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This example of how Forest Laboratories hoped to market an antidepressant Lexapro to doctors through financial incentives to prescribe the drug is detailed in a document that was made public by the Senate's Special Committee on Aging. The document is the "Lexapro Fiscal 2004 Marketing Plan." Forest licensed Celexa from Lundeck of Denmark and brought it to the US market in 1998. Then as the drug's patent life was short it tinkered with it and developed a new version calling it Lexapro and introduced it in the US market in 2002. Withits marketing effort Lexapro had $2.3 billion in sales in 2008, while all the time generic versions of Celexa and other durgs in its class sell for afraction of the Lexapro price. For instance amonth's supply of 5 millgram tablets of Lexapro costs $87.99 at drugstore.com, while a month's supply of generic version of Prozac is $14.99. Forest spends a lot compared to its larger rivals on sending money to doctor's. In the plan $34.7 million was to go to pay 2,000 psychiatrists and primary care doctors to deliver 15,000 marketing lectures to their peers that year. $36 million was to go to providing lunch to doctors in their offices. Asks Senator Herb Kohl, a Democrat from Wisconsin who is chairman of the Committee on Aging- "is the line between medical education and marketing blurred." For these companies there was no line. ...

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Bernie Sanders is reelected Senator from Vermont, as one of the oldest and most senior members of the US Congress in history. He will be 89 at the end of his fourth term in the US Senate. At 83 years he is the most resilient and active Senator in the US. Bernie Sanders support was key for president Biden's election in 2020. “It should come as no great surprise that a Democratic party which has abandoned working-class people would find that the working class has abandoned them,” Sanders said. “First, it was the white working class, and now it is Latino and Black workers as well. While the Democratic leadership defends the status quo, the American people are angry and want change. And they’re right. “Today, while the very rich are doing phenomenally well, 60% of Americans live paycheck to paycheck and we have more income and wealth inequality than ever before. Unbelievably, real, inflation-accounted-for weekly wages for the average American worker are actually lower now than they were 50 years ago. “Today, despite an explosion in technology and worker productivity, many young people will have a worse standard of living than their parents. And many of them worry that Artificial Intelligence and robotics will make a bad situation even worse. “Today, despite spending far more per capita than other countries, we remain the only wealthy nation not to guarantee healthcare to all as a human right and we pay, by far, the highest prices in the world for prescription drugs. We, alone among major countries, cannot even guarantee paid family and medical leave.” ...

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The Economist quotes experts saying that drug innovations would not be affected by price controls on drugs. Pricing reforms can accomplish the reverse, spur innovation by doing as Britain and Germany are doing- pioneering comparitive reviews of drugs effectiveness and cost-benefit analyses aimed at reimbursing firms for new drugs based on their performance. Sanford Bernstein, a financial advisory firm, says in its study that a 20% reduction in what Medicare pays for drugs would not kill off innovation, it would reduce earnings per share of big pharma firms by 3-8%. As drug research is now done in many countries, and its a globalized industry, innovation is not likely to be automatically affected by price reductions in one country like the USA, according to Alna Garber of Stanford University and Patricia Danzon of Wharton Business School.

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Elizabeth Rosenthal looks at Obamacare's contribution to cost containment in 2013-2014. Rosenthal says its is a kind of delicate maneuvring at the edges, because serious work needs to be done. The fee-for-service and many of the drivers for increases in medical costs, the old system of pricing, are still in place. In 20 years at the current rate and after Obamacare health care will still take 25% of the U.S. budget if nothing is done. Healthcare costs are about half that of the U.S. in some of the advanced European countries. She calls Obamacare a trickle down theory of cost containment becaue it leaves most of the drivers for cost increase in place and works at the margins. Princeton economist Uwe Reinhardt calls it an ugly patch on a somewhat ugly system. Rosenthal cites the armies of consultants anticipating every move to reduce prices, and working on "strategic billing'' to increase revenues for hospitals and doctors. For those who say the prices are now up more slowly than in the past, Michael Chernew of the Harvard Medical School, has this to say- its like a diet, reminding us that that we haven't even lost weight, just gaining weight slower than before. ...

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Montes and Cordoba of the WSJ provide this exceptional account of corruption at the state level in Mexico. Ironically the very effort to reduce the power of centralized administration with PRI winning repeated elections and having a monopoly in power for many years, led to the decentralization and passing on power and money to the state governments in Mexico after the 1990's. But this was done without putting in the checks and balances required. Instead too much power was now concentrated in the hands of the state governments which appointed even the judges and officials at all levels including election bodies. Federal transfers of tax money to states increased 20 fold to $88 billion in 2016, according to this report.  The result 41 state governors faced corruption charges between 2000 and 2013, according to the Mexican Competitiveness Institute. This includes the state of Veracruz where state coffers are almost empty and there is no money to pay municipal bodies. The PRI governor of Veracruz Mr. Duarte supported president Pena Nieto, and was at 43 years age cited as the new face of the young PRI. This report  says he is nowhere to be found now that $2.5 billion in state funds cannot be verified. Other states are Tamaulipas, Quintana Roo, Coahuila, Sonora, where corruption charges remain. The Veracruz scandal is among the worst and is the focus of attention for the public in Mexico. At this point president Pena Nieto of PRI has about 12% popularity rating, lowest of any modern Mexican president.   ...

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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 situation in Tampico, Mexico, with corruption, crime and dangers to public safety, show the problems Mexico is still grappling with to ensure a rule-of-law state right next to the U.S. The paradox is that of a breakdown in public safety with Calderon's war against drug gangs undermined by corrupt police and local government, and the continued foreign investment in the country. DuPont is investing $500 million in a new plant near the port of Tampico and South Korea's steel manufacturer POSCO is planning a $300 million investment to double production in this area.

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Mexico's Felipe Calderon cites the achievements during his 6 years in office: the efforts to establish a rule of law state, reduce the influence of drug trafficking gangs, improve higher technical education with 113,000 engineers now graduating each year, generating jobs and economic growth, and reducing the flow of people moving across the border with the U.S. as conditions improve in Mexico.

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Estimates show the 50 million Americans enrolled in Medicare today will increase to 80 million by 2030, according to the program's actuaries. Simple demographics as the baby boom generation ages is making controlling the deficit without controlling increase in health care costs as both sides in the fiscal cliff negotiations are attempting to do can only lead to defunding critical areas such as education, R&D and infrastructure, and breaching the safety net for lower income Americans. Health care spending took up 7% of GDP in 1960, increasing to 17.9% of GDP in 2010. Federal spending on healthcare has grown to about 25% in 2012 from 10% in 1960, and is projected to increase to about 33% in ten years by the Congressional Budget Office.

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A wide ranging interveiw by New York Times reporters Archibold, Cave and Malkin, with Mexico's President Felipe Calderon. Calderon tells the reporters that Mexico had to be cleaned up and it was upto him to do it. A Pew Research poll shows that only 45% of respondents say Mexico has made progress in the fight against drug cartels, yet 83% support the use of the military against the drug cartels. Calderon's six year term ends in 2012 and the opposition PRI candidate leads in the polls. Calderon is limited to the six year term by term limits. PRI candidate Nieto has a program that is not very different from Calderon's to fight drug gangs. Calderon says he should have taken on the task of buillding up the state and local police forces more aggressively from the very beginning, now that it is clear that corruption and lack of training have diminished their capacity to provide safety. Calderon points to the success in creating jobs, expanding health care, building trustworthy police and judicial institutions, and social programs to fight roots of crime, as achievements of his administration....

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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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Analysts fear an oil shock in 2012 similiar to that in 2008. There is similiarity in the situation now and in 2008- as in 2008, the surge in oil prices comes at a time of higher tensions with Iran and shrinking spare capacity. Spare capacity is at 2.5 million barrels a day on average for January and February 2012, according to the Energy Information Administration. This compares with 3.7 millon barrels a day for the same period in 2011. Part of the reason is that global oil demand is increasing in 2012 by 1 million barrels a day, to 89 million barrels a day. Technical and political problems have shutdown another 750,000 barrels a day. The problems begin to kick in during the second half of 2012. The U.S. ban on dealing with the Iranian central bank for oil trades starts in June 2012. According to the International Energy Agency, the EU embargo and U.S. sanctions will take 1 million barrels a day of Iranian crude out of the market. The result will be that demand exceeds supply by the third quarter by 1.1 million barrels a day, according to the U.S. Energy Information Administration. Use of existing reserves in Europe, the U.S. and other countries will make up the gap. The effect will be to put pressure on oil prices. May Brent crude on the ICE Futures Europe exchange was up to $125.81 a barrel, on March 16, 2012, and prices for April delivery were at $107.06 a barrel on the New York Mercantile Exchange....

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The 10 year distribution contract between Walgreen Co., Alliance Boots, and AmericsourceBergen Corp., for distribution of generic and other drugs worldwide. The higher volumes as a result of the distribution contract gives it leverage in negotiating better prices from generic manufacturers.

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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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How the Delta Pan Am merger is still a mess at JFK Terminal. Not a good sign for future mergers. Describes the results of prior mergers and shows a rather mixed record at best. Cites difficulties such as meshing computer reservation systems and facilities. Of major importance is the pride in their work and energy of the people involved, and how it be best tapped into, considering the experience of Continental and Gordon Bethune. America West's Doug Parker is trying to do this at US Airways, and Brazilian airline TAM is working with Varig assets.

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As Washington Post writer points out from personal experience- he is one of those who put up 15% to buy ahome inDenver at the top of the market and now has negative equity as prices drop- negative equity is one of the most serious problems facing the US economy. It has the potential to undo many of the encouraging things from the stimulus, as rising foreclosures continue to act as adrag on the overall economy. As he says about one fourth of Americans with home mortgages, or about 11-15 million people, owe more money on their homes than the market value of their homes. As Hoffman says the administration's approach has been a Band-Aid at best for a serious injury. The Obama administration set aside only $75 billion to get banks to modify loans and also made this voluntary for banks to modify loans. Treasury Secretary Geithner testified in Congress: "This is a conscious choice we made, not to start with principal reduction. We thought it would be dramatically more expensive for the American taxpayer, harder to justify, create much greater risk of unfairness." But making it voluntary means very little of this $75 billion has gone to help achieve modifications- banks had no incentives to do this. Only 31,000 permanent loan modifications have been made. Of the 750,000 temporary loan modifications made as of Dec 2009 only 4% of homeowners signing up have qualified for permanent federal relief. See the links to Martin Feldstein's proposals for this on the pages of the Wall Street Journal in 2008 and 2009 which called for aggressive program of relief for the sake of the economy. With 2.4 million Americans likely to lose their homes in 2009 according to Moody's Economy.com estimates, following the 2 million in 2009 and 1.7 million in 2008, this may be a serious mistake of the Obama administration and drag out this recovery....

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Failure to provide principal reductions to millions of U.S. homeowners under water and the prospect of further price declines in housing in 2012-2013. This would prevent a recovery in the U.S. economy.

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The $350 billon in proposed cuts to Medicare and Medicaid in the 2011 deficit reduction talks will do little to reduce the rapid rise in medical costs. Instead it shifts the costs to seniors, state governments and public hospitals. Gail Wilensky, former head of Medicare under the first President Bush and now a senior fellow at Project Hope, says this should not be confused with real reform to Medicare which reduces the rapid increase in costs. It does little in the way of fundamental changes that would reduce the growth in costs. About $53 billion comes from reductions to senior's ability to buy extra Medicare supplemental insurance or Medigap. Another $14-26 billion would have the government reduce payments to hospitals for unpaid debt. The few items to curtail fraud in the use of CT scans or purchase of power wheelchairs would provide savings of $2-3 billion over 10 years. $4 billion comes from lowering Medicaid payments to hospitals treating a high percentage of low income patients, hospitals such as Cook County Hospital in Chicago, San Francisco General Hospital, and Parkland Hospital in Dallas....