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Providing health insurance to the roughly 50 million people that are uninsured costs some $120 billion ayear. This will hae to be paid for through limiting the tax deduction on employer provided health insurance (something Obama campaigned against), or cost reduction in the bloated cost structure for health care in the country. But the same health care providers who committed to cost reduction in arecent conference at the White House are lobbying against some measures that reduce cost.

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Questions being addressed to get health care to the uninsured and to all Americans at an affordable level.

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With 5.7 million jobs lost since December 2007 fewer people are paying payroll taxes to support Medicare and Social Security says Labor Secretary Solis. As aresult Medicare will run out of funds by 2017, 2 years earlier than predicted last year. Medicare and Social Security issued their annual report yesterday, suggesting the nation cannot afford the cost of Medicare at the rate of current expenditure growth. Social Security will run out of money by 2037 four years earlier than predicited before. The only way to keep Medicare solvent says Mr Geithner is to reduce the rate of growth of health care costs.

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How diagnostic tests in portable toolskits, that patients can use themselves, are being developed at low cost in developing countries like China. This creates the kind of care appropriate for poor countries, where patients need something they can afford, and something that does not require repeat visits to doctors offices or clinics. Ustar Biotechnologies is a Chinese startup, that says it has the technology, costs that the founder says "no one can compete with," and affordable prices for poor countries. The sales of such diagnostic test portable devices or kits is expected to soar in coming years. Quimin You, the inventor and founder of Ustar, graduated in North America and worked with multinationals. His proposals for cheap diagnostic technologies were turned down by multinationals, who in their narrow focus saw these thechnologies undermining their existing products. Now Qimin is back in China with a startup that will do this.

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Glaxo's Dr Garnier talks with Jeane Whalen of the WSJ about his work, a lot about his committment to running a company not just for rich countries, that access is a very important word for him and his efforts to make drugs affordable or even free or close to free depending on the country's standard of living, his 24-7 day handling the Avandia issues, and the innovative drug pipeline he has put together over the years.

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How the French health care system works. France comes in first and the USA 37th in aWHO health care ranking. THe difference in deaths from respiratory disease is half that in the USA, and lower rates of death from heart disease and diabetes. IT has more hospital beds and doctors per capita than the USA. 65% of French people are satisfied with their health system compared to 40% in the USA, and yet France spends 10.7% of GDP on health care and the USA spends 16% for poorer results. THe French system is more generous to its seniors. Unlike Medicare there are no deductibles, just modest co-payments that are often dismissed for chronically ill. And diabetes and critical surgeries are covered 100%. French also buy supplemental insurance like Medigap for extra expenses like dental and eyglasses. Cancer patients are treated free of charge. Avastin treatments costing $48,000 a year are provided at no charge. France's PMI or Protection Maternelle et Infantile, is rated highly. It is anetwork of thousands of healthcare facilities, that ensure that every mother and child in the country receives basic preventive care. Mothers even receive afinancial incentive for attending their pre and post natal visits. France makes this care affordable by reibursing doctors at a much lower rate. The average yearly net income for doctors is around $55,000, about athird of what doctors in the USA make. But French doctors don't have to pay back huge student loans as medical school is paid for by the state and malpractice insurance premiums are only a tiny fraction of that in the USA. And again the French government pays two thirds of the social security tax for most French physicians- which is typically 40% of income. So the $55,000, is more like $92,000 taking that into account and more like $110,000 when student loans and malpractice is taken into account at US levels. Specialists who have 4 or more years experience can charge what they want, but as one gastroenterologist says, there in an unspoken and undefined limit to what you can cahrge or what is socially acceptable. Yet even in France there is inflation in health care costs that the government deals with through price controls and more spending. The French national insurance system is running increased deficits each year and this is now $13.5 billion, and it has led to higher taxes for employers and workers. ...

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The EU's competition commissioner to crackdown on pharmaceutical companies that are delaying the entry of generics drugs with various tactics that are anticompetitive. EU has raided the offices of several marge drug companies and retrieved documents that show this activity was going on. About 5% of medical bills or 3 billion euros coud have been saved from 2000 to 2007, if companies had allowed generics to enter the market earlier and not resorted to these antitcompeitive strategies. Like paying off generics companies or having so many patents on the ingredients of the drug, in one case 1300 patents on one single drug, and then suing the generics companies to tie up the case in the courts.

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Areas for growth for the Indian drug Industry include the large growing domestic market, the outsourcing by US drug manufacturers, and sales in other developing countries of Asia, Middle East, Latin America and Africa. Analyst estimates are that India will spend $30 billion a year on drugs to improve care for its people in the next 10 years up from $8 billion today. And the distribution network is being developed by drug companies insdie India to reach more people. Also companies like Pfizer plan to double outsourcing of manufacturing drugs from 10% today to 20%.

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The House Energy and Commerce Committee passes ahealthcare plan with 31 to 28 vote. The Senate version takes adifferent approach. The Senate version has moved away from the employer requirements in the House bills. The Senate committee is moving towards aproposal to require employers to contribute if their workers are getting government assisted insurance coverage. It has also moved away from the surtax on the wealthy in the House bills which is expected to raise $500 billion. Instead the Senate version proposes an excise tax on insurers for health plans that offer generous benefits. Under the current bill being considered in the Senate such a insurance policy tax could raise $180 billion. The Senate Finance Committee is also different in that instead of the public insurance option it offers nonprofit health insurance cooperatives as an alternative. There is agreement between the two parties on anumber of things so the debate will center on the public insurance option, surtax on the wealthy to pay for the plan, and the requirement for an employer mandated coverage for all employees....

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Krugman talks about the misunderstandings and the whole lot of misinformation that comes from advertising and political commentary. With one man telling a Congressman at a town hall meeting: "keep your government hands off my Medicare." In apolitically charged atmosphere this makes rational decisions in acalm thoughful environment difficult or impossible- when the influence of lobbying by the health care industry and the influence of interests on behalf of patients and other interests have already created a difficult situation.

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The discussion on whether it is feasible to achieve any significant cost savings as long as middle class consumers are not cost conscious about their employer provided health insurance. This would be so as long as their health insurance benefits are not taxed as income. America suffers from a particularly strong case of not minding the price increases imposed by the health care industry as long as its not out of pocket cost. But Obama seems stuck on his insistence that the middle class not take on any burden, that there be no middle class tax in the form of this tax on health care benefits. Critics say even FDR did this by having the middle class pay with payroll contributions for Medicare and Social Security. And even if the 5% of Americans who make more than $280,000 are taxed it will not generate by itself the money to pay for the $1 trillion cost of the plan, as the prospects of cost reduction are uncertain- especially when the basic nature of America's health care system are not changed, like the lack of cost consciousness of consumers of health care when its perceived to be free and employer provided....

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Comparative effectiveness research will be conducted to evaluate what is the best treatment for any ailment or disease or health problem under the $1.1 billion allocated for this in the Stimulus Plan. What are the alternative methods of treatment, what is the effectiveness of each treatment, what are the comparative costs and so on. Is it better to treat neck pain with surgery or acombination ofphysical therapy, exercize and medications? If there is ablockage of arteries in the lower leg and leg pain, how does drugs and watchful waiting compare with surgery? For chronic heart failure how does home monitoring of blood pressure and weight and exercise in addition to medications provide an alternative route as opposed to just medications. Dr Fisher of Dartmouth Medical School cites these as examples of questions that can be asked in comparitive effectiveness research. The money will be available to the Health and Human Services Department and will be used over several years. About 15 federal employees will form a council to coordinate the research and advise President Obama and Congress on how to use the money. In 2007 the US spent $2.2 trillion, or 16% of GDP, on health care, and the Congressional Budget Office says it will grow to 25% of GDP at the rate its growing by 2025 if left to its own devices. ...

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Of the people asked the question "what issue do you see as the most important for health care" 44% in a NBC/WSJ poll said they considered Cost as the biggest issue, and 37% said that they considered the Uninsured as the biggest issue, 11% said quality of care was the biggest issue. The President is focussing on cost as he develops the health care plan. He is also saying that to provide health care for all and cover the uninsured without controlling costs would break the bank. Another thing that the White House shows it has learned from previous failed attempts, is that it is doing this with an open Health Care Forum with participation of different sides in the health care discussion. Clinton's effort in 1993 ran into problems because it was developed secretively, and without much discussion, and little effort to get different people's views. The previous attempt also waited too long after the election, and this time the President is moving quickly when he enjoys large popular support. Its also true now that there is serious concern especially in this downturn of what a threat spiralling costs of health care are becoming to the future prosperity of the American people. This time the leaders in Congress are setting an aggressive schedule to get health care palns legislation on the floor by June and get a floor vote in August 2009....

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Laffer says there is a big gap between the cost of health care and what people actually pay, which keeps cost escalating as there are no pressures from users of services to economize or bring reductions in the prices. But Laffer offers no effective solutions either his patient centred approach to health care reform does not address the problem that employers are paying for health care for the large part and these are not taxed as benefits leaving the employee free to load up on services and ignore the cost, which works just fine for the health care providers who increase revenues and profits- also called cost escalation upto the point now reached where the nation can no longer afford it.

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The House bill on health care cleared the House Committee on Energy and Commerce with a vote of 31 to 28. Five Democrats joined all 23 Republicans. Compromises were reached with Blue Dog Democrats, centrist Democrats who had concerns about the cost of the health care overhaul. The bill will be taken up again in September after the August recess, when Congress will be faced with the task of recociling the House and Senate versions and reaching common ground on a number of proposals. Some common ground has already been achieved between centris and Blue Dog Democrats and Democratic members who support Obama's proposals. Among the changes on which consensus was reached in the House version: 1. Access Insurers will have to accept all applicants and will not be able to charge higher premiums because of medical history or current illness. All insurers will have to offer a minimum package of benefits, to be defined by the federal government, and nearly all Americans will be required to have insurance. Insurers will have to get prior approval from the government before increasing premiums over a certain amount. About 95% of Americans will be covered this time. The cost will still be approaching $ 1trillion over 10 years. Federal subsidies will be given to those who cannot afford health insurance and Medicaid coverage will be expanded. And the insurance will be made more affordable for the uninsured. Democrats also reached a consensus on creating some sort of government insurance plan or nonprofit cooperative to compete with private insurers. 2. Mobility And under this new plan it will be easier to change jobs as one would retains one's health insurance. This should actually help the job market, and help promote the mobility that is needed, now that jobs are shifting out of sectors like autos to sectors like energy. 3. Cost The Energy and Commerce Committee voted 47 to 11 to set aprocedure for the government to give federal approval of generic versions of expensive biotechnology drugs. By one estimate this saves $9 billion over 10 years. The Democratic proposals from the Energy and Commerce Committee would authorize the Health and Human Services Secretary to negotiate prescription drug prices for Medicare benificiaries. The agreement and consensus among the conservative, liberal and centrist Democrats, and Democrats with ties and connections to the health care industry was reached after intensive negotiations, and adoption of a package of amendments that helped bridge the differences they had. ...

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As Obama faces the situation FDR faced, between political popularity after election in 1932, and loss of some political capital in the first year by 1933, and a lot depends on political will and courage. He has to execute and implement plans for efficient government spending that builds jobs to replace those lost, and to use the investments in really productive ways including projects that provide returns for years into the future. As David Axelrod points out in the Frank Rich column in the NYT, people sometimes live in a parallel universe, which may be completely at odds with what the rest of the country caught in the economic currents of layoffs and collapsing businesses is thinking.

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The inflated costs for spinal surgeries at some hospitals in California. How surgeons, doctors, consultants, distributors and hospitals operated in a flawed system to make revenue gains through overbilling, and focus on increasing the number of surgeries performed.