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Brooks says no to the current health reform bill as most experts say it does little to control the bulging healthcare cost curve which will take it from 17% of GDP to 22% and beyond. He goes over the pros and cons. Passing this gets little done for health care reform in a fundamental way that is so badly needed today. Says Brooks the system today is rotten to the bone with opaque pricing and insane incentives, with consumers insulated from the costs of their decisions, this won't change with the current health care bill. In fact he says according to the chief actuary for Medicare it will cause health care spending to grow faster. At this rate we will be giving more money to insurance companies and programs that have great social value like expanded preschool and other needs that America has will be shoved aside. In coming years as the population of America ages there will be growing needs for health care. With no increase in supply, and the perverse incentives still in place, prices will continue to grow rapidly without the focus on efficiencies that is badly needed. Brooks points out that its not the politics is the chief obstacle to reform as most people say, but the reverse is the truth, unless one gets the fundamental incentives right politics will be terrible forever. ...

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The public option as anecessary step for effective cost control in healthcare in the USA. The potential for higher healthcare costs in the future gutting the whole effort to provide universal health care if there isn't the money to pay for it. Which means that if the public option brings costs down its anessential part of any healthcare program that is sustainable years from now. Krugman calls for audacity from the President.

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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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Under a new program to increased spending on healthcare from 1.3% of GDP to 2.5% the Indian government plans to provide free pharmaceuticals at state run hospitals. This is expected to cost $5 billion over 5 years. Initially 350 drugs would be on a list of essential medicines and would be purchased from generics manufacturers in India. Dr. K. Srinath Reddy, heads the committee advising the Indian government on healthcare. He says this will help improve access to medicines for the vast majority of the people. Estimates show 70% of out of pocket medical costs for Indians come from spending on drugs. About 40 million people are pushed into poverty each year because of the high cost of medicines, says Dr. Reddy. He said that in 1984 31% of the medicines at government run hospitals were provided free to admitted patients, dropping to 9% in 2004. For outpatients this dropped from 18% to 5%. The free medicine program would be part of a larger universal health care program to be introduced over the next decade. India's large generics pharmaceutical industry makes the provision of free medicines on a large scale a feasible option in India because of the lower prices, with additional pricing advantages when purchased in larger volumes by the government. This would also have a major impact on the quality of healthcare in the country of 1.2 billion people for a relatively small investment. It also promotes a sense of fairness and equal access because the benefits of decades of modernization have been unevenly distributed and because of widespread poverty....

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Lack of ammunition on the Ukrainian side. Russia losing huge numbers of casualties as a large part of its army is committed to the war. The sense of a war no side can win. Dysfunctional aspects of foreign policies in Europe that will cost $138 billion to $750 billion to fix by rebuilding damage in Ukraine, money that could have been used in the absence of the conflict to support the action against climate change and in development needs after the pandemic devastated economies of many countries. No country has surplus money after the pandemic- NYT reports today that China is struggling to meet the high health costs of the elderly during the pandemic. India has huge needs in transport, logistics, housing, healthcare. Both India and China lack a system of social security like that of the US and EU countries. 

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Questions about the true cost of the Obama health care legislation and the assumption that the legislation cuts the deficit by billions of dollars. This WSJ editorial says one has to look at this closely, and not merely look at CBO projections, which may be based in a certain context and not reflect the true costs, especially because many accounting gimmicks and use of numbers to present a particular picture is taking place. The information this editorial cites is that: it uses 10 years of taxes to fund six years of subsidies, Social Security and Medicare revenues are double-counted to the tune of $398 billion, a new program funding long-tem care frontloads taxes but backloads spending, and the assumption of an automatic 25% cut to physician payments that Congress is unwilling to authorize. Rep. Rand Paul has tried to present an alternative view which needs to be studied just as closely, because of the enormous impact of a jump in spending at a time when the public finances are fragile. WSJ also cites the work of Richard Foster, the chief Medicare actuary, as an alternate perspective of how things could turn out, Doug Holtz-Eakin, and Eugene Steuerle. It calls for common sense in evaluating programs, entitlements, defense or other government spending. They not only cost money, but costs escalate over time as history has shown over decades, till they eventually are discovered to be not affordable unless the middle class is willing to dig deeper into its finances to pay for them. Alternate perspectives from a range of informed opinion, Howard Dean, Martin Feldstein, and the head of Harvard's Medical School show that the issue needs to be looked at closely and carefully and cannot be something in which CBO numbers can be trusted to tell the whole story. Especially when common sense, history, and informed opinion across a spectrum of thought advises caution, and fragile public finances also suggest caution. Howard Dean, former Governor of Vermont, says the health care bill is not real reform, and may do more harm than good. He says in a Washington Post article, December 17, 2009, the Obama health care bill does not insert competition into insurance markets, does not significantly reduce costs, and does not improve the delivery and use of health services. It was he says done with a political calculus and crafted for votes not real reform. Jeffrey S. Flier, Dean of the Harvard Medical School, gave the Obama health reform bill an "F" grade, saying in a Nov 18, 2009, WSJ article, that it was disingenuous to call this reform, Congress and the White House were simply deceiving the public. He said the bill will accelerate US health care spending, postpone most of the major health care problems, expecially the ones that drive cost, including the "fee for service" system and delivery of health care. He says in his discussions with economists and other health care leaders the opinion was unanimous that the bill will accelerate health care spending. He cites Massachusetts as an example, where access to care was expanded under the same dysfunctional system, and spending went up, and it doesn't work. Feldstein, who in early 2008 suggested proactive solutions to the mortgage debt crisis which were never adopted, says that the Obama health care law means higher taxes in the long run to pay for the $1 trillion cost of health care for the uninsured group over 10 years. Feldstein says that the Obama plan is to cut Medicare to cut spending, and will reduce the amount of medical services, as reduced spending comes from fewer services, not reducing payments to providers. And he asks if the cost reductions are weighted too heavily towards reduced services and not reduced payments to providers ,would this result in large cuts to services to affect the quality of healthcare for the 85% of the American people who are accustomed to a different pattern of healthcare. ...

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About 53% of the uninsured Americans disapprove of the Obama health care law, in comparison to 51% of the insured with health care coverage who disapprove of the new law. About 35% of the uninsured say they are likely to pay the penalty for not carrying insurance, and six of ten uninsured say it will make their health better. Overall the approval of the law is at 39% and disapproval at 50% in the Dec. 2013 poll. A striking part of the poll result is that 57% of the uninsured say it will increase their health care costs, compared to 52% of the insured. Only 20% say it will decrease their health care costs. This reflects the lack of serious controls on the surge in healthcare spending in the law. A separate research shows that more of the costs are passed on to users who will pay higher out-of-pocket costs after the law.

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The National Health Service in Britain is struggling under the effects of budget cuts, covid delays, and an aging population, says the WSJ. With the cost of living crisis and the Tory resistance to wage increases when nurses are found turning to food banks there is now a strike by healthcare workers. A former head of the NHS says the UK healthcare system is facing a crisis like nothing he has seen in his career. The UK has mistaken cheapness for efficiency in its approach to health, and it is now coming to roost. It is coming apart- people with heart attacks have to wait average one and half hours for an ambulance. Hospital beds are scarce tuning patients away. One in ten are on waiting lists for non emergency surgeries. 

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Using the equivalent of 5 nuclear reactors in energy as Altman pushes AI to do means neglecting the needs for climate change action and for education and healthcare priorities. The huge diversion of funds equivalent to the GDP of European nations is absurd. It would put Democracy at risk even more as literacy shrinks as less and less investment in made in childcare, education and increasing access to education to all, and less and less investment is made in healthcare and increasing access to healthcare, as capital markets are pushed into highly and dangerously distorted allocation of our resources. As shown in the Washington Post article below Andrew Van Dam- about 30% of Americans already read no books at all, or lack the access to books and knowledge to participate effectively with civic preparedness. And could throw the Nation into political and economic chaos without the necessary knowledge for effective participation. Catherine Rampell of the Post shows above that every $1 invested in free preschool day care would return $6 in economic benefits, according to Yale Brown universities study, not counting the educated workforce for the Nation's future. ...

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About half of private equity investors have money tied up in zombie funds in 2024 according to JP Morgan Chase. US state and local governments manage about $5 trillion in pension money. Large public pension funds have 14% of their money in private equity. And large corporate pension funds have 13% in private equity. California's worker pension fund will have put more money into its private equity part of its investments than it gets out 8 years in a row. CALPERS and California Teachers Pension funds are funds which have take out loans of 5% to 10% of fund holdings to deal with problems of private equity investment. Pension funds are selling private equity funds takin a hit. At a time when retirees such as teachers and public sector employees are facing cost of living and high healthcare costs they can ill afford such losses showing how widespread capital misallocation is today. 

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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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Problems that are emerging as the AfD takes up role of Opposition in legislatures at the state level in Hesse, Thuringia and Bavaria. Finding proactive solutions to immigration, cost of living concerns and investing in infrastructure, in education, healthcare, childcare  that would improve the lives of people would go a long way to strengthening democracy at the local and state level in all parts of Germany with the help of the federal government.

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A new West Coast Model is emerging with ballot measures in the states of Washington, California and Oregon. The model is to make up for decades of faulty income distribution which favored tech communities in west coast states leaving behind people from minority communities and the working class outside tech hubs such as San Francisco, San Jose and Seattle. During this period budgets for education and healthcare, social services and essential infrastructure suffered as budgets were squeezed for local governments. Minimum wage also lagged behind and communities struggled to keep up. Washington votes for a ballot measure that raises the minimum wage to $13.25 statewide and mandate paid sick leave for workers. In California a ballot measure makes permanent an income tax surcharge on millionaires to use these funds for education. In Oregon measure 97 places a gross receipts tax on corporations with annual sales in Oregon over $25 million, raising $3 billion a year for schools, health care and other programs. The California and Washington measures are likely to pass, Oregon uncertain, say experts. And even in Oregon supporters have learned from the experience to put forward new proposals on the ballot. The Washington measure is supported by Nick Hanauer, and Zach Silk, president of Civic Ventures in Seattle, who say it is essential to put more money in workers wages to increase growth and to bring better lives outside the tech hub areas. Most of the tech booms of the last two decades have not touched the areas outside tech hub metropolitan areas. The conservative approach adopted in Louisiana and Kansas of reducing taxes first and then when holes in state budgets developed to cut education, health and other service expenditures has not worked, and it has led to the backlash in the form of the new West Coast Model, which is expected to be brought up in other states in the east and midwest. The tech hub areas have grown with the boom in tech but this has largely ignored the rural areas, communities just outside of the tech cities, and led to uneven and distorted growth shortchanging the working class and the middle class, and hurting investment in education and healthcare across each state. Bill Whalen, a research fellow at Stanford University's Hoover Institution conservative think tank ,says that its hard to deny that the balanced growth for all communities across the state has lagged far behind as the tech booms boosted growth in the economies of California, Oregon and Washington. An article in the German online site Zeit on Silicon Valley described this vividly showing how this can happen in communities sitting side by side in the San Jose area, with minority Hispanic communities and working class communties seeing very little of the benefits of growth. ...

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With a shortage of nurses and healthcare workers, some hospitals are dropping the vaccine mandate for healthcare workers. Shortages existed before the pandemic. The burnout for healthcare workers led to people dropping out. The lure of high pay has also led to nurses to travel to hot spots further crimping supply of workers. Recently workers who do not want ot get vaccinated have quit the industry or lost their jobs, some have left for facilities that do not follow the vaccine requirement. CDC estimates 30% of healthcare workers at 2000 hospitals in the US are unvaccinated as of September 2021. The Biden vaccine mandate would be effective for second shots by Jan. 4. A federal judge in Louisiana has ruled in Nov. questioning the president's authority for a vaccine mandate. Following that ruling HCA, AdventHealth, Tenet, Cleveland Clinic are among the hospital chains reversing earlier decisions for vaccine mandate. Other hospital chains in California Kaiser Permanante and in New York Northwell Health have kept the vaccine mandate. Kaiser had 98% staff vaccinated, with a similar situation at Northwell. Kaiser has 210,000 employees and Northwell 77,000. Utah Mountain also has 98% vaccinated.  Research on vaccine mandates suggests them to be effective. U Penn psychology research shows people are more likely to get encouraged to get vaccine than discouraged with a vaccine mandate not vaccinated working in healthcare in September will shrink considerably by January. ...

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The differences in the Democratic party between conservatives and liberals that make it difficult to get things done in healthcare, energy and other areas. The lack of White House leadership in a number of areas, and in anumber of instances. The lack of Senate leadership on these issues with the Senate not having done much in energy and healthcare legislation. Add to this the influence of the $133 million that lobbyists spent in the 2nd quarter 2009 alone. The failure of Republicans and Democrats in Congress to push vigorously for cost control in the health care industry adds to these problems.

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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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How companies like United Health are lobbying aggressively to shape the new helathcare legislation to their benefit. BW says the health insurers like United Health, Aetna and Wellpoint are already winning through clever and effective lobbying of Congress. Former Senator Tom Daschle works as aconsultant for United Health. Senator Conrad who has led aeffort to replace the public plan with nonprofit medical cooperatives, which would be a weaker competitive threat to insurers, is also influened by the insurers. United Health's CEO Helmsley and its person working with Congress on healthcare Simon Stevens met with Conrad on June 4. When lawmakers in Congress cite consulting group Lewin Group, that 88 million or 56% of those with employer provided coverage would desert private insurance for a government run program, they are quoting acompany owned by United Health. The Congressional Budget Ofice says these numbers are too high. United Health has used savy presentations on how to cut costs, and help Blue Dog and other Democrats articulate their positions, to gain influence in shaping the plan to their interests. United Health thus counts a lot with Matheson, and Mike Ross of Arkansas, who are prominent with the 52 Blue Dog Democrats. and with Senator Mark Warner of Virginia. And United Health put together an effective lobbbying group, even hiring the chief of staff of House Democratic leader Steny Hoyer. ...

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Values of St Augustine are to be celebrated with Vance, and of Mohandas Gandhi with Harris. Then why the discord? End wars (Biden ending the war in Afghanistan). End migrant incursions Harris pledge to sign the Lankford-Biden legislation into law that fixes asylum entry and Closes the Border with Mexico. Cost of living that hurts the needy and middle class the most. As Applebaum writes about Housing costs Trump has no plan, Harris is willing to put government resources into it. Republicans have their hands tied by a hands off government that is supposed to do nothing and hope everything will work out. That is without corporate housing company greed in a system that doesn/t work -they set the prices too high. As Kristof writes about in the NYT the Republicans will not support paid marital leave, will not support child care assistance, will not support cuts to high pharmaceutical costs, making healthcare unaffordable even to the middle class not to speak of the lower income working class. And will not support investment in the infrastructure that is crumbling around us even as the infrastructure is crumbling around us, like the bridge in Baltimore that went down in minutes. Trump used infrastructure issue in 2016 and rightly so, and talked about it being Infrastructure Week every week, yet did nothing for infrastructure, nothing serious until Biden in 2016-2020. This a continuing project for Harris. Part of this is to end the wars (Biden's efforts in Afghanistan ending it). And end the migrants incursions, Harris 's pledge to sign the Lankford-Biden immigration bill that fixes asylum entry and closes the US Border with Mexico. ...

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Peas, legumes, beans are a CLEAR WINNER says the Oxford Environmental Institute, both for reducing emissions related to climate, and for fibre, vitamins and minerals, and cost.

Dr Marco Springmann, from the Environmental Change Institute, Oxford says-

 “Unprocessed legumes such as peas and beans were the clear winner in our assessment. They performed well from all perspectives, including nutritional, health, environmental and cost."

Next come tofu and tempeh and other vegetarian processed foods. Beans are the simplest and the highest in fibre, helping to increase life spans by 6%, which with good sleep and clean air, exercise and other nutritional content ,could add up to increase lifespan by a fifth and significantly improve the quality of life, reduce unnecessary healthcare visits and cost when attention is paid to the very basics of the basics.

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Samuelson points to the risks to the American economic growth from excessive health care costs. This is hurting take home pay and shows up in consumer spending. It is hurting government spending in other areas such as needed infrastructure spending and efforts to reduce the deficit. This hurts private capital investment to create jobs because of lower demand from constricted consumer spending. The U.S. budget has as its largest single expense 27% on health care compared to 20% on defense the next largest expense, with growth in health care spending taking this to one third of the budget in coming years. Without addressing health care, says Samuelson, the Supercommitte in Congress even if successful at deficit reduction will basically have failed to do its job, and it did not have the time, resources or conviction to do this. According to a new study from the Organization for Economic Cooperation and Development (OECD), U.S. healthcare spending per person is $7,960 per person in 2009. This compares with Norway $5,352, Britain $3,487, France $3, 978, an OECD average of $3,233. Life expectancy in the U.S. is 78.2 years, compared to Japan 83 years, OECD average of 79.5 years. Chile and the Czech Republic have life expectancy equal to the U.S. Except for cancer care where the five year survival rate is 89.3% in the U.S. and the OECD average is 83.5%, the U.S. lags far behind in much needed critical areas such as diabetes and asthma. Rates of emergency hospitalization for asthma are 3 times that in France and 6 times that in Germany and Italy. The U.S. has fewer doctors per thousand population and higher cost per medical procedure- with more frequent use of the costliest procedures- creating a supply shortage that induces higher prices, and less preventive and early action care through physician visits. The number of practicing U.S. doctors is 2.4 per thousand population in the U.S. compared to 3.1 per thousand for the OECD average; and number of annual doctor consultations 3.9 per capita in the U.S. versus 6.5 for the OECD average. Appendectomy cost $7,962 in the U.S., $5,004 in Canada and $2,943 in Germany. Coronary angioplasty cost $14,378 in the U.S., compared to $9,296 in Sweden, and $7,027 in France. Knee replacement cost $14,946 in the U.S., $12,424 in France, and $9,910 in Canada. Knee replacements, angioplasties and MRI exams are twice as common in the U.S. compared to the OECD countries. ...

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What the French take for granted today- 99% of the French people are covered by national health care- started when Charles De Gaulle faced rising scial discontent in the postwar period, and accepted a demand for worker protections. During the postwar period Frenchmen are paying higher taxes, but in the first 30 years because French salaries were growing fast this was not noticeable. With slow growth and rising healthcare costs its getting harder to increase these tax deductions for overall social security, which have reached one third of apaycheck at the low end, say for ataxi driver in Marseilles. So you have the government running deficits of $15 billion in 2004, even after increasing co-payments for routine care and doctors visits. Experts say this could reach $40 billion in 2010 and $90 billion in 2020. In 2007 health care cost the government $300 billion, or 11 % of GDP, (OECD numbers) and the bureaucracy and rules are getting more complicated. This 11% is well below what Americans pay for asystem that leaves out about 50 million people. France ranked 8th on the OECD list in cost per capita, the US at the top. And the French life expectancy is higher at 80.98 vs. 78.11 for the USA, higher by about 3 years. For this cost the system is cost effective according to the OECD. And the French find the American debate abouthealthcare public option "altogether surreal", as the newspaper Le Monde put it. To keep the system in viable form the government is increasing copayments, such as the decrease in reimbursements from 80% to 65% for routine care and doctors visits in 2004. As aresult the deficit dropped to $6 billion in 2008. ut the global economic crisis and rising unemployment has made this grow to estimated $13 billion for 2009. Measures under consideration: increasing hospitalization copayments to $28 a day from $22. To fill this substantial gap for routine care and other costs the French system has private insurance companies called mutuals that offer different policies. Which is where the Fench notion for equal treatment in health care gets distorted because different people can have different coverage. The French though compare their system to the British system and say theirs is not as nationalized as it appears and the Brisih one is much more so. The French system though supervised by the government is different from government run health care as in Britain. French people are free to choose their own doctor who is often a private practitioner. ...

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

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A small town mayor who says he will fight with Biden for workers and families in every county in Pennsylvania wins the Senate seat against aTV health show host favored by Mr. Trump. The scrappy fight put up by Democrats on their own in different parts of the country is the main takeaway from this election for control of running 36 of America's 51 states and control of Congress. Fighting an election with major legislation on controlling healthcare costs and for renewable energy, infrastructure investments, Mr. Biden and fellow Democrats was forced into a back to the wall fight because of price increases from Russia's war in Ukraine. Voters took notice not falling for the message on inflation alone that is being tackled by the Fed's Jerome Powell, giving room for seeing the larger picture.

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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. ...

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It is no surprise what we see in the US today- the loss of the middle class, the unaffordability crisis for education, healthcare, childcare, and poor, broken infrastructure. Over 10 years the US trade deficit with China has led to loss of about 25 million jobs and $250 billion in taxes that support local infrastructure and public services. Where 20% of the people do 80% of the spending, 80% of the people only 20% of spending (Moody's Analytics). This is how the uneven trade led to the destruction of manufacturing centers and communities across the 51 states in America, devastating families and young people. This is no longer Washington's, Lincon's or FDR's land of opportunity. Each $1 billion in additional imports to the US costs 4252 jobs. (CPA) This can be read as how many jobs are being lost in the additional trade of goods when one side is exporting more than the other.  There are three levels of losses. There is also an indirect job loss in the number of jobs created by that one job in manufacturing to serve the needs of these factory families in communities. This can be estimated at 1 job that depends on 1 manufacturing job. Together this means 8500 jobs lost for every $1 billion of goods in a trade deficit. US trade deficit of $295 billion in 2024 with China translates into about 2.5 million jobs lost every year. Over 10 years this is about 20-25 million jobs, enough to decimate America's entire manufacturing capabilities and manufacturing infrastructure, whole communities and towns disappearing or suffering destruction across the country.  With the loss of these jobs comes a third cost, the taxes paid that maintain small town infrastructure and public services like libraries, schools and health centers where these factories are located. At $10,000 in taxes lost per job, for 8500 jobs lost per $1 billion in uneven trade there is a loss of $85 million.  For the $295 billion deficit the US has with China this loss adds up to $25 billion per year. Over 10 years this means taking out this much in local infrastructure and public services like libraries, schools and health centers worth $250 billion.  ...