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Increasingly hospitals in the U.S. are buying independent medical practices of physicians and writing the contracts in their favor. This is part of a general consolidation of health care services in the U.S. In 2012 about 39% of physicians are in independent medical practices compared to 50% in 2000, according to consulting firm Accenture.

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Under new lending facilities the U.S. Federal Reserve will buy $500 billion of short term debt of U.S. states, counties with more than 2 million residents and cities with more than 1 million residents. This is intended to ease funding strains for cities, counties and states in the U.S. that are seeing large revenue drops and rising expenses from simultaneous economic and health crises. Two other changes from the Fed. New classes of debt are included under the Term Asset Backed Securities Lending Facility or TALF. The Fed will now accept triple A rated tranches of existing commercial mortgage backed securities, and newly issued collateralized loan obligations. $100 billion is available under that program. To help business with less than 10,000 employees or revenues of less than $2.5 billion loans will be made through the Main Street Lending Program. This will initially fund up to $600 billion in loans, with restrictions on stock buybacks, dividends, and executive compensation. The emphasis is on helping businesses that were doing well before the crisis hit. Some that were carrying A ratings and were investment grade but downgraded to B after the health pandemic hit are considered "fallen angels." The Fed will also support new debt issuance by these firms in its corporate program.   ...

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Reinhart is saying something similiar to what Krugman said earlier, and Peter Eavis said in the Heard on the Street column on March 24, 2009. The Geithner plan is similiar to the Paulson plan. It is trying to get private investors to buy up toxic assets by offering incentives. But the pricing issue like before is left vague and unanswered. And its success looks increasingly doubtful as the is not only the problem of confidence and illiquidity that these plans are confronting, but something more structural and basic about how much these toxic assets are worh and whether it makes sense to bid for them and at what price so that ooooooone is protected on the downside. Reinhart points out that the stress tests are also there, and it may just be that the government is waiting for public support to build for taking on the losses involved in getting rid of toxic assets, and is right now going the longer circuitous route. At some point the government may decide the time is right to sort out the banking institutions finances through the stress tests, make the tough decisions for banks that are not healthy by government takeover, and deal with the toxic assets as owner of these failed banks....

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John Cochrane, professor at the Booth School of Business, University of Chicago points to the simple truths about U.S. healthcare- out of control pricing because of the pathologies created by previous laws and regulations. He points out that costs are high in healthcare because regulations keep them high. Supply of new doctors is controlled because Congress and the AMA made it that way with a cap on residency programs and AMA opposing the expansion of medical schools. In a system of open competition new hospitals and health care businesses would challenge old ones which is not happening in a regulated market with regulations working to limit competition for the firms already in the business and with the influence to limit competition. Insurance costs for major expenses in an open and deregulated competitive market without the regulations would be so much lower than todays costs that its likely we would not even need a mandate such as the one the Obama healthcare law imposes.

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Emmanuel Macron graduated from Sciences Po University in 2004 with a degree in public affairs. He joins the Finance Ministry as an inspector and then buys himself out of government service contract by 2008 to join a private bank. He arranges an acquisition from Nestle and other business deals during this period. In 2012 he is appointed as deputy secretary general for the president's office after Francois Hollande a socialist is elected to the presidency. In 2014 he is offered the position of Minister of Industry and Digital Affairs in the second Manuel Valls government. He makes some changes to French government but opposes the wealth tax or tax on business, and is generally pro-business, though he acts as a member of the Socialist party.  He uses this period to build momentum for his own run for the presidency as support for Hollande falters having lost support from his working class base with Macron and Valls inspired changes.  Macron finally announces he will run for the presidency forming his own En Marche movement which he finances with his own fund raising. Throughout this period right up to the election in 2017 Macron has not run for public office. When he wins the presidency in that year he lacks the experience needed as the youngest president in French history at the age of 39. Like another young president Obama he handles his public image with the media for his En Marche movement promising to unblock France. This public image and his lack of experience makes him impervious to the social changes going on in France that lead to the yellow vest protests in 2018. This is a period when there are changes in the midwest as workers in Michigan and other midwestern states turn away from Hillary Clinton and Obama.  French workers are in the position of workers in the US with the decline of manufacturing, much of it shifted with the supply chain to China and Japan, and the gap opening between rural and urban tech educated areas. Macron follows Obama's quick rise from Senator to run for president yet lacks experience, and lacks sufficient grasp of the social changes with loss of manufacturing, the wide gaps between rural and urban tech educated people, conditions in the rural and farming areas. Macron survives this period, is reelected in 2022 with the help of socialist Melenchon voters. He says he will govern differently, less distant from average Frenchmen, but his instincts are to push for pension reform. At a time of cost of living crisis, and when the French budget office says the change in pension from 62 to 64 was not critical at the present time when inflation was hitting the public after the pandemic. Macron does this by Article 49 in the way he has done under the Manuel Valls government, by executive action alone. This time he faces a no confidence motion in parliament in March 2023 following some of the largest protests France has seen in years, with two thirds of the French according to FR24 opposing the change in pension law. Women see this as coming at a time when age discrimination hurts their chances of earning a living after 50 years of age.  Age discrimination is widespread in France, in a way it is not in Germany, say reports in the NYT. And with the cost of living crisis acts as a major hurdle for the average French person, if pensions are delayed without addressing these cultural issues in France. The result is that the protests have substance and Macron is seen as not sensitive to this at a time when he lacks a majority in parliament. ...

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The WHO, World Health Organization, comes under criticism for failing to warn about the pandemic. President Trump says the U.S. finances the WHO with $450 million but the WHO has opposed some of the basic common sense approaches to the virus such as early quarantines and suspension of flights from virus hotspots. Including opposing the U.S. action taken by president Trump on January 27, 2020 to close all passenger flights between U.S. and China. A 14 day quarantine was put into effect for Hubei province. About 8.5 million passengers visited the U.S. from China in 2018 according to the U.S.Transportation Department. Reports show Chinese cities deserted on NYT January 30, but infections only 1300 a week earlier going up to 12,000 and only 259 deaths. President Trump says the world was misled by the WHO on the extent of the crisis developing in China, as he sets up a review of the WHO's role in the crisis and on funding by the U.S. President Trump says the crisis in the U.S. would be much larger if some of the 8.5 million passengers from China arrived in U.S. cities. He also says the decision was his own intuition about what was happening with health experts not realizing the extent of the crisis as there was very little data on the crisis. Most of the experts Mr. Fauci and Dr Birx were also not aware at the time of the gravity of the crisis, and some leading epidemiologists at American universities even called it an emotional reaction. ...

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Mexican president Nieto's poll numbers are at all time low of 24%, according to Reforma newspaper. He took office in late 2012 and has been hurt by human rights scandal of the murder of 43 students in the state of Guerrero, corruption issues, and failure to improve the economy. The invitation to Trump to visit Mexico left even people close to the president surprised, and was criticized widely inside Mexico. It is not clear what Trump or Nieto gained from the trip. As Trump continued his talk about building a wall on the Mexican border and having Mexico pay for the estimated $23 billion it would cost. He did this in a speech to supporters in Pheonix on the same day he met Nieto, showing the use of teleprompters and prepared script was not his way of campaigning. Just as the message to black people that Democrats take them for granted cannot resonate without the basic message delivered with compassion and understanding- such as done by the presidents Bush and Reagan- so also the message to Hispanic people is suffering from the same lack of empathy. Recent polls show only 3% of blacks support Trump. McCain and Romney gained only 4-6% in the U.S. presidential elections of 2008 and 2012. The message of the wall is also baffling as an election strategy. A Gallup poll in July 2016 shows only 15% of Americans opposing a pathway to citizenship for illegal immigrants, and only 24% of Republicans. There is another problem in the strategy. The rhetoric about walls and mass deportations, and the Trump temperament combined with handling of nuclear weapons is not winning college educated women in the suburbs with polls showing Trump lagging behind Clinton by about 20 points or 4 million voters with this group. It is hard to undo the damage done by this kind of rhetoric used in the primary elections as it gains distrust of voters. It would require a bad economy with illegal immigrants taking local jobs, and handling of immigration seen as weak, for such a message to gain some national traction. Both are absent for the most part with a steadily improving economy since 2012, lower unemployment, a tough enforcement policy on deportatons under Obama that exceeded that under Geoge W. Bush, and the talk of a wall comes with illegal immigration having declined steeply since the 2008 financial crisis. The real culprit appears to be elsewhere, the triple hit taken from hollowing out of the manufacturing economy that hurt the Conservatives in Canada, the insecurity created for older whites from the job losses and hits to net worth from the 2008-2009 financial crisis, and the increasing loss of access to health care and educational opportunities with high  costs. About 62 million households or the bottom half of the distribution in the U.S. have a net worth of about $10,000, a quarter of this group having zero net worth, according to the Federal Reserve's Janet Yellen at an Inequality Conference in Oct 2014. Problems no wall is going to solve, problems that built up over 2 decades, problems that will take a generation to fix.  It shows the tech miracle of the last 2 decades as a mirage for quality of life of the middle and working class. Tech as a tool to a goal, not a goal in itself, is the better way forward. ...

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The OECD countries in Europe including Germany, France, Denmark, Italy, spend on average $14,000 on childcare. The US spends astonishingly only $500 per toddler, about 4% of what advanced countries in Europe spend.The Biden plan is to change that. On the floor of the US Congress Senate minority leader McConnell protests against what he calls extravagant spending by the US in the Biden plan for families and workers.

In our selection of reports in world media we show the effect on women during the pandemic taking on childcare responsibilities with schools closed because of coronavirus. The impact has been a catastrophe for women leading to increase in mental health problems as culture and other reasons lead to women taking on 60-70% of child care and household chores. Women with careers are not able to join the workforce because of childcare shortages, losing income and feeling overburdened.

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Dressing in a sloppy manner is related to a sloppy approach to other people's money, says this NYT story about the 30 year old founder of FTX. Silicon Valley mystique was partly built on this type of clothing and style by careful manipulation of cultural elements, just as the Marlborough campaign for cigarettes with "glamorous" cowboys at one time. The culture based in Silicon Valley has led to a massive misallocation and destruction of capital. This diverts capital into non essential purposes that is critical for  investment in America's aging and dilapidated infrastructure, and for creating social mobility in the US through investment in manufacturing, education, health and communities throughout the US. It was sold like a pack of Marlborough cigarettes were once sold in the US with television advertising of the glamorous cowboy. Conceived in 1954 it lasted till 1999.

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Mark Gilbert, a visiting associate professsor of European History at the John Hopkins School for Advanced International Studies in Bologna, describes the crisis of the political culture in Italy that goes deeper than the economic crisis and has lasted for most of the post war period. Gilbert says the political parties have avoided implementing financial discipline and opening up the economy for most of the last two decades, except for brief periods, and did not take the opportunity of joining the eurozone to make serious changes. Italy has many parties with the Democratic Party having 25-30% support in the polls and Berluconi's People of Liberty (PdL) having the support of 20-25% of voters. There is also the Northern League, the Third Pole of centrist Catholic parties, the Italy of Values party, and the Ecology Freedom party. Italy lacks a national consensus on making the changes. The risk is that Monti will not have enough time to make the changes, as new elections may be held by April 2013. His government was formed as a government of technocrats led by former EU commissioner Mario Monti, after President Napolitano forced the PdL, the PD, and the Third Pole to work together to support the new government. Changes are needed in the legal system, local government, the health sector, and in the university system. One factor favoring Monti is that 90% of Italians voters are dissatisfied with the political parties, according to Italian think tank ISPI. For Italy the EU crisis has in this sense a positive aspect as it has forced Italy to come to grips with economic and cultural changes under a leadership from outside the political system....

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Not since the days of the Vietnam War has Madison, Wisconsin seen the kinds of demonstrations that were seen last week. This raises a question whether this creates an awakening of the progressive movement. Wisconsin, New Jersey, Ohio, seem to suggest that whats happening in the states will become more important in shaping public opinion as the U.S. elections of 2012 approach. Ohio also has a plan by Governor John Kasich that restricts collective bargaining rights of public workers. A key question is how much public support there is for reduction of pension and health benefits of public employees. Even though the favorable ratings of unions are at a low, according to a survey by the Pew Research Center, the public is divided over whether it supports unions or state governments in disputes about benefits, with slightly more support for the unions. And other states such as Michigan with new Republican governors and majorities in state legislatures say they are not taking the path of Wisconsin in limiting collective bargaining rights, suggesting caution in this respect, even as they plan cuts in benefits. Because of the intensity and passion that has been aroused something more than the calculations of the politicians, including the President, may be at play. President Obama, says the Washington Post, is playing a longer game on the budget, with a measured response, but also saying that teachers, firefighters and police officers were being vilified. The demonstrations in Wisconsin were more bottom up than top down, and have the potential to affect the political dynamic and the way the U.S. addresses its problems in unpredictable ways....

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Kevin Roose explains the unique structure of Open AI which has 4 board members and is structured as a nonprofit with the overriding goal of safety and making AI beneficial to humanity. Ilya Sutskeyer is chief scientist and member of the board. He says Altman's ouster was necessary to protect OpenAI's mission of making Artificial Intelligence beneficial to humanity. Mr. Altman was asked to join a video meeting of the board on Friday 17th November and was immediately fired. Open AI started in 2015 as a nonprofit and in 2019 setup a capped profit subsidiary in which investors returns are capped in relation to the investment. It keeps the nonprofit in charge and able to fire the CEO of the profit subsidiary and keeps the mission as overarching for both subsidiaries. There are three other members who hold no shares in the company and who are bound to a fiduciary duty to "create safe AI that is broadly beneficial to humanity." Tasha McCauley and Helen Toner are the two other members who are members of the Effective Altruism movement who have raised concerns that AI could lead to the extinction of humanity. Adfam D'Angelo is the other member, he is CEO of Quora a question and answer site. ...

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Plastic water bottle use surged with a shift to single bottle use of bottled water as a preferred option to using sugar drinks and sodas. In the U.S. this use has surged 284% since 1994, with 67% of the bottled water sold not in jugs but in single use convenience type plastic water bottles.  Manufacturers of plastic water bottles have failed to come up with a technology that makes the kind of plastic that can be easily recycled. Danone's bottled water company Evian brand makes about 30% of its plastic water bottles from recycled plastic and no aims at shifting entirely to recycled plastic by 2025.  Images of bottles filling landfills and hurting sealife have led to consumer opposition to their prolific use. Ocean Conservancy says plastic water bottles are behind cigarette butts and food wrappers the thrid most item washing up on shorelines.  Curbs- Cities in Massachusetts along the coastline are banning their use. New York City is banning the sale in parks, beaches, of these bottles. And the European parliament  is backing laws for member states to collect 90% of these bottles for recycling by 2025. Mumbai has banned this year eater being sold in small bottles. The importance of this is now sinking in. ...

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Most American large companies support president Biden's decision to mandate vaccinations for all employers with more than 100 employees. Smaller business also supports the decision as it makes this decision for them. The US Business Roundtable of the largest US companies issued a statement saying it "welcomes the Biden Administration's continued vigilance in the fight against Covid." It went on to applaud the decision of some companies to implement a vaccine mandate before the president's decision. Companies would like to see a rapid ramp up in testing capacity as they see testing capacity levels not the vaccine mandate as the real problem today with the surge in Delta variant. These companies such as Target, Nike, and retailers see testing capacity as "stressed" and say "testing capacity must be scaled immensely to meet the new requirements." Labor unions clearly support president Biden's decision including teachers associations, and the AFL-CIO. Some companies including Delta Airlines are imposed health surcharges for unvaccinated employees, and United Airlines has brought in its own vaccine mandate. The president's vaccine mandate has broad and deep support of the American people and business, according to this WSJ report, with recognition of the huge risks posed by the transmission rates of the Delta variant in the surge of coronavirus in September 2021. However companies say the Biden Administration has to scale up testing capacity quickly to make it work. ...

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Three million additional Americans get access to Medicaid as a result of the Obama Healthcare Law (Affordable Care Act). Under the law states could expand Medicaid to people less than 65 years old with income of 133% of the federal poverty level of $15,521 for individual or $31,721 for family. About half of U.S. states expanded Medicaid and the rest kept the prior income guidelines. The figures are from a report by the Centers for Medicare and Medicaid Services, which show 58 million Americans on Medicaid in third quarter of 2013, and up to 61 million in March 2014.

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Serious concern about lower consumer spending in the U.K that would reduce growth and reduce government tax receipts. The unemployment rate has remained at 7.6% for 22 months. Wage levels are not keeping up with inflation of about 4.5%. The increase in the sales tax from 17.5% to 20% has added three quarters of one percent to the inflation rate, according to the National Statistics Office. VocaLink says annual wage growth in the three months through May 2011 was 1.8%, much lower than the inflation rate. Deep spending cuts are going into effect in 2011-2012, and about 300,000 jobs would be lost in the public sector with spending cuts by 2015. The IMF has reduced its estimate for growth in the U.K. to 1.5% from 1.7%. At the same time the Bank of England is under pressure to increase the interest rate of 0.5% (which is a record low), to control inflation. Britain under prime minister Cameron plans to cut government spending from 47% of GDP to 40% of GDP over six years. This will take 6 years of spending cuts, something even a previous prime minister Margaret Thatcher was not able to do. The government's Office of Budget Responsibility predicts a drop in the deficit from 11% of GDP to 7.9% by March 2012. Yet a lot depends on government tax receipts which in turn depend on economic growth. Britain showed a large deficit of 10 billion pounds in April 2011, and the situation is fraught with a high degree of uncertainty....

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New York city Mayor Bloomberg, says President Obama and Republicans should stop promising a free lunch, or something for nothing. He points to Obama's reelection strategy of higher taxes for the rich- by taxing those earning over $1 million at minimum of 30% in federal income taxes- as generating $1.1 billion, according to Congress's Joint Committee on Taxation. This would make little difference on a federal government with $1.2 trillion gap in spending and revenue. And he says Republicans who say making the Bush tax cuts permanent while at the same time cutting the deficit are promising a free lunch, with no connection to reality. The answer says Bloomberg should be to eliminate the Bush tax cuts for all groups, for shared sacrifice, and for Congress to pass the Simpson-Bowles deficit reduction plan with $4 trillion in savings on an up or down vote.

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Martin Feldstein renews his call for new policies that channel significant government aid to homeowners under water. He says this is the only way to stem the decline in home prices. Letting the forest fire of foreclosures burn itself out is simply not an option, as it would only damage the economy further.

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The IMF extends $100 billion in loans to countries that have healthy economies but need temporary help, such as S.Korea, Brazil, Mexco and Singapore. Some of these countries have borrowed heavily in other currencies and the drop in the value of their own currencies makes repayment difficult. No strings such as requirements to raise interest rates and to cut public spending are attached to this program. Under this program countries could borrow five times the amount they are normally entitled to, $25 billion in Brazil's case, without the strict conditions that normally accompany such loans. Nobel Prize winner Stiglitz was chief economist at the World Bank. He said the funds use of the words restore confidence itself could make a lot of countries nervous. That is because in the Asian and Latin American crises in the past, the IMF set strict conditions to increase interest rates and cut public spending and food subsidies at a time when the poor especially and the rest of the people, all needed help, thereby increasing public distress. In the developed countries stimulus packages and infrastructure spending goes up to support employment and incomes, but the IMF has advocated quite the reverse in the case of the developing countries, with the US Treasury a key factor in IMF support and ideology. Which is why countries in Asia like South Korea see a stigma attached to the IMF and are refusing IMF help. In Pakistan also the IMF support is a last resort or Plan C. Iceland for instance raised rates in return for IMF help from 6% to 18% to try to stabilize the currency. The IMF was created as part of the Bretton Woods agreement of 1944 when the Allied Powers USA and Britain and other countries that sent representatives met in New Hampshire for a postwar economic system. Japan, S. Korea, India and China and many other countries were not part of it because of the war or colonial empires....

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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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The contrast between the background and style of Britain's chancellor of the exchequer, George Osborne, and the shadow chancellor, Mr. Balls.

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Turner Adair, head of Britain's Financial Regulatory Authority thinks that banks have assumed an outsize role in the British and world economy, and are coopting their regulators. He sees the need to check many of the excesses. Why not use profits to build up reserves rather than give out huge bonuses and paychecks, he asks. He sees the need to challenge the accepted thinking on Wall Street and in the City of London, where the ideology of efficient markets became embedded, as it did also in the regulatory community. He came in the week Lehman Brothers collapsed as chairman of the FSA. And he wants to shake up the existing thinking. In March, the Turner Review. a 126 page report was published. A lot of attention was paid to his suggesting atax on financial transactions, called the Tobin tax, but its designed more to get people thinking and questionning the existing way of running banking as Turner said in an interview, "we have begun to accept this idea of liquidity as the new God." Can British or American society and the financial industry in both countries work to the benefit of both? Nobel prize winning economists and other experts have advised ashift to productive investments that grow the economy using technology, science and brainpower and new ideas, as opposed to the investment in mortgages and other speculative investments. As the regulators -including former and current heads of the SEC, and other regulatory bodies in the US, Cox, Schapiro and others- once held on to the same theory of uninhibited operation of free markets as best for generating increased wealth for society as the banking community, they tended to get co-opted in letting bad practices flourish. Went to sleep on the job as it were. See the links in Intelilinks. Adair Turner's admonitions are designed to get people thinking. He says, "banks need to be willing, like the regulator, to recognize that there are some profitable activities so unlikely to have a social benefit, direct or indirect, that they should voluntarily walk away from them." Investments in science, technology and new products, as in the 60's that generated a revolution in living standards, than the mortgages and consumer lending of the last decade, is what he may be saying, as do these Nobel prize winning economists....

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Chinese companies are heavily invesing in the stock markets and many companies get a large part of their earnings from the stock markets. The myth is that the real economy will simply go on like before if the stock market takes a nosedive. This is not true because large and small companies are both playing the stock market and IPO's in a big way. They are using corporate funds to invest in IPO's and stocks to boost their earnings. Morgan Stanley estimates that more than one third of corporate earnings in China come from putting money in stocks. The figures are much higher for some industries. In the health sector this number is 54% including real etate earnings also and in consumer goods sector 65% according to Morgan Stanley. If the markets take a steep downturn then these companies will have to show the losses on their income statements, depressing earnings and pushing their stock prices down even further and more steeply. Japan experienced something similiar in the the eighties. And in one respect the situation is more dismal than in Japan. The financial statements may be even less transparent than the ones in Japan's boom period. And investors lack the expertise to figure out whats behind the financial statements. There is no effort to think deeply about what can happen when a nosedive in stocks hits corporate earnings and these losses create a vicious cycle that sends stocks into a further fall turning into a freefall. A Professor of Accounting at a Business School in Shanghai, head of China research at Morgan Stanley and a governance expert in HongKong all point to the dangers in the situation as it evolves. Most of these bubbles like the housing bubble in the US have a situation which George Soros described recently as it burst after he had kept predicting for years that its going to collapse and finally he got tired of saying that because it continued going up. Its possibly the nature of bubbles that a sharp observer can tell whats going on but the phenomena will continue for quite awhile even when its obvious that something is wrong. Its something to do with human nature and the dynamics of human situations where knowing the danger the person will continue to act the opposite way just because everybody else is playing in a certain way. This is the situation in China in 2007. ...