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The influence of the AMA convened Relative Value Scale Update Committee (RUC) on how the Medicare payments to doctors is shared, and on the growth of the Medicare budget. Concern that the interested party is driving the decision making process. Medicare costs went up by 9% in 2009. Fears that doctors have too much control over the dollars in the $500 billion Medicare program. The tendency to focus on more expensive procedures and short change preventive and less costly care. Medicare spends $60 billion on doctors fees. The older codes remain in place even when costs are reduced, leading to higher costs for the Medicare budget each year. And there is little incentive for doctors in RUC to revise overvalued codes.

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Some of the crude rhetoric at Donald Trump rallies, and use of coarse language, according to the NYT. Working class and older Americans show their anger at a system that appears to have left them behind with slogans, stickers, T-Shirts. The idea of the wall figures in much of this and shows that the wall has become not jut about Mexico but a metaphor that captures this anger, that reflects this anger. Another aspect of the 2016 campaign is that those most vulnerable and most in need of help have not sought the comfort of knowing about programs to improve middle class and working class wages, incomes, to build infrastructure, create jobs, stop companies from shifting jobs overseas, plans for improving accesss to health care and education, to ask for specifics and delivery. This is the supreme irony of the 2016 election campaign that not enough attention is going to what will be done for the middle and working class, and what specifics will be delivered, in what time frame- which is essential for restoring the condition of the American middle and working class to where it was in the 2 decades after the Second World War. ...

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A professor of sociology at the University of Basel describes the growing inequality in Germany, in graphic terms. For the lower middle class the efforts to gain upward mobility are like trying to move up on a downward escalator. About one third of jobs are temp jobs which lack the protections of permanent jobs which were at one time 90% of all jobs. Her book is titled- "The Hidden Crisis; German Social Decline at the Heart of Europe." Nachtwey says on the surface Germany has become competitive and has maintained its growth rate, benefiting from the strong manufacturing sector with trade surpluses, low unemployment. Yet this conceals the underlying crisis of the cost which this has come at- a persistent erosion of the social compact of one elevator where everybody moved up together that was the norm in the early postwar period, fulltime employment, a strong welfare state. Job protections weakened, and while manufacturing sector pay remained stable or rose, less skilled and low wage workers suffered. This has also led to the fracturing in the vote with the fragmentation of political parties following the refugee crisis and the weakening of centrist parties. Voters are now open to different messages after the increase in inequality and uncertain economic future for the lower middle class. ...

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Leonhardt points out a couple of problems with Paul Ryan's budget proposal for Medicare. He says Medicare recipients, with the exception of the very affluent, currently haven't paid enough for the benefits they receive. He cites a study that shows Medicare pays out several hundreds of thousands of dollars for the average retiree more than they ever paid in. Medicare funds go for hospital expenses, the rest for doctors bills come from general government revenues. Government borrowing increasing the national debt to unsustainable levels so that current retirees do not have to pay higher taxes, is simply shifting the burden to the next generation. He says the Ryan plan shields those who will retire in the next 10 years because they are a powerful voting bloc, making this more of a political calculation than a bold reform step, as this means younger people will have to bear a disproportionate share of the burden. The other part of Ryan's calculus is that it has proven extremely difficult to reduce the volume of medical care that is consumed in terms of tests, lack of preventive care leading to graver problems, and surgeries. Simply by shifting a larger share of the cost to future retirees this will have an effect on the volume of medical care consumed and put a lid on costs. This is something that needs to happen says Leonhardt, but at the same time all Americans need to share in the higher taxes that are necessary to fund Medicare, exempting 75 million Americans only creates an imbalance in contributions. The other problem with this is that the costs of this exempted group will postpone serious deficit reduction for ten years....

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

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How to deal with Bush era tax cuts is a big issue dividing Democrats and Republicans in the U.S. If no deal is reached by Jan 1. taxes on the average middle income family would increase by $2000 in 2013. Median inflation adjusted income declined 8.9% to $50,054 in 2011 from $54,999 in 1999, and economic mobility has fallen. The Democrat's position is for Bush tax cuts to apply to incomes below $250,000. Peter Orszag of the Congressional Budget Office and Jared Bernstein point out that while this makes the tax code move in a progressive direction it also creates handicaps in providing a sufficient revenue base to support middle class spending programs down the road. According to the Tax Polcy Center, if Congress is unable to reach agreement and all tax increases go into effect Jan 1, taxpayers in the bottom 20% of income distribution would see a $412 increase in taxes compared to an increase of $633,000 for the top 0.1%. New York Mayor Bloomberg has supported eliminating the Bush tax cuts for all groups, saying there is no free lunch. Alan Krueger, head of the White House Council of Economic Advisors, says the trends caused by globalization and skill-biased technological change which have increased inequality are likely to continue or accelerate. ...

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Extreme positions on business related issues taken by politicians in the Republican party. An effort to influence the Republican party's platform through the ouster of moderate Republicans like Jim Bennett of Utah. The impact on the US Congressional elections in 2010. Positions such as the abolition of the Federal Reserve, prohibiting stimulus funding, sealing the borders and doctrinaire positions on the role of government. Education reform, immigration reform, investment in infrastructure building all will be out in this type of platform adopted by some candidates. A Senate candidate from Alaska suggests Social Security is unconstitutional. By appealing to popular discontent with the Obama administration, and anger with the bank bailouts, what is called the Tea party movement has taken shape. It is built around politicians Sarah Palin of Alaska, Jim DeMint, Rand Paul of Kentucky, and other candidates such as Haley in South Carolina who are using it to tap into discontent. It has the support of Fox News, and Dick Armey former Congressman from Texas who heads FreedomWorks, and libertarian billionaire David Koch. Built around seductive principles of small government, the movement has no clear program considering the diverse positions of the different politicians and different extreme positions adopted, including a general hostility to large corporations without differentiating a BP or a Goldman Sachs from a GE. GE's operation of MSNBC puts it in the same category as a Goldman Sachs. The lack of a clear position by the US Chamber of Commerce, because of its opposition to the Obama administration. The movement carries with it risks, as the Republican party's control of the House of Representatives is not ensured. Ideology of a vague kind has become a substitute for good credentials and experience, in the fast-forward effort by activists such as Dick Armey to capture popular discontent. Says Dick Armey, "We live by the creed 'hard work beats Daddy's money,' " raising serious questions about how a statement like this would help the jobless or the economy. ...

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Krugman points out the gains on three fronts evident from the Census Bureau report of 5.2% gain in median income of households in the U.S. He says the first is the growth in incomes of ordinary working class and middle class families, second the large decline in the poverty rate, and third the further rise in insurance coverage in 2015 for people without health insurance. He points to the steady efforts of the Obama administration to improve lives of ordinary families as working based on the Census report though results have taken time, and could have been better. The Stimulus, says Krugman could have been larger following the blow of the 2009 financial crisis and increased unemployment at the time. Janet Yellen at the inequality conference of the Boston Fed in 2014 pointed out the problems of 62 million households having net worth of about $10,000, and why this was running against the American idea of a better life for all Americans. In that sense the Census report is a movement in the right direction but a lot remains to be done.   ...

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Paul Krugman points out that the Bush tax cuts if continued in the US for all income levels will cost $680 billion over the next decade. This estimate is from the Tax Policy Center.

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Friedman reviews Acemoglu and Robinson's new book, "Why Nations Fail." Acemoglu says that nations fail when wealth and opportunities are concentrated in the hands of few people, that a condition for societies to succeed is to create opportunities for more people. For this to happen it is important to create inclusive political and economic institutions. This is an important insight, but for Western society this is an insight as old as Adam Smith when he pointed out the importance of this aspect of western societies after the feudal period in his "Wealth of Nations." For Smith it was the failure to create inclusive societies that led to the gradual unravelling of societies in the river valleys of the Yangste and the Ganges, in China and India, of increasing poverty and the gradual disappearance of what constituted the middle class in India and China. Chapter 8 titled "Of Wages and Labor" in the "Wealth of Nations" makes specific reference to this.

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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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Erskine Bowles, a former chief of staff under President Clinton, and Alan Simpson, former senator from Wyoming, say the U.S. Supercommittee members should remember that their personal priorities and the common good are not at odds. The authors of the Bowles-Simpson Presidents Commission for deficit reduction say there is growing discontent among voters with politicians who are obsessed with gaining partisan advantage. Using issues of national importance that require a common approach from all parties as a way to score political points will only backfire on these politicians. Personal priorities of members of Congress are now no longer at odds with the common good, they are converging. It is upto the Congress, members of both parties, to push back against the special interests and partisan politics, and show leadership on the deficit. The eurozone crisis has shown the dire consequences of any sluggishness or procrastination. The failure of the political class and leadership in Italy and Greece, and in other nations of the EU, has put the fate of these countries in the hands of markets, which have relentlessly pushed up the borrowing rates of Greece, Italy, Spain and other countries, and taken future direction out of the hands of politicians. Erskine and Bowles say don't wait for a fiscal crisis to take action because it will be disastrous economically and politically, with everyone as losers and no winners. Timidity is not an option, leadership is required to take action that is big and broad, tackling tax expenditures, entitlement expenditures, defense, across the board....

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Results of a CBS New York Times Poll of 1018 adults in the U.S., reported Feb 28, 2006. Results show 55% showed support for gasoline tax if it reduced dependence on foreign oil, 59% showed support if it also reduced global warming. There is additional support if the money is used to fight terrorism, allocated to specific projects such as electric cars, or help low income people with extra gasoline costs. The important distinction in the results is what respondents were asked. When told about their response to a gasoline tax 85% of respondents opposed it, but when told it would reduce dependence on foreign oil 55% support it. Some respondents want to see it earmarked so that its use would reduce dependence on foreign oil through fuel efficiency improvements. The gasoline tax has remained at 18.4 cents a gallon since 1993. Politicians see the 85% and stay away from the issue and at periods of higher oil prices there is more concern about the impact on consumers. Prof. Borenstein, director of an energy institute at the University of California, Berkeley, says his calculations show a 10% increase in gasoline cost would reduces consumption by 6-8%. As the tax is regressive by putting a higher burden on low income consumers, this should be offset by income tax relief that would make middle and lower income people better off , says Prof. Borenstein. Some of the revenues would be used to support projects at automakers and research universities to develop more fuel efficient technologies for automobiles. Shows support is there if the tax and where money is spent is shaped in the right way....

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Theresa May becomes the only candidate for leadership of the Conservative Party after Ms Leadsom withdraws from the race. No leadership vote will no take place with Conservative Party members and no early general election is planned. May is expected to become prime minister of Britain by July 12, replacing David Cameron. Her theme is for "one Britain" and to do away with the rising inequality and gap between London and the rest of the country, which was part of the anxiety of voters who voted 52% for Brexit on issues of immigration burden on social and health services, national sovereignty, and a sense of ordinary people being neglected by elites in both parties. May will invoke Article 50 to leave the European Union and begin a 2 year period of negotiations only after she has developed a clear negotiating strategy. Kenneth Clarke, a Conservative Party cabinet minister called May a "bloody difficult woman," but this did not affect May, who said Mr Juncker of the EU was the one who would find this out in negotiations.  What is significant for Britain is May's moderate position coupled with a clear goal for removing some of the causes of the inequity in British society, which is needed for Britain to remain united. She called on companies like Amazon, Google and others to pay their fair share of taxes, and made clear her intent to strengthen the mechanisms for controlling executive pay. Also part of this strategy will be a more effective immigration control policy, which she did not implement vigorously as Home Secretary in the Cameron government, partly because of constraints set by EU membership. May made clear her agenda going forward by saying: "There is a growing divide between a more prosperous older generation and a struggling younger generation. And there is a gaping chasm between wealthy London and the rest of the country."  Changes May is supporting are to make executive pay rules to become binding not just advisory, and for employees and consumers to gain seats on company boards.  ...

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Krauthammer quotes Congressional Budget Office Director, Elmendorf, who said "we don't estimate speeches," when Elmendorf was asked about President Obama's April 13 debt plan speech. President Obama has failed to come up with specific ideas for debt reduction and not taken up any position on debt reduction, including removing tax expenditures as recommended by the President's Bowles-Simpson Commission report. Krauthammer says the President is using the discussion on debt reduction and the debt talks as a way to move forward with his reelection campaign. This President Obama has done by not putting forward any new ideas of his own or backing the ideas of the Bowles -Simpson Commission, and by putting Republicans on the defensive for coming up with any new ideas which may be unpopular. He calls the President's February 2011 efforts on debt issues a farce, and the April 2011 efforts empty, lacking any substantial specifics.

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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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Samuelson warns that turning seniors into a protected class making no sacrifices whatsoever, will mean shrinking all other social programs, defense and investments in education and infrastructure. This is the reality of the budget deficits facing the U.S. He cites the Congressional Budget Office projections that even with cutting defense and non defense discretionary spending by a third, the U.S. risks a deficit in 2023 of about 6.75% of the economy or gross domestic product (GDP). To cover this would require $1 trillion in higher taxes, an increase of a third above the 1970-2011 average. He says Democrats are using demagoguery and intimidation on this issue, and ironically even Paul Ryan's proposal reflects a desire not to touch seniors benefits and willingness to pass on the costs to the young to pay for these programs. Social Security and Medicare are a critical part of the American fabric, and no one wants to dismantle them, it is about modernizing them to reflect higher life expectancy and larger wealth accumulated by the elderly compared to previous generations, and to reduce the burden on the young. ...

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The U.S. Supercommittee in Congress fails to reach an agreement to come up with $1.2 trillion in savings to reduce the deficit by the Nov. 23, 2011 deadline. This shifts the focus to the sequester or triggering automatic cuts in Jan. 2013, as mandated in the Congressional deficit reduction deal of August 2, 2011. These automatic cuts would reduce defense spending by 10%, cut social programs without touching Medicaid and Social Security, by 7.8%, and reduce Medicare payments by 2%.

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The Obama administration's proposed budget for fiscal 2013- for the year beginning Oct. 1, 2012- shows the budget deficit for the year at over $1 trillion. It shows new revenue of $1.7 trillion over 10 years mostly from ending the Bush period tax cuts on families earning more than $250,000 a year, restoring the estate tax to the 2009 level and limiting subsidies for oil and gas companies. It proposes raising the tax rate on dividends from 15% to as much as 39.6%, for households earning more than $250,000 a year. This measure is expected to generate $206 billion over 10 years. The budget also offers "principles" for future tax reform by proposing the Buffett rule replace the Alternative Minimum Tax (AMT). The AMT was not indexed for inflation so it has the weakness of putting more middle class taxpayers into AMT, leading to temporary solutions by Congress. The Buffett rule would have people earning more than $1 million pay a tax rate of at least 30%. Many wealthy Americans like Mitt Romney paid lower taxes using deductions to lower tax rates- Romney's tax disclosures show he paid effective tax rate of 14%. The White House says the budget will reduce the deficit by $3 trillion over 10 years through the new taxes, and small changes to Medicare and Medicaid and other spending cuts. This is in addition to the $1 trillion in spending cuts agreed to in a deficit reduction agreement in 2011 between Democrats and Republicans in Congress. The budget proposal proposes investment in education and transportation projects of $137 billion, and continuing through Dec. 2012, a tax break for businesses to increase investment. It includes mandatory spending of $2.7 billion for new community college programs, $6 billion to modernize schools, and $1.8 billion to make homes more energy efficient. It also increases the resources of the Securities and Exchange Commission and the CFTC (two agencies overseeing the banks), $26 million for a new Interagency Trade Enforcement Center to counter unfair trade practices, and cuts U.S. postal delivery to 5 days a week. The result is a program designed to be balanced in terms of economic fairness, making modest investments in the future for education and energy, continuing policies to stimulate growth, and extending the date for bringing the deficit under control to 2018 instead of 2014 as planned earlier....

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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.