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Republicans are divided in Texas in 2023 which could turn it over to Democrats. One forgets that Texas is the state that a Democrat LBJ Lyndon Baines Johnson was from and his base of support, first vice president under John Kennedy and then elected president. LBJ signed legislation for amending Social Security to create Medicare and Medicaid. He also passed Civil Rights Act of 1964 banning segregation and in 1965 enfranchised black voters. The WSJ in this editorial sees the divisions between Republicans in the House and the Senate over the impeachment of Attorney General Paxton as signs that Texas has one party dominance for too long. It says this could turn the state to a Democrat majority in 2024 as it was under LBJ in 1960, who helped create programs revered by all Americans.

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America whether under Eisenhower or under Truman, Johnson or Reagan embodied some measure of fairness and good sense. How this was lost when it comes to pharmaceutical pricing under Bush in 2003 and Obama in 2008 is shown here in a WSJ podcast. Bush and Republican allowed Medicare to pay for pharmaceuticals yet taking away its right to negotiate prices. Obama and Democrats in 2008 this podcast shows allowed the Bush introduced violation of good financial common sense to continue in exchange for support for Obamacare from the manufacturers. Over 15 years by 2019 pharmaceutical costs soared and remaining goodwill withered, this podcast shows. During this same period the financial industry went through a similar cycle and with it the ideas of a free market economy. The free market economy like everything else in life depended on good common sense, and a sense of how it benefits all, as both Adam Smith and the country's principal founders constantly reminded people.      ...

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Leonhardt says that there is little reason to think that the flatter rates are better always. With the need to finance Medicare and health care for all, the government can use the extra dollars from taxing the very wealthy, the very rich in different tax brackets. The top bracket in 2008 started at 357,000, and you paid 35% whether you made 400,000, or $4 million, or $40 million. So basically the upper middle class was lumped in with the extremely wealthy. And considering the cost of college tutions for 2 or 3 kids, the upper middle class is only middle class. It makes sense not to lump the two together. Considering that there has been a lot of wealth accumulated at the the very high end, it would also reduce inequality, generate tax revenues for health care, and not have much effect in the incentives for generating economic growth. It is something he says the Obama adminisstration may and should consider.

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For the approaching US midterm elections president Biden seeks to draw a sharp contrast with Republican Senator Rick Scott's Plan which he says would worsen inflation and increase taxes on working class families. Mr. Scott's plan is for sunset on all federal legislation and president Biden says this would include Medicare and Social Security. Mr. Scott also wants all Americans to pay some income tax to have skin in the game. At this time about half of all Americans pay no taxes says Mr. Scott. Former US president Trump continues to lead the Republican party in 2022  yet he faces a very different Democratic party under president Biden. Mr. Biden's focus is on his $2 trillion plan for Workers and Families, rebuilding American manufacturing and renewing supply chains, unlike Hillary Clinton whose lacked such a focus. Leading to Mr. Trump's appeal with working class families and disdain for traditional Republican policies that secured him the presidency in 2018 by defeating Hillary Clinton. The changes with president Biden's focus on workers and families are happening also in the European Union. Scholz and the Greens in Germany, Macron in France with potentially Melenchon as prime minister, and similar changes in Denmark and other EU countries suggest that there is a renewed focus on infrastructure, rebuilding manufacturing and supply chain renewal, rebuilding incomes and lives of workers and families, in Europe and the US. ...

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Samuelson warns that turning seniors into a protected class making no sacrifices whatsoever, will mean shrinking all other social programs, defense and investments in education and infrastructure. This is the reality of the budget deficits facing the U.S. He cites the Congressional Budget Office projections that even with cutting defense and non defense discretionary spending by a third, the U.S. risks a deficit in 2023 of about 6.75% of the economy or gross domestic product (GDP). To cover this would require $1 trillion in higher taxes, an increase of a third above the 1970-2011 average. He says Democrats are using demagoguery and intimidation on this issue, and ironically even Paul Ryan's proposal reflects a desire not to touch seniors benefits and willingness to pass on the costs to the young to pay for these programs. Social Security and Medicare are a critical part of the American fabric, and no one wants to dismantle them, it is about modernizing them to reflect higher life expectancy and larger wealth accumulated by the elderly compared to previous generations, and to reduce the burden on the young. ...

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The tough job President Obama faces as he faces opposition from politicians who have interests to protect, and healthcare businesses with interests to protect. The President has to come up with a plan that is deficit neutral, because financial markets could see a healthcare bill that further widens the deficit as a signal for higher interest rates that would deepen the recession. At the same time each of the three sources of revenue puts him at loggerheads with political leaders in Congress or groups with interests to protect. Limiting income tax deductions for high earners could raise $267 billion in 10 years. It would require taxpayers in the top tax brackets deduct their mortgage interest, state and local taxes, and charitable donations, at the 28% tax rate instead of the 33% and 35% tax rates. The opposition is with democratic leaders that it would hurt charities, universities that depend on tax deductible donations, and taxpayers in high tax cities like New York city that are the home base of Democratic leaders. Yet only 1.4% of households would be affected says the nonpartisan Tax Policy Center. The Center on Philanthropy at Indiana University, says charitable giving would decrease by 2%. The other opposition on this comes from the preference of Senators Baucus and Grassley, who head the Senate Finance Committee, for tax increases or cost savings to come from the health sector. Specifically they want to see the value of workers' employer provided health benefits subject to income taxes. It is a situation in which every sensible person admits the need for healthcare reform and would see the current pace of healthcare costs as unsustainable and dangerous; and after that will just go back to his group and try to preserve as much of the status quo as possible, so as not to disturb by much the benefits or compensation they have secured from the system over the years. Then there are political leaders in Congress with their own preferences, and Congressmen who are the subject of heavy lobbying by these interests. The administration and the Presidents job is to navigate this stream with a workable deficit neutral plan, without any requirement for any group to make sacrifices, and in some situations even small sacrifices for the public interest. Would charitable institutions be hurt that much, what if charitable institutions were exempted, why would other interests the try to obtain the same exemption. Its like the unions trying to keep the old unsustainable goldplated healthcare and other benefits at GM even as the ship was going down. Taxing employer provided employee health benefits as income would raise $2.5 trillion over a decade. The opposition here is from unions which are a force in the Democratic party and which count tax free health benefits as a legacy of the labor movement. Employer provided health insurance covers 160 million American employed and their dependents under the age of 65, so it has a wide impact. Yet most economists favor ending the tax break. They say it mainly goes to upper income taxpayers, and discourages cost consciousness among consumers of health care, thus encouraging excessive spending and surging health care costs. Senior Obama advisors, Peter Orszag, the budget director, and economist Jason Furman favor this approach. So do Republicans in Congress. Senators Baucus and Grassley are not asking for the complete removal of the tax break, what they want to see is capping the value of benefits that go untaxed. If the tax-free limit is $13,000, a policy worth $15,000 would pay income taxes on $2000. A third spource is to spend less on Medicare. About two thirds of the $948 billion in savings Mr Obama has proposed over 10 years comes from a number of reductions in Medicare spending. $177 billion comes from insurance companies bidding for government reimbursements for offering private plans to seniors. $106 billion comes from cutting the subsidies to hospitals serving the uninsured as universal coverage should remove this need. And $110 billion in reduced payments to hospitals and doctors because of productivity gains. A range of industries insurance companies, hospitals, doctors drugmakers, nursing homes, home health care companies and medical device makers, all stand to lose from reduced payments from Medicare and Medicaid. And these groups with interests to protect are another factor in this process of working out a healthcare plan. ...

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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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US president Biden proposes to reduce the US deficit by $2 trillion by increasing taxes on American households worth more than $100 million that would apply to their earned income, and their unrealized gains on liquid assets like stocks. Biden also plans quadrupling the tax on stock buybacks by companies, a tax approved in the Inflation Reduction Act of 2021. The deficit in 2023 will be about $1.4 trillion and rise to about $2 trillion, so that Biden's plan is to practically eliminate the  large deficit if the Republicans come on board. Republicans prefer cuts in spending. US companies have engaged in a dramatic increase in stock buybacks in recent years leading to calls for increasing the tax on stock buybacks. Biden says even high income households will not see an increase in their taxes, only the wealthiest households with over $100 million who have benefited vastly through the Reagan type policies of the last two decades. These households with over $100 million in assets will not be affected in the same way as students, workers, and middle income households are affected in shouldering a large part of the burden of these Reagan type policies that did not adequately fund education, healthcare, and manufacturing in communities across America. This was a period when Democrats in Congress awed by Reagan type policies failed to vigorously oppose policy that increased the US deficit and burden on households for health costs by not allowing Medicare to negotiate prices with pharmaceutical companies. A senior AARP official says that when we talk about the Biden Inflation Reduction Act of 2021 the key component is the Medicare price negotiation with companies that is now law. Why Republicans and Democrats before Mr. Biden allowed such a gross distortion for two decades since 2001 that burdened ordinary  working Americans while neglecting American manufacturing, till Mr. Biden assumed the presidency, says much about the policies of the last two decades and how it has affected ordinary working families. Shriveling factory towns and creating much distress in these communities with these distortions that are a legacy of Reagan type laissez faire policies that government should do little. The result of these policies is that manufacturing is concentrated in only one country for the whole supply chain something that would never have happened with a thoughtful policy planning process. India and Vietnam are only today seen as alternatives for the supply chain in 2023 when policies were in place in these countries since 2014 for the supply chain to be distributed in a way that would be a win-win situation for all countries, avoiding the national security threats of today with overconcentration of manufacturing in China. This has not benefited China or the US because of the rancor and tension it has created. It was the fall of the Berlin Wall that created some of this awe for Reagan, when looking at it objectively it was nothing more than a course correction in Europe after the Hungarian revolution suppressed in 1956, Czech in 1968. It had little to do with what policies the US should pursue for workers and families, just as the war in Ukraine today remains another course correction in a different direction in Europe, and does not affect domestic policy in the US to build a better society for workers and families that Mr. Biden is doing. ...

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The Centers for Medicare and Medicaid Services ban Elizabeth Homes, CEO of Theranos, from running a blood testing laboratory for at least 2 years, and took away regulatory approval for its California lab. The questions about the irregularities in Theranos blood testing led to the voiding of all test results in 2014 and 2015 for its Edison device. The WSJ first raised questions about the effectiveness of blood testing by Theranos leading to investigations by federal agencies.

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In this interview with Herndon of the NYT Bernie Sanders refutes the labels "progressive" or "left" and says it is simply about policy that benefits the workers and families that make up the vast majority of this Nation. Sanders says 60% of workers are living from paycheck to paycheck. The vast majority of people 60-70% support Medicare for All, improvements in Social Security, cutting pharmaceutical costs, and tution support to make higher education accessible to all. Why he asks do workers support Trump? He says it is because the truth is that the Democratic party has abandoned its roots. He does not go into this, yet it can be said that the rise of the Tech industry in the last two decades has led to tech billionaires and business people coopting the Democratic party for their agenda. In the last year of the Obama administration it was evident that Rural America and people who represent rural America such as Agriculture Secretary Tom Vilsack of Iowa felt ignored while Obama spent more time with tech and internet business people. Former president Trump simply stepped into this void as Democrats failed to turn up for rural America. President Biden has turned things around by making Tom Vilsack an important part of his administrations with the president listening to  him and others speaking for rural America. The passion with which Senator Pat Schumer talked recently on CBS Face the Nation about bringing broadband to rural America shows how Biden and Harris, Harris and Walz see Rural America. This Democratic ticket is fighting for Rural America every step of the way to bring hope and a better life to Rural America. Sanders reminds people of FDR in 1936 after four years of fighting the Depression and improving lives there was so much that needed to be done. It is the same today and Sanders is wading into this fight with Harris and Walz in the same way as FDR did in 1936. ...

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Bernie Sanders launches his 2020 presidential campaign at Brooklyn College by sharing his personal story of parents who were immigrants from Germany during the Nazi period. His father made a living selling paint to hardware stores and the family struggled in the early years.  He tells students he lived only a short distance away growing up "in a three and half room rent controlled apartment, and going to quality public schools." Mr. Sanders is the top choice in the early primaries including New Hampshire, competing with former vice president Mr. Biden. His campaign raised $10 million in just two weeks at the beginning of the campaign. He is campaigning for Medicare for All, $15 minimum wage, tution free public college. With Mr. Corbyn leading the Labor party in Britain in a new direction, Mr. Sanders is leading the Democratic Party in a new direction, both supporting the pro-working class traditional policies of their parties for most of the twentieth century. ...

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The top 1% of billers get 17.5% of the payments from the U.S. Medicare program for 2012, according to the Medicare agency's reports. The Medicare agency released data with details of payments to 950,000 doctors, medical providers, certain health care companies, the second year this information is being released. This covers $90 billion of payments. Astonishing as it may sound the transparency comes late, after large increases in medical costs and the increasing U.S. deficit. It happened only after the long and persistent effort by the Wall Street Journal to overturn a 1979 ruling that required such records to be kept secret. By intervening in that suit in 2011, the WSJ's parent company Dow Jones was able to convince a judge about the need for transparency, leading to reversal of the injunction in May 2013. The WSJ and the media has used this information to monitor the waste and fraud in the Medicare system, a vital role only the media can perform to protect the public interest.

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Nagourney Igielnik and Baker, give this report in the NYT that shows on questions of temperament and character and who you could trust, there is a shift towards Harris. In addition 75% of the people see the country headed not in the right direction, and on this issue of change Harris does better. Then there are he states such as Pennsylvania, Wisconsin, Michigan, North Carolina and Georgia, where things are being sorted out with the hurricanes adding to the picture. In the west there is also Arizona and Nevada. Also of interest is that in states like Texas there is only a 6% lead for Republicans. Lyndon Johnson was Democrat from Texas JFK's running mate and set up Social Security and Medicare as we know it today. It suggests a realignment from the old rural urban divide and college educated vs not college educated ideas separating the two parties. A new state university educated, small college educated, or community college educated is also emerging that like Harris's running mate from the State University of Minnesota in Mankato, sees things differently, and is spread across all parts rural, urban, white, minority, and from lower income families. These people are looking for who they can trust personally to improve their lives and make up 60-70% of American households.  ...

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Community Aging in Place: Advancing Better Living for Elders, has been here since 2009, it is offered in about 65 places across 26 states. in the US. It helps people 60 and up stay in their homes such as Chikao Tsubaki 87 years shown here in the Washington Post. It brings a repair worker into the home to figure out how to make it safer for falls, in addition to an occupational therapist and a nurse. Center for Disease Control and Prevention says these falls contribute to deaths of 41,000 older Americans each year and cost Medicare $50 billion. Yet this report in The Washington Post shows Medicare does not cover it, and most private insurance plans do not grasp the idea of keeping people healthy in good settings, paying only when people fall, doing little to prevent the falls. Sarah Szanton is a nurse practitioner who worked with older Americans in home settings in West Baltimore and started CAPABLE in 2009, and is now Dean of the John Hopkins University School of Nursing. In it the client and care team work together to do problem solving and brainstorming. One study shows $20,000 in savings a year for Medicare continuing for 2 years person after one CAPABLE intervention. ...

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The new fiscal 2012 budget proposed by the Obama administration projects this years deficit will reach $1.6 trillion. This includes the renewal of the Bush tax cuts and the temporary cut to the payroll tax that was part of the tax deal reached in December 2010. This is up from the $1.3 trillion deficit in 2010. At this time both the Democrats and Republicans are choosing to leave Medicare and Social Security out of the picture as they deal with the 15% of total spending that is discretionary and unrelated to defense and security. Both parties are hesitant to propose changes to the popular Medicare and Social Security programs without getting the other party to join in the proposed changes. As this could affect voters perceptions. Social Security, Medicare and other entitlement programs will take up 60% of all federal spending or $2 trillion next year, not counting the interest on the federal debt, according to the Congressional Budget Office.

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Tim Walz uses a sports metaphor about being one behind, fighting for every inch in this football game to score, as he brings to life this final effort of 75 days to win the election for president Kamala Harris, for president Biden, and for workers and families across the 51 States. Read the full speech at the Convention as Tim Walz accepts the Democratic nomination for Vice President. "Their Project 2025 will make things much, much harder for people who are just trying to live their lives. They spend a lot of time pretending they know nothing about this. But look, I coached high school football long enough to know, and trust me on this: When somebody takes the time to draw up a playbook, they’re going to use it. And we know, if these guys get back in the White House, they’ll start jacking up the costs on the middle class. They’ll repeal the Affordable Care Act. They’ll gut Social Security and Medicare. And they will ban abortion across this country, with or without Congress. Here’s the thing. It’s an agenda nobody asked for. It’s an agenda that serves nobody, except the richest and the most extreme amongst us. And it’s an agenda that does nothing for our neighbors in need. Is it weird? Absolutely. Absolutely. But it’s also wrong, and it’s dangerous. It’s not just me saying so, it’s Trump’s own people. They were with him for four years. They’re warning us that the next four years will be much, much worse." ...

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"I’m going to make sure that the richest among us, who can afford it, pay their fair share in taxes. It is not right that teachers and nurses and firefighters are paying a higher tax rate than billionaires and the biggest corporations, and I plan on making that fair.” Kamala Harris will finance child care tax credit, aid to small businesses and for first time home buyers, homecare for seniors, and other benefits by everyone paying their fair share and from savings in what Medicare pays out. "When you talk quietly with a lot of folks in Congress, they know exactly what I’m talking about because their constituents know exactly what I’m talking about. Their constituents are those firefighters and teachers and nurses.” For three Reaganite decades America has neglected access to all for child care, education, healthcare, seniors care, the very things that makes America a strong Nation, a Nation where the future belongs, going against the warnings of George Washington in the Draft of the First Inaugural in 1789 that - "I rejoice in the belief that intellectual light will spring up in the dark corners of the earth...That mankind will reverse the absurd notion that the many are made for the few." Absurd notion it was in 1789, absurd notion it is now in 2024. ...

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Gerald Seib, executive editor of of the WSJ, attributes the divisions in America both on the left and the right to a deep skepticism among people about the intentions of the U.S. political and financial establishment to conduct the country's affairs in a way that benefits all people. Both the traditional Democratic and Republican establishments, the Bush-Reagan, Clinton-Obama politicians and the financial community were seen as self-serving and looking after their own interests. The right of center supply side economics and the the tolerance for immigration levels of 30% rise in the last decade were discredited. A much larger recovery program was seen as needed from the deeply bruising effects of the financial crisis of 2008, started by the reckless financial establishment behaviours, than either the Reagan supply siders or the Obama people had understood or planned. This opened the way for Mr. Trump to take up the cause of ordinary Americans with a message of ambitious infrastructure development, confronting China's use of trade adversely affecting American workers, and slowing down immigration. And within the Democratic party the emergence of Elizabeth Warren and Bernie Sanders with programs for a wealth tax that would finance Medicare for All and college education supported by the federal government. Both the traditional Republicans under Bush and Democrats under Clinton Obama were seen not upto the task, after the 2008 financial and economic crisis created deeper scars than were imagined possible. The lack of effective policies under Bush or Obama simply aggravating the situation further. The culture wars have split Americans down the middle with a breakdown of the traditional American family and social structures creating deep anxieties in America. Obama's comments unsettled people in the heartland when he said that economic decline in the Rust Belt had made people there to "cling to guns or religion or antipathy toward people who aren't like them."   The trillions of dollars spent in wars in Asia and the Middle East were seen by Mr. Trump as an enormous waste when much needed investment was deprived of attention at home. Mr. Trump hammered this point home till today it is well accepted across America.  Even as political divisions persist they are now on how to tackle the redevelopment and growth of the U.S. The new focus of agreement has shifted with agreement across the country that infrastructure development in the U.S. and defending workers rights to jobs and opportunities is the top priority. That trade relations need to be reshaped keeping this priority ever present in negotiations. As a result all parties could agree on infrastructure and the recently concluded agreement for trade with Mexico and Canada and phase 1 of negotiated agreement with China. In overseas affairs the U.S. under Trump seeks cost sharing with a 2% of GDP defense spending by other nations so that money can be diverted to use at home. In this sense the debate has already shifted in the U.S. and the UK to how to address the problems of uneven development and growth across the two countries and better allocation of scarce resources to needs at home. Which is for the U.S. a good thing in the middle of all the perception of divisions.      ...

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The Romney story says this editorial is one of a turnaround- of a kind patiently nurtured from his days turning around businesses as a management consultant. This one was different and probably required a lot of soul searching and courage to take up new positions. As a technocrat, says the Journal, Romney would have been more comfortable with a room full of IQ's going over spreadsheets of numbers. He tried to do this by not taking up specific positions till the need to convince voters, first in the GOP base and then centrists and independents after the convention, forced Romney to make the reassessment and turnaround he needed to make. In November 2011 he accepted the Ryan position that Medicare needed changes, and in Feb 2012 he took up the case for lower tax rates and cutting deductions. In October 2012 came the first debate, with it Romney abandoned his reluctance to put forward a plan for the economic recovery and put forward his five point plan. That was the turning point in the campaign but all the other steps including the selection of Ryan, a Congressman from a working class district in Wisconsin, agianst the advice of advisors, were leading up to this turnaround. This was likely the most difficult of turnarounds, even searing in its soul searching as Romney scribbled "Dad" on paper at the lectern before the first debate- turning back to beginnings he had doubted for so long....

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The failure of the 117th Congress to pass key parts of president Biden's agenda for hard hit families and workers in America is now taking place. The 50-50 standoff in the US Senate and failure of two Democrat senators Sinema of Arizona, Manchin of West Virgina to support Biden's Families and Workers Plan leaves key parts of the safety net being left out. This leaves out the education, and paid leave part of the agenda and provisions for utilities to accelerate shift away from coal out of the bill. It fails to implement a new national agenda for upward mobility, child care and paid leave to help stressed out mothers and families. The failure to include even a modest community college 2 years of support at a time when men's college enrollment is dropping to disastrous levels for America's economic competitiveness is a failure of the 117th Congress to grasp the needs of families and workers in America today. Only a new Congress in 2022 can take up the needed action for families and workers in education, health care, child care and help for families. The passage of the infrastructure bill and the current version of the social spending bill can only be seen as a first step in the right direction, after three decades of different administrations neglecting infrastructure, education, healthcare, childcare, elderly care, upward mobility, and climate change. On the plus side as the first step to restore dignity and health of families and workers in America it includes- $150 billion for rental assistance, home buying help, public housing repairs, and building 1 million affordable housing units. $150 billion for federal programs for home health care and community care for older Americans and people with disabilities $165 billion to reduce premiums for people under Affordable Health Care Act, cover additional 4 million through Medicaid, adding hearing coverage but not dental or vision to Medicare. $200 billion for child care tax credit to parents. $400 billion to reduce health care costs and give universal pre-kindergarden for 3-4 year old children. $40 billion for worker training $555 billion for fighting climate change including through tax incentives for sources of energy that are low emission and low carbon. It will be paid for by additional taxes on incomes of very high income earners in annual $1 million plus range, and by having a corporate minimum tax of 15% for large corporations, including on profits overseas, that previously did not pay this tax. A wealth tax on unrealized capital gains of billionaires or other wealth of the richest Americans is left for a future Congress to consider for financing the key parts of climate change provisions, education and health care that were left out. The education and healthcare provisions need to be expanded to restore America's historic mission of upward mobility for all. A provision for Medicare to comprehensively negotiate prices with pharmaceutical companies that would be taken for granted in any advanced country as in Europe, is also left for a future Congress that understands and responds to the dire needs of families and workers in America for affordable healthcare medicine neglected by administration after administration for the last three decades.   ...

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One in six dollars generated by the U.S. economy goes to pay for health care, almost twice the average for rich countries. It hurts America in many ways; by being a burden on the taxpayer when it comes to Medicare and Medicaid paying for the poor and the elderly, on companies being one reason GM went bankrupt, it eats up federal and state budgets, rising costs make any form of future coverage for all unsustainable, and it robs other priorities such as infrastructure building and other national scale investments. The Economist says that if it had to design a system from scratch, it would go for a system based mostly around publicly funded health care. For the uninsured the solution of an employer mandate is now well accepted, so this is not an issue. What is an issue is how to make the new system affordable? Here the Economist says that whether in stages or in one move, the tax deductability of employer paid health insurance, which is costing the U.S. government $250 billion ayear, has to go. It is necessary to remove this deduction, and its something all interests involved will have to swallow, as other savings are smaller and will not be adequate. The deductability of insurance makes the true cost of insurance transparent, so it supports gold plated insurance. This does not make cost control the pressing priority it needs to be. So the deducatability of employer paid health insurance hurts both ways. The other necessary action is in the area of moving out of the current culture where most doctors work on a fee-for-service basis, where the more tests they prescribe or procedures they perform the greater their incomes. This acts as a perverse incentive, and has aruinous effect in mushrooming health care costs in America. Cutting back on unnecessary tests and procedures, and prescriptions , would save 10% to 30% of health costs says the Economist. And it says this has been proven with the Mayo Clinic in Minnesota and Kaiser Permanente in California showing that cutting back doesn't hurt care and outcomes., so much so that cutting back would occur along with improved outcomes. But Americans with employer paid insurance just take things for granted as its not much out of pocket expense for them. THis creates the lack of a force for controlling costs even as employers are shouldering abigger and bigger burden, and the employee who thinks he is doing fine actually is seeing more of his salary dollars going to pay for his health insurance. In a way the consumers of health care are stuck with the perception that they are not somehow paying for these mushrooming costs and too manytests, procedures and prescriptions. This perception leads them a false sense of comfort with the system they are in, and a fear of something new fanned by the medical lobbies, that any change will impact users negatively. This makes the whole discussion on health care or the process of finding solutions to become an exericize in which terms like "rationing" and "choice" play a distorting role. ...

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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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President Obama presents a $3.73 trillion budget proposal for fiscal year 2012, for the year beginning October 1, 2011. The budget calls for $1 trillion in deficit reductions over 10 years. Three fourths of this comes from spending cuts and the rest from tax increases or elimination of tax breaks. In fiscal 2012 the budget shows savings by reducing or closing 200 federal programs for deficit reduction of $33 billion. This includes a cut to the Low Income Home Energy Assistance Program of $2.5 billion. Most of the reductions are in the discretionary on-security spending portion of the budget, which is only 12% of all federal spending. No changes are made to Medicare or Social Security. Defense spending is cut by $78 billion over 5 years in this budget to bring the defnse budget to zero real growth. The Dept of Education funding would be increased from $64 billion in 2010 to $77 billion, with additional funding to increase the number of science, engineering and math teachers in schools by 100,000. The President's Deficit Commission recently proposed deficit reductions of $4 trillion over 10 years, including larger reductions in defense and reductions in spending on Medicare and Social Security....

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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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For opportunistic politics the Evan Newmark Mean Street USA Meanie awards go to Obama, Budget director Orszag who joined Citigroup, Rep. Charlie Rangel, Michael Bloomberg. For the stuff that is going on in Wall Street Goldman Sachs, Steve Rattner in the pay to play pension scandal, high frequency traders on Wall Street in the May 6 Flash Crash, Blackstone CEO Steve Schwarzman and private equity's benefitting from tax loopholes. For Main Street Meanies the awards go to Bowles -Simpson and their leaving out cuts in Medicare benefits as they show extraordinary concern for the deficit, bond investors who will blame Wall Street and Obama for losses in bond funds in 2011, and the Americans living rent free in foreclosed homes as the robo-signing problems continue.