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US president Biden's $2 trillion Families and Workers plan, for early childhood education, paid leave, healthcare and climate change investment, is coming up for a vote in Congress. Paid leave that also includes maternity leave and leave that would help women return to the workforce, has been added back to the bill. Community college aid was earlier removed from the package with resistance from private colleges that expect to lose tuition paying students, even though male students are falling dangerously behind in attending college without government support. The Biden administration is facing resistance from just a couple of Democratic Congressmen- about five led by a Congressman from New Jersey, and 2 Senators from Arizona and West Virginia- on community college government aid that helps young American men and women from the working class and on paid leave that helps women. Many Republicans have supported taking this action for renewal of America on serious issues that face the country, making it likely that these issues will only become more pressing in the next three years. Sometimes as is happening today some isolated or eccentric situations can block major legislation for the good of the country such as the makeup of a Congressional seat in New Jersey with large pockets of conservative Republicans who oppose spending, and conservative instincts of two Democratic senators from Arizona and West Virginia. This WSJ report looks at Biden's position that deterrence when filing tax returns will generate close to $400 billion and not $150 billion that the Congressional Budget Office says is its estimate. To accomplish this Biden plans to spend $80 billon in large investments to increase the resources of America's tax collecting agency. Much of this was never done and policies geared to where large corporations never paid their fair share of taxes. The first step was to prevent outshoring of headquarters to reduce taxes- and this was achieved in the first year of the Biden Administration with over 100 countries agreeing on a corporate minimium tax. In the same way president Biden now seeks to correct other flaws in the tax system so that much needed investments can be made by generating new revenue not just in infrastructure, but for renewal of America through renewal of support for women, children, and America's working classes. Much of that was badly neglected by different  administrations over the last three decades.     ...

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Biden is a US president in a hurry, says this analysis in The Times. And it says this is for a good reason. Biden as vice president in the Obama administration has watched as time slipped by and much of the hopes remained unfulfilled for infrastructure and other plans including climate change. Biden also has long experience in Congress and long experience working with Congressional rules. He also understands that the Democratic majority may not last beyond 2 years, better to go all out now and lose no time. This is the thinking behind his plan for $2 trillion in infrastructure spending in the first 100 days of his administration, and the idea that he does not need to win Republican support by watering down his plan.

The American people now support this kind of bold vision and bold plan after the pandemic showed the weak nature of presidential plans and aspirations till now for three decades.

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With the rushed approach adopted by the Trump administration not enough consideration was given to winning support in the House from 25 conservatives in the Freedom Caucus. Without their support the bill cannot be passed in the House of Representatives. The fight also includes one over what are essential health benefits including whether  maternity care would be included. As a result some moderate Republicans are also expressing opposition on the grounds that less people will be covered and fewer benefits will be provided under the Republican House plan called AHCA. President Trump has not involved himself in the details, and the bill comes very early in the first 100 days, leading to the perception that health care has become a partisan conflict without really grappling with the problems of high cost of health care and creating a solution that all can support. Democrats are seen as having made the same error early in Obama administration's first term. President Trump sees this as a much needed win with a drop in his approval ratings, making this even less of an effort to come out with a good plan.  ...

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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 major provisions of the Republican House healthcare bill that passed by a vote of 217-213 are- 1. To help people buy insurance coverage the bill offers $2000 to $4000 a year, upto $14,000 a year in credits based mainly on age, reducing them for families making $150,000, individuals making $75,000. 2.  Under the Affordable Care Act insurers cannot charge older Americans more than 3 times for same coverage they offer to younger people, the new bill makes this 5 times. This would increase premiums for older Americans and reduce it for younger Americans. This is the most controversial part of the bill. Older Americans supported the Republican party in the presidential election. 3. The new bill ends Medicaid as an open ended entitlement and places this on a budget with cuts of $880 billion over 10 years. 4. To mollify conservative Republicans a provision allows state to opt out some provisions of the ACA that requires minimum benefits such as maternity care and emergency services. It retains coverage for pre-existing conditions to mollify moderate Republicans. The bill provides states with $138 billion over 10 years to subsidize premiums, provide coverage for pre-existing conditions, mental healthcare and drug addiction. 5. The bill removes the taxes imposed under the Affordable Care Act (ACA) on high income people of about $300 billion over 10 years by repealing a payroll tax increase and tax on investment income. This bill and the ACA offer 2 competing visions on healthcare, both bills passed only by a margin of 4-5 votes in the House. The ACA overlooked the impact on premiums causing discontent among middle income Americans. The new bill lets premiums rise for older Americans in order to keep premiums down for other Americans. This shows the many tradeoffs involved and choices being made, and the lack of a consensus on the issue of healthcare in the U.S., becoming a highly politicized issue instead of the way it is treated in western Europe.     ...

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Al Maktoum is prime minister of Dubai. He points out some important facts about the Arab world. About half of the 300 million people in the Arab world are under the age of 25. Unemploment is very high among these 150 million Arab youth. About 50% of the jobless are youth, according to the prime minister. About 65 million of the Arabs are illiterate, and 10 million children under the age of 25 are not enrolled in any school. He points out that with so little education, the Arab youth are especially vulnerable to propaganda that creates extremism and is hostile to the west and the USA. One of his key points is that the Arab world is the most militarized place in the world, and spending on conflicts in the Middle East in the last 60 years is about $3 trillion. And in the last 15 years he says the spending on education which is 20% of what the world's 30 wealthiest countries spend, has dropped to 10% of that amount. And very little is being done to educate girls and give them opportunities. As a result of these convictions, Al Maktoum, who is also the ruler of Dubai and from the royal family, has committed about $3 billion to various initiatives to provide schooling to children, especially girls, and education for young people. This makes him one of the more enlightened leaders in the region pushing for new directions. This also reveals the critical weakness among the Arab peoples and why they tend to be so radicalized. Improvements in education and more opportunities for jobless youth, and creating a peaceful region -with the US and the EU countries committing to policies that lead to much diminished military sales to Mideast countries and reducing hostilities in the region -would do more to reduce anti-American sentiment in the region and improve US security than any other policy actions. As Iran, Pakistan and Afghanistan, and the Muslims of India share the same characteristics as the Arab peoples, and the same cultures, the same is true of this region, actually more so. Education has been even worse neglected in the South Asian Muslim region than among the Arabs. It is the key to peace, does more than troops to ensure the peace. The need is for more schools to be built and run in the region, for essential services like healthcare and development, and financing of job creating industries. ...

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Sharply lower consumer spending is hurting Apple sales in China. Apple cut sales and issued a sales warning in January 2019. This follows Apple's sharp slowdown in India with its uncompetitive pricing.

Retail sales growth in China- which bounced back in previous downturns- dropped to the lowest level in 15 years in November 2018. Auto sales are down with the sharpest drop in 7 years- the first annual drop in sales since 1990. Fears of a housing bubble have led to restrictions on home purchases for speculation which have not been lifted. Income tax reduction has not increased spending. GDP growth for the fourth quarter dropped to 6.4%.

Further signs of a sharp pullback are seen in the drop in consumption tax revenue falling by 61% in October and 71% in November 2018. The consumption tax is placed on cars, gasoline and luxury goods, and is paid by the companies making the products.

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Health and Education are the best bets for investment to revive the economy. BW's Mandel says the health and education fiscal channel is still functioning, while other ways of stimulating the economy are in breakdown mode. Taxpayer money given to banks, businesses and households will be saved to pay down high levels of debt and because of uncertainty. But funds directed to schools and hospitals will be spent to buy new equipment, modernize and update, put up new buildings, and hire workers. Health care especially is keen on hiring new nurses, medical technicians, home aides, and so on. And over the past year health care and education workers have risen by 500,000. In these hard times the hardest hit areas like Michigan have seen health and education make up 23.7 % of jobs, while manufacturing has dropped to half that, only 12.5%. And in the past decade health and education has had a stabilizing influence already. Nationally these areas have hired steadily, adding 5.3 million jobs since 1999. Meanwhile the rest of the economy has seen booms and busts, and off shoring and outsourcing overseas, with only 400,000 new jobs created in 10 years. Education has suffered neglect for needed infrastructure including broadband and internet capabilities for classrooms, and health care suffers inefficiencies such as computerization of records, and cost inefficiencies. These areas can be modernized and improved, adding to benefits years from now. They are large sectors employing 30 million workers or 22% of the workforce, and now badly needed to stabilize the economy as these employees are well paid and could help keep consumption from falling badly. A Gallup poll taken in February, shows 56% of Americans showed that education investments were "one of the most important items " for stimulus spending, coming out on top, and beating tax cuts....

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The costs of fraud in medical care from spurious Medicare claims to kickbacks for unecessary services is estimated at $125 to 175 billion. Costs of unnecessary care from overuse to unnecessary lab tests are between $250-325 billion. The amount wasted for on treatment for preventable conditions such as heart disease and diabetes. is $25-50 billion. This number is much higher when all the complications from obesity are figured in. These amounts alone add up to $500 billion. Add to it the problems and the costs of medical errors leading to bad drug reactions or other misdiagnosed procedures which cost an estimated $75-100 billion and the the total is upto $600 billion. These amounts are not going to be tackled by computerization of medical records. The whole manner and ways in which medicine is practiced today and the manner in which the public takes care of its health would have to change for an impact to be made in these numbers.

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Biden sees his plan for American workers and families put together in the $3.5 trillion spending package that covers child care, education, healthcare, services, climate change proposals, infrastructure building, as a way to show that democratic governments can work for the people. After two decades when American workers and families were largely put aside in the nation's priorities during a tech driven and capital markets driven expansion that benefited large corporations, America is returning to its core concept of government by the people, for the people, of the people. White House officials say this is to be seen even in the program he put forward in his upset victory many years ago for the US Senate from Delaware. Because economic strength of America depends on a strong middle class, and strong working class, strong families, and underpins the world leadership role of America, even Republicans and hesitant Democrats, cannot give in to the current situation of doing nothing or too little for workers and families which weakens America. And at a time when its leadership role in Asia and Latin America, Africa is sorely needed. The size of the package in $3.5 trillion is because too little was done in the past in the mistaken acceptance of Reagan policies of no government role in the economy- surrendering this role of guidance entirely to the capital markets driven from New York, London, and Silicon Valley. The rise of China today, and also of Japan and South Korea, and of India as it plans for 2030 shows that government guidance of the economy is needed in global competition. Trade entirely driven by capital markets, without a role for government to emphasize national priorities in spending can lead to disastrous results such as we see today where manufacturing even in critical fields such as healthcare, semiconductor driven technology, entire parts of the economic structure are ceded to China and supply chains outside the US. German elections are also leading in the same direction with Social Democrats emphasizing national priorities in child care, education, healthcare, and delivery of social services, building of infrastructure. And the Greens emphasizing climate change. Merkel in Germany and in the European Union, her predecessor Schroeder, pursued policies of no government role in emphasizing and articulating national priorities, in a way that past US presidents have done, resulting in the CDU falling to 20% support in the September German elections. Across all parts of the world, from India, China, to Europe and the US, the focus is on government voicing the national priorities  and allocating funding instead of capital markets driven from London, New York and Silicon Valley, or capital markets in Shanghai or Mumbai, as the pandemic runs into its second year. ...

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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 is an exceptionally humorous operating room story of Dr. Trump and Dr. McConnell by Kristof of the NYT. Sometimes humor tells the story- and Kristof does this using a story of a surgeon president Trump in the operating Room trying to address the concerns of the patient Janet, as he keeps telling her she needs a new heart with great benefits, great benefits, before she implodes or goes down failing. Flat out take the old heart out even if a replacement hasn't been found, believe me great benefits the surgeon tells her, just that the patient just isn't getting convinced as its happening to her. The analogy is with replacing a health care plan, not just the Obama plan, any plan without something to take its place. For a few days before this article by Kristof, the Republican effort to repeal the Affordable Care Act without having a replacement was presented as a good idea. Janet is like the three Republican women- Collins of Maine, Capito of West Virginia, and Murkowski of Alaska who wanted to keep the heart they had till a replacement was found, against the surgeon Trump's advice. In a way it is about politicians in the last decade who never had any discussions as they rushed through with their own agendas, as the Republican and Democratic health care plans were rushed through Congress with relatively little participation and debate to hear all viewpoints. ...

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The French system what works and what does not work compared to the Anglo-Saxon systems of Britain and the USA. Health care works, public transport and high speed rail works, nuclear energy and the energy industry works, education works for small elite universities but fails in the larger system. The large public projects are executed well, and France has done well with its long tradition of the state building infrastructure projects. But when it comes to individual initiative and starting up new companies such as in computers and high tech of that kind, France does not do so well. And the state collects a larger proportion of taxes than in other countries to finance these benefits. France is also good at rule making, which serves it well in controlling the kinds of bubbles that regularly hit the Anglo-Saxon countries. And with 21% of jobs of all workers in France in the public sector and government, with 49% when one includes related sectors protected from economic downturns, the French workers are much better protected than workers in Britain, USA and other countries from economic downturns. Unemployment stays high in upturns and at 8%, and in downturns does not go too far above 8%....

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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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Total public and private spending on health care in the U.S. will increase by 6.1% in 2014 compared to 2014 in a revised Commerce Department forecast. The total spending will reach $4.1 trillion in 2014 from $3.9 trillion in 2013. Some of the lower rise in spending than the earlier 7.4% forecast will come from 28 states opting out of Medicaid expansion under the health care overhaul because of a June 2012 Supreme Court ruling. Employers are trying to reduce costs and the public is reducing spending because of the recession. Less generous health plans mean users are paying more out of their own pocket, paying more attention to prices and even postponing care. Growth in health care costs is a about 3.9% a year since 2009 following the recession. The costs increase in 2015 by 5.8%, in 2018 by 5.9% and 2022 by 6.5%, according to U.S. government forecasts, because of enrollment in Medicare for baby boomers. This is still higher than the inflation rate of below 2%.

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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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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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How the French health care system works. France comes in first and the USA 37th in aWHO health care ranking. THe difference in deaths from respiratory disease is half that in the USA, and lower rates of death from heart disease and diabetes. IT has more hospital beds and doctors per capita than the USA. 65% of French people are satisfied with their health system compared to 40% in the USA, and yet France spends 10.7% of GDP on health care and the USA spends 16% for poorer results. THe French system is more generous to its seniors. Unlike Medicare there are no deductibles, just modest co-payments that are often dismissed for chronically ill. And diabetes and critical surgeries are covered 100%. French also buy supplemental insurance like Medigap for extra expenses like dental and eyglasses. Cancer patients are treated free of charge. Avastin treatments costing $48,000 a year are provided at no charge. France's PMI or Protection Maternelle et Infantile, is rated highly. It is anetwork of thousands of healthcare facilities, that ensure that every mother and child in the country receives basic preventive care. Mothers even receive afinancial incentive for attending their pre and post natal visits. France makes this care affordable by reibursing doctors at a much lower rate. The average yearly net income for doctors is around $55,000, about athird of what doctors in the USA make. But French doctors don't have to pay back huge student loans as medical school is paid for by the state and malpractice insurance premiums are only a tiny fraction of that in the USA. And again the French government pays two thirds of the social security tax for most French physicians- which is typically 40% of income. So the $55,000, is more like $92,000 taking that into account and more like $110,000 when student loans and malpractice is taken into account at US levels. Specialists who have 4 or more years experience can charge what they want, but as one gastroenterologist says, there in an unspoken and undefined limit to what you can cahrge or what is socially acceptable. Yet even in France there is inflation in health care costs that the government deals with through price controls and more spending. The French national insurance system is running increased deficits each year and this is now $13.5 billion, and it has led to higher taxes for employers and workers. ...