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The 2016 primaries with Sanders and Trump have brought to the forefront voter dissatisfaction with the agenda of both parties, especially so for Republicans with the lack of specifics and personality driven campaign of frontrunner Trump. On a whole host of issues from poverty, wages and inequality, regulatory reform, to trade, borders, security, ISIS, both parties are facing questions from voters. Particularly the Republicans who have lacked specifics during the two terms of the Democratic Obama administration with a divided Republican Congress, and the risks for Republicans running for Congress under frontrunners Trump or Cruz who have provided few details on their agenda. The Agenda project of Ryan will have about 25 meetings and prepared specific agenda, including white papers and legislation, that would give Republicans hope to run on positive proposals that are placed before the Republican Convention in Cleveland. Chairmen of House standing committees were assigned 6 areas- health care, taxes, national security, regulatory reform, poverty, and Congress reasserting constitutional authority. Ryan told the Ethics and Public Policy Center on April 19, 2016- "A lot of people don't like conservatism as they know it. For too many people Republicans seem to be caught in a time warp. They're thinking, 'We don't control our borders. Wages are going nowhere. College and healthcare keep getting expensive. ISIS continues to spread. And what are Republicans going to do about it?' So we need to adapt our policies to meet the challenges of the 21st century."...

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David Wessel points to some problems with the Paul Ryan budget proposal. Ryan's plan does not balance the budget till after 2030, and Congress would have to raise the debt ceiling each year till then. The changes to Medicare Ryan proposes would limit how much the government spends, but the savings from this do not come for a decade, as people expected to retire in the next 10 years will still have Medicare. Ryan's proposal shows how deep the cuts will have to be if deficit reduction is done without raising taxes. Pete Domenici and Alice Rivlin who developed a deficit reduction plan, said they were disappointed that the Ryan plan "fails to address the need for new revenue," which they consider crucial for truly tackling deficit reduction. The Obama budget failed to offer a comprehensive deficit reduction plan, leading to openness for new ideas. The health care delivery system in the U.S. needs to be efficient and costs need to come down. Ryan's proposal gives no idea where the efficiencies will come from. Would they come from competition between private insurers? How will escalating healthcare costs be controlled. Another consideration is that even with its problems Medicare is less costly to administer than private insurance. Everything depends on seniors shopping vigorously for the best premiums because risks and costs are borne by seniors, with the idea that this will somehow control escalating medical costs....

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Vindu Goel of the NYT gives this report on IBM's expansion in India including an interview with Vanitha Narayanan, chairman of IBM India. In 2017 IBM had 130,000 employees in India, at operations in Pune, Calcutta, Chennai and Bangalore and other cities, double that in 2007. The U.S. operations have about 100,000 employees. As IBM's revenues have declined with technology disruptions, it has concentrated on expansion in India with its vast base of knowledge workers and costs of about one half to one fifth of what it would cost in the U.S. IBM has 380,000 employees worldwide, with 26% in the U.S. and 34% in India, and 40% in other countries. Microsoft employs 8000 employees in India and 124,000 total worldwide, Google has 1800 in India and 72,000 worldwide.  IBM removed operations in India in 1978 after a dispute with the Indian government. In 1993 it started operations in India in a joint venture with Tata. By 2004 the operations had expanded and IBM took full control. A $750 million 10 year contract was signed in 2004 with an Indian phone company Bharti Airtel. As Goel points out the shift is happening towards expansion in India with the growing demand from industry and government in India. The Watson venture has expanded in healthcare in India with contracts including one with Maniphal Hospitals. In 2016 this had reached $38 billion in hardware and software, services, to Indian industry and the government agencies. IBM's work is not simply in offsourced work from American companies. High tech and cutting edge research is also taking place and expanding. IBM is now uniquely positioned to get an expanding share of the business as more tech services are provided to the hundreds of millions of people in India who did not have access to tech and tech services before. Research concentrates on doing this at a fraction of the cost and in new ways suited to the local region, so that services can be delivered with a wider reach. This report provides a new perspective on how the next decade could see American companies with a long term focus take advantage of the rapid growth in the fastest growing large economy in the world, with advantages for both the U.S. and India. ...

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Gail Collins on why Senator Lieberman is opposing the public option, expanding Medicare Eligibility and other parts of the health care bill.

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Drug companies spent $168 million on lobbying in 2007, up 32% from 2006, according to the Center for Public Integrity. The biggest spender is the Pharmaceutical Research and Manufacturer's Association of America which paid $23 million, a 26% rise from ayear earlier. Amgen was first among drug firms at $16.2 million, Pfizer at $13.8 million, Roche at $9 million, Sanofi-Aventis at $8.4 million, GlaxoSmithKline at $8.2 million, and Johnson & Johnson at $7.7 million. In 2006 Democrats received 31% of the industry lobbying funds, now with Democrats controlling Congress the shift is to more money given to Democrats.

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The Medicare for All movement in the U.S. gathers momentum after the U.S. midterm elections with states. Governor Newsom of California says he will seek federal authority to setup a state single payer plan for health insurance. An expert at Georgetown University says there is a new burst of energy for broader coverage or universal health coverage. States with new governors or seeing this momentum are California, Washington, New Mexico, Maine, Nevada, Delaware, Oregon, Connecticut, Wisconsin, Michigan, Illinois. Polls show a large majority of Americans now support Medicare for All as a form of universal health coverage for all Americans, a system that prevalent in Canada for the last 50 years. Two hearings will be held in Congress on Medicare for All in 2019.

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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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Modifications proposed for Agnipath recruitment to the Indian armed services include full healthcare benefits and pension benefits for the scheme. The government has presented a fact vs. myth explanation to provide a clear understanding of the intent of the scheme to reflect a younger population and integrated India without the regimental bias towards caste and region present since British times. Job security is always a concern in India. The better technically trained and better financed Agniveer recruit would have more opportunities for education and training after 4 years and become an attractive asset for the private and public sector. A program of this kind was the GI Bill in the US that Franklin Roosevelt signed in 1944 and the Veteran Act of 2008 that continued educational benefits for free college. These programs have resulted in benefit of great value to the US economy and to the military veterans who used these benefits. In India's fast growth period after 2025 the Indian economy would be 50% larger and be easily able to take in these graduates from the armed services with technical training and advanced courses just as the US economy did decades ago. During the days following the pandemic there is a sense of pessimism in some sections and the government can enhance the package with added pension benefits and healthcare and still keep the financial aspects in good shape. ...

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Poland has a huge shortage of doctors and nurses. The ratio of doctors to every 100,000 of population is the lowest in the European Union. It is twice that in Germany whose relative success in tackling covid pandemic comes from having foreign doctors and nurses treat patients. Consider that the average age of Polish doctors is 53, only a few years from retirement. The situation in terms of immigration reminds pone of East Germany and its depopulation of young people who left for West Germany. Something like this has happened in Poland in health care.  In similar ways other countries in the EU, Hungary, Slovakia, Romania stocked up on ventilators but now have few doctors and nurses left to operate them. It is stretching the limits of human endurance as this report shows in WSJ, with doctors working 36 hour shifts and working 73 hours a week.  Here we see Dr. Rotnicki, who works these long hours at a hospital in western Poland and says that it is like the Second World War, that it is hard times in Poland for health care workers. This report says Italian and British hospitals, not just German ones, are tackling coronavirus with Polish, Hungarian and Romanian doctors and nurses. This report shows that headhunters in Germany drive in to western Poland blanketing windshields with pamphlets promising 5 times more pay, 2 years of free language classes and housing. In Slovakia a third of all nursing graduates leave the coutnry immediately after graduation. In Poland not nursing pay has lagged behind with fewer going into nursing schools. Staff remaining in the region are older and educated under communism when less English was taught, or have returned back home from years overseas. Forcing doctors to give up private practice and work in public hospitals during coronavirus pandemic is not working in Hungary, where surveys find 6 out of ten medical school graduates intending to leave Hungary. These doctors say they are better off working at Aldi and Tesco if needed and making more pay, plus getting weekends off. Poland only recently increased pay for healthcare workers, some even survived on cash given to them by patients. Not a good situation for a country to be in and reflecting the wrong priorities not just in the U.S. and western Europe, but also in eastern Europe, during the last 3 decades. These priorities shifted money away from health care, education and infrastructure priorities. The people simply lost control of their spending allocation to "financial markets" that shifted money in a way that benefited only small group in society neglecting others and national interests. ...

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Delayed FDA approval of diabetes drug Tresiba in the U.S. market. The FDA requested additional testing data which Novo Nordisk says it cannot provide in 2013. Novo Nordisk has 27% market share in the diabetes market with its fast acting NovoLog insulin. Sanofi has 19% market share with its long acting Lantus insulin. Tresiba was approved for use in Europe. About 44% of Novo Nordisk drug sales in 2012 were in the U.S. market.

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The TSX Group, Toronto Stock Exchange and TSX Venture Exchange, is second only to the Bombay Stock Exchange in the number of listings. Its a popular place for smaller companies to list because of the flexibility it offes to smaller companies. The average listed company on the TSX Venture Exchange has a market capitalization of $27 million. Its a haven for new biotech, technology, and healthcare companies from the USA.

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Robert Putnam a 79 year old Professor of Public Policy at Harvard answers the question what is happening now- when everything seems to be stalling and solutions offered by parties of centre, right and left are all failing to deliver for improving lives of poor white people, black people, middle class white people. Failing to deliver on health care for all, on access to medicines, access to infrastructure, on access to public services. He sees this as a result of the over focus on "I' and on the concentration of wealth in the hands of a few people in the financial world or in Silicon Valley without concern for the needs of the country or the people.  Putnam compares this to the period of the 1870's onwards in America. when for several decades the emphasis was on selfish pursuit of money and wealth with everyone focussed on individual gain. It was only after this period brought America as a nation and the people of America into hard times people was the whole culture of "I" and overfocus on individual gain questioned and repudiated. The period of "we" began with Theodore Roosevelt breaking up the monopolies and Franklin Roosevelt fighting for a New Deal for American workers and the people of the United States. Putnam sees this happening again and America at a crucial juncture of repudiating the existing culture and values in the same way as it did in the past. The change in culture in America is part of a wider trend that includes all English speaking countries Britain, Canada, Australia and India. In all these countries the shift is towards rebuilding the culture that brings opportunities and hope to the working class and middle class, to rural areas, through a new vision for infrastructure, public services, healthcare and education. Putnam brings long experience studying the development of America starting with the book "Bowling Alone" published in 2000 which described the trend to rampant and unrestricted individualism in public and business life. In 2015 Putnam's "Our Kids" covered the issue of declining upward mobility and  failing to give opportunity for young people to make improvement in their social and economic aspects of their lives. The three books have extensive research and look at a lot of data making them academic of nature but they also serve a useful purpose. Any intuitive grasp of the situation also leads one to think in the same direction that the past carries lessons for the future, that there is a better way out, and that this situation cannot go on for much longer without damaging the nation and the people, not just America, but other English speaking nations Britain, Canada, Australia and India that share the same problems of lack of development, lack of infrastructure and services, and neglect of the common man, of everyman.   ...

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About the title it depends- costs have come down for food made at home and eating at home, it is the cost of eating outside that has doubled from 3% in 1960's the Kennedy years to 5.7% in 2024 as a share of personal disposable income.  Costs of eating at home are now half of what they were in the Kennedy years when they were about 13% of personal disposable income, as shown in USDA data and charts.The American public says in voting preference and other surveys  that inflation is a key concern, food prices  are mentioned as a key concern. Food prices fell by about 8% during the pandemic 2020 and rose quickly by 2022 by 12%.    Eating at home declined from about 13% of personal disposable income in the Kennedy years in 1962 to about 9% in the Reagan era in 1990 and down to 5.7% today. The real culprit in food inflation is people paying higher prices to eat outside at restaurants. In that period obesity has increased and general health has declined by these spending habits and lack of food savy cooking knowledge that not only cuts costs but also makes it possible to eat healthier by controlling intake of the fat, oil, and other poor ingredients by cooking for oneself at home. At home one avoids packaged goods and cooks the food from healthy ingredients. A correction is badly needed and will help not only health but also the family budget. Its a crazy way to do things not to educate children on healthy foods starting early in school, including in designing lunches and gradually increasing interest in making simple items from scratch. And instead to neglect food and food intake ending up with increase in cost plus poorer health outcomes. Hitting not just the family budget, also the nation's budget with higher and higher expenditures on healthcare. American habits need a change to make more at home like mothers and grandmothers in the 1960's and reverse obesity, poor health outcomes. As for the manufacturers of packaged foods President Biden talked recently about shrinkflation putting less in each bag of food at the same price. "The American public is tired of being played for suckers. I've had enough of shrinkflation. It's a ripoff." WSJ looks at food prices in 1991 and other points in the past and today. In 1991 as a percentage of disposable income food was 11.3%, according to Agriculture Department. This was after an inflationary increase in the 1970's. USDA data shows it has reached 11.2% in 2022. The public is responding by eating less outside and making its own granola and other items, and generally buying less that cuts into sales, a healthy trend. This is expected to lead grocery stores and manufacturers to reduce prices in 2024. ...

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Sony is setting aggressive goals for its medical business by targeting sales of 200 billion yen ($2.6 billion) by 2020. The Olympus joint venture with Sony is expected to make up about one third of the sales. Olympus has a 70% share of the endoscopes market. Sony is planning on sales of 50 billion yen for its medical monitors, printers and other equipment by March 2015. With its recent investment of 50 billion yen in the joint venture Sony now has a 11% stake in Olympus, making it the largest shareholder. Olympus will use half of the capital injection to develop better medical devices and the rest to setup training centers in emerging markets and cover costs.