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Generic version of Zocor by Merck to reduce bad cholesterol is now available and can substitute for Lipitor which costs $2 to $3 per day. This generic can be bought at Costco at 10 cents per day. Generics can have a huge impact on cost for patients and for the country's medical bill and for affordable health care its very important to achieve affordable health care.

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Rick Rieder of Black Rock and David Kelly of  JP Morgan Chase and others sense that the US is entering a phase they call "the satellite economic phase in which there are no crash landings and takeoffs but steady orbiting in space. Less boom and bust and more steady growth for years is the new economy Biden is creating with huge investments in infrastructure and manufacturing and worker skills training that upgrade the workforce. Investments in health and education are part of this. This makes the US economy more resilient with government working both as a partner and agencies of the government that regulate and provide the rules for fairness and level playing field acting to prevent the booms and busts of the past such as the 2009 financial crisis and other crises. With China, EU, India, Japan+South Korea and the US, all 5 of the largest economies aligned to maintain steady growth for their people the prospect of war acting to reduce growth potential will also be managed in a setting that is needed following the pandemic. This will make both the Middle East and the Eastern European recurring crises to be toned down and a shift made to growth in these regions from the war ravaged periods of reckless behaviour of nation actors. This is a view now emerging among key people in the US economy such as Rieder Black Rock and Kelly JP Morgan. Both says the ways of understanding this and the terminology "soft landing" or "cylical, midcycle" are now outdated and no longer apply. Says Reider-“But one point to keep in mind is that satellites don’t land and maybe that is a better analogy for a modern advanced economy” like the United States.  ...

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Chief Justice Roberts let the Obama healthcare law stand arguing that the individual mandate for everyone to carry health insurance acted as a tax, and was on these grounds constitutional. Justice Roberts found middle ground by first rejecting the Obama's administration's argument that asking every American to buy health insurance was legal under the commerce clause, and following this with the a non partisan approach that found the mandate legal under the tax clause. Roberts was guided by the writings of an eminent legal authority, Justice Oliver Wendell Holmes. Roberts referred to this in his opinion saying: "It is well established that if a statute has two possible meanings, one of which violates the constitution, courts should adopt the meaning that does not do so." Legal scholars speculate whether Roberts changed his vote later on or whether the Justice had used the questions in the hearings on the law to explore the idea that the law could be constitutional on different grounds. During the arguments in the hearings Roberts said: "The idea that the mandate is something separate from whether you want to call ita penalty or tax just doesn't seem to make much sense."...

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Lou Jiwei chairman of China Investment Corporation met with Treasury officials in Washington to give reassurances that China's sovereign wealth fund would invest as a portfolio investor and be a good citizen when it comes to investing in the USA. He reiterated the pledge by Chinese Premier Wen Jiabao that the Chinese government would not interfere in the operations of the fund, and that the fund would have its own corporate governance structure. He also met with officials of the IMF who are drawing up a code of "best practices" for sovereign wealth funds. Following the Chinese experience with the Unocal deal and the experience of Dubai in a deal to buy a company that manages USA ports, both deals falling apart on concerns in the media and Congress, the Chinese and the Persian Gulf sovereign funds have become more savy and aware of these concerns and tried to handle them better. They also point out that in the case of the financial institutions caught in the US mortgage securities crisis, it is these companies like Morgan Stanley and Citigroup that have come to them, to China, to Persian Gulf countries and to Singapore and other countries, asking them to invest for small stakes in the companies. Their line goes like this- if you have second thoughts about our investment we will invest elsewhere in other countries. Another facet of this is that these portfolio investments are spread out between many different countries sovereign wealth funds, and the possible influence is small in management decisions. China Investment Corporation has $200 billion in assets. Lou says that only a third would be invested to buy foreign assets, about $70 billion. The other two thirds would be used to support China's three large commercial bank balance sheets. ...

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Chuck Hagel on the need to bring in more countries to handle difficult situations such as the one the US faces in Iraq and Afghanistan. He says thats why the world now has a G20 and not a G8. No country can face these situations alone especially when there is a mutual interest of many countries in these situations. He calls it a 20th century reaction to 21st century realities. He says the 2 wars cost more than a trillion dollars. One sees a new respect for international institutions such as the UN, World Bank, IMF, and GATT renamed WTO, even with Republicans. Chuck Hagel's point makes a lot of sense and is generally accepted in people's understanding of the situation from the Defence Department to the Administration, and among respected politicians. It is putting it onto practice that is the hard part. As Hagel puts it, it is important to remember what Lyndon Johnson told Senatior Russell, that he knew the Vietnam war could not be won, and yet he did not want to pull out and be the first American President to lose a war. This is a contradiction because if it can't be won its going to be lost under the next President or the one after that, in this case Gerald Ford. Hagel says it not ours to win and lose. Here he points to the interconnectedness and shared interests of all nations. Every great threat to the U.S., whether it is economic, terrorism, nuclear weapons proliferation, health pandemics, environmental degradation, energy or water and food shortages, is also a threat to global partners ansd rivals. So its wrong to view engagements in Iraq and Afghanistan through the lens that says its about winning or losing. And he asks win what? Too many cultural, ethnic and religious dynamics are involved for any one nation to control. Hagel concludes by saying that the US, the Defense Department, the Obama administration, must get this right, as it affects the global architecture for the next generation. Fresh thinking is needed. Single issue engagement is obsolete in the 21st century in dealing with global partners or rivals, or countries with aspects of both....

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Public health experts warn that it is essential that countries reopening their economy have a reproduction ratio of much less than 1.0 so that the rate of increase is under control. Germany's Robert Koch Institute which advises the German government says the reproduction ratio which was 0.70 in mid April is now up to 0.96 after creeping back up. This is based on a mathematical model and extrapolated from infection numbers several weeks back.  It doesn't reflect the change by recent easing of lockdown measures starting with reopening smaller stores. This validates the careful approach adopted by France which was put forward by prime minister Edouard Philippe in his address to the National Assembly. The Assembly approved the plan 368 to 100. More legislation will back up the French government's authority to ban non essential travel between French departments and the creation of a large brigade to perform contract tracing. That involves finding testing and isolating everyone potentially infected, using dedicated locations. Detailed restrictions on travel, work and gatherings will take effect when France reopens partially on May 11.  France is also putting resources behind its testing program to test every person having coronavirus symptoms, and all they are in contact with. That means about 700,000 tests a week. Officials will generate a color coded map from this with red areas facing more restrictions than green areas. Student size is capped at 115 per class. Cafes, restaurants, movie theatres and large museums will remain closed. Gatherings of more than 10 banned. Those who can work from home asked to do so. Public transit users will be required to use masks, and marks on platforms will indicate the social distance required. Only essential travel is allowed more than 62 miles from home. These rules remain till June 2, when new ones will be set. Large music festivals and sporting events are canceled till the fall. Mr. Philippe says "these efforts will not be in vain and should allow us to arrange for a better summer season." ...

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Germany faces the possibility of a pandemic surge of the unvaccinated, something that is happening today in the southern United States.  For days the percentage of people that are fully vaccinated remains at 62%. Some vaccination centers are closed. A vaccination center outside the train station in Cologne offers passersby free vaccinations. Berlin's Social Democrat mayor Michael Muller is very frustrated. He says "I am now coming to a point where I think we have exhausted what we can do in politics."  At 62% the rate of fully vaccinated people in Germany is too low to prevent a surge of the Delta variant in the way that it has hit the southern US, and California. Vaccination rates of close to 85% are needed to tackle the risk of another surge in highly contagious delta variant. Not everyone remaining is die hard opposed to vaccines. The Robert Koch Institute estimate is that 5 to 10% of people are in that die hard category. The remaining 20-30 % are people who have various other concerns and fears, hesitancy, that may be changed.  The chairman of the World Medical Association Frank Ulrich Montgomery favors a vaccine mandate, what he calls a 2G rule, that should be introduced in Germany requiring vaccination to attend events, sports, restaurant visits, adopted nationwide. German government has rejected idea of mandatory vaccination of health personnel, that was adopted in France. Vaccination drives are regionally based. Some are ineffective such as the Deutsche Bahn train system vaccination drive for commuters that only had a few hundred doses of J&J vaccine and ran out quickly in Berlin. One prick J&J some say is better for vaccine skeptics. Vaccine skeptics think they may get away without getting covid infection. How does one get over this misconception? Others including members of the Greens party say vaccine needs to be delivered where people are- transit points, bus stops, doses offered in evening and early morning hours, trying new ways to reach people and inspire confidence. Germany now ranks behind France but ahead of Bulgaria in terms of vaccination percentage in September 2021, not a good situation. ...

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Alan Blinder, Princeton University professor and former vice chairman of the Federal Reserve, says the biggest reason for the growing deficit in the years out to 2040 is because of increases in health care spending. Its not that there is runaway spending in other areas. He cites CBO projections that show other costs stable relative to GDP from 2015 to 2035 and declining. This is why healthcare spending is at the heart of the problem. And why tackling the deficit has a lot to do with reducing healthcare cost increases.

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Judith Warner coins the phrase "dysregulation," for the cultural phenomena that may be behind the lack of restraint exercized in everthing that relates to personal lives like obesity, to the lack of regulation in the gulf and financial crisis. Citing Whybrow's book, "American Mania: When More Is Not Enough," she points to a disturbance in the national psyche, something that disturbs some inner clock or mechanism, that disturbs some inner balance that is built into us from the beginnings of man in the universe.

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The inflated costs for spinal surgeries at some hospitals in California. How surgeons, doctors, consultants, distributors and hospitals operated in a flawed system to make revenue gains through overbilling, and focus on increasing the number of surgeries performed.

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Darren Woods of Exxon gives the view of many in business in the U.S. when he says of the Paris climate change accords of 2015- "We need a framework like that to address the threat of climate change." GE's CEO Immelt says a decision to leave the Paris accords "is not going to change one thing we do for energy efficiency, and I think all business is going to feel the same way." Most utilities including AEP see the political changes in government as coming and going, making it important to base their long term strategies on the economics and the general trends worldwide. Only support for the move to leave is coming from some coal companies and the steel industry, a small fraction of the overall industry in the U.S. Not mentioned here is the moves worldwide, by China motivated by health and pollution concerns to shift away from coal after disastrous pollution effects seen in China, and the decades old effort in Germany that has made the country self sufficient in renewable energy through use of solar and wind energy. India has set aggressive targets for renewables energy and is likely to join this long term trend as the economics shift in favor of wind and solar, especially when the health costs are counted in.   ...

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Jenny Strasbourg of the WSJ provides this much needed report from London about the courageous decision by AstraZeneca and Oxford University to give vaccines away at no profit to the whole world, to billions of people in Africa, Asia, and Latin America. Without this brave decision by a British company and a British University the world would be a lot poorer, more variants could have happened, making us realize the great contribution Britain has made and how indispensable it is to the planet. Add to this the effort of Indian companies including Serum Institute that provided the manufacturing facilities and capabilities for making most of the British vaccine. AstraZeneca delivered 2.3 billion doses of the vaccine globally as of mid-December, according to the company. The International Monetary Fund estimates that low and middle income countries received 3.25 billion vaccines as of Dec. 11, About half of this or 1.6 billion doses were Astra Zeneca shots. This is a bigger share than any other vaccine by far and a life saver to the world. AstraZeneca stepped up early in a true to the best ideals in Britain to meet the needs of the world-  aiming to deliver 3 billion doses in 2022 and sell them at no profit as long as the pandemic continues. As the shot does not need cold storage it is ideal for India and other Asia, Africa and Latin America. "We are all very proud throughout the company of the impact we have had," says AstrZeneca CEO Pascal Soriot. By far the biggest manufacturing was done at Serum Institute of India which supplied 1.3 billion doses of the AstraZeneca vaccine to 70 countries. Mr. Modi pushed forward the export of vaccine made in India to the world from the beginning in the same spirit of cooperation and the best ideals that Britain was living upto. Serum Institute can produce as much as 250 million doses of vaccine a month making it possible for India to tackle the vaccination population of 1.3 billion people.   None of this could have happened without Oxford University and AstraZeneca and Indian companies with Mr. Modi's active support living up to the best ideals of Britain and India for the world. "When you add up the benefits to humanity, I think you'll find the vaccine holds up pretty well in terms of the ill health it has prevented, and the deaths it has prevented," says John Bell, a senior Oxford academic who in 2020 guided the University through its vaccine-partnership talks with Astra Zeneca. Because in the real world AstraZeneca shot has held up so well it is also a choice for booster shots. ...

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Doctors face a 21% cut in the amount of Medicare payments for treating seniors having Medicare, though this cut will be delayed till 2011 under legislation in Congress. This issue goes back to 1997, when a budget law set spending targets, and stated that if they were exceeded formulas to reduce doctors payments would go into effect. The formulas seriously cut into doctor payments by Medicare in 2002, so the formula was put off. The result of this is that the cuts based on the formula now amount to 21%. The cuts are not expected to go through, but at the same time Congress has an headache on its hands with the growing deficit. In the Senate there is opposition to a $120 billion bill to extend long term unemployment benefits which lapsed in June 2010, for tax breaks, and other expenses. Senators want to pare down the bill's price tag, as $80 billon of this is unfunded and will be added to the budget deficit. For a primary care doctor in Washington state, Medicare pays about $95 compared to private insurers payment of $129, and a plan for state workers that pays $140....

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How companies like United Health are lobbying aggressively to shape the new helathcare legislation to their benefit. BW says the health insurers like United Health, Aetna and Wellpoint are already winning through clever and effective lobbying of Congress. Former Senator Tom Daschle works as aconsultant for United Health. Senator Conrad who has led aeffort to replace the public plan with nonprofit medical cooperatives, which would be a weaker competitive threat to insurers, is also influened by the insurers. United Health's CEO Helmsley and its person working with Congress on healthcare Simon Stevens met with Conrad on June 4. When lawmakers in Congress cite consulting group Lewin Group, that 88 million or 56% of those with employer provided coverage would desert private insurance for a government run program, they are quoting acompany owned by United Health. The Congressional Budget Ofice says these numbers are too high. United Health has used savy presentations on how to cut costs, and help Blue Dog and other Democrats articulate their positions, to gain influence in shaping the plan to their interests. United Health thus counts a lot with Matheson, and Mike Ross of Arkansas, who are prominent with the 52 Blue Dog Democrats. and with Senator Mark Warner of Virginia. And United Health put together an effective lobbbying group, even hiring the chief of staff of House Democratic leader Steny Hoyer. ...

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Swiss bank UBS plans to make 10,000 job cuts in the next 3-5 years. Most of the job cuts will come at the investment banking operations which has 16,432 employees. Carsten Kengeter will be made chief of investment banking to concentrate on the downsizing effort. Andrea Orcel, who was brought in by new CEO Sergio Ermotti to be co-head of investment banking will run the remaining businesses of advising on mergers and equity underwriting. Trading businesses, especially fixed income, will be closed down. A third of the employees and 15 lines of business in the investment banking operation will be cut. The strategy is focus on businesses that do not require much capital to run and to build on its competitive advantages. This means focussing on its strong points in wealth management operations and the asset management division, which combined have $2 trillion under management. This move away from capital intensive business is part of an effort by Mr. Ermotti to dispel notions that UBS is not adequately capitalized. UBS suffered losses of $50 billion during the early part of the 2008 financial crisis, followed by the rogue bets by a trader in the London office leading to a loss of $2 billion in 2012. Following the most recent losses Sergio Ermotti was hired to replace Oswald Grubel in 2012. UBS now provides an example for other banks to overhaul their banking operations and downscale the importance and risks of investment banking....

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In the third Democratic presidential debate in Dec. 2013 Hillary Clinton came out looking much stronger than Sanders and Malloy. She described the Sanders government programs to make helath care and college free as too expensive requiring a 40% increase in federal spending, or $18 trillion-$20 trillion. Clinton said "we have to be really thoughtful about how we're going to afford what we propose." And said she would not increase taxes on those making less than $250,000 a year. On foreign policy issues she differed with Sanders and Malloy on the Assad regime and civilian deaths in Syria, saying Sanders had supported the removal of the Qaddafi regime in Libya. She used her long experience as Secretary of State to display a better command of the issues. On Hillary Clinton's comment about Donald Trump's statement for barring Muslims from entry into the U.S., that it was becoming a recruiting tool for ISIS videos, a NYT fact check shows no proof of this. Clinton said she preferred not to turn the issue of terrorism into a clash of civilizations with Islam, as her Republican opponents have done....