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One in six dollars generated by the U.S. economy goes to pay for health care, almost twice the average for rich countries. It hurts America in many ways; by being a burden on the taxpayer when it comes to Medicare and Medicaid paying for the poor and the elderly, on companies being one reason GM went bankrupt, it eats up federal and state budgets, rising costs make any form of future coverage for all unsustainable, and it robs other priorities such as infrastructure building and other national scale investments. The Economist says that if it had to design a system from scratch, it would go for a system based mostly around publicly funded health care. For the uninsured the solution of an employer mandate is now well accepted, so this is not an issue. What is an issue is how to make the new system affordable? Here the Economist says that whether in stages or in one move, the tax deductability of employer paid health insurance, which is costing the U.S. government $250 billion ayear, has to go. It is necessary to remove this deduction, and its something all interests involved will have to swallow, as other savings are smaller and will not be adequate. The deductability of insurance makes the true cost of insurance transparent, so it supports gold plated insurance. This does not make cost control the pressing priority it needs to be. So the deducatability of employer paid health insurance hurts both ways. The other necessary action is in the area of moving out of the current culture where most doctors work on a fee-for-service basis, where the more tests they prescribe or procedures they perform the greater their incomes. This acts as a perverse incentive, and has aruinous effect in mushrooming health care costs in America. Cutting back on unnecessary tests and procedures, and prescriptions , would save 10% to 30% of health costs says the Economist. And it says this has been proven with the Mayo Clinic in Minnesota and Kaiser Permanente in California showing that cutting back doesn't hurt care and outcomes., so much so that cutting back would occur along with improved outcomes. But Americans with employer paid insurance just take things for granted as its not much out of pocket expense for them. THis creates the lack of a force for controlling costs even as employers are shouldering abigger and bigger burden, and the employee who thinks he is doing fine actually is seeing more of his salary dollars going to pay for his health insurance. In a way the consumers of health care are stuck with the perception that they are not somehow paying for these mushrooming costs and too manytests, procedures and prescriptions. This perception leads them a false sense of comfort with the system they are in, and a fear of something new fanned by the medical lobbies, that any change will impact users negatively. This makes the whole discussion on health care or the process of finding solutions to become an exericize in which terms like "rationing" and "choice" play a distorting role. ...

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Chief Justice Roberts let the Obama healthcare law stand arguing that the individual mandate for everyone to carry health insurance acted as a tax, and was on these grounds constitutional. Justice Roberts found middle ground by first rejecting the Obama's administration's argument that asking every American to buy health insurance was legal under the commerce clause, and following this with the a non partisan approach that found the mandate legal under the tax clause. Roberts was guided by the writings of an eminent legal authority, Justice Oliver Wendell Holmes. Roberts referred to this in his opinion saying: "It is well established that if a statute has two possible meanings, one of which violates the constitution, courts should adopt the meaning that does not do so." Legal scholars speculate whether Roberts changed his vote later on or whether the Justice had used the questions in the hearings on the law to explore the idea that the law could be constitutional on different grounds. During the arguments in the hearings Roberts said: "The idea that the mandate is something separate from whether you want to call ita penalty or tax just doesn't seem to make much sense."...

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Howard Dean, former Governor of Vermont, where Dean helped set up health care improvements, says the bill currently in Congress for health care reform does not deserve to be called reform and may do more harm than good. He points out that it does not insert competition into insurance markets, does not significantly lower costs, and does not improve the delivery and use of health care services. And few Americans will see any benefits till 2014, by which time premiums will have increased significantly. He sees insurance companies as winers in this bill, and the American taxpayer about to be fleeced with a bailout in a situation that dwarfs even AIG. One of his keen criticisms is already apparent to the public in this health care bill, that clear thinking has been thrown out in favor of compromise and political calculus, and by political moves the bill has been stripped of real reform , the end result being a bill crafted for votes and not to reform health care. It also then sets an irreversible course of how future healthcare reform is done, doing more harm in the future. ...

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The $350 billon in proposed cuts to Medicare and Medicaid in the 2011 deficit reduction talks will do little to reduce the rapid rise in medical costs. Instead it shifts the costs to seniors, state governments and public hospitals. Gail Wilensky, former head of Medicare under the first President Bush and now a senior fellow at Project Hope, says this should not be confused with real reform to Medicare which reduces the rapid increase in costs. It does little in the way of fundamental changes that would reduce the growth in costs. About $53 billion comes from reductions to senior's ability to buy extra Medicare supplemental insurance or Medigap. Another $14-26 billion would have the government reduce payments to hospitals for unpaid debt. The few items to curtail fraud in the use of CT scans or purchase of power wheelchairs would provide savings of $2-3 billion over 10 years. $4 billion comes from lowering Medicaid payments to hospitals treating a high percentage of low income patients, hospitals such as Cook County Hospital in Chicago, San Francisco General Hospital, and Parkland Hospital in Dallas....

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UnitedHealthcare says it will keep parts of the healthcare law relating to preventive healthcare services without co-payments, allowing parents to keep children on insurance till age of 26, even if the Supreme Court rules against the healthcare law. Most insurers see these parts of the law that are popular quite favorably.

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The EU's competition commissioner to crackdown on pharmaceutical companies that are delaying the entry of generics drugs with various tactics that are anticompetitive. EU has raided the offices of several marge drug companies and retrieved documents that show this activity was going on. About 5% of medical bills or 3 billion euros coud have been saved from 2000 to 2007, if companies had allowed generics to enter the market earlier and not resorted to these antitcompeitive strategies. Like paying off generics companies or having so many patents on the ingredients of the drug, in one case 1300 patents on one single drug, and then suing the generics companies to tie up the case in the courts.

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Baucus is a six term senator from Montana. He won easy re-election in the fall. Question are being raised about the extent of fundraising Baucus is doing even as he is conducting the negotiations for writing up the health care reform bill. He continues to accept donations from health care executives and health care companies. Public Citizen advocacy group says that Baucus's fundraising in the middle of the health care debate is very troubling. As chairman of the Senate Finance Committee, Baucus is a key person in the health care legislation development.The Washington Post says health care companies gave Baucus $1.5 million in 2007 and 2008 as he began to hold hearings for the health care reform debate. The health care industry gave $170 million to federal lawmakers in 2007 and 2008, with 54% going to Democrats, according to the Center for Responsive Politics. Senator Grassley of Iowa, the ranking Republican in Baucus's committee received more than $2 million from the health care industry since 2003. House Ways and Means Committee chairman Rangel took in $1.6 million, and ranking Republican Dave Camp $1 million. Clearly any new health care legislation will fall short on achieving the critical reduction in health care costs that is needed to help the U.S. economy as long as lawmakers are beholden to lobbyists and donations....

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Public opinion in the district of Steve King, a Republican in the House of Representatives favoring defunding of Obamacare healthcare law.

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Ron Wyden, Democratic Senator from Oregon, on maintaining competitive choice for 200 million Americans who have to buy insurance outside the Exchange proposed in many of the bills being put forward in the U.S. Congress. This lack of choice between seriously competitive plans will leave the situation in the same way that it is today, with little hope for controlling runaway costs and doom health care reform. The key to controlling costs says Wyden is introducing choice and competition. Wyden will introduce this plan as an amendment called Free Choice to legislation being debated in Congress.

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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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A study by Dr. McCormick of the Harvard Medical School and professors at the City University of New York School of Public Health at Hunter College, shows that the anticipated savings from conversion to medical records may not materialize to the extent expected. This study of data from 1100 doctors of 28,000 patient visits shows that with access to digital records doctors actually increased the number of tests ordered- from 12.9% of visits without digital records to 18% of visits with digital records. For more advanced tests such as MRI and CT scan the rate was 70% higher. Dr. McCormick says this may be because the new digital technology may have made it easier to order tests.

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The French system what works and what does not work compared to the Anglo-Saxon systems of Britain and the USA. Health care works, public transport and high speed rail works, nuclear energy and the energy industry works, education works for small elite universities but fails in the larger system. The large public projects are executed well, and France has done well with its long tradition of the state building infrastructure projects. But when it comes to individual initiative and starting up new companies such as in computers and high tech of that kind, France does not do so well. And the state collects a larger proportion of taxes than in other countries to finance these benefits. France is also good at rule making, which serves it well in controlling the kinds of bubbles that regularly hit the Anglo-Saxon countries. And with 21% of jobs of all workers in France in the public sector and government, with 49% when one includes related sectors protected from economic downturns, the French workers are much better protected than workers in Britain, USA and other countries from economic downturns. Unemployment stays high in upturns and at 8%, and in downturns does not go too far above 8%....

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The sense that is growing in the House that the healthcare bill has made compromise after compromise ending up with abill that is good for insurance companes and the pharmaceutical industry. Mr Obama's opposing the bill permitting importation of drugs to help Americans is on more evidence to these members of Congress and the Senate of being sold out by Obama.

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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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New ways to price drugs based on how well they work for patients.

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