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Serious problem of rapid premium increases for middle class people not eligible for subsidies under the Affordable Care Act. Insurance companies have increased premiums rapidly to pay for the cost of treating people with previous conditions and the uninsured, as well as population with poor health conditions.

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According to the General Accountability Office inquiry, 28 drug products had price increases over 100% in 2000, in 2008 71 drug products had such large increases. Medicines like Adderall for attention deficit disorder, Inderal for chest pain, Sumycin for infections were in the list of 416 brand name drug products where makers or distributors raised prices at least once by 100% or more for period 2000-2008. As large pharmaceutical companies sold their marginally profitable drug products or small selling products to smaller companies, these smaller companies would immediately increase prices to recover the money they paid to the large pharmaceutical companies. 26 of the brand name products saw prices raised 10 fold. A third of the drugs with large price increases treat depression and disorders of the central nervous system.

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Under a plan called "premium support" Paul Ryan's U.S. budget proposal would have seniors choose a private insurance plan from a federally operated exchange. Each year the government would pay private insurers a specific amount to cover the cost of premiums with the rest borne by seniors. The total amount paid by the government would go up only at the rate of overall inflation, it would not go up at the higher rate of health care inflation. By doing this the government would take off the trillions of dollars of projected spending on health care that are largely the result of the higher inflation rate in health care costs. This higher inflation rate on health care costs is something that both parties have failed to control, and remains a major weakness in all health care proposals to date, including the Obama health care legislation. Allowed to continue growing at this rate when U.S. debt to GDP is nearing 100%, health care inflation costs pose major risks to the nation's finances.

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The influence of the AMA convened Relative Value Scale Update Committee (RUC) on how the Medicare payments to doctors is shared, and on the growth of the Medicare budget. Concern that the interested party is driving the decision making process. Medicare costs went up by 9% in 2009. Fears that doctors have too much control over the dollars in the $500 billion Medicare program. The tendency to focus on more expensive procedures and short change preventive and less costly care. Medicare spends $60 billion on doctors fees. The older codes remain in place even when costs are reduced, leading to higher costs for the Medicare budget each year. And there is little incentive for doctors in RUC to revise overvalued codes.

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Walk in clinics at drug stores like CVS and stores like Walmart now have the cooperation of hospitals. Hospitals are now affiliated with 25 Walmart clinics. THe Cleveland Clinic has lent its name and backup services to a number of CVS clinics in northeastern Ohio. And the Mayo Clinic is operaing ne Express care clinic at asupermarke in Rochester, Minnesota, and asecond one at ashopping mall. This helps clear emergency rooms of people seeking bsic medical care as for astrep throat or flu. About one thousand clincs are operating in the US at drugstores, supermarkets and big stores since the idea took root 4 years ago. Wal-Mart has partnered with hopitals like the Christus Medical Group in Texas, Aurora Health System in Wisconsin and COxHealth in Missouri to setup clinics. Mayo did so after employees and patients said they wanted more convenient treatment for minor medical problems, so there may be a need here that as not been met. The lower costs at these centers compared to primary care doctors offices or emergency rooms make it possible for them to price lower and meet the needs of the 45 million or so uninsured people in the US, numbers growing as jobless rate increases. They are typically staffed by nurse practitioers or physicians asistants. Dr Herman at Mayo Clinic, who supervises its retail store clinics, says rather than fight this trend primary care doctors should learn from it, and work with hospitals around the country to offer more convenient locations and consumer friendly office hours, including periods of walk-in care with no appointment....

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The Congressional Budget Office's Elmendorf says without spending cuts in payments to doctors and hospitals and other providers, providing coverage to the unisured will put the nation deeper into debt. Popular measures such as increasing preventative care, expanding medical records and rewarding doctors for choosing treatments that improve cost and quality have potential but its not proven how much the savings from this would be. The administration and the White House Budget Director, Peter Orszag, say they are in agreement with the CBO that something needs to be done to seriously reduce costs, reducing payments for Medicare and Medicaid to doctors and hospitals, and making other changes.

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This WSJ story shows how China started its steel industry from small beginnings when Chinese leader Deng visited a Nippon Steel plant in 1978. He made the decision to go big with Baosteel, with an investment of $6 billion, with the words- "if we do it lets do it big." This was 36 times the Chinese foreign exchange reserves at the time. From 4% of steel production, this went up and up, passing the U.S. in 1993, past Japan in 1996, and in 2018 producing three times the steel of U.S., Russia and China combined, producing 923 million metric tons of steel in 2018, or more than half of world production of steel. With steel China was able to build its automobile industry, shipbuilding, bridges, infrastructure, high speed rail network. This was done using global demand, subsidies from the government, cheap loans and tax breaks. Markets worldwide were affected by substantial excess production in China. From Baosteel the spread of the steel industry to all 23 Chinese provinces led to China accounting for 25% of world exports. By 2016 5 million workers mostly from the agrarian countryside were employed in the steel industry, helping China transform itself into an rapidly urbanizing and modern economy. It was a period when the rail network was tripled between 1975-2017, with shipping companies that ensured access to Australian coal and Brazilian iron ore. From 2011 to 2017 Chinese steel dropped global prices by 57% triggering closure of steel mills in EUrope and the U.S. About a third of trade complaints since 2001 by G20 countries against China are about steel. After entry into the WOrld Trade Organization Chinese steel exports rose to 8% of GDP from 2%. Subsidies, cheap energy, and shift of agrarian workers to cities. U.S. investigations around 2006 showed Chinese steelmakers subsidies covered 30% to 45% of the subsidized value of steel pipes exported overseas. China's steel prices were set 20-40% lower than the U.S. China responded to complaints saying it was trade protectionism. The WTO rules call for full disclosing of all subsidies. This was disclosed 5 years after joining WTO in 2001, and only for central subsidies. Local government subsidies were not disclosed till 2016- the U.S. says 15 years late. Still the Bush and Obama administrations failed to take action. In 2018 Mr. Trump seized on this as a campaign issue that resonated with American workers in manufacturing communities across the U.S. In 2018 November president Trump announced a 25% tariff on imports of Chinese steel. A six month probe by U.S. officials had already shown 40% of sales value came from subsidies for corrosion resistant steel from China. The U.S. Trade Commission imposed tariffs of its own from 39% to 241%, with the Trump tariffs of 25% coming as an additional tariff to tackle the trade surplus with China. Meanwhile in China the government is closing uncompetitive smaller steel mills and in 2016 it combined baosteel with Wuhan Steel to create a larger company, and consolidate remaining companies. Baosteel now provides the steel for CIMC to dominate the steel container business, and to make ship to shore cranes, and make the San Francisco-Oakland Bay Bridge.  It also goes to show what can be accomplished from small beginnings for countries in the developing world from Asia to Africa and Latin America, with government and industry focussed on development and growth.   ...

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How Toyota's labor cost advantage is disappearing. By late 2009 Toyota's Georgetown Kentucky plant, 23 years old, where most workers are at the top of the pay scale could be the highest labor cost auto factory in the USA. A large number of Toyota workers are at the top wage of $25 an hour. Detroit's 4 year deal with the UAW gives them a 2 tier wage contract where lower paid workers earn only $26 an hour including benefits according to the Center for Automotive Research. At GM in 2011 its estimated the number of workers will be down by 6500 to 68000 workers, and one third of them earning the lower wage. How is Toyota responding? New hires will take 5 years not 3 to get to the top wage. And starting pay at a plant in Mississippi will be lower than the traditional $16. Its also cutting health care costs by setting up medical centers on site as at its San Antonio factory.

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Geithner in written testimony to the Senate Finance Committee, stated that "President Obama - backed by the conclusions of a broad range of economists- believes that China is manipulating its currency." What is noteworthy is that experts are generally in agreement that something should be done about this in cooperative fashion, from Obama's economic team, Obama's own views on this, The National Association of Maufacturers, Labor and so on. The trade deficit with China has continued at high levels even with the current economic slowdown, so this issue remains as one that the Bush administration never really addressed. Simon Johnson, a MIT Professor, and former IMF Chief economist says that even the IMF has not addressed it, and that the Obama administration needs to call China to account. He says this could lead to a spat with China, and if the US does not back down to a row. The concern has been that China would not buy up Treasury debt the way it has in the past, at the same time the question is whether there is some point where the deficit is so large and the US so dependent on foreign buyers of Treasury debt, that it needs to be addressed on a number of levels. Including addressing currency and fair trade issues, a more rational balanced consumption of everything from oil to goods from lowcost Asian countries, to reduce the toll on the overextended American consumer and on the extent of US borrowing needed. From China's perspective there may also be the same concern about export led growth, which may come to be seen as undependable anyway, because with or without some currency advantage the overextended US consumer is not buying anyway, holding off on purchases of everying from cars to flatscreen televisions. With growth at 6.8% in 4th quarter 2008, according to the Chinese Government Statistics Bureau, and expected to drop to 5% in 2009, the export growth model is no longer the panacea for China's unemployed as it once was at 12-13% growth rates in 2006-2007. In fact it may now look to be a better wiser policy if China had increased the value of its currency even more than its slow gradual approach to slow the growth rate from 12-13% to a more sustainable 9-10%, and lower American imports and lower the American trade deficit. Part of the problem in China was the difficulty of applying any sort of brakes once the local governments were set free to expand as much as they could, and prevented any controls from being effective. Steel production continued to grow even after there was evidence of large overcapacity, and government direction failed. Buy some time to shift to domestic consumption based recovery, is what the Chinese policy may be now. Indications of this are evident with its grappling at the issues it has not tackled like giving ownership of land to farmers in rural areas, and to building a healthcare system for the country, both of which are part of a host of issues to shift to domestic consumption based recovery. So unlike the way the media and some experts portray it its not a tough line that the US is taking against Chinese unwillingness. China may want to cooperate.That may be true if China was missing out on 10-13% growth rates, but these were unsustainable anyway and bad policy. At growth rates below 5% as projected by analysts China may want to jettison the export model of growth and build an alternative one. In that case as China shifts to domestic consumption, currency adjustments may be seen quite differently than they were in the past....

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Paul Ryan, speaker of the U.S. House of Representatives, wins the Republican primary in his house seat of Janesville, Wisconsin, defeating his challenger Nehlen, by 84% to 16%. The Republican nominee Donald Trump earlier had refused to endorse Ryan, and only reluctantly endorsed Ryan following the vice presidential nominee Mike Spence's endorsement of Ryan. Senator Susan Collins, senior Republican senator from Maine, joined other leading Republicans saying she would not support Trump. Paul Ryan has split with Trump on trade, immigration, Mexico, and other issues. He has insisted on decency and fairness in politics, and has won his seat in a working class town that had a closed GM plant in 2008 after Ryan voted to support rescue of the auto industry and worked hard to keep it open. Even though some of his policies have not directly helped working class families, he has won increasing support from his district as the economy recovered with unemployment down to 4.4% in Janesville, according to BLS for May 2016. Much of that support since 1998 has been based on Ryan's decency, faith and family. He made it a condition that he would go back on weekends to Wisconsin to stay in touch with people, when he accepted the position of Speaker of the House, and he listens to local concerns. Ryan said about the national discourse- "It's simple to prey on people's fears. That stuff sells, but it doesn't stick. It doesn't last. Most of all, it doesn't work." His job in today's deteriorated national discourse is as vital as ever, both for Wisconsin as representing the best in the national spirit, and for the country.   ...

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The language and tone of the leaders says something about what is likely to be the outcome of the G20 summit. Its a first for significant participation, as countries as diverse as Russia, China, India, Indonesia, Saudi Arabia, and the Netherlands are represented. The credible positions of both sides, the US, UK and Japan, and the European side of France, Germany and the Czech Republic, well presented, provide for some serious discussion and negotiations. France's Sarkozy and Germany's Merkel want to see a global regulator that would reach inside the borders of the US with stricter regulation. Sarkozy calls this "nonnegotiable." And he said that he would reject an agreement that puts off stringent new regulations on banks, tax havens, and hedge funds. He said "the compromise has to come from all countries around the world." US President Obama said that if there is going to be renewed growth it can't just be the US as the engine, everybody is going to have to pick up the pace," at the same time saying that the US had to be concerned about its own deficits. The fact is that the US stimulus will mostly help a severely impacted domestic economy recover with social safey net payments to local and state governments and unemployment insurance, as well as targeted investments in infrastructure, education, energy and health care. It will not mean anywhere near the kinds of imports the US made from other countries, especially China. And Obama made that clear when he said the US will never return to that situation, where the US had become a "voracious consumer market." For the Germans the major market for their middle companies is China, and China has its own stimulus spending on infrastructure spending, which should provide for continued imports of machinery from Germany at a much lower level. Thus Germany and France see a strong tendency to call the source of the crisis and repeat that call till the US listens, and refer to the failure of free market capitalism in its unregulated form. And to insist on fixing it through a global regulator with strict and systemwide rules. So you hear this in Merkel's words, "the foundation for this finacial architecture must be laid now, that is why we seem to be so tough." While the vivacious Sarkozy talks of compromise, and a US gesture in regulation in return for Franc's gesture of joining NATO, the mild mannered Merkel is clear and focussed about her concern. She rejects the idea of linking stimulus spending demands of the Anglo-Americans with the Franco-German demands for global systemwide regulation. "This is not a bargaining chip," she says. The media may mistakenly report lack of consensus as a failure of the summit. But in the long run in the presence of good positions on both sides, it could lead to some tough negotiations even if continued at another meeting. And result in something serious, credible and lasting in its impact, rather than something that was easy and did not in Andy Grove's useful words involve "constructive confrontation." ...

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Ruth Marcus looks at the assumptions behind Romney's tax plan and questions whether simplifying the tax system with lower rates would help create the climate for higher economic growth and lower unemployment. Much of the differences between Republicans and Democrats revolve around this assumption, a core belief on one side and skepticism on the other. An effort to obtain a bipartisan assessment was made with the Simpson-Bowles commission recommendations, which advised closing loopholes and reducing deductions. The work done by Martin Feldstein on the Romney Tax plan builds on this approach of limiting deductions, and reducing taxes across the board. An issue for Democrats is inequality. Lower wages to improve competitiveness in manufacturing industry is a trend in Republican and Democratic administrations, because of the effort to improve U.S. competitiveness against other trading nations and has played a large part in lowering incomes in manufacturing oriented midwest and eastern states. The other cause of increasing inequality is the housing crisis and the effects on the economy through foreclosures and unemployment. The housing crisis developed under a Republican administration, and the lack of effective measures to prevent foreclosures under the last 4 years of a Democratic administration worsened the economic condition of the middle class, and especially so for minorities. During the housing and foreclosure crisis the proposals put forward by Republicans Martin Feldstein, a Harvard economist, and Sheila Bair, head of the FDIC who calls herself a "populist from Kansas," for bold government help to homeowners under water would have helped the middle class financially, and especially minorities, far more than the efforts of the Democratic Obama administration, and under Feldstein's plan even turned aound the housing market and boosted a recovery. Trends in world trade and industry have large effects outside what administrations of either party can control, and a lot depends on the temperament, wisdom and leadership provided....

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Even China has not campaigned the way Canada, Mexico and British, American media have against DJT Tariffs because China knows it is basically about getting an even playing field when it is the only country with $1 trillion in trade in its favor in 2024, 12 times the Japanese high of $82 billion trade surplus in 2007. But why should China campaign when the American and British, German media are going to do the job for China? A simple quiz to K-12 would ask school children when is the last time a country has a $1 trillion trade surplus? Answer: Never. Greg Ip has written a few years back that the devastation of China outshoring of American factories and jobs was unlike the 1980's Japan trade invasion because of first China's size, second by the speed with which it happened at 10-14% Chinese GDP growth. There is a third Japan was an ally needing US for security and backed down, China's case is different it is challenging the US for control of the world economy and will fight this one over the long haul. Greg Ip of WSJ on the 53 countries asking to negotiate US Liberation Day April 2, 2025 Tariffs. These countries include Allies of the US in full support asking to negotiate Israel, Japan, Taiwan, South Korea, India Allies of the US in partial support asking to negotiate Britain Allies of the US not in full support asking to negotiate Germany, France Allies of the US in the past campaigning against the US, asking to negotiate Canada, Mexico Not Allies of the US, not in full support, not campaigning against the US China A look at his list tells one only one thing, mostly all trading partners except for the $146 billion exports of the US which represents exports to China are the exports that are at risk if things don't work out on tariffs. This is what the media today WSJ added this last week to the NYT, Wash. Post and the BBC, Guardian of UK, German media will not tell the reader.  The DJT Tariffs and Tariff negotiations are Lighthizer Tariff negotiations which won the fight with Japan in the 1980's over unfair trade and gaining a level playing field. Lighthizer as Deputy US Trade Representative conducted the tough negotiations with Japan. He was USTR in 2016-2020 and his Deputy Jamieson is now USTR in 2025       ...

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The dollars situation may not be as bad as it looks. There are signs that the dollar is strengthening against the British pound and the Australian dollar and other important currencies. And the weaker dollar is already working to reduce imbalances in America's trade deficit. There are two aspects of the dollar's role, one is as a means of international exchange and the other as a store of value. For the first reserves of any country need to be highly convertible and America offers highly liquid markets and this has not changed. As a store of value the dollar has lost some of it value especially against the euro. But the reason that the dollar should not see a sudden drop in value is because the largest holders of dollar reserves China with $1.4 trillion and Japan with $1 trillion would stand to lose by shifting out of dollars significantly at atime when the dollar was so undervalued besides hurting their export markets if it affected the US economy. And though the euro looks good in the short term, over the longer term Europe's aging societies may see lower growth and the future may look different once the USA has corrected some of it imbalances which is precisely what the weaker dollar accomplishes as the US exports start humming. Seen against the historical background the USA has periodically gone through this situation with dollar weakness in 1977-79, 1985-88, 1993-95. In 1985 the dollar went to 81 Japanese yen and there was concern about its reserve currency status at the time. However the dollar has weathered these storms. And there is always the option for a country to peg its currency not to one currency alone but to a combination of the dollar and the euro. This was the case before 1914 when 3 currencies the British Pound, the French Franc and the German Mark were used. In the post 1918 environment the dollar replaced the German mark alongside the Pound and the Franc. The Persian Gulf countries have this option so they can use their own monetary policy to control inflation by pegging not just to the dollar but to a basket of currencies as Kuwait has done. See the link to the Persian Gulf countries handling of this currency issue in WSJ, November 20th and Nov 1, 2007....

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Nickel cadmium batteries - this year 2008 the European Union is banning the sale of all nickel cadmium batteries. Question is why is the US not banning them. And why are companies like Energizer, Duracell, P&G, Mattel, Toys R Us and Walmart still buying them? Why is Panasonic making them? A toy costs $1.50 less to make using nickel cadmium batteries. Are parents aware of what it does to workers making them? Are plants safe in developing countries especially in corruption prone coercive environments like the one in factories in China? Some of the owners of such factories are in Hong Kong, Hong Kong based companies, are they aware enough of the risks and the ethics of doing is? This story is of an engineer who was exposed to factory conditions in a company GP that was supposed to be a good company to work for, and few knew about the effects of cadmium in the year 1995 when she joined. The Panasonic factory is in Wuxi which is not in some remote part of China. And note this about 10% of China's arable land is contaminated with heavy metals such as cadmium according to China's own State Environmental Protection Agency, and the metals are entering China's food supply. 12 studies have shown unsafe level of cadmium in fruits and vegetables. Is this a necessary price of industrialization or is it possible to find a way thats better- a challenge for countries like India. Can there be better protection of workers and still have industrialization? Wouldn't it make sense that a motivated well treated work force will perform better in better working conditions. Aren't there costs involved for workers and owners of such plants. Owners also bear costs, bad press, medical payments, workers leave and good workers are hard to find in the wave of bad publicity and health risks, customers in the west refuse to buy the product, the company's brand name is tarnished forever, as would happen for GP in this case. The coercive patterns of using police to suppress publicity for a Hong Kong Company shows owners in Hong Kong have the same disregard for worker rights, even when living in an area that one hears talk about democratic rights. See the link to chemical spills contaminating a river in China also by a Hong Kong based company. ...

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Questions raised about Dr Pazdur's decisions at FDA for anemia drugs made by Amgen and Johnson and Johnson. Dr Pazdur is head of the FDA office that regulates oncology drugs, all cancer drugs. Dr Pazdur's review process and decision shows how reviewers are human and their own experience helps determine what they see prominently. His experience with his father who suffered severely from the side effects of steroid drugs would make him aware of the the other effects of drugs. He is an oncologist, his wife is an oncology nurse, and some relatives have died of cancer, so he has lived with cancer patients. It appears from close associates that he like open communication and hears all sides but makes the final decision himself. He had an experience with a drug for lung cancer Iressa made by Astra -Zeneca, which the FDA approved based on testimonials, but not enough statistical evidence, which later failed and approval had to be withdrawn. This may have made him more inclined to look for strong results and statistical evidence before concluding on the safety and effectivenes of a drug. An approach evident with Amgen's anemia drug. It also appears that the FDA is not clear on whether the drug's effectiveness is to be judged by what result, is it whether it prolongs life only that counts, or whether the effectiveness in relieving significantly the symptoms of a patient even if life is not prolonged. There is the controversy surrounding the FDA's rejection of a drug by Genta Inc Genasense that relieved patient symptoms for leukemia but did not prolong their life. These and other questions continue to give sleepless nights to people at the FDA and outside as the drug review process faces difficult balancing act between what to give importance and what direction to take with a drug in patient's interests. In Dr Pazdur's case this is made more difficult as he thinks every day of his father who died in 1979 and suffered from the side effects of steroid drugs, went blind when Dr Pazdur was only a teen, and had pulmonary fibrosis and diabetes. He is described by doctors who trained under him as gentle but did meet a patient's eyes and tell him that he had to come to terms with his disease. ...

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Are high prices for pharmaceutical products and healthcare services putting a severe burden on U.S. finances and defunding education, infrastructure, R&D in new technologies, which provide the underpinnings for future U.S. competitiveness? Yes say experts. In 2009 Americans per person cost of healthcare was $7,960. By comparison Canada was $4,808, Germany $4,218, and France $3,978. And without necessary efforts for educating people about caring for health and preventive care, the health conditions of Americans are no better than these countries, and poorer in some dimensions. Klein says deficits would not be a problem for the U.S. if prices for pharmaceutical products and healthcare services in the U.S. were similiar to that of the largest developing countries. Experts say the Obama healthcare law simply postponed the addressing of this problem.

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The Supreme Court in a 6-3 decision, says Aereo, a startup video streaming service, violated copyright laws by taking broadcast signals on miniature antennas and giving them to subscribers for a small fee.

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The U.S. Supreme Court's 6-3 decision against Aereo. Justice Breyer writing an 18 page opinion stated: "We conclude that Aereo is not just an equipment supplier." Adding that Aereo had a "overwhelming likeness" to cable companies which have to pay fees to retransmit broadcast programming. Breyer rejected Aereo's argument that it did not make copyright violations because of the technical makeup of its system, saying that "we do not see how the fact that Aereo transmits via personal copies of programs could make a difference."