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This WSJ editorial describes the choices facing states in the U.S. for Medicaid- staying in and increasing the strain on state budgets or opting out altogether from Medicaid when hospitals in the states have enlarged their Medicaid dependent programs- as being a kind of extortion. Justice Kennedy said this was not giving the states much of an option, and Justice Scalia described it with a Jack Benny humor quote about being held up by a robber saying "your money or your life." Justice Roberts described the overwillingness of states to accept federal funds that got them to this point. The overall sense of the hearings at the U.S. Supreme Court on the third day, was that of skepticism on the part of Justices Scalia, Alito, Kennedy and Roberts, leaving Solicitor General Verrilli to make an appeal to humanitarian and patriotic sentiment about millions of the poor who would go without medical care if the Court ruled against the government.

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Estimates show the 50 million Americans enrolled in Medicare today will increase to 80 million by 2030, according to the program's actuaries. Simple demographics as the baby boom generation ages is making controlling the deficit without controlling increase in health care costs as both sides in the fiscal cliff negotiations are attempting to do can only lead to defunding critical areas such as education, R&D and infrastructure, and breaching the safety net for lower income Americans. Health care spending took up 7% of GDP in 1960, increasing to 17.9% of GDP in 2010. Federal spending on healthcare has grown to about 25% in 2012 from 10% in 1960, and is projected to increase to about 33% in ten years by the Congressional Budget Office.

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Paul Ryan, chairman of the House Budget Committee, explains his U.S. budget proposal to bring down the deficit. Ryan's Republican budget proposal is a bold effort to make a break from a status quo which is leading to higher levels of U.S. debt as a percentage of GDP. It envisions changes to Medicare, Medicaid, and the tax code. It is built on the idea that sustainable finances will lead to a better economic future for America, compared to small changes to the staus quo envisioned in Democratic proposals and the 2012 budge proposal of the Obama administration. It is also bold in its effort to tackle Medicare with a "premium-support" system, and Medicaid by turning it into a block grant system. It also incorporates the Bowles -Simpson President's Deficit Commission's ideas for simplifying the tax code.

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In a factory the size of 5 football fields located in Gurnee, Illinois, Abbott Labs makes its BinaxNow Covid-19 home tests. Abbott turned out 1 billion tests in 2021 and at one point had 80% of the market. Along with Pfizer vaccine, BinaxNow Home covid-19 tests are a dominant product during the pandemic. Abbott generated a fifth of its $43 billion in revenue from these home tests. Abbott faced several hurdles along the way. It gained when the US government authorized it to make the test. Yet after vaccination took off by mid 2021 the demand for tests declined and Abbott nearly idled its giant factory in Gurnee. Delta and Omicron variants led to a sudden reversal and surge in demand. Abbott developed its test based on an existing design it used in the US for flu tests, by a company it inherited by acquisition called Binax. To do that test one sends a swab up the nose, add that sample and a liquid mixture to a rectangular paper card, and close the card shut. The liquid then travels up the paper strip, revealing one or two pink lines, one for negative, two for positive. This is done in 15 minutes and the simple design described as a lollipop shape, put Abbott far ahead of competitors. The US FDA authorized Becton Dickinson and Quidel to make the tests before it authorized Abbott, but these rival companies had a poor and complex design. The Trump administration gave Abbott a $760 million contract to buy 150 million tests for distribution to health departments, long termcare facilities, nursing homes, and schools. And by October 2020 Abbott was already making 50 million tests a month. When it comes to distribution Abbott tapped into its pharmacy connections for baby products such as Similac baby formula. This gave it an advantage over Quidel and others who also lacked the manufacturing knowhow for large scale ramp up. The BinaxNow in pharmacies was sold at $24 for a box of two tests, while government paid $5 for one test. Abbott says it makes $ 7 per single consumer test. Yet there was one problem waiting to hit Abbott in 2021- demand dried up as the vaccination campaign took off. In fact the plant manager, Mr. Rodriguez, planned to move to another job inside Abbott as production declined. Then came the Delta variant and he was asked to ramp up production again. With Omicron demand soared. The Biden administration committed $3 billion to help boost test production and asked Kroger and Walmart to sell over the counter tests at cost for 3 months. Abbott had to lure workers from Amazon at $25 an hour for the Gurnee plant expansion. What was learned by the government and Abbott from this experience? The US government now looks for ideas in meeting demand volatility, supply challenges and production needs,. Sustaining production capacity is important for future virus flareups- a new government-industry partnership is required for maintaining test making infrastructure. With government help Abbott plans now to keep the facility at Gurnee operating indefinitely. ...

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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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Sharply lower consumer spending is hurting Apple sales in China. Apple cut sales and issued a sales warning in January 2019. This follows Apple's sharp slowdown in India with its uncompetitive pricing.

Retail sales growth in China- which bounced back in previous downturns- dropped to the lowest level in 15 years in November 2018. Auto sales are down with the sharpest drop in 7 years- the first annual drop in sales since 1990. Fears of a housing bubble have led to restrictions on home purchases for speculation which have not been lifted. Income tax reduction has not increased spending. GDP growth for the fourth quarter dropped to 6.4%.

Further signs of a sharp pullback are seen in the drop in consumption tax revenue falling by 61% in October and 71% in November 2018. The consumption tax is placed on cars, gasoline and luxury goods, and is paid by the companies making the products.

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The House healthcare bill that just passed by amargin of 220 to 215. The cost would be $1.055 trillion over 10 years, with cost of $894 billion factoring in penalties for individuals and businesses that don't buy insurance. Adding increased coverage for Medicare prescirption drug coverage for seniors its around $1.2 trillion. $460 billion is from new taxes on single people with income of over $500,000 or couples with inocme of $1 million. There are $400 billion in cuts to Medicare and Medicaid, and additional money coming from penalties for not buying insurance. First column here is Senate version, second for House version and third President's version. Other features individuals must have insurance or pay afee of 2.5% of income, hardhip waivers will be available. Employers must provide insurance to employees or pay a penalty of 8% of payroll. Small businesses with fewer than 10 workers get tax credits. The threshhold is $500,000 of payroll. To help families with lower incomes and the poor the bill provides: families earning $29,000 a year pay no more than 1.5% of income for premiums. Families with incomes of $88,000 ayear would pay no more than 12% of income for premiums. ...

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Many important changes in the health care bill do not come till 2013 or 2014. Its only in 2014 that government will hand out tax credits to low and middle incoem Americans to offset the cost of buying insurance and expand Medicaid federal-state programs to help expand insurance for the poorer sections of society.

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Brad Stulberg reflects in this article on the idea of groundedness and how it creates internal strength and a sense of fulfillment in life. The pandemic has worsened mental health and created the need to reflect on living a better healthier life. Here he points out that one needs to accept the present, the mess of vulnerabilities he says we find ourselves in, as a natural part of life. To build on a good process that gets us there. This means clarity, simplicity, and concentration so that one does not end up wasting one's energies in different directions. Focus on one or two tasks, what he calls deep focus work, play and connection. Experts say it is not true that there are sudden leaps in performance. Most work is diligently done each step preparing ne for the next step which eventually with patience and persevering on tasks brings results. They only appear to be sudden achievements, but always build on work done before patiently and step by step. This can be seen in the work of recent Nobel prize winners in science who have worked on a new discovery for decades with failures that were overcome, and obstacles that were surmounted with patient work day after day. Stolberg quotes St. Augustine and the Buddha on the importance of close knit groups, companionship and being part of a deep community. When Buddha's disciple Ananda says this is half of the spiritual life, Buddha says in response -  not so, this deep community is the whole spiritual life. Stolberg's new book is "The Practice of Groundedness." Much of this is also seen as important in the Bhagavad Gita and in Christianity- the ideas of simplicity and concentration in life on just one or two tasks, the clarity of mind that comes from this free of tensions.  The Cistercian monasteries all over Europe in the Middle Ages attest to this. One such abbey the restored Abbey of Fontenay in France, embodies this idea. Written about the restored abbey are the words- "The sun brings life to the austere bareness of Cistercian architecture, the way God's light spreads grace through the simplicity loving souls of the monks." ...

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Retail sales in China dropped sharply. Retail sales dropped from double digit increases for most of 2014-2017 to single digits in 2018- sales dropping to 8.1%. Government restrictions to prevent a housing bubble restrained housing sales, and policies to control corporate debt limited growth. Higher inflation for food and housing, have led to asharp pullback in growth of consumer spending.  Trade tensions with the U.S. have hurt consumer sentiment. The feeling that China's growth would stabilize because of its connections to the world economy is fading as consumers see persistent trade tensions with the U.S. including tariffs of upto 60% in tit for tat actions as hurting China's prospects.  The GDP growth is expected to be about 6.5% for 2018 according to government estimates, which experts say is actually much less or even half that as exporters retrench in the face of slack demand in China and lower sales to the U.S.  Rail and other infrastructure projects that were considered unsuitable are now being given approval in efforts to boost the economy. More tax cuts and expanded deficit spending are policies likely to be followed.  At foreign companies no overtime, and job cuts are commonplace especially in the auto industry. ...

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Tyler Owen points out that the innovations that made areal difference in the standards of living and incomes of people in America came in the earlier decades of the 20th century. From 1947 to 1973, this pattern continued with the doubling of inflation adjusted median incomes in the USA. From 1973 to 2004, it rose 22%. Over the last decade it actually declined. The impact of automobiles, airplanes, anitbiotics and new household appliances was huge in the prosperity and incomes of the American people. The personal computer and the internet do not offer the same potential for improvement in incomes and standards of living. At the same time as society ages in the US and healthcare dollars are measured as part of GNP, the increasing GDP from such dollars does not reflect an improvement in the health care people receive.

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President Obama is acutely aware of Republican concerns of waste as the government increases spending to support the economy. He told the US Conference of Mayors, that "if there are wasteful projects" he would "call them out on it." He also said the preceding administration had paid too little attention to urban problems. His years as a community organizer in the urban environment of Chicago gives him aunique perspective of waht is happening on the ground level in cities across the country. Mayors spoke with Cabinet secretaries during their visit to the White House, and had avariety of projects in mind from new community health centers, new water towers, sewage treatment plants. Republican Mayors are also responding positively to the stimulus, now that the money is there, Mayors like Patrick McCrory of Charlotte, N.C., support finding the best way to use the money.