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Are there costs or are there savings from the Obama health care bill? Does it affect jobs and how? The Congressional Budget Office says the health care law will save $230 billion in ten years based on a whole set of calculations and assumptions. Commonsense and basic math leads others to question how spending $930 billion on insuring 32 million Americans could end up with significant savings. The different view argues that the Budget Office erred in making some calculations, by counting $70 billion in premiums from long term care because they would be used to pay benefits later, omitted $115 billion in spending to adminster the law, and omitted $208 billion needed to prevent scheduled reductions in Medicare payments to doctors. The money needed on the Stimulus, on two wars in Iraq and Afghanistan, and the uncertain prospects of the US economy in the longer term till debt and other issues are resolved, injects the critical element of difficult choices and priorities. If state and local budgets are severely strained in 2011-2012 would that require federal help and will there be other needs that will have to be met by the federal government that are critical such as another unexpected downturn, or a resolution of unresolved bad debt at the large US banks There is also a sense that the health care law does not do enough to reduce the cost of health care that will be needed over the next decade so that other priorities are not neglected. Both parties are not up to the task in this respect for running the country's finances withot using the numbers to tell different stories....

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David Brooks says the Paul Ryan Budget proposal is a bold step forward that is badly needed in this debate on health care, even though it has some grave weaknesses which need to be corrected. It is a bold step forward because he says Democrats say they want no middle class tax increases, or are not willing to say what kinds of tax increases they support, and yet they believe the Medicare and Medicaid and Social Security programs are worth preserving. This is'nt based on reality. He cites the weaknesses, beginning with the one discussed in David Leonhardt's column in the New York Times on April 7, 2011. Too many Americans pay too little into Medicare taxes and expect to collect several hundred thousand dollars more in Medicare benefits. The example given in Leonhardt's column is from a study that shows 56 year olds with average earnings pay about $140,000 in dedicated Medicare taxes over a lifetime, and then go on to collect $430,000 in benefits. Middle class and affluent boomers can't get off paying their share like everybody else. Its just the right way for their children and the nation's children. Ryan's plan excludes older people reaching retirement in ten years. The other major weakness is that the cuts are too deep. Things like the Pell grants which Ryan proposes to cut back to 2008 levels need to be preserved, and more money has to go into science, education and research and early childhood education for the U.S. to be competitive with China and India. The Ryan proposal places cuts that would be required so that tax revenues need to be at 18% of GDP. The number where a larger consensus exists is for tax revenues at 20% of GDP (also supported by business and the Wall Street Journal's editorial columns). This would preserve programs that are most productive for the economic future of the U.S. Ryan's proposal lets the hope for reducing costs of medical care rest entirely on future retirees deciding how much medical care (tests, procedures etc) they consume through larger cost sharing. Yet a structure and framework is needed to manage these costs effectively, and some combination of incentives to retirees to control costs and an effective structural framework is needed. ...

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This story by Emmarie Huetteman describes the effort of three Republican women in the U.S. Senate who had the courage to listen to the different voices in their home state and use their informed judgement in deciding how to vote on a Republican healthcare bill or Affordable Care Act repeal effort. Especially when they heard that it would hurt people in their state, the elderly, low income and other vulnerable people without offering alternatives. Even when this meant resisting pressure from fellow Republicans. The senators are Capito of West Virginia, Collins of Maine, and Murkowski of Alaska. This is particularly significant at a time when too much polarization has led to paralysis in coming up with informed discussion and good solutions to problems. It is also significant that senators from the midwestern states such as Iowa- Mr Grassley, and Kansas- Mr. Moran, also joined the effort to listen first to people back home in their districts before making up their mind. 

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Senator Mitch McConnell, the Republican Majority leader in the U.S. Senate has come up with a new health care bill that is aimed at winning over reluctant Republican Senators. Two taxes on high income people on 3.8% investment income and a payroll tax of 0.9% on incomes over $200,000 for individuals and $250,000 for couples are retained in this version of the bill, which adds $231 billion over a decade. Some of this is used to offset rising premiums in the new bill, and provide additional funds. The deep cuts to Medicaid are retained and Senator Collins of Maine says she is opposed to the new bill because this will hurt people in rural areas of Maine, and does nothing to change this. Senator Rand Paul of Kentucky is also opposed to the bill. Opposition comes from moderate Senators opposed to deep cuts to Medicaid in Republican health care alternatives to president Obama's Affordable Care Act, and from conservative Senators opposed for other reasons.  Senator Graham of South Carolina and Bill Cassidy of Louisiana introduced their own version just minutes before Mitch McConnell brought up his revised bill. All Democratic Senators are opposed to the Republican bill and call the deep cuts to Medicaid disastrous for lower income people.  ...

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UnitedHealthcare says it will keep parts of the healthcare law relating to preventive healthcare services without co-payments, allowing parents to keep children on insurance till age of 26, even if the Supreme Court rules against the healthcare law. Most insurers see these parts of the law that are popular quite favorably.

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The skills to navigate different personalities and work patiently on the issues surrounding changes to the U.S. tax system of Rep. Dave Camp (MI), chairman of the U.S House of Representatives Ways and Means Committee, will be immensely useful in the effort to make changes to the U.S. tax system. Camp works well with fellow House Republican leaders Boehner, Ryan, Cantor, and his Democratic counterpart in the U.S. Senate Max Baucus. Camp is a good listener, refuses to engage in partisan criticism, and has the patience to work through difficult issues of achieving savings and keeping fairness in the the tax changes. Earlier efforts to achieve consensus in late 2011 failed, making it even more important to have leadership which can create productive debate and bridge the differences. The tax changes are part of the overall effort for U.S. economic recovery by reducing the deficit.

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A new study by the Washington Post and the Kaiser Family Foundation shows partisan politics will affect the new president in the U.S. in 2013, to the point of making it difficult to govern.

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Under a plan called "premium support" Paul Ryan's U.S. budget proposal would have seniors choose a private insurance plan from a federally operated exchange. Each year the government would pay private insurers a specific amount to cover the cost of premiums with the rest borne by seniors. The total amount paid by the government would go up only at the rate of overall inflation, it would not go up at the higher rate of health care inflation. By doing this the government would take off the trillions of dollars of projected spending on health care that are largely the result of the higher inflation rate in health care costs. This higher inflation rate on health care costs is something that both parties have failed to control, and remains a major weakness in all health care proposals to date, including the Obama health care legislation. Allowed to continue growing at this rate when U.S. debt to GDP is nearing 100%, health care inflation costs pose major risks to the nation's finances.

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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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Lipton, Austin and LaFraniere of the NYT tell the story of how the serious differences between the prime contractor for the federal healthcare website, CGI Federal, and the Obama administration officials handling the website, evolved into conflicts that could not be resolved. This led to the flawed website being rolled out on schedule ignoring serious problems with the website. The detailed report comes after interviews with Obama administration officials and specialists who worked on the project and looking into government and contractor documents. A month ago in October 2013 the healthcare website for the Obama healthcare law was up only 42% of the time with 10 hour failures happening frequently. Basic steps for the functioning of website backup systems in case there is a failure, testing to ensure negligible or no outages, were not secured. The government officials responsible for the rollout did not have the capabilities to handle such a project. Henry Chao, who worked in the Medicare agency for 19 years was left to oversee day to day questions for the website HealthCare.gov, but lacked a formal background in software engineering and no authority to make the decisions needed. The $630 million project was setup inside the Medicare Agency, instead of a separate agency specially setup for this project and staffed with the appropriate skills as originally proposed. Five different lower level government officials made decisions without the authority needed and no one person with the necessary skills was given overall responsibility and decisionmaking. A series of missteps were allowed to take place- settting many added requirements that made it difficult for contractors to focus on basic steps and get them right, use of the MarkLogic database system instead of systems from IBM or Oracle against the advice of contractors, multiple contractors without a way to control the overall project, shifting requirements from the government and bureaucratic delays for resolving basic issues such as use of social security numbers, all worked to create delays. With the delays came a deterioration of relations between Obama administration officials and the contractors. The government officials response was to stick to the deadline of Oct. 1 rollout, with Michelle Snyder, chief operating officer of Medicare agency telling people she would fire the contractor if possible. In the end no one took responsibility for a safe reliable rollout, even though the system failed a test of 500 users in late September and was down half the time in mid-October. President Obama or his advisors were either not kept fully informed, or did not grasp the significance of the collapse in relations between contractors and the government and a project out of control. His aloof distanced approach was not an asset in such matters- saying about the rollout and use of the website: "this is real simple" like using the Kayak website for travel bookings- and he saw no need to take action leading to the major failure for the administration that followed....

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Senator Patrick Toomey (Pa.) and Rep. Jeb Hensarling (Tex.) are lobbying Republican party members in Congress behind the scenes to accept $300 billion in taxes as the only way to get an agreement on debt reduction in the Supercommittee. This would be part of a plan that addresses entitlements, and changes the tax code to lower rates and reduce tax expenditures by closing deductions and loopholes. This is leading to an intense debate in the Republican party about the wisdom of a purely ideological position on taxes that does not take into account current realities, and risks letting markets take control of the nation's future.

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Rep. Dave Camp, House Ways and Means Committee chairman, representing northern Michigan, says every deduction in the tax code is there because of a reason, and powerful lobbies will oppose any changes. The best he can do is work himself out of this job as he will have to tackle the Democrats on entitlements, the business lobbies on tax loopholes, and other lobbies protecting their preferences in the tax code. He plans to achieve a simpler tax code with lowered rates of 25% for business and earners above six figures, and 10% for everyone else. The approach he is taking is to be revenue neutral when tackling tax reform, in the belief that the economic growth generated from a simpler tax code and lower rates would generate revenues of 18 to 19% of GDP, up from about 16% today. He says the economc cost of not getting this done to get the economy rolling again is so high that he is upbeat that both sides can come together after the election no matter who wins. He is also looking at a repatriation tax of 5% on profits kept by American companies overseas, which would boost revenues for business which could be reinvested in stead of sitting idle. Today the much steeper tax rate on repatriation makes businesses reluctant to bring it back....

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The rarely mentioned origins of the U.S. Medicare reform proposal of Rep. Paul Ryan and Rep. Ron Wyden, which includes work done at the Hoover Institution and liberal think tanks, in a debate subject to distortions on all sides.

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An average of major opinion polls compiled by Real Clear Politics website shows 50.5% of Americans opposed to the Obama U.S. health care law.

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Romney says in the first presidential debate he will not increase taxes on the middle class: "I will not reduce taxes paid by high income Americans. And I will not, under any circumstances, raise taxes on middle-income families. I will lower taxes on middle income families." How he would do this is through limiting or eliminating deductions and loopholes among several measures, with work done on this by his advisor Martin Feldstein, Reagan's economic advisor and a professor at Harvard University- Romney's Tax Plan can raise revenue, WSJ, 8/28/2012. Where the Democrats and Republicans differ is that economic growth generated by creating incentives for business to invest and hire also plays a part in generating the additional revenues as it did under Reagan's economic plan. Behavioural factors play a large part of this as much as the incentives and other steps, to create a climate of business confidence- search in Janvoo for the Group "Reagan memo of 1980 by Shultz, Friedman," for more on this....

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The differences in the Democratic party between conservatives and liberals that make it difficult to get things done in healthcare, energy and other areas. The lack of White House leadership in a number of areas, and in anumber of instances. The lack of Senate leadership on these issues with the Senate not having done much in energy and healthcare legislation. Add to this the influence of the $133 million that lobbyists spent in the 2nd quarter 2009 alone. The failure of Republicans and Democrats in Congress to push vigorously for cost control in the health care industry adds to these problems.

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Krauthammer cites Congressional Budget Office numbers that show the Obama U.S. health care law continues the spiralling costs of health care with new government mandates at a time of severe budget cuts in education and other areas- for 2013-2022 the costs come to $1.76 trillion. The initial Obama administration figures of 10 year costs of $938 billion announced in 2010 reflected the fact that the new U.S. health care law would take 4 years to fully go into effect. Costs after 2021 are shown to be $250 billion each year in the CBO figures. The law is now before the Supreme Court in 2012, which has to decide on the basis of the limits of the Commerce Clause.

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The U.S. Senate voted 51 to 49 on a Democratic party measure for further reductions in 2012 Social Security payroll taxes for workers and employers, including a surtax on incomes over $1 million. A measure supported by the Republican party to pay for the payroll tax cut by reducing the Federal payrolls was defeated, with half the Republicans voting against it. Democrats hope to use this issue to show Republicans favor the rich over the middle class, as the payroll tax cut benefits most Americans. Polls show Americans by a large majority see Republican policies favoring the rich. A New York Times/CBS poll in October showed 7 of 10 Americans feel this way. Pollster Geoff Garin says the income inequality issue is beginning to override other issues including antigovernment feeling. This is one way in which the Occupy Wall Street Movement's slogan of "the 99 percent" has resonated with U.S. public opinion. The Democratic party sees this as an opportunity to define the campaign issues for 2012, with Republicans running for reelection cautious about being seen this way....

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Friedman says Obama's 2012 presidential campaign lacks bold vision, a failure to articulate tangible achievements, and owes too much to campaign consultants. He describes it as being developed in test tube fashion. The failure to embrace and strongly advocate his own presidential commission's Simpson-Bowles deficit reduction plan, which could be coupled with long term investment in the productive potential of the U.S. economy, shows the lack of courage to prepare a plan going forward. It is likely to cost support of independent, center and center-right voters in the 2012 U.S. presidential election.

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Peter Coy of Bloomberg Business Week points out that the debt ceiling and proposed deficit reductions in the range of $4 trillion really obscure the real size of the problem which is much larger. The real problems hit when the U.S. faces a larger graying population by 2020 with sharply higher per capita health care spending; and at the same time workers from this generation retire and become beneficiaries of Social Security and Medicare with fewer younger workers to support the system with tax revenues. Another problem is that older Americans are likely as a voting bloc to vote themselves benefits that will cost the younger generation, benefits that the younger generation will not be able to enjoy. Even the Paul Ryan plan with its cuts to Medicare insulated todays seniors from the sharp cuts, as it becomes political necessity for both Republicans and Democrats to shy away from touching the current beneficiaries.

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The US House of Representatives voted 245-189 in favor of repealing the health care law. Only 3 Democrats joined the entire Republican caucus in voting for repeal, compared to 34 Democrats who voted in March 2010 against the health care law. This is a largely symbolic move as the Democrat controlled Senate will not consider the repeal, and even if it did the President would veto it. Republicans favor some aspects of the health care law which allow children to be on the parent's insurance till age 26, and a ban on insurers denying coverage due to pre-existing conditions. Opinion polls show 46% of respondents opposed repealing and eliminating the law, and 45% favored repealing it. The health care issue ranks third among the economic issues important to respondents, behind unemployment and reducing the federal budget deficit.

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The 2011 State of the Union address by President Obama. A calculated effort to move the debates that will frame the future election to a different place. He emphasizes the importance of investing in the future, in global competitiveness, through spending on education, infrastructure, alternative energy and other projects. But there was little in the way of specifics for reducing the high jobless rate which stands at 9.4%. And little in the way of specifics of how the investments in the future for global competitiveness and infrastructure spending are to be achieved. Especially when the fiscal imbalances are growing after the compromise on the Bush tax cuts and the passage of health care legislation. The Washington Post says that a majority of Americans approve of his overall performance, yet they are generally negative in their evaluation of how the Obama administration and President Obama has handled key issues relating to the economy. And this is more so among independent voters who will be crucial in the 2012 elections....