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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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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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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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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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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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Joseph Stiglitz writes that keeping the dollar as the reserve currency is no longer the option. He tells us that it comes with some hidden costs such as a weaker global economy. Having developing countries keep hundreds of billions of dollars in the US in low interest earning reserves makes no sense considering the needs of developing countries, and the improved prospects for the USA and Europe in exports to a growing developing country economies. He points out that a new global reserve currency, with an orderly transition, may be the most important reform to ensure the longterm health of the world's economy. Its bad for the USA to keep exporting T-bills, says Stiglitz, as it does not create jobs. And its bad for all concerned as it lowers global economic growth. Especially he says when it is so unseemly for developing countries not to use the money to improve living standards in their own countries, with the help of exports from developed countries, that in the end improves global growth and the global future....

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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.

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In this Agenda column Simon Nixon takes on the U.S. Treasury's criticism of Germany for its current account surplus of 7% of GDP in 2012, and not doing enough for the economies of southern Europe. The German government called it "incomprehensible." Nixon says it is better for the German economy to remain strong and to boost competitiveness and consumer spending in Spain, Portugal, Italy and Greece. He says the low eurozone inflation of annualized 0.7% for September 2013, which prompted the ECB to cut rates by 0.25%, is healthy to the extent that consumer prices are declining to adjust to a decline in wages. The reduction in labor costs is a way to restore lost competitiveness, just as Germany did in the last decade. The criticism is considered by many economists to be misdirected, and seen as "incomprehensible" by Germans, as Germans ask what would the U.S. have them do- provide stimulus when the government debt to GDP ratio is currently 82%, increase wages and how would this help Southern Europeans. Focussing on Germany's current account surplus says Nixon, is obscuring the larger issues of increasing consumer and business confidence and spending in the eurozone, and increasing bank lending. The new ECB bank resolution arrangements and other changes including deposit insurance if done right should help the recapitalization and restructuring needed for restoring bank lending to support recovery. Spain is furthest along in regaining competitiveness, with changes in Portugal, Italy and Greece also supporting a gradual return to growth....

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Bayer CEO, Marijn Dekkers, plans to divest its plastics business, called Material Science. The plastics division requires large investments with lower returns than can be made in health care or the agricultural crop science business. Crop Science generated earnings before interest and taxes of 1.81 billion euros in 2014, and Health Care helped by 5 new prescription drugs reported EBIT of 3.58 billion euros, compared to poor returns of 555 million euros on the polyurethane and polymers used for laptops to soccer balls in the Materials Science division. CEO Dekkers is a Dutch born executive who worked for 25 years in the U.S. Since taking over in 2010 he has brought a significant culture change to Bayer, by insisting on speed and agility from executives. Division heads with marketing backgrounds are preferred to science degrees, and the planning orientation of the company is being changed to one where the company executives are not afraid to take risks based on incomplete information. Dekkers prefers an IPO for the $10 billion plastics business to generate more cash and reduce the debt of 20 billion euros. He acquired the over the counter drug business of Merck for $14.2 billion, and has boosted drug sales with the introduction of Xarelto in partnership with J&J, eye treatment Eylea, cancer drugs Stivarga and Xofigo, pulmonary hypertension drug Adempas. Sales of these 5 drugs are expected to go up from 2.9 billion euros in 2014 to 4 billion euros in 2015, contributing significantly to Bayer's profits. Dekker's venture capitalist type focus on profit margins is showing results in share price performance- Bayer's share price has advanced 60% in 2015 mid-March price of 145.85 euros compared to the prior year month. In the small town of Leverkusen, Germany, where Bayer is located, there were initially fears that Dekkers was "too American" and too focussed on shareholder value to understand the need to respect tradition. Since then Germans have realized that Dekkers understands tradition and is only bringing necessary change- the transition to being a life sciences company makes sense to shareholders in Germany, for employee representatives on the supervisory board the guarantee of current level of 17,000 jobs in the plastics division for a few years shows his concern for job protection during the transition period. For Dekkers who left Holland in 1985, and has a U.S. passport with an American wife and kids who speak no Dutch or German, the important thing is to get the right balance- he says the system of 99-1 where 99% of the information had to be in before a decision could be made is making the change to 90-10 where only 90% of the information is now necessary to go ahead, even if he would like to see it at 80-20. Bayer still sponsors the local soccer team known as Bayer Leverkausen, and 26 other clubs. Dekkers steps down at the end of 2016....

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According to recent Center for Disease Control numbers, about two-thirds of American women are obese or overweight. Retail stores like Target are trying to appeal to women in the 14 plus sizes where demand is growing.

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The lack of consensus on social distancing and stay at home lockdown, poses huge problems for Brazil, with the governors of Sao Paulo and Rio de Janeiro calling for social distancing and the president not taking action. The public health systems have been underfunded for years and are at risk of being overburdened. Dengue and other virus are also a risk in Brazil, along with coronavirus. The government froze all social spending under the previous president Michel Temer. Years of overspending and dysfunctional pension systems put Brazil into this situation.  Azevedo Silva, a researcher at Rio's state university UERJ, says it is of utmost importance that Brazil guarantees social isolation now so that fewer people will need hospital treatment. Health minister Henrique Mandetta also supports social isolation measures to be taken now as the crisis escalates in the U.S.

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Pearlstein points to the need for the structural changes in the U.S., Europe and China to address the serious imbalances that are at the root of the problem. This process will be painful and mean a short term drag on the economy even if the right actions are taken. The process of unwinding the imbalances will take time. Lower growth in China will be good for the bubble in real estate markets and the reduction in the trade surplus, even though this will reduce imports of European and U.S. machinery. Higher savings in the U.S. and reduction of consumer debt will slow retail sales but this is healthy for longer term growth. The same is true for savings in deficit reduction that will result in more layoffs at the local level. The government needs to have similiar action take place at the banks to end their "extend and pretend" practices and finally write off bad loans in residential and commercial real estate. There is no easy way out, no solutions that can be made without a sharing of the pain. Policy makers around the world have tried to look for painless solutions for years and this may be the end of the road. There is some action that the governments and central banks can take. Pearlstein suggests that the European Central Bank buy up some of the sovereign bonds being dumped on the market even if it means printing money. The Fed, the Bank of Japan and the central bank of China can also swap some of the Treasuries they own for European sovereign bonds. This would give time for the EU leaders to give the European Financial Stability Facility the resources and powers to replace the sovereign bonds with more reliable European bonds. The Fed can take this opportunity to sell some of its huge pile of Treasury bills into the market so that it has more room for action in future years. The U.S. government can move up the spending for infrastructure in years 8, 9, and 10 to the next 2-3 years to give some support to the economy as these changes take place. The spending decisions should be left to an independent Infrastructure Bank. See the related article by Krauthammer in the Washington Post, August 5, 2011, which provides a companion policy prescription for U.S. deficit reduction based on the work done by the Bowles-Simpson Commission and by preserving efficiency and fairness....

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AstraZeneca PLC showed a net profit decline of 8.3% in fourth quarter 2011, on sales that remained stable at $8.66 billion compared to $8.62 billion in the prior year quarter. AstraZeneca is facing competition from low cost generics and cuts in government health care spending similiar to the rest of the industry. The company has announced new job cuts of 7,300 job for 2012, which brings total job cuts to 30,000 for the last 5 years. Most of the job cuts are in the U.S. and Europe. Hiring has continued in emerging markets leaving the net job cuts over the last 5 years at 9,600. Of the 7,300 job cuts planned for 2012, 2,200 will be in R&D departments, 1,350 in manufacturing and 3,750 in sales. AstraZeneca is changing the way it will do research and development with these changes. It will close the neuroscience research laboratories in Sodertalje, Sweden and in Montreal. It will have in its place "virtual" neuroscience units, small groups of 40-50 researchers working with academic groups and scientists outside to utilize the best science in the field. This is one of the most radical changes in R&D practices among pharmaceutical companies. In marketing the approach has shifted from having full time sales people call doctors offices to using online marketing tools and telemarketers. This approach is also being adopted for emerging markets....

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This editorial in the Wall Street Journal says faster approvals at the Food and Drug Administration have helped bring more generic drugs to market lowering prices for the public. In 20 months the Trump administration approved 1617 generic drugs, 81 a month on average or a 17% increase over the preceding 20 months. Council of Economic Advisers in October said this was a saving of $26 billion for the public.

President Trump is looking at price controls as a way to bring down drug prices. With increasing outcry about high drug prices in the U.S. the Trump administration and Democrats in Congress are looking for new approaches to bring down prices.

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The costs of fraud in medical care from spurious Medicare claims to kickbacks for unecessary services is estimated at $125 to 175 billion. Costs of unnecessary care from overuse to unnecessary lab tests are between $250-325 billion. The amount wasted for on treatment for preventable conditions such as heart disease and diabetes. is $25-50 billion. This number is much higher when all the complications from obesity are figured in. These amounts alone add up to $500 billion. Add to it the problems and the costs of medical errors leading to bad drug reactions or other misdiagnosed procedures which cost an estimated $75-100 billion and the the total is upto $600 billion. These amounts are not going to be tackled by computerization of medical records. The whole manner and ways in which medicine is practiced today and the manner in which the public takes care of its health would have to change for an impact to be made in these numbers.