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The influence of the AMA convened Relative Value Scale Update Committee (RUC) on how the Medicare payments to doctors is shared, and on the growth of the Medicare budget. Concern that the interested party is driving the decision making process. Medicare costs went up by 9% in 2009. Fears that doctors have too much control over the dollars in the $500 billion Medicare program. The tendency to focus on more expensive procedures and short change preventive and less costly care. Medicare spends $60 billion on doctors fees. The older codes remain in place even when costs are reduced, leading to higher costs for the Medicare budget each year. And there is little incentive for doctors in RUC to revise overvalued codes.

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A look at the views of candidates running in the U.S. presidential election of 2016 on mass incarceration. Benie Sanders, Democratic Senator from Vermont, says the situation worsened for incarceration during the Clinton years when a policy of building prisons and increasing law enforcement was adopted. The 2.2 million persons in prison today are double that for the years before the early 1990's, said Sanders. Under president Clinton the 1994 Violent Crime Control and Law Enforcement Act was passed creating tougher penalties for drug offenders, and putting $30.2 billion for more police officers and new prisons. Hillary Clinton called for putting "an end to the era of mass incarceration." Adding in other remarks that missing African-American men means "missing husbands, missing fathers, and missing brothers."

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The Climate Change Bill, Inflation Reduction Act of 2022, CHIPS and Science Act, gun control legislation have moved forward president Biden's program for Build Better America forward leading to a huge change in the perception of his administration. There may be a sense that Biden could do more in Congress in the way FDR and Truman changed America, and creating once more a beacon for the world shaken by the pandemic.

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The perception comes from seeing decisions made but not the process of decisions which is lengthy and even seen by participants as long, in which Mr. Modi act as a patient listener to all voices. Could'nt it be shorter is felt by some participants, yet Mr. Modi would have 2-3 meetings listening to all participants with humility before arriving at a decision. Tough decisions were made on vaccines to get to 1 billion vaccinations goal, on demonetisation and GST, and on digital India, housing schemes, bank accounts, and Jal Jeevan.  Mr. Shah points out that where earlier governments had brought bank accounts, electricity water, and cooking gas to some people, the approach of Mr. Modi was to get electricity, water, cooking gas to all homes for 1.4 billion people in India. He says Mr Modi is hard for even his colleagues to understand in terms of his passion and endless capacity for hard work for bringing essential services to every Indian, and the last Indian is a concept that not the BJP or any party had, it was entirely Mr. Modi's idea for New India. Mr. Modi he says is not the BJP or himself even, he is always thinking how could the lives of ordinary Indian be better in every way, and every rupee going to that last man in line in a nation of 1.4 billion. It can best be understood through Vivekananda's writings some 125 years ago. The passion for India and the Indian people of Vivekananda in his writings is a huge reservoir of energy for someone like Modi, that Modi has tapped into from his beginnings in Gujarat government and more so when he left Gujarat for Delhi. Vivekananda's foresight, energy, and passion for the Indian people is reflected in the efforts for New India. ...

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The problems that hit the UK economy with the announcement of unfunded tax cuts were worsened by very poor communications, the cavalier attitude of the new Truss government and finance minister Kwarteng, and a lack of experience, says this report in the WSJ.The toxic mix of inflation, higher interest rates particularly in the US, and the conflicting messages from the Conservative party with critics within the Conservatives calling the step misguided, had a strong impact on financial markets. Yields on British government bonds jumped beyond that of Greece and Italy, and the British pound fell with large drops in its value falling to 1.03 to the US dollar. Only the intervention by the Bank of England helped recover the pound to $1.11 and yields that went up from 3.6% to over 5% to drop back down to 3.8%. Many other countries face the same high inflation and rising interest rates in the US, so that poorly managed political situations such as the leadership race in the Conservatives party in the UK can have damaging economic consequences. This is a point of caution for other countries economies and governments says the WSJ. Italy's new government coalition has managed to keep expectations of major changes to policy to the Draghi government to the minimum in anticipation of economic problems that could emerge with differences with the European Union, and to avoid poorly managed communications. This is true of all countries in the world and a reminder of the importance of correct messaging in financial markets, and taking a prudent role of funding extra spending programs. This was also done in the $360 billion Inflation Reduction Act and Climate bill of 2022 by the Biden administration. where the dollar spending was adequately accounted for with policies considered prudent to tackle climate change, support badly impacted segments of society, and new infrastructure. This is a learning lesson for other governments. ...

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South Korea has tested about 300,000 people for coronavirus. About 20,000 can be tested daily for coronavirus through 40 drive thru locations. South Korea invented this method of testing. Another feature of the South Korean method is the tracking down of people who have come into contact with those testing positive for coronavirus. The South Korean government is able to do this because it can access the credit card and cell phone information of people in the country. This is possible through laws that were passed after the failures during a previous epidemic of MERs. The government then tracks down and isolates the people who came into contact with infected persons. This includes people who show no symptoms, an important aspect of the South Korean program which needs to be adopted in other countries once the production of test kits and testing is ramped up. The reason is that about 30% of people who tested positive in South Korea were not showing any symptoms but acted as silent carriers. This is similar to the figures for people in the Wuhan region of China. This testing capability is one of South Korea's key strengths, though Germany's Robert Koch Institute says it has a similar capability to test 160,000 people a week. The U.S. has tested about 30,000 people by comparison. The U.S. government is procuring 60,000 test kits under the Defense Production Act. South Korea also enforces social distancing though a $2500 fine and a 1 year prison sentence. Germany now has a 2500 euros fine in some states for curfew violations.  By comparison the fine in Britain is insignificant.  Another difference between China and South Korea with Germany and the rest of Europe, the U.S., is that in China and South Korea self-isolation is monitored, tightening the control over coronavirus spread at every turn.   ...

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The Indian Budget speech by Finance Minister Nirmala Sitharaman seeks to keep the fiscal deficit on a downward trajectory from 4.9% fiscal deficit in 2024, lowering it each year 2025-2028. The total expenditures for Indian Budget 2024 are $720 billion and the total government revenues excluding borrowing $480 billion, tax revenues $390 billion. To attract investment by foreign companies in India the corporate tax rate is reduced from 40% to 35%. And abolition of angel tax for startups. capital gains tax reduced to 20% for short term gains and 12.5% for long term gains. Simplification of the Income Tax Act of 1961 within 6 months. Lowering of taxes for personal income taxes to 30% above 15 lakh rupees. Exempt 25 critical minerals from basic customs duties to assist processing in India. Reduce basic customs duties on mobile phones to 15%. Customs duties to support domestic manufacturing, export competitiveness. Simplify and rationalize the hugely beneficial GST Tax, "a success of vast proportions, reducing the compliance burden and logistics cost for trade and industry." "The gross and net market borrowings through dated securities during 2024-25 are estimated at ` 14.01 lakh crore and ` 11.63 lakh crore respectively. Both will be less than that in 2023-24. 114. The fiscal consolidation path announced by me in 2021 has served our economy very well, and we aim to reach a deficit below 4.5 per cent next year. The Government is committed to staying the course. From 2026-27 onwards, our endeavour will be to keep the fiscal deficit each year such that the Central Government debt will be on a declining path as percentage of GDP." For the year 2024-25, the total receipts other than borrowings and the total expenditure are estimated at ` 32.07 lakh crore and ` 48.21 lakh crore respectively. The net tax receipts are estimated at ` 25.83 lakh crore. The fiscal deficit is estimated at 4.9 per cent of GDP. ...

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Hannah Devlin writes about Jess Thom the Psychologist for Great Britain's Olympics teams. How Jess Thom gets British athletes to overcome self doubt, negativity and nerves as they compete in the most difficult of competitions. Here is what she tells athletes to do, which also applies in daily worklife in striving for excellence at work. “One of the most powerful things to understand is that it’s normal to have those unhelpful thoughts and feelings,” she said. “Even athletes have self-doubt at times. They get anxious or frustrated and still go on to win Olympic gold. Those thoughts and feelings don’t have to dictate how we behave.” Mindfulness is useful training of the mind. Yet accomplishing the required level of self-awareness still requires training, discipline and grit. “Notice your feelings, accept them, come back to the present moment. That’s the general strategy,” she said. “It sounds super easy on paper, but doing that in a high-pressure environment is impressive.” Thom tells athletes to think about their demeanor and how they think and act when they are at their best. If that means showing your style of athleticism at the start line, then doing that is fine. She encourages athletes to behave like you would when you have that real .strong confidence even if you’re not necessarily feeling that right there. What about negative thoughts. She gives them a name - Frank. And she says athletes can say- "Frank, not right now," to just set aside these thoughts. To control fears, athletes are told to write a “what if” list. It  serves as a backup plan for worst-case scenarios. This could mean getting a bad start in a race or going a set down in tennis.  Personal superstitions are included.   ...

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Much of the inflation reduction actions were taken by the US Federal Reserve as the central bank of the Nation and by president Biden in passing the Inflation Reduction Act and investing in growing the economy. All this may be jeopardized by the action of a Trump administration limiting the independence of the central bank. The support for crypto currency by Trump creates more risks to the economy. Additional risks are posed by the views expressed in Project 2025 on the US central bank. It is stated that the financial stability mandate be removed, that employment stability be removed and its regulatory role be effectively taken out. A commission to be appointed to look at alternatives to the central banking role of the US Fed. There are inflationary episodes and banking crises yet they stem from poor behaviour of banks as private players (2009 financial crisis) and price gouging by companies and firms and are not because of the central bank. There are also episodes of poor management  which reflected the culture of that period such as Libertarian culture under Greenspan. As in management in private industry firms good or poor managers make adifference. The institution created of the central bank around 1910 comes from the crises that happened in the period before that  and how it evolved into its postwar role. This includes the Great Depression when it did not have its regulatory, financial stability and employment role. Tampering with the basic structure that has evolved over 100 years of experience would cause lasting damage to the US economy and expose it to hidden risks. This would put a severe burden on the Nation after the loss of one million lives in the pandemic that just happened, the cost of living crisis, and the severe impact that decades of loss of local manufacturing have placed on communities across America- which both the US Federal Reserve under Jerome Powell and president Biden have fought so hard to tackle. ...

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US Business has considerable apprehension about the former president in 2024 compared to its willingness to consider Trump in 2016. At the time executives from investment bank Goldman Sachs and heads of oil companies joined the Trump administration. This time US business and corporate interests are apprehensive about becoming the target of a tweet they might find the next morning under a Trump administration. They are not supportive of student loan forgiveness, but when it comes to the CHIPS and Science Act they see president Biden as effective and helping industry. Business leaders have a negative view on the Trump effort through appointment of 3 Supreme Court Justices of overturning decades old rights of women on abortion, and on this issue alone many will support Harris-Walz, overriding other concerns they might have. The visions of Harris and Trump are so vastly different with one calling climate change a hoax and hyping up social issues and infrastructure needs without any record of delivery when in office, and the other a strong position on climate change, wages and income, delivering on infrastructure and CHIPS that US Business. The result is that it leaves US Business with no better option in 2024 than to support the vision  that takes America forward. There are different sections of the business community which have different priorities.  Silicon Valley, and oil, pharmaceuticals because it profits most from light regulation which brings with it social costs is a special issue not addressed here. Other business, banking, automobiles, and a range of other industries have other priorities yet also see the need for the economy and the US to move forward with a different vision than one that simply ignores climate change, and fails to address child care, child poverty, wide disparities in wealth, and other issues facing of wages, cost of living facing most Americans.  ...

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DJT executive orders include one ending birthright citizenship. “It was really meant for children of slaves." DJT is referring to the 14th Amendment that was passed in 1868 by Congress and ratified by 1868 by the states. It came after the Civil War and Emancipation of slaves and was intended without any doubt for one and only one purpose to make slaves citizens of the United States Look at Section 4 of the 14th Amendment which says the United States will not allow any claim for the loss of any slave. "But neither the United States nor any State shall assume or pay any debt or obligation incurred in aid of insurrection or rebellion against the United States, or any claim for the loss or emancipation of any slave; but all such debts, obligations and claims shall be held illegal and void. The only SC decision in US vs Wong Kim that gave citizenship in 1898 to Wong Kim was not intended to go beyond that particular case, it was only meant to make an exception to the Chinese Exclusion Act  of 1882 after which till 1960 (JFK's election) Chinese immigration to the US was stopped, and the same for all Asians. Only immigrant labor allowed in was from Mexico for agriculture till 1960. And in 1954 Operation Wetback wwas conducted by Eisenhower to return about 1 million illegal immigrants to Mexico. DJT says- “It was not meant for everyone to come into our country by airplane, or charging across the borders from all over the world and think they’re going to become citizens.” The millions that came illegally across land border  and the flow of drugs is a new situation that Congress and the Supreme Court are only facing since 2014 a period in which wars in Afghanistan and Iraq took time and resources away from problems at home. ...

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The relations between the former president Obama and the current president Trump have soured in the first 100 days. Obama lauded activists opposing the travel ban, and Trump sees leaks being conducted for his administration by Obama supporters. Obama was clear from the beginning that he would voice his opinion when it came to systematic discrimination, right to dissent, and deportation of children. Trump's claims that Obama ordered his offices to be wiretapped during the election have caused a rift. Trump took to Twitter to says that Affordable Care Act was "a total disaster," and made it personal by saying "How low has President Obama gone to tap my phones during the very sacred election process. This is Nixon/Watergate. Bad (or sick) guy!" Attorney General Sessions said he will recuse himself from the investigations into Russian efforts to influence the election.

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The protests happened as Immigration agents moved to enforce the law in a town Paramount just south of Los Angeles. Protesters blocked streets and defaced property. In response under Title 10 authority of the Insurrection Act president DJT called in 2000 of the California National Guard. 

Los Angeles has the largest Mexican American population in the US followed by counties in Texas Dallas and Houston areas and Cook County, Illinois. There were about 21 million people of Mexican descent in the US in 2000 which has almost doubled to about 37 million in 2023. Of this about 16 million live in California and 11 million live in Texas. Because of this concentration in Los Angeles immigration enforcement is faced with new challenges in the LA area. President Trump won a mandate in 2024 to take strong immigration enforcement of the nation's laws.

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Treasury Secretary Yellen says on her second trip to China that she will make this the top issue in discussions, the danger that Chinese overproduction in green energy products will lead to the kind of overspill that happened for steel and aluminium where subsidized products drove American companies out of the market. Speaking at a solar energy factory in Norcross, Georgia, that was itself closed in 2017 and is back up again with the assistance in the Inflation Reduction Act for promoting American green energy manufacturing, Yellen said: "It is important to me and the president that American firms and workers can compete on a level playing field." Yellen's remarks on supply chain resilience- "China's overcapacity distorts global prices and production patterns and hurts American firms and workers, as well as firms and workers around the world. Challenges for individual firms can lead to concentrated supply chains, negatively impacting global economic resilience.”   ...

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It is only appropriate to bring up Aneurin Bevan in 2024 after the pandemic and as ordinary Britons seek to improve health and living standards, and their compatriots in the US also seek a better form of universal health coverage that works to provide better health  for less cost similar to Europe. In 1948 the National Health Services Act was passed into law with Aneurin Bevan having seen it through parliament as a member of the Labour party from Wales. The NHS was operational in July 1948. Clement Attlee summoned Bevan after winning in a landslide in 1948 and asked him to take the Housing and Health Ministry. Bevan was a coal miner's son who then used his skills in parliament to get passage of laws that created one of the most enduring  institutions of modern times. A docudrama by Prince about a visionary Welshman Aneurin Bevan as Health Minister who founded the NHS National Health Service of Britain. Michael Sheen plays Bevan.

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WSJ tells the story about Biden being slow to act in 2021 and 2022 to close the Southern Border, without telling the complete story and all the facts. Biden did close the Border in 2024 by executive order- when Trump blocked passage of Republican Lankford's legislation in Feb 2024 supported by Biden to close the southern Border. No mention is made that Biden was faced with a once in a century pandemic, winning the fight for vaccines over skepticism, and on Feb. 22 2022 Putin launching an attack on Kiev, Ukraine, and negotiating to get the crumbling infrastructure of the US rebuilt, funds for CHIPS and Science. On top of this the Venezuelan economy completely collapsed leading to an unanticipated migrant surge. Only FDR and Lincoln faced so many huge challenges and tackled them one by one. Without these facts the result can be to stall the biggest boom in manufacturing under president Biden/Harris that America has experienced since the space race in the 1960's. ...

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A serious problem for higher education, for universities and colleges in the US is the failure to focus on reducing cost. It costs $120,000 for a 4 year education at Michigan State University.Tution fees for one year have gone from about $10,000 to $20,000 over 12 years 2012- 2024 for state universities. Another priority should be reading comprehension as shown in Lyrarc's Movement for Global Literacy. This opinion piece describes the problems with colleges and universities further aggravating the fragmentation of the electorate into college educated and non college educated, with focus on theories of race and history when it should be focused on cost that makes it unaffordable to the vast majority of Americans. Priorities are misplaced and do not reflect the need to give good reading and math skills beyond high school in an advanced country where by 2010 about half the young population lacked reading comprehension in the ACT tests going further downhill since then. ...

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Jean Edward Smith who wrote on FDR, calls him the Great Divider. But he asks who today would not ask how anyone could oppose social security, and yet FDR passed Social Security against the vote of entrenched interests. And in establishing the Tennessee Valley Authority to priovide cheap electric power to the impoverished South, FDR did not consult wth utility giants Commonwealth and Southern. When he created the SEC he did not request the cooperation of those to be regulated. When passing Glass Steagall Act that separated investment banking and commercial banking he did not look for approval from JP Morgan, Goldman Sachs and Lehman Brothers. So goes the situation in September 2009 as President Obama's initiative on health care is bogged down by lack of support from Blue Dogs in the Senate and Republicans.

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Italian prime minister, Mario Monti, told the European Parliament in Strasbourg, that he wanted to see more power reside in the European Parliament, that democracy was consistent with integration. German chancellor Merkel says the European Commission should "act more like a government with all the powers," and the European Parliament should become more important than national parliaments. This is the vision of Europe that leaders are supporting in 2012. Monti gave as one major reason for a European governing entity- national governments with their own local interests had created the economic trouble Europe faces today, with Greece being a textbook example of how everything can go wrong. Germany and France, he says relaxed the fiscal discipline rules of the Stability and Growth Pact, and this could happen again.

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A World Bank 2008 Report concluded that Brazil's current state of education would lead to its falling behind other developing economies, and act as a constraint on growth. Brazil's 15 year old chidren came in 49th out of 56 countries on the reading exam for the Program for International Student Assessment, with more than half scoring in the test's bottom reading level in 2006, with scores in math and science worse than that. Of the 25 million workers who could join the work force in 2010, about 22% are not considered qualified for the labor market, according to a government report. The World Bank Report says Brazil stands to miss out on the "demographic window," in which increasing numbers of younger workers make the economy more productive, unless it addresses problems in education.

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Warren Stephens, head of Stephens Inc, in Little Rock, Arkansas, says repeal of the Glass-Steagall Act was a mistake. U.S. banks should have a 5% cap on holdings of total deposits in the U.S., and no "grandfathering" of banks over the 5% limit. Five institutions controlling 50% of the deposits in the U.S. creates too much systemic risk in another financial crisis. Banks should be expected to be one or the other, commercial banks or investment banks, not both. These recommendations are not new. Bank of England Governor, Mervyn King, called for breaking up the largest banks or shrinking the size of the largest banks during the global financial crisis in 2008. This position for banks that are smaller in size is supported by veteran bankers Paul Volcker, Thomas Hoenig and other experts.

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The apparent call by the US Chamber of Commerce for a Scopes type monkey trial cited in a Los Angeles times article -like that of the 1920' for evolutionists and creationists- to test the science of climate change, has led to vigorous protest from Exelon, autility company that manages most of the nuclear plants in the country. PG&M and PNM are other companies that vigorously protested these theatrics as they call it. The US Chamber of Commerce has opposed environmental legislation and is vocally opposing the EPA's use of an existing law, the Clean Air Act, to set limits on greenhouse gases. Exelon, PG&E, and PNM have withdrawn from the US Chamber of Commerce to protest. Other companies opposing the chamber's statements on climate change are Nike, J&J, Duke Energy.

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The yen strengthened to 88 yen to the dollar, the strongest in 13 years, and Hirohisa Fujii, the new Finance Minister said that the government would not step in to weaken the yen even if it went up further. Thomas Harr a foreign exchange strategist at Standard Chartered in Singapore says the elections were a big boost for the yen. It created a new environment in Japanese politics for the first time since World War II as the LDP party was swept out of power. The hope is that by moving away from dependence on exports and reviving the domestic economy Japan can turn the page to a new chapter in its economic growth, away from the stagnation of the last two decades. But its a tricky balancing act between exporters and the domestic consumer.

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Mervyn King of the Bank of England and Ben Bernanke both were academics at MIT, and both share the approach they are taking for quantitative easing or credit easing. They are buying up assets like government bonds in the case of Bank of England to reduce the yields, and commerical paper, mortgage backed securities, and consumer debt in the case of the Fed, also to reduce yields and drive up prices. The idea is to act more decisively than the Bank of Japan did during Japan's banking crisis, and flood the system with cash so that there is real impact. There is less danger of inflation in this downturn, which is one of the calculations that the Fed and the Bank of England are both making as they do this.