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The basic problems facing American health care. Douglas Elmendorf , head of the Congressional Budget Office, says none of the bills he has seen make the fundamental changes needed in how medical care is delivered and paid for. The big issue is the unwilingness of different interests to accept serious changes. THe NYT says the long run solution to the problem of rising costs is to move away from the fee-for-service system that pays hospitals and doctors for each additional service they provide and into anew system that is organized around ways that encourage low-cost and high quality healthcare. The difficulty is that the long run may be too far, considering the seriousness of the crisis. Elmendor also suggests taxing employer provided health benefits, as this will discourage the excessive use of medical care. As the NYT says this is politically risky, even though it believes this may be a way to the new system which has to discourage the use of health care in the manner it is conducted now, with too many tests being conducted. A new system requires an enlightened approach on the part of each interest group in the face of a crisis, and the failure to do that may only end up retaining some of the worst aspects of the old system just mentioned that drive up costs and make universal health care unaffordable....

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Krauthammer says President Obama has failed to come out openly in support of the Bowles-Simpson commission's recommendations on deficit reduction. The recommendations were made in December 2011. The President's February 2011 budget did not take up these recommendations. He gets a sense that there is too much electioneering in the Obama posture on deficit reduction- being in the best position for the 2012 presidential election rather than a sincere effort. He suggests the Republicans pursue a short term debt ceiling hike of $500 billion containing $500 billion in budget cuts by passing this in the House. And couple this with a call to follow the Simpson-Bowles recommendations which, in one option, cut $1.1 trillion of deductions, credits and loopholes while lowering tax rates across the board to a top rate of 23%. This would give enough time to come up with a thoughtful and open effort with public scrutiny, and is preferable to the current closed door negotiations without the deliberations necessary for decisions of such far reaching consequences. Failing this there is the McConnell Plan B. Boles- Simpson focussed on tax expenditures as a key part of their plan. Martin Feldstein and other experts also point to limiting or eliminating "tax expenditures" (the deductions and loopholes that reduce revenues) as a key part of the solution to the U.S. deficit problem....

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The view from the streets of Athens in November 2011, by Landon Thomas, shows Greece teetering on the brink. A situation it appears that is not fully grasped by EU officials who have throughout 2009, 2010 and 2011, acted always lagging far behind new developments and struggled to cope. Greek manufacturing will contract by 6% in 2011, on top of earlier declines. Auto sales have practically ceased and are at the lowest levels since 1993. The number of uninsured drivers increased by 500,000 in just the last 3 months, taking the total to 1.5 million. And small shops in Greece which depend on domestic demand are closing every day. A flood of money is leaving Greece. Since January 2010, Greece's banks have see a loss of $63.5 billion in deposits, 20% of Greece's annual economic output. Greece's bankers estimate that in just the last 2 months, September and October 2011, the numbers jumped to a figure ranging from $13.8 billion to $20.7 billion. The government has imposed value added taxes and a special real estate tax attached to Greek electricity bills, which is further cutting into consumer spending. And the public is blaming the politicians. Any setttlement by a unity government with the EU may be illusory, because the rapid deterioration of the economy would hasten a default. ...

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James Pressley, in this review of Joseph Stiglitz's new book- "Freefall: America, Free Markets and the Sinking of the World Economy," says Stiglitz's advice should be taken into account by the new administration. Stiglitz, says, the Obama administration has so far offered no alternative vision of capitalism and is only "mudddling through." It is simply following the course the Bush administration had taken. And has retained as key economic advisors, Geithner, Ben Bernanke and Summers, all from previous administration's economic teams, thus largely removing the possibillity of serious change. And by doing so, says Stiglitz, the Obama administration has "squandered the opportunity," to fix things that needed to be fixed in the economy. Stiglitz, says Pressley, urges Americans to think what kind of America they want to see, what kind of society they want to make, and then what kind of economy will get them there. Stiglitz wants to see banks back to where they they only make loans, and act as an efficient payments system, and not engaged in risk taking. At a meeting of the American Economic Association, Stiglitz, presented a paper that suggested that between globalization for integrating world financial markets and keeping them separate, the latter is the better course. Financial markets he believes, need circuit breakers to not bring down the whole system....

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BP is by far the oil company most concentrated in deep water oil exploration. So it is coming up for criticism in the industry for not having prepared better for a subsea oil leak at this depth. Talking with journalists BP's President Tony Hayward acknowledged this failure to "prepare for an emergency of this kind. " BP appears to observers to be trying to create the technology to deal with the leak on the go, and Hayward accepted this criticism by saying BP should have done things differently and had the capability to act instantly. Hayward went through two days of hearings in Congress, and the exchange of blame between Transocean Ltd, the Swiss based company that owned and operated Deepwater Horizon, and Halliburton which provided services for the rig, and BP, only worsened its image. Testimony showed that company managers at BP decided to go ahead with finishing work on Deepwater Horizon well even though tests showed highly combustible gas had seeped into it. The failure of a massive effort at its Houston offices to have much to show for results, only demonstrates that poor quality systems and maintenance cannot be corrected easily no matter what the scale of the effort. The publicity surrounding BP's handing out contracts to potential claimants to seal off future claims has not helped....

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Th Basel Committee on Banking Supervision set strict financial guidelines for capital and liquidity that banks have to hold, but failed to implement early compliance. Banks get 8 years to comply for most of the banks, and 13 years for some of the banks. Increasing capital requirements by triple the current levels in the form of current equity, as required by the new Basel rules, gives banks a larger buffer in a situation that some of their assets lose value in a crisis such as the one in 2008. The US argued for stronger requirements and early implementation. Germany held back the implementation timetable mainly because its regional banks are saddled with bad loans; which might require $100 billon capital infusion by the German government, if early compliance was set in the new rules. The result is that the Basel rules have not grasped the opportunity to act quickly to strengthen the banking system, according to Prof. Jeremy Stein of Harvard University, a former advisor to the U.S. Treasury Department. In Stein's view the timetable is so far out, that another crisis will probably take place before the implementation. In the event, regulators from the U.S., Germany, and other countries let fears of tightened lending by banks prevail to an extent where the new rules timetable is stretched way out for 8-13 years....

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So far the Italian government has already recovered $15 billion for 2011 in its fight against tax evasion. The fight includes an advertising campaign depicting tax evasion as anti-social activity and vigorous enforcement by tax officials and the financial police. Italy has already banned cash transactions to reduce possibilities for evading taxes. This problem is severe in Italy because the underground economy is about 17.5% of GDP. An estimated $150 billion is lost to the Italian treasury from tax evasion. As a result Italy has a chronic budget deficit problem and is not able to make necessary investments in improving competitiveness to keep up with other countries. This may be one of the lasting achievements of the new administration of Mario Monti, along with its efforts to change the way the public thinks about other issues including labor laws that place large burdens on small companies in hiring practices. Italians sense the need to change the way they think about taxes because this is one way to reduce the burden of austerity measures- higher tax revenues could enable lowering taxes. It would also enable investing in improving competitiveness that would the economy grow and provide the jobs to reduce the high unemployment rate among young workers. One of the lasting positive aspects of the eurozone crisis is the change in the way the people and society think about many issues....

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The Netherlands government of prime minister Mark Rutte collapsed on April 22, 2012, after the Freedom party of Geert Wilders said it would not support futher budget cuts. Mr. Wilders said: "We don't want our pensioners to bleed just to meet the dictates coming from Brussels." Government forecasts had predicted the Netherlands deficit at 4.6% of GDP in 2012, above the 3% goal set by the European Union. And negotiations that collapsed were about making $18 billion in budget cuts to help meet the deficit goal. Rutte will now lead a caretaker government till elections in September or October 2012. Credit agencies may lower the Netherlands credit ratings from AAA and this would raise Netherlands borrowing costs in coming months. The result would be to increase the deficit even further. The Netherlands government was a strong supporter of Germany to introduce strict austerity measures and budget cuts in the eurozone during the debt crisis in EU countries in 2010-2011. With the elections in France and the defeat of French president Sarkozy in the first phase of elections by Socialist candidate Francois Hollande, the austerity programs in Europe appear to be unravelling. The deeper Europe goes into a recession in 2012-2013, the more likely new measures will be needed to address competitiveness, growth, interest rates and overvalued currencies as opposed to largely fiscal and budget measures alone....

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With yields on ten year Greek bonds reaching new highs, the Economist says it is time to go to Plan B. The German government wants to see something different from a continuation of the 2010 plan and merely loaning more funds to Greece. One option is for Greece to pledge privatization proceeds as collateral for new loans. Another option is the restructuring of Greece's debt, even though the German government is reluctant to impose losses on holders of Greek bonds. But Trichet and the ECB are opposed to any restructuring. ECB officials fear this could cause a crisis like that caused by the collapse of Lehman Brothers in 2008. And privately ECB officials say they could go so far as to refuse to accept Greek bonds as collateral for ECB loans if a restructuring goes through. The contagion from a Greece default could affect Ireland, Portugal, and impact the European banking system and the ECB's own balance sheet. Yet a sounder plan would be for European governments to come up with the funds to recapitalize hard hit banks, knowing that Greece will never be able to pay back its loans under the current plan. The IMF and the German government should push for an orderly restructuring of Greece's debt as the only workable solution, says the Economist....

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GM executive Mark Hogan had candid discussions with Akio Toyoda when Hogan began a second five year stint at NUMMI in 1997, and Akio was executive vice president at NUMMI in 1998. NUMMI was a joint venture between Toyota and GM. He now joins the Board of Directors at Toyota, the first outside board member, and only the second foreigner to do so after Jim Press. His role is to help counteract the insular culture at Toyota based in Nagoya, Japan, where most decisions end up coming to Nagoya. This was a problem that led to poor handling of the recall crisis in 2010, when Akio Toyoda brought Hogan in as an advisor to Toyota. He will listen to voices outside Japan and have direct access to Akio Toyoda. Hogan told the media: "I see my role as listening to global voices outside of Japan and then sharing insights that will help Toyota to respond more quickly to changes in society." His role also includes looking at Toyota's Brazilian operations, where Toyota has only 5.2% of the market and lags far behind Fiat, VW, and other competitors. Hogan headed GM's Brazilian operations in the 1990's and says he would kid Akio about Toyota's underperormance in Brazil. In 1994 Hogan left GM to become president of Magna International, a Canadian auto parts maker....

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The humble roots of Jorge Bergoglio, born of Italian immigrants to Buenos Aires, Argentina. He studied theology in Germany before becoming a Jesuit priest in 1969. Bergoglio was made bishop in 1992, archbishop of Buenos Aires in 1998, and cardinal by Pope John Paul in 2001. Bergoglio has spent much of his time working with the poor and improving education and has avoided the titles and trappings of the position. He lived in an apartment near the cathedral in the Plaza de Mayo in Buenos Aires, and cooked his own meals as archbishop. He loves Argentine tango music and is a soccer fan of the San Lorenzo Club, which was founded by Father Lorenzo, a priest who assisted at-risk kids. The sense of observers is of a person of overwhelming authenticity. Many in the Catholic Church worldwide feel this was a good choice for Pope by the cardinals because this is likely to bring the church closer to the people in Latin America, Europe and other parts of the world, and infuse the Church with new energy for renewal. Evangelical churches have spread in Latin America, particularly in Brazil, and church pews are seeing smaller numbers of people in Europe. Bergoglio, now Pope Francis, is seen as the right choice to reverse this trend and bring a regeneration of Catholicism at a difficult time. ...

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HP CEO in aplanned reorganization will merge the printer business with the PC business. It is ameasure of how far the PC business has come since Mr Hurd was made CEO 4 years ago, and after he hired Mr Bradley a former Palm CEO to shake up the PC business. Mr. Bradley has made the PC division supply chain more efficinet especially in the fast growing consumer netbook PC business, and has cut costs. Meantime the printer business under Joshi has stagnated. The PC business was merged into printer business by Fiorina in the hope that Joshi could make a difference. Hurd separated the two and put Bradley at the PC division.Now its the PC business that is taking off and its head who will try to improve the printer business. Bradley has run alean business and improved PC margins even as prices of PC's have tumbled. HP also passed Dell in PC's sold. In the quarter ending July 31,2009 HP PC sales were$8.43 billion and $386 million in earnings, accounting for 12% of profits, printer and ink were $5.66 billion and $960 million in earnings for 30% of overall profit. Hurd told analysts in aconference call that he was disappointed in how the printer unit inventory was managed, and that HP had to get some internal stuff right. The ...

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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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A locally produced ton of hot rolled coil steel in India, an industry benchmark, is up 42% in price to $675, since January 2008, when Tata unveiled the Nano. Raw materials account for a higher portion of the costs of making a car like the Nano, and account for 23% of the costs of making the Nano, according to consultants Global Insight. This means margins will be harder to preserve on the Nano. As Ratan Tata, Chairman of the Tata group of companies put it at a shareholder meeting July 24, "if we passed on all costs to the consumer, it will affect demand, and if we don't it will affect margins". Tata is accomodating suppliers like Rico Industries that make the engine blocks that use steel for increased costs of raw materials. Other costs also are going up. For new car loans the interest rates are between 14 and 16% and fuel prices are going up making the cost of operating the 50mpg Nano costlier for those riding motorcycles. Tata faces other higher costs, its managng director Ravi Kant says the project for the Nano plant in Singur is costing more. The $470 million invested so far is 18% more than it had projected in January and double the amount stated when the prject was started in 2006....

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Not much in any meaningful way is being done so far for homeowners facing loss of their homes. The bailout plan has wording that encourages the government to help but no concrete measures beyond that. At this point loan modifications by banks are doing little meaningful to help homeowners. Some critical measures of what is happening. According to Sheila Barr of FDIC troubled loan portfolios have yielded about 32% of book value compared with 87% for loans in which the borrower is current, in her statement in Congress. But with fear gripping the credit markets the banks are reluctant to take any immediate losses by writing down principal balances unless the government steps in, because their capital is under huge strain and some banks are going under. Deutsche Bank estimates 40% of homeowners or about 20 million households will owe more than their home is worth by the time the housing market stabilizes. This suggests he scale of the problem as Martin Ferldstein pointed out in the WSJ someof these homeowners may simply walk away from their home as a rational decision. It also suggests how this combined with rising unemployment could lead to significant drops in consumption spending making the situation in the economy much worse, and allowing rising unemployment to play an additional role in increasing home foreclosures for the first time....

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This very exceptional report from the city of Recife in Brazil's northeastern state of Pernambuco, comes from WSJ reporters Johnson and Jelmayer. It is about the physicians Vanessa van der Linden Mota, and Ana van der Linden Mota, her mother, who first alerted health authorites in Pernambuco about the cases of encephaly and the links to the mosquito Zika Virus in Recife, Brazil. From 147 recorded encephaly cases, and babies born with shrunken skulls or calcified brain structure in 2014 in Brazil, the cases reported jumped to 4,180 suspected cases. Estimates of cases by 2020 for such cases run up to 50,000 to 100,000 if the problem is not tackled. The family of the van der lindens come from Dutch-German immigrants settled in northeastern Brazil, a less developed region of the country. The family is unique with five doctors including neuro pediatricians Ana and Vanessa working in public hospitals in Recife , and father Helio a neuro surgeon. The entire state of Pernambuco has a total of 15 neuropediatricians, according to this report. The Ebola Virus emerged in countries such as Sierra Leone and Liberia which suffered from war and neglect of health infrastructure. Here in Pernambuco state, as reporters Johnson and Jelmayer point out, the problem stems from neglect in public health infrastructure, especially sanitation and drinking water for shantytown dwellers and vast majority of poor residents in a city of 3.5 million, typical of developing countries in Latin America and South Asia, where development in some parts of the country have lagged far behind, and where needed public health infrastructure investments have not been made. Lack of dependable drinking water means collecting water in containers that are susceptible to breeding mosquitoes, such as the mosquitoes carrying the Zika Virus. A public debate on the lack of attention by socialist and worker's party led governments to this type of infrastructure and transportation services was already underway in Brazil leading to widespread protests in 2013. A $226 million investment in a soccer stadium in Recife, and similar investments in other smaller cities in the northeast were made under the Worker's Party government. Large investments for the Olympics now come as the economy contracted in 2015, and Brazil is hurt by another boom-bust cycle with the slowdown in China- with fiscal austerity policies, a loss of a third in the value of its currency, and the popularity rating of the newly elected government from the Worker's Party in single digits....

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How Merck has approached the Vioxx lawsuits. Taking each case and looking at whether Vioxx was taken continuously for months or years and its proximity to the heart attack, did Vioxx or something else cause the heart attack. It had no choice because 105 million prescriptions were written for Vioxx for the five years preceding the Vioxx concerns, 100,000 heart attacks for 20 million Vioxx users. The question remained what really caused the heart attacks cholesterol, obesity or something else other than Vioxx, or Vioxx, in each individual case the situation could be different. About 45,000 cases have been filed and so far only 20 have reached juries. It has cost Merck $1 billion but its exposure would have been huge, $25 billion vs the $5 billion this strategy might cost. Its stock has gone up 80% since it hit a low from the Vioxx controversy. So far Merck has won most of the cases that went to juries, and this has discouraged additional lawsuits.

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The way a number of lawsuits and a antitrust investigation turn out about whether Abbott violated antitrust laws in efforts to prevent an Israeli company selling a generic version of Aboots drug for cholesterol called Tricor, will say a lot about how far drug companies can go in fighting generic versions coming from competitors.

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In Europe, France, Spain, Germany and other countries are giving cash subsidies to customers to buy cars when they turn in older cars. These refunds range from 1000 to 2500 euros, and reward the purchase of smaller more fuel efficient vehicles. It has boosted sales in Europe where sales are running at an annual rate of more than 13 million because of the subsidies, according to Credit Suisse analyst, which is well above the 11 million level of last year. The average American car says the analyst has been on the road for 9 years similar to that in Germany, so it makes sense for the USA. He says it could increase sales in the USA to 12 million cars, down from the 16 million sold in 2007 or the 13.4 million rate of 2008, but far higher than the 9.5 million rate in the first few months of 2009. In Europe small cars are dominant and it plays to the markets of large carmakers like Peugeot, VW, FIat, and Renault. But in the US Japanese carmakers are dominant in the small car market. Detroit carmakers make too many large cars and pickup trucks so the impact would be less. But the program could be fashioned in the US on a drop down in size and increase in fuel efficency, so that the clear direction is towards smaller cars. Turning in a pickup truck for a family car like a Malibu or a LaCrosse might promote fuel efficiency, and move things in the right direction. Its useful to note that even in Germany more expensive cars or brands have barely benefitted German car sales jumped 21.5% in February, but mass market manufacturers recorded a 37% surge, while sales of premium cars fell 19%. In Italy which started its program Feb. 6, buyers receive 1500 euros for trading in acar at least 10 years old. Fiat Punto sales have shown a strong increase. Fiat's facory in Melfi, southern Italy, is now running at full capacity after running on areduced scale from October 2008 to February 2009. It makes the Punto. In France 30-40% of car sales are coming from the scrapping deal, according to French Auto Manufacturers Association. Overall sales are running at about 6% below last year's rate, but in the absence of the scrapping deal sales might be off 10-15%. One concern for the French is that sales not drop off after the scrapping deal stops.France saw this happen in 1997and 1998 after ascrapping deal in 1994-1996. However considering that the cost to the German government for scrapping deal was $2 billion, the solution to this would be continue this program till the economy recovers and car sales are strong. Considering the benefits for an important industry and the societal benefit in lower pollution, it would be worth the cost....

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Chrysler's job cuts would reduce its 2006 work force of 80000 employees by 30%. These are deep cuts, about 11000 cuts were announced yesterday and these are in the Michigan, Ontario, and Ohio plants. Sales for Chrysler are down 3% so far this year, but October sales were down 12.5 % on an adjusted basis compared to 2006.