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BBC cites a report from ProPublica site that shows US billionaires pay little or no taxes. BBC has not confirmed this, yet it comes at a time when president Biden's plan is for American recovery with $1.8 trillion in spending on infrastructure, education and healthcare, services for elderly. This Biden plans to finance with taxes for people with the highest incomes. Earlier reports have shown some large corporations pay only a fraction in taxes that they normally would pay under a fair tax code. In some cases such as tech companies the tax code has not been updated, in others companies have used overseas tax locations. Much of the American public is unaware of how this affects the overall shape of society and the condition of America's infrastructure, the state of its educational system and its healthcare system, and of public services, the conditions for the elderly and children. The affluent have simply looked the other way.

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US president Biden's multi-trillion dollar spending plans for infrastructure, climate change plans, education and healthcare, are based on a changing perception about the effectiveness of the public sector spending initiatives. The Reagan period idea that the public sector is not as efficient as the private sector that lingered through the Clinton, Bush and Obama, Trump administrations is no longer accepted. After the pandemic another perception is taking root that when it comes to health infrastructure the government has a leading and indispensable role to play. Gone are the doubts about this that hung like a cloud over the nation's plans for infrastructure in health, education and supply channels. Following the global competition with China a new factor is also playing its part. The need for government to play an active role in trade, in protecting technological resources, and in supporting US technological firms in competition with other countries. There is a new perception that the government should be determined to play this role. In the effort to be self-reliant after the pandemic the government is expected to play a role in redesigning the supply channels and providing the direction and incentives for supply channels worldwide that give America a competitive advantage and less dependence on other nations. ...

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Questions China faces on AI- 17% high youth unemployment and 200 million young people in the gig economy in low wage demanding work. Chinese Communist party wants to see a stable China that can pursue industrial progress for decades like the European Union and the US. For this reason it is not going to let this level of dissatisfaction with high youth unemployment and low wage demanding work for young people to go to the next level. For this reason it will carefully make investments in AI -not the hyper investments in AI that are taking place in the US. The competition with China is going to take place on many fronts, and the industrial bloc created by the EU with India and Nordics has a 15 year plan during which it and the US are likely to far exceed anything China does at a slower rate of growth. As in the US choices will have to be made in China, investment in one area means disinvestment in other areas that have equal or more priority. Today's capital markets are in complete dysfunction in the US operated by a few banks and tech company leaders, similar to the situation prevailing in pharmaceuticals and healthcare. Investment priorities and planning are needed. It is a major error to say US cannot plan that capitalism does not have planning, because it is absolutely true that planning goes on at every level in American companies with Xerox, IBM, Oil Companies and other large companies, all having a Long Range Plan as well as planning for individual projects and investments in plants. If a good infrastructure plan, project by project, state by state, and at the local level, is not put in place this will simply not take place. If no good reindustrialization plan, project by project, state by state, and at the local level, is not put in place, this will simply not take place. In that case the competition with China would surely be lost before it had begun. Yet that is surely not the case, as every good American company has a long term plan. And this plan looks at all the potential investments the Nation can and should make in priorities and in the interests of the Nation and the People. All have to compete for resources and AI surely would not get the lions share of resources in China, or in the US, in a fair and well run market system where planning rightly takes place, because it would displace the very basic structure of a fair and well balanced economy that serves the American people, or the people of European Union and India, or the people of China. ...

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US workers quit 5.6 million fewer jobs in the first 11 months of 2024, a 12% decline, compared to 2023. This suggests fewer job opportunities than previously. Most of the job creation in 2023 was in three sectors leisure hospitality, government and healthcare with unemployment rate at 3.7%.

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Every day lost in the struggle with coronavirus is a big thing, which is why Itay's most affluent northern region has gone from being well equipped with resources of healthcare to seeing the health system overburdened to the point of disaster. This WSJ report shows why this has a lesson and an early warning for how the U.S. and other countries should design their response. It is also why the White House team that includes President Trump in the U.S. emphasized the plan for just the first 15 Days in the news conference at the Brady Room in the White House on March 16. It is saying the first 15 days are critical, not a day to lose.  It does not matter if you are an advanced economy with state of the art hospitals. Social behaviours must change, old rules rewritten and implemented throughout nations, quickly in days. Here WSJ shows lessons learned by Dr. Cereda at the Hospital of the University of Pennsylvania who trained in Milan and was in constant contact with colleagues in Milan and elsewhere. Many of the lessons relate to not overburdening hospitals and health systems and protecting health systems. This means mild to moderate cases are managed from home and not in the hospital, through massive deployment of outreach services and telemedicine. It means therapies can be delivered at home or through mobile clinics. The second major lesson from Italy is to protect healthcare workers and doctors. The entire White House team with Dr Faucci of CDC and Dr Brx, head of Infectious Diseases in the U.S. news conference of president Trump March 16, focused on the goal of protecting healthcare workers, doctors and hospitals, so they remained strong to take on the crisis. The second goal of the White House team is to protect the elderly with medical conditions. To do this only the most serious patients are treated in hospitals the rest for mild to moderate at home.  Studying the conditions in Bergamo and other parts of Lombardy and northern Italy, is helping U.S. medical leaders to prepare for the current nationwide effort, the 15 days plan announced by the White House. The lessons from the Papa Giovanni Hospital in Bergamo are important say U.S. medical leaders, including Dr. Brendan Carr, head of emergency medicine at Mount Sinai Health System in New York.  He says build capacity in hospital beds before we need it. Clear out hospital space and add new hospital beds.  ...

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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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The numbers are shocking. In 2019 alone the costs of the Opioid epidemic in the U.S. was $188 billion including healthcare, child and family assistance programs, criminal activities, and lost wages, according to the Society of Actuaries. Now 3 large pharmaceutical distributors and some pharmaceutical manufacturers are hoping to settle the lawsuits by paying $50 billion. The costs to the nation are enormous in human toll and in lost economic activity.

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Ignorance about the risks and benefits of good healthcare was once seen as a problem in less developed countries such as in South Asian region. The coronavirus is changing this so quickly that it leaves one incredulous. This report in WSJ shows how people in the U.S. are questioning the risks of coronavirus, skeptical about prevention measures, and questioning the value of a vaccine. From El Paso, Texas to Boise, Idaho in smaller towns and cities across the U.S. there are higher daily cases because of this attitude. The U.S. had daily cases of new infections of 195,000 on december 2 during the second wave. Compare this with 31,000 in India on December 1 for 4 times the population and one can see that nothing can be treated as given or a state of affairs that will exist in the future- the capacity for change is upto oneself. Even this reversal for the U.S. can be changed starting with a clean slate and a clean heart after lessons are learned.

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Insurance premium rise 2022-2025 is costly for employee wages with employers slow to increase wages when so much money is going into healthcare premiums for their employees. Each year employee premiums in the US have increased by 7% for the last 3 years. $27000 is the cost of health insurance premium for American family in 2025 which is exorbitant and shows a breakdown in the health system that is affecting the cost of living, the wages of workers, and the money left in the economy for other essential needs.

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Affordability should be a major factor in figuring out what is the best place to retire. Climate gets Arizona and Florida the top two spots. Yet considering today's higher cost of living and smaller retirement savings in the U.S., Britain, and European countries, and the higher cost of living in India, China, and other Asian, African, and Latin american countries, affordability should play a much larger role so that savings stretch out and one can afford a better standard of living, more travel and room for better choices in food and other things.  Bankrate for instance gives 40% importance to affordability in its retirement assessment of locations. Climate gets only 15% in this assessment of location. Places which are friendlier, with which you are familiar ar attractive for other reasons. Bankrate gives Nebraska, Iowa and Missouri top ratings in this commonsense approach.  Also important after affordability, are access to healthcare, weather, culture and crime. Bankrate analysis gives affordability 40%, wellness and healthcare 25%, culture 15% weather 15%, and crime 15%. Access to healthcare is a factor that is also included in Affordability as the premium in Florida for Medicare Supplement, is $286  month vs $90 a month in Nebraska. Using a similar approach places in India, China, other African, Asian and Latin American countries countries that are in high demand and have rising cost of living may not be the best places to retire. Using Affordability, wellness and healthcare, culture, and friendly atmosphere and familiarity with having lived there for a time, may be the best criteria with less importance to weather. A better standard of living and access to better things in life with one's dollars or rupees or whatever currency one uses stretch is important.   ...

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The WSJ provides an excellent summary of the positions of the candidates in the U.S. presidential election of 2016 on key issues, education, healthcare, immigration, taxes, national debt, infrastructure spending, and economic growth. Clinton is clear on specifics, Trump has not made clear the details of policies and talks in general terms. On immigration the 2 candidates are far apart, on issues of infrastructure Clinton plans a $275 billion effort to repair the country's infrastructure and Trump says he would make a big effort. On taxes Clinton plans to pay for spending with higher taxes on the rich. Trump says he would provide huge tax cuts, yet make large infrastructure spending without clarifying how this would be done with sharply lower taxes. Both candidates oppose the TPP and oppose trade agreements that lead to loss of U.S. jobs.

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UK underinvestment in health care infrastructure and NHS is leading to it "underperforming significantly," says a King's fund health thinktank study. UK annual capital spending in healthcare is about 0.33% of GDP in 2019 compared to 0.65% in the US. A lack of doctors and nurses is a severe problem for the NHS in UK.

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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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The global minimum corporate tax will enable US, France, Germany, India and other countries to invest more in healthcare, education, infrastructure, in the years to come. Countries that helped tax avoidance shown in this graph in Live Mint are Netherlands, Cayman Islands, Britain, Ireland, Hong Kong, China. The biggest contributor to tax losses for advanced countries US, Europe and India is the Netherlands with $27 billion in tax that is diverted away, as shown in Live Mint.

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The union representing 75000 nurses and pharmacists and other workers in California reached a settlement after a 3 day strike. Julie Shu, acting Labor secretary participated in the negotiations. Kaiser Permanente has 40 hospitals, medical offices and 213,000 employees other than doctors, serving 12.7 million people on the West Coast of the US. A sticking point was outsourcing. It is the largest strike of healthcare workers in the US for wages and benefits.

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Years of poor funding of public health departments in the US, Europe, and other countries have left public health departments lacking basics, lacking staff and resources. Here the WSJ shows how this has affected Alabama in the southern US. Alabama has the slowest vaccination program in the US with 10,000 doses given per 100,000 population. Positivity rate is very high at 29.1% for coronavirus, one of the highest for positive coronavirus tests in US in the past month of  Jan. 2021.

A large portion of the population of Alabama lives in rural areas. These rural areas are some of the worst hit in healthcare in the US. Since 2009 7 hospitals have closed in Alabama resulting from poverty of patient populations and population loss. This is part of the general erosion of rural healthcare infrastructure across the US in the last 20 years. A problem that now faces the Biden and future administrations. to tackle the problems of rural US communities.

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Compare AI models for versions v2 v3 by DeepSeek that cost $5.6 million with Anthropic AI model that cost $100 million+, and one gets the order of magnitude in cost for the new DeepSeek China model vs its US counterparts.  The hundreds of billions of dollars that OpenAI and big spenders such as Google, Meta, and Microsoft would have to drain capital markets would be a disaster for workers and families in the US and the standard of living, the infrastructure improvements that don't get done, and the investments in transportation and other vital needs such as schools, education and healthcare that directly impact the cost of living and the standard of quality of life in America and other countries. This is where competing models from China, from India, and from European countries can get us back to where we want to be to continue improving the cost of living and standard of living, quality of life in America for workers and families. This is the choice workers and families made in 2020 and in 2025, rejecting the wasted resources in wars that serve no purpose, and rebuilding the Nation's infrastructure, its water, schools, transportation, healthcare, childcare.  ...

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"Cancel Culture"- how Democrats and Republicans Conservatives and Liberals see the shaming of people for their views on social media- it is having accountability for some, and seen as censorship or punishment by others. Pew Researchers show the views of different people by age, gender, political affiliation, on the idea of "cancel culture." Some say does it even help doing this on a platform like social media as it tends to exaggerate and is rarely helpful to educate people and create real conversations to increase knowledge. When people are being shamed for racism or sexism, there is little idea of getting people to change or for patient forgiveness, or educating on why certain behaviours are wrong. Yale University's 58 page document on where it went wrong on "holistic admissions" and "cancel culture," is an example of how "cancel culture" when adopted inadvertently at universities and colleges across the Nation can be misguided and not result in positive actions. In the process can this denigrate the achievements of western civilization through the Renaissance of ideas, the awakening of knowledge in Europe in the 17th and 18th centuries, the Enlightenment, and the Scientific Revolution that resulted from this. Followed by the Industrial Revolution unique in Europe and the US that created the Modern World and the standards of living, of literacy, education and healthcare, and transportation we know today. This is the question Yale and other universities are asking today in 2026. ...

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Three million additional Americans get access to Medicaid as a result of the Obama Healthcare Law (Affordable Care Act). Under the law states could expand Medicaid to people less than 65 years old with income of 133% of the federal poverty level of $15,521 for individual or $31,721 for family. About half of U.S. states expanded Medicaid and the rest kept the prior income guidelines. The figures are from a report by the Centers for Medicare and Medicaid Services, which show 58 million Americans on Medicaid in third quarter of 2013, and up to 61 million in March 2014.

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Action to tackle the cost of living crisis taken by G-7 countries France, Germany, Italy, Canada, US, is shown here in The Guardian. France and Germany have taken the strongest action to protect lower income people, the US with the Inflation Reduction Act has taken broad steps to limit healthcare costs and invest in the economy. The UK appears to be the weakest in taking action and the new budget of Mr. Kwarteng is seen in this way as failing to protect vulnerable parts of the population.

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George Bush's administration passed healthcare legislation that allowed private pharmaceutical companies not to have to negotiate with Medicare on cost of drugs. It also passed the so called Medicare Modernization Act that created a huge opportunity for profits through Medicare Advantage Plans. The chart in WSJ shows profits it calls a bonanza. What it means is that instead of reducing the costs of providing medical care to elderly Americans it has increased the cost leaving less and less money for infrastructure for roads and bridges and airports that are dilapidated in the US, and less money for essential services in education and health care, transportation, housing. This has reduced the standard of living and quality of life in America. For healthcare it is providing less for higher cost when compared to China, India, Germany, France and the UK. George W Bush administration put America into 2 wars in Asia and the Arab world which also drained resources contributing to a lack of investment in the country in essential infrastructure and services. ...

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US president Biden's effort to appeal to all American families and workers in the $2 trillion plan for investment in child care, paid leave, healthcare and education, and the importance of staying away from the divisive and polarizing effect of the Clinton years on Republicans, is part of the new approach of the Biden administration as it tackles America's most important problems with hopes for bipartisan support.

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The problem of elites in the US controlling most of the wealth and funding of candidates is discussed in The Times by Matthew Syed. The distortions in the American system of democracy and lack of funding of infrastructure, basics of education, healthcare, and public services, the misallocation of capital by capital markets in the current state, a reversal of everything Lincoln, Teddy Roosevelt and FDR- Truman set out to do, that is a result of the current situation prevailing in America.

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The Biden Infrastructure plan aims to put $400 billion into home healthcare for seniors shifting away from hospitals and institutions. By 2030 one in every five people will be at retirement age in the US, as the aging population surges. Studies show seniors can - if supported by services and the resources allocated by the government - live better quality lives at home for an extended period in retirement. This is an important issue for seniors and the Biden administration after the pandemic.

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WSJ looks at the changes in the way medicine should be practiced in the light of what we have learned from the pandemic.  Medicine practiced before the pandemic and still today relies mainly on a visit to the doctor or specialist who is short of time. There is a shortage of doctors. Patients have many illnesses as a result of decades of neglect of proper nutrition, and exercize habits. Obesity is at about 40% in the U.S. about 30% in the UK and 17% in France, and high also in other parts of the world. These high rates were unknown throughout history and result in many illnesses and increase by four times the vulnerability to the coronavirus. One authority in medicine calls obesity pouring gasoline on a fire for effects of the virus.  A doctor's appointment with doctors short of time with no coordination around a whole range of factors related to obesity, illnesses, health checkups, mental health, is now seen as a heavily handicapped way to practice medicine or for patient healthcare and wellbeing. The alternative is discussed here as the way forward. A  team will be responsible for a patient's care not just an individual doctor. The team would care for general health after a patient's checkup, cover individual illnesses, weight issues, mental health, exercize nutritional needs and other good healthcare habits. Instead of relying on doctors at a time of shortages of doctors the team would be led by nurse practitioners.  A nurse practitioner is someone with a bachelors degree and a masters degree or doctoral degree in nursing with 1000 hours of clinical training. Studies have shown that they are effective and even more effective than individual doctors. Today particularly with the problem of doctors with limited time compounded by the built up problems of decades of bad habits in nutrition and exercize and poor "cultural" habits getting entrenched, there has never been a greater need for a better way to practice real healthcare for a person's wellbeing. Particularly in rural areas with an even larger shortage of doctors the health practitioner led team will play a big role. Patients will under this setting receive more care virtually and get more followup care by phone and video messaging. The numbers tell the story- there are shortages of doctors in USA, Europe, Africa, Latin America and Asia. In the U.S. shortage of doctors is 55,000 projected to 2033 by Association of American Medical Colleges. There are 290,000 nurse practitioners licensed in the U.S. and 131,0000 physician assistants. The goal will be to get an adequate number of nurse practitioners licensed in this decade to take care of these teams. The pandemic has made virtual visits to doctors and nurse practitioners popular. Medicine reimbursement should and would be practiced on the basis of how well a patient is doing not on a fee for each micro service that is delivered. For this to happen the teams led by the nurse practitioner have to commit to patient education of the benefits from good practices and good habits for nutrition, exercize, caring for oneself. A doctor short of time is hardly the person to carry on this patient education which is where the major opportunities for a new system arise. The virtual care also provides a new medium for patient education and awareness of the risks of getting illnesses, preventive actions to be taken in advance. One approach being tested in California and Texas is for a monthly fee for patients more payments by health plans to doctors or healthcare teams if the patient is healthier. Additional health professionals are added to the team including health coaches, dietitians and medical assistants to increase its effectiveness in counseling and education and monitoring.  The nurse practitioner team approach is already being practiced in parts of the U.S. including the example of New Hampshire shown here, and is predicted to be the approach for primary care in the next decade. ...