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

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No one in Northern Ireland wants to go back to the sectarian clashes of the twentieth century says one resident of the region. Most people recall the divided barricaded border with watchtowers and helicopters with extreme anguish. All that was dismantled long ago. But Northern Ireland still looks to the outside for help. Will president Biden bring new investment in the region? Can the Sinn Fein and DUP be persuaded to work together with US participation. A new generation has moved away from the sectarian to the economic issues of the cost of living and provision of public services in education and healthcare across the region. This was affirmed by Sinn Fein winning 27 seats the largest bloc in the 2022 election where focus was on economic issues and the quality of life. Because of Mr. Biden's very personal connection to Ireland there is much hope in Ireland for a new chapter to be written again. There is also a different sentiment in Britain with Keir Starmer's experience as human rights adviser to the Northern Ireland Policing Board. Starmer attributes his decision to go into politics to this experience seeing the changes he could make in Northern Ireland from the inside. The switch to a government by Labour could come at a good time for Northern Ireland and for Scotland.  ...

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The debt brake put into the German Constitution by Angela Merkel's government in 2009 to limit the structural budget deficit to 0.35% of GDP during the 2009 financial crisis caused by poor banking behaviour, and in the 2015 eurozone debt crisis with overborrowing by Greece and Spain, is no longer relevant in 2024. It can be said that Merkel made some mistakes- not investing in digitization, in infrastructure and making the German economy dependent on low cost oil and gas from Russia. Putting the debt brake in the German Constitution and setting it at 0.35% of GDP except in emergencies adds to these mistakes, because it deprives policymakers and government of the minimum needed flexibility to meet changing situations in the interests of the German people.    It means there is no money to invest in the country's future, no money for infrastructure even when it is old and crumbling for roads, bridges rail stations and airports, no money for digitization of the economy in which Germany has fallen behind, not enough for defense, and no money to fund needs in education, healthcare, childcare. And not enough money to invest in climate change action. Absent this investment the German economy falls behind, jobs become precarious and public dissatisfaction leads to volatile political situation. ...

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The CBO annual report on the budget and economic outlook shows a deficit of $1.1 trillion for the current fiscal year, a decline of $200 billion from the prior year. Health care spending is a key factor driving the deficit. Cost of spending on healthcare programs is expected to double in the next 10 years, increasing by 8% a year and reaching $1.8 trillion in 2022.

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How the Drug Industry and Drug Companies will go through a complete change and look nowhere near what it looks like today. Huge changes are overtaking the Drug industry and old ways of doing things will go out the window. Patent expirations for blockbuster drugs, safety issues, increased regulation, rise of generics drugs, cost issues, outsourcing of manufacture and testing and some R&D, changes in marketing practices, slimming down of marketing and sales force personnel, new approaches to R&D- Novartis emphasizing science, Glaxo breaking up into smaller teams, and the growth of emerging markets. All this happens as the public in the USA looks at healthcare in anew way and the demand for healthcare expands quickly in growing developing countries of Asia, Africa and Latin America and Eastern Europe.

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Allan Blinder gives a spirited account of what he sees in the Paul Ryan Republican deficit reduction plan. He says that with the voucher plan retirees would fall further and further behind the increasing cost of health insurance. With no explicit cost containment proposals it assumes that some kind of miracle will occur for costs to be kept in check- especially as Republicans want to repeal the cost containment proposals in the President's healthcare plan. He asks whether someone is saying, that we have to destroy Medicare so it can be saved. Ryan woulld also turn Medicaid into a block grant, then underfund it and let the states figure it out when they are in a budget squeeze. Blinder points to the estimates of the Center on Budget and Policy Priorities, that show about two-thirds of Ryan's budget cuts would come from programs that serve low and moderate income Americans. And to make matters worse the steep spending cuts go to finance tax cuts that largely benefit the wealthy. He calls this Robin Hood operating in reverse, and coming on top of 30 plus years of rising inequality. David Stockman makes a similiar point on the editorial pages of the New York Times, April 24, 2011; also adding the point that the middle class will have to pay higher taxes for the deficit to be addressed, something President Obama's plan fails to do. Blinder says that the Bowles-Simpson and Rivlin -Domenici proposals attack the deficit reduction problem in a better way, that asks something from all classes and interests. ...

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With a mere 1% of GDP invested in public healthcare India remains backward in its commitment to the welfare of the rural poor. Prime minister's Modi's plan is laudable says this BBC report, but the record of implementation is spotty at best at the state level for such plans. The new plan announced in the 2018 Indian Budget is for a health plan covering 500 million Indians with 5 lakh rupees coverage, something never tried before but with a cost of a mere $1.7 billion is something that the country woefully lacked or neglected to tackle.

This plan may be better implemented at the national level, and particularly where the reputation of the governing party and its plans for industrialization are at stake in the coming year's national elections. If accomplished and the Modi government is eager to take on these challenges it would be a significant step to balanced and overall development of the Indian economy.

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That is before Wengfeng branched out into AI and his venture DeepSeek to do at a tiny fraction of the cost what these chaps at OpenAI had been openly propagandizing to take not billions, even trillions out of capital markets to leave us all worse of without funds for essential needs in education, schools, healthcare, childcare, transportation. Liang Wengfeng, who founded a $8 billion hedge fund and  invested in AI research fo Deppseek that does in $5.6 million what it takes OpenAI $100 million to do. It started with quant models to predict share prices. He wrote the introduction to the Chinese edition of Zuckerman's book on hedge fund manager Jan Simmons who was into advanced work on quantified modelling for share prices. It says-   “Whenever I encounter difficulties at work, I recall Simons’s words: ‘There must be a way to model prices.' " Liang also says “The publication of this book unravels many previously unresolved mysteries and brings us a wealth of experiences to learn from.” That is before Wengfeng branched out into AI an his venture DeepSeek to do at a tiny fraction of the cost what this chaps at OpenAI had been openly propagandizing to take not billions, even trillions out of capital markets to leave us all worse of without funds for essential needs in education, schools, healthcare, childcare, transportation. ...

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Obama's politics of consensus face a test as some of the issues before the country require strong leadership in the face of competing interests, intense lobbying, and politics as usual. Wavering support from supporters during the primaries, as leadership is delegated to Congress heavily influenced by lobbying on healthcare. And loss of support from the centre and independents who are unconvinced by the lack of clear direction and the tendency for the debate to be carried by competing interests. These independents are also concerned about the costs of a not well thought out plan influenced too much by rival interests.

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Vindu Goel of the NYT gives this report on IBM's expansion in India including an interview with Vanitha Narayanan, chairman of IBM India. In 2017 IBM had 130,000 employees in India, at operations in Pune, Calcutta, Chennai and Bangalore and other cities, double that in 2007. The U.S. operations have about 100,000 employees. As IBM's revenues have declined with technology disruptions, it has concentrated on expansion in India with its vast base of knowledge workers and costs of about one half to one fifth of what it would cost in the U.S. IBM has 380,000 employees worldwide, with 26% in the U.S. and 34% in India, and 40% in other countries. Microsoft employs 8000 employees in India and 124,000 total worldwide, Google has 1800 in India and 72,000 worldwide.  IBM removed operations in India in 1978 after a dispute with the Indian government. In 1993 it started operations in India in a joint venture with Tata. By 2004 the operations had expanded and IBM took full control. A $750 million 10 year contract was signed in 2004 with an Indian phone company Bharti Airtel. As Goel points out the shift is happening towards expansion in India with the growing demand from industry and government in India. The Watson venture has expanded in healthcare in India with contracts including one with Maniphal Hospitals. In 2016 this had reached $38 billion in hardware and software, services, to Indian industry and the government agencies. IBM's work is not simply in offsourced work from American companies. High tech and cutting edge research is also taking place and expanding. IBM is now uniquely positioned to get an expanding share of the business as more tech services are provided to the hundreds of millions of people in India who did not have access to tech and tech services before. Research concentrates on doing this at a fraction of the cost and in new ways suited to the local region, so that services can be delivered with a wider reach. This report provides a new perspective on how the next decade could see American companies with a long term focus take advantage of the rapid growth in the fastest growing large economy in the world, with advantages for both the U.S. and India. ...

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This editorial in the WSJ describes the sharp increase in premiums under the Affordable Care Act of president Obama. The average premium increase is about 24.2% according to a Barclay's analysis, and as high as 43.9% in states such as Illinois. Bill Clinton calls it the craziest thing with small business affected, and some premiums doubling. Of the 17 million people in the individual market eight million buy without subsidies. One in five enrollees cannot qualify for subsidies. Democrats say subsidies are too small. Hillary Clinton has proposed to have a Medicare "buy-in" for people ages 55-65, and a "public option" government run plan. Republicans want to rewrite the law. But this depends on which party wins the Senate, with the election in Missouri giving Democrats an opportunity to maintain a Senate majority.

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The recent effort to eliminate funding for Planned Parenthood clinics in the U.S. because some of the money goes to abortions has run into a cloud of misinformation. In reality only 3% of the funding goes to abortions. Title X funds that help support these clinics cannot be used for abortion care at any time. Medicaid funds going to the clinics in 17 states can be used to reimburse abortion providers only if the life of the mother is endangered. The clinics see 5.2 million low income and uninsured women who need tests for infections, breast exams, pap smears, preventive services and screenings, contraception services. By reducing low income women's access to such health services through defunding the clinics would only increase the number of unwanted pregnancies and abortions. Planned Parenthood centers provides contraception to about 2.5 million patients each year and educates women about birth control. By burdening the U.S. healthcare system- adding most of the 5.2 million who access these clinics -with problems ranging from cancer to other serious health issues when they could have been detected by tests at an early stage and treated earlier or prevented altogether, would also add to the burden of healthcare costs. In addition the 800 Planned Parenthood Clinics in the U.S screen 3 million patients each year for other problems such as blood pressure, diabetes, smoking and obesity related issues, also help treat these problems at an earlier stage, which is essential if costs to be brought under control. ...

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This view from the Guardian by David Adler from July 8 2019, gives a third perspective on Greece as it goes into elections. It looks at the turbulent period of 2015-2019 when a new leader Alexis Tsipras promised to lead Greece out of the eurozone crisis by standing up to the ECB and Germany, instead of looking at Greece's own responsibility in letting debt buildup till it overwhelmed Greece. Adler says Syriza was too much on one end blaming Germany for strict conditions on a loan bailout, and after this did not work embracing the loan program in a complete reversal causing much anguish to his own support base when this led to callous implementation.  Mitsotakis is careful to say in his interview with Reuters that the vulnerable have to be protected while also committing to a path of economic growth for Greece. It says 50 billion euros was provided to help people with the cost of living crisis, pensions were increased, minimum wage increased by 20%. It also shows the need to judge by looking at the situation not by labels of centre left or center right, are people better off, will people be better off in the future, are all the bases education, healthcare, public services, infrastructure covered? Is the government honest with the people and doing everything it can after listening to the people? ...

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Churchill came up with the idea of British restaurants that serve nutritious meals at reasonable cost so that no family would suffer from lack of access to healthy food at moderate prices. This would insulate people from the high prices during the war in the 1940's for food and energy. The Guardian shows these public diners in 1940's Britain. At its peak there were more British restaurants of this kind than McDonalds's or Weatherspoon's exist today. There is a need for this type of government supported food place that serves affordable meals serving quality food ethically produced as a new form of national infrastructure. Nourish Scotland is calling for reviving it today. It tackles health inequality and food insecurity. Abigail McCall, project officer at Nourish Scotland, says- "For other aspects of our wellbeing – water, transport, healthcare, even wifi – we have built the public infrastructure to ensure that everyone has quality, universal access. We are missing that in relation to food,” said Abigail McCall, project officer at Nourish Scotland. “Poor diets have overtaken smoking as the leading cause of preventable ill health for some time now. We need the government to make a bold intervention in our food environment, and invest in delivering what the market doesn’t: healthy, climate-friendly food in a convenient way and at an affordable price."   ...

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The State Budget Crisis Task Force is co-chaired by former Fed chairman Paul Volcker and Richard Ravitch, a former lieutenant governor of New York. The Report of the Task Force says rising pension expenses and healthcare costs for public sector employees and Medicaid costs are severely reducing the ability of states in the U.S. to fund essential infrastructure improvements, education for low income students and other services. The report said there were six major threats to the fiscal situation of states- including Medicaid spending, underfunding of retirement, "budgetary gimmicks" to address the short term needs, and uncertain tax revenues. Ravitch told a news conderence: "It will be a hell of a lot more expensive to deal with theses problems in five or ten years than to deal with them now." The report focussed on California, New York, New Jersey, Illinois, Virginia and Texas. It was funded by the foundation of Blackstone Group co-founder Peter Peterson, and George Soros's Open Society Foundation....

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This article in the NYT provides a look at the features of the Republican House Health Care Plan- Both the Affordable Health Care Act and the House Plan provide incentives for buying insurance- the ACA bases these incentives on income levels whereas the House Plan does not provide additional help for low incomes or elderly. Incomes at $20,000 would see a loss greater than  $2000 under the House Plan and as many of the elderly poor living in high cost areas may not have the resources to make up for this loss of subisidies they may forgo buying insurance or have insurance coverage that protects only in a limited way. President Trump has given assurances that all will be covered. For people with incomes of $50,000 or $75000 the loss of $2000 subisidies would also have some impact. At larger incomes or the well to do the subsidies are not handed out under either plan. Under the ACA the emphasis was on income levels and high cost insurance areas the subsidies were greater, under the House Plan the subisidies would be higher for the elderly compared to the young but very low income levels are not given additional help.     ...

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Jared Bernstein of the Economic Policy Institute points to trade barriers reducing competition and free trade that should raise an outcry when free trade and competition advocates focus alone on the Trump steel tariffs. He points to estimates that show $90 billion in additional costs to Americans from the barriers that prevent Americans from paying world market prices for surgeries and medical treatment, prices similar to what is paid in advanced countries like Germany, Britain and France. A bigger barrier in pharmaceuticals prices being sheltered from market competition worldwide costs a huge $370 billion in additional costs to Americans. These two costs in healthcare would help Americans by a magnitude compared to tax cuts that do not work for average Americans with the business tax cut going more into share buybacks than into increasing wages or capital investment in 2018.  Bernstein points to Neil Irwin's column in the NYT that flags statements such as Senator Mike Lee, Republican, that the steel tariffs are a huge job killing tax hike, as being misleading. Bernstein says two actions were never taken that would have used benefits of free trade to help affected communities that lost jobs in industries such as steel and textiles, other industries affected by foreign competition.  He lists these steps as sectoral employment training, apprenticeships ,and job creation efforts in the worst affected areas. Basically no one really knows what is good trade policy, the textbook concepts and theories are out of date when countries can subsidize particular industries such as steel and dump products into the American market. At a press conference on CSPAN with the Swedish prime minister Mr. Trump stated that China was exporting more than what is officially shown as there are transshipments from other countries, some of them with no steel mills.  As Mr. Trump stated at that press conference he was elected partly because of the worst affected communities- in places such as Michigan and other states in the midwestern U.S.- that suffered from unfair trade. Bernstein admonishes the economists and politicians, media, for the headlines that are misleading in showing that bad trade policy is being pursued and trade wars are being started. This deserves attention because the Trump administration and advisors such as Lighthizer who served in the Reagan administration seek fair trade, and the Commerce Secretary Wilbur Ross successfully pushed for NAFTA trade deal renegotiation not the outright rejection of NAFTA that was mentioned in the election campaign. Ironically no one is helped by this trade rhetoric and misleading headlines. In fact the strengthening of the U.S. currency as the huge trade surplus of China goes into U.S. assets, and with the election of Mr. Trump, gives foreign competitors a continued advantage. And in fact Japan, South Korea, China, had a mild response to the tariffs as reported, because these countries are aware of global overcapacity created especially by China which produces 50% of the world's steel, and as China shifts to higher technologically value added products closing many older steel mills. ...

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Allan Blakeney was health minister of the Canadian province of Saskatchewan, and later premier of the province. Blakeney, as health minister in premier Woodrow Lloyd's government expanded a program in 1962 to cover the costs of doctor provided medical care. Earlier in 1946, the Saskatchewan government of Tommy Douglas setup a program of universal insurance coverage for hospitalization. This program of universal healthcare was extended to all of Canada in 1966. He later headed the provincial New Democratic Party and was premier of Saskatchewan from 1971-1982. During this period he introduced a New Deal for People, which included a dental program for children, prescription drug program, subsidized housing and a guaranteed income supplement for the elderly poor.

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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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David Wessel points to some problems with the Paul Ryan budget proposal. Ryan's plan does not balance the budget till after 2030, and Congress would have to raise the debt ceiling each year till then. The changes to Medicare Ryan proposes would limit how much the government spends, but the savings from this do not come for a decade, as people expected to retire in the next 10 years will still have Medicare. Ryan's proposal shows how deep the cuts will have to be if deficit reduction is done without raising taxes. Pete Domenici and Alice Rivlin who developed a deficit reduction plan, said they were disappointed that the Ryan plan "fails to address the need for new revenue," which they consider crucial for truly tackling deficit reduction. The Obama budget failed to offer a comprehensive deficit reduction plan, leading to openness for new ideas. The health care delivery system in the U.S. needs to be efficient and costs need to come down. Ryan's proposal gives no idea where the efficiencies will come from. Would they come from competition between private insurers? How will escalating healthcare costs be controlled. Another consideration is that even with its problems Medicare is less costly to administer than private insurance. Everything depends on seniors shopping vigorously for the best premiums because risks and costs are borne by seniors, with the idea that this will somehow control escalating medical costs....

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President Biden removes one of the costly boondoggles thrust on the American people with Bush's Drug Improvement and Modernization Act of 2003, which was anything but an improvement. .The following are the 10 pharmaceutical drugs that will be negotiated for Medicare prices under the Inflation Reduction Act- Eliquis and Jardiance (strokes), Jardiance, Xarelto (diabetes), Entresto (heart failure), Enbrel (arthritis). Laws passed under Republican president younger Bush incomprehensibly took away the right of the government to negotiate drug prices with pharmaceutical companies in one of the most egregious and costly decisions in postwar history by the government of the United States. It has only aggravated the problems and cots of healthcare for the American people. President Biden reversed this with the passage of the Inflation Reduction Act during the pandemic. Strangely it is part of the real culture war in America in which about 80% of both Republicans and Democrats support this but the media allowed the Bush legislation to be passed without saying it made no sense to say this negotiation was a form of price controls by the US government. This is how low the US policymaking had fallen by 2003 with legislators and press unable to make a simple point. Bush's legislation was called even more incomprehensibly the Medicare Drug Improvement and Modernization Act, when it was one of the biggest financial disasters for the American people costing them hundreds of billions of dollars in their savings and incomes to pay inflated prices of pharmaceuticals that people in Europe and Asia (India and China) were not paying.  ...

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Argentina, South Africa, Mexico, India, UK, European Union elections are taking place by June 2024 and US in November 2024. Yet it is misleading to lump them together. Much discontent is there to see as in the UK with cost of living, governance, time wasted on Brexit, India with lingering effects of the pandemic on rural voters, caste based voting. In India protest vote of lower caste Dalit voters in Uttar Pradesh and Maharashtra, even with government support in forms of universal healthcare, food for poor households during pandemic extended, cooking gas, housing support, clean tap water, direct bank account deposit to accounts of poor and farmers. Yet in the states in the south and east in Orissa and Andhra Pradesh, and generally in the south the BJP vote count increased so that losses in the north were made up leaving the percentage of vote for India for Modi's BJP party at 37 percent in 2024 instead of 38% in 2019, losing the absolute majority 240 seats of 543 yet having campaigned heavily for partners who added seats 294 of 543. In the UK Keir Starmer may see some vote preference for Labor erode yet the Conservative record is in shambles even conservative experts will say, as in India where the opposition parties offer no prospects for the future and little track record for making India the second or third largest economy in the world which the BJP has set and shown to have achieved over 10 years by taking India to No. 5 in the world economies. ...