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NYT reports show the Republican health care bill AHCA 33 votes short of passing the House and likely to fail. Conservative Republicans were looking to whittle down the safety net in the Affordable Care Act, and moderate Republicans could not stomach the whittled down bill removing guarantees of essential benefits for instance. The basic problem- no real consensus among Americans about providing health care to all Americans, and no real solutions possible as long as there is acceptance of disproportionately high levels of medical care costs for treating each disease in the U.S. compared to Europe and other countries.

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This NYT editorial points out that the cuts to Medicaid amount to taking out a fourth of its budget and are sure to hurt low income Americans. The cuts are about $880 billion over 10 years for Medicaid. The $300 billion less in subsidies over ten years is likely to hurt the elderly. It also points out that removing the individual mandate will make it harder to reduce premiums as fewer healthy adults offset the costs of sick patients.

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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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Peter Coy of Bloomberg Business Week points out that the debt ceiling and proposed deficit reductions in the range of $4 trillion really obscure the real size of the problem which is much larger. The real problems hit when the U.S. faces a larger graying population by 2020 with sharply higher per capita health care spending; and at the same time workers from this generation retire and become beneficiaries of Social Security and Medicare with fewer younger workers to support the system with tax revenues. Another problem is that older Americans are likely as a voting bloc to vote themselves benefits that will cost the younger generation, benefits that the younger generation will not be able to enjoy. Even the Paul Ryan plan with its cuts to Medicare insulated todays seniors from the sharp cuts, as it becomes political necessity for both Republicans and Democrats to shy away from touching the current beneficiaries.

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With Republicans elected to a majority in both chambers of the state legislature and a Republican governor, Wisconsin is moving ahead with a sweeping plan to fix its budget deficit. Walker promised he would get public workers' compensation in line with other workers. He is now proposing a plan which will go to the legislature for swift approval that will simply go ahead and cut public employees benefits without negotiating. He says he doesn't have anything to negotiate with, because with the growing deficit he has nothing to give. His plan: limit collective bargaining for most state and local government employees to the issue of wages (instead of to many issues such as vacations, health coverage), require government workers to contribute 5.8% of pay to pensions, and have state employees pay at least 12.6% of health care premiums (instead of the 6% most pay today). The plan will save $30 million in the current budget and $300 million in the next budget. Republican leaders are saying the alternative is to lay off some 6000 state workers, and take away Medicaid coverage for thousands of children, which is a much worse alternative....

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The WSJ Editorial Board speaking for the business community traditional Republican groups finally takes up the election on issues of policy difference between Trump run Republican party and Harris run Democratic Party which it should have from Day One. The former president says something that has never happened in the last hundred years- policy will be decided after the election depending on what he decides to do. Cost of Living action is No 1 on voter priorities. "Drill, Baby Drill," is the whole Republican party platform for cost of living action. What is the Harris Democrats policy plan for cost of living action? WSJ says it is spending blowouts that caused inflation, the Green New Deal, entitlement expansions and student loan forgiveness.The real reason for the increase in cost of living comes from the overconcentration of supply chain by American business in China, on which every president Bush, Obama, Trump, did little or nothing. The lack of an effective vaccination program and ineffective vaccines in China by 2021 and 2022 led to the loss of the supplies from China leading to shortages for automobiles parts and other supplies and surge in prices in 2021-2023. Powell and the US central bank correctly raised rates but cautiously and waited for this to correct, president Biden brought manufacturing home through huge investments called the "spending blowout" that brought down the inflation from 9% to 3%. Some of that "spending blowout" went to chips and science to correct the errors of American Business and Reagan-Friedman theory of the Republican party that created this problem with a culture of utter  indifference to the ultimate costs of who makes what and where. The Inflation Reduction Act also tackled higher health and other costs paid by American workers and families, and invested in public services and in repairing the dilapidated crumbling American infrastructure. Are Republicans saying let the roads, bridges, airports, built in the 1940-1960's heyday of American industrialization as China and India's is now, let them crumble? What do the educated minds of the WSJ Board say about coal in China and India and their effects on their massive use multiple times that of US and EU in history, is it not damaging to the environment and why the Chinese realized the health in North China with coal winter use was worse than in South China cut their coal use. Are they saying lets burn fossil fuels and ignore, and if investment has to be made in solar who is going to do it? Is it Ok for Republicans thet we just import from China all our solar panels indefinitely into the future. "Green New Deal" is just a perjorative term, policy has to be made thoughtfully and without prejudice or bias of any sort for the best that we can do for the American people, ignoring so called "right" or "left." Doing what is right, what makes sense, is a lot harder.     ...

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After a decade of austerity and the financial crisis of overextended banks, the deep recession starting in 2009, and worsening inequality with lack of infrastructure development, Britain finally shifts to larger government spending. The spending planned by Labour and Conservative parties in Britain charts a different future for health, education and infrastructure development from that of the last decade. The public supports this. Conservatives plan $128 billion of new spending, Labour party plans to spend even more. This comes after centre right parties such as the Republicans under Mr. Trump in the U.S. shifted to heavy spending on infrastructure. The Democrats under Obama failed to push for higher spending in traditional working class areas leaving open a gap that Mr. Trump has since used to attract working class Democrats to his side. In Britain Labour under Corbyn has pushed for larger spending on infrastructure, health and education. This is setting a new trend. This report in the WSJ shows that in this situation it is new politicians who replaced earlier politicians in their parties- Mr. Trump displacing Bush, Johnson displacing Cameron and May, Corbyn and McDonnell displacing Blair and Brown, that are initiating thsi trend. The experts at the IMF and the central banks are only now beginning to say this is a good idea. For a decade the mantra of economic experts at these central banks was in favor of austerity, even in the face of massive misallocation in capital markets.   ...

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The Republican House health care bill AHCA  keeps some some of the more popular parts of the Affordable Care Act such as not taking pre-existing conditions to deny insurance, keeping children covered on parents insurance till age 26, and increase contributions to Health Savings accounts. It is different in that the expansion of Medicaid at 138% of poverty rate threshold is rolled back. Age is used for tax credits instead of income, hitting those approaching Medicare age harder. The maximum charged to older people is now set at  5 times compared to 3 times what young have to pay. In general the Republican bill is seen as targeting the elderly to keep premiums down. The elderly on low incomes are hit hardest. Fox News O'Reilly Show showed the host questioning House Republicans, citing the CBO estimates that elderly on low incomes may have to pay as much as $14,000 a year for insurance making it basically unaffordable, and 52 million Americans would be affected adversely. Large companies are no longer required to offer mandatory health insurance under the new bill. Conservatives from Freedom Caucus wanted to see the essential areas of benefits covered by the law limited to fewer than the ten areas in the Affordable Care Act. The ACHA Republican bill leaves to states to determine what are required essential benefits. At one point maternity benefits were to be dropped but this was changed to let states decide. As a result the bill is 33 votes short of the number needed for passing the house in March 2017.   Neither the Democrats Affordable Care Act or the Republican House bill of Speaker Ryan do much to tackle the real problem- the absolute amount and increases for health care dollars for treating each disease in the U.S. compared to European and other countries. As a result health care has become more of a partisan struggle between the two parties than a real effort by all to overcome the problems that have to be tackled. Republicans want to see premiums drop and keep the burden on the deficit down- but with the level of U.S. health care costs disproportionately high compared to Europe and the rest of the world the arithmetic is tough and ends up leaving out vulnerable groups such as the elderly on low incomes, thus making the whole proposition prone to fail. For the same reason the Democrats failed to keep premiums down with a wider safety net leading to calls for repeal of their version.   ...

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The U.S. House of Representatives votes to repeal and replace the Affordable care Act 217-213. Moderates were won over by an addition of $8 billion  to add coverage for a popular feature of the ACA that covered people for pre-existing conditions.  The bill that passed gives credits of $2000 to $4000 a year, depending mostly on age, upto $14,000 for a family. Credits are reduced for individuals making over $75,000 a year or families making over $150,000. There is no mandated insurance coverage. This trims the federal budget deficit, yet also is expected to keep 24 million more Americans without health coverage after 10 years. The bill now goes to the Senate where moderate Republicans are worried that this may increase premiums for older people, one of the drawbacks of the earlier version of the House Republican bill.

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Gerald Seib of the WSJ points out that the winners in the passing of the Republican healthcare bill in the House by a 4 vote margin are Speaker Ryan who never wanted the job in the first place, and president Trump who showed he could cajole Republicans into getting it passed because he likes winning. Now comes the hard part says Seib, when it goes to the Senate- House conservatives are not going to be happy when they find major changes they dislike. If the bill clears the Senate in a modified version Republicans will now have to own any issues with healthcare, including says Seib things that may not work out for pre-existing conditions- or for groups that are disadvantaged, including older people.

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Tom Steyer, founder of NextGen America points out the dangers of the Republican tax plan. He calls it a sham, in the WSJ. As evidence he cites a meeting of the WSJ CEO Council, where few hands went up when asked it they would increase investment if the tax bill passed. By saddling future generations with more debt the bill would hurt investment in infrastructure, health and education that are badly needed. This is not the time for another Reaganomics plan, says Steyer, as the middle class and working class have shrivelled under both presidents Bush and Obama, with the export of jobs overseas and the deep recession years. As proof that it does little for the middle and working class, he cites the Tax Policy Center's review of the bill showing 62% of the Senate's version of the tax bill benefits go to the top 1% of the earners. And that nearly half of American families will see their taxes rise under the bill eventually. This means nothing less than taking money from the middle and working class to fund the cuts, and gutting investments in health, education and infrastructure.  ...

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This report in the WSJ points to president Biden's speech to a joint session of the US Congress that providing two years of free community college would "change the dynamic" for education in America taking the first step to correct a dangerous drop in college enrollment for young men in America and ensuring working class families have access to college education. The last thirty years of skewed wealth distribution, loss of manufacturing in America, have created alarming distortions in  the access to college education for working class families. Mrs. Biden is a fervent advocate for community college access in today's America, as a community college teacher for 30 years. Biden's $45.5 billion 5 year plan would waive tution for 2 years of public community college. States would have to opt-in to participate, and federal government would provide 100% funding in the first year, decreasing contribution by 5% each subsequent year, with states picking up rest of the cost. It is quite shocking that this is being dropped from the Biden $3.6 trillion Families and Workers Plan that is now being whittled down to $2 trillion. Not because it is not badly needed for American economic competitiveness, and helping workers and families. But because following narrow parochial interests the National Association of Independent Colleges and Universities opposes it. And because the US Congress is evenly split between Democrats and Republicans 50-50 in the Senate. The Association of Independent Colleges sees a shift to community colleges and a sharp drop in its enrollment. Community colleges saw a dangerous drop in enrollment of 12% to 4.5 million students in 2020 from the spring of 2019, according to National Student Research Center. Never was a program more badly needed, as American men are alarmingly falling behind in enrollment. Here are some responses to the failure to take even the first steps to broaden college access so that America can return to economic competitiveness. "What kind of world do we want to live in?" Martha Kanter, College Promise. "That's kind of a devil's choice, isn't it? The whole system has to work from infant care all the way through." Senator Tina Smith, Democrat of Minnesota. This is because child care and children's education will be funded yet a struggling generation of college students will be left out. US Chamber of Commerce opposes a $45 billion program that is critical to American competitiveness with China and other countries. US Congress drops a program that at $45 billion is only about 2% of the $2 trillion package and which is critical to economic competitiveness. Former Republican Governor Bill Haslam of Tennessee supports community college access as a pillar of economic development and it passed the supermajority in 2014. Mike Krause, Republican former director of the state higher education commission says- "I have been surprised by the lack of enthusiasm for what is really a massive workforce development concept that also provides a path to the middle class. You'd think that would hold some appeal for Republicans and Democrats." The lack of clarity and concentration, lack of unity of purpose to get all vaccinated,  is visible in America's vaccination drive. That same lack of clarity and concentration, lack of unity of purpose, is visible in America's faltering efforts at correcting serious and alarming problems for access to college and American competitiveness in the world. Julie Bykowicz and Douglas Belkins wrote this article in the WSJ.   ...

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Unorthodox cabinet nominees- Kash Patel at FBI, Tulsi Gabbard at Intelligence get nominated. Others where the nominee is supported broadly by moms and parents, and many senators Rand Paul and Ron Johnson who are highly enthusiastic, are RFK Jr. for Health Secretary who still faced questioning from Republican Kennedy and other Republicans. All of them get nominated by Feb 15, 2025. Republicans in Congress stay together, Democrats do the same strangely opposing everything on the other side, including action on obesity and chemicals in food, drug industry practices they have been railing against for years that are RFK's agenda.  By tapping into different ideas just because they are good, make common sense, and not worrying too much about whether it is from the opposing Kennedy clan, and willing to take some risk with Patel and Gabbard, try youngsters such as Pam Bondi at Justice Department, Elise Stefanik at the UN and Kate Leavitt as Press Secretary, a woman Kristi Noem in the toughest job there is today at Homeland Security, DJT and Chief of Staff Susie Wiles have put forward a different set of people highly motivated, more than a bit rambunctious and boisterous, to get things done on immigration zero illegal migrants, zero fentanyl deaths, and zero deindustrializing technology transfers to the Nation's competitors, and zero play except on a level playing field in trade and business. ...

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The Congressional Budget Office analysis of the Republican healthcare plan advocated by Mr. McConnell, Senate Majority leader, is that it would add 22 million uninsured if implemented. That plan ran into opposition from Republican Senators Collins, Capito, Murkowski, Paul, and Moran, and lacked enough support in the Senate. All Democrats opposed it and with the thin majority Republicans were divided. By taking away some benefits given under the existing Affordable Care Act the plan hurt the elderly and low income people, making some Republicans listen to their constituents in home districts and not the Republican leadership. The NYT profiled two in particular who astonishingly in a sign of today's strange politics were the only ones publicly holding townhall type meetings to hear the views of people in their voting districts- Susan Collins of Maine and Jerry Moran of Kansas. Both senators were listening to rural communities and Moran stated his opposition with the words- "I am a product of rural Kansas." With it the nation takes a breather and the message goes out that it is best to listen first and then to seek middle ground, not do what both parties Democrats and Republicans did in 2009 and 2017- rush serious legislation through without support across party lines and without serious discussion.   ...

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This analysis in The Guardian says US president Biden is reversing 3 decades of policy since president Reagan that looked with skepticism at government intervention in the economy. The $1.9 trillion aid package Biden has pushed through Congress is a big game changer in the way government operates to help rebuild America after the pandemic. The 2009 response by the government under president Obama was done without conviction that the government response was the best way to help the economy. By 2016 voters turned to a Republican, Mr. Trump, to help working class voters with a USA first policy, after decades of presidents from both parties Republican and Democrat failed to protect American interests in manufacturing, jobs and incomes.  US president Biden is continuing Trump's policies to protect working class Americans. And bringing new conviction that government not only has a positive role, but has an essential and vital role to play in protecting workers and households struggling to make ends meet. President Reagan had introduced such a deep skepticism of government, that it took so long for people to remember FDR and the role of government before the second world war and afterwards under the Truman administration.  What changed? The health care crisis exposed the weak areas in the governance and policy mindset in America. China had advanced mainly through strong government role of the Communist Party  in steering the economy and business to gain competitive advantage. The health crisis from the pandemic further devastated America's lower middle and working class following the banking and financial sector mismanagement by 2009. The pharmaceutical and health care sector similar to other sectors had shipped manufacturing overseas. In 2021 there is a deep sense that theories don't work, one has to act based on the needs and the situation the country is facing. The way competitor nations such as China are building new infrastructure, gaining manufacturing advantage, dominating key sectors and industries, and creating jobs, requires America to respond. In this situation posing the threat America faces as well as the social dislocation of decades of misguided policies, the US government is the only one capable and having the resources and capacity to respond.  ...