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Results at Midland Memorial Hospital in Texas, show that a low cost conversion to electronic medical records by using the VA system's open software and having computer software companies adapt it to Midland's needs. This cost Midland $7 million and has resulted in many benefits. Senator Rockefeller is introducing legislation to promote the use of this open software for conversion to electronic medical records. Medsphere chairman Kenneth Kizer, former undersecretary ohealth care at the VA oversaw the development of VIstA software. He says its enhanced version called Open Vist A, "can be installed in one third the timeand for about one thrid the cost of the big-name proprietary systems." There is alot to be said for open software as this would enable hospitals and clinics acoross the country talk to each other and pull up records and sen them electronically, wich is hard to do when different systems of differnt commerical vendors interact. If Midland Memorial is any guide there are huge savings in the conversion. By enabling access instantly of patient records, lab results and Xray images, there are a huge array of benefits. It helped Midland catch up with a$16.7 million coding and billing backlog for 4,500 patient records in 4 weeks instead of 5-6 months. In the 18 months since the system was made hospital wideinfection rates dropped 88%, because of guidelines in the record system that prompted nurses to follow infection control procedures, such as changing dressing or following procedures when inserting a new IV. That is huge. Bed sores were reduced from electronic prompting to nurses to turn patients.And Midland increased by 77%in staff compliancewith guidelinesfor care for patientson ventilators, which if not followed could lead to pheumonia....

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Peter Orszag's role in the healthcare debate and the formulation of health care policy proposals. One proposal of Orszag, who heads the Congressional Budget Office, is to set up a new agency with powers to cut spending and implement changes in Medicare. Says Orszag, "one of the reasons we have such disjointed and skewed incentives is that we have an excessively political process." At a recent meeting with House Democrats, one Congresswoman said her top priority is winning higher payments for oxygen suppliers, and Orszag was taken aback. For years officials have been trying to cut payments to oxygen and medical equipment suppliers, which are said to be inflated. When a new competitive bidding process was set to take effect last year, industry supporters in Congress were able to delay the plan, and these supporters are still fighting to block changes says the WSJ. Here is a 40 year old Orszag, with degrees from Princeton and London School of Economics, who got his early experience in the Clinton adminstration at age 24. He then followed this with a number of policy oriented jobs, ending with appointment to head CBO in 2007. And he faces the whole system of Congressmen from both parties beholden to interests in the healthcare industry, who provide the donations for them to finance their election campaigns. Dan Eggen describes this in the Washington Post, 7/21/2009. Max Baucus of Montana, and to some extent Grassley of Iowa, are senators from both parties who Eggen points out are beholden to the healthcare industry because of large donations they receive from the interests in the healthcare industry. These interests want to see their payments system protected. The further escalation in health care costs, which would make the whole healthcare system unaffordable even as it delivers poor results, can only be prevented by making cost control an exercize that is not influenced by healthcare industry donations. Jackie Calmes describes the huge hurdles in achieving a deficit neutral move to universal health care in the U.S. in the NYT 6/26/2009. See the link. The exchange between Grassley and Orszag on the issue of the $177 billion in savings needed from the payments to health insurers under the Medicare managed care plans- which allow seniors to obtain Medicare coverage outside the government run program -went as follows. These are dubbed overpayments by outside experts and efforts have been made to cut them in Congress. When Mr Grassley raised concerns about the impact of such cuts in a hearing, -and Grassley has opposed the cut for this overpayment to insurers- Orszag responded saying: "I very firmly believe that capitalism is not founded on excessively high subsidies to private firms. This is what this system delivers right now." ...

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US differences with Pakistan are based on two different perspectves that are not reconcilable. Recent events and the relationship between the US and Pakistan's army chief have confirmed that this is not going to change. US sees militants and Taliban inside Pakistan as havens for the short term as the US disengages from Afghanistan, whereas Pakistan's army sees them as useful elements in Pakistan's security interests in relation to India for the long term. Whe Kayani met with Obama in Washington, he handed Obama a 13 page document showing Pakistan's strategic perspective and emphasizing the gap between short term US interests and Pakistan's long term interests. The Wikileaks cables show Kayani discussing with US officials a possible removal of President Zardari and his preferred replacement. This made Kayani, normally reticent, to rant for hours on the irreconciliable differences between the US and Pakistan with a group of Pakistani journalists. He described Pakistan as the US's "most bullied ally," and said the frames of reference of the US and Pakistan regarding regional ssecurity "can never be the same," according to news accounts. And added that "the real aim of US strategy is to de-nuclearize Pakistan." Holbrooke and Admiral Mullen had hoped to reverse "a trust deficit" between the two sides. But this has not happened. General Petraeus is taking a tougher attitude and patience is thin on both sides. According to a Kayani friend, air marshal Chaudhry, Kayani is always asking Petraeus what the strategic objectives are in Afghanistan. US officials say they have given up on changing Kayani's thinking and that Kayani has told them: "I don't trust you." Kayani's position makes sense when one looks at the strongly anti-American public in Pakistan. Pakistani military and intelligence officials say a campaign against militants inside Pakistan incites domestic terrorism and uproots local communities. And by following Pakistan's own interests and frames of reference Kayani sends signals that win esteem among the Pakistani public. Opinion polls now show the military held in higher esteem than the Zardari administration. This puts the US in a no-win situation in Afghanistan with no clear objectives for the long term. This leaves the US in a time of tight budgets stretched thin to meet the needs in other defence areas that need attention, such as modernization of forces, trouble spots such as Korea, Iran and elsewhere, and resources needed for modernization of US infrastructure and supporting new technologies and industries. The lasting solutions that will take time, careful thought and preparation would be to integrate South Asia as a whole into an economic zone, extensive infrastructure building, and bring India and Pakistan closer through diplomacy and negotiations. See the articles by Richard Haas and others on the need to redirect resources. ...

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Simon Johnson reminds readers that in October 2008, Johnson, Peter Boone, and James Kwak, suggested that some European countries had given taxpayer-backed pledges to banks that had liabilities larger than their own gross domestic products. Their proposal included creation of a European Stability Fund with at least 2 trillion euros of credit lines guaranteed by all member nations, as well as Switzerland, Sweden, and the U.K., to buy time dealing with underlying insolvency in Ireland and other countries. Simon Johnson, is former chief economist of the IMF. He says the euro-zone only belatedly acted on this advice and the politicians never took responsibility for what they allowed to happen. The runaway financial globalization he says, was allowed to happen by US Treasury officials, but European banks were seriously involved in similar behaviour. These banks became too large relative to their economies, captured their regulators and acted recklessly. Europe's leaders haven't fully faced up to this and keep telling their voters that the problem is entirely because of US banks irresponsible behaviour. Ireland was the extreme example of this. And Johnson provides readers with the names of two books on the subject. David Lynch has "When the Luck of the Irish Ran Out," Fintan O'Toole has "Ship of Fools: How Stupidity and Corruption Killed the Celtic Tiger." Both laying out the intermingling of politicians, bankers and real-estate developers that resulted in the reckless growth and collapse of Ireland. In his own account in Atlantic magazine, May 2009, Johnson compared the US economc boom-bust-bailout cycle to what happened to Argentina, Russia and Indonesia. These were emerging middle class countries with crony capitalism, unsustainable debt and other problems. Johnson says, don't think these problems are limited to emerging markets. Its a global or general occurrence in which powerful people get together to build an economic model that brings growth based on debt. Under public pressure the German government keeps saying there must be burden sharing, that creditors must take losses also. Johnson says Angela Merkel and her colleagues have not thought through what signal this sends to the markets- which is to tell people to get out of Irish banks now. And the big German banks are telling the government they face big losses if Ireland or other European countries default. If the ECB can't pay, and the German taxpayer won't pay, Johnson asks, does the IMF have the resources to tackle Spain? If China offers to recapitalize the IMF with some of its $2.6 trillon in reserves, and becomes the largest shareholder, would the IMF headquarters be moved to Beijing as the Articles of Agreement require for the largest shareholder. ...

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The New York Times reports from the comments of current and former members of the Chase Chief Investment Office (CIO), that risk officers at Chase were ignored when they raised issues about the complex trades made by trader Iksil. Iksil's trades had the support of his manager Mr. Macris, and Ms. Drew who was in charge of CIO. The comments also indicate that at one point Mr. Macris brought in a Risk Officer with whom he had worked closely for many years. Risk Officers are supposed to be independent and their concerns seriously heard, with the authority to halt trades that pose excessive risks. Which made this kind of cozy behaviour in the CIO trading offices in London cause for alarm. These reports also say Mr. Braunstein, the new CFO at JP Morgan Chase, did not strengthen controls after he assumed office in 2010. Bank officials disputed this. The New York offices did not fully grasp the complex trades being made in the CIO London offices, and upper management let the CIO operate pretty much on its own, especially with CEO Jamie Dimon's confidence in Ms. Drew's management of the CIO. This led to another gap in the process of risk management. Dimon had other priorities and distractions, from problem mortgages coming with the acquisition of Washington Mutual, pushing back aginst financial regulation after the 2008 crisis, stress tests and others. At the same time the U.S. Federal Reserve, regulators, and Treasury's coordinated effort to merge failing banks with other larger banks- because of the lack of the process of unwinding failed banks provided later under Dodd-Frank legislation- created mega financial banks. Unlike what the U.S. under Treasury Secretary Rubin pushed for in the case of S. Korea during a banking crisis in 1997, Treasury under Geithner and Fed officials did not push for unwinding of failed financial institutions such as Countrywide and Washington Mutual in 2008-2009 Chase's own portfolio of assets under the CIO, increased by an astounding amount from $76 billion in 2007 to $356 billion in 2011. Even if Ms Drew had managed CIO well before, managing a portfolio of this size is most likely to have presented a whole set of new challenges and problems for which the CIO office was not prepared. Similiar concerns were raised by other Fed officials such as Fed governors, Hoenig and Fisher, who raised the issue that such mega-banks posed unacceptable risks and were too big to manage. Pressures to increase investing profits, growing complacency, relaxing risk management controls, led to the situation where a single trader Mr. Iksil, who had only joined the bank in 2007 according to other reports, could create large losses. This follows a situation at UBSin 2011, where a novice trader made bets that resulted in large losses....

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The demand for ships went up so steeply that shipping rates hit the roof, and the prices of ships went up accordingly. Between the end of 2006 and July 2008 , shipyards received enough commissions, says the Economist, that this would double the world's fleet. Just as demand has collapsed and international trade has gone down, about 9000 ships are coming onstream. Now 11% of fleet capacity justs sits on the water, in the seas outside the harbors of Singapore, Hong Kong and other southeast Asian ports. A 150 tonne cape class ship that sold in 2003 for $18.5 million in the used market, when rates for charter were $15,000 a day, had risen by summer 2008, to $85 million with rates of $175,000 a day. These rates went up even more to $300,000 a day, which is 20 times what it was in 2003. And rates today are back down to $15,000 a day, where they were in 2003. This ship, cited by a broker, to give some idea of the extent of this boom and its collapse, was sold for scrap at $7 million. And South Korean shipyards are taking this into account, in their pricing and collection of payment, with 20% demanded upfront, 60% during construction, and 20% upon delivery. The backlog in shipyards is estimated by Clarkson Research, a maritime research firm, at $526 billion, even as banks are leery of lending and concerned about the value of the collateral in the event of default. Some smaller Korean shipyards are closing. Steve Mann, analyst at HSBC, says that half of the orders for delivery in 2010 will be delayed, so that there is work for 2011 and inventory or excess capacity does not pile up on the oceans. Even in this situation China, India and Vietnam continue to support the expansion of their own shipyards. This suggests additional losses for shipbuilders, shipping lines and the banks that lend to shipyards. All this also goes to show that the rush to industrialize, once it gets a firm footing- like it has in the Chinese model of increasing investment and local governments pushing infrastructure, industry and export factories with officials judged on GNP growth numbers- can exacerbate a boom-bust cycle. This is one industry, others include machinery manufacturers, commodity producers, and manufacturers of parts that go into finished products assembled in China for export. This means it would take the world economy down with it, if some external factor like the drop in export demand suddenly slows everything down. Machinery manufacturers in Germany, commodity producers in Brazil, Argentina, Chile, Australia, and manufacturers of the high tech parts in Japan and Taiwan that are shipped to China for assembly, all go down in this boom-bust cycle, in a dramatic manner. ...

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Tankersley points to the broken links between economic growth and growth in jobs and incomes since 1989, which have created a shrinking U.S. middle class. In the postwar period before 1989, a one percent increase in economic growth generated a six tenths of one percent increase in jobs growth during economic recoveries. During the 1992 recovery under George Bush this was down to 0.4%. In the 2001 recovery under George W. Bush this dropped to 0.2%, during the current recovery under Obama this is at 0.3%. Income growth also showed a similiar pattern. Median household incomes declined from 1990-1992 and from 2002-2004, after adjusting for inflation, even with economic growth of 6% during this period. For the 2009-2011 recovery period the economic growth was about 4% yet real median incomes increased barely at 0.5%. By contrast from 1982 to 1984 with economic growth of 11%, real median incomes went up by 5%. The result workers median wages are lower now in the beginning of 2013, after inflation adjustment, than at the end of 2003, and real household income lower in 2011 than in 1989, says Tankersley. Why were the recoveries of 1990 and 2001 for the most part jobless? U.S. Federal Reserve studies show employers mindset had changed, instead of hiring back laid off workers during recoveries, employers did not add many jobs. Automation in factories requiring fewer workers, global outsourcing and supply chains, manufacturing overseas, lack of union-management cooperation on wages and jobs in industries such as the auto industry, increase in temp workers, all played a part in creating fewer and fewer good paying jobs. Some of this is playing out worldwide. In Japan the economic recovery has also come with similiar costs- moving jobs overseas for the auto and electronics industries, increase in temporary worker jobs with lower pay and benefits to about one third of all jobs, and depressed consumer spending as a result lowering the economic growth potential. Even the recent German economic recovery has come with an increase in lower paying temporary jobs and driven by exports to Asia. For the U.S. the situation was worsened by three additional factors- housing foreclosures and the hit to savings from the 2008 financial crisis, high cost of college tution and resulting debt, and the high cost of medical care. The Obama administration's effort to increase the minimum wage would help the poor, but do little to address the broken links between economic growth and jobs growth/income growth. The push for college education does not address affordability and neglects jobs training. Most of the questions raised by the changing patterns remain unanswered, which may be why Obama calls this a generation's task, not that of one administration....

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The economics situation in Eastern Europe is looking much better now after the recovery of confidence in the USA and Western Europe with stimulus measures and other steps to ease credit, and the decision at the G20 summit in London in early 2009 to provide a strong line of credit to emerging market economies struggling in this crisis. The European Bank for Reconstruction ad Development sees a 5.2% drop in GDP in 2009 over 2008, and the IMF 4.9% for Eastern European economies. The region varies country by country, with GDP decline forecast for 2009 over the prior year by the IMF showing a modest decline of 0.7% for Poland which is doing well, Czech Republic 3.5%, Hungary 3.3%, Bulgaria 2%. Other countries Lithuania 10%, Ukraine 8% and Russia at 6% decline in GDP for 2009 are hit hardest but thing there are also improving compared to last quarter. The stock market in Poland went up by 40% since the low in February 2009, Hungary by 50%, and Russia by nearly 90%, reflecting this increased confidence. A big difference is in the way the IMF under Dominique Strauss Kahn is operating. WIth the new mandate to help emerging market countries and the new funds from western countries, China and Japan, the IMF is working in cooperation with the European COmmission, the banks, and the national governments in Eastern Europe, to lessen the effects of this crisis. This is afirst for the IMF and aremarkable change. In May 2009 the IMF gave a$21 billion credit line to Poland with no strings attached , the kind of loan it made to Mexico, as aproactive measure to restore confidence. IMF told the Ukraine that a deficit of 4% of GDP was realistic when it released a $2.8 billion tranche recently. Latvia was allowed to run adeficit of 7% for 2009, with a committment to bring this down to 4% in 2010. Another change is that more aid is now given to western banks with souring loans in eastern Europe, so that these banks do not cut back severely or pull out of Eastern European economies. The EBRD has raised $24.5billion to lend to banks and other companies in the region. And $590 million went to UniCredit Italia, an Italina bank heavily exposed to Eastern Europe. Ther EBRD is looking at investing in 12 other western European banks. The Swedes have national schemes too to help the Baltic countries. The political situation is improving also, as the transition to new administration as aresult of voter discontent is being managed wisely. In the Czech Republic acompetent tranisiton government is headed by Jan Fischer, chief statistician, till elections in October 2009. In Hungary the transition government is run by an economist Gordon Bajnai, till an election next spring....

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The Fed announced that it will review compensation policies of 28 of the large complex banking organizations in the USA. The review will be an horizontal one that compares them to each other. The other significant move is that the Fed wants to see employees who take greater risks and use large amounts of borrowed money, to receive negative points in evaluating how well they have done, and consequently to be compensated less than other employees who earn money for banking firms while controlling the risks associated with transactions. This ties in with the discussions at the G-20 meeting in Pittsburgh, where the Europeans pushed for tighter regulation on bonuses and pay, to control the excessive risktaking of banking firms. This is because the prevailing culture in global financial institutions is a high risk high return culture, which ignores the social consequences of bad decisions. There is no cost to individuals taking the risks on other people's money, and regulations discouraging risk are not in place. The question remains, is this an adequate response to prevent future crises, or too little too late? If the banking community does not see it this way, and financial regulation is watered down in Congress- see the links to this- then it will much like Don Quixote swinging at windmills. In this sense the title of this piece is a misnomer, as the Fed has not hit banks with sweeping pay limits. It only said it would review pay practices. It is jawboning of the mild kind to show the public something is done. See Paul Volcker's point that pay practices would adjust and desirable goal of less risktaking and reasonable salaries would be achieved by separating deposit taking banks from banks engaged in trading activities. Similiarly, the governor of the Bank of England, Mervyn King, made the point recently that the biggest banks should be broken up. That is supported by the intuitive sense of experts that banks engaged with depositors should be engaged in the social functions of society, lending and supporting economic activity, and the trading desks of investment banks should operate entirely separately from this. One should be insulated from the other. In this sense there is a bit of evasion in these actions. A Wall Street capture of regulatory activity continues, of regulators and senior economic advisors in the administration, as the coziness between the two lingers on from a previous era of deregulation. This has the potential to cost the country and the global economy dearly in another crisis, and the jobless and young jobless people especially. In this economy both in Europe and the USA, the jobless young have been left with the least hope. ...

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Roshe gives an independent view of whats happening in the economy and sees a recession, sticky inflation that will last a long time for the US and the world economy in a semirecession for a long time. Roche of independent Strategy consultancy in London does not see the Fed's actions to increase liquidity having any effect in resolving the issues of solvency which have resulted from the overleveraging of brokerage and mortgage firms on Wall Street, only exacerbating the effects of a weaker dollar and higher inflation over the longer term. He points out that hedge fund and broker balance sheets or nondeposit financial institutions (NDFI's) half the size of banks in the USA and a quarter of the size of banks in Europe have their assets and liabilities financed by repurchase agreements. They lend and borrow against the collateral of assets that are marked to market, which means that they can borrow more and easily in a rising market cycle and can borrow less and with more difficulty in a falling market cycle. With the contracting cycle in place now they are facing insolvency issues. This may have been delayed till now because of investment banking profits and having credit lines for the duration of a contract. Till now investmet banking profits gave them leverage over lenders who made money from fees in investment banking. Now the banks hurt by writedowns of loans in mortgages and other areas are likely to tighten lending and call in their loans. What the Fed's actions will do is delay things a bit but not prevent a credit contraction and fall in asset prices. David Roche was Global Strategist for Morgan Stanley before starting Independent Strategy to provide fresh thinking and new insights on financial markets. His estimate is that reduction in available credit for corporate investment in technology, R&D and factories as a result of contraction in the financial system will require reducing corporate debt ultimately by 11-12 %. This will generate a loss of 5% points of real GDP growth for the US and put into a recession. For Europe he estimates loss of 2% points of real GDP growth. Global credit losses of $1.4 trillion would cause a contraction in world GDP of 2.5 percentage points or half the current rate of growth. For the global economy he sees a gray dull world of semi-recession and stickly inflation that will last a long time even without any major policy blunders. If this is original thinking and he is right then the Fed, the IMF, the Council of Economic Advisors, and general thinking on Wall Street that sees a short recession lasting several quarters may be in for a big shock....

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About 63% of respondents in a Washington Post/ABC poll conducted in July 2011 say they would look for new faces in Congress in the 2012 elections. There is serious public discontent with the lack of compromise by Republicans and Democrats in the debt ceiling and deficit reduction talks.

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The head of Italy's statistics agency Istat, Enrico Giovannini, says Italy's manufacturing sector has performed quite well, and the problem is with the services sector, in lagging sectors such as transport, communications, tourism, retail and social services. The manufacturing sector is only one sixth of the economy. He says productivity is poor and there is lack of investment in human capital and information technology for the services sector. IT's contribution to growth in Italy's labor productivity is the lowest in Europe, according to the European Investment Bank. Italy's total efficiency gains declined one half percentage point from 1995-2005. Retail and tourism sectors lack the needed productivity gains. This means actions taken by prime minister Monti to change labor laws and related changes will not be enough to generate confidence in the economy and economic growth. Giovannini says investment in human capital and productivity is badly needed, and shifting education and training to where there are new job opportunities....

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Gretchen Morgenson describes the issues of regulatory capture for Treasury Secretary Timothy Geithner during the 2008 financial crisis and the first term of the Obama administration, which affected how Geithner treated homeowners and banks. Morgenson describes close ties to Citicorp.

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The Italian government sold 5 billion euros of three year bonds in Jan 2013 at an interest rate of 1.85%, the lowest since 2010. This is a remarkable change from 2012.

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The European Union Commission says Ireland must recover 13 billion euros in back taxes for giving tax preferences to Apple that are against EU rules. The EU Commission says Ireland allowed Apple to pay a corporate tax rate of 1% on its European profits in 2003, and .005% in 2014. The EU Commissioner says the use of Ireland as the place where Apple pays taxes on operations in Europe has no base in reality, as most profits are earned in other countries outside Ireland. Taxable profits of Apple "did not correspond to economic reality," according to Ms. Vestager, the EU Commissioner.  In the current environment where political upheaval is unsettling the democratic process in the U.S., Britain, Spain, France and Italy, as well as in Brazil and other countries in the developing world- because of deep recessions, and efforts to cut the deficits with deep cuts in state spending including in education and healthcare, basic services- the moves by companies to reduce taxes to these absurdly low levels such as .005% when other companies in the EU are paying 12.5%, is becoming increasingly unpopular. As pointed out in this BBC News article this sounds like the way Carnegie, Rockefeller and Vanderbilt operated during the late 19th century, and were seen as operating in a manner that was above the law. Janet Yellen pointed out at a Boston Fed Conference on inequality in Oct 2014 that the bottom half of the distribution or 62 million households in the U.S. in 2013, had a net worth of about $10,000, One quarter of these households had a net worth of zero dollars. The working class and blue collar workers in the U.S. provide much of the support at Trump rallies. Younger college educated people support Sanders, because of the situation of the working and middle class in the U.S., and a similar situation exists in Europe. It is for the sake of the democratic process and delivering services in education, healthcare, and other basic areas to all, that companies small and large need to pay their fair share of taxes, regardless of size, influence, or technological advantages. Today this is is seen by most leaders who draw public support as the right way forward for the U.S., Latin America, Europe and Asian countries, including proper allocation of resources to best serve the needs of working people. For example the 13 billion euros is equal to all of Ireland's healthcare budget, and 66% of its social welfare budget.    ...

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The head of the Liberal-National coalition wins the election in Australia coming from behind because of inflighting in his coalition. Australia had 5 prime ministers in 6 years because of differences within the Liberal party.  Mr. Morrison's coalition was leading or won in 74 seats with 75% of votes counted, and headed for a 76 vote majority. Morrison campaigned alone on economic issues while the opposition Labour party led by Mr. Shorten, a trade union leader campaigned on climate change and better relations with China. ScoMo kade this election about the economic choice for Australians and who they could trust for jobs and the future. Morrison had just replaced Malcolm Turnbull only 9 months ago. Mr. Morrison planned to continue with the close relations with the U.S. as it confronts China on trade and technology issues. Mr. Shorten would have diverged from the U.S. on these issues, even though Australia has already turned down Huawei 5G on its telecom networks. With so much infighting in both parties, no prime minister has served a full term in Australia since 2007. Every 3 years Australia has an election. Voting is mandatory with a A$20 fine for not voting resulting in 95% of 16.3 million voters voting this time, compared to 55% in the U.S. and 69% in UK for their last elections. ...