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The U.S. Congressional Budget Office (CBO) revised estimates in May 2013 show the U.S. debt to GDP ratio in 2013 at about 75.1%, coming down slightly in the next couple of years and then rising to about 73.6% by 2023. The U.S. deficit for fiscal 2013 is estimated to be about 4% of GDP, down from 7% in 2012 and 10.1% in 2009. The deficit is estimated at 3.4% of GDP in fiscal 2014 and 2.1% of GDP in 2015. Spending levels increase closer to the 2020s as more people reach retirement age. Lower projections on Medicare, Medicaid and Social Security spending have reduced the cumulative deficits over the next decade.

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Low bank wages for the U.S.'s 500,000 bank tellers. The median annual income of a bank teller in the U.S. is about $24,100 or $11.59 an hour, according to the Bureau of Labor Statistics. According to a report by the Committee for Better Banks, about 39% of bank tellers in New York rely on public assistance. Nationally bank tellers need $105 million in food stamps, $250 million in earned income tax credit and $534 million in Medicaid and Children's Health Insurance Program to get by. According to SNL Financial bank profits reached $141.3 billion in 2012, and median chief executive pay was about $552 million.

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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.

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The Washington Post survey of 1200 readers on how the Republican healthcare plan of Speaker Ryan and the House of Representatives looks to them, how it affects them in their lives. Here Somasekhar of the Post gives the stories of 5 Americans. Some see the prospect of losing their insurance under the Republican plan even as they reach an older age, others a smaller segment says the Post, whose premiums jumped under the Affordable Care Act say they faced high premiums and high deductibles. The Post says the large majority of opinions have expressed anxiety over the proposed Republican Ryan House plan for healthcare. One of them is an uninsured poor farmer, Mr. Woosley,  income about $18000 who gained benefit from expanded Medicaid under the Affordable Care Act,  one Mr. Smith, 32 years, a personal injury attorney who faces paying $10,000 if he did not take insurance and $10,000 if he took insurance because of high premiums so a wash either way deciding to do without it, one a tech worker Mrs. Powers, 62 years, income $22,000 on year and $4000 the next, from middle class during the tech boom but facing fewer opportunities and uncertain income from part time work, hit by the deep recession facing fewer opportunities as she gets older and now the prospect of losing insurance without government subsidies, one who is from the middle class who sees little benefit from the Affordable Care Act and is forgoing insurance because of the high premiums yet faces a penalty for not being insured under the ACA, another Mr. Blanchard, 52 years, is from the middle class, a computer programmer who lost his job in downsizing, earns $100,000 as a consultant self-employed, pays $767 in premium a month and relies on the Affordable Care Act which helps him gain freedom from working at a company that could downsize,  another is a middle class programmer Mr Riffle,age 44, and his wife, who does not qualify for a subsidy with a $71,000 family salary from working 4 jobs between himself and his wife- this person finds it too expensive for his salary to buy insurance $900 a month and $14,000 deductible under the Affordable Care Act. His views are worth listening to as they go to the crux of the problem- he says he may not be any better with the Republican plan. He sees the real problem as the high cost of health care in the U.S. and the only way this can be fixed is for members of Congress to be asked to use the insurance exchanges they create. If this sample is representative it shows that there are real problems with both the Affordable Care Act and the Republican plan, that the high cost of health care the problem lurking behind every plan that does not squarely address this, and till that happens and members of Congress experience what ordinary people face, this problem can never by fully solved.   Woosley, Smith, Powers, Blanchard, Riffle, and their personal experience is at the crux of what is right and wrong  with the Affordable Care Act, and also with the new Republican plan of Speaker Ryan and the House of Representatives. For every Woosley, Powers and Blanchard who benefit, there is a Smith and a Riffle who are indifferent or are affected by the high cost under Affordable Care Act and the current system of medical care with its high cost. The Affordable Care Act does not  tackle high cost, for that to happen the culture in America that makes it possible and acceptable to charge high prices must change. Another problem apart from bringing health care costs is that any solution needs to have the whole country behind it. If the notion that all people are entitled to basic health care is to stand, the whole country needs to believe it as they do in countries like France, Britain, Germany and Japan. If this has to be made a workable proposition health care has to be offered at a price that makes this possible to achieve, and that idea also needs the deep and broad sense of support from the culture in America similar to that in these other countries. Until that happens politicians in America will get elected and turned out of office in turns on issues such as health care, based on which side they take and which problems they choose not to face squarely and responsibly. ...

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Senators Mike Lee of Utah and Jerry Moran of Kansas declare their opposition to the Republican Health Care bill proposed by Senator McConnell. This decision by the two senators makes it impossible to begin debate on the bill. Earlier two other senators, Susan Collins of Maine and Rand Paul of Kentucky announced their opposition. This means the Republican health care bill has no chance in the Senate even after changes to the bill passed by the House of Representatives. Republicans have a thin majority in the Senate make it difficult to pass legislation. Collins met with residents in Maine and Moran with people in his home state of Kansas, and both senators heard a lot about the negative effects of the Republican bill on people in their state. The bill is seen as hurting people in rural areas, elderly, and not likely to do enough to bring down premiums. Its plan to slash Medicaid spending has drawn strong opposition from all Democrats.

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Business Week's Chad Terhune points out that the health reform bill that passed Congress will do little to restrain the overbilling by pharmaceutical companies, medical device and equipment makers. Chad cites numbers from the U.S. Health and Human Services Department that shows $47 billion in Medicare spending went to dubious claims in the year ending Sept 30, 2009. This is 10% of the $440 billion Medicare program. And 10% of the Medicaid program also goes to dubious claims. Consider then that Congres allocated $10 million annual increase to fight fraud. A suit filed by a former Siemens manager at the federal court in Philadelphia states that Siemens routinely overbilled the Veterans Affairs Department and other governmental agencies by humndreds of millions of dollars for MRI and CT scan machines.

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Copies with slight changes to extend drug life with new brand names- Clarinex for Claritin, Nexium for Prilosec, Paliperidone for Risperdal being the latest in this new marketing strategy of drug companies to extend the life and sales of a successful drug. The drug companies try to market the copy drug as a significant improvement, which is what J&J is doing with Paliperidone. Experts are skeptical. Pricing of the generic versions of Risperdal or its copy will be much less expensive. Cost is a sensitive issue. About 15% of Risperdal's $1.35 billion sales were from Medicaid, generic substitutions offer potentially large savings. Meantime J&J did not do clinical tests between Risperdal and Paliperidone, the tests with 1600 patients compared Risperdal with a sugar pill. A psychiatry Professor at Duke and another professor at NYU are skeptical of J&J claims for Paliperidone. United Health shows savings of $150 million by using generics instead of Nexium, so managed care payors will tread carefully....

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U.S. States faced a shortfall of $86 billion during the 2011 budget season, according to the National Conference of State Legislatures. This was after a rise in tax collections during the last year from an improving economy, and about $30 billion of tax increases passed in 2009 and 2010. States faced the end of $66 billion in federal stimulus aid, and their share of Medicaid costs are expected to go up by $16 billion in this fiscal year, according to the National Association of State Budget Officers. The political mood has shifted with worries about the deficit and fears that tax increases could make the states less attractive for employers. As a result there is a focus on spending cuts with very few tax increases. Forty six states began a new fiscal year this week after legislatures focussed on spending cuts, mostly avoided tax increases, and some states placed restrictions on the pay and benefits of public employees.

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A detailed breakdown of the the waste, fraud and improper payments in federal spending is shown in this WSJ report. . Of $4.1 trillion, a big chunk of the $6.7 trillion the US had in federal spending in 2024 according to CBO, 3.7% is self identified by agencies as improper payments or $149 billion. 90% of improper payments are overpayments. It reached a high of 7.1% of federal spending in 2021 during the pandemic when loose controls led to more improper payments. Only $22 billion was recovered for 2024. Outside agency control including state and local control where the federal and states are running programs is the single most difficulty in getting improper payments back. Top government programs with improper payments are: Health and Human Services Medicare $31.7 billion Medicaid   $31.1 billion Medicare Advantage $19.1 billion Medicare Prescription Benefit $3.6 billion Treasury - Earned Income Credit $15.9 billion Agriculture- Supplemental Nutrition Assistance $10.5 billion Social Security Supplemental Security Income $6.5 billion Labor- Federal and State Unemployment Insurance $5.1 billion ...

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The US is facing a new pattern of demographic changes and their impact on Medicare and Social Security programs. The number of people on Medicare will grow in 2 decades, 2010- 2030, from 47 million to 80 million for Medicare, and from 44 million to 73 million for Social Security, according to this estimate. The workforce will grow more slowly and the tax base wiill shrink accordingly during this period. This pending worker-pensioner imbalance and the jump in the cost of the bill for Medicare and Medicaid, as well as the federal health benefit for poor people, create a major problem for the US. At the same time the group of people over 65 will rise in these 2 decades from 17% of the voting age population to 26%. This group and the people who expect to soon join this group will resist any changes to Medicare or Social Security programs, making it that much harder for the political process to tackle these issues to make the programs sustainable in the long run.

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Some features of the U.S. health care law are likely to be retained even if the Supreme Court overturns the health care law- the feature that lets parents carry a teenager on their polcy till age 26, and the feature that private insurers cover preventive services without copays. These are very popular and preventive services make sense for the insurance companies to reduce higher costs later on. Other features such as the discount pharmaceutical companies must give to seniors falling under the Medicare gap, and annual physicals without copays may not be retained. 3.6 million Medicare benificiaries saved $2.1 billion on prescription drugs, $604 per person, from the Medicare gap discount. And 32.5 million Americans took advantage of the annual physical without co-pays in 2011. About 50,000 Americans insured temporarily for people with a pre-existing condition also may lose their coverage. Another provision which prevents states from tightening eligibility rules for Medicaid before 2014, may be questioned also as states feel burdened by these rules during a period of budget cutting in areas such as education....

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President Obama will nominate Jacob Lew for Treasury Secretary to replace Timothy Geithner. In making this decision Obama stayed within his close advisors. Lew has held firm in budget negotiations, at one point walking out, and at another point in negotiations of the last two years saying flatly Medicaid is off the table. This signals Obama is not going to give in to Republican demands without a fight. In picking the 57 year old Lew, Obama is choosing someone who has substantial experience in budget matters and in working with Democratic leaders, all the way back to working with Speaker Tip O'Neill from the Reagan days. He was head of the Office of Management and Budget, and is currently White House Chief of Staff. He was chief operating officer of Citi Global Wealth Management and Citi Alternative Investments for 2 years, which suffered large losses in the 2008 financial crisis, but was not closely involved in the way decisions on investing were made. He was brought to Citigroup by Robert Rubin, a former Treasury Secretary under Clinton....

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The Commission addressed the employer deduction for health care that distorts incentives for cost control and costs $200 billion a year. It did not address Medicare and Medicaid growth.

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With Republicans elected to a majority in both chambers of the state legislature and a Republican governor, Wisconsin is moving ahead with a sweeping plan to fix its budget deficit. Walker promised he would get public workers' compensation in line with other workers. He is now proposing a plan which will go to the legislature for swift approval that will simply go ahead and cut public employees benefits without negotiating. He says he doesn't have anything to negotiate with, because with the growing deficit he has nothing to give. His plan: limit collective bargaining for most state and local government employees to the issue of wages (instead of to many issues such as vacations, health coverage), require government workers to contribute 5.8% of pay to pensions, and have state employees pay at least 12.6% of health care premiums (instead of the 6% most pay today). The plan will save $30 million in the current budget and $300 million in the next budget. Republican leaders are saying the alternative is to lay off some 6000 state workers, and take away Medicaid coverage for thousands of children, which is a much worse alternative....

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The House healthcare bill that just passed by amargin of 220 to 215. The cost would be $1.055 trillion over 10 years, with cost of $894 billion factoring in penalties for individuals and businesses that don't buy insurance. Adding increased coverage for Medicare prescirption drug coverage for seniors its around $1.2 trillion. $460 billion is from new taxes on single people with income of over $500,000 or couples with inocme of $1 million. There are $400 billion in cuts to Medicare and Medicaid, and additional money coming from penalties for not buying insurance. First column here is Senate version, second for House version and third President's version. Other features individuals must have insurance or pay afee of 2.5% of income, hardhip waivers will be available. Employers must provide insurance to employees or pay a penalty of 8% of payroll. Small businesses with fewer than 10 workers get tax credits. The threshhold is $500,000 of payroll. To help families with lower incomes and the poor the bill provides: families earning $29,000 a year pay no more than 1.5% of income for premiums. Families with incomes of $88,000 ayear would pay no more than 12% of income for premiums. ...

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Many of the achievements of Jindal in the areas of education, and competitiveness and health care and infrastructure for the state of Louisiana are now at risk because of an anticipated deficit of $2 billion in state revenues for 2009 and in the current year the $865 million surplus has evaporated and turned into a$365 million shortfall all in a short time. The state budget used afigure of $84 abarrrel for oil in calculating the state's revenues related to oil revenues generated in the state from offshore drilling but with oil at $40 a barrel things are not lookin good. The total intake from oil and gas from royalties and leases accounts for 17% of the Louisiana state budget. The state rolled back atax increase and increased expenditures on much needed higher education and health care and infrastructure spending. Louisiana needed these programs because it continues to lose people to migration and is the only southern state to do so. The expected cuts are $109 for education and an additional $160 million for health care cuts much from Medicaid. It also shows how quickly things can change for states that are overdependent on natural resource revenues and in this deep downturn for a range of states from California, to New York to Louisiana....

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Jerry Muller, professor of history at the Catholic University of America, offers some useful insights into the nature of inequality in advanced capitalist societies and other parts of the world, and a clear eyed way to tackle the problem of inequality. Tackling the problem should be done in a way that preserves the economic protections for the middle class and the poor which are needed for capitalism to work- unemployment insurance, Medicare, Medicaid, Social Security, Earned Income Credit, and the Affordable Care Act. Much of this system is already in place in advanced capitalist societies. Incremental gains in this area will be much smaller and it is important to recognize the need for strengthening the economic engine that supports these benefits, says Muller. Economic dynamism has to be preserved and nurtured with human capital deployed in the best possible way, and competitiveness of countries increased. Each country and society has to find its own way of achieving this. The family matters, and matters a lot in taking advantage of educational opportunity, says Muller. The culture of different ethnic, immigrant groups, also matter. These differences were present in earlier periods in the nineteenth and twentieth century and are likely to remain. Strengthening the pool of human capital and deploying it is essential to progress. In an earlier book "Adam Smith In His Time and Ours- Designing a Decent Society," Muller emphasized the importance Smith placed on the civic duty of citizens to promote the welfare of the whole society, and the importance of education, family and moral character, with no substitute for the "general prevalence of wisdom and virtue." ...

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Jeanne Whalen on the Two Speed Economy in the US September 2025- diverging paths of low and high income Americans. With the new administration in 2025 priorities shift to immigration and what to do about 14 million illegal migrants from Latin America and other places, war on fentanyl and drug trafficking gangs with hundreds of thousands of lives lost to fentanyl and drugs in the US, crime and safety which includes the unprecedented illegal movement of drug trafficking in the Nation, and to a bold posture on using US advantages of its huge market to get European Union, Japan, South Korea, and China to level the playing field on trade bring jobs home.The Biden administration had already conceded to DJT's approach in its one term presidency by shifting on uncontrolled illegal migration but not fast enough, by not removing DJT's tariffs, and failing to take an aggressive posture on fentanyl and drug trafficking. Of the DJT plan US has tariff based revenues of 10--15% for all countries imports into US can that it redirect to groups to soften any effects of tariffs. DJT administration oil transition policy of stretching out the transition to give middle class and lower classes cost of living relief was also accepted by the Biden administration and is now the policy of Democrat run California state government.  The US economy was slowing in 2024 under the Biden administration. What has changed in 2025 is that the US stock markets are responding to steps taken by the DJT Republican administration to lower the cost of doing business by softening regulations, and giving US business the upper hand in different industries, and rebuilding the manufacturing sector with calls for EU and Japan/South Korea to invest more in the US as a quid pro quo for market access. This has led to increase in the value of market portfolios of the income earners above 250,000, or 10% of American households. As this happens the process of trade renegotiation has introduced some uncertainty in 2025 and businesses are looking for more clarity before increasing investment and slowing job hiring which hurts younger people entering the job market and lower income Americans. Were things better under Biden? Government Covid assistance and payouts in the early years 2020-2021 helped lower income workers, as this faded and the cost of living autos, housing increased sharply under Biden in 2022-2024 the situation deteriorated. The situation today is similar to the situation in 2024 with the difference in 2025 that inflation is coming down just as government help is receding. And added factor is the DJT administration plan to tackle head on the increasing cost of Medicaid to about $1 trillion by adding new requirements and reducing subsidies. The federal workforce had a disproportionate share of black workers and the policy changes to reduce the federal workforce have increased black unemployment from 6.1% under Biden in August 2024 to 7.5 % a year later. Hispanics have seen slight improvement in unemployment to 5.3% in 2025, and the middle class incomes also have held up and are holding steady. Meantime Bloomberg points out that one third of people in the top 10% are living paycheck by paycheck because of high cost of housing, university education for children, and inflation.     ...

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The structure of the deal that is coming up for a vote in Congress on August 1st, a day before the August 2 deadline. A deal put together mainly by Senate minority leader Mitch McConnell and Vice President Biden after other deals failed. It gives the government $400 billion immediately and another $500 billion in the fall for raising the debt ceiling. Another 1.2 trillion will be added in 2012. The entire burden for raising it falls on Obama. Obama will be able to get the debt ceiling raised without another long struggle before 2012 elections. On spending cuts- agency spending will be cut by $900 billion over the next 10 years. A new legislative committe will be set up to come up with $1.2 trillion in additional savings by the end of 2012. The mechanism that would force the committe to act or make sure spending cuts were taken if the committee failed, was set up as one in which the trigger is to force automatic across the board cuts. The automatic across the board cuts would be for $1.2 trillion to agency budgets for the next 10 years, and split this half and half between domestic programs and defence. Programs aiding the poor including Medicaid and Social Security would be exempted, but Medicare payments to providers could be touched. No new taxes are part of this deal....

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The basic outlines of new health care legislation takes shape as Senators Dodd and Kenedy come up with a plan that scales down subsidies to low-income people to buy insurance. Attached to their revised outline is a budget office analysis thatprojects the plan costing $611 billion over 10 years and with expected changes from the Senate Finance Committee would cover 97 percent of all Americans. And earlier plan received much criticism because the Congressional Budget Office estimated its cost at $1 trillion over 10 years and left 37 million Americans uninsured. In addition there is the revised Medicaid expansions for aid to the poor that would add a couple of humndred billion dollars to the total tab. The administration's goal is to keep the cost down to $1 trillion over 10 years. The legislation as it stands includes the public option which is designed to control insurance costs. Mr. Obama said this week that "the public option would keep insurance companies honest." Employer mandated insurance is part of the Kennedy-Dodd legislation proposal. Employers with 25 or more workerswould have to provide coverage or pay the government an annual fee of $750 for each full-time worker and $375 for each part-time worker. The government pays the startup costs for the public insurance option as a loan to be repaid, and premiums would make the option self-sufficient....

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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....

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Questions remain about how the U.S. budget battle and possible shutdown of government will affect the political support for the Democrats and Republicans.