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The Washington Post survey of 1200 readers on how the Republican healthcare plan of Speaker Ryan and the House of Representatives looks to them, how it affects them in their lives. Here Somasekhar of the Post gives the stories of 5 Americans. Some see the prospect of losing their insurance under the Republican plan even as they reach an older age, others a smaller segment says the Post, whose premiums jumped under the Affordable Care Act say they faced high premiums and high deductibles. The Post says the large majority of opinions have expressed anxiety over the proposed Republican Ryan House plan for healthcare. One of them is an uninsured poor farmer, Mr. Woosley,  income about $18000 who gained benefit from expanded Medicaid under the Affordable Care Act,  one Mr. Smith, 32 years, a personal injury attorney who faces paying $10,000 if he did not take insurance and $10,000 if he took insurance because of high premiums so a wash either way deciding to do without it, one a tech worker Mrs. Powers, 62 years, income $22,000 on year and $4000 the next, from middle class during the tech boom but facing fewer opportunities and uncertain income from part time work, hit by the deep recession facing fewer opportunities as she gets older and now the prospect of losing insurance without government subsidies, one who is from the middle class who sees little benefit from the Affordable Care Act and is forgoing insurance because of the high premiums yet faces a penalty for not being insured under the ACA, another Mr. Blanchard, 52 years, is from the middle class, a computer programmer who lost his job in downsizing, earns $100,000 as a consultant self-employed, pays $767 in premium a month and relies on the Affordable Care Act which helps him gain freedom from working at a company that could downsize,  another is a middle class programmer Mr Riffle,age 44, and his wife, who does not qualify for a subsidy with a $71,000 family salary from working 4 jobs between himself and his wife- this person finds it too expensive for his salary to buy insurance $900 a month and $14,000 deductible under the Affordable Care Act. His views are worth listening to as they go to the crux of the problem- he says he may not be any better with the Republican plan. He sees the real problem as the high cost of health care in the U.S. and the only way this can be fixed is for members of Congress to be asked to use the insurance exchanges they create. If this sample is representative it shows that there are real problems with both the Affordable Care Act and the Republican plan, that the high cost of health care the problem lurking behind every plan that does not squarely address this, and till that happens and members of Congress experience what ordinary people face, this problem can never by fully solved.   Woosley, Smith, Powers, Blanchard, Riffle, and their personal experience is at the crux of what is right and wrong  with the Affordable Care Act, and also with the new Republican plan of Speaker Ryan and the House of Representatives. For every Woosley, Powers and Blanchard who benefit, there is a Smith and a Riffle who are indifferent or are affected by the high cost under Affordable Care Act and the current system of medical care with its high cost. The Affordable Care Act does not  tackle high cost, for that to happen the culture in America that makes it possible and acceptable to charge high prices must change. Another problem apart from bringing health care costs is that any solution needs to have the whole country behind it. If the notion that all people are entitled to basic health care is to stand, the whole country needs to believe it as they do in countries like France, Britain, Germany and Japan. If this has to be made a workable proposition health care has to be offered at a price that makes this possible to achieve, and that idea also needs the deep and broad sense of support from the culture in America similar to that in these other countries. Until that happens politicians in America will get elected and turned out of office in turns on issues such as health care, based on which side they take and which problems they choose not to face squarely and responsibly. ...

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The U.S. Senate passes a motion that allows the chamber to proceed with a debate on a health care bill. The motion passed 51-50 with Vice President Mike Pence casting the deciding vote. Republican Senators Collins and Murkowski voted against the motion. This report in the WSJ says this sets in motion a process in which debate will take place and amendments will be made. It is not clear what shape the bill will take. Under the process used only a simple majority is needed in the Senate, yet this allows for many amendments to be made.  Only hours after this motion passed by one vote, a bill replacing major parts of the Affordable Care Act failed to pass 57 votes against and 43 in favor. Senator John McCain who arrived in Washington from Arizona following brain tumor surgery, delivered strong criticism of the way the Republican healthcare bill was rushed through allowing very little debate. Experts have commented on the way the bill was rushed through with a thin majority for passage, with very little debate, first by Democrats in 2009 and now in the House by Republicans. With the same pattern now followed in the Senate by Mitch McConnell, the Republican leader in the Senate. A backup bill would remove just the individual and employer mandates and a tax on medical devices- the elements Republicans agree on, if no majority can be put together for the healthcare bill. ...

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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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U.S. healthcare spending of about $3 trillion comes with poor results. The cost per person is about three times that of countries such as France, Britain, yet the results show U.S. doing extremely poorly. The author points out that less spending on healthcare and more on social services in areas such as education, nutrition, housing and other services would improve the outcomes and results. It is this missing factor that is helping other countries in Europe, Japan and China achieve better outcomes and returns per dollar spent.  Social spending can affect such things as nutrition, exercize levels, lifestyles, housing and result in dramatic improvements in obesity levels for instance, or inflammation levels in the population that play a role in many diseases. The idea is prevention. This is not happening because higher health dollar spending has lobbies to support it. Social spending also is a dollar expense that shows up immediately whereas results are spread out into the future as a longer term benefit with healthier populations that need to consume less healthcare and treatment. Elizabeth Bradley, president of Vassar College is an expert on this subject. She says social services spending gives more bang for buck  in health outcomes.  The point is relevant also for countries in South Asia and Africa that have taken some on some aspects of the U.S. health system resulting in health care spending that does not deliver the most for the dollar spent, and ignores the critical role of prevention.  The solution lies in moving these health care dollars out of the health care spending and into education for health outcomes, lifestyles, exercize habits education, and into social services that enable prevention and better health. ...

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Studies have shown that the root causes of the obesity epidemic are lack of education and cultural lift in the food intake and lifestyle of Americans, Europeans, with just moderate adjustments in the food and in exercize routines yielding as much or more than the 15%-30% improvement from weight loss drugs that when withdrawn for the low income demographic leads to further deterioration. For men these simple improvements also lead to improvements in the prostate and a healthier happier lifestyle reducing significantly the number one cause of cancer for men.  Yet pharmaceutical companies and the healthcare industrial complex in the US continues on its course like a mighty Mississippi roaring America into oblivion. This report says companies that dominated the weight loss industry are now facing knockoffs that wipe out a large part of the market of a Danish maker of weight loss drugs, with the panic facing obesity hit America hitting the healthcare complex that cares little about lifestyle education. ...

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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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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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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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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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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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The Affordable Care Act or Obamacare gave families of 4 with incomes of less than 125,000 or single income less than $60,000 a chance to buy insurance with federal subsidies. When these subsidies were increased under the IRA Act of president Biden the enrolment has doubled in the last 5 years to $24 million. These subsidies expire in 2025. Under the One Big Beautiful Act the policy of subsidies for ACA is not being renewed when it expires in 2025. This shows the band aid approach of Obama to healthcare and the lack of a comprehensive approach. The policy on migrants during the Obama and Biden administration also stretched public funding resources. Insurance companies now plant to make up for the los of subsidies from the government by raising prices for this subpopulation in a broken healthcare system in the US by 15-20%. This report in WSJ shows a young woman on ACA insurance in Illinois with a payment of $590 a month to Blue Cross of Illinois facing a new payment of $678, almost the size of a mortgage. ...

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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.