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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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A 41 year old doctor, Vasant Narasimhan, is the new CEO of Novartis in Feb. 2018. Under Narasimhan R&D is expected to get prominence. His predecesor Mr. Jimenez's focus was on developing new prescription drugs. Dr. Narasimhan sees a shift to new technology, improving data science and digital capabilities to discover new medicines. This shift raises the possibility of a spinoff of the Alcon eyecare business and the Sandoz generics business.   Narasimhan joined Novartis in 2005 from consultancy Mckinsey & Co. and becoming head of R&D. He is expected to push a series of tech based initiatives including artificial intelligence to be used for new biomarkers showing effectiveness of treatment, new sensor technologies developed with Microsoft. This shift is a result of the earlier effort under previous CEO's to make up for the loss of patent protection on profitable drugs by diversifying into consumer healthcare. During the period under Jimenez Novartis share price performance was mediocre, rising 41% over 8 years. Its business is stagnant with a 1% increase in 2017 for revenues, the first increase in 3 years.   ...

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The situation in nursing homes and eldercare is a huge black eye says this report from Canada. The situation is poor also in the U.S. and Britain. All the Anglo-Saxon countries appear to have the same problem of neglect of eldercare and homes for older citizens compared to say Japan, Germany or France with different healthcare systems and more invested in these areas of health and older citizens.Look at the numbers- in Canada 80% of deaths from coronavirus among older people in nursing homes. Next Ireland at 62%, and the U.S. at 40%. This report says these elder care facilities in Canada are run down, poorly equipped and understaffed. Canada's armed forces sent medics to the nursing homes in Quebec and Ontario and their reports are described as distruging and worrisome by prime minister Trudeau. In these countries lawmakers and policymakers have failed, and the culture of investing in areas other than health and public services and infrastructure, has failed the people. A poor scorecard for this generation of politicians, lawmakers, and leaders both in business and the government. ...

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This is the higher education equivalent of the moonshot says one education expert. The community college initiative of President Obama would double the numbe of people graduating out of community colleges. About six million students a year enroll for credit at America's 1200 community colleges, but only about 555,000 earn a two year degree, and another 295,000 a year earn a vocational certificate. The administration is putting a big emphasis on community colleges. Martha Kanter, the former chancellor of the Foothill-De ANza Community college district in California, has been appointed to the No.2 position in the Education Department. Arne Duncan made his first official visit to Miami community college, and Joseph BIden's wife teaches at acommunity college. The way community colleges have functioned in the American system of higher education, is that they provide post-secondary schooling for low-income studetns who have few other options. This works through open admissions. And most students are employed adults attending parttime; and according to some studies more than half need remedial courses before tackling college level work. The Obama effort is to require community colleges to work harder to retain students until graduation, and to encourage partnerships between community colleges and employers to offer workforce training. Without the access to the additional funding community colleges would actually find themselves in a bind, with rising enrollment rates just as their funding access deteriorates with state spending budget cuts. Debra Bragg, co-director of the Forum on the Future of Public Education at the University of Illinois, says that most new graduates produced under the Obama proposal would complete certificate programs, usually lasting 6 months to ayear , offering specific credentials for middle skill jobs. These jobs could be in healthcare, information technology, or other growing areas. See the article in BW showing the problem that is growing of unfilled jobs in many growing fields during a period of high joblessness, because of amismathc between the qualifications of jobless people and the requirements in the new fields. An example id autoworkers in Michigan taking up new skills for jobs in other fields. In this sense this program can be immensely useful in closing the gap. Results will take time as these resources take effect and graduation rates increase over time. ...

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The Economist points out (in this cover issue on India-Pakistan relations) several fundamental facts. The first is that the current state of relations betweeen India and Pakistan hurts Pakistan the most. It makes a much smaller country and smaller economy bear the burden of defense against a large neighbor- defense takes up much needed allocation of funds for infrastructure and development, education and healthcare. It also weakens democratic institutions and their development by an overdependence on the military for governance. Poor India-Pakistan relations have significant adverse effects on the U.S. In fighting the Taliban U.S. forces are fighting a force that Pakistan's military helped create and support from its early beginnings as a way to counter Indian influence. With an Indian-Pakistani peace settlement of issues in Kashmir and other outstanding issues the U.S. would be in a significantly better position to disengage from the region, especially when the entire Middle East is moving in a new direction in 2011. Consider the difficulties in establishing peace in Northern Ireland, and between Turkey and Greece, and the difficulties of establishing peace between India and Pakistan cannot be considered even more difficult. Pakistan and India muddle along- neither side is doing much to take the initiative. For the U.S. disengagement from South Asia can be best achieved by pushing for a settlement between the two countries. Pakistan and India have much to gain from a settlement. Considering the progress made in Ireland, such places as Yugoslavia, and in Turkish-Greek relations, there is a lot more that can be done and should be done to bring India and Pakistan together. In Ireland diplomatic efforts were made by U.S. envoy George Mitchell, and in Yugoslavia U.S. envoy Holbrooke made diplomatic efforts towards the Dayton accords. Greek-Turkish relations have advanced to the point where Erdogan and Papandreou, the Greek and Turkish prime ministers, discuss solutions to the Greek debt crisis. This includes options to reduce Greece's defense expenditures in the light of Turkey's new foreign policies. The lack of such efforts to break the deadlock between India and Pakistan by the U.S,. the U.K. and other countries involved in the NATO mission in Afghanistan, the emphasis on a military solution supported first by Gen. McChrystal, and then by by Gen. Petraeus, all show a lack of understanding of the real issues that need to be tackled- issues relating to a peace settlement between India and Pakistan....

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The Labor department reported that unemployment surged to 10.2 % in October 2009. 190,000 jobs were lost in October 2009. Ther breakdown lokks like this. Construction lost 62,000 jobs, manufacturing lost 61,000 jobs forming the bulk of the job losses. Its interesting to note that only 16,000 jobs were gained in the federal government and 16,000 jobs were lost at the local government level making the net gain zero at the government level. And what was gained in the health care sector 28,700 jobs and in educational services 10,700 jobs for a total of 39,400 jobs was completely offset by 39,800 jobs lost in retail sector. The useful point here is that local governments are hurting and retail sector is hurting and little is going to change this as long as job losses continue and the gains at the government level and healthcare and educational services are simply offset by losses inretail and local government. This situation will likely ocntinue into 2010. The losses in manufacturing are likely to continue. A sample of companies like Eaton, Boeing and John Deere shows that 2010 will not generate many jobs. Eaton has decided to have its 55,000 employees take aweek of each quarter, so there is one twelfth work capacity unused which is where Eaton will turn to before hiring. At Boeing there are layoffs of 10,000 planned but its also hiring 3800 workers for anew factory in South Carolina, and at John Deere 452 workers will be recalled in November but in December there is aplanned shutdown. A September Survey by Business Roundtable found that 13% of firms planned to increase employment in the next 6 months, but 40% planned to cut payrolls. So manufacturing looks to go on like this in 2010 with slowing but continued job losses. The numbers show that in October the median number of weeks it takes to find ajob up to 18.7 weeks which is the highest number since the sixties. What gets ignored by the small print you find it in the Wall Street Journal is the broader unemployment rate which is 17.5% when you include those who have stopped looking, those who work part time but need full time work and the marginally unemployed. The rates jump for younger workers here and in Europe also. ...

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A joint article by Robert Rubin, Clinton era Treasury Secretary and Jared Bernstein of the Economic Policy Institute. Rubin was senior adviser to Citigroup during the period that Citigroup leveraged itself and invested in lower quality securities that have left the firm exposed to substanital losses, and led to hiring a new CEO Vikram Pandit to clean up the mess. And this may explain the joint article with a less well known economist Jared Bernstein, and the tentative nature of their advice as the two differ on the important issue of long term fiscal deficits and still agree on investing heavily in healthcare, education infrastructure, worker training and energy. In a short recession they may be complementary and you could have the best of both worlds as in the other postwar recessions. But this is unlike any of the postwar recessions and is shaping up to be a long and deep downturn unlike anything seen in the postwar period. That Rubin does not even mention this shows that probably he is out of touch, as he was during his years when Citigroup was acting much like the other banks that were in serious trouble this year. Some of the decisions for lax regulation during the Clinton years were taken with the support of Rubin and Greenspan. What Rubin calls the longest expansion could have been for the most part good fortune and a steady period for the economy with Rubin's contribution being fiscal discipline, stewardship of the Mexican rescue package and committment to free trade policies, but not facing upto huge headwinds in the economy that required challenging leadership and judgement. Here Rubin mentions nothing that suggests bold vision and judgement, instead hoping that old policies that worked during the good times would somehow work today. And on some issues like labor being squeezed and getting a smaller portion of the economic pie with no support for unionization, a drop in the number of unionized workers and weakened labor bargaining strength, Rubin who now sees this as a bad trend for the working middle class incomes, did little in his years in the Clinton administration to reverse or slow this trend. He cites productivity growth of 20% from 2000 to 2007, and yet the real income of working age middle class households was falling $2000 or 3%. ...

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The FDA sets a pathway for developing "biosimilar" drugs in the U.S. Biosimilar drugs are cheaper versions of higher cost biotech drugs. Europe has moved further ahead in this area.

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The Indian pharmaceutical industry is expected to grow by 13% to $24 billion in 2010. R&D is a special focus, as new drugs can be developed at much lower cost in India. Mr. Piramal, for instance, kept the R&D operation of Piramal when he sold the rest of the company to Abbott Labs of the USA. The Piramal lab in Mumbai has 300 researchers and scientists, and Mr Piramal says he can develop new drugs at a tenth of the $1.5- $2 billon cost it takes for this in the USA and Europe.

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Indian firms in the pharmaceutical industry. Inventing new drugs from scratch through research and development and lab work and testing is only now taking shape.

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Pearlstein quotes Dickens in "Oliver Twist," about the law being an ass, and the constitutional law exercize in the Supreme Court of the U.S. giving a sense of a failure of the so-called best and brightest in reasoning out the issues. He points out that a serious problem is that American business which is burdened with high health care costs for employees is seriously missing in this debate after years of complaining about high costs. The National Federation of Independent Businesses is actually one of the plaintiffs questioning the constitutionality of the Obama health care law. Pearlstein says business wanted an end to the fee-for-service medicine that increases consumption of medical services and pushes up cost relentlessly, and that Obama's health care law does this. This is not the case as both Democrats and Republican administrations have failed to resolve this side of the cost issue, and this is the hidden reason for the loss of credibility for both sides in this debate, leaving health care problems to be resolved in future administrations. ...

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In France MEDEF the employers union is calling for relocating strategic industries back to France. In its plan of reopening of May 28 it calls for "targeted relocating of strategic sectors, to France, and Europe, with healthcare a priority." The French government of president Macron and people support this. To get an idea of how people feel consider that surveys recently taken show 89% of French people wanting to relocate industries back to France, and 47% want to do this completely, even if this means higher prices for consumers.  French carmaker Renault announced 4600 job losses in France as demand has dropped, even after the 5 billion euros of state help it has received for the pandemic losses. France has a 15% stake in Renault and Renault has given a commitment to bring value added manufacturing back to France after state aid. President Macron has called for economic sovereignty. His call as the pandemic leads to rethinking of old supply chains is - "We must build more in France, on our soil. And rebuild our national and European sovereignty." It is a rethinking that is now getting overwhelming support of the French people. ...