LyrArc Article Gist
Jonathan Gruber, the MIT professor, who has done extensive modeling of U.S. health care systems. Gruber advised Massachusetts Governor Romney in crafting the health care law in that state. He also advised the Obama administration in crafting the health care mandate that requires all Americans to buy health insurance to keep costs down. Gruber estimates the number of newly insured Americans could drop to 8 million from an estimated 32 million if the Supreme Court strikes down the health care law mandate. The result he believes will drive insurance premium prices even higher.

LyrArc Article Gist
The basic outlines of new health care legislation takes shape as Senators Dodd and Kenedy come up with a plan that scales down subsidies to low-income people to buy insurance. Attached to their revised outline is a budget office analysis thatprojects the plan costing $611 billion over 10 years and with expected changes from the Senate Finance Committee would cover 97 percent of all Americans. And earlier plan received much criticism because the Congressional Budget Office estimated its cost at $1 trillion over 10 years and left 37 million Americans uninsured. In addition there is the revised Medicaid expansions for aid to the poor that would add a couple of humndred billion dollars to the total tab. The administration's goal is to keep the cost down to $1 trillion over 10 years. The legislation as it stands includes the public option which is designed to control insurance costs. Mr. Obama said this week that "the public option would keep insurance companies honest." Employer mandated insurance is part of the Kennedy-Dodd legislation proposal. Employers with 25 or more workerswould have to provide coverage or pay the government an annual fee of $750 for each full-time worker and $375 for each part-time worker. The government pays the startup costs for the public insurance option as a loan to be repaid, and premiums would make the option self-sufficient....

LyrArc Article Gist
Josh Gotbaum, head of the U.S. Pension Benefits Guaranty Corporation and the reorganization of American Airlines (AMR). Gotbaum's strong response made AMR reverse its decision to shift $9 billon in pension liabilities to PBGC, which would have increased PBGC's current deficit by one-third. PBGC is funded by insurance premiums paid by companies sponsoring private sector retirement plans. It has handled 10 pension defaults since 2002- nine in the airline and steel industries. It deficit stood at $26 billion in Sept. 2011, up from $23 billion the prior year. PBGC funds retirement benefits for 1.5 million people, and sends out 800,000 checks.

LyrArc Article Gist
How ACA a company that provided bond insurance for Collaterized Debt Obligation or CDO's basically did not provide good insurance to the CDO issuers becase it did not have the financial resources necessary to do this but instead let banks and investment houses to benefit from the accounting rules in the insurance industry which allow another set of accounting rules different from GAAP (Geerally Accepted Accounting Principles). Under these rules banks and investment houses did not have to follow the mark to market rules of GAAP and could book the difference between interest payments and the insurance premium across the life of the bond (5-10 years), in the quarter they bough the insurance, what were essentially illusory profits. Merill Lynch issued a lot of these CDO's. In November 2007 ACA was forced to take $1 billion in losses for the third quarter. Standard and Poors downgraded ACA from A to CCC a month later. The downgrade forced ACA to come up with more collateral to show that it had the funds to back up its insurance. When it came short of funds Merrill Lynch, UBS, CIBC had to take big losses on these policies. This began the first big shocks on the Street at te end of 2007. Note that $43 billion in securities backed by risky corporate loans and bonds like the ones used for a lot of the buyouts have insurance from ACA. These could be the next to sour and lead to more writedowns as the economy weakens. ...

LyrArc Article Gist
Einer Elhauge, professsor of law and founding director of the Petrie-Flom Center in Health Law Policy at Harvard University, says there are limits to Congressional powers under the Commerce clause such as enacting a law requiring Americans to eat broccoli. If the health care law required all Americans to subject themselves to health care this would be the case. But the law only requires all to buy insurance so that insurance can cover the costs of healthcare for all. He points to the "necessary and proper clause" as also authorizing the health care mandate. That clause gives Congress the power to pass laws that are "rationally related" to execution of constitutional powers, such as criminalizing the interference with mail, on the basis of the constitutional power to setup post offices. In this case the health care law mandate is related to the constitutional power to regulate premiums and prohibit rejecting the sick, says Elhauge.

LyrArc Article Gist
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. ...

LyrArc Article Gist
A study by AARP of 514 brand name and generic drugs between 2005 and 2009, shows that generic drug prices went down an average of 31% during this period, and brand name drug prices went up by 41%. One of the authors of the report says that it is important to look at individual drug prices and not studies showing total spending on drugs, because this is a significant cost for people paying out-of-pocket, It drives up insurance premiums, and pushes retirees into coverage gaps in Medicare Part D drug program. Analysts indicate pharmaceutical companies are increasing prices on drugs before patent expiration to get as much profit before the patents expire.

LyrArc Article Gist
Howard Dean, former Governor of Vermont, where Dean helped set up health care improvements, says the bill currently in Congress for health care reform does not deserve to be called reform and may do more harm than good. He points out that it does not insert competition into insurance markets, does not significantly lower costs, and does not improve the delivery and use of health care services. And few Americans will see any benefits till 2014, by which time premiums will have increased significantly. He sees insurance companies as winers in this bill, and the American taxpayer about to be fleeced with a bailout in a situation that dwarfs even AIG. One of his keen criticisms is already apparent to the public in this health care bill, that clear thinking has been thrown out in favor of compromise and political calculus, and by political moves the bill has been stripped of real reform , the end result being a bill crafted for votes and not to reform health care. It also then sets an irreversible course of how future healthcare reform is done, doing more harm in the future. ...

LyrArc Article Gist
Alicia Munnell, is the director of the Center for Retirement Research at Boston College. Munnell says the Domenici-Rivlin deficit reduction proposals should serve as the basis for putting Social Security on a sound financial basis. Tackling the budget deficit should not be focussed simply on the 12% of the budget that makes up nondefense discretionary spending in his view. Tackling Social Security would build confidence and reduce the long term deficit. The Domenici-Rivlin plan has the following proposals for Social Security- indexing the full retirement age after it reaches 67 to improvements in life span, a smaller cost of living adjustment, increasing the earnings subject to the payroll tax to about 180,000 from 106,800 in a gradual way, and gradually taxing employer and employee premiums for health insurance.

LyrArc Article Gist
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. 

LyrArc Article Gist
During the years 2002-2008 the growth in doctors per thousand people at about 1.5, and hospital or clinic beds per thousand people at 3, are essentially flat. See graph. Figures from China's Ministry of Health. Now the State Council, China's cabinet is giving details on a $120 billion plus initial phase of a revamp of the country's health care system. Its a big step for China. A construction surge by 2011 is to give every village a medical clinic, and every county at least one hospital. Under this plan state subsidies for insurance premiums will aim at giving at least basic coverage to 90% or more of China's 1.3 billion people. For 30 years since China moved to a more capitalistic type system health care costs have been borne by the people, and these cost made access to health care difficult for a large number of people. These are steps to rebuild the social safety net in China in this crisis.

LyrArc Article Gist
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.

LyrArc Article Gist
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.     ...

LyrArc Article Gist
With use of the software technologies and cloud computing Athenahealth hopes to revolutionize the medical records of physician practices. Here Joseph Rago of the WSJ talks to Jonathan Bush, CEO of Athenahealth. Bush says the way things are done now in healthcare there is no choice and choosers, and ther is not thing like a market in health care and people in Washington DC don't understand remotely why a market might be remotely useful. The deep problem in American health care he says is that no one knows the actual value of the services doctors give, not even the doctors, and the complexity of the method of payments keeps everything hidden, as doctor's clerical staff bills your treatment to insurance companies picked by your employer, and pays the doctor through money taken from premiums or foregone wages. Athena designed a program to digitize records and automate billing and is moving into clincal record keeping. It now has 15,000 physicians in 43 states using its program as avirtual office and growth at 30%....

LyrArc Article Gist
On one hand the issue of the $165 million in bonuses going out to employees in the 370 person Financial Products Group, and oth the other the need to wind up the complex derivative contracts that are causing these huge losses at AIG. But are such huge payouts needed for these employees to do their job? Isn't this aprofessional responsibility of these employees? And AIG's retention-payment program was disclosed a year ago and the amount of the bonuses $400 million, says the Washington Post, had been widely reported. The company is set to pay according to the WPost $600 million in retention awards to about 4700 people throughout the global insurance units. WHat happens to the $600 million, as no opinion has been voiced on these upcoming payments. The whole idea of retention payment raises another question. Will the skills of these employees be needed in a long drawn out economic downturn spread over several years or longer. And will thefailure of such things as derivatives, and the tighter regulation, mean that they will play amuch smaller role in the future. And even in the insurance units will these skills draw a premium in a market where the supply of new talent is larger than the job market ? One expert has sugggested that even if some of them left, there would be younger people to replace them who might bring an even better set of qualifications, with amix of skills, caution and prudence. So is there something self-interested and spurious in the retention argument itself and shouldn't this bluff be called? ...

LyrArc Article Gist
Sony has lost its focus, it is in so many lines of business, that its brand identity has been lost. Especially in Japan where it is in cosmetics, massage, mailorder shopping club, insurance, finance, robots etc. It has 1000 subsidiaries and affiliates worldwide, of which a third are unrelated to its core electronics business. How does this hurt? It hurts because management is distracted, and when top management is distracted then its not focussing on customers, changing business trends, creativity in its business pioneering new products. In a big company this problem is just magnified by the bureaucracy that develops. Problems similiar to the ones faced by IBM and General Motors. The analysts and Howard Stringer talk about restoring the Sony premium. What is a premium, its not just the brand, its the innovation or something special behind the brand that enables it to command the premium. Stringer probably understands that its the innovative edge that Sony as lost. See the other piece "Howard Stringer, Sony's Road Warrior" by Siklos and Fackler in the Sunday NYT, May 30, 2006 with Stringer shown in a large picture imagining him as a Sumo wrestler. An unforgettable picture. In that piece it becomes clear that Stringer is keenly aware about Sony's and Japan's weakness in software which is increasingly driving success in products when combined innovatively with new bold concepts. He says there that Sony takes great pride in its hardware, and this is true of Japanese creative spirit in innovative and miniature gadgetry, but its capabilities in software are very modest. As one action step Stringer has hired Tim Schaaf , a senior Apple executive to lead that effort at Sony. The other part, getting the focus back by focussing on customers of electronic products is evident in this piece. Ryoji Chubachi, head of electronics and co-head of Sony with Stringer, regularly visits large retailers to offer incentives for making Sony products more visible, something the prior management failed to do. The prior management failed to focus on customers, and thought it beneath their highflying ways. One of the decisions by Chubachi in TV's is to price HDTV sets close to the price of Panasonic, Samsung and Sharp at large retailers in Japan. This makes sense to gain market leader status, as it shows Sony is living in the real world and taking decisions appropriate and relevant to a premium free environment in television sets. You a manufacturer cannot imagine a premium, a premium is a perception in the minds of customers and most likely reflects a perception of uniqueness, creativity, fashion and some other attribute, which can include engineering. Sony's philosophy has stated in Akio Morita's book "Made in Japan", was to be a pioneer, to walk the untrodden ways, break new ground. One aspect of this in comparison to Matsushita, Sharp and other competitors, was going to be its individuality, something Morita borrowed from his days in the US, because it is typically American and sort of unJapanese in a way. Though this is a generalization and many American companies merely follow and some Japanese companies have their own way of doing things even if it is thought of as being very Japanese like, witness Toyota in its Aichi prefecture surroundings. In this light the surveys show Sony significantly deteriorating in "conspicuous individuality." The New York Times cites a survey from BP Nikkei Consulting in Tokyo that the number of consumers saying that Sony showed "conspicuous individuality dropped to about 25% from about 40% the year before. ...

LyrArc Article Gist
The House passes the $819 billion tax and spending bill. Every Republican in the House voted against the bill in the 244-188 vote. Most of the money to be spent of about $526 billion will be spent in 2009 and 2010, though some spending on student loan programs, clean water projects and housing assistance will carry over into future years. To help workers with the downturn $27 billion will go to continue unemployment insurance benefits till December 31, 2009. $9 billion will go to increase the current benefit from $300 to $325 per week. This is money that will be spent as workers lose jobs. The bill also lets former employees to get COBRA coverage, It funds 65% of individual's premiums for upto 12 months. And workers over 55 or with more than 10 years service will get to keep their COBRA coverage until they get a new job or get Medicare. A big departure is allowing those who are unemployed enroll in Medicaid, and Medicaid will temporarily expand to include millions of unemployed workers. See the link to Education spending for the $125 billion going into Education spending that will save the jobs of hundreds of thousands of teachers and create jobs for construction as schools are repaired and renovated....

LyrArc Article Gist
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.

LyrArc Article Gist
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. ...

LyrArc Article Gist
What Buffett has that others don't. The ability to strike a deal on favorable term because of the size of the investments he makes, and the number and firepower of analysts combing through every detail of a transaction. And more importantly his investments in companies like airy Queen and see's candies and the folksyimage belie the fact that he gets an advantage through his large investments in the insurance business where he has access to the float in terms of the premiums he can use on investments. And he is good at running the insurance businesses he owns.