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The Congressional Budget Office's Elmendorf says without spending cuts in payments to doctors and hospitals and other providers, providing coverage to the unisured will put the nation deeper into debt. Popular measures such as increasing preventative care, expanding medical records and rewarding doctors for choosing treatments that improve cost and quality have potential but its not proven how much the savings from this would be. The administration and the White House Budget Director, Peter Orszag, say they are in agreement with the CBO that something needs to be done to seriously reduce costs, reducing payments for Medicare and Medicaid to doctors and hospitals, and making other changes.

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Andy Stern, head of the Service Employees International Union, in an interview with WSJ's Matthew Kaminski. Membership at the SEIU has doubled to 2 million while other unions have gone into steady decline. In 2005, Stern took the SEIU out of the AFL-CIO preferring grassroots organization over political emphasis and emphasizing the shift to a service and global economy. He sees a new situation from the one in 1993, as the issues facing the country have changed. He lists the income inequality and stagnation of wages. He prefers the European model. Better a little more unemployment as Western Europe has done, but a lot more equality, says Stern. And as the ranks of the uninsured swell with the half a million laid off workers in November in the USA reported by the Labor Department, the first priority for the union is universal health care. With donations of $85 million from the SEIU being the largest of the total union donations of $450 million for this years elecion campaigns, the SEIU hopes to hold the new administration accountable....

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One in six dollars generated by the U.S. economy goes to pay for health care, almost twice the average for rich countries. It hurts America in many ways; by being a burden on the taxpayer when it comes to Medicare and Medicaid paying for the poor and the elderly, on companies being one reason GM went bankrupt, it eats up federal and state budgets, rising costs make any form of future coverage for all unsustainable, and it robs other priorities such as infrastructure building and other national scale investments. The Economist says that if it had to design a system from scratch, it would go for a system based mostly around publicly funded health care. For the uninsured the solution of an employer mandate is now well accepted, so this is not an issue. What is an issue is how to make the new system affordable? Here the Economist says that whether in stages or in one move, the tax deductability of employer paid health insurance, which is costing the U.S. government $250 billion ayear, has to go. It is necessary to remove this deduction, and its something all interests involved will have to swallow, as other savings are smaller and will not be adequate. The deductability of insurance makes the true cost of insurance transparent, so it supports gold plated insurance. This does not make cost control the pressing priority it needs to be. So the deducatability of employer paid health insurance hurts both ways. The other necessary action is in the area of moving out of the current culture where most doctors work on a fee-for-service basis, where the more tests they prescribe or procedures they perform the greater their incomes. This acts as a perverse incentive, and has aruinous effect in mushrooming health care costs in America. Cutting back on unnecessary tests and procedures, and prescriptions , would save 10% to 30% of health costs says the Economist. And it says this has been proven with the Mayo Clinic in Minnesota and Kaiser Permanente in California showing that cutting back doesn't hurt care and outcomes., so much so that cutting back would occur along with improved outcomes. But Americans with employer paid insurance just take things for granted as its not much out of pocket expense for them. THis creates the lack of a force for controlling costs even as employers are shouldering abigger and bigger burden, and the employee who thinks he is doing fine actually is seeing more of his salary dollars going to pay for his health insurance. In a way the consumers of health care are stuck with the perception that they are not somehow paying for these mushrooming costs and too manytests, procedures and prescriptions. This perception leads them a false sense of comfort with the system they are in, and a fear of something new fanned by the medical lobbies, that any change will impact users negatively. This makes the whole discussion on health care or the process of finding solutions to become an exericize in which terms like "rationing" and "choice" play a distorting role. ...

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During 2022 the San Francisco Federal Reserve Bank issued 6 warning citations to Silicon Valley Bank, saying that its bank practices did not allow for enough cash in the event of crisis. By July 2022 in a full supervisory review it was rated deficient for governance and controls. At a meeting with senior leaders of the bank the possible exposure to interest rate losses related to Fed increasing rates was also discussed says this report in NYT. The Fed regulators stated that the bank was using wrong models showing that SVB bank would do better as interest rates increased. Questions are being asked about why things that were in plain sight were overlooked by the regulators- 97% of deposits were uninsured by the federal government. In the event of a crisis depositors might try to get their deposits out causing a run on the bank which is what actually happened with $42 billion attempted withdrawals in one day. Michael Barr is the vice chair for Fed supervision. A investigation report is expected by May 1. March 29 the House Financial Services Committee will hold ahearing in Congress. Peter Conti-Brown, an expert on financial regulation at the University of Pennsylvania calls it failure of banking supervision, and says it will become clear from the investigation whether the supervisors failed in their work. One of the problems is that the CEO of SVB bank, Gregory Becker, was on the Board of the San Francisco Fed. NYT says the optics of this is bad. Bernie Sanders, Senator from Vermont, calls it absurd that he was appointed to the Fed board of the institution that was regulating SVB bank. Another problem is that Randall Quarles, vice chair of Fed supervision 2017-2021 carried out a 2018 regulatory roll back law of president Trump in an expansive way says NYT. This law exempted banks with less than $250 billion in assets from strict banking supervision that larger banks were expected to go through. Fed chairman Powell is criticized for not  flagging these steps as potentially dangerous for the banking system in the way this was done by vice chair Lael Brainard. Brainard is now head of Biden's National Economic Council. She never favored the Trump law and had grasped early the risks of such deregulation. Sanders will bring a new law to prevent bank CEO's from sitting on Fed boards, and Senator Elizabeth Warren has called for an independent review that does not include Powell.     ...

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A critical part of the Affordable Care Act is the setup of marketplaces or exchanges to let people without insurance buy individual health plans. Some states setup their own exchanges, and some states let the federal government step in and run them. To help the lower middle class and poor the Act provides health subsidies to buy insurance in the exchanges, and 85% of customers in the exchanges qualify for this benefit. The U.S. Supreme Court voted 6-3 in 2015, compared to a tight vote in 2012 on the Affordable Care Act, to maintain the health subsidies. Justice Roberts wrote the majority opinion, saying "Congress passed the Affordable Care Act to improve health insurance markets, not destroy them." Justice Scalia dissented calling it "interpretive jiggery-pokery." Justices Clarence Thomas and Samuel Alito Jr. dissented. Voting in favor were Justices Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor, Elena Kagan, Justice Kennedy dissented in the 2000 case. The challengers petition to the courts was based on a reading of phrases in the Affordable Act which had not occurred to the writers of the law. The reading suggests only people enrolled in state setup exchanges are eligible for subsidies. If the Supreme Court ruled in favor of the plaintiffs the 6.4 million Americans who are enrolled in the federal exchanges would lose the subsidies provided under the law and lose health insurance. And the economic foundations of the Affordable Act would be undermined with insurance companies required to provide insurance to all regardless of pre-existing conditions and subsidies removed, leaving the companies with sicker pool of customers resulting in destabilizing the exchanges and higher premiums. The court ruled in favor of an interpretation that is compatible with the whole law and the intentions of the statute to help the middle class and the poor buy health insurance. The chaos in the insurance markets that would result in going with the plaintiffs because of a careless writing of a phrase, was uppermost in the majority's mind. Chief Justice Roberts emphasized this, saying- "The statutory scheme compels us to reject petitioners' interpretation, because it would destabilize the individual insurance market in any state with a federal exchange and likely create the very 'death spirals' that Congress designed the act to avoid." This case originated with 4 plaintiffs from Virginia who challenged the IRS regulation that said subsidies were allowed regardless of whether the exchanges were run by the state or the federal government, arguing that this was at odds with the particular phrase in the law that was ambiguous about federal exchanges eligibility for health subsidies. Judge Roger Gregory of the Fourth Circuit Court of Appeals in Richmond, Virgina, ruled that the phrase was indeed ambiguous, but the IRS was owed deference in its opinion. Chief Justice Roberts made it clear that this was not a case for the IRS, saying "it is instead our task to determine the correct reading." ...

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Leonhardt argues that rationing is rational allocation of limited resources, health care budgets are limited resources even in rich countries like the USA, and if you overpay here you cut somewhere else. Now the cuts that are not noticed he says are in take home pay as employers face increased premiums from insurers. Rationing is taking place all the time with poor health outcomes relative to the cost for poor allocation of resources as survival rate for many diseases are not that much better than other countries. Rationing takes place everyday when patients see doctors only for a few minutes as doctors race to see more patients, and when diseases are not caught early on in the process as doctors do not know their patients well enough. And rationing is taking place as patients simply delay or forego treatments based on the extra cost, or as uninsured get no care. There are so many buzzwords like this thrown around, with doctors, hospitals and insurers and other groups trying to preserve the status quo, even as it is becoming rapidly unaffordable fort the US to be spending so much on health care....

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At the Archway cookie plant in Ohio which closed recently all employees laid off lost their health insurance. A similiar article on Archway in the NYT and the situation in gowing ranks of uninsured.

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The view from the streets of Athens in November 2011, by Landon Thomas, shows Greece teetering on the brink. A situation it appears that is not fully grasped by EU officials who have throughout 2009, 2010 and 2011, acted always lagging far behind new developments and struggled to cope. Greek manufacturing will contract by 6% in 2011, on top of earlier declines. Auto sales have practically ceased and are at the lowest levels since 1993. The number of uninsured drivers increased by 500,000 in just the last 3 months, taking the total to 1.5 million. And small shops in Greece which depend on domestic demand are closing every day. A flood of money is leaving Greece. Since January 2010, Greece's banks have see a loss of $63.5 billion in deposits, 20% of Greece's annual economic output. Greece's bankers estimate that in just the last 2 months, September and October 2011, the numbers jumped to a figure ranging from $13.8 billion to $20.7 billion. The government has imposed value added taxes and a special real estate tax attached to Greek electricity bills, which is further cutting into consumer spending. And the public is blaming the politicians. Any setttlement by a unity government with the EU may be illusory, because the rapid deterioration of the economy would hasten a default. ...

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Kathleen Sebelius, a former Governor of Kansas, pushed forward implementation of the Obama Healthcare Law as U.S. Health and Human Services Secretary, 2008-2014. She resigned in 2014 after IT problems made it difficult to use the government's Healthcare.gov website in 2013.

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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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The EU's competition commissioner to crackdown on pharmaceutical companies that are delaying the entry of generics drugs with various tactics that are anticompetitive. EU has raided the offices of several marge drug companies and retrieved documents that show this activity was going on. About 5% of medical bills or 3 billion euros coud have been saved from 2000 to 2007, if companies had allowed generics to enter the market earlier and not resorted to these antitcompeitive strategies. Like paying off generics companies or having so many patents on the ingredients of the drug, in one case 1300 patents on one single drug, and then suing the generics companies to tie up the case in the courts.

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Arguments that are expected to be used by both sides before the U.S. Supreme Court on the health care law. At the heart of this is the 1942 decision, Wickard v. Filburn, on the limits of federal power. Mr. Filburn, was an Ohio farmer who questioned a 1938 federal law that imposed a penalty on every extra bushel of wheat on his farm beyond the stipulated amount. The decision was unanimous and went against Filburn. At issue is whether the federal government can impose a penalty on individuals for not buying health insurance. Justice Robert Jackson wrote in that case: "Even if appellee's activity be local, and though it may not be regarded as commerce, it may still, whatever its nature, be reached by Congress, if it exerts a substantial economic effect on commerce." The Obama administration's argument in its brief is that the decision of individuals not to buy insurance, like that of Filburn to plant that extra bushel, has larger effects beyond the local one and serious consequences for the whole country- it raises insurance rates of people in states across the country and makes hospitals bear the burden of caring for these uninsured people. For over 50 years the Supreme Court has largely supported the idea behind the Filburn decision, except in 1995 and 2000- these two decision invalidated laws made about guns near schools and violence against women. The Court ruled that the activities were local and noncommercial and beyond the federal power to regulate interstate commerce....

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The recent effort to eliminate funding for Planned Parenthood clinics in the U.S. because some of the money goes to abortions has run into a cloud of misinformation. In reality only 3% of the funding goes to abortions. Title X funds that help support these clinics cannot be used for abortion care at any time. Medicaid funds going to the clinics in 17 states can be used to reimburse abortion providers only if the life of the mother is endangered. The clinics see 5.2 million low income and uninsured women who need tests for infections, breast exams, pap smears, preventive services and screenings, contraception services. By reducing low income women's access to such health services through defunding the clinics would only increase the number of unwanted pregnancies and abortions. Planned Parenthood centers provides contraception to about 2.5 million patients each year and educates women about birth control. By burdening the U.S. healthcare system- adding most of the 5.2 million who access these clinics -with problems ranging from cancer to other serious health issues when they could have been detected by tests at an early stage and treated earlier or prevented altogether, would also add to the burden of healthcare costs. In addition the 800 Planned Parenthood Clinics in the U.S screen 3 million patients each year for other problems such as blood pressure, diabetes, smoking and obesity related issues, also help treat these problems at an earlier stage, which is essential if costs to be brought under control. ...

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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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The House bill on health care cleared the House Committee on Energy and Commerce with a vote of 31 to 28. Five Democrats joined all 23 Republicans. Compromises were reached with Blue Dog Democrats, centrist Democrats who had concerns about the cost of the health care overhaul. The bill will be taken up again in September after the August recess, when Congress will be faced with the task of recociling the House and Senate versions and reaching common ground on a number of proposals. Some common ground has already been achieved between centris and Blue Dog Democrats and Democratic members who support Obama's proposals. Among the changes on which consensus was reached in the House version: 1. Access Insurers will have to accept all applicants and will not be able to charge higher premiums because of medical history or current illness. All insurers will have to offer a minimum package of benefits, to be defined by the federal government, and nearly all Americans will be required to have insurance. Insurers will have to get prior approval from the government before increasing premiums over a certain amount. About 95% of Americans will be covered this time. The cost will still be approaching $ 1trillion over 10 years. Federal subsidies will be given to those who cannot afford health insurance and Medicaid coverage will be expanded. And the insurance will be made more affordable for the uninsured. Democrats also reached a consensus on creating some sort of government insurance plan or nonprofit cooperative to compete with private insurers. 2. Mobility And under this new plan it will be easier to change jobs as one would retains one's health insurance. This should actually help the job market, and help promote the mobility that is needed, now that jobs are shifting out of sectors like autos to sectors like energy. 3. Cost The Energy and Commerce Committee voted 47 to 11 to set aprocedure for the government to give federal approval of generic versions of expensive biotechnology drugs. By one estimate this saves $9 billion over 10 years. The Democratic proposals from the Energy and Commerce Committee would authorize the Health and Human Services Secretary to negotiate prescription drug prices for Medicare benificiaries. The agreement and consensus among the conservative, liberal and centrist Democrats, and Democrats with ties and connections to the health care industry was reached after intensive negotiations, and adoption of a package of amendments that helped bridge the differences they had. ...

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Generic version of Zocor by Merck to reduce bad cholesterol is now available and can substitute for Lipitor which costs $2 to $3 per day. This generic can be bought at Costco at 10 cents per day. Generics can have a huge impact on cost for patients and for the country's medical bill and for affordable health care its very important to achieve affordable health care.

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This editorial in the WSJ describes the sharp increase in premiums under the Affordable Care Act of president Obama. The average premium increase is about 24.2% according to a Barclay's analysis, and as high as 43.9% in states such as Illinois. Bill Clinton calls it the craziest thing with small business affected, and some premiums doubling. Of the 17 million people in the individual market eight million buy without subsidies. One in five enrollees cannot qualify for subsidies. Democrats say subsidies are too small. Hillary Clinton has proposed to have a Medicare "buy-in" for people ages 55-65, and a "public option" government run plan. Republicans want to rewrite the law. But this depends on which party wins the Senate, with the election in Missouri giving Democrats an opportunity to maintain a Senate majority.

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Comparative effectiveness research will be conducted to evaluate what is the best treatment for any ailment or disease or health problem under the $1.1 billion allocated for this in the Stimulus Plan. What are the alternative methods of treatment, what is the effectiveness of each treatment, what are the comparative costs and so on. Is it better to treat neck pain with surgery or acombination ofphysical therapy, exercize and medications? If there is ablockage of arteries in the lower leg and leg pain, how does drugs and watchful waiting compare with surgery? For chronic heart failure how does home monitoring of blood pressure and weight and exercise in addition to medications provide an alternative route as opposed to just medications. Dr Fisher of Dartmouth Medical School cites these as examples of questions that can be asked in comparitive effectiveness research. The money will be available to the Health and Human Services Department and will be used over several years. About 15 federal employees will form a council to coordinate the research and advise President Obama and Congress on how to use the money. In 2007 the US spent $2.2 trillion, or 16% of GDP, on health care, and the Congressional Budget Office says it will grow to 25% of GDP at the rate its growing by 2025 if left to its own devices. ...

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Full Yield is a startup in Boston that is trying to help address the nation's obesity problem by introducing healthier foods and meals in cafeterias. It plans to introduce a line of Full Yield branded food made from fresh items and natural ingredients for sale in corporate cafeterias and prepared food sections of local supermarkets. It is based on a simple idea that if you eat healthier food you will be healthier. A study in the Jan-Feb issue of journal Health Affairs says 75% of the $2.5 trillion in health care spending deals with obesity, Type 2 diabetes, heart disease and cancer. And how much of this traceable to obesity and bad eating habits, smoking and lack of exercize? This study says most of the cases are preventable by changing these behaviours. Dr. Kenneth Horpe, chairman of the department of health policy and management at Rollins School of Public Health, Emory University, shows that if trends continue U.S. annual health care costs related to obesity would reach $344 billion by 2018, which is 20% of total health care spending. In 2009 it accounts for 9%. Thorpe says if even the 1987 levels of obesity were reached it would free up enough money to cover the uninsured population today. For American companies the problem has grown to alarming proportions and yet no nationwide coordinated plan bringing together companies, government, universities, public interest organizations, and other groups exists in the U.S. The CEO of U.S. grocery chain Safeway, Steven Burd, says Safeway was spending $1 billion to cover health care insurance for workers by 2005, with costs rising 10% a year- this meant putting out twice in health care insurance than Safeway's earnings and hitting another $500 million by 2010. Between 2004-2009 the costs of insurance surged 31%, making this the fastest growing single corporate expense, according to Towers Perrin. This reduces incomes of workers as companies pass on part of the extra cost, and reduces the profits that can be put back in new investment for economic growth....

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Jan Corzine, Governor of New Jersey has talked to governors from the states of Ohio, Michigan, Wisconsin, New York, and Massachusetts about how best to execute an effective economic recovery stimulus program with the federal government. Here are the ideas they have come up with. The stimulus should cover five areas, infrastructure, countercyclical programs, housing, education, and middle class tax cuts. The principle to keep in mind is to take advantage of the strengths of the federal government and of the state and local governments. Infrastructure investment should be intelligent ones to modernize the capabilities of the country for the next phase of development and competition in the global economy and in making far reaching changes in transportation and energy for sustainable development in a global economy. A key point of Corzine's here is that safety net social programs will need to be shored up or the stimulus effects will be lost. Over the 2 years 2009 and 2010 he suugests the federal government boost its countercyclical spending by at least $250 billion. And it should do this by increasing the federal medical assistance percentages, federal share of Medicaid costs and other health care related programs such as reimbursement to hospitals for treating the uninsured, Temporary Asistance for Needy families, and child care grants. He proposes doubling the federal funding of unemployment trust funds under the Unemployment Insurance Modernization Act, with incentives to cover vulnerable low-wage and part-time workers who are often denied unemployment benefits. Corzine emphasizes this. That even if the Obama administration puts large sums into infrastructure spending, cutbacks in state and local safety net programs would cancel out much of the effect of the stimulus. The reason is simple while the federal government is adding to jobs on one hand, the states without the money would be cutting back jobs and services. This point will be critical in making the stimulus work. The other point Corzine appears to emphasize by quoting Roosevelt at Oglethorpe University in 1932, is that bold experimientation not clinging to rooftops in the flood, will be needed....

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The Health Exchanges set up under the Affordable Healthcare law (Obama Healthcare law) reaches 5 million by mid-March 2014. The Congressional Budget Office estimate is for 6 million enrollment in 2014 compared to a previous estimate of 7 million.