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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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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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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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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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This is huge- for Germany, for France, and for the European Union. After initial hesitation and a decade of not looking ahead, Germany under Angela Merkel is finally not just looking ahead to its vision for Germany but doing this as a part of the larger European community. And the European Central Bank after its initial lack of community spirit, is paving the way with its own actions for the Europe wide recovery with a significant increase in lending to EU countries.  Germany's finance ministry has agreed to spend 130 billion euros on more than 50 initiatives to promote growth in Germany. No longer is the government looking at the car industry as it did in the past. It is looking beyond to what Merkel calls the "profound upheaval" coming from climate change and digitisation. For Merkel after the changes caused by the pandemic something more had to be done- "We just could'nt introduce a traditional stimulus package. It had to be done with an eye to the future, so that is what we especially emphasized."  This also brings together France's Macron and Germany's Merkel in a combined effort to bring Europe up to face the future with confidence. It is amazing how the pandemic has changed minds in Europe. From the long drawn out period since 2008 when traditional policy ideas and austerity thinking prevailed, to the idea today that this is no way to face the future with confidence for Europe to be back on its own feet, for hope to return. Instead of partnering in austerity with the Dutch and the Swedes, the finance ministry is now looking to France, Italy and Spain, considering the common pain of the core European countries during the pandemic and looking to the future.  Merkel moved to circumvent the traditional Bundestag's refusal to permit debt sharing  across the euro area by producing 500 billion euros of grants for hard hit businesses across the European Union. As Macron says it was a necessary  step- " What is sure is that this 500 billion euros will not be repaid by the beneficiaries.... We are proposing to do real transfers (of money) ... that's a major step." Forecasts from Capital Economics and other forecasters show the European Union's major economies of France, Italy and Germany rebounding quickly in 2021 after the blow in 2020, in a V shaped recovery with growth of close to 6% in France, and higher in Italy because of the bigger hit taken there than Germany. The strong U.S. jobs report with addition of 2.5 million jobs for May shows that the rebound can be sharp upward swing if the policy, will and community spirit is summoned up by leaders and people, no matter what happened in the past decade. It is also based on having the right spirit that knows about investing where it really counts for the people - in infrastructure, health, public services, and avoiding the misallocation of resources and spending that happened before. ...

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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....

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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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The Senate FInance Committee's $829 billion bill, would cut by $113 billion money for America's Health Insurance Plans over ten years, specifically Medicare Advantage, reducing insurer profits. The AHIP is responding with aad campaign to seniors to fight this setting up aconfrontation with the Obama adminsitration.

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Feldstein says that for the 85% of the people who have healthcare the Obama proposals are not a good deal. The Obama proposals mean higher taxes in the long run to pay for the $1 trillion cost of healthcare for the uninsured group over 10 years. This lower income group has no coverage despite the $300 billion Medicaid program. Feldstein says there surely must be better and less costly ways of getting this lowincome group healthcare. Raising the top income tax rate to 45% from 35%- as a result of letting the Bush tax cuts expire and adding aproposed health surcharge on higher income individuals- would actually lower revenues for the government, as it would change behavior of high income individuals in ways that lower their taxable inome. The result is higher deficits and higher taxes when even without this large deficits are projected for the future. How to slow the rapid growth in healthcare spending? The Obama plan is to cut spending on Medicare. Feldstein sees the govenment's effort aimed at reducing the amount of medical services, as reduced spending comes from fewer services, not reduced payments to providers. Will this result in enough of acost reduction to make the system work. And if the cost reductions are too heavily weighted towards reduced services and not reduced payments to providers would this result in large cuts to services to affect the quality of healthcare for the 85% who are accustomed to a different pattern of healthcare, even though it is structured to allow cost escalation. Feldstein offers no solutions to the problems of cost escalation except to suggest that the Obama plan does not really tackle the cost escalation issues directly with providers, and instead burdens the national finances to an extraordinary degree. And the need for apause and reflection....

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In a new WSJ/NBC New poll, conducted July 24-27, 2009, 42% called the Obama health plan a bad idea, and 36% called it a good idea. In mid June the poll showed Americans evenly divided on this question. It reflects rising anxiety over the costs of the health plan and what it will do to the deficit, and also shows public anxiety about the ways in which Obama and Congress are reaching compromises to pay for it and to control costs. Added to this are the anxieties raised about government involvement in healthcare and medical decisions about care. Noteworthy are two differing pieces of evidence. In the WSJ/NBC News poll, only two in ten people thought the quality of their own care would improve, only 15% of those with private insurance thought that it would improve the quality of their care. And 4 in ten people thought quality of care would get worse, and 45% of those with private insurance thought quality of care would get worse. By focussing on the cost of health care, the administration seems to have ignored or missed the concerns of people about the quality of care if government focussed on cutting costs. These concerns are real as a vast majority of the public, or about 85% of the people, as Martin Feldstein points out in a recent Washington Post column, are insured. The question is what cost would they be willing to pay for the admittedly worthy cause of insuring the uninsured? And even with the unisured, it seems likely with the current Obama reform plan that immigrants and other people may still remain uninsured, at least for some time. Would a huge burden of $1 trillion make this worthwhile, and is there some better way to do this without the prospect of higher taxes further down the road to pay for this. These are points Feldstein makes. The other piece of evidence is that at the same time that there are reservations about what is coming out of Congress today, there is general support for making constructive changes to healthcare. The WSJ poll showed 56% of respondents favoring the basic ideas in the reforms being considered in Congress, with 38% opposing it....

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David Wessel points to some problems with the Paul Ryan budget proposal. Ryan's plan does not balance the budget till after 2030, and Congress would have to raise the debt ceiling each year till then. The changes to Medicare Ryan proposes would limit how much the government spends, but the savings from this do not come for a decade, as people expected to retire in the next 10 years will still have Medicare. Ryan's proposal shows how deep the cuts will have to be if deficit reduction is done without raising taxes. Pete Domenici and Alice Rivlin who developed a deficit reduction plan, said they were disappointed that the Ryan plan "fails to address the need for new revenue," which they consider crucial for truly tackling deficit reduction. The Obama budget failed to offer a comprehensive deficit reduction plan, leading to openness for new ideas. The health care delivery system in the U.S. needs to be efficient and costs need to come down. Ryan's proposal gives no idea where the efficiencies will come from. Would they come from competition between private insurers? How will escalating healthcare costs be controlled. Another consideration is that even with its problems Medicare is less costly to administer than private insurance. Everything depends on seniors shopping vigorously for the best premiums because risks and costs are borne by seniors, with the idea that this will somehow control escalating medical costs....

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Self reflection by the boomers, born between 1946 and 1964 numbering some 78 million people, who gave commencement speeches this year from Ken Burns, documentary maker, at Boston College, to Democratic Senator Bennet of Colorado at Colorado College, on the mistakes of this generation. Senator Bennet used three figures to make his point about the failure, from 2000 the annual median family income declined in the US by $300, health care costs went up by 80%, and the cost of higher education went up by 60%. By contrast to this the so-called Millenials, born between 1982 and 2001, just want to see what works and get on with it, says Stefanie Sanford, an education expert. One graduate from the University of Kentucky, Julie Meador, a marketing major, is earning $7.50 an hour as part-time sales associate at Gap. Her view is that what she most thinks of is finding a good job, and not thinking of saving the world just yet.

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Colombia's GDP is $350 billion, in 2025 Venezuela's is $50 billion. Socialism under Chavez imitating Simon Bolivar as shown here starts out well with more housing, health care reaching poorer neighborhoods and parts of the population that were ignored. But only till 2011 in the early years. As mismanagement, corrupt cronies take over the nationalized enterprises, petroleum company fails to invest, and mismanagement of the economy sets in, educated classes leave the country in the class warfare, the results are disastrous. As much as 20-30% of the population leaves, hyperinflation, bad relations with the US, leading to the worst humanitarian disaster in the American continent since 1900.  It shows that the educated classes of every nation bear a major responsibility to  create a healthier society at the beginning so that the glimmers of hope of free services lead to the wrong people ending up in power and mismanagement on a massive scale destroying everything. New York City's educated classes should shoulder the responsibilities that people like Felix Rohatyn as head of MAC describes in his book- Bold Endeavors, that is the true spirit of the Nation (2009). ...

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The Centers for Medicare and Medicaid Services ban Elizabeth Homes, CEO of Theranos, from running a blood testing laboratory for at least 2 years, and took away regulatory approval for its California lab. The questions about the irregularities in Theranos blood testing led to the voiding of all test results in 2014 and 2015 for its Edison device. The WSJ first raised questions about the effectiveness of blood testing by Theranos leading to investigations by federal agencies.

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Estimates by the Congresssional Budget Office in January 2011 show the federal budget deficit in the US at nearly $1.5 trillion in 2011. The deficit would equal 9.8% of the US gross domestic product. In 2009 the budget deficit was $1.4 trillion or 10% of GDP. The CBO estimates show the debt held by the public increasing from 40% of GDP at the end of fiscal year 2008 to about 70% at the end of fiscal year 2011. Republican senators Orrin Hatch of Utah and John Cornyn of Texas called for a constitutional balanced budget amendment in an op-ed published in Politico.

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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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McGurn of the WSJ looks at the Gallup study on Trump supporters showing that they are older and white, but not more likely to come from communities adversely affected by trade competition. The study shows intergenerational mobility, health prospects, and relative racial isolation, more likely blue collar workers, as being key features, yet more likely to be employed or self-employed. Of this cultural angst, and lack of intergenerational mobility, poor health prospects, are critical findings. McGurn sees them as the people who feel left behind, and says the nation needs to look at them not as "losers" but to address the problems of intergenerational mobility in the U.S. following the election. Theresa May, the new prime minister of Britain has described the "burning injustice" in her first speech when taking office, in a reference to people who suffered under the 7 years of austerity programs in the Cameron years, people from similar groups who face a situation where their children's prospects are no better or worse than their own. ...