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Leonhardt argues that rationing is rational allocation of limited resources, health care budgets are limited resources even in rich countries like the USA, and if you overpay here you cut somewhere else. Now the cuts that are not noticed he says are in take home pay as employers face increased premiums from insurers. Rationing is taking place all the time with poor health outcomes relative to the cost for poor allocation of resources as survival rate for many diseases are not that much better than other countries. Rationing takes place everyday when patients see doctors only for a few minutes as doctors race to see more patients, and when diseases are not caught early on in the process as doctors do not know their patients well enough. And rationing is taking place as patients simply delay or forego treatments based on the extra cost, or as uninsured get no care. There are so many buzzwords like this thrown around, with doctors, hospitals and insurers and other groups trying to preserve the status quo, even as it is becoming rapidly unaffordable fort the US to be spending so much on health care....

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Not a very flattering picture of the chancellor. She has already lost 1.3 million CDU voters to the Greens, and about 260,000 to the far right AfD party. In all about 4.3 million CDU voters have shifted from Merkel's CDU to other parties on the right or the left and to the Greens, between the general elections of 2017 and the European elections in 2019, according to Infratest Dimap. It had 33% of the vote in 2017, now it polls at 27%, down 6 points. The Greens come next at 22%, in recent Politico poll. Merkel's sentiments may have overtaken the reality of how much Germans wanted to integrate war and economic refugees from Africa and Asia. She has since revised her judgement that it was a decision made at the time based on what happened at that time without enough time to prepare for the sudden influx of refugees from Budapest. A new party the Alternative for Germany AfD emerged from the migrant crisis in the eastern part of Germany that had 13% of the votes in 2016, building on discontent from reunification, depopulation of the east, and a sense of drift and neglect. Even a sense that the affluent western part of Germany was more concerned about refugees than its own economically insecure countrymen in the east. After being in power since 2005 Merkel's period shows signs of aging. Her record on investment infrastructure and health, education and child care is also found to be weak. The effort to maintain austerity for so long following the financial crisis of 2008 by profligate banking and bad accounting by member states in the EU including Ireland, Spain and Greece, has hurt parts of the middle and working class stuck with low wages and inequality in the EU and in Germany. The migrant crisis and refugees have split her party and German opinion adding to the problems of the economy in the EU and Germany.  ...

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If the decline in manufacturing in rural southern Virginia for 500 workers in a low tech deli meatpacking plant can devastate whole communities, then imagine what happens  when manufacturing in chips and science with high paying jobs are put at risk by market forces focused on AI.  This week WSJ carried a story about Qualcomm which does design and does no manufacturing is planning a takeover of Intel, a leader in manufacturing for advanced chips in the US, a key part of Biden-Harris strategy to regain a American foothold in Chips manufacturing. Such a takeover makes no sense for America's long term interests. Qualcomm could simply jettison the manufacturing capabilities -a key part of America's long term chips and science strategy just because AI focus has distorted market forces. IMAGINE THE DAMAGE. Regulators need to safeguard the Nation's long term interests for reliable chips manufacturing within the US, to avoid the crisis experienced with chips outsourced overseas leading to severe shortages in 2021-2023. How this has happened is that AI has created distortions in the market so that companies are valued differently. So that an Nvidia gets valued at $1 trillion and even for a day at $2 trillion then going back down to half that, all within a 12 month period. AI is distorting the market in ways that a chip leader like Intel now gets valued at $90 billion a third of the $290 billion it is valued at only a short time ago, making talk of takeovers possible even from smaller design only companies such as Qualcomm. The market failure in this case comes from markets being distorted by not reflecting true costs of shortages America experienced in chips from lack of its own advanced manufacturing during 2021-2023.   ...

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Deborah Solomon interviews Abby Cohen of Goldman Sachs. Cohen is asked about bank bonuses and compensation, about the role of the banks in the financial meltdown, and whether she and Goldman Sachs felt any responsibility for the economic crisis.

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The rarely mentioned origins of the U.S. Medicare reform proposal of Rep. Paul Ryan and Rep. Ron Wyden, which includes work done at the Hoover Institution and liberal think tanks, in a debate subject to distortions on all sides.

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CEO's of more than 80 large U.S. companies have come together behind a plan that would reduce the U.S. federal deficit with tax revenue increases and reduced spending. The CEO statement was organized by the Fix the Debt campaign, a bipartisan effort inspired by Republican Alan Simpson and Democrat Erskine Bowles of the 2010 Simpson-Bowles Deficit Commission. The CEO statement calls for an overhaul of the U.S. tax code to eliminate or reduce deductions, credits and loopholes (reduction of tax expenditures also referred to as "broadening the base"). The CEO statement says any fiscal plan to succeed has to control increases in health care spending, make Social Security solvent, and include "comprehensive and pro-growth tax reform, which broadens the base, lowers rates, raises revenues and reduces the deficit." This is the first time a large group of business leaders have supported raising taxes as part of an overall solution. This puts together elements of the Bowles-Simpson plan, reduces deductions and loopholes, lowers rates as part of overall tax reform and cutting spending. The CEO statement says the Simpson Bowles recommendations for $3 in spending cuts for every $1 in tax increases was an "effective framework" for tackling a problem that affects the economic well being and security of the U.S....

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A whole range of issues can be seen in the debt crises in developing countries. The margin for error shrinks with poor governance, lack of honest assessment and transparency for finances, wars and conflicts within or outside the countries, living beyond their means, lack of focus on development, infrastructure that is unproductive or unaffordable including some Belt and Road Initiative infrastructure at higher interest rates. Countries that are dependent on overseas remittances, tourism, that were hit hard by the pandemic have seen their finances further weakened reducing the margin for error even more to the point that the smallest tipping point can lead to huge crises. Once the finances are weak all it takes is an external tipping point that creates serious crisis. The war in Ukraine with shortages of wheat, fertilizer and skyrocketing oil prices acted as that tipping point. Because this was a major blow the crises have a level of magnitude that is more than a payments crisis. One sees this in South Asia in Sri Lanka and Pakistan, and in the Middle East for countries such as Egypt and Tunisia shown in this WSJ report. It is now not simply a crisis but a crisis of great magnitude because in the case of Sri Lanka and Pakistan this WSJ report says that both countries foreign exchange reserves have dwindled to the point where they can pay for only one or two months of imports according to central bank data, analysts and IMF. This crisis has affected countries that were seeing steady foreign investment such as Turkey for decades, then a sharp falloff in foreign investment with a change in the climate for foreign investment. The crisis has taken the form of high inflation, significant depreciation of currency that makes imports costlier so that shrinking revenues from loss of remittances, tourism, or other sources will now have less value in supporting import needs. Lack of a credible path can delay setting a path out of the crisis. The $1.5 billion fuel and electricity subsidy made by the prime minister of Pakistan in late February was done without IMF approval leading to the IMF program having to be renegotiated. Lack of national political and cultural consensus on a solution simply makes it that much more difficult to find the way through it. In this regard South Korea was able to tackle the 1997 financial payments crisis effectively because of a national consensus. The situation in Egypt- Egypt has borrowed $20 billion from the IMF since 2016., placing it second to Argentina in aid from IMF since 1980's.  In 2020 and 2021 Egypt' government spent more than 40% of its revenue servicing its debt, and is forecast to do the same in 2022. The situation in Tunisia- A shortage of sugar, flour, and other critical supplies, and government delaying wage payments to civil servants. The government got $400 million in financing last month from the World Bank and hopes to secure a lifeline from the IMF. Compared to the period between the 2 World Wars the two bright spots are China and India where lessons of the past of civil wars, religious or political conflict, and poor governance, lack of knowledge of how the western countries industrialized and modernized, was replaced with the conviction that drives patient effort, courage in the face of adversity, honesty, and humility to learn including from western countries that have forged their own path through the same difficult road. The most difficult experiences have offered lessons which were learned- for South Korea the Korean War and invasion from the north, China the civil war and Japanese invasion, for India the partition of India and million of refugees. Stagnation from stumbled efforts also taught lessons, the Great Leap Forward in China, the License Raj with corruption in India.       ...

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Much of the debate in Germany today is around the topic of reunification, was it good or bad for Germany, and why there is an issue of a separate identity in the East. Most East Germans feel they live in a separate country with a separate identity. This issue has social cultural and political consequences, says the Economist.    The CDU is increasingly facing questions about how it has turned out for East Germany. It is losing votes to the AfD in Saxony, Thuringia, and other places in the east. The migration crisis in 2015-2016 created new fault lines. When the Integration minister in a government in Saxony, which includes east German city of Leipzig, talked to people in her state why Germany was helping refugees, she was told to first integrate East Germans.  East Germans do not like resources being wasted on refugees when they feel left out themselves in their own country. After reunification of Germany by chancellor Kohl in 1990 about 8500 companies in the east were privatised or liquidated leading to a loss of jobs in old industries such as mining. Many of these older people ended up in odd jobs and then on Hartz IV, skimpy unemployment benefits. At unification 1 million people moved to the west from the east, predominantly younger people and predominantly women.  Over time one fourth of the population in the east 18-30 years moved to the west, two thirds of them women. Rural areas especially hit hard, with tax revenues slumping, shops and schools closed. Some estimates are that 80% of east Germans were out of work at one point. The humiliation their parents felt is only now being discussed as children in the east talk to their parents about what happened and the hardships their parents suffered 25 years ago. Was unification done the right way is a topic for discussion today. Today the east is much older than the west. Since 1990 over 60's increased by 1.1 million even as the overall population dropped by 2.2 million. In future some districts in the east will have 4 funerals for every birth say forecasters. So what could have been done differently in 1990 so that East Germans did not end up feeling like a "colonized people" by a biased western exploitative culture that portrayed them as culturally inferior and with very little that the west could learn from. Today it is said that the government agency Treuhand that handled closure of businesses could have moved slowly. The 1:1 transfer of west german currency for east german currency was to make east german companies uncompetitive overnight, and should have mitigating plans to tackle the problems of keeping these businesses in operation to keep local jobs. A new constitution and economic plans could have been written, a transition period for such a constitution and economic plan be put in place, so that changes could be studied and plans made to reduce the negative effects.  Culturally there was something the east did better. It had a culture of social solidarity that could have provided lessons for the west.  The good aspects in the east such as respect for women and encouraging them to work outside the home, free child care, the welfare state protecting vulnerable groups, could have lessons for the west to emulate and adopt practices. This would have given easterners a sense of self-respect as in some ways the German Democratic Republic (GDR) as the country was called in the east, had aspects that the west could learn from. For this to happen west Germans need to change their views- half of them see the reunification as a success, two thirds of east Germans see it as a failure culturally, and socially, and wrought with the economic impact of sudden shift in population and business, and loss of most productive young people to the west. ...

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Senate Finance Committee chairman says Senate Democrats have found ways to reduce the cost of the health care plan from $1.6 trillion to $1 trillion. A tax on some employer provided health benefits, cuts in Medicare and Medicaid spending, employers helping to pay the cost of health insurance for low-income workers, and limiting the eligibility for subsidies to households with incomes at 3 times the poverty level or $66,150, instead of 4 times the poverty level. Also a reduction in the plan to give tax credits to small businesses to help them buy insurance. And expansion of Medicad would be delayed to 2013.

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The American Medical Association came out against the public option in President Obama's health care reform plan. The outpouring of comments on this article show that public opinion today seriously questions the actions of the AMA, and think that this is not in the best interests of the nation. Its the kind of outpouring of criticism that GM's old management received from readers fed up with the management of the Detroit automakers, before the GM bankruptcy. Out of the 26 most read or recommended comments on this article shown on the link to the article in the NYT, 25 were strongly critical of the AMA's position on health care, none were in favor, and one was critical of the insurance companies. The 25 that were strongly critical had a total of reader recommends of 6539 readers when they were totalled up for all 25 comments. Some of these comments were strongly critical and explained at length why. Some were from doctors who disassociated themselves from the AMA. One suggested that the American College of Physicians also represented doctors, and the AMA represented only one group of mostly older doctors who are against any change. The financial crisis and the election of a new President, the changes in the country since the last failed reform effort in 1993, the new mood of the country as it changes to its more frugal past, a new generation of doctors and a new generation of young people coming to the fore, all may mean that things are no longer the same, and actually very different. Are the people running the AMA, like the people who were running GM a short time ago, not able to see how they are perceived by the public? ...

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The Institute of Medicine releases areport of the 100 health topics that should get high priority, as the Obama adinistration proceeds with a plan to $1.1 billion to compare the effectivenesss of treatments. Some of these areas for research are prostate cancer treatments, a surgical procedure called ablation, and others.

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The NYT editorial says budget reconciliation should kick in if by a certain date in the fall bipartisan agreement is not reached. With budget reconciliation, the term for a expedited processs, health care legislation can pass by a simple majority vote. NYT says bipartisan agreement is a good thing, but more important is effective health care reform. And there is little evidence of Republican cooperation so far on any issue.

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WSJ's CEO council advocates a goal of 10% electric cars by 2020 and upto 50% of the fleet by 2030. Other top priorities of the CEO's from Google, Intel, Time-Warner, Fedex and other companies at a recent 1 day conference were obesity, a stimulus program in excess of $300 billion, and restarting the Doha round of talks for global trade.

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With 10.3 million workers unemployed according to the Bureau of Labor Statistics, and this includes 2.8 million added this year so far in 2008. Most of the people who lost their jobs also lost their health benefits. This increases the urgency for the Obama administration to come up with action in the health care area as the ranks of the uninsured will grow in 2009.

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The situation in nursing homes and eldercare is a huge black eye says this report from Canada. The situation is poor also in the U.S. and Britain. All the Anglo-Saxon countries appear to have the same problem of neglect of eldercare and homes for older citizens compared to say Japan, Germany or France with different healthcare systems and more invested in these areas of health and older citizens.Look at the numbers- in Canada 80% of deaths from coronavirus among older people in nursing homes. Next Ireland at 62%, and the U.S. at 40%. This report says these elder care facilities in Canada are run down, poorly equipped and understaffed. Canada's armed forces sent medics to the nursing homes in Quebec and Ontario and their reports are described as distruging and worrisome by prime minister Trudeau. In these countries lawmakers and policymakers have failed, and the culture of investing in areas other than health and public services and infrastructure, has failed the people. A poor scorecard for this generation of politicians, lawmakers, and leaders both in business and the government. ...

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A study by AARP of 514 brand name and generic drugs between 2005 and 2009, shows that generic drug prices went down an average of 31% during this period, and brand name drug prices went up by 41%. One of the authors of the report says that it is important to look at individual drug prices and not studies showing total spending on drugs, because this is a significant cost for people paying out-of-pocket, It drives up insurance premiums, and pushes retirees into coverage gaps in Medicare Part D drug program. Analysts indicate pharmaceutical companies are increasing prices on drugs before patent expiration to get as much profit before the patents expire.

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Speaking at a banking conference, advisors including the head of Russia's largest retail bank Sberbank, German Gref, minister of the economy, Aleksei Ulyukayev, and head of the central bank , Elvira Nabiullina, express deep concern about the economic prospects in 2015. Foreign investment is down from about $90 billion in the 1st quarter of 2013 to a negligible amount in the 3rd quarter of 2014. Capital outflows following the Ukraine crisis are estimated at about $110 billion by former finance minister Alexsei Kudrin. The ruble dropped to its lowest level against the dollar since the 1990's. And the sharp decline in oil prices with Brent crude at about $90 is another risk factor as 50% of the budget comes from oil and gas revenues and 60% of exports are still oil and gas, with no serious or effective effort to diversify under the Putin adminstration. Putin told the banking conference that a deficit free budget and reserves of $460 billion are "fundamental factors supporting stability." Advisors and leading bankers remain unconvinced. The problem is that even at the beginning of 2014 before the Ukraine crisis foreign investment had slowed to a trickle, similiar to what India experienced in 2013. The central bank head says her effort to open up the bond markets in Russia to foreign investors is now in vain because there are few foreign investors. Instead of reversing the situation as is happening in India with the new Modi administration, policy under Putin and the Ukraine conflict may have scared investors away with the increasing western sanctions and stagflation (estimated 8% inflation and about 0.5% growth in 2014). The head of Sberbank Mr. Gref told the banking conference- "The Soviet Union broke apart because of the mind boggling incompetence of the Soviet leadership. They did not respect the laws of economic development." The problem with sovereign reserves is that it can protect a sovereign currency such the Russian ruble or the Brazilian cruzeiro to some extent, but today's vibrant economies need foreign investment and foreign technology for growth. Even a country such as China with a trillion dollars in reserves needs the reserves in its special case because of its billion plus aging population, and is no exception to these laws of economic development about the need for foreign technology and foreign investment. ...

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The U.S. Justice Department files a civil lawsuit accusing S&P and parent company McGraw Hill of giving improper ratings to poor mortgage investments which allowed them to inflate in value, creating the conditions for a crash in these investments when the crisis happened in 2008. The penalty sought by the Justice Department and the attorney generals for 16 states is $5 billion to cover losses to investors such as state pension funds and federally insured banks and credit unions. The civil suit comes 5 years after the onset of the financial crisis of 2008, which created the greatest financial crisis since the 1930's. Negotiations for a settlement were conducted by the Justice Department with McGraw Hill for an extended period of time. The talks broke down in January 2013. In these negotiations the Justice Department sought a penalty of over $1 billion and S&P's acceptance of wrongdoing. S&P countered with a proposed settlement of $100 million. The government pushed for admission of guilt on at least one count of fraud. It is not known why the Justice Department filed this lawsuit 5 years after the crisis when the public's memory of the ratings issue is beginning to fade. Is it because the preparation of the case required this much time, the action not taken because it would be seen as punitive in 2011 when S&P downgraded the U.S. sovereign credit rating, the fragility of the economy in 2011, because of the approaching election in 2012, or some other reason. One of the reasons why it was important to take corrective action early was to preserve the integrity and credibility of financial markets, so critical for public confidence. An additional reason was to secure from credit ratings companies the internal reforms and change in leadership and culture that would prevent recurrence and damage to the economy. An example of this change is the change in leadership and culture underway at Barclays bank in Britain after the investigation into the manipulation of the London Interbank Offered Rate or LIBOR. The Justice Department action in this respect is an advance from the policy at the S.E.C., which has not insisted that companies involved in the crisis admit wrongdoing, setting up the process for changes in leadership and culture such as the one at Barclays....

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Details of the $825 billion stimulus plan. Renewable energy does well under the plan including production tax credit for renewables, with $32 billion for a "smart" electrical grid for which GE makes components and lobbied for. Renewable energy producers win an extension of production tax credits now convertible into cash for companies whose losses leave them unable to use the credits. Transportation infrastructure green projects did not do so well, with $32 billion for transportation projects and only $10 billion for mass transit projects.The Natural Resources Defense Council had compiled a list of more than 80 environmentally friendly infrastructure and transportation projects worth about $405 billion. Only a small number of these projects made it. What is in the stimulus to create jobs and stimulate capital investment? Businesses get bonus depreciation, which speeds up depreciation deductions for companies that invest in plant and equipment. The stimulus doubles the amount small businesses can immediately write off for capital investments and purchasing new eqipment, and gives incentives for businesses to invest in renewable energy. States get help with $90 billion going to increase the federal share of Medicaid payments, and an additional $79 billion to help states avoid cutbacks in education and other services. And there is a "Make Work Pay" tax credit for $500 per worer and $1000 per couple. Experts say the effects of the stimulus will be felt in the latter part of 2009 and into 2010. Which is one reason the view of economists that there would be a second half recovery does not reflect conditions on the ground. Goldman has revised its view to 2010 and even that may be optimistic. One example of what has happened in the stimulus in this respect is that the earlier optimistic view of largeinvestments in science and technology, broadband networks, and transportation projects for fast rail and transit have all been trimmed down. Part of the reason may be that the bill for the nation's banking system revival may be larger than realized as an additional amount of $15-20 billion is being negotiated for Bank of America and more money will go to Citigroup. $6 billion is shown for highspeed internet access for rural and underserved areas. Science facilities get $10 billion. Repair of public infrastructure (read roads and bridges) gets $31 billion. School modernization gets $21 billion. And modernization of health information technology systems gets $20 billion which its hoped will provide equivalent or higher returns to pay for some of the universal health care costs, and preventative care gets $4 billion. There is a tax credit for R&D work on energy innovations and renewable energy production of $20 billion, and $32 billion for a "smart electricity grid." These are the proactive parts of the stimulus that create something new and make improvements. They add up to $144 billion. So much money goes to shore up the existing services and supplement incomes, and to relieve stresses on the banking system, and other ways to shore up the system, that the proactive expenditures are only a small fraction or 17% of the $825 billion stimulus. And all the time the federal deficit and debt increases with these huge outlays just to shore up the system. The Heritage Foundation Data Analysis Director Mr. Beach told Congressmen at a discussion chaired by Congressman Cantor (R), on January 16, 2009, that the federal debt would reach 92% of the nation's GDP in 2009 from 58 billion or 70% in 2008, with the $825 billion for stimulus. The federal deficit would go up to $1.31 trillion or 9.2% of GDP up from $541 billion in 2008. See the research paper on the Heritage website. ...

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This WSJ editorial points out that the current corruption drive in China is opaque and politically driven. Transparency International in its Corruption Perceptions Index shows China at 36 points having dropped by 20 places because of the lack of transparency in tackling corruption. Whistleblower protection should be part of an effecive drive says Transparency International. Also needed is an independent judiciary, free speech and the rule of law, institutions China has still to develop.