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While communities with high unemployment and depressed areas like Rocky Mount in N. Carolina, with 14% unemployment -and many customers skipping prescriptions because they can't afford them- are the worst off, the national picture shows many similiarities. Even with Medicare drug benefit, lowcost generics, and Walmart type low cost drugs, many Americans cannot afford prescription medications for life threatening illnesses. Nationally a third of respondents say they are not complying with prescriptions as they cannot afford them, compared to a fourth three years ago.

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The basic outlines of new health care legislation takes shape as Senators Dodd and Kenedy come up with a plan that scales down subsidies to low-income people to buy insurance. Attached to their revised outline is a budget office analysis thatprojects the plan costing $611 billion over 10 years and with expected changes from the Senate Finance Committee would cover 97 percent of all Americans. And earlier plan received much criticism because the Congressional Budget Office estimated its cost at $1 trillion over 10 years and left 37 million Americans uninsured. In addition there is the revised Medicaid expansions for aid to the poor that would add a couple of humndred billion dollars to the total tab. The administration's goal is to keep the cost down to $1 trillion over 10 years. The legislation as it stands includes the public option which is designed to control insurance costs. Mr. Obama said this week that "the public option would keep insurance companies honest." Employer mandated insurance is part of the Kennedy-Dodd legislation proposal. Employers with 25 or more workerswould have to provide coverage or pay the government an annual fee of $750 for each full-time worker and $375 for each part-time worker. The government pays the startup costs for the public insurance option as a loan to be repaid, and premiums would make the option self-sufficient....

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Senator Mitch McConnell, the Republican Majority leader in the U.S. Senate has come up with a new health care bill that is aimed at winning over reluctant Republican Senators. Two taxes on high income people on 3.8% investment income and a payroll tax of 0.9% on incomes over $200,000 for individuals and $250,000 for couples are retained in this version of the bill, which adds $231 billion over a decade. Some of this is used to offset rising premiums in the new bill, and provide additional funds. The deep cuts to Medicaid are retained and Senator Collins of Maine says she is opposed to the new bill because this will hurt people in rural areas of Maine, and does nothing to change this. Senator Rand Paul of Kentucky is also opposed to the bill. Opposition comes from moderate Senators opposed to deep cuts to Medicaid in Republican health care alternatives to president Obama's Affordable Care Act, and from conservative Senators opposed for other reasons.  Senator Graham of South Carolina and Bill Cassidy of Louisiana introduced their own version just minutes before Mitch McConnell brought up his revised bill. All Democratic Senators are opposed to the Republican bill and call the deep cuts to Medicaid disastrous for lower income people.  ...

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Janet Yellen Fed chairwoman, says many obstacles still exist for women in the workforce. Bringing more women into the workforce will increase the productive capacity of the American economy. The increasing participation of women in the workforce was factor in the growth and prosperity of America by the middle of the 20th century. In a speech sharing her personal narrative at Brown University, her alma mater, she described how other nations had passed the U.S. in women's participation in the workforce, and how it remains stalled at 75% for women either working or looking for work. Her speech was at a conference "125 Years of Women at Brown." The U.S. is now 17th among 22 developed nations in participation of women in workforce, mostly because of government and business policies that relate to paid maternity leave, affordable child care, and flexible work schedules.

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Are there costs or are there savings from the Obama health care bill? Does it affect jobs and how? The Congressional Budget Office says the health care law will save $230 billion in ten years based on a whole set of calculations and assumptions. Commonsense and basic math leads others to question how spending $930 billion on insuring 32 million Americans could end up with significant savings. The different view argues that the Budget Office erred in making some calculations, by counting $70 billion in premiums from long term care because they would be used to pay benefits later, omitted $115 billion in spending to adminster the law, and omitted $208 billion needed to prevent scheduled reductions in Medicare payments to doctors. The money needed on the Stimulus, on two wars in Iraq and Afghanistan, and the uncertain prospects of the US economy in the longer term till debt and other issues are resolved, injects the critical element of difficult choices and priorities. If state and local budgets are severely strained in 2011-2012 would that require federal help and will there be other needs that will have to be met by the federal government that are critical such as another unexpected downturn, or a resolution of unresolved bad debt at the large US banks There is also a sense that the health care law does not do enough to reduce the cost of health care that will be needed over the next decade so that other priorities are not neglected. Both parties are not up to the task in this respect for running the country's finances withot using the numbers to tell different stories....

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As Japanese sales in the USA drop from 4.35 million vehicles in 2007 to 4 million in 2008 and an estimated 3.67 million in 2009 according to CSM Worldwide, even the Prius and the Honda Civic are afected. The Mississipi Blue Springs plant originally designed for the Higlander SUV , then assigned the task of making Prius after the shift to smaller cars, now will not make the Prius. The plant investment will stop at $300 million, with the plant construction being completed but the equipment not being installed, and no plans to manufacture cars there till things improve and the plant is made fully operational. At the same time it is noteworthy that employees Toyota has hired at the plant will keep their jobs. Toyota has not laid off permanent staffers at its plants in North America or any other region despite slowing sales in its worldwide markets. What does this mean? The culture of the United Autoworkers Union developed through the prewar confrontations between the union and the auto companies, and union workers and union officials and company managers came to a consensus through these struggles with the coexistence of high executive compensation and union medical benefits and other benefits and job security. But its not really been a frutiful arrangement as it has constantly been whittled away and eroded to the point of going out of existence even as the union clung on to the old ideas and management just went on with the status quo. Jobs security is nonexistent and jobs constantly cut as plants close, and now high executive compensation will face government oversight with the auto loans. See the link to Business Week which states that the numbers show the auto workersin Detroit union plants pay about 5% of their medical costs as opposed to 30% for workers who have healtcare coverage in the USA. But what good is the additional benefit in an environment where plants are constantly closing and jobs being cut. Is'nt aworker at a Toyota plant with no job cuts but costlier medical benefits better off than his Detroit counterpart? Which is to say with forward looking management that lowered executive compensation and unions that discarded an entitlement attitude and proactively matched its medical benefits to levels to nonuninized Japanese plants, and management that proactively shifted to higher fuel efficency and smaller cars in the interest of energy conservation and good strategy to be level with companes like Honda ad Toyota in that performance measure, wouldn't that have led to fewer plant closures and jobs, and public support across the country including in dealer showrooms?...

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U.S. states want flexibility in applying the Medicaid program which covers 53 million Americans earning lower levels of income. This amount was $11,616 a year for working parents in 2009, according to the Kaiser Fondation. Some states have a higher income level, as high as $48,400. The problem for states are serious budget deficits, with Medicaid comparing with education as a major cost. The recession and job losses has added 8 million Americans to Medicaid rolls. The Federal government supports 57% of the Meddicaid budget on average. A provision in the 2010 health care law says states cannot limit Medicaid eligibility, or they would lose funding by the federal government. The Obama adminstration's position is that eligibility or provider cuts will not bring in large savings, and will allow larger cost-sharing by Medicaid users, with only minor cuts in eligibility. Its position is also that the law does not give the federal government waiver authority. Some of the issues raised relate to the structure of Medicaid cost and its rapid escalation. Health and Human Services says 1% of benificiaries, especially the long term care, use up 25% of the Medicaid expenditures. One astonishing fact is that two thirds of all U.S. nursing home residents are on Medicaid. The total cost is rising, from $187 billion for Medicaid in 2000, to $346 billion in 2009, according to the Centers for Medicare and Medicaid Services. In July 2011, $26 billion in additional federal Medicaid funding expires, which will be added to state expenses as they struggle with large deficits. In states like Maine, with generous benefits, about one fourth of all residents are in the Medicaid program. ...

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A Brookings Institution study of hiring trends and unemployment in the 100 largest metropolitan areas of the U.S. at the end of 2012, shows 78 metropolitan areas adding jobs in the 4th quarter 2012. 14 of these areas had more jobs at the end of 2012 compared to before the 2008-2009 recession. Six of these cities were in Texas. This included Knoxville, which gained from jobs added at a nearby VW plant. Other cities were Oklahoma City, Omaha, Salt Lake City, Charleston. Only three cities in the East and West are on the list- Pittsburgh, Washington and San Jose, and none in the midwest, showing the geographical divide in job gains. And Washington D.C. will lose government jobs after job cuts in the government. Charleston will lose jobs from cuts in military spending.

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Laffer says there is a big gap between the cost of health care and what people actually pay, which keeps cost escalating as there are no pressures from users of services to economize or bring reductions in the prices. But Laffer offers no effective solutions either his patient centred approach to health care reform does not address the problem that employers are paying for health care for the large part and these are not taxed as benefits leaving the employee free to load up on services and ignore the cost, which works just fine for the health care providers who increase revenues and profits- also called cost escalation upto the point now reached where the nation can no longer afford it.

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Reports from the Sixth China North-South Lung Cancer Summit meeting of 300 experts focusses on controlling tobacco use and promoting early detection and treatment of lung cancer. Lung cancer is now the leading form of cancer in China, with 22.7% of cancer deaths each year. Currently about 1 million die in China from smoking related illness each year. CCTV reports this is increasing by 26.9% a year. Causes cited are aging population, air pollution, and widespread smoking. About one in three of China's people smoke, or about 350 million. Awareness of the dangers of tobacco use is not high outside two or three major cities. China manufactures about 1.7 trillion cigarettes a year, according to CCTV, and tobacco contributes 7-10 percent of state revenues.

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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. ...