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George Bush's administration passed healthcare legislation that allowed private pharmaceutical companies not to have to negotiate with Medicare on cost of drugs. It also passed the so called Medicare Modernization Act that created a huge opportunity for profits through Medicare Advantage Plans. The chart in WSJ shows profits it calls a bonanza. What it means is that instead of reducing the costs of providing medical care to elderly Americans it has increased the cost leaving less and less money for infrastructure for roads and bridges and airports that are dilapidated in the US, and less money for essential services in education and health care, transportation, housing. This has reduced the standard of living and quality of life in America. For healthcare it is providing less for higher cost when compared to China, India, Germany, France and the UK. George W Bush administration put America into 2 wars in Asia and the Arab world which also drained resources contributing to a lack of investment in the country in essential infrastructure and services. ...

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US president Biden's effort to appeal to all American families and workers in the $2 trillion plan for investment in child care, paid leave, healthcare and education, and the importance of staying away from the divisive and polarizing effect of the Clinton years on Republicans, is part of the new approach of the Biden administration as it tackles America's most important problems with hopes for bipartisan support.

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The Big Beautiful Tax and Spending Bill in the US Congress faces close votes in the US Senate with Senators Rand Paul of Kentucky, and Thom Tillis of North Carolina, both Republicans against it.  The Senate version has additional cuts to Medicaid funding. Tillis expressed concern about these cuts. Senator Rand Paul is opposed to increasing the deficit for enlarged spending and tax cuts. Republicans and DJT have close votes in the Senate and in the Congress. Republicans Murkowski of Alaska and Curtis of Utah want to change the early phaseouts of tax credits to the renewable energy industry in the Senate bill, and the excise tax after 2027 to avoid buying from China and develop American manufacturing in renewables. Senator Collins of Maine has an amendment to add $25 billion for rural healthcare and rural hospitals to offset the effects of large Medicaid cuts. Collins plan also lets taxes revert to 39.6% from 37% for married couples incomes over $50 million.  The bill then heads back to the House for changes by Wednesday, July 2, for a goal to have it on the president's desk by July 4th, Friday. ...

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The problem of elites in the US controlling most of the wealth and funding of candidates is discussed in The Times by Matthew Syed. The distortions in the American system of democracy and lack of funding of infrastructure, basics of education, healthcare, and public services, the misallocation of capital by capital markets in the current state, a reversal of everything Lincoln, Teddy Roosevelt and FDR- Truman set out to do, that is a result of the current situation prevailing in America.

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The Biden Infrastructure plan aims to put $400 billion into home healthcare for seniors shifting away from hospitals and institutions. By 2030 one in every five people will be at retirement age in the US, as the aging population surges. Studies show seniors can - if supported by services and the resources allocated by the government - live better quality lives at home for an extended period in retirement. This is an important issue for seniors and the Biden administration after the pandemic.

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WSJ looks at the changes in the way medicine should be practiced in the light of what we have learned from the pandemic.  Medicine practiced before the pandemic and still today relies mainly on a visit to the doctor or specialist who is short of time. There is a shortage of doctors. Patients have many illnesses as a result of decades of neglect of proper nutrition, and exercize habits. Obesity is at about 40% in the U.S. about 30% in the UK and 17% in France, and high also in other parts of the world. These high rates were unknown throughout history and result in many illnesses and increase by four times the vulnerability to the coronavirus. One authority in medicine calls obesity pouring gasoline on a fire for effects of the virus.  A doctor's appointment with doctors short of time with no coordination around a whole range of factors related to obesity, illnesses, health checkups, mental health, is now seen as a heavily handicapped way to practice medicine or for patient healthcare and wellbeing. The alternative is discussed here as the way forward. A  team will be responsible for a patient's care not just an individual doctor. The team would care for general health after a patient's checkup, cover individual illnesses, weight issues, mental health, exercize nutritional needs and other good healthcare habits. Instead of relying on doctors at a time of shortages of doctors the team would be led by nurse practitioners.  A nurse practitioner is someone with a bachelors degree and a masters degree or doctoral degree in nursing with 1000 hours of clinical training. Studies have shown that they are effective and even more effective than individual doctors. Today particularly with the problem of doctors with limited time compounded by the built up problems of decades of bad habits in nutrition and exercize and poor "cultural" habits getting entrenched, there has never been a greater need for a better way to practice real healthcare for a person's wellbeing. Particularly in rural areas with an even larger shortage of doctors the health practitioner led team will play a big role. Patients will under this setting receive more care virtually and get more followup care by phone and video messaging. The numbers tell the story- there are shortages of doctors in USA, Europe, Africa, Latin America and Asia. In the U.S. shortage of doctors is 55,000 projected to 2033 by Association of American Medical Colleges. There are 290,000 nurse practitioners licensed in the U.S. and 131,0000 physician assistants. The goal will be to get an adequate number of nurse practitioners licensed in this decade to take care of these teams. The pandemic has made virtual visits to doctors and nurse practitioners popular. Medicine reimbursement should and would be practiced on the basis of how well a patient is doing not on a fee for each micro service that is delivered. For this to happen the teams led by the nurse practitioner have to commit to patient education of the benefits from good practices and good habits for nutrition, exercize, caring for oneself. A doctor short of time is hardly the person to carry on this patient education which is where the major opportunities for a new system arise. The virtual care also provides a new medium for patient education and awareness of the risks of getting illnesses, preventive actions to be taken in advance. One approach being tested in California and Texas is for a monthly fee for patients more payments by health plans to doctors or healthcare teams if the patient is healthier. Additional health professionals are added to the team including health coaches, dietitians and medical assistants to increase its effectiveness in counseling and education and monitoring.  The nurse practitioner team approach is already being practiced in parts of the U.S. including the example of New Hampshire shown here, and is predicted to be the approach for primary care in the next decade. ...

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US Senator Lisa Murkowski gets $25 billion for rural hospitals and assistance for Alaska in One Big Beautiful Act 2025. She was the 50th vote for the Tax Cuts Bill in the US Senate, without her vote the bill would not pass. Senator John Thune worked hard to get her on board. At about 1.30 am in the wee hours she agreed to support it only after getting $25 billion for rural hospitals and special allocations for Alaska healthcare needs, and other benefits for Alaskans including $25 billion for the Coast Guard. Places are spread far out in Alaska and patients have to be flown in to Anchorage for care. Alaska is a different place for health care including needs of native tribes. Lisa Murkowski is a rare senator with a passion to serve Alaska, and her concerns for disadvantaged people.

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US president Biden holds his first formal news press conference of 2022 on January 19. It comes at the end of Biden's first year in office. Biden's achievements include 200 million Americans vaccinated, and $1 trillion infrastructure bill passed with a direct impact on the nation's infrastructure gaps. A $2 trillion Build Back Better plan for building healthcare and education, and a climate change plan are next on the agenda requiring the president to increase support for national revival and addressing challenges of climate change.

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Only 6% of Chileans support president Pinera of Chile and 81% call management of the pandemic a failure. Parliament adopted reform that allows citizens to have 10% of pension savings paid out as emergency coronavirus aid. Latin America has no aid funds in the way aid is given in the U.S. and in the European Union, and in Britain, leaving people dangerously exposed during the pandemic. Chile was presented as a much more affluent country but this no longer holds true. This DW.com report says the government remains overwhelmed and helpless in the face of the pandemic and internal protests that started over pension inadequacies and subway price hikes, lack of healthcare services.

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Distorted priorities from the last 2 decades and lack of investment allocation for healthcare are hurting states in the U.S at a critical time. With 16 million cases of coronavirus and 300,000 deaths in December, including over 3000 deaths a day by December 12, the situation is dire. Yet states lack the billions needed to conduct the vaccination program to pay for the trucks, get the refrigeration and storage, pay the nurses and the medical personnel, outreach costs, and other costs for a massive vaccination program. Some estimates are that states need about $9 billion for the vaccination programs. New York alone needs $1 billion. For years billions of dollars were wasted in distorted priorities that benefited certain groups at the expense of society as a whole. The very large companies that benefited paid little or no taxes. 

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For the first time the public in Britain believes the Labour party under Keir Starmer can do better than the Conservatives under Johnson to improve healthcare, give respect and dignity to workers and families lost in the last two decades, improve incomes, and tackle the pandemic. Labour now is up by 4 points and Conservatives down by 3 points in a YouGov poll done for The Times. Following the lead of Scholz in Germany with the SPD in alliance with the Greens, and Biden in the US, Britain is faced with a real choice for the future.

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Bihar unemployment and West Bengal unemployment of 3-5% a fake number as the jobs counted include unstable temporary poorly paid work. Quality Jobs are only 10% of the workforce. These figures disguise huge problems. In Bihar and West Bengal youth unemployment is high and many youth simply leave the state for states in the western part of the country such as Gujarat and Maharashtra looking for work. In West Bengal the situation is particularly dire as the state government has blocked foreign investment and it is not an investment friendly environment. In addition the idea of a cut or a fee for everything and services, encouraged by the state government, leads to an entrenched climate of corruption that keeps out investment in industry and in infrastructure. The lack of cooperation with the federal government at the West Bengal state level leads to people in the state not having access to federal programs for housing, healthcare and water, sanitation. None of this shown in the media. When the media inside India and in the US or EU covers India, it fails to even give this importance. Probably because of the huge ignorance about India, its history and struggle for industrialization and modernization for the last 50 years. It is similar to the huge ignorance in America and Europe and inside China itself during the years of Japanese occupation of China in the 1930's, and through the efforts for industrialization in the 1960's and 1980's. A BBC article on fish is an example of this shown alongside this article on Bihar (and West Bengal). Both states were part of British Bengal, which is where the British based their Empire after the British East India Company secured rights to the revenues of Bihar and West Bengal by the 1780's, that had been take earlier by the Moghuls during their invasions from Afghanistan and Iran. This was the beginning of the destruction of West Bengal's economic structures in the way it happened in China by the 1850's with the Treaty Ports secured by the same East India Company of the British merchant Navy. The process of unwinding of this enterprise goes on today even 75 years after 1950 against the roadblocks to industrialization and modernization in India set by native corrupt state administrations. ...

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US jobs reports May June 2025 revisions suggest slowdown.14000, 19000,  and 73000 US job gains May June and July 2025 suggest slowdown in the economy. Layoffs are low but hiring is slowing as companies tackle uncertainty. Number of people unemployed 27 weeks increases from 1.65 to 1.83 million in July 2025. Healthcare and social assistance added jobs. Government layoffs were 12000. Unemployment rate increases from 4.1% to 4.2% in July 2025.

In 2024 166,000 jobs were needed for unemployment rate to be steady, now just 86,000 jobs because immigration has dropped to new lows. This is important to note for rest of 2025 to 2030.

Also jobs reports are seeing downward revision because smaller companies tend to send in data late to the Labor Department in the current uncertainty.

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A study of the economies of the 100 largest metropolitan areas in the U.S. by the Brookings Institution suggests that states in the South may be facing a harder time recovering from high unemployment than the northeast and midwestern states. Of the ten states with the highest unemployment six are in the West and the South, including Nevada, California, and S. Carolina. Unemployment in S. Carolina is 11.1%. A researcher at the Federal Reserve Bank of Atlanta, says the better performance of the South in earlier years was driven by development and in-migration. This has abruptly ended. A Brookings Fellow, Howard Wial, suggests the possibility of California, Nevada, Arizona and Florida being depressed for a long time, while states in the Great Lakes region see a rebound. States and regions that are dependent on education, healthcare and energy, are doing better than others. In Pennsylvania, the Pittsburgh region with its emphasis on education and healthcare is doing better than Philadelphia. In New York, Buffalo and Rochester in the upstate region are doing better than the New York City metropolitan area. Areas around Akron and Youngstown in the rustbelt part of Ohio are recovering better than Tucson and Colorado Springs....

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Samuelson points to the risks to the American economic growth from excessive health care costs. This is hurting take home pay and shows up in consumer spending. It is hurting government spending in other areas such as needed infrastructure spending and efforts to reduce the deficit. This hurts private capital investment to create jobs because of lower demand from constricted consumer spending. The U.S. budget has as its largest single expense 27% on health care compared to 20% on defense the next largest expense, with growth in health care spending taking this to one third of the budget in coming years. Without addressing health care, says Samuelson, the Supercommitte in Congress even if successful at deficit reduction will basically have failed to do its job, and it did not have the time, resources or conviction to do this. According to a new study from the Organization for Economic Cooperation and Development (OECD), U.S. healthcare spending per person is $7,960 per person in 2009. This compares with Norway $5,352, Britain $3,487, France $3, 978, an OECD average of $3,233. Life expectancy in the U.S. is 78.2 years, compared to Japan 83 years, OECD average of 79.5 years. Chile and the Czech Republic have life expectancy equal to the U.S. Except for cancer care where the five year survival rate is 89.3% in the U.S. and the OECD average is 83.5%, the U.S. lags far behind in much needed critical areas such as diabetes and asthma. Rates of emergency hospitalization for asthma are 3 times that in France and 6 times that in Germany and Italy. The U.S. has fewer doctors per thousand population and higher cost per medical procedure- with more frequent use of the costliest procedures- creating a supply shortage that induces higher prices, and less preventive and early action care through physician visits. The number of practicing U.S. doctors is 2.4 per thousand population in the U.S. compared to 3.1 per thousand for the OECD average; and number of annual doctor consultations 3.9 per capita in the U.S. versus 6.5 for the OECD average. Appendectomy cost $7,962 in the U.S., $5,004 in Canada and $2,943 in Germany. Coronary angioplasty cost $14,378 in the U.S., compared to $9,296 in Sweden, and $7,027 in France. Knee replacement cost $14,946 in the U.S., $12,424 in France, and $9,910 in Canada. Knee replacements, angioplasties and MRI exams are twice as common in the U.S. compared to the OECD countries. ...

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The present state of affairs only puts all countries in a race to the bottom as companies seek the lowest tax rate to base their headquarters, leading to tax systems that are unstable and tax revenues that cannot support essential public goods and services such as healthcare, and essential infrastructure. US central bank head Janet Yellen called for a globally coordinated tax rate which would apply regardless of where a global company is located. In her speech to the Chicago Council of World Affairs she redefined what competitiveness should mean today- "Competitiveness is about more than how US headquartered companies fare against other companies in global merger and acquisition bids...It is about making sure that nations have stable tax systems that raise sufficient revenue to invest in essential public goods and respond to crises, and that all citizens fairly share the burden of financing the government." For too long the burden of  investing in essential public goods such as healthcare, education, environment, and infrastructure has not been fairly shared by all citizens in advanced nations of Europe and in the US and essential investment has been neglected in the process. The pandemic today has only exposed the major cracks in the system that prevails today. President Biden's infrastructure plan of $2 trillion to fund renovation rebuilding of roads, bridges, water systems, electricity systems, and the entire network of infrastructure including for health and education, is only possible in an environment that encourages essential investment and provides sufficient revenues to do this. Europe is in the same situation, and so is much of Asia, Africa and Latin America. ...

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The epitome of massive distortions in the way capital is allocated in capital markets of the last two decades even as healthcare, childcare, manufacturing technologies and infrastructure was starved of captal funding is Masayoshi Sen and Softbank which posted a $23 billion loss in the April-June 2022 quarter. This is one and half times the loss in the first quarter. Heard on the Street in WSJ dismisses Mr. Sen's contrition on these losses as this will continue into the future it says, and is simply the style of these types of extreme speculation funds. It obscures a larger problem in society and in America and Europe of capital markets giving the pass on such wasteful use of capital on huge scale amounting to trillions of dollars and not funding desperately needed healthcare, education, infrastructure, childcare and other needs of the 900 million people in these countries. Even the claims of profits hangs hollow on the necks of these investments, with dubious selection of many projects. Capital returns are insignificant or zero as the WSj says many of Softbanks funds have net zero gains since 2017. Yet extravagant demands for capital are met with extravagant supply where the needs or reasoining are the least credible in today's distorted capital market allocations causing egregious harm to the 900 million people of the US and Europe.   ...

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The $1.8 trillion Biden Families Plan for workers, students and families takes on the unfinished work for the New Deal, says Binyamin Applebaum in the NYT. Women were not out in the workforce in the way they are today under Franklin Delano Roosevelt in the 1930's and US president Biden is making them and childcare a big part of his Families Plan. Women have been hit harder than men during the pandemic shouldering a greater burden of the home and childcare. Healthcare and education are essential for quality of living- never has there been a greater realization of this than today after years of underinvestment in infrastructure and the foundations of democratic society.

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This Washington Post article by Henry Farrell explains the implications of the 2016 EU ruling on Apple asking it to pay 13 billion euros in back taxes. Other countries in the European Union are upset that Ireland is taking away business and siphoning away tax revenues from their country, and giving most of it back to Apple. Normally the European Union Commission does not have authority over taxes in the member states. However considering the social and political implications at a time of deep recession and political upheaval in the EU and the U.S., the European Union Commission under Margarethe Vestager has seen it proper to look at arrangements in which companies come up with tax arrangements that deprive member states unfairly of tax revenues- revenues that could support social welfare and basic education, healthcare services at a time of painful cuts. A tax rate of .005% in 2013 for Apple is cited by Vestager as she points out that Apple's taxable profit does not correspond to economic reality, as most operations are conducted outside Ireland. Ireland is just on paper the tax location for EU operations. Vestager has thus come up with a legal approach based on Ireland's tax arrangements being a form of illegal state subsidy, which is not allowed under EU rules, and gives the EU Commission authority to require that it be reversed by paying the back taxes of 13 billion euros. Farrell answers the question why the U.S. Treasury is saying that Apple should not have to pay these taxes, as the U.S. also hopes to get some of these taxes at some future date with Apple repatriating profits to the U.S. under a still to be set tax arrangement. ...

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Vigorous and eloquent testimony before Congress by Treasury Secretary Scott Bessent, answering questions from Republicans and Democrats. Bessent had just landed from London at 3 am in the morning and after 3 hours of sleep took the time to answer over 5 hours of questioning by members of the House of Representatives. In question after question he explained how the certainty offered by the tax cuts bill would help small business and job creation in the US. The permanence of the 100% expensing of buildings and equipment would help farmers and small business , regulations would be cut, and manufacturing would take off. Manufacturing employs 9% of the workers in the US and their wages will rise faster than for service workers. The combined effects of the improvements for small business, farmers and for manufacturing workers will help the American middle class, America's working class, and increase the growth of the economy. Bessent points out that in the original bill of which the new tax bill is an extension the top 10% paid 7% more in taxes in 2017. He also points out that workers were hurt the most by the slower rise in wages and the rise in cost of living of 21% in 2021-2022, which he says was in essential goods with the actual impact of about 30%. With higher jobs creation by small business and more investment in the economy more able bodied men can join the workforce and gain healthcare benefits under new rules. He pointed to low inflation at 2.1% and to higher job creation, and to higher growth in the economy of 2.6%, that with other savings could lower the deficit. ...

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This month president Biden signed into law 100% tariff on China made EV's and 50% tariff on solar panels. The Guardian describes the hollowing out of factory towns in England such as Sheffield and the same in the US and Europe, which was a disaster for these communities dependent on manufacturing. There is now a sense that heavily subsidized products made in Asia should not be allowed to deindustrialize the US and take jobs away from these communities across the US. Trade has to be fair before it can be called free trade. Wars in Asia,  trade that ripped up American manufacturing, monopolies and burdensome pricing of pharmaceuticals and healthcare, lack of investment in infrastructure and public services, shows the deeply flawed policy pursued by presidents from Reagan and Bush to Clinton and Obama that have reduced the standard of living of the American worker and the American people.

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Medicare Supplemental insurance (also called Medigap) covers out of pocket cost that are not covered by Medicare Advantage. Over long period of retirement thes plans offer the best protection from unanticipated costs. The Plans use alphabetical leters A B C D F G K L M N with F discontinued. And are standardized, meaning regardless of insurer or state you are in they are the same being set by the US federal government. These plans are sold by private insurers the largest being AARP plan by United Healthcare. One can join when enrolling for Medicare Part B when premiums are usually better yet one can also join afterwards. About 36% of Medicare holders have Medicare Supplemental or Medigap policies for health insurance.

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China's healthcare costs have increased in the last decade without effective cost control measures. With the decline in consumer spending in the last decade to where it is now only 35% of GDP, and ordinary Chinese setting aside a large portion of savings for costly drugs and healthcare, reducing healthcare costs is a high priority to rebalance the economy and increase consumer spending. By comparison in the U.S. it is 70%. Bussey points out the importance of this for the new leadership of Jinping-Keqiang in China. Xinhua, the Party offical news agency, expressed China's new policy, saying that "some believe China may see a nationwide price cut on medicines." Regulators have begun probes of Nestle and Danone for possible anticompetitive activity and the two companies dropped prices for baby formula.

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About 565,000 workers are missing in the UK workforce in December 2022. The Guardian asks the question- Will they ever come back? Many left under stress from healthcare work, from the hotel and restaurant business, and from manufacturing during the pandemic. Some took early retirement, some taking care of family members. A similar situation exists in the US. Jay Powell at the US Federal Reserve, its central bank, and Fed Governors including the head of the Federal Reserve for California are working on ways to get these people back. Brian Deese of Biden's National Economic Council is also working to find solutions including better child care and better benefits for workers. Settling the rail strike on terms attractive for workers and getting rid of onerous rules for workers who could not get paid heath care leave in rail companies, are ways the Biden administration is responding.

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President Biden visits Nevada and calls for a 5% cap on rent increases by corporate landlords with over 50 rental units. The WSJ report July 15 shows 25% of people renting apartments in the US pay over 50% of their income just to pay rent leaving little for food and transport, education and healthcare. This is a severe problem in Nevada and in the US across all 51 states. The president is closely following mortgage rates that went up from 3% to 8%, creating affordability issues for prospective homeowners. Another proposal of the president that he can act on as it does not require Congressional action is to use federally underused land and repurpose it for building 15,000 affordable housing units in Nevada. Such proposals across the 51 states are needed today to address acute rental housing shortage and price increases of about 20% by landlords.