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How the French health care system works. France comes in first and the USA 37th in aWHO health care ranking. THe difference in deaths from respiratory disease is half that in the USA, and lower rates of death from heart disease and diabetes. IT has more hospital beds and doctors per capita than the USA. 65% of French people are satisfied with their health system compared to 40% in the USA, and yet France spends 10.7% of GDP on health care and the USA spends 16% for poorer results. THe French system is more generous to its seniors. Unlike Medicare there are no deductibles, just modest co-payments that are often dismissed for chronically ill. And diabetes and critical surgeries are covered 100%. French also buy supplemental insurance like Medigap for extra expenses like dental and eyglasses. Cancer patients are treated free of charge. Avastin treatments costing $48,000 a year are provided at no charge. France's PMI or Protection Maternelle et Infantile, is rated highly. It is anetwork of thousands of healthcare facilities, that ensure that every mother and child in the country receives basic preventive care. Mothers even receive afinancial incentive for attending their pre and post natal visits. France makes this care affordable by reibursing doctors at a much lower rate. The average yearly net income for doctors is around $55,000, about athird of what doctors in the USA make. But French doctors don't have to pay back huge student loans as medical school is paid for by the state and malpractice insurance premiums are only a tiny fraction of that in the USA. And again the French government pays two thirds of the social security tax for most French physicians- which is typically 40% of income. So the $55,000, is more like $92,000 taking that into account and more like $110,000 when student loans and malpractice is taken into account at US levels. Specialists who have 4 or more years experience can charge what they want, but as one gastroenterologist says, there in an unspoken and undefined limit to what you can cahrge or what is socially acceptable. Yet even in France there is inflation in health care costs that the government deals with through price controls and more spending. The French national insurance system is running increased deficits each year and this is now $13.5 billion, and it has led to higher taxes for employers and workers. ...

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U.S. healthcare spending of about $3 trillion comes with poor results. The cost per person is about three times that of countries such as France, Britain, yet the results show U.S. doing extremely poorly. The author points out that less spending on healthcare and more on social services in areas such as education, nutrition, housing and other services would improve the outcomes and results. It is this missing factor that is helping other countries in Europe, Japan and China achieve better outcomes and returns per dollar spent.  Social spending can affect such things as nutrition, exercize levels, lifestyles, housing and result in dramatic improvements in obesity levels for instance, or inflammation levels in the population that play a role in many diseases. The idea is prevention. This is not happening because higher health dollar spending has lobbies to support it. Social spending also is a dollar expense that shows up immediately whereas results are spread out into the future as a longer term benefit with healthier populations that need to consume less healthcare and treatment. Elizabeth Bradley, president of Vassar College is an expert on this subject. She says social services spending gives more bang for buck  in health outcomes.  The point is relevant also for countries in South Asia and Africa that have taken some on some aspects of the U.S. health system resulting in health care spending that does not deliver the most for the dollar spent, and ignores the critical role of prevention.  The solution lies in moving these health care dollars out of the health care spending and into education for health outcomes, lifestyles, exercize habits education, and into social services that enable prevention and better health. ...

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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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President Murmu addresses the first session at the new parliament building in New Delhi, India. In the tradition of British parliamentary democracy followed by India the opening speech of parliament is done by the president outlining the government's plans for the coming years. Murmu describes the achievements in providing basic infrastructure, water, cooking gas, rail and transport, food, healthcare to over 1 billion people in the last ten years, and controlling the cost of living. Making new investments in digital and other technologies, in infrastructure development to build an advanced economy under Vikshit Bharat by 2047, the 100th anniversary of independence from British rule. It also reflects women's empowerment and diversity in a democracy in Asia as Murmu was a schoolteacher in Orissa in the northeast and the Finance Minister Nirmala Sitharaman is a woman from the Chennai area in the south.

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Out of 50 economists in a WSJ Survey on inflation in the US, 28 economists say inflation will be higher under a president Trump. Only 8 economists say inflation will be higher under a president Biden. Trump's plan to crackdown on illegal immigration and to raise tariffs will put an upward pressure on prices say the economists in the WSJ Survey. This weeks inflation figure came out at 3%. Under president Biden inflation which reached 9% has come down to 3%, a remarkable achievement that the president alluded to in his press conference yesterday. This is a result of president Biden's cost of living actions on several fronts including housing, energy, retail prices, banking, pharmaceuticals, healthcare, childcare. Biden has made it his top priority. By raising tariffs across the board on imports Trump's actions would lead to higher prices.

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Wal-Mart's efforts to boost its smaller stores as customers go to competitors when they make midweek trips for small basket size fill-in supplies. Sales at Wal-Mart for the year ending Jan 31, 2014, show flat sales. By comparison sales at its smaller stores and neighborhood markets were up 5%. Online sales were up 30% to $10 billion and are growing rapidly. Wal-Mart's sales forecast for 2014 are for sales to increase modestly by 3%. It will incur additional $330 million in benefit costs for healthcare under the new law for workers signing up for its healthcare plan.

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The author of the study Youth in Germany Kilian Hampel says, German youth after the pandemic have increasing stress about soaring housing costs, inflation, war in Ukraine, and fears about old age poverty. This is similar to what is happening in the US. This will be a factor in the European elections. Though a lot is written about far right parties. Much of the work that remains is about ensuring fairness, and equity, tackling inflation and building housing. This needs greater investment than Germany is today undertaking. Much of the Greens and Socialist party plans to invest in the last federal election were stalled when they did not get a majority and had to depend on the FDP which is too conservative for making the investments needed in the economy. In the US Biden forged abipartisan effort and invested heavily in Republican areas in the south and west. A similar task is needed in Germany including investing in the East and in education, healthcare and building new infrastructure. Rail, road, airport and bridge infrastructure in Germany is dilapidated and only by investing in it can the economy gain strength to meet the aspirations of young people. ...

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Germany, the UK and Canada offer additional models for health care insurance that vastly improve results for dollar spent over the dysfunctional U.S. model. Here Jamie Daw take a look at the German social health insurance system which dates back to hte period of Bismarck in 1884. The German system is funded through progressive taxation which charges for healthcare based on incomes not on health needs.

About 100 nonprofit health insurers provide insurance and all Germans are required to have health insurance. Contributions to sickness funds are centrally pooled and allocated using a formula to insurers. Insurers can only charge small out of pocket fees limited to 2% of income annually. Sickness funds combine market power to negotiate lower prices.

Administrative and governance costs are 3% in Canadian system and 5% in the German system. 

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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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William Galston in WSJ points to the failure of governance as the cause of so much of the uncertainty and sense of unease felt by people in America, not decline in religion. He looks back and sees wars in the Middle East under Reagan, Bush, Obama and Trump that wasted resources while neglecting the rebuilding of infrastructure and investing in education and healthcare. Tech monopolies have not led to better educated citizens, and instead lowered the literacy required for a democracy to function well, leaving sites like Lyarac.com with the hard work of doing this. The 2009 financial crisis led to financial speculation by Banks and hurt the middle class. The shipping out of manufacturing destroyed hope for workers in America's factories. The pandemic caused about a million deaths.It is only now that America is coming out of it. Supply chain disruptions have led to higher cost of living. President Biden is taking action on each of these problems and the plan is bringing hope to the middle class, restoring America's manufacturing base, investing in infrastructure in a way that has not happened since the 1950's and 1960's, and investing in healthcare and education.  This not looking to religion is what would restore faith in the Nation and the democracy that America is, for the US and no less for the world, says Galston. Behind the cultural issues is a deep sense of ignoring the needs of the middle class and the workers in America's factories, and the people in lower income groups. It is now about restoring the spirit of the New Frontier of John F. Kennedy that was our misfortune to be cut short in 1963, about an America ready to meet the new challenges it faces from now on to 2050. ...

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  The hundreds of billions of dollars these American AI people talked about are needed to rebuild the nation's infrastructure, schools, water, housing, education, healthcare and other needs that directly raise living standards. DeepSeak is the AI model of Liang Wenfeng's $8 billion hedge fund Deep-Flyer. It does what Microsoft's OpenAI does at a tiny fraction of the cost. It proves that smaller competitors with less funding can tackle AI. This includes AI Mistral from France and AI startups from India and other countries.  Another immediate effect of DeepSeek as an open AI model is to provide serious competition for Nvidia and OpenAI and the big spenders such as Google, Meta Platforms that seek to dominate every niche in the IT world. It proves that the latest cutting edge chips such as Nvidia are not needed and that one can come up with other methods and software to do what others can do without the latest and most powerful chips that cost a lot lot more by huge magnitude. It is what happened in the Space Race to put satellites in space- the entities that can do it at less cost such as the Indian space program entities are the ones that dominate the field- cost matters. The hundreds of billions of dollars these American AI people talked about are needed to rebuild the nation's infrastructure, schools, water, housing, education, healthcare and other needs that directly raise living standards. ...

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Woman and better educated suburban people supported Nikki Haley. By contrast rural less educated went to the former president. What happens to these Haley supporters is important in 2024. Many are conservatives yet they are not finding a home in the new Republican party that has shifted from what it was before to look very different from before the 2009 financial crisis. The gradual disappearance of manufacturing in America as it was shipped overseas and the damage to communities built around it, the neglect of rural areas, the spiralling cost of healthcare, were already ripping apart the social fabric, only to be hit with the 2009 financial crisis from banking mismanagement and greed. The social and economic fabric which was next hit by the pandemic is only now recovering under president Biden. The Trump one term with all its good intentions failed to deliver on infrastructure and rebuilding manufacturing. The Biden work is a work in progress yet of a scale that America did in the 1950's to become the dominant nation after World War II through Truman, Ike and JFK. ...

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This report in WSJ looks at the Biden education, healthcare and climate change plan. It is part of the Families and Workers Plan put forward by president Biden for $3.6 trillion. This figure has now been lowered to $2 trillion and may drop crucial provisions for education such as the cost free community college which poses serious risks for working class families unable to afford community college, and skews education access even further to higher income families. It also lowers college attendance of American men, which is falling to alarming levels. The reason the plans are being whittled down is the 50-50 split between Democrats and Republicans in the Senate and the failure of Republicans and two Democrat senators Manchin of West Virginia, Sinema of Arizona to support community college access. Parts of the current bill support child care, access to affordable housing and in home care for elderly Americans. New elections for Senate and House of Representatives in 2022 would have to settle the issues related to financing assistance for families and workers as the Senate today is divided 50-50 between Democrats and Republicans. A separate Bipartisan Infrastructure package has the support of all in the US Congress to build bridges and roads, other infrastructure badly neglected by different administrations over the last 2 decades. ...

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Kamala Harris describes her vision of The Opportunity Economy in an address at Wake Tech Community College in Raleigh, North Carolina. Like president Biden she wants to build America's Middle Class. When the Middle Class does well everyone does well, Biden says this many times. By contrast she said Trump's plan would cost Americans $3900 a year raising cost of living. Kamala Harris said- "And key — key to creating this opportunity economy is building up our middle class.  It is essential.  (Applause.) The middle class is one of America’s greatest strengths, and to protect it, then, we must defend basic principles — such as, your salary should be enough to provide you and your family with a good quality of life. (Applause.) Such as, no child should have to grow up in poverty.  (Applause.) Such as, after years of hard work, you should be able to retire with dignity.  (Applause.) And you should be able to join a union if you choose. Building up the middle class will be a defining goal of my presidency, because I strongly believe when the middle class is strong, America is strong. " (Applause.) Harris described the vision of president Trump, as a complete contrast- "Now compare what Donald Trump plans to do.  He wants to impose what is, in effect, a national sales tax on everyday products and basic necessities that we import from other countries.       That will devastate Americans.  It will mean higher prices on just about every one of your daily needs: a Trump tax on gas, a Trump tax on food, a Trump tax on clothing, a Trump tax on over-the-counter medication.       And, you know, economists have done the math.  Donald Trump’s plan would cost a typical family $3,900 a year.  ...

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Kamala Harris laid out her economic plan for Cost of Living Action at a rally in Raleigh, North Carolina. This includes action to restrict price gouging, excessive prices of supermarkets for groceries. It includes restricting rent increases to 5%, a first time home buyer help with down payment of $25,000, and a child tax credit of $6000 per child.

Kamala Harris said:

"Your salary should be enough to provide you and your family with a good quality of life … such as, no child should have to grow up in poverty. Such as, after years of hard work, you should be able to retire with dignity, and you should be able to join a union if you choose.”

“Our supply chains have now improved, and prices are still too high,” Harris said. “Many of the big food companies are seeing their highest profits in two decades. And while many grocery chains pass along these savings, others still aren’t."

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What has to give in government oversight and reshaping the debt and costs at General Motors? The auto workers and retirees inspite of all the givebacks still pay only 5% of theirhealthcare costs vs an average of 30% for the rest of Americans with healthcare coverage. With a sharing that reflects the national average GM wouldn't have to shoulder the size of the health care obligations for union workers and retirees of the sum of $47 billion. And the debt holders of GM debt, the bondholders would take a cut of something approaching Senator Corker's proposal to trade debt for equity at a 70% discount. That would reduce the GM debt from $63 billion to less than half that.

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With unemployment at 27% millions of Greeks and the elderly like Nikos Solomos, 60, cannot afford premiums and have joined the ranks of the uninsured. Greece's budget cuts have hit the health care sector hard because of mismanagement and corruption with prescription drugs costing about three times the cost in other EU countries. Cuts in heathcare are over 25% since 2009 and more cuts planned. Anthony Faiola with contribution from Elinda Labropoulou provides an exceptional account of the state of health care through the stories of ordinary Greeks like Nikos Solomos with intestinal cancer and the shortage of staff, equipment and supplies at Metropolitan Community Center in South Athens and Gennimatas General Hospital. Problems now include a resurgence of tuberculosis. Some of this pain is being felt in other EU countries with sharp cuts in public health spending, including Spain and Ireland.

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The failure of the 117th Congress to pass key parts of president Biden's agenda for hard hit families and workers in America is now taking place. The 50-50 standoff in the US Senate and failure of two Democrat senators Sinema of Arizona, Manchin of West Virgina to support Biden's Families and Workers Plan leaves key parts of the safety net being left out. This leaves out the education, and paid leave part of the agenda and provisions for utilities to accelerate shift away from coal out of the bill. It fails to implement a new national agenda for upward mobility, child care and paid leave to help stressed out mothers and families. The failure to include even a modest community college 2 years of support at a time when men's college enrollment is dropping to disastrous levels for America's economic competitiveness is a failure of the 117th Congress to grasp the needs of families and workers in America today. Only a new Congress in 2022 can take up the needed action for families and workers in education, health care, child care and help for families. The passage of the infrastructure bill and the current version of the social spending bill can only be seen as a first step in the right direction, after three decades of different administrations neglecting infrastructure, education, healthcare, childcare, elderly care, upward mobility, and climate change. On the plus side as the first step to restore dignity and health of families and workers in America it includes- $150 billion for rental assistance, home buying help, public housing repairs, and building 1 million affordable housing units. $150 billion for federal programs for home health care and community care for older Americans and people with disabilities $165 billion to reduce premiums for people under Affordable Health Care Act, cover additional 4 million through Medicaid, adding hearing coverage but not dental or vision to Medicare. $200 billion for child care tax credit to parents. $400 billion to reduce health care costs and give universal pre-kindergarden for 3-4 year old children. $40 billion for worker training $555 billion for fighting climate change including through tax incentives for sources of energy that are low emission and low carbon. It will be paid for by additional taxes on incomes of very high income earners in annual $1 million plus range, and by having a corporate minimum tax of 15% for large corporations, including on profits overseas, that previously did not pay this tax. A wealth tax on unrealized capital gains of billionaires or other wealth of the richest Americans is left for a future Congress to consider for financing the key parts of climate change provisions, education and health care that were left out. The education and healthcare provisions need to be expanded to restore America's historic mission of upward mobility for all. A provision for Medicare to comprehensively negotiate prices with pharmaceutical companies that would be taken for granted in any advanced country as in Europe, is also left for a future Congress that understands and responds to the dire needs of families and workers in America for affordable healthcare medicine neglected by administration after administration for the last three decades.   ...

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The point at which pensions begin and retirement begins is thought of normally as 65 years. This is changing. Experts on ageing at Britain's ONS, Office of National Statistics say 70 years is replacing 65 years as the age at which people can work and contribute to society, working later in their careers and doing voluntary work. This would help ease pressure on pension system financing and cost of social service to elders. Because of rising longevity and improvements in healthcare, diet and lifestyles people age 70 had characteristics of people age 65 in 1997, say ONS experts. ONS looks at a new way to measure ageing. Do not use chronological years from birth, work backwards from remaining life expectancy and operate on the basis of 15 years as the marker for old age. Under this method start of old age is 70 for men and 72 for women. As people over 65 years is approaching a fourth of the population this fresh thinking gives more room for pension system sustainability, and helping engage people at work for longer more productive lives. Both for the economy and personally for the individual. ...

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Compare the presidential election spending in France and US one sees a huge, really huge difference. In France by law the first round it is limited to 16 million euros and second round to 22 million euros. Companies cannot donate and maximum donation is euros 4600 per year. All candidates must be given equal time by networks after official campaigns start usually March 28. If you get 5% of the presidential vote you get about 48% of the $22 million ceiling and if not only about 5%. Its a fairer system considering about $5 billion will be spent in US presidential election 2024. It keeps out lobbyists and donors looking for silent favors as the pharma industry and the tech industry in the US that has prevented any legislation on fair drug pricing or oversight of the monopolies of Apple, Google, Microsoft, Amazon, Meta and others, taxation of profits of tech and fossil fuel companies, or passage of healthcare for all. Indian elections cost of 1.35 lakh crores or $13 billion in 2024 are also similar to the US with parties spending leading to much corruption in the democratic process and defeating its best character.  ...

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One perspective of what Silicon Valley is focused on is shown by Reid Hoffman. It does not mention climate change, not one word on climate change, no words on cost of living action, little is said about factories and jobs for reviving American manufacturing, helping workers and families and redesigning the world's supply chains. It is critical of addressing monopolies and regulatory action by the FTC even where it is needed. It calls for huge investments in AI that would leave little for investments in science, education, healthcare and infrastructure, and says "trust us to do the right thing." It calls for pro-innovation direction when pro-innovation has been the thrust of policy for three decades with the results that we have seen leading to widening gas between the upper and lower classes and shrinking of the middle, a pharma industry out of control in pricing, and negligible investments in education by so called "tech" companies who like Apple have outsourced manufacturing to China. A return to tech and Silicon Valley is not needed as embedding it in the nation's policy making priorities is the Nation's problem. ...

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African continent debt reached $1.1 trillion in 2024. About 900 million people live in African countries where interest payments on debt exceed money spent on healthcare and education. In Nigeria external debt is $40 billion, in Kenya $35 billion and Uganda $12 billion.  Take Nigeria with 220 million people. 40% of the revenue collected goes to meet interest payments on debt. For many African countries there is zero per capita income growth for a decade. During the 2010 crisis as interest rates reached new lows US and European Reagan era intellectuals including Democrats encouraged African countries to borrow at low rates and banks loosened restrictions putting more African countries into debt buildup borrowings. As interest rates went up the cost of paying the debt accumulated required more loans at higher interest rates. Nigeria paid a premium over that of 10% for a loan of $2 billion just for interest payments. The debt crisis means African currencies depreciate reducing purchasing power.  With war in Ukraine and Covid prices of food and energy rose. Only the strong and disciplined leadership and rapid industrialization provided breathing room as with Modi in India, Jinping in China, the African continent and Latin America lacked this and are feeling the pain. ...

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It is no surprise what we see in the US today- the loss of the middle class, the unaffordability crisis for education, healthcare, childcare, and poor, broken infrastructure. Over 10 years the US trade deficit with China has led to loss of about 25 million jobs and $250 billion in taxes that support local infrastructure and public services. Where 20% of the people do 80% of the spending, 80% of the people only 20% of spending (Moody's Analytics). This is how the uneven trade led to the destruction of manufacturing centers and communities across the 51 states in America, devastating families and young people. This is no longer Washington's, Lincon's or FDR's land of opportunity. Each $1 billion in additional imports to the US costs 4252 jobs. (CPA) This can be read as how many jobs are being lost in the additional trade of goods when one side is exporting more than the other.  There are three levels of losses. There is also an indirect job loss in the number of jobs created by that one job in manufacturing to serve the needs of these factory families in communities. This can be estimated at 1 job that depends on 1 manufacturing job. Together this means 8500 jobs lost for every $1 billion of goods in a trade deficit. US trade deficit of $295 billion in 2024 with China translates into about 2.5 million jobs lost every year. Over 10 years this is about 20-25 million jobs, enough to decimate America's entire manufacturing capabilities and manufacturing infrastructure, whole communities and towns disappearing or suffering destruction across the country.  With the loss of these jobs comes a third cost, the taxes paid that maintain small town infrastructure and public services like libraries, schools and health centers where these factories are located. At $10,000 in taxes lost per job, for 8500 jobs lost per $1 billion in uneven trade there is a loss of $85 million.  For the $295 billion deficit the US has with China this loss adds up to $25 billion per year. Over 10 years this means taking out this much in local infrastructure and public services like libraries, schools and health centers worth $250 billion.  ...

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The tough job President Obama faces as he faces opposition from politicians who have interests to protect, and healthcare businesses with interests to protect. The President has to come up with a plan that is deficit neutral, because financial markets could see a healthcare bill that further widens the deficit as a signal for higher interest rates that would deepen the recession. At the same time each of the three sources of revenue puts him at loggerheads with political leaders in Congress or groups with interests to protect. Limiting income tax deductions for high earners could raise $267 billion in 10 years. It would require taxpayers in the top tax brackets deduct their mortgage interest, state and local taxes, and charitable donations, at the 28% tax rate instead of the 33% and 35% tax rates. The opposition is with democratic leaders that it would hurt charities, universities that depend on tax deductible donations, and taxpayers in high tax cities like New York city that are the home base of Democratic leaders. Yet only 1.4% of households would be affected says the nonpartisan Tax Policy Center. The Center on Philanthropy at Indiana University, says charitable giving would decrease by 2%. The other opposition on this comes from the preference of Senators Baucus and Grassley, who head the Senate Finance Committee, for tax increases or cost savings to come from the health sector. Specifically they want to see the value of workers' employer provided health benefits subject to income taxes. It is a situation in which every sensible person admits the need for healthcare reform and would see the current pace of healthcare costs as unsustainable and dangerous; and after that will just go back to his group and try to preserve as much of the status quo as possible, so as not to disturb by much the benefits or compensation they have secured from the system over the years. Then there are political leaders in Congress with their own preferences, and Congressmen who are the subject of heavy lobbying by these interests. The administration and the Presidents job is to navigate this stream with a workable deficit neutral plan, without any requirement for any group to make sacrifices, and in some situations even small sacrifices for the public interest. Would charitable institutions be hurt that much, what if charitable institutions were exempted, why would other interests the try to obtain the same exemption. Its like the unions trying to keep the old unsustainable goldplated healthcare and other benefits at GM even as the ship was going down. Taxing employer provided employee health benefits as income would raise $2.5 trillion over a decade. The opposition here is from unions which are a force in the Democratic party and which count tax free health benefits as a legacy of the labor movement. Employer provided health insurance covers 160 million American employed and their dependents under the age of 65, so it has a wide impact. Yet most economists favor ending the tax break. They say it mainly goes to upper income taxpayers, and discourages cost consciousness among consumers of health care, thus encouraging excessive spending and surging health care costs. Senior Obama advisors, Peter Orszag, the budget director, and economist Jason Furman favor this approach. So do Republicans in Congress. Senators Baucus and Grassley are not asking for the complete removal of the tax break, what they want to see is capping the value of benefits that go untaxed. If the tax-free limit is $13,000, a policy worth $15,000 would pay income taxes on $2000. A third spource is to spend less on Medicare. About two thirds of the $948 billion in savings Mr Obama has proposed over 10 years comes from a number of reductions in Medicare spending. $177 billion comes from insurance companies bidding for government reimbursements for offering private plans to seniors. $106 billion comes from cutting the subsidies to hospitals serving the uninsured as universal coverage should remove this need. And $110 billion in reduced payments to hospitals and doctors because of productivity gains. A range of industries insurance companies, hospitals, doctors drugmakers, nursing homes, home health care companies and medical device makers, all stand to lose from reduced payments from Medicare and Medicaid. And these groups with interests to protect are another factor in this process of working out a healthcare plan. ...