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The major provisions of the Republican House healthcare bill that passed by a vote of 217-213 are- 1. To help people buy insurance coverage the bill offers $2000 to $4000 a year, upto $14,000 a year in credits based mainly on age, reducing them for families making $150,000, individuals making $75,000. 2.  Under the Affordable Care Act insurers cannot charge older Americans more than 3 times for same coverage they offer to younger people, the new bill makes this 5 times. This would increase premiums for older Americans and reduce it for younger Americans. This is the most controversial part of the bill. Older Americans supported the Republican party in the presidential election. 3. The new bill ends Medicaid as an open ended entitlement and places this on a budget with cuts of $880 billion over 10 years. 4. To mollify conservative Republicans a provision allows state to opt out some provisions of the ACA that requires minimum benefits such as maternity care and emergency services. It retains coverage for pre-existing conditions to mollify moderate Republicans. The bill provides states with $138 billion over 10 years to subsidize premiums, provide coverage for pre-existing conditions, mental healthcare and drug addiction. 5. The bill removes the taxes imposed under the Affordable Care Act (ACA) on high income people of about $300 billion over 10 years by repealing a payroll tax increase and tax on investment income. This bill and the ACA offer 2 competing visions on healthcare, both bills passed only by a margin of 4-5 votes in the House. The ACA overlooked the impact on premiums causing discontent among middle income Americans. The new bill lets premiums rise for older Americans in order to keep premiums down for other Americans. This shows the many tradeoffs involved and choices being made, and the lack of a consensus on the issue of healthcare in the U.S., becoming a highly politicized issue instead of the way it is treated in western Europe.     ...

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Much of the cost of the Common Prosperity campaign of president Xi to increase access to healthcare, education and housing will fall on heavily indebted local governments in China, says WSJ. Today in 2022 these three education, healthcare and housing are moving beyond reach of ordinary Chinese because of rising costs and referred to as the "three big mountains." In education and housing the government has moved to improve access. Today parents like Ding Jianxiong in Beijing can give their children two extra hours of classes in school for not cost. It saves money and time compared to tutoring classes that the government is discouraging. Teachers have to work longer hours for this to happen and the cost is borne by local governments. Governments at provincial, municipal and county level finance 80%, 70%, and 60% of China's fiscal expenditures on education, healthcare and housing projects. Data from China's Finance Ministry shows local governments have built up $4 trillion in debt at end of 2020, up 20% from a year earlier, much of it to finance infrastructure projects in the last 20 years. This experts say is an underestimate with additional debt buried and camouflaged in financing vehicles, other forms of debt. In 2020 the central government restricted sales of land that were creating an overinflated housing market and driving cost of housing ever higher, depriving local governments of a principal source of revenues. Land sales are now down about 15% and falling. Experts say a new property tax could only bring in one fifth of what was derived through land sales by local governments. The result is a fundamental mismatch today between revenues and costs for local governments that has not been addressed. ...

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George Bush's administration passed healthcare legislation that allowed private pharmaceutical companies not to have to negotiate with Medicare on cost of drugs. It also passed the so called Medicare Modernization Act that created a huge opportunity for profits through Medicare Advantage Plans. The chart in WSJ shows profits it calls a bonanza. What it means is that instead of reducing the costs of providing medical care to elderly Americans it has increased the cost leaving less and less money for infrastructure for roads and bridges and airports that are dilapidated in the US, and less money for essential services in education and health care, transportation, housing. This has reduced the standard of living and quality of life in America. For healthcare it is providing less for higher cost when compared to China, India, Germany, France and the UK. George W Bush administration put America into 2 wars in Asia and the Arab world which also drained resources contributing to a lack of investment in the country in essential infrastructure and services. ...

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Feldstein says that for the 85% of the people who have healthcare the Obama proposals are not a good deal. The Obama proposals mean higher taxes in the long run to pay for the $1 trillion cost of healthcare for the uninsured group over 10 years. This lower income group has no coverage despite the $300 billion Medicaid program. Feldstein says there surely must be better and less costly ways of getting this lowincome group healthcare. Raising the top income tax rate to 45% from 35%- as a result of letting the Bush tax cuts expire and adding aproposed health surcharge on higher income individuals- would actually lower revenues for the government, as it would change behavior of high income individuals in ways that lower their taxable inome. The result is higher deficits and higher taxes when even without this large deficits are projected for the future. How to slow the rapid growth in healthcare spending? The Obama plan is to cut spending on Medicare. Feldstein sees the govenment's effort aimed at reducing the amount of medical services, as reduced spending comes from fewer services, not reduced payments to providers. Will this result in enough of acost reduction to make the system work. And if the cost reductions are too heavily weighted 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% who are accustomed to a different pattern of healthcare, even though it is structured to allow cost escalation. Feldstein offers no solutions to the problems of cost escalation except to suggest that the Obama plan does not really tackle the cost escalation issues directly with providers, and instead burdens the national finances to an extraordinary degree. And the need for apause and reflection....

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Are high prices for pharmaceutical products and healthcare services putting a severe burden on U.S. finances and defunding education, infrastructure, R&D in new technologies, which provide the underpinnings for future U.S. competitiveness? Yes say experts. In 2009 Americans per person cost of healthcare was $7,960. By comparison Canada was $4,808, Germany $4,218, and France $3,978. And without necessary efforts for educating people about caring for health and preventive care, the health conditions of Americans are no better than these countries, and poorer in some dimensions. Klein says deficits would not be a problem for the U.S. if prices for pharmaceutical products and healthcare services in the U.S. were similiar to that of the largest developing countries. Experts say the Obama healthcare law simply postponed the addressing of this problem.

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Federal data showing international and domestic migration by US state and the natural growth in US Population 2026. California, Hawaii, Vermont, New Mexico lost population because of domestic outmigration, lower international migration and natural birth/deaths led to net negative growth. Population growth was fastest in Idaho, Utah, Washington, Texas, North and South Carolina, Tennessee, Georgia, Florida, Arizona, in southern and western mountain states. Births were higher in these states in addition to the domestic in-migration from other states. Population is slowing to about 0.5% after the big surge in international migration under the Biden Administration from failed states such as Venezuela, Guatemala, and from Mexico at the southern Border- by 1.8 million to reach 341.8 million. One of the problems is integrating newcomers- the Movement for Literacy in the US is to ensure new US citizens have an essential grasp of the ideas that shaped the nation and civic information, knowledge of the English language. Another is burden on social services needed and healthcare services which were under strain under the Biden administration open border policy. Also significant is the concerns of residents for homelessness and safety in urban areas.  ...

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The numbers are shocking. In 2019 alone the costs of the Opioid epidemic in the U.S. was $188 billion including healthcare, child and family assistance programs, criminal activities, and lost wages, according to the Society of Actuaries. Now 3 large pharmaceutical distributors and some pharmaceutical manufacturers are hoping to settle the lawsuits by paying $50 billion. The costs to the nation are enormous in human toll and in lost economic activity.

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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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Walmart is going to require employees to use certain hospitals for costly spine surgeries, an effort to weed out unnecessary procedures and lower healthcare costs. The retailer earlier used a voluntary scheme to get employees to use the hospitals offering lower cost quality care, but found that half of the people needing spine surgery who volunteered to travel decided not to undergo expensive spine surgery. A spinal fusion surgery costs $77,000 at Mayo Clinic which tries to first see if other options of physical therapy can do the job. Walmart has insurance coverage for 1 million people.

Costs are going up and up. The average cost of family health plans from employers is up 5% this year to $20,000, with workers paying one third of cost, a survey by Kaiser Family Foundation shows. 

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

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China's healthcare costs have increased in the last decade without effective cost control measures. With the decline in consumer spending in the last decade to where it is now only 35% of GDP, and ordinary Chinese setting aside a large portion of savings for costly drugs and healthcare, reducing healthcare costs is a high priority to rebalance the economy and increase consumer spending. By comparison in the U.S. it is 70%. Bussey points out the importance of this for the new leadership of Jinping-Keqiang in China. Xinhua, the Party offical news agency, expressed China's new policy, saying that "some believe China may see a nationwide price cut on medicines." Regulators have begun probes of Nestle and Danone for possible anticompetitive activity and the two companies dropped prices for baby formula.

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Action to tackle the cost of living crisis taken by G-7 countries France, Germany, Italy, Canada, US, is shown here in The Guardian. France and Germany have taken the strongest action to protect lower income people, the US with the Inflation Reduction Act has taken broad steps to limit healthcare costs and invest in the economy. The UK appears to be the weakest in taking action and the new budget of Mr. Kwarteng is seen in this way as failing to protect vulnerable parts of the population.

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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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Insurance premium rise 2022-2025 is costly for employee wages with employers slow to increase wages when so much money is going into healthcare premiums for their employees. Each year employee premiums in the US have increased by 7% for the last 3 years. $27000 is the cost of health insurance premium for American family in 2025 which is exorbitant and shows a breakdown in the health system that is affecting the cost of living, the wages of workers, and the money left in the economy for other essential needs.

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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 Economist cites the Dartmouth Atlas Project which shows differences in cost across the country for health outcomes and spending involving Medicare. It cost $5000 per person in Salem, Oregon in 2006, $8000 in San Francisco, and more than $16,000 in Miami, with outcomes for health tending to be better in places where the costs were lower. This is one of the statistics that Peter Orszag of the Congressional Budget Office uses to come up with his estimate of 30% waste in health care spending in the United States. Prof. Skinner at Dartmouth and Prof. Garber at Stanford point out that of most health systems around the world the American system is "uniquely inefficient" and wasteful. The Economist cites information that the American system is twice as costly per person for healthcare than the Swedish system, and that it costs twice as much in Minnesota as in Miami. A poll done for the Economist shows 52% of the people in the UA are dissatified with the quality of care, 40% think the system needs fundamental change, and 29% think that it should be fundamentally rebuilt. The lack of uniform coverage is also causing turmoil in the system. About 49 million are uninsured, and a quarter or more are able to buy insurance and do not buy it because it is so costly, has exclusions and coverage is inadequate. But these people also end up in the emergency rooms along with the indigent costing the whole system tens of billion of dollars for costly late interventions that could have been avoided with preventive care early on. With the economic crisis and rise in joblessness, the dire condition of state and local budgets, the situation has probably drastically worsened, and the system near breakdown. ...

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Healthcare coverage of illegal migrants is at the center of the fight between Democrats and Republicans leading to the government shutdown on October 1, 2025. A slight majority of Americans favor deportation of illegal migrants is shown in a recent NYT poll. Even higher numbers are likely to see higher priorities in the Nation than funding of housing and healthcare for illegal migrants when most families in the US are living from paycheck to paycheck and government subsidies and assistance are being cut after Covid.

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UnitedHealthcare says it will keep parts of the healthcare law relating to preventive healthcare services without co-payments, allowing parents to keep children on insurance till age of 26, even if the Supreme Court rules against the healthcare law. Most insurers see these parts of the law that are popular quite favorably.

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The fee-for-service system that is seen as the main reason for the inability to control costs. Patients don't see the costs of healthcare as long as they see companies and employers paying for their health care. About 75% of those with insurance say they are satidfied with their care even though the system encourages excessive testing and increases costs year after year.

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Negative interest hurt the vulnerable the most- consider how much in interest would have to be deposited in retirement accounts savings of retirees to make up for lost interest over two decades. It could be in the hundreds of billions of dollars. It has added to the poverty in the Nation as interest income went gradually to negligible amounts. It also disincentivised savings,  and reduced the cost of capital so that hundreds of billions of dollars of retirees and other people's income was shifted into startups and dubious investments that did little to add to essential public services, education, healthcare, that would improve the quality of life for workers, families and children.It was in effect a misuse of economic policy to serve one section of the population at the expense of the large majority of the people in the Nation, and a shift of hundreds of billions of dollars over two decades from the vulnerable who needed it most to other uses. And aggravating the situation resulting from the failures in investing in manufacturing in the US that put whole communities at risk, neglecting the investment in infrastructure that helps ordinary people the vast majority in the nation the most. Only now are these investments being taken up by the Biden administration reallocating funds to infrastructure, manufacturing and clean energy, to retirees, and to communities across America. During this time of two lost decades for America, and into the future, the great nations of Asia, China and India, have advanced and are advancing with focused attention on the needs of all the people in their nations, and most importantly of all in advanced infrastructure and advanced manufacturing.  ...

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In a new WSJ/NBC New poll, conducted July 24-27, 2009, 42% called the Obama health plan a bad idea, and 36% called it a good idea. In mid June the poll showed Americans evenly divided on this question. It reflects rising anxiety over the costs of the health plan and what it will do to the deficit, and also shows public anxiety about the ways in which Obama and Congress are reaching compromises to pay for it and to control costs. Added to this are the anxieties raised about government involvement in healthcare and medical decisions about care. Noteworthy are two differing pieces of evidence. In the WSJ/NBC News poll, only two in ten people thought the quality of their own care would improve, only 15% of those with private insurance thought that it would improve the quality of their care. And 4 in ten people thought quality of care would get worse, and 45% of those with private insurance thought quality of care would get worse. By focussing on the cost of health care, the administration seems to have ignored or missed the concerns of people about the quality of care if government focussed on cutting costs. These concerns are real as a vast majority of the public, or about 85% of the people, as Martin Feldstein points out in a recent Washington Post column, are insured. The question is what cost would they be willing to pay for the admittedly worthy cause of insuring the uninsured? And even with the unisured, it seems likely with the current Obama reform plan that immigrants and other people may still remain uninsured, at least for some time. Would a huge burden of $1 trillion make this worthwhile, and is there some better way to do this without the prospect of higher taxes further down the road to pay for this. These are points Feldstein makes. The other piece of evidence is that at the same time that there are reservations about what is coming out of Congress today, there is general support for making constructive changes to healthcare. The WSJ poll showed 56% of respondents favoring the basic ideas in the reforms being considered in Congress, with 38% opposing it....

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Compare AI models for versions v2 v3 by DeepSeek that cost $5.6 million with Anthropic AI model that cost $100 million+, and one gets the order of magnitude in cost for the new DeepSeek China model vs its US counterparts.  The hundreds of billions of dollars that OpenAI and big spenders such as Google, Meta, and Microsoft would have to drain capital markets would be a disaster for workers and families in the US and the standard of living, the infrastructure improvements that don't get done, and the investments in transportation and other vital needs such as schools, education and healthcare that directly impact the cost of living and the standard of quality of life in America and other countries. This is where competing models from China, from India, and from European countries can get us back to where we want to be to continue improving the cost of living and standard of living, quality of life in America for workers and families. This is the choice workers and families made in 2020 and in 2025, rejecting the wasted resources in wars that serve no purpose, and rebuilding the Nation's infrastructure, its water, schools, transportation, healthcare, childcare.  ...

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Medicare Supplemental insurance (also called Medigap) covers out of pocket cost that are not covered by Medicare Advantage. Over long period of retirement thes plans offer the best protection from unanticipated costs. The Plans use alphabetical leters A B C D F G K L M N with F discontinued. And are standardized, meaning regardless of insurer or state you are in they are the same being set by the US federal government. These plans are sold by private insurers the largest being AARP plan by United Healthcare. One can join when enrolling for Medicare Part B when premiums are usually better yet one can also join afterwards. About 36% of Medicare holders have Medicare Supplemental or Medigap policies for health insurance.

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Infratest Dimap polling institute is commissioned by DW.com to find out what Germans think of the refugee policy of chancellor Merkel one year later. In summer 2015 Merkel said on Aug 31, "We can do it." Costs related to the refugees are about $17 billion, do Germans think services are overstretched for education, healthcare housing and other services. On the other side German society is aging and for every 100 unemployed people there are 200 open positions for skilled personnel. But the refugees who are accepted do not have the skills required and have to acquire the skills or given training and education. On this issue DW.com asked the question whether it will strengthen the German economy. About 51% agree and 45% disagree on this question, and about the same number agree and disagree on the question that Germany will be overstretched providing the services for housing, education, healthcare and other services. The higher educated and young are more favorable to accepting refugees, with those over 50 and basic schooling unfavorable. On the AfD side most people are unfavorable, and in the Greens party most are favorable. On terrorist incidents probability, over 58% think this is more likely, 38% disagree. On the question of whether this will make Germany more diverse 56% agree, 40% disagree. Overall the situation appears to be balanced, with a range of views expressed, and the positive and negative sentiment "evenly balanced", says DW.com.  ...

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The Ayushman Bharat Mission (Swasth Bharat) launched by the Indian prime minister this week aims to fix the healthcare infrastructure that was neglected for decades since independence. It aims to increase investment to provide much of the rural population access to healthcare services. Investment in healthcare will increase over a six year period from 1.15% to 2.25% of GDP. The investment is of 64,000 crore rupees, about $10 billion over 6 years. By comparison the UK invested 5% of GDP in 1980 for healthcare spending which increased to 9% by 2017. This suggests that this is just the first step towards increased investment in healthcare spending to build medical colleges, hospitals facilities, and rural healthcare clinics from the smallest unit level in districts across the country.  The pandemic showed weakness in India's healthcare facilities particularly at the rural level. The Ayushman mission was launched in Uttar Pradesh India's largest state with a population of 250 million where healthcare facilities suffered most from neglect since independence. ...