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Senator Mitch McConnell, the Republican Majority leader in the U.S. Senate has come up with a new health care bill that is aimed at winning over reluctant Republican Senators. Two taxes on high income people on 3.8% investment income and a payroll tax of 0.9% on incomes over $200,000 for individuals and $250,000 for couples are retained in this version of the bill, which adds $231 billion over a decade. Some of this is used to offset rising premiums in the new bill, and provide additional funds. The deep cuts to Medicaid are retained and Senator Collins of Maine says she is opposed to the new bill because this will hurt people in rural areas of Maine, and does nothing to change this. Senator Rand Paul of Kentucky is also opposed to the bill. Opposition comes from moderate Senators opposed to deep cuts to Medicaid in Republican health care alternatives to president Obama's Affordable Care Act, and from conservative Senators opposed for other reasons.  Senator Graham of South Carolina and Bill Cassidy of Louisiana introduced their own version just minutes before Mitch McConnell brought up his revised bill. All Democratic Senators are opposed to the Republican bill and call the deep cuts to Medicaid disastrous for lower income people.  ...

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U.S. Senator Ben Sasse suggests an alternative approach of simply repealing the Affordable Care Act called Obamacare and replacing it at a later date. This is endorsed by president Trump. This is the new Republican strategy in July 2017. Forty nine senators voted in favor of this repeal in 2015, when president Obama vetoed this legislation. Two more senators are expected to support repeal according to Ben Sasse.

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The Impossible City Paris in the 21st Century by Simon Kuper is reviewed in the Washington Post. It shows the incredible revival of the French capital and its suburbs as France has done an exceptional job of preparing the city for the Olympics. No other city has done so much for its population. Martin Gelin says after visiting the city now compared to 4 years back- parking spaces have become cafe patios, heavily trafficked boulevards bike lanes, new bookstores and galleries popping up everywhere, the city building sports and cultural facilities in neglected neighborhoods. Attention to social housing and huge expansion of public transit. Car traffic halved so air is cleaner than in 1990's. Paris is different from New York and London- it is avoiding "plutocratisation" of the city so that the best spaces do not go to banking and finance. In Paris the social housing units have tripled since 1990's including in 13th, 19th and 20th arrondisements. Paris does not want to become a city of millionaires,  tourists and poor people like San Francisco, says Kuper. Anne Hidalgo, Mayor of Paris wants 30 percent of all Parisian homes to be social housing by 2035, and another 10% as affordable housing (with rents  at least 20% below market rates). Grand Paris project will create 68 new subway stations so all of Metropolitan Paris is within 10 minute walk to a subway station. Diversity can be seen and it creates a healthy human experience in cities so that people are less likely to act with prejudice. ...

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Biden said that after the pandemic which took a million lives and caused grave threats to mental health in the country the country has come out of these depths with record 15 million jobs created, unemployment at record lows of 3%, and inflation down from 9% to 3%. And huge investments in clean energy and in infrastructure under laws he had passed with bipartisan support generated from his decades of experience in Congress. "In fact my policies have attracted $650 Billion of private sector investments in clean energy and advanced manufacturing creating tens of thousands of jobs here in America!  Thanks to our Bipartisan Infrastructure Law, 46,000 new projects have been announced across your communities – modernizing our roads and bridges, ports and airports, and public transit systems.  Removing poisonous lead pipes so every child can drink clean water without risk of getting brain damage.  Providing affordable high speed internet for every American no matter where you live.  Urban, suburban, and rural communities — in red states and blue.  Record investments in tribal communities.  Because of my investments, family farms are better be able to stay in the family and children and grandchildren won’t have to leave home to make a living."  ...

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All sides joined the President at the White House, as part of his consensus building efforts, and to get aseat at the table in restructuring health care. The insurers and health care providers, including technology providers, all committed to cutting the cost of health care. New social insurance programs to cover 45 million uninsured Americans, and to make health care affordable for businesses and individuals, will be unworkable at currently projected rate of increase in health care costs of 6.2% a year for the next decade. The industry promised to reduce that by 1.5% through voluntary efforts, even though there is skepticism about whether they will deliver. The insurers are against a government sponsored health plan fearing it will drive them out of business. Insurers and health care providers are lobbying against the cuts in their Medicare payments, and insurers are fighting Obama's cuts to their private Medicare Advantage plans by a total of $176 billion over 10 years. Doctors are fighting a 21% cut in their Medicare fees scheduled to take place in January 2010. Pharmacuetical companies and makers of medical devices are concerned that new products will have to pass a cost-benefit test before being approved for coverage under Medicare. Its just that they all see the continued rise in costs as somehow unsustainable, especially in the current economic crisis, and share the feeling with business and the rest of the country that the system is broken. At the same time like the banks and bank executives, health care companies and their executives go on lobbying aggressively and doing things the old way, which raises questions about how well these systems that are broken can be put on the right path....

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U.S. president Trump's 2017 budget is an effort to reshape spending priorities by the Republican party. Apart from Medicare and Social Security all other entitlement programs from the days of Lyndon Johnson's Great Society are subject to cuts. Deep cuts to Medicaid and food stamps, including introducing work requirements. The philosophy behind it is that compassion will now be measured not by how large these programs are but by how much the government can get people "off these programs and back in charge of their lives,"  according to Budget Director Mulvaney.  The cuts are $616 billion to Medicaid and Children's Health programs, $193 billion in cuts to Food Stamps, $143 billion in student loans, $72 billion in disability programs. The overhaul of the Affordable Health Care Act is part of this change. The reallocation would put more money into infrastructure for $200 billion, and in tax cuts, $19 billion in a parental leave program and $29 billion for veterans programs, plus added spending on the military. William Hoagland of the Bipartisan Policy Center, a Republican who worked on budget issues says it will be politically difficult as the cuts to lower income groups come with tax cuts for small businesses and higher income individuals.  Beyond the policy priorities there is an area where both Republicans and Democrats are skeptical of the budget. This is how it impacts the U.S. debt. Under Congressional Budget Office estimates the U.S. debt as a percentage of GDP which rose to about 75% after the Great Recession starting in 2008, is projected to grow to about 85%. In sharp contrast the Trump administration estimates of the Office of Management and Budget are for it to drop to 65% based on rosier estimates of 2% inflation, 3% growth for the decade ahead. Experts say this is unlikely once the Fed raises interest rates and the unemployment rate currently at 4.4% leads to rising inflation, undercutting growth which has remained below 2% for a long period. These concerns are also voiced by Hilsenrath in the WSJ based on the experience of other countries such a Britain that cut corporate taxes without seeing an uptick in economic growth. ...

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Gerard Baker in The Times of London looks at California as some kind of dystopia, a malfunctioning place with rolling blackouts from PG&E the electricity company, drought and water shortages, housing costs soaring making it affordable only to the few at the top, and high taxes. He cites an expert from Chapman University who compares it to some sort of medieval feudal place run by nobility at the top, the investors, lawyers and people in entertainment, with the academy and the media as a kind of clerisy who propagate the ideas that this nobility supports, a small middle and the rest as serfs or minimum wage workers in logistics, retail and farms. Median costs of housing are about $613,000, and the affordability index of people who can afford housing is 32% compared to 56% in the country. Hispanic immigrants now prefer Texas, though with a loss of 6 million people in the last decade and gain of five million, it sees increase in population with high birthrates from the existing population to about 40 million. Half the population of homeless in the U.S. are now in California though it has only one eighth the population of the country. High housing costs and high cost of living hurt people at the low end, the lower middle and the retired the most. With low wages at the bottom and extremes of wealth, homeless, housing zone restrictions, drought and rolling electricity blackouts, this is not what the future should look like.  ...

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Gerald Seib of the WSJ points out that the winners in the passing of the Republican healthcare bill in the House by a 4 vote margin are Speaker Ryan who never wanted the job in the first place, and president Trump who showed he could cajole Republicans into getting it passed because he likes winning. Now comes the hard part says Seib, when it goes to the Senate- House conservatives are not going to be happy when they find major changes they dislike. If the bill clears the Senate in a modified version Republicans will now have to own any issues with healthcare, including says Seib things that may not work out for pre-existing conditions- or for groups that are disadvantaged, including older people.

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This report in the WSJ shows American households are acting prudently by building up savings of $1.6 trillion, according to the Federal Reserve Bank of New York. As much of these savings are not distributed evenly across the population, and coming back from a period after the 2009 financial crisis when savings in the lower classes had dropped to alarming levels, this saving is good for the future of the American people by building a path to sustained growth for the long term. Readers responses to this report show their dismay at calling savings hoarding, dismay at the idea that saving 3-6 months of expenses would be considered prudent when 1-2 years would be a minimum  and 2-3 years desirable would be considered decent protection in times like the last 2 decades of manmade disasters (shipping out American manufacturing, 2009 financial crisis) or nature driven disasters (the pandemic). For the Biden administration the saving also provides hope that the mistakes of the last two decades and the 2009 period can be avoided. By targeting the $1 trillion in infrastructure spending plan to projects that build synergy throughout the economy and generate more growth for every dollar spent in a long term Renewal America project. Recent WSJ reports show this is happening. The $2 trillion Families and Workers Plan works in a similar way to bring hope in improving the quality of life in America through children's education, childcare, paid leave, health care, affordable housing, climate change investments. The public in America is showing equal prudence by aligning the savings to this approach to set America on a path of long term renewal and development that could be sustained to 2030 or 2035. This will also enable the investments needed to build America's role in the world and help its partners in Europe, Asia, Latin America and Africa take the same approach for sustained and balanced growth into the next decade.  ...

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The coverage of the Republican healthcare bill and how it affects the elderly, and people on Medicaid, people in rural areas, is likely to have changed public opinion in the U.S. about the necessity of ensuring all Americans have health coverage. The Pew survey cited here in this NYT report by Zernike and Goodnough was done in Jan 2017, and shows a shift. The shift would be much higher today after people look hard at the consequences of what were simply hypothetical positions or ideological positions taken without looking at consequences in daily living. On Medicaid that opinion by July 2017 compared to Jan 2017 has shifted 10 percentage points for Republicans to 53% who think Medicaid is important to them and their families, according to Kaiser research. There is stronger sentiment about people having benefits taken away.  [article-55059] The opinion has shifted to where people see that coverage is important and people should not have coverage denied or benefits taken away from them. Opinion remains strong in favor of changes to reduce the high premiums, but not to replace the existing health benefits and law with no law at all to replace it. That leaves 20 million more uninsured according to the Congressional Budget Office. Changes have to be constructive is the popular view today,  and this requires dialogue between Republicans and Democrats- which has not taken place. ...

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The Congressional Budget Office analysis of the Republican healthcare plan advocated by Mr. McConnell, Senate Majority leader, is that it would add 22 million uninsured if implemented. That plan ran into opposition from Republican Senators Collins, Capito, Murkowski, Paul, and Moran, and lacked enough support in the Senate. All Democrats opposed it and with the thin majority Republicans were divided. By taking away some benefits given under the existing Affordable Care Act the plan hurt the elderly and low income people, making some Republicans listen to their constituents in home districts and not the Republican leadership. The NYT profiled two in particular who astonishingly in a sign of today's strange politics were the only ones publicly holding townhall type meetings to hear the views of people in their voting districts- Susan Collins of Maine and Jerry Moran of Kansas. Both senators were listening to rural communities and Moran stated his opposition with the words- "I am a product of rural Kansas." With it the nation takes a breather and the message goes out that it is best to listen first and then to seek middle ground, not do what both parties Democrats and Republicans did in 2009 and 2017- rush serious legislation through without support across party lines and without serious discussion.   ...

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This story in the NYT describes how the flawed effort to pass the Republican healthcare bill or repeal the Affordable Care Act passed under president Obama failed after another effort. Many developments killed it. In the end the president lost interest, especially when he saw Republican Senator Rand Paul of Kentucky go on talk shows on the weekend before its collapse to complain about the bill. Senator Collins of Maine was exasperated by the way the bill was being rushed through Congress, and she voiced her strong opinions about this by talking to people back home in Maine and sharing her conversations with the media. The bill pushed by Senator McConnell, the Republican leader in the Senate, imposed annual caps on Medicaid spending. And did this without any discussion, shutting out committee debate, any public discussion, or formal drafting. Once this process was set in motion in this way the Republican Senators formed camps. Senator Grassley of Iowa and Jerry Moran of Kansas, normally conservative moved to the moderate side. Moran held a town hall meeting covered in the NYT, where older people voiced their concerns. Most of the patient advocacy groups, the hospital groups such as the American Hospital Association, and other medical groups also opposed it.  After Senator McCain of Arizona said he could not return following a surgery in Phoenix, Senators Lee and Moran announced their opposition. With this the bill's support crumbled including any effort to repeal the Affordable Care Act.  ...

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A health care practitioner says the real problem is the high cost of medical care in the U.S. when compared to other countries. She points out that the Obama bill in 2008 did not take effective steps to bring down the cost of health care before enacting legislation to cover the uninsured, leading to higher premiums for the middle class. The link between healthcare and profits is seen as the main problem. 

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The India- U.S. trade deal after the negotiations and the visit of the Indian prime minister to the U.S. is expected to take additional time. The U.S. wanted to see a 20% duty on mobile phones and ethernet switches to be reduced, greater access to the Indian market for medical devices such as stents and knee implants, and greater access for dairy, agricultural products. Making these products affordable in India is a goal of the government preventing it from making concessions. India wants preferential access to the U.S. market as a developing country restored under the Generalized System of Preferences.  A comprehensive trade deal would have to include issues of intellectual property, e-commerce, and the sensitive issue of H1B visas. Commerce minister Piyush Goyal led negotiations for India and Foreign Secretary Vijay Gokhale said the two sides "narrowed" down their differences. India's Jio from Reliance Group has hugely reduced the price of mobile phones and mobile data making it accessible with 4G across the country at prices that are the lowest in the world. The introduction of a universal health care program requires bringing down the price of medical products to improve access to modern medicine. This means less room for American products that would increase the price and reduce access in a vast developing country. India is also playing catchup in these technologies so that there is less room for unrestricted entry in the Indian market.  Efforts were made to increase trade and investment in India with the help of Mr. Bloomberg during the visit of the prime minister, and the Bill Gates Foundation continued its commitment to public welfare gains in India in the fields of sanitation, hygiene and healthcare.  ...