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Hillary Clinton narrowly loses the Michigan primary to Bernie Sanders in March 2016, as the Sanders campaign focusses on Clinton's support for trade agreements that hurt American workers and lead to loss of manufacturing jobs. About three fifths of voters in the Michigan primary considered this a major issue. Many less educated younger workers see their job prospects diminish and wages drop with free trade that hurts American manufacturing jobs. Bill Clinton signed the NAFTA agreement with Mexico, and as a member of the Obama administration Clinton supported the Trans Pacific Trade Agreement, later opposing TPP when she left the cabinet. Sentiment against trade that hurts manufacturing jobs in the U.S. is strongest in midwestern states such as Michigan, Ohio and Illinois. This was also a major issue benefitting the Liberals under Justin Trudeau who won in Canada's industrial Ontario province which has suffered hollowing out and loss of manufacturing jobs under the Conservative Harper administration. In the U.S. the issue goes back to the Clinton Administration for two decades. New jobs created by Apple, Google, and other tech companies pale in comparison with the industrial jobs created in another era that benefitted working class families. This issue and high unemployment or under employment, lower wages for working class families, was a major issue in the 2016 U.S. presidential election campaign. Widening wealth disparities, and lack of upward mobility, high tution and healthcare costs for ordinary families, dominated the campaign in the U.S....

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Gerald Seib of the WSJ points out that the winners in the passing of the Republican healthcare bill in the House by a 4 vote margin are Speaker Ryan who never wanted the job in the first place, and president Trump who showed he could cajole Republicans into getting it passed because he likes winning. Now comes the hard part says Seib, when it goes to the Senate- House conservatives are not going to be happy when they find major changes they dislike. If the bill clears the Senate in a modified version Republicans will now have to own any issues with healthcare, including says Seib things that may not work out for pre-existing conditions- or for groups that are disadvantaged, including older people.

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US president Biden signs a broad executive order on July 9, that is directed at promoting competitive behaviour in the American economy, and taking action against companies that have anti competitive behaviours. It also aims to limit corporate dominance that then can lead to anti competitive behaviours. These types of behaviours puts consumers, workers and small compoanies at a disadvantage. The Biden plan stretches from the smaller items such as hearing aids and baggage fees, to the task of putting in place the first antitrust regulation on tech companies Apple, Google, Amazon and others. Industries Biden sees as needing help are agriculture, healthcare, shipping, transportation, technology, and labor practices that limit wages and mobility. In making the executive order the White House says it "will lower prices for families, increase wages for workers and promote innovation and even faster economic growth." As each step is taken by the Biden administration to help workers, families, women and children, the situation is a reminder of the actions taken by Franklin Delano Roosevelt at another period of crisis in the nation's history. The July 9 executive order will create a Competition Council as proposed by Tim Wu, special assistant to the president for technology and competition policy in the White House National Economic Council. The Compeititon Council task will be to get federal agencies to take action to promote competitive behaviours for the first time since the 1980's when Republican presidents Reagan, Bush, and Democratic presidents Clinton, Obama, allowed such behaviours in some industries to get entrenched. In Biden's own words "the rise of monopolies weaken labor." In each industry agencies will now have the task of pushing back against anti-competitive behaviours already put in place by companies. In agriculture it will help small farmers, in pharmaceutical sector it will help the American people deal with a problem that has no end in sight of high drug prices and practices that support this. In all areas of the economy the Biden plan is for a new coordinated effort across all the agencies of the government and under the leadership of the president, to restore the vibrant economy to what it was before the long deterioration through anti-competitive behaviours. ...

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This editorial in the WSJ points out that U.S. president Obama made economic inequality "the defining challenge of our time" in his State of the Union address in 2013, yet the U.S. has seen widening economic and social disparities in his two terms- creating the situation where Bernie Sanders is now in a virtual tie in Iowa with Hillary Clinton. It says Hillary Clinton wins handily over Sanders on three of four issues of the most concern for Democratic caucus voters in pre-entrance polls, healthcare, terrorism, and on the important issue of jobs and economy by 51% to 42%. Where she falls behind is on the issue of income inequality, and by a very wide margin reflecting voter disillusionment with policies that resulted in marginalization of some workers through globalization and long term unemloyment, and reduced access to education with high tution costs- there Sanders wins by 61% to 34%. Federal Reserve policies that kept rates low near zero hurt middle class savers, working class savers, and benefitted disproportionately upper class investors in the stock market, widening the social and economic disparities....

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This NYT editorial points out that the cuts to Medicaid amount to taking out a fourth of its budget and are sure to hurt low income Americans. The cuts are about $880 billion over 10 years for Medicaid. The $300 billion less in subsidies over ten years is likely to hurt the elderly. It also points out that removing the individual mandate will make it harder to reduce premiums as fewer healthy adults offset the costs of sick patients.

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Mr. Trump's conflict with the Justice Department in the last weeks of his presidency to appoint a new Attorney General with intent to contest the results of the presidential election of 2020, is shown in this report in NYT. This created risks for American democracy. The cracks in social cohesion following four decades of foreign wars 1980-2021, irresponsible behavior of financial institutions leading to financial crises and impoverishment of America, incompetent elites, neglect of rural America, ceding of technology and competitive position to China, failure to fund education, healthcare and infrastructure, under presidents Reagan, elder Bush, Clinton,  Bush, Obama, led to a situation of revolt against the status quo by a maverick politician using a new and proven dangerous form of communication social media. Ultimately this put democracy at risk. Lessons from this are only now being learned as people in the Biden administration and outside of it reflect on what happened. In this WSJ report Mr. Trump is seen pressuring officials of the Justice Department to agree to appointment of a new Attorney General shortly after the election. This was seen as an effort to question the results of the 2020 presidential election. A leading senator on the Judiciary Committee says this would lead to "shredding the US Constitution to stay in power." Of this and also of four decades of neglect in America Washington has this to say in his first Inaugural Address on April 30, 1789- "The blessed religion revealed in the word of God will remain an eternal and awful monument to prove that the best institutions may be abused by human depravity; and that they may even in some instances be made subservient to the vilest of purposes. Should, hereafter, those entrusted with the management of this government, incited by the lust of power and prompted by the supineness or venality of their Constituents, overleap the known barriers of this Constitution, and violate the inalienable rights of humanity: it will only serve to shew, that no compact among men (however provident in its construction and sacred in its ratification) can be pronounced everlasting and inviolable- and if I may so express myself, that no wall of words, that no mound of parchment can be so formed as to stand against the sweeping torrent of boundless ambition on the one side, aided by the sapping current of corrupted morals on the other." ...

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The major provisions of the Republican House healthcare bill that passed by a vote of 217-213 are- 1. To help people buy insurance coverage the bill offers $2000 to $4000 a year, upto $14,000 a year in credits based mainly on age, reducing them for families making $150,000, individuals making $75,000. 2.  Under the Affordable Care Act insurers cannot charge older Americans more than 3 times for same coverage they offer to younger people, the new bill makes this 5 times. This would increase premiums for older Americans and reduce it for younger Americans. This is the most controversial part of the bill. Older Americans supported the Republican party in the presidential election. 3. The new bill ends Medicaid as an open ended entitlement and places this on a budget with cuts of $880 billion over 10 years. 4. To mollify conservative Republicans a provision allows state to opt out some provisions of the ACA that requires minimum benefits such as maternity care and emergency services. It retains coverage for pre-existing conditions to mollify moderate Republicans. The bill provides states with $138 billion over 10 years to subsidize premiums, provide coverage for pre-existing conditions, mental healthcare and drug addiction. 5. The bill removes the taxes imposed under the Affordable Care Act (ACA) on high income people of about $300 billion over 10 years by repealing a payroll tax increase and tax on investment income. This bill and the ACA offer 2 competing visions on healthcare, both bills passed only by a margin of 4-5 votes in the House. The ACA overlooked the impact on premiums causing discontent among middle income Americans. The new bill lets premiums rise for older Americans in order to keep premiums down for other Americans. This shows the many tradeoffs involved and choices being made, and the lack of a consensus on the issue of healthcare in the U.S., becoming a highly politicized issue instead of the way it is treated in western Europe.     ...

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The loss of some 4 million jobs is expected by experts in 2009, and Obama economic advisor Christina Romer has presented information at a meeting that shows the current downturn will be more severe than anything we experienced in the last 50 years. At that meeting on December 16, 2008, Obama met with Romer and other economic and policy advisors for 4 hours. It was decided that the target for jobs should be 3 million jobs created in 2009 and 2010. This still means a lot of the 4 million job loss will still occur in 2009, even if the infrastructure jobs estimated at $136 billion by the nation's governors get off to a fast start as they are supposedly ready to go. Money to states and local governments will reduce job losses and loss of services, and money in the form of lower payroll taxes would probably be saved to reduce debt by the public. Money to the poor to support medicaid and health care services and expanding healthcare coverage for those who lose coverage will be safety net reinforcement and support. So finding places to spend where jobs can be created quickly will be a challenge going forward and some of the $1 trillion stimulus will not go directly to job creation but as support. For the December 16 meeting Romer consulted with Martin Feldstein the senior Republican economist who said that " without action the economy will continue to decline rapidly." For a long time Martin Feldstein has been advocating strong action especially to reduce foreclosures and help stabilize housing prices. As the economy has weakened he has revised upwards what needs to be done, and his estimates are close to the lower end of the $800 billion to 1.3 trillion that is being estimated for 2 years. Lawrence Lindsay and other economists are supporting upto $1 trillion stimulus. ...

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Difficulties facing a Obama administration, taking over in the middle of a huge economic crisis, with so many high expectations aroused by the lofty rhetoric that a letdown would occur for the faithful and young people energized by his candidacy were these expectations to remain unfulfilled. Two wars and their conduct could raise controversy as they cannot be abruptly be wound down and the Afghan war could present surprises as it has for all foreigners. And there are no easy solutions to the economic crisis which could be stubborn and prolonged like the one faced by Japan and its lost decade. Japan had a leader in Koizumi who energized the Japanese during their economic crisis years, some changes ocurred but Japan still labors on and its a different country now without the same hardworking ethic and cando spirit among the young. And there are no easy solutions like investing heavily in infrastructure and energy and providing healthcare to all working people, because with the one trillion dollars going to shore up the financial system and the banks there is only so much Obama and Democrats can do with public spending without much higher deficits and other difficulties. Not delivering on these promises or delivering inadequately could lead to a letdown for supporters. And for black people and Hispanics in the working class, and workers who have lost jobs as unemployment rises especially in the auto industry in the midwest where he got much of his crucial support, the conditions are tough with jobs scarce and rising home foreclosures, for which the government may be able to help but only in a limited way as the economic crisis may take a long time to unwind. ...

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G-7 nations reach agreement for a global minimum tax of 15% a floor for taxes that the Biden administration finds acceptable. This agreement was reached at a meeting of the Treasury chiefs of the 7 G-7 countries in London on June 5, 2021. The G-7 countries are Canada, France, Germany, Italy, Japan, UK, and US. Next agreement from Russia, China, India and Brazil in the G-20 nations would establish new ground rules for the major economies. The G-20 meeting is in Venice July 9-10. The OECD is steering the international efforts to achieve that goal. For the agreement to be effective a number of small nations that use tax rates of below 15% to attract business have to be part of the new rules. One of these countries is Ireland with a tax rate of 12.5%. For the Biden administration in the US the goal is a significant one as president Biden seeks business to pay its fair share so that long neglected priorities for education, healthcare, infrastructure, post pandemic improvements can be met. France and other nations in the EU face similar needs in the post pandemic environment. By setting a floor the Biden administration is both creating a new cultural concept of fairness in taxation and making it possible to finance the $2 trillion spending programs for these priorities of president Biden. Behind this are important facts that have left the large tech businesses paying little or no tax depriving governments of the very revenues that are needed for infrastructure and services for a modern well run state. The Biden administration seeks to include the tech businesses as well as all businesses in the new tax rules so that a uniform idea of fair taxation applies across the whole economy for the first time in two decades. In this way it makes up for the missed opportunities in the OBC administrations of Obama, Bush, Clinton that have led to loss of faith in the state and institutions in the US. A similar situation prevails in the UK,  France and Germany where previous administrations failed to address this important issue of fair taxation and financing infrastructure and priorities in health, education, and critical needs of the people.   ...

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In a new twist drugmaker AbbieVie will bring out less costly versions of Humira in Europe where its patents have expired and still keep the U.S. market at higher Humira prices using a thicket of patents. Reports show pharmaceutical drug pricing as a major issue in U.S. midterm elections. Biologic drugs are costly. In this case Humira will sell at a 10-20% discount in Europe. Abbie Vie countered by getting hundreds of new patents in the U.S. to continue selling at high prices.

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This is the higher education equivalent of the moonshot says one education expert. The community college initiative of President Obama would double the numbe of people graduating out of community colleges. About six million students a year enroll for credit at America's 1200 community colleges, but only about 555,000 earn a two year degree, and another 295,000 a year earn a vocational certificate. The administration is putting a big emphasis on community colleges. Martha Kanter, the former chancellor of the Foothill-De ANza Community college district in California, has been appointed to the No.2 position in the Education Department. Arne Duncan made his first official visit to Miami community college, and Joseph BIden's wife teaches at acommunity college. The way community colleges have functioned in the American system of higher education, is that they provide post-secondary schooling for low-income studetns who have few other options. This works through open admissions. And most students are employed adults attending parttime; and according to some studies more than half need remedial courses before tackling college level work. The Obama effort is to require community colleges to work harder to retain students until graduation, and to encourage partnerships between community colleges and employers to offer workforce training. Without the access to the additional funding community colleges would actually find themselves in a bind, with rising enrollment rates just as their funding access deteriorates with state spending budget cuts. Debra Bragg, co-director of the Forum on the Future of Public Education at the University of Illinois, says that most new graduates produced under the Obama proposal would complete certificate programs, usually lasting 6 months to ayear , offering specific credentials for middle skill jobs. These jobs could be in healthcare, information technology, or other growing areas. See the article in BW showing the problem that is growing of unfilled jobs in many growing fields during a period of high joblessness, because of amismathc between the qualifications of jobless people and the requirements in the new fields. An example id autoworkers in Michigan taking up new skills for jobs in other fields. In this sense this program can be immensely useful in closing the gap. Results will take time as these resources take effect and graduation rates increase over time. ...

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State based exchanges in New Mexico, Oregon and other states have experienced difficulties setting up and running the exchanges. Many states have turned to the federal government to operate the exchanges.

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U.S. Senator Ben Sasse suggests an alternative approach of simply repealing the Affordable Care Act called Obamacare and replacing it at a later date. This is endorsed by president Trump. This is the new Republican strategy in July 2017. Forty nine senators voted in favor of this repeal in 2015, when president Obama vetoed this legislation. Two more senators are expected to support repeal according to Ben Sasse.

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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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Senators Elizabeth Warren and Bernie Sanders defend Medicare for All, a version of free healthcare for all, and free university, from attacks by moderates. So far in the campaign in the Democrats part the moderates have failed to gain traction. Warren and Sanders lead the field. The only other contender is from the old Obama presidency, Mr. Joe Biden. Warren and Sanders say now is the time for bold ideas. Sanders won the Michigan and Wisconsin primaries, by articulating this vision in the last campaign 4 years ago.

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The startling truth about health "reforms," - they won't control spending, and without that the whole system of health care will rapidly become unaffordable and unsustainable. Obama's Council of Economic Advisors points out in new report that since 1975 annual health spending per person, adjusted for inflation has grown 2.1 percentage points faster than overall economic growth per person. At this rate health spending which was 5% of the GDP in 1960, and is 18% of GDP today, would grow to 40% of GDP in 2040. Medicare and Medicaid would increase from 6% of GDP now to 15% in 2040, or equal to three fourths of federal spending. Employer paid insurance premiums for families which grew 85% in inflation adjusted terms from 1996 to $11,941 in 2006, would increase to $25,200 by 2025 and $45,000 in 2040. This would force employers to reduce take home pay. Samuelson says the uncontrolled health spending is singlehandedly determining national priorities, reducing discretionary income, raising taxes, widening budget deficits and squeezing other government programs, while it is producing large amount of waste in medical spending. See the link to Prof. Tyler Cowen of George Mason University in NYT, 6/14/ 2009, who cites the habit of doctors to write many expensive tests as one of the prime culprits in the wasteful spending. And in the process it delivers higher cost for lower overall quality of health for the American people. This at a time when many European countries provide live examples of doing it in a better way- lower cost, better health. The serious problem with the Obama health reforms says Samuelson is that it talks about restraining spending but may end up increasing spending. Its talk about controlling spending he says is good intentions, but based more on hopeful thinking, public realtions and risks becoming cosmetic reform. Because to really control spending will require coming to grips with its fundamental cause- hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, private or governmental. Such a system encourages doctors and hospitals to provide more services, expensive tests, favors heavy use of expensive medical technologies to increase profits, and for patients to expect them. Samuelson puts his finger on the root of the problem - there is no incentive and every disincentive for all the players in this game , doctors, hospitals and patients to seek reform of this system. For doctors and hospitals the hope would be that this cosmetic "reform" would leave the system basically unchanged, and patients to continue with a lifestyle and expectations that do not not acknowledge the fact that a lot of healthcare does not come from spending but from preventative care, education, good eating and exercize habits, and healthy lifestyles. And the uninsured are no exception, they would simply start consuming the expensive care for lower quality of overall health like everyone else. With this kind of situation confronting us, the views of Samuelson, and Professor Tyler Cowen of George Mason University, as welll as a growing chorus of informed public opinion on this subject, is that insuring the uninsured is a good idea, but doing it within the bounds of the present system, can only increase the costs. And too much is at risk, to rely on what Samuelson calls a scattershot of measures to control costs made up by Congress such as "evidence -based guidelines," "electronic record-keeping," "bundled payments to hospitals, to give the illusion of progress that won't make a serious difference. A sweeping restructuring of health care is needed, that would overhaul "fee-for-service" payment and reduce the fragmentation of care. It will also need what has not even be touched on adequately in the debate. This is the massive need for education in the schools about nutrition, eating, exercize, healthy lifestyles. It would also require opinion leaders in each field from sports and other fields to lead by example and with constant public presence, the media, and companies to form a partnership with private institutions to change existing eating habits and lifestyles that encourage obesity, smoking, fast food eating habits, large portions in restaurants....

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The 2016 primaries with Sanders and Trump have brought to the forefront voter dissatisfaction with the agenda of both parties, especially so for Republicans with the lack of specifics and personality driven campaign of frontrunner Trump. On a whole host of issues from poverty, wages and inequality, regulatory reform, to trade, borders, security, ISIS, both parties are facing questions from voters. Particularly the Republicans who have lacked specifics during the two terms of the Democratic Obama administration with a divided Republican Congress, and the risks for Republicans running for Congress under frontrunners Trump or Cruz who have provided few details on their agenda. The Agenda project of Ryan will have about 25 meetings and prepared specific agenda, including white papers and legislation, that would give Republicans hope to run on positive proposals that are placed before the Republican Convention in Cleveland. Chairmen of House standing committees were assigned 6 areas- health care, taxes, national security, regulatory reform, poverty, and Congress reasserting constitutional authority. Ryan told the Ethics and Public Policy Center on April 19, 2016- "A lot of people don't like conservatism as they know it. For too many people Republicans seem to be caught in a time warp. They're thinking, 'We don't control our borders. Wages are going nowhere. College and healthcare keep getting expensive. ISIS continues to spread. And what are Republicans going to do about it?' So we need to adapt our policies to meet the challenges of the 21st century."...

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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....