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

LyrArc Article Gist
In just 7 months the Trump administration has a falling apart with business leaders and union leaders on the days following the Charlottesville car attack. Here Richard Trumka gives his reasons in the NYT for withdrawing from the president's Manufacturing Council. He says Trump presented big idea such as infrastructure and fair trade deals but he is not likely to live up to his promises. Only tweaks are expected on NAFTA says Trumka, and labor rights are taking a hit under president Trump. The AFL-CIO was not called to a single meeting by president Trump, says Trumka. He now sees the Trump administration in the same way as other political leaders- filled with broken promises. In the case of the Trump administration he sees working families ending up much worse off. Trumka says a University of Pennsylvania study shows even if a plan for infrastructure comes up the president's budget proposal would sink it- leading to a net loss of $55 billion for highway, water facilities and public transit. Trumka points out the damage to the social safety net as a matter of serious concern- cutting $1.5 trillion from Medicaid, $59 billion from Medicare, $64 billion from Social Security over 10 years. With cuts to construction workers wages, and a 6% cut for government workers. He calls as "morally bankrupt" and bad economic actions the effort for large scale deportation.  He calls the events in Charlottesville and the president's condoning of the violence in Charlottesville by blaming both sides, the last straw for his union. Separately business leaders resigned from two advisory groups. Chase CEO Dimon pointed out that for economic progress the basic consensus in the country must be preserved, and divisive rhetoric can lead to the unraveling of economic progress- the vital link between society, politics and the economy in line with America's ideals being evident to the business community, as well as to labor. ...

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

LyrArc Article Gist
The Republican House health care bill AHCA  keeps some some of the more popular parts of the Affordable Care Act such as not taking pre-existing conditions to deny insurance, keeping children covered on parents insurance till age 26, and increase contributions to Health Savings accounts. It is different in that the expansion of Medicaid at 138% of poverty rate threshold is rolled back. Age is used for tax credits instead of income, hitting those approaching Medicare age harder. The maximum charged to older people is now set at  5 times compared to 3 times what young have to pay. In general the Republican bill is seen as targeting the elderly to keep premiums down. The elderly on low incomes are hit hardest. Fox News O'Reilly Show showed the host questioning House Republicans, citing the CBO estimates that elderly on low incomes may have to pay as much as $14,000 a year for insurance making it basically unaffordable, and 52 million Americans would be affected adversely. Large companies are no longer required to offer mandatory health insurance under the new bill. Conservatives from Freedom Caucus wanted to see the essential areas of benefits covered by the law limited to fewer than the ten areas in the Affordable Care Act. The ACHA Republican bill leaves to states to determine what are required essential benefits. At one point maternity benefits were to be dropped but this was changed to let states decide. As a result the bill is 33 votes short of the number needed for passing the house in March 2017.   Neither the Democrats Affordable Care Act or the Republican House bill of Speaker Ryan do much to tackle the real problem- the absolute amount and increases for health care dollars for treating each disease in the U.S. compared to European and other countries. As a result health care has become more of a partisan struggle between the two parties than a real effort by all to overcome the problems that have to be tackled. Republicans want to see premiums drop and keep the burden on the deficit down- but with the level of U.S. health care costs disproportionately high compared to Europe and the rest of the world the arithmetic is tough and ends up leaving out vulnerable groups such as the elderly on low incomes, thus making the whole proposition prone to fail. For the same reason the Democrats failed to keep premiums down with a wider safety net leading to calls for repeal of their version.   ...

LyrArc Article Gist
Dionne cites comments by Bowles and Simpson saying the Paul Ryan U.S. budget proposal falls short of a serious bipartisan effort for deficit reduction for a number of reasons. The reasons cited by Bowles and Simpson are: The proposal exempts defense spending from reductions, does not apply savings from tax expenditures to deficit reduction, relies on much larger reductions in domestic discretionary spending than the Bowles-Simpson deficit reduction plan, and at the same time making reductions in safety-net programs that could in their words "place a disproportionately adverse effect on certain disadvantaged populations." This should give moderates in this debate time for pause and reflection says Dionne.

LyrArc Article Gist
Pearlstein quotes Dickens in "Oliver Twist," about the law being an ass, and the constitutional law exercize in the Supreme Court of the U.S. giving a sense of a failure of the so-called best and brightest in reasoning out the issues. He points out that a serious problem is that American business which is burdened with high health care costs for employees is seriously missing in this debate after years of complaining about high costs. The National Federation of Independent Businesses is actually one of the plaintiffs questioning the constitutionality of the Obama health care law. Pearlstein says business wanted an end to the fee-for-service medicine that increases consumption of medical services and pushes up cost relentlessly, and that Obama's health care law does this. This is not the case as both Democrats and Republican administrations have failed to resolve this side of the cost issue, and this is the hidden reason for the loss of credibility for both sides in this debate, leaving health care problems to be resolved in future administrations. ...

LyrArc Article Gist
Tyler Cowen, Professor of Economics at George Mason University, points out some basic truths about health care as it is practiced today in the USA, and healthcare spending as it stands today. He questions whether starting out with extra spending plans to provide coverage to all will help solve the basic problems facing American health care. Too many tests and diagnostic procedures used by doctors is not aproblem that will be solved by spending more money to cover everyone. And government taking on more spending to cover all will not address all the other major shortcomings of the American way of practicing medicine, like prescribing a battery of tests, that tend to drive up costs, to just mention one of the problems. And it will not address any of the shortcomings in the way Americans take care of their health, diet, exercize and healthy lifestyles. THese are critical to get good health outcomes for the people, and which combined with careful spending of dollars where it will provide the greatest benefit, is the only way the health care solutions can be found....

LyrArc Article Gist
The Congressional Budget Office's Elmendorf says without spending cuts in payments to doctors and hospitals and other providers, providing coverage to the unisured will put the nation deeper into debt. Popular measures such as increasing preventative care, expanding medical records and rewarding doctors for choosing treatments that improve cost and quality have potential but its not proven how much the savings from this would be. The administration and the White House Budget Director, Peter Orszag, say they are in agreement with the CBO that something needs to be done to seriously reduce costs, reducing payments for Medicare and Medicaid to doctors and hospitals, and making other changes.

LyrArc Article Gist
Medical device makers for heart like the stent and hip like replacement hips have margins of over 70%. THese and other medical devices may come under pressure from the changes that are anticipatd in the way Medicare reimburses hospitals for these devices, which are largely used by older patients under Medicare coverage. Stocks of these device makers like Boston Scientific, Stryker, and Zimmer, have fallen in recent weeeks

LyrArc Article Gist
Doctors face a 21% cut in the amount of Medicare payments for treating seniors having Medicare, though this cut will be delayed till 2011 under legislation in Congress. This issue goes back to 1997, when a budget law set spending targets, and stated that if they were exceeded formulas to reduce doctors payments would go into effect. The formulas seriously cut into doctor payments by Medicare in 2002, so the formula was put off. The result of this is that the cuts based on the formula now amount to 21%. The cuts are not expected to go through, but at the same time Congress has an headache on its hands with the growing deficit. In the Senate there is opposition to a $120 billion bill to extend long term unemployment benefits which lapsed in June 2010, for tax breaks, and other expenses. Senators want to pare down the bill's price tag, as $80 billon of this is unfunded and will be added to the budget deficit. For a primary care doctor in Washington state, Medicare pays about $95 compared to private insurers payment of $129, and a plan for state workers that pays $140....

LyrArc Article Gist
Alan Meltzer would like to see the Fed reverse its quantitative easing, and lower excess reserves gradually starting now. By this he hopes to see the Fed avoid the mistake of making a big shift from excessive ease to severe contraction further down the road. He also warns agains excessive deficit spending. He says a weak economy is not the time to cut spending or raise taxes, and he is not talking of draconian immediate steps. He would like to see a multiyear program to increase fiscal probity and reduce deficits size and frequency. As it stands now he takes both parties to task for lack of fiscal discipline and honest accounting. About $1 trillion in deficits each year on average for next 10 years is in the works, and is an underestimate because the savings of $200-$300 billion in medicare spending have still to be realized, and states do not have funds for increased Medicaid spending, and payments to doctors have still to go down by 25%. Chinese government purchases of half our debt will postpone the day of reckoning says Meltzer, but far better for us to strike at the problem now, before we blow a hole in the dollar and start a downturn. See the separate report on the shrinking UK economy....

LyrArc Article Gist
Romney picks seven term Wisconsin Congressman Paul Ryan as his running mate for the 2012 U.S. presidential election. It is a daring pick because Ryan has clear ideas about reducing the U.S. deficit which are in sharp contrast to the approach taken by Obama and Biden, offering American voters a clear choice. This is similiar to the contrasting choices between Reagan-Bush and Carter-Mondale during a period of high unemployment and inflation in the 1980 presidential election. The contrast was also made clear by the release of the Shultz memo to President Reagan and the comparisons with the Reagan election by Romney economic advisor Glenn Hubbard, both recently published in WSJ.

LyrArc Article Gist
The first budget of the Obama government makes a sharp swing away from decades of earlier policy, and puts America on a new direction focussed on priorities in education, health care for all, and energy. The 134 page doocument on the budget defines the governing principles and priorities of the new government. "This is the legacy that we inherit- a legacy of mismanagement and misplaced priorities, of missed opportunities and of deep, strutural problems ignored for too long," the document says. It declares that "government must lead" in contrast to Reagan's "government is not the solution, government is the problem." In contrast to "trickle down" policies of Reagan it proposes "trickle up" policies- shifting income from rich to the poor. It creates a $630 billion fund towards a national health insurance program built with the help of savings and cuts elsewhere. Government takes over most student lending, and dramatically expands Pell grants for poor college bound strudents, transforming it into something like Medicare that is automatic rather than approved each year by Congress. Businesses that emit carbon and heat trapping gases will have to purchase permits to do so starting in 2012. Hundreds of billions of dollars from these permits will pay for clean-energy technology and for tax credits for working couples. Income tax rates will rise for couples earning more than $250,000 beginning in 2011 and will have lower personal exemptions, lower itemized deductions, and higher capital gains tax rates. The estate tax will be preserved. Hedge fund and private equity managers wil have to pay income tax rates for that compensation as high as 39.6% after 2010, not the low 15% capital gains rate they pay now. The Defense Department would see a $20.4 billion boost or a 4% increase in 2010 over 2009, it will request an additional $75.5 billion in 2009 for the wars in Iraq and Afghanistan, and an additional $130 billion for 2010. The budget is for $3.6 trillion for 2009, and projects a deficit of $1.75 trillion for 2009, or 12.3% of GDP- a level see in 1942 when the US entered World War II. Under optimistic White House assumptions for a strong economic rebound, the deficit would drop to $533 billion by 2013....

LyrArc Article Gist
A plan to postpone a 21% cut in payments to doctors for treating Medicare patients, and instead give a slight payment increase under a House proposal, at a total cost of $245 billion over 10 years, is raising questions about the the impact on the USA budget deficit in coming years. The Congressional Budget Ofice says the House health bill will increase the deficit by $239 billion by 2019. In past years the lawmakers in Congress have postponed the implementation of these cuts, and the administration would like to see this as a separate item and not showing increasing the deficit. The American Medical Association lobbied to have this provision in exchange for its support to the health care plan.

LyrArc Article Gist
"Progressive" is a misused word, people are just interested in the words "decent," "fairness," and "Christian" from the color of the heart.  It is just how Republicans see the contest for the US Senate  that reveals their sense of priorities for the Nation.The main concerns of Republicans, old traditional Republicans shown here in this WSJ Editorial are that somehow gains on the US Supreme Court could be reversed with retirement of Alito and Thomas in their seventies, and fears of the same policies that set up Medicare and Social Security- following the changes of the Industrial Revolution and dismal factory conditions and wages at the turn of the century- under Republican Teddy Roosevelt  (the incipient changes), Woodrow Wilson an academic from Princeton, and Franklin Roosevelt. A new version of old Tory politics still exists in the US. It is these industrial conditions rewritten with work safety laws, workmen's compensation, first 54 in 1918 after the Triangle Factory Fire,  then 40 hour week, unemployment insurance, worker union rights for fair negotiations on wages, that made the US a strong manufacturing nation and Industrial power, creating the synergies for worker contributions combining with technologies, managerial skills for a decent standard of living that surpassed all other nations. It is this achievement that was put at risk in the 21st century by shipping factories overseas and thoughtlessly sending the technologies with it, which happened under a series of administrations since the 1980's Reagan, Bush, Clinton, Bush Jr., Obama and Trump. Done thoughtlessly and recklessly. And the wars that started with president Reagan in Iraq/Iran/Afghanistan that diverted the two trillion dollars that would have rebuilt America's aging infrastructure. Biden was the first president to have a clear focus on the changes needed to rebuild infrastructure and manufacturing, technologies and science, and rural America, in a concerted push that has made gains that surpass any that exist in Europe or China. Restoring the US economy to No. 1. Harris in her own way offers the pieces of the puzzle to reverse the pandemic induced cost of living increases that complement the work of president Biden in 2024, continuing the work of rebuilding infrastructure and manufacturing for leadership in the world.     ...

LyrArc Article Gist
An account of the meetings between Speaker Boehner and president Obama in the fiscal cliff negotiations. The WSJ pieced together the flow of the negotiations based on interviews with aides and lawmakers. There is little to show the two sides closer than before the election. If anything the WSJ report concludes the discussions this time left both sides further apart, and the lack of trust in the relations between Republicans and president Obama has worsened. Speaker Boehner asks Obama at one meeting what he gets in return for offering $800 billion in revenues and Obama tells him he gets nothing. At another meeting Obama tells Boehner he is asking Obama to accept Mitt Romney's tax plan and sees no reason to do that. Obama's first offer is for $1.6 trillon in new revenue over 10 years, a permanent increase in the debt ceiling and $400 billion in spending cuts. The Republicans find 25 cents of spending cuts for every dollar in tax increases as simply unacceptable and hold out for $1 in cuts for $1 in new tax revenues. Obama drops down to $1.2 trillion in new revenues and Boehner asks for $100 billion in additional spending cuts. Boehner drops a demand for raising the Medicare eligibility age. Obama raises the tax figure for the Bush tax increases to incomes over $400,000, Boehner proposes $1 million. But no level of trust has been gained in the negotiations. And no rapport established, as at one point Boehner tells Obama the two can just stare at each other or he Boehner could come back. Boehner then proposes to pass Plan B in the House for Bush tax cuts on incomes over $1 million. At that point the president feels the Republicans are not negotiating in good faith and some Republican Congressman in the House say they would not support Plan B. The distrust on all sides is worse than before. In the weeks leading to this in Dec. 2012 a review of oped pages show Democrats and Republicans saying a bad agreement- meaning too much in spending cuts for Democrats and too much in tax increases for Republicans- was worse than the fiscal cliff of automatic cuts, which could be addressed in other ways....

LyrArc Article Gist
The discussion on whether it is feasible to achieve any significant cost savings as long as middle class consumers are not cost conscious about their employer provided health insurance. This would be so as long as their health insurance benefits are not taxed as income. America suffers from a particularly strong case of not minding the price increases imposed by the health care industry as long as its not out of pocket cost. But Obama seems stuck on his insistence that the middle class not take on any burden, that there be no middle class tax in the form of this tax on health care benefits. Critics say even FDR did this by having the middle class pay with payroll contributions for Medicare and Social Security. And even if the 5% of Americans who make more than $280,000 are taxed it will not generate by itself the money to pay for the $1 trillion cost of the plan, as the prospects of cost reduction are uncertain- especially when the basic nature of America's health care system are not changed, like the lack of cost consciousness of consumers of health care when its perceived to be free and employer provided....

LyrArc Article Gist
Providing health insurance to the roughly 50 million people that are uninsured costs some $120 billion ayear. This will hae to be paid for through limiting the tax deduction on employer provided health insurance (something Obama campaigned against), or cost reduction in the bloated cost structure for health care in the country. But the same health care providers who committed to cost reduction in arecent conference at the White House are lobbying against some measures that reduce cost.