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Medical insurance choices are complicated for a reason. This WSJ report says a PhD. is not sufficient to figure it out. They were designed this way to maximize profits from a government program by private insurers and capture as large of the market for the Medicare Advantage plans they offer. Heavy lobbying in Congress makes it possible to write legislation that keeps selecting coverage complicated.  The only way to clean up this mess is through universal health insurance, that is UN's SDG 3.8,  that is fair for all, which everyone can understand, and the US as an advanced technological nation can support. Reducing transparency works with heavy advertising for private insurers with Medicare Advantage Plans to capture the largest chunk of what the government spends. Medicare Advantage insurers capture $943 billion of spending on Part A & B Benefits compared to $693 for traditional Medicare. 

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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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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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Full Yield is a startup in Boston that is trying to help address the nation's obesity problem by introducing healthier foods and meals in cafeterias. It plans to introduce a line of Full Yield branded food made from fresh items and natural ingredients for sale in corporate cafeterias and prepared food sections of local supermarkets. It is based on a simple idea that if you eat healthier food you will be healthier. A study in the Jan-Feb issue of journal Health Affairs says 75% of the $2.5 trillion in health care spending deals with obesity, Type 2 diabetes, heart disease and cancer. And how much of this traceable to obesity and bad eating habits, smoking and lack of exercize? This study says most of the cases are preventable by changing these behaviours. Dr. Kenneth Horpe, chairman of the department of health policy and management at Rollins School of Public Health, Emory University, shows that if trends continue U.S. annual health care costs related to obesity would reach $344 billion by 2018, which is 20% of total health care spending. In 2009 it accounts for 9%. Thorpe says if even the 1987 levels of obesity were reached it would free up enough money to cover the uninsured population today. For American companies the problem has grown to alarming proportions and yet no nationwide coordinated plan bringing together companies, government, universities, public interest organizations, and other groups exists in the U.S. The CEO of U.S. grocery chain Safeway, Steven Burd, says Safeway was spending $1 billion to cover health care insurance for workers by 2005, with costs rising 10% a year- this meant putting out twice in health care insurance than Safeway's earnings and hitting another $500 million by 2010. Between 2004-2009 the costs of insurance surged 31%, making this the fastest growing single corporate expense, according to Towers Perrin. This reduces incomes of workers as companies pass on part of the extra cost, and reduces the profits that can be put back in new investment for economic growth....

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After the 2008 election of president Obama rural whites left the Democratic Party, Following the election of president Trump educated suburbanites left the Republican Party. These two trends have accelerated as seen in the 2018 U.S. Congressional elections. Democrats won in and around major cities, and Republicans won in rural and small town America. Democrats won 27 GOP Republican COngressional seats to win the majority. Republicans added 2 seats to their Senate majority.  The electorate is sharply divided in terms of education in a way that is regressive and not good for America, and in a way that has never happened before. Republicans share of of House districts with lowest shares of college education bachelors degrees increased from 44% in 1998 to 60% in 2018. Democrats share of House districts with the highest share of Bachelors degrees went up from 50% in 1998 to 81% in 2018. Much of the Democrats support from educated suburbanites comes from lopsided support from educated women. The result is that the Republican Party is trading faster growing counties for slower growing smaller counties and now has a base of older voters. The Democrats have to find a leader who can rally support from this new combination of educated suburbanites, younger voters, and minorities. And big issues are at stake. About 77% of people in recent polls now support a national health care insurance like than in the UK and Canada. Poor reading skills and reading comprehension in school tests show a need for greater investment  in education. Infrastructure investment is a big priority for a decade that has yet to be tackled directly. Of the 50 new Democrats in the House of Representatives 24 campaigned on a promise for a national health insurance like that in Canada or UK. The focus on economic issues would move the Democratic Party back to where it was in all the post war years till the distractions from cultural issues  in the last decade shifted its focus from its historical base support of working class voters. ...

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The NYT fact checker on the interview with president Trump in July 2017 with Haberman and Baker, finds errors on the following subject matter- Ms. Abe the Japanese prime minister's wife speaks English though Mr. Trump said she doesn't, the 2 Napoleon's get mixed up, and interpretation of health insurance and social security gets mixed up, the FBI Director reports to the Attorney General not the president, Deputy Attorney General Rosenstein is from Philadelphia, and adoptions relate to sanctions in U.S. -Russia relations.

Being loose with facts can be humorous in some situations and more serious in others. It helps for readers to always have the facts straight.

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The U.S. Supreme Court lets the Obama healthcare law stand in a 5-4 vote with Justice Roberts casting the deciding vote. The Court ruled that the government could impose the individual mandate that all people carry health care insurance not because of the commerce clause but because: The provision "need not be read to do more than impose a tax...This is sufficient to sustain it."

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US president Biden's 2024 Budget places great emphasis on aid to workers and families in the US and shores up the Medicare hospital-insurance trust fund. He will do this by raising taxes on the wages, investment gains and self-employment income of people making more than $400,000 a year. Additional savings come from increasing the drugs on which Medicare can negotiate prices from 20 to 50 drugs.  Childcare- families making less than $200,000 a year will get subsidized child health care, the lowest income families paying nothing. Housing- Building and preserving 2 million housing units. Series of tax credits to make buying homes more affordable. College education- Reducing the cost of going to education with $12 billion allocated for this. Offering tution free community college. Family and Medical Leave- Federal paid family and medical leave program. Retirees- a $2000 cap on out of pocket cost of prescription drugs for retirees. Reduced taxes for under $400,000 income households- This would be done without increasing the deficits to extend the tax reduction from the 2017 tax cuts to households making less than $400,000 a year.     ...

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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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The total government expenditure of the US including the individual states spending is 37% of US GDP (IMF). Musk $2 trillion cuts is 92% of the 2.17 trillion excluding defense, veterans benefits, interest on debt, Social Security, Medicare. The simple math means he plans to shut down the government. US  37.5%  Germany 48% France 57% UK and Canada 43% Japan 42% This shows that the US that has no universal health insurance and  subsidized public transportation, spends less than the developed OECD countries as a percentage of its GDP. Of the Budget of $6.75 trillion in 2024 Social Security $1.46 trillion   22% Medicare            $874 billion   13% Interest on Debt  $880 billion    13% Trump plans to remove tax on Social Security which would take this from 48% to over 50% meaning half of the Budget is off limits. If defense spending goes up not down then $874 and $325 for Veterans benefits are $1.2 trillion also off limits.  This means cuts of $2 trillion on $2.17 trillion or 92%. Do the simple math and this would shut down the government. ...

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As the final Republican tax bill is debated in Congress on December 19, 2017, Senator Bob Casey cited the following points from the Joint Committee on Taxation Report on the floor of the Senate.  1. Americans building their hopes that their pay checks in February 2018 will be increasing are in for a big disappointment said Senator Ron Wyden of Oregon, a senior member of the Finance Committee. The Joint Committee on Taxation estimate is that for the 57 million families making less than 100,000 dollars a year the tax cuts in the Republican legislation will either not reduce their taxes or reduce the taxes by about $100 a year. 2. The bill does little for the big tasks facing America of rebuilding failing infrastructure. Senator Casey cited 4500 bridges needing repair or replacement in Pennsylvania alone. It also does little for health care access for middle class families and is likely to lead to 10% increase in health care premiums. Affordability of college and other hurdles of middle class and working class families remain unaddressed.   3. The $9 billion in the estate tax cuts would finance the Children's Health Insurance program which has expired.  4. The $36 billion in tax cuts for corporations comes at a time when corporate profits are at the highest they have been in 15 years, according to Vanguard founder Bogle. He also points out that wages as a percentage of GDP are the lowest in 15 years. The tax cuts in the Republican bill are not likely to correct this imbalance.  5. The share of GDP of people making more than one million dollars in 1980 was 11%, this is up now in 2017 to 20%. This has led to questions about the wisdom of these tax cuts which disproportionately benefit a very small percentage of Americans who do not need these tax cuts, and come with significant sacrifices for the middle class in terms of what is available in public services, and the cost to their children as infrastructure and access to health and education is made more distant because of a growing U.S. debt from this tax cut. The big problem then with this bill is that it further damages intergenerational mobility in the U.S., undermining the foundation of a democratic society. Damage has already happened in the past three decades as Federal Reserve chairman Janet Yellen pointed out at a conference on Economic Opportunity and Inequality on Oct. 17, 2014, saying-"The past several decades have seen the most sustained rise in inequality since the 19th century after more than 40 years of narrowing inequality following the Great Depression." This is why there is substantial agreement in the media from the Wall Street Journal's Greg Ip to Krugman in the New York Times that the bill fails to correct a harmful trend, and goes further in the wrong direction for a democratic society.       ...

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Low bank wages for the U.S.'s 500,000 bank tellers. The median annual income of a bank teller in the U.S. is about $24,100 or $11.59 an hour, according to the Bureau of Labor Statistics. According to a report by the Committee for Better Banks, about 39% of bank tellers in New York rely on public assistance. Nationally bank tellers need $105 million in food stamps, $250 million in earned income tax credit and $534 million in Medicaid and Children's Health Insurance Program to get by. According to SNL Financial bank profits reached $141.3 billion in 2012, and median chief executive pay was about $552 million.

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Arguments that are expected to be used by both sides before the U.S. Supreme Court on the health care law. At the heart of this is the 1942 decision, Wickard v. Filburn, on the limits of federal power. Mr. Filburn, was an Ohio farmer who questioned a 1938 federal law that imposed a penalty on every extra bushel of wheat on his farm beyond the stipulated amount. The decision was unanimous and went against Filburn. At issue is whether the federal government can impose a penalty on individuals for not buying health insurance. Justice Robert Jackson wrote in that case: "Even if appellee's activity be local, and though it may not be regarded as commerce, it may still, whatever its nature, be reached by Congress, if it exerts a substantial economic effect on commerce." The Obama administration's argument in its brief is that the decision of individuals not to buy insurance, like that of Filburn to plant that extra bushel, has larger effects beyond the local one and serious consequences for the whole country- it raises insurance rates of people in states across the country and makes hospitals bear the burden of caring for these uninsured people. For over 50 years the Supreme Court has largely supported the idea behind the Filburn decision, except in 1995 and 2000- these two decision invalidated laws made about guns near schools and violence against women. The Court ruled that the activities were local and noncommercial and beyond the federal power to regulate interstate commerce....

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

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Ron Wyden, Democratic Senator from Oregon, on maintaining competitive choice for 200 million Americans who have to buy insurance outside the Exchange proposed in many of the bills being put forward in the U.S. Congress. This lack of choice between seriously competitive plans will leave the situation in the same way that it is today, with little hope for controlling runaway costs and doom health care reform. The key to controlling costs says Wyden is introducing choice and competition. Wyden will introduce this plan as an amendment called Free Choice to legislation being debated in Congress.

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Greg Ip of the WSJ provides this exceptional report offering readers remarkable clarity on what the Republican Tax Law does- its high and low points.  High Points 1. It reduces the corporate tax rate to bring it in line with other advanced industrialized countries. The corporate tax rate in Germany and Japan is 30%, in the UK it is 19%. For 5 years businesses can write off capital equipment immediately instead of depreciating over a couple of years. This could boost investment and growth. 2.  The law takes aim at deductions that led to distortions. It limits the mortgage interest deduction, and caps the deduction for state and local taxes. This removes the incentive to pay more for homes that exacerbated the housing crisis in 2008. The Alternative Minimum Tax is largely removed. The Low Points 1. The biggest drawback is that lawmakers did not properly fund the tax cuts. Of the 10 costliest tax breaks nine were not touched, including employer health insurance, retirement savings, capital gains. Only the state and local taxes deduction was reduced. And a new tax deduction  was created, a 20% tax deduction for small business (proprietors and partnerships) paying taxes on their individual tax returns. Taxes on the wealthy or value added taxes, reducing tax breaks, is how other advanced industrialized countries paid for the corporate tax cuts, but did not happen here. Additional economic growth  to generate added tax revenues is the way Republicans in Congress say this is funded. Yet this is a questionable assumption as Britain reduced the corporate tax rate to 19% without seeing a surge in economic growth, as Greg Ip pointed out in an earlier WSJ article. At best the Joint Committee on Taxation estimates $500 billion over a decade in added revenues from added growth leaving $1 trillion to be added to the deficit. The WhartonPenn Budget Model (WPBM) estimates only $140 to $367 bill from the additional economic growth resulting in added tax revenues. Under this model only 0.03 to 0.08 percent added U.S. economic growth per year is expected from the Republican Tax Cuts. Such a situation would be bad  for the U.S. as the gradual improvement in Debt to GDP ratio to 78% following the financial crisis of 2008 would be sharply reversed taking the ratio to 97% by 2027. An unsustainable trajectory which will require tax increases in a few years and hurt investment in education, health and infrastructure into the future. This is what worries many experts most on both sides of the political spectrum today about what the Republican Congress has pushed through for a legislative "victory." This is why experts believe this is not serious tax reform and will require a new effort after 2019.   ...

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The US House of Representatives voted 245-189 in favor of repealing the health care law. Only 3 Democrats joined the entire Republican caucus in voting for repeal, compared to 34 Democrats who voted in March 2010 against the health care law. This is a largely symbolic move as the Democrat controlled Senate will not consider the repeal, and even if it did the President would veto it. Republicans favor some aspects of the health care law which allow children to be on the parent's insurance till age 26, and a ban on insurers denying coverage due to pre-existing conditions. Opinion polls show 46% of respondents opposed repealing and eliminating the law, and 45% favored repealing it. The health care issue ranks third among the economic issues important to respondents, behind unemployment and reducing the federal budget deficit.

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US is shutting down 10% of airport traffic because of government shutdown in November 2025. Democrats are holding up the passing of the new budget till Obama's Affordable Care Act healthcare subsidies for low income Americans are restored. Republicans who control both houses of Congress are unwilling to restore these subsidies saying it will cost $350 billion over 10 years. Editorials in the Washington Post in November see Obama's Affordable Care Act as a bandaid approach for a broken healthcare system in the US. Public opinion in the US supports this assessment. Trade unions and labor have called for an end to the government shutdown. Democrats are acting as though the party is for low income Americans and labor yet this is not the party of FDR who fought hard for labor over vested interests, Democrats today are the vested interests whether from Tech which is taking a disproportionate share of the Nation's wealth and resources and pouring it into projects that do not reduce the cost of living or rebuild crumbling obsolete infrastructure, or from Banks which were not sanctioned for their part in the 2009 financial crisis, or from healthcare interests that oppose restructuring the entire healthcare system for fairness in insurance, pharmaceutical pricing and wellness. Republicans are making an effort to displace Democrats in the role of FDR and Lincoln under newcomer DJT who rejects both the incompetent Bush (Republican) and Obama (Democrat) administrations that wasted money and resources in foreign wars while overlooking America's many challenges and strengthening foreign powers including China, while weakening the US. The US government is cutting airport traffic to relieve unpaid traffic controllers. Also at risk are SNAP benefits which are for the loew income Americans. The US president is asking the Senate to drop the filibuster rule which requires 60 votes in the Senate for the biudget to pass it and pass it by majority vote. The Senate Majority Leader Republican Thune wants to keep the filibuster because it acts as a brake for hasty legislation passed by whichever party is in government. ...

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Upward mobility in China was weak and income growth for average workers sluggish during the years before the coronavirus outbreak. In this sense China is similar to the U.S. and Europe where upward mobility gains after the second world war were lost in the last 30 years partly from the loss of manufacturing to China. It is much worse now as the effects of the coronavirus lead to drops of as much as a third in income for ordinary workers. Lower income workers, the vast majority of Chinese numbering hundreds of millions now suffer from lost work or diminished wages. Small businesses cannot afford to pay the salaries paid before and as workers dip into savings or increase borrowing the retail spending is taking a hit. As a result economists see a vicious cycle of lower spending and lower incomes for the hundreds of millions of ordinary workers in construction and smaller businesses. Some small businesses could just close down because of weak demand affecting the economy over the long term. Before the coronavirus China went over three decades from being a Communist country with relatively equal distribution of wealth but lack of growth and technological development to a capitalist country with the structure of state control of the economy from the Communist period. The result is that 1% of the people control 33% of the wealth and the bottom 25% having 1% of the wealth, according to a 2015 Peking University study. China's president Xi Jinping, head of the Communist party, tried to reverse some of these trends by attacking corruption and making changes that began the task of reversing decades of unequal distribution of wealth under state sponsored capitalist growth. Investments were made in rural medical care, infrastructure and basic services. This did not have much impact because much of the pattern of growth over three decades continues including the housing bubble.  With coronavirus the trend is set for even more unequal distribution of wealth as many workers at the bottom half of the population in incomes either lose work, or see drop in incomes as businesses that hire them struggle from shoe factories to other retail business. Reports of informal economy and street markets in Chengdu in western China and bringing this part of the economy back by the state are effort to get people work in other ways. Researchers estimate that China's bottom 60% of household in incomes lost about $200 billion in income in the first half of 2020. In May premier Li Keqiang said 600 million people in China earn only about $140 a month. Many who lost income or jobs do not have support from the government as China lacks a program of comprehensive unemployment insurance as in Europe and the U.S. to help people get over bad times. 300 million migrant workers are particularly vulnerable to loss of income and dipping into savings.   ...

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The Republican House Health Care pLan in 2017 relies on tax credits of between $2000 and $4000 based on age. Under the Affordable Health Care Act the elderly poor in high cost insurance areas received additional help. These people would lose over $2000 per person and may forgo full coverage or coverage entirely under the Republican House Health Care Plan. A report by Standard & Poor's estimates about 2 to 4 million people who are in 50's and 60's not yet qualifying for Medicare might lose their coverage they now have under ACA. The Republican plan also gives incentives through tax credits higher for older people, $4000 for a 60 year ol and $2000 for a 25 year old. Under the ACA the insurers are not allowed to charge more than three times what is charged for younger people, under the Republican plan this goes up to five times. 

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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.     ...