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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. ...

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Of the people asked the question "what issue do you see as the most important for health care" 44% in a NBC/WSJ poll said they considered Cost as the biggest issue, and 37% said that they considered the Uninsured as the biggest issue, 11% said quality of care was the biggest issue. The President is focussing on cost as he develops the health care plan. He is also saying that to provide health care for all and cover the uninsured without controlling costs would break the bank. Another thing that the White House shows it has learned from previous failed attempts, is that it is doing this with an open Health Care Forum with participation of different sides in the health care discussion. Clinton's effort in 1993 ran into problems because it was developed secretively, and without much discussion, and little effort to get different people's views. The previous attempt also waited too long after the election, and this time the President is moving quickly when he enjoys large popular support. Its also true now that there is serious concern especially in this downturn of what a threat spiralling costs of health care are becoming to the future prosperity of the American people. This time the leaders in Congress are setting an aggressive schedule to get health care palns legislation on the floor by June and get a floor vote in August 2009....

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The direction Germany is moving is now clear. The Greens polling as the second largest party in Germany have a good chance of forming the next government in a coalition with one of the other parties the CDU or the SPD. Policy will shift to invest in the environment, health, education, social care, digitization as the Greens will have a leadership role. This was neglected in the Merkel years with the financial crisis in the eurozone limiting investment and only shifting public perceptions with the pandemic. Annalena Baerbock, MP from the eastern city of Potsdam, is elected as the new leader of the Greens party. She could be the next chancellor to succeed Merkel in elections on September 21, 2021. Baerbock and co-leader Robert Habeck 51, are together the leaders in the Green party going into this election. Baerbock has a masters degree in International law from the London School of Economics. She is respected by German business leaders and chancellor Merkel. By contrast the CDU/CSU is divided today with no clear direction for the future. The SPD, the party of Willy Brandt, still comes in third with only about  fifth of the voters favoring it. Years of neglect of its working class base during the Schroeder administration has led to the SPD playing a less significant role. This leaves the Greens in a favorable position with climate change becoming a major issue in Germany and the shift to renewable energy underway. Neglect of digitization, education, healthcare and social care under Merkel now offer German voters an opportunity to vote in a government that cares about this. ...

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The Venezuelan government provides gasoline to people in the country at a few cents a gallon- almost free. Even Saudi Arabia, the Emirates and Kuwait which have way better financial balances and dollar reserves do not provide gasoline at such prices. The result is chronic shortages of basic parts and other imports because the government does not have enough dollar reserves for imports. Venezuela devalued its currency by 32% recently, making imports more expensive and pushing inflation up even higher to 28%. The problems it creates are excessive and wasteful use of gasoline, and free gasoline that then provides consumers money to pay for surging cost of everyday imported products. Nullifying any real benefits when shortages, inflation, dilapidated infrastructure and lack of development and jobs, are taken into account. The lack of capital to invest in the oil industry has led to declining production making the situation unsustainable. Yet neither party of Maduro or Capriles in the upcoming April 14, 2013 election, following the death of Chavez, supports ending this subsidy. Efforts to end the subsidy by president Carlos Andres Perez in 1986 led to riots and about hundred deaths in police response, and a coup by Chavez, then a military officer, a few years later. Under Chavez the subsidy was extended to the level at which gasoline is about 4 cents a gallon. Compare this with the price in neighboring Colombia at $4.72 a gallon, and Brazil at $5.40 per gallon. Consumption per capita in Venezuela is excessively high, about seven times per capita than neighboring Columbia. The investment in infrastucture is hobbled by lack of capital, the capital Caracas dilapidated, and no major infrastructure projects taken up by the government. It costs Venezuela 8.6% of GDP or $27 billion to pay for the excessively high subsidy, compared to 3.2% of GDP going to healthcare spending and 5.1% for education. In comparison Indonesia, another developing country, uses 2.5% of GDP or 21 billion for its subsidy for a population of over 200 million. It is not that a fuel subsidy is provided, but the entitlement to free gasoline that makes Venezuela the lone exception. There is a reason why prices in Brazil and China, large developing countries, price gasoline to motorists at over $4 a gallon- to discourage excessive and wasteful use, and release scarce capital for infrastructure development, building dollar reserves for imports of machinery and equipment, and other uses in industrializing economies. Compare Venezuela with Bolivia under the socialist government of Evo Morales. In 2010 Bolivia increased its price of gasoline by 80%. The price in 2013 is about $2.00 per gallon. Morales cushioned the increase by increasing salaries in the health and education sectors, armed forces and police by 20%, and increasing prices of locally produced wheat, corn and rice by 10%. Morales said he did this to reduce state subsidies of $380 million for $660 million in gasoline imports, of which $150 million was siphoned off by smuggling gasoline to neigboring countries. Incentives were provided to oil companies to produce gasoline in Bolivia to reduce imports. ...

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About 1% of doctors account for 14% of Medicare's payments in 2012, according to WSJ analysis of data released by the Centres for Medicare and Medicaid Services.

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Dan Maffei won his Congressional seat from an incumbent Republican from Syracuse. Others of the 35 first term Congressmen represent a rural, small town and suburban areas like Maffei. And they are not about to lose their seats after tough congressional campaigns, they say, by voting the wrong way on health care reform. As one from Maryland put it he is not willing to foloow the lead just to follow the lead. These are the Congressmen that Steny Hoyer, Rep. from Maryland, who leads the Democrats in the House, wants to give more time as this is what they wanted. And these Congressmen are making themselves heard and making changes in the health care legislation where they disagreed.

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Chris Cillizza of CNN shows here that back home in Maine Republican Senator Susan Collins hears from people saying again and again that they support her stand against the Republican health care bill. The rural and elderly are hurt most by this bill and Cillizza says Maine has a lot of these people.  He also cites the opposition of Republican Senator Rand Paul who doesn't like the other costly things tagged onto this bill, and wants a clean bill free of "billion dollar ornaments."

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Chancellor Merkel tells the newspaper "Sachsische Zeitung," that she sees a follow through on policies on refugees after reestablishing control over EU borders as one of the lessons learned from last years refugee crisis. This has reduced the flow of refugees and Merkel says the process of deportation of non-German nationals who had no residency permit had to be done rigorously and speeded up.  Having said this Merkel defended her policy on refugees as "coherent," and was clear about it- "I do not see a change of course, but coherent work over many, many months." Responding to Pegida and anti-immigrant sentiment in Dresden, Merkel said it is important to remember the lessons of history, that "we are the people" slogan used by the far-right is misplaced, that in a free society "we all are the people."

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Improvements in birth rate and more immigrants in Germany are making the demographic picture look better in Germany. About 13 million people are expected to reach retirement age in just a few years, according to Prof Enzo Weber, Institute of Employment Research. This means 13 million new pensioners. Birthrate today is about 1.4 children per woman. At this level of birthrate and even a low rate of immigration of 100,000 per year Germany's population of 83 million today would decline over time. Between 1990 and 2008 more people left Germany than came in with a net outflow. Some level of immigration would be the only way to keep the level of people in the workforce of 43 million today to become stable in the future. This would be needed to support the increasing number of pensioners. Yet the general aging of the population is expected to continue. And a high level of immigration in too short a time such as from the Syrian refugee crisis creates other tensions in the social fabric of society. Germany's very homogenous society faces a challenge that goes beyond the politics of the refugee crisis of today. Too many immigrants in too short a time is not the solution, immigration has become too politicized in today's context, good and early integration of immigrants through language and culture training needs to be established. Prof. Weber points out that the influx of immigrants from Southern and Eastern Europe has helped the labor market, and there is no reason that the labor market could not dry up with the number of people retiring soon. Tackling that will involve making family and career life choices easier and enabling flexible work-life choices, increasing retirement age, and some level of healthy immigration. A demographic summit will be held on March 16th in Berlin to look at the problem. ...