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Legal aspects and challenges to the Obama healthcare law that may have been overlooked by the Obama administration.

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Feldstein says that for the 85% of the people who have healthcare the Obama proposals are not a good deal. The Obama proposals mean higher taxes in the long run to pay for the $1 trillion cost of healthcare for the uninsured group over 10 years. This lower income group has no coverage despite the $300 billion Medicaid program. Feldstein says there surely must be better and less costly ways of getting this lowincome group healthcare. Raising the top income tax rate to 45% from 35%- as a result of letting the Bush tax cuts expire and adding aproposed health surcharge on higher income individuals- would actually lower revenues for the government, as it would change behavior of high income individuals in ways that lower their taxable inome. The result is higher deficits and higher taxes when even without this large deficits are projected for the future. How to slow the rapid growth in healthcare spending? The Obama plan is to cut spending on Medicare. Feldstein sees the govenment's effort aimed at reducing the amount of medical services, as reduced spending comes from fewer services, not reduced payments to providers. Will this result in enough of acost reduction to make the system work. And if the cost reductions are too heavily weighted towards reduced services and not reduced payments to providers would this result in large cuts to services to affect the quality of healthcare for the 85% who are accustomed to a different pattern of healthcare, even though it is structured to allow cost escalation. Feldstein offers no solutions to the problems of cost escalation except to suggest that the Obama plan does not really tackle the cost escalation issues directly with providers, and instead burdens the national finances to an extraordinary degree. And the need for apause and reflection....

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Kansans come out at a town hall meeting in rural Palco, Kansas, setup by Senator Moran, to say they have serious problems with the healthcare bill in a Republican Congress. Kaplan of the NYT says few Republicans in Congress have setup town hall meetings to hear the views of people in their constituency because of the strong criticism from older Americans hurt by the bill's provisions. Rural Kansas is affected by the bill. Senator Moran says of the bill that he is from rural Kansas and wants to hear what people think. Senator Moran is one of the few Republican Senators who have come out against the bill. Kansans are realizing that policy matters after the experience with actions taken by Governor Brownback to cut taxes and spending. Now Kansans are also realizing that there is a cost to being ideologically driven in coming up with solutions whether from the right or the left of the spectrum. Senator Moran after all is in the mainstream and led the 2014 effort to give Republicans control of Congress. It is also the state of Dwight Eisenhower, whose hometown was Abilene, Kansas, known for being moderate on issues, a descendent of down to earth Pennsylvania Dutch families, and for saying- "a people that values its privileges above its principles soon loses both." Here Moran does exactly that, listening to how the Republican healthcare bill affects rural Kansas, without getting muddled up with the politics on the issue. ...

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US president Biden's multi-trillion dollar spending plans for infrastructure, climate change plans, education and healthcare, are based on a changing perception about the effectiveness of the public sector spending initiatives. The Reagan period idea that the public sector is not as efficient as the private sector that lingered through the Clinton, Bush and Obama, Trump administrations is no longer accepted. After the pandemic another perception is taking root that when it comes to health infrastructure the government has a leading and indispensable role to play. Gone are the doubts about this that hung like a cloud over the nation's plans for infrastructure in health, education and supply channels. Following the global competition with China a new factor is also playing its part. The need for government to play an active role in trade, in protecting technological resources, and in supporting US technological firms in competition with other countries. There is a new perception that the government should be determined to play this role. In the effort to be self-reliant after the pandemic the government is expected to play a role in redesigning the supply channels and providing the direction and incentives for supply channels worldwide that give America a competitive advantage and less dependence on other nations. ...

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US president Biden's State of the Union address comes at a new inflection point in history for the US, the European Union and India. The Ukraine crisis and setting the US response, as well as US response to the neglect of infrastructure, healthcare, social cohesion during the last two decades.

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The first home testing kits approved by the FDA are on their way in coming weeks to healthcare workers from LabCorp, says this report in NYT. A test is done at home and returned in an insulating packet to the lab. Cost $119. President Trump says the testing costs will be reimbursed.

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Even the entry into the Philippines by Wirecard executive might have been faked- where there was supposedly $1.9 billion in Philippines bank accounts of Wirecard that are reported to simply not exist- says this report in the WSJ.  

It shows how flagrant activities in misallocating capital have become at a time when PPE supplies, healthcare equipment and medicines are hard to find during the pandemic. Hundreds of billions of dollars have not only been misallocated away from basic infrastructure, education and healthcare but also in many ways wasted. A kind of Dickensian "it was the best of times, it was also the worst of times." 

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The work of David Malpass at the World Bank in approving $1 billion for India's coronavirus emergency response and health preparedness project. 

This will help India move quickly to setup the contact tracing, isolation centers, treatment facilities, and healthcare preparedness for coronavirus, so that the transmission of coronavirus is strictly limited.

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Insurance premium rise 2022-2025 is costly for employee wages with employers slow to increase wages when so much money is going into healthcare premiums for their employees. Each year employee premiums in the US have increased by 7% for the last 3 years. $27000 is the cost of health insurance premium for American family in 2025 which is exorbitant and shows a breakdown in the health system that is affecting the cost of living, the wages of workers, and the money left in the economy for other essential needs.

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Affordability should be a major factor in figuring out what is the best place to retire. Climate gets Arizona and Florida the top two spots. Yet considering today's higher cost of living and smaller retirement savings in the U.S., Britain, and European countries, and the higher cost of living in India, China, and other Asian, African, and Latin american countries, affordability should play a much larger role so that savings stretch out and one can afford a better standard of living, more travel and room for better choices in food and other things.  Bankrate for instance gives 40% importance to affordability in its retirement assessment of locations. Climate gets only 15% in this assessment of location. Places which are friendlier, with which you are familiar ar attractive for other reasons. Bankrate gives Nebraska, Iowa and Missouri top ratings in this commonsense approach.  Also important after affordability, are access to healthcare, weather, culture and crime. Bankrate analysis gives affordability 40%, wellness and healthcare 25%, culture 15% weather 15%, and crime 15%. Access to healthcare is a factor that is also included in Affordability as the premium in Florida for Medicare Supplement, is $286  month vs $90 a month in Nebraska. Using a similar approach places in India, China, other African, Asian and Latin American countries countries that are in high demand and have rising cost of living may not be the best places to retire. Using Affordability, wellness and healthcare, culture, and friendly atmosphere and familiarity with having lived there for a time, may be the best criteria with less importance to weather. A better standard of living and access to better things in life with one's dollars or rupees or whatever currency one uses stretch is important.   ...

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Reports from hospitals and healthcare workers in Indonesia shown here in The Guardian provide a picture of a health system under severe stress. The government was not able to curb travel during the Eid holiday. Packed airports, bus stations and railways during the holiday travel period combined with the high transmission rate from delta variant has hit the country hard.

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UK underinvestment in health care infrastructure and NHS is leading to it "underperforming significantly," says a King's fund health thinktank study. UK annual capital spending in healthcare is about 0.33% of GDP in 2019 compared to 0.65% in the US. A lack of doctors and nurses is a severe problem for the NHS in UK.

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In Rural America in 2024, in places such as Wisconsin, people are looking for government to fund roads, library services and healthcare. It comes after decades of austerity in the state have starved funding for public services. This report looks at the city of Wausau, the seat of Marathon County, in north central Wisconsin, 90 miles northwest of Green Bay.

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The U.S. Senate passes a motion that allows the chamber to proceed with a debate on a health care bill. The motion passed 51-50 with Vice President Mike Pence casting the deciding vote. Republican Senators Collins and Murkowski voted against the motion. This report in the WSJ says this sets in motion a process in which debate will take place and amendments will be made. It is not clear what shape the bill will take. Under the process used only a simple majority is needed in the Senate, yet this allows for many amendments to be made.  Only hours after this motion passed by one vote, a bill replacing major parts of the Affordable Care Act failed to pass 57 votes against and 43 in favor. Senator John McCain who arrived in Washington from Arizona following brain tumor surgery, delivered strong criticism of the way the Republican healthcare bill was rushed through allowing very little debate. Experts have commented on the way the bill was rushed through with a thin majority for passage, with very little debate, first by Democrats in 2009 and now in the House by Republicans. With the same pattern now followed in the Senate by Mitch McConnell, the Republican leader in the Senate. A backup bill would remove just the individual and employer mandates and a tax on medical devices- the elements Republicans agree on, if no majority can be put together for the healthcare bill. ...

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George Bush's administration passed healthcare legislation that allowed private pharmaceutical companies not to have to negotiate with Medicare on cost of drugs. It also passed the so called Medicare Modernization Act that created a huge opportunity for profits through Medicare Advantage Plans. The chart in WSJ shows profits it calls a bonanza. What it means is that instead of reducing the costs of providing medical care to elderly Americans it has increased the cost leaving less and less money for infrastructure for roads and bridges and airports that are dilapidated in the US, and less money for essential services in education and health care, transportation, housing. This has reduced the standard of living and quality of life in America. For healthcare it is providing less for higher cost when compared to China, India, Germany, France and the UK. George W Bush administration put America into 2 wars in Asia and the Arab world which also drained resources contributing to a lack of investment in the country in essential infrastructure and services. ...

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Much of the cost of the Common Prosperity campaign of president Xi to increase access to healthcare, education and housing will fall on heavily indebted local governments in China, says WSJ. Today in 2022 these three education, healthcare and housing are moving beyond reach of ordinary Chinese because of rising costs and referred to as the "three big mountains." In education and housing the government has moved to improve access. Today parents like Ding Jianxiong in Beijing can give their children two extra hours of classes in school for not cost. It saves money and time compared to tutoring classes that the government is discouraging. Teachers have to work longer hours for this to happen and the cost is borne by local governments. Governments at provincial, municipal and county level finance 80%, 70%, and 60% of China's fiscal expenditures on education, healthcare and housing projects. Data from China's Finance Ministry shows local governments have built up $4 trillion in debt at end of 2020, up 20% from a year earlier, much of it to finance infrastructure projects in the last 20 years. This experts say is an underestimate with additional debt buried and camouflaged in financing vehicles, other forms of debt. In 2020 the central government restricted sales of land that were creating an overinflated housing market and driving cost of housing ever higher, depriving local governments of a principal source of revenues. Land sales are now down about 15% and falling. Experts say a new property tax could only bring in one fifth of what was derived through land sales by local governments. The result is a fundamental mismatch today between revenues and costs for local governments that has not been addressed. ...

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Under a new program to increased spending on healthcare from 1.3% of GDP to 2.5% the Indian government plans to provide free pharmaceuticals at state run hospitals. This is expected to cost $5 billion over 5 years. Initially 350 drugs would be on a list of essential medicines and would be purchased from generics manufacturers in India. Dr. K. Srinath Reddy, heads the committee advising the Indian government on healthcare. He says this will help improve access to medicines for the vast majority of the people. Estimates show 70% of out of pocket medical costs for Indians come from spending on drugs. About 40 million people are pushed into poverty each year because of the high cost of medicines, says Dr. Reddy. He said that in 1984 31% of the medicines at government run hospitals were provided free to admitted patients, dropping to 9% in 2004. For outpatients this dropped from 18% to 5%. The free medicine program would be part of a larger universal health care program to be introduced over the next decade. India's large generics pharmaceutical industry makes the provision of free medicines on a large scale a feasible option in India because of the lower prices, with additional pricing advantages when purchased in larger volumes by the government. This would also have a major impact on the quality of healthcare in the country of 1.2 billion people for a relatively small investment. It also promotes a sense of fairness and equal access because the benefits of decades of modernization have been unevenly distributed and because of widespread poverty....

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How companies like United Health are lobbying aggressively to shape the new helathcare legislation to their benefit. BW says the health insurers like United Health, Aetna and Wellpoint are already winning through clever and effective lobbying of Congress. Former Senator Tom Daschle works as aconsultant for United Health. Senator Conrad who has led aeffort to replace the public plan with nonprofit medical cooperatives, which would be a weaker competitive threat to insurers, is also influened by the insurers. United Health's CEO Helmsley and its person working with Congress on healthcare Simon Stevens met with Conrad on June 4. When lawmakers in Congress cite consulting group Lewin Group, that 88 million or 56% of those with employer provided coverage would desert private insurance for a government run program, they are quoting acompany owned by United Health. The Congressional Budget Ofice says these numbers are too high. United Health has used savy presentations on how to cut costs, and help Blue Dog and other Democrats articulate their positions, to gain influence in shaping the plan to their interests. United Health thus counts a lot with Matheson, and Mike Ross of Arkansas, who are prominent with the 52 Blue Dog Democrats. and with Senator Mark Warner of Virginia. And United Health put together an effective lobbbying group, even hiring the chief of staff of House Democratic leader Steny Hoyer. ...

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Peter Orszag's role in the healthcare debate and the formulation of health care policy proposals. One proposal of Orszag, who heads the Congressional Budget Office, is to set up a new agency with powers to cut spending and implement changes in Medicare. Says Orszag, "one of the reasons we have such disjointed and skewed incentives is that we have an excessively political process." At a recent meeting with House Democrats, one Congresswoman said her top priority is winning higher payments for oxygen suppliers, and Orszag was taken aback. For years officials have been trying to cut payments to oxygen and medical equipment suppliers, which are said to be inflated. When a new competitive bidding process was set to take effect last year, industry supporters in Congress were able to delay the plan, and these supporters are still fighting to block changes says the WSJ. Here is a 40 year old Orszag, with degrees from Princeton and London School of Economics, who got his early experience in the Clinton adminstration at age 24. He then followed this with a number of policy oriented jobs, ending with appointment to head CBO in 2007. And he faces the whole system of Congressmen from both parties beholden to interests in the healthcare industry, who provide the donations for them to finance their election campaigns. Dan Eggen describes this in the Washington Post, 7/21/2009. Max Baucus of Montana, and to some extent Grassley of Iowa, are senators from both parties who Eggen points out are beholden to the healthcare industry because of large donations they receive from the interests in the healthcare industry. These interests want to see their payments system protected. The further escalation in health care costs, which would make the whole healthcare system unaffordable even as it delivers poor results, can only be prevented by making cost control an exercize that is not influenced by healthcare industry donations. Jackie Calmes describes the huge hurdles in achieving a deficit neutral move to universal health care in the U.S. in the NYT 6/26/2009. See the link. The exchange between Grassley and Orszag on the issue of the $177 billion in savings needed from the payments to health insurers under the Medicare managed care plans- which allow seniors to obtain Medicare coverage outside the government run program -went as follows. These are dubbed overpayments by outside experts and efforts have been made to cut them in Congress. When Mr Grassley raised concerns about the impact of such cuts in a hearing, -and Grassley has opposed the cut for this overpayment to insurers- Orszag responded saying: "I very firmly believe that capitalism is not founded on excessively high subsidies to private firms. This is what this system delivers right now." ...

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

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The coverage of the Republican healthcare bill and how it affects the elderly, and people on Medicaid, people in rural areas, is likely to have changed public opinion in the U.S. about the necessity of ensuring all Americans have health coverage. The Pew survey cited here in this NYT report by Zernike and Goodnough was done in Jan 2017, and shows a shift. The shift would be much higher today after people look hard at the consequences of what were simply hypothetical positions or ideological positions taken without looking at consequences in daily living. On Medicaid that opinion by July 2017 compared to Jan 2017 has shifted 10 percentage points for Republicans to 53% who think Medicaid is important to them and their families, according to Kaiser research. There is stronger sentiment about people having benefits taken away.  [article-55059] The opinion has shifted to where people see that coverage is important and people should not have coverage denied or benefits taken away from them. Opinion remains strong in favor of changes to reduce the high premiums, but not to replace the existing health benefits and law with no law at all to replace it. That leaves 20 million more uninsured according to the Congressional Budget Office. Changes have to be constructive is the popular view today,  and this requires dialogue between Republicans and Democrats- which has not taken place. ...

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What is the difference between a K95 mask and a N95 mask. A K95 mask is based on a Chinese standard. A N95 mask is based on the American standard. The N95 masks was first made by 3M a company making masks for industrial and healthcare use based in Minneapolis, U.S. Tests on K95 masks have shown that many fail to meet basic filtration quality test standards.

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The Obama healthcare law is expected to reduce the total number of hours Americans work by equivalent of 2.3 million full time jobs in 2021, according to Congressional Budget Office projections. Earlier forecasts for this were 800,000 equivalent full time jobs. Some of these hours will be taken up by other workers looking for jobs, according to CBO's report.

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"Cancel Culture"- how Democrats and Republicans Conservatives and Liberals see the shaming of people for their views on social media- it is having accountability for some, and seen as censorship or punishment by others. Pew Researchers show the views of different people by age, gender, political affiliation, on the idea of "cancel culture." Some say does it even help doing this on a platform like social media as it tends to exaggerate and is rarely helpful to educate people and create real conversations to increase knowledge. When people are being shamed for racism or sexism, there is little idea of getting people to change or for patient forgiveness, or educating on why certain behaviours are wrong. Yale University's 58 page document on where it went wrong on "holistic admissions" and "cancel culture," is an example of how "cancel culture" when adopted inadvertently at universities and colleges across the Nation can be misguided and not result in positive actions. In the process can this denigrate the achievements of western civilization through the Renaissance of ideas, the awakening of knowledge in Europe in the 17th and 18th centuries, the Enlightenment, and the Scientific Revolution that resulted from this. Followed by the Industrial Revolution unique in Europe and the US that created the Modern World and the standards of living, of literacy, education and healthcare, and transportation we know today. This is the question Yale and other universities are asking today in 2026. ...

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The work space company WeWork is valued at $47 billion then 4 years later in 2023 it is filing for bankruptcy. In 4 years FTX a cryptoexchange founded in 2019 collapses and by 2023 its founder is convicted on 7 counts.  Huge amounts of capital continue to be wasted in these schemes when America needs to Build Better Faster and Better to meet infrastructure needs, and in education and healthcare.