revenue. The Obama administration was only holding up a failed idea by holding out a helping hand to tourism in Cuba knowing full well that a change to a Republican administration would simply lead to heavy investments in tourism at the neglect of infrastructure, public services and the economy, of health and education, to become large economic losses. This is what has happened.  As China and India have proven and are proving there are no magical ways to economic development- the same route that was traveled by the nations of Northern and Western Europe with scientific advances, technological advances, have to be taken, the same route that was traveled by the US in its industrial revolution and building of infrastructure, that same route has to be taken by all nations. It does not have to take a time period of centuries as in Europe. The US accomplished it faster with new technologies and vast human and natural resources over 100 years, Japan in 50 years, China in 30 years. India in 25 years ongoing.There is room for intelligent solutions to problems, for speed and tapping into new technologies, yet the same inputs of land, labour, capital and technology have to be put together for development. For states or regions, cities, within China and India, the same inputs, the same access to foreign investment and new technologies is the only route to rapid development. Long range plans are set in motion, decades of stable efficient, clean governance is put in place, and alliances are built with the nations of Europe and with the US. This road is traversed though hard work as Japan and China have done, and India today is thoroughly engaged in. ...

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The Congressional Budget Office analysis of the Republican House health Care bill shows 24 million Americans would lose health insurance over 10 years. In terms of budget savings the bill saves $337 billion over 10 years. The increase in uninsured comes from the roll back of expansion of Medicaid under the House plan, the reduction of tax credits, plus the removing of income based credits replacing it with tax credits based on age. President Trump is promoting the bill saying it will reduce the premiums that have gone up since Affordable Care Act was passed and increase competition. House Speaker Ryan in promoting his plan says he is not in "some coverage beauty contest." The House Plan says Ryan, does not mandate that all be covered, but simply says coverage is in a free market giving people the option to buy insurance that they want, so that the numbers of insured would not be as many as under a mandate.

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U.S. Senator Ben Sasse suggests an alternative approach of simply repealing the Affordable Care Act called Obamacare and replacing it at a later date. This is endorsed by president Trump. This is the new Republican strategy in July 2017. Forty nine senators voted in favor of this repeal in 2015, when president Obama vetoed this legislation. Two more senators are expected to support repeal according to Ben Sasse.

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California's governor Jerry Brown has put forward his budget plan for fiscal 2013 showing a budget surplus of $851 million. Brown was able to get Proposition 30 passed in the November 2008 elections. Higher income earners pay more in taxes for several years and the sales tax is increased. An improved economy with unemployment down from 11.3% in 2011 to 9.8% in Nov. 2012 is helping with higher tax revenues. General fund revenues are expected to increase 3.3% to $98.5 billion in the 2013 fiscal year from $95.4 billion the prior year. Brown has accomplished a remarkable feat of balancing the budget for 2013 and still continuing to invest in education and healthcare. Spending will increase 5% to $97.7 billion in fiscal 2013 from $93 billion in fiscal 2012 with higher spending on education and health care and lower spending in other areas. Brown's path to achieving this was eased after Democrats won control of both houses in the the state legislature. Says Brown: "Right now, for the next 4 years, we'll be talking about a balanced budget, we're talking about living within our means... This is new." Even Republicans praise this effort from a veteran of California politics- his father was governor in the Kennedy years, and he was governor in the 1980's....

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The Congressional Budget Office analysis of the Republican healthcare plan advocated by Mr. McConnell, Senate Majority leader, is that it would add 22 million uninsured if implemented. That plan ran into opposition from Republican Senators Collins, Capito, Murkowski, Paul, and Moran, and lacked enough support in the Senate. All Democrats opposed it and with the thin majority Republicans were divided. By taking away some benefits given under the existing Affordable Care Act the plan hurt the elderly and low income people, making some Republicans listen to their constituents in home districts and not the Republican leadership. The NYT profiled two in particular who astonishingly in a sign of today's strange politics were the only ones publicly holding townhall type meetings to hear the views of people in their voting districts- Susan Collins of Maine and Jerry Moran of Kansas. Both senators were listening to rural communities and Moran stated his opposition with the words- "I am a product of rural Kansas." With it the nation takes a breather and the message goes out that it is best to listen first and then to seek middle ground, not do what both parties Democrats and Republicans did in 2009 and 2017- rush serious legislation through without support across party lines and without serious discussion.   ...

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This analysis in The Guardian says US president Biden is reversing 3 decades of policy since president Reagan that looked with skepticism at government intervention in the economy. The $1.9 trillion aid package Biden has pushed through Congress is a big game changer in the way government operates to help rebuild America after the pandemic. The 2009 response by the government under president Obama was done without conviction that the government response was the best way to help the economy. By 2016 voters turned to a Republican, Mr. Trump, to help working class voters with a USA first policy, after decades of presidents from both parties Republican and Democrat failed to protect American interests in manufacturing, jobs and incomes.  US president Biden is continuing Trump's policies to protect working class Americans. And bringing new conviction that government not only has a positive role, but has an essential and vital role to play in protecting workers and households struggling to make ends meet. President Reagan had introduced such a deep skepticism of government, that it took so long for people to remember FDR and the role of government before the second world war and afterwards under the Truman administration.  What changed? The health care crisis exposed the weak areas in the governance and policy mindset in America. China had advanced mainly through strong government role of the Communist Party  in steering the economy and business to gain competitive advantage. The health crisis from the pandemic further devastated America's lower middle and working class following the banking and financial sector mismanagement by 2009. The pharmaceutical and health care sector similar to other sectors had shipped manufacturing overseas. In 2021 there is a deep sense that theories don't work, one has to act based on the needs and the situation the country is facing. The way competitor nations such as China are building new infrastructure, gaining manufacturing advantage, dominating key sectors and industries, and creating jobs, requires America to respond. In this situation posing the threat America faces as well as the social dislocation of decades of misguided policies, the US government is the only one capable and having the resources and capacity to respond.  ...

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This is an exceptionally humorous operating room story of Dr. Trump and Dr. McConnell by Kristof of the NYT. Sometimes humor tells the story- and Kristof does this using a story of a surgeon president Trump in the operating Room trying to address the concerns of the patient Janet, as he keeps telling her she needs a new heart with great benefits, great benefits, before she implodes or goes down failing. Flat out take the old heart out even if a replacement hasn't been found, believe me great benefits the surgeon tells her, just that the patient just isn't getting convinced as its happening to her. The analogy is with replacing a health care plan, not just the Obama plan, any plan without something to take its place. For a few days before this article by Kristof, the Republican effort to repeal the Affordable Care Act without having a replacement was presented as a good idea. Janet is like the three Republican women- Collins of Maine, Capito of West Virginia, and Murkowski of Alaska who wanted to keep the heart they had till a replacement was found, against the surgeon Trump's advice. In a way it is about politicians in the last decade who never had any discussions as they rushed through with their own agendas, as the Republican and Democratic health care plans were rushed through Congress with relatively little participation and debate to hear all viewpoints. ...

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This story in the NYT describes how the flawed effort to pass the Republican healthcare bill or repeal the Affordable Care Act passed under president Obama failed after another effort. Many developments killed it. In the end the president lost interest, especially when he saw Republican Senator Rand Paul of Kentucky go on talk shows on the weekend before its collapse to complain about the bill. Senator Collins of Maine was exasperated by the way the bill was being rushed through Congress, and she voiced her strong opinions about this by talking to people back home in Maine and sharing her conversations with the media. The bill pushed by Senator McConnell, the Republican leader in the Senate, imposed annual caps on Medicaid spending. And did this without any discussion, shutting out committee debate, any public discussion, or formal drafting. Once this process was set in motion in this way the Republican Senators formed camps. Senator Grassley of Iowa and Jerry Moran of Kansas, normally conservative moved to the moderate side. Moran held a town hall meeting covered in the NYT, where older people voiced their concerns. Most of the patient advocacy groups, the hospital groups such as the American Hospital Association, and other medical groups also opposed it.  After Senator McCain of Arizona said he could not return following a surgery in Phoenix, Senators Lee and Moran announced their opposition. With this the bill's support crumbled including any effort to repeal the Affordable Care Act.  ...

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David Brooks of the NYT describes the approach taken by British prime minister David Cameron and his Conservative Party government to help the working class poor in Britain, and tackle the social roots of poverty. He says an American adaptation similar to this is badly needed in the Republican Party, with the candidates in the election providing solutions from an old rulebook. Only after Trump's popularity with appeals to less educated older Americans has the Republican leadership responded, with Speaker Ryan helping organize a forum on poverty under the Jack Kemp Foundation- emphasis was placed on education, work, opportunity and accountability for anti-poverty programs in the discussion moderated by Ryan and Senator Tim Scott. Less attention was paid to the other social aspects mentioned here by Brooks, and cited by Cameron when he described the inadequacy of traditional solutions from the right and left of the political spectrum. Cameron outlined the principles of his anti-poverty plans called "Life Chances Strategy," in a speech on Jan. 11, 2016, in north London, with the entrie transcript on the gov.uk website. Cameron acknowledged in the speech that social issues including single parent families, and other social problems such as long term unemployment, can make it harder for some people to use self-reliance and personal responsibility in a growing economy as a way to grasp opportunities. Cameron proposes a combination of economic, social and job growth strategies. His second term plans include 30 hours a week of free childcare for 3 and 4 year olds so both parents can work, parental maternity leave, expansion of Troubled Families Program, in addition to the introduction of National Living Wage, tax cuts, universal credit. In tackling social aspects of the problem Cameron cited the need for development in the early years of childhood, the huge importance of family, social connections and experiences, informal mentors, cultural experiences, broadenend horizons, that enable young people to acquire language skills, character and resilience. Second term projects include expanding reach of high performing schools to deprived areas, emphasis on core English, math, science, history, geography Ebacc skills, a 1 billion pound investment in the National Citizens Service by 2021, a plan to transform housing estates including rebuilding from scratch, additional 1 billion pounds to provide mental health treatment including treatment within 2 weeks in homes and communities. Throughout Cameron's "Life Chances strategy" is aimed at tackling not just the material dimensions of poverty, but also what he describes is broken in Britain- "the paucity of opportunity."...

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This article in the NYT provides a look at the features of the Republican House Health Care Plan- Both the Affordable Health Care Act and the House Plan provide incentives for buying insurance- the ACA bases these incentives on income levels whereas the House Plan does not provide additional help for low incomes or elderly. Incomes at $20,000 would see a loss greater than  $2000 under the House Plan and as many of the elderly poor living in high cost areas may not have the resources to make up for this loss of subisidies they may forgo buying insurance or have insurance coverage that protects only in a limited way. President Trump has given assurances that all will be covered. For people with incomes of $50,000 or $75000 the loss of $2000 subisidies would also have some impact. At larger incomes or the well to do the subsidies are not handed out under either plan. Under the ACA the emphasis was on income levels and high cost insurance areas the subsidies were greater, under the House Plan the subisidies would be higher for the elderly compared to the young but very low income levels are not given additional help.     ...

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This Washington Post editorial says Obama and the politicians, both Democrats and Republicans, want something for nothing. The Ryan budget, Obama's health care plan, all require paying for it with higher taxes, but the mention of the word "tax" is the last word any of the politicians will say. These comments come as the U.S. Supreme Court considers the mandate that young Americans and others be forced to pay for health care along with the rest, as required by the health care mandate, with the idea of keeping costs down. The idea of getting something for nothing was also emphasized in an op-ed in the WSJ, March 29, 2012, by Mayor Bloomberg of New York City, where he called for letting the Bush tax cuts expire for all income groups, and an up or down vote in Congress on the Simpson-Bowles deficit reduction plan, as part of a two step plan.