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A critical part of the Affordable Care Act is the setup of marketplaces or exchanges to let people without insurance buy individual health plans. Some states setup their own exchanges, and some states let the federal government step in and run them. To help the lower middle class and poor the Act provides health subsidies to buy insurance in the exchanges, and 85% of customers in the exchanges qualify for this benefit. The U.S. Supreme Court voted 6-3 in 2015, compared to a tight vote in 2012 on the Affordable Care Act, to maintain the health subsidies. Justice Roberts wrote the majority opinion, saying "Congress passed the Affordable Care Act to improve health insurance markets, not destroy them." Justice Scalia dissented calling it "interpretive jiggery-pokery." Justices Clarence Thomas and Samuel Alito Jr. dissented. Voting in favor were Justices Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor, Elena Kagan, Justice Kennedy dissented in the 2000 case. The challengers petition to the courts was based on a reading of phrases in the Affordable Act which had not occurred to the writers of the law. The reading suggests only people enrolled in state setup exchanges are eligible for subsidies. If the Supreme Court ruled in favor of the plaintiffs the 6.4 million Americans who are enrolled in the federal exchanges would lose the subsidies provided under the law and lose health insurance. And the economic foundations of the Affordable Act would be undermined with insurance companies required to provide insurance to all regardless of pre-existing conditions and subsidies removed, leaving the companies with sicker pool of customers resulting in destabilizing the exchanges and higher premiums. The court ruled in favor of an interpretation that is compatible with the whole law and the intentions of the statute to help the middle class and the poor buy health insurance. The chaos in the insurance markets that would result in going with the plaintiffs because of a careless writing of a phrase, was uppermost in the majority's mind. Chief Justice Roberts emphasized this, saying- "The statutory scheme compels us to reject petitioners' interpretation, because it would destabilize the individual insurance market in any state with a federal exchange and likely create the very 'death spirals' that Congress designed the act to avoid." This case originated with 4 plaintiffs from Virginia who challenged the IRS regulation that said subsidies were allowed regardless of whether the exchanges were run by the state or the federal government, arguing that this was at odds with the particular phrase in the law that was ambiguous about federal exchanges eligibility for health subsidies. Judge Roger Gregory of the Fourth Circuit Court of Appeals in Richmond, Virgina, ruled that the phrase was indeed ambiguous, but the IRS was owed deference in its opinion. Chief Justice Roberts made it clear that this was not a case for the IRS, saying "it is instead our task to determine the correct reading." ...

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Eduardo Porter compares Italy's propensity to collect and invest tax dollars in healthcare and public services to a much greater degree than the U.S. In 2007 he points out Italy spent 25% of its output on social programs such as health, food and housing, compared to 16% in the U.S. He reflects on the possible reasons for this based on research. Italians see the tax dollars at work in a health care system that works for them and their children, as in this example of Eduardo and his child at a health clinic in Liguria, Italy. In the U.S. there is less evidence of this and the sense that government is likely to waste tax dollars, that the individual is better able to make choices. The less homogenous society in the U.S. also means there is less support for public services that might benefit other lingusitic and cultural groups.There is also the feeling that in American society there is greater oportunity for the less well off to join the upper class given the open capitalist framework, as compared to Italy where connections and traditional advantages matter. Some experts attribute this to smaller taxes leading to economic growth, but Porter says the examples of Sweden, Norway, and Japan showed growth was higher or similiar to that in the U.S. ...

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Glenn Hubbard, says Bowles and Simpson, have provided the framework for solutions to the US deficit. He says the elimination of the mortgage interest deduction and other actions such as elimination or reduction of deductions for charitable giving and employer provided healthcare subsidies, actually help reduce the marginal tax rates. Bowles-Simpson report, he says, correctly identified the problem that you need higher offsetting marginal tax rates because of these kinds of deductions to raise offsetting revenue. The two chairmen want to see government reduce marginal tax rates to a range of 8 to 23%, as opposed to 10% and 35% now, and this is a positive development. These kinds of deductions favor upper income households more than other households. He sees the co-chairmen's proposal to cut the tax rate for corporate income tax to 26% from 35%, as being a wise move, as it should not require much offsetting revenue, because OECD research has shown this to be the revenue maximizing rate. He concedes that liberals would have difficulty with the report, because the proposal accepts that maintaining a broad welfare state is inconsistent with the need to balance the country's finances through economic growth and social insurance. Yet he sees the limits on tax deduction and cutbacks in the entitlement's benefits for upper income households, as giving Bowles-Simpson proposals a progressive character....

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Ajami points out the risks of the deal secularists and liberals in Egypt have made in calling on the military to upset the elected government of prime minister Morsi. The liberals and the Muslim Brotherhood were both equally opposed to the military and police intervention in politics in the period following Mubarak's ouster. The six decade rule of the military in Egypt has little to show for it in the modernization of Egypt and improving economic conditions. Egypt has seen this script before, says Ajami of the Hoover Institution- in 1952 the military stepped in after corruption in the political parties and political violence. The results were dismal extending throughout the period of modernization in Asia and Latin America. It has left Egypt frightfully behind in most dimensions of education, healthcare, and technological progess. The lack of training in parliamentary and democratic governance, and in the institutions of democracy are painfully evident- the poor roadmap for democracy laid out by the military, followed by the election, the decrees and authoritarian style critics describe of prime minister Morsi in failing to incorporate liberal opinion in policy, and the flawed secularist calls for the military to overturn the elected government with only one year in office. These institutions will take a long time to build and require patience, flexibility and the gift of wisdom on all sides....

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The third pick of songs by chancellor Merkel for a farewell ceremony at the Defense Ministry, after her first pick of a Christian hymn from the 18th century "Holy God we praise thy name," is one that was on East German pop charts in 1974. It is "You forgot the color film," by Nina Hagen. The song is an angry lament that admonishes Hagen's boyfriend Michael, for not bringing the color film during their visit on holiday to Hiddensee Island. As a result she sings "no one will believe how beautiful it was here." The lyrics were written by Edward Demmler and it was sung by Nina Hagen in conventional schlager style. Merkel spent much of these 16 years seen on television sticking to strict austerity measures for European Union countries. Not investing in childcare, education, retirees, healthcare, and the infrastructure for broadband, roads and bridges, leaving Germany and with it the European Union in stagnation. Only in her last years was she persuaded by her vice chancellor Scholz of the SDP of the need to invest heavily in Germany and the European Union to fight the coronavirus pandemic with aid to the people of Germany and European Union. As she leaves she ponders the lessons both of the GDR in the east and the Federal Republic in the west, both had their flaws and their potential and both could learn from what was missing in the other. An opportunity for reflection and understanding. It is to Scholz and the Greens that is left the task of making the Federal Republic what it could be, to reaching as much of its potential for the good of Germany and the good of the European Union. Even though the singer became a punk artist after moving to the west following the fall of the Berlin Wall, she was a conventional. schlager style singer before that. So that 16 years after trying out the free market version of capitalism Merkel who grew up as a young East German teenager in the former German Democratic Republic realizes that this period after the fall of the Berlin Wall was not all that it was made out to be. As the Guardian puts it this embrace of her East German identity is no characteristic of Merkel as during these 16 years she rarely brought up her growing up years in East Germany. ...

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US president Biden's $2 trillion Families and Workers plan, for early childhood education, paid leave, healthcare and climate change investment, is coming up for a vote in Congress. Paid leave that also includes maternity leave and leave that would help women return to the workforce, has been added back to the bill. Community college aid was earlier removed from the package with resistance from private colleges that expect to lose tuition paying students, even though male students are falling dangerously behind in attending college without government support. The Biden administration is facing resistance from just a couple of Democratic Congressmen- about five led by a Congressman from New Jersey, and 2 Senators from Arizona and West Virginia- on community college government aid that helps young American men and women from the working class and on paid leave that helps women. Many Republicans have supported taking this action for renewal of America on serious issues that face the country, making it likely that these issues will only become more pressing in the next three years. Sometimes as is happening today some isolated or eccentric situations can block major legislation for the good of the country such as the makeup of a Congressional seat in New Jersey with large pockets of conservative Republicans who oppose spending, and conservative instincts of two Democratic senators from Arizona and West Virginia. This WSJ report looks at Biden's position that deterrence when filing tax returns will generate close to $400 billion and not $150 billion that the Congressional Budget Office says is its estimate. To accomplish this Biden plans to spend $80 billon in large investments to increase the resources of America's tax collecting agency. Much of this was never done and policies geared to where large corporations never paid their fair share of taxes. The first step was to prevent outshoring of headquarters to reduce taxes- and this was achieved in the first year of the Biden Administration with over 100 countries agreeing on a corporate minimium tax. In the same way president Biden now seeks to correct other flaws in the tax system so that much needed investments can be made by generating new revenue not just in infrastructure, but for renewal of America through renewal of support for women, children, and America's working classes. Much of that was badly neglected by different  administrations over the last three decades.     ...

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WSJ's Monica Langley provides an exceptional report with a close look at the first woman CEO at a large corporation in the cusp of great change. IBM CEO Ginni Rometty is remaking IBM by moving out of existing businesses and shifting to new growth areas such as analytics, cloud computing, new R&D advances. She sees her job as building the IBM of the future, and this includes divestments and phasing out of some businesses, acquisitions, and building some businesses such as the Watson Heath Care business from scratch. In some fast growing areas such as cloud computing this means competing with other established competitors, Amazon, Google, and Microsoft. Rometty's job is tough because of the size of IBM with 380,000 people in 170 countries, a culture that lacks the agilityof younger companies, and the older businesses which continue to slow IBM's progress, and where divestments reduce revenues. IBM sales are down for 12 consecutive quarters from the year earlier quarter. IBM's share price is down about 10% since Rometty became CEO in Jan. 2012, resulting in investor dissatisfaction with results. Rometty's goal is for 40% of IBM's revenues to come from corporate markets in analytics, cloud computing, cybersecurity, social networking, and mobile technologies, increasing it from 27% of about $93 billion in sales in 2014, and 15% of $105 billion in sales in 2013. Sold off and divested are low end servers, IBM's chip maker, and other hardware businesses. It is so extensive that whats left of the mainframe business is focussed on new technologies for mobile. Rometty setup a partnership with Apple for the corporate mobile market, and started Watson Health as a new venture in analytics for healthcare using its Watson Computer technology. Rometty grew up in Chicago, one of 3 daughters raised by a single mom, who says she was taught to be "fearless" by her mother. She graduated from Northwestern University with majors in electrical engineering and computer science, joining IBM as a systems engineer in 1981. She carries a backpack, school size notebooks, on her frequent trips to see customers in person and is constantly prodding employees at IBM to go faster. Rometty has a passion for scuba diving in her spare time and always carries the gear with her. Christine Lagarde at the IMF is one of the few women heading large organizations that have the same level of energy. Lagarde's passion is swimming having competed in sychronized swimming, and both Rometty and Lagarde describe the loss of a parent in different ways as a significant impact in their life. ...

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Chrysler will contribute about $10 billion into a VEBA type trust. By this Chrysler can pass on $16 billion in healthcare obligations to the trust to be run by the UAW. New hires will be paid less in a two tier wage system. Chrysler will not sell Mopar part division thus keepig 2600 union jobs.

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Bernie Sanders is reelected Senator from Vermont, as one of the oldest and most senior members of the US Congress in history. He will be 89 at the end of his fourth term in the US Senate. At 83 years he is the most resilient and active Senator in the US. Bernie Sanders support was key for president Biden's election in 2020. “It should come as no great surprise that a Democratic party which has abandoned working-class people would find that the working class has abandoned them,” Sanders said. “First, it was the white working class, and now it is Latino and Black workers as well. While the Democratic leadership defends the status quo, the American people are angry and want change. And they’re right. “Today, while the very rich are doing phenomenally well, 60% of Americans live paycheck to paycheck and we have more income and wealth inequality than ever before. Unbelievably, real, inflation-accounted-for weekly wages for the average American worker are actually lower now than they were 50 years ago. “Today, despite an explosion in technology and worker productivity, many young people will have a worse standard of living than their parents. And many of them worry that Artificial Intelligence and robotics will make a bad situation even worse. “Today, despite spending far more per capita than other countries, we remain the only wealthy nation not to guarantee healthcare to all as a human right and we pay, by far, the highest prices in the world for prescription drugs. We, alone among major countries, cannot even guarantee paid family and medical leave.” ...

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Philips health care division operating margins drop from 13.6% to 4.3% in the 1st quarter of 2009, a result of the severe impact of the 2008-2009 global financial crisis. Philips Electronics showed a operating loss for the 1st quarter 2009 of 74 million euros.

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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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Senators Elizabeth Warren and Bernie Sanders defend Medicare for All, a version of free healthcare for all, and free university, from attacks by moderates. So far in the campaign in the Democrats part the moderates have failed to gain traction. Warren and Sanders lead the field. The only other contender is from the old Obama presidency, Mr. Joe Biden. Warren and Sanders say now is the time for bold ideas. Sanders won the Michigan and Wisconsin primaries, by articulating this vision in the last campaign 4 years ago.

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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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U.S. health insurance company WellPoint Inc. will offer higher payments to primary care physicians. This is part of new strategy to reduce emergency room visits and costs after deterioration in a patients condition by relying on primary care physicians for better care at the outset. Payments to primary care physicians will be increased by 10%, with higher payments when the results show better quality and preventive care. WellPoint has a network of 100,000 primary care doctors. Physicians who meet certain goals such as lowering the overall cost of a patient's health care costs will be given an incentive of 20-30% of the savings realized. The new effort will add 1-2 percentage points to the 6-8% of the $100 billion that Wellpoint pays for claims processed each year. WellPoint's management sees a reduction in medical costs of about 20% by 2015 as a result of such efforts.