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The Congressional Budget Office's Elmendorf says without spending cuts in payments to doctors and hospitals and other providers, providing coverage to the unisured will put the nation deeper into debt. Popular measures such as increasing preventative care, expanding medical records and rewarding doctors for choosing treatments that improve cost and quality have potential but its not proven how much the savings from this would be. The administration and the White House Budget Director, Peter Orszag, say they are in agreement with the CBO that something needs to be done to seriously reduce costs, reducing payments for Medicare and Medicaid to doctors and hospitals, and making other changes.

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The impact on the Republican party in 2012 of reform governors who came in with the 2010 U.S. elections- Christie of New Jersey, Walker of Wisconsin, Brownback of Kansas, Snyder of Michigan, Daniels of Indiana, Jindal of Louisiana and other state governors from Maine to Tennessee.

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Debbie Wasserman Schultz's vigorous efforts to fire up the Democratic party's base after the waning of support since the 2008 presidential election. She says it is a make or break moment for the middle class and drawing attention to the problems of the middle class is not class warfare. She was chosen by Obama as the Democratic National Committee chairwoman as the party heads into the 2012 presidential election.

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Speaker Boehner's difficulties getting Republican votes in the U.S. House of Representatives. 151 Congressmen and majority leader Cantor voted against the McConnell-Biden fiscal cliff agreement of Jan. 1, 2013.

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Liberal groups feel president Obama has lost the leverage he had after the McConnell-Biden fiscal cliff deal of Jan. 1, 2013, saying this only sets the stage for talk of spending cuts.

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Japan's new LDP government will follow France and the U.S. by increasing the tax rate on top income tax brackets from 40% to 45%. Currently the top rate applies to those making above $200,00. The U.S. top rate of 40% applies at $450,000. It is hoped that this will make the increase in the sales tax to 10% more acceptable to the public and keep a sense of fairness in tax policies. Tax exemptions on estates will also be reduced with the figure at 30 million yen ($340,000) instead of 50 million yen. The U.S. has a figure of $5 million per individual. Tax increases on the wealthy will bring in about $2.3 billion a year. Japan is a more egalitarian society than the U.S. and is closer to Europe in this respect. Higher taxes are supported by the conservative LDP party compared to the Republican party's strong opposition to tax increases in the U.S. It is also a more homogenous society with fewer immigrants and closer to Europe in this respect than the U.S.

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The Economist points to a second hit from bad debt in the post 2008 stimulus binge of spending in China. This is after an earlier hit, that was absorbed as a result of high growth rates and high savings. About $420 billion was injected into 5 state owned banks since 1998, according to one estimate, as a result of the first hit to China's banks from bad debt. In this second round of bad debt, covered in more detail by David Barboza in the New York Times, and merely alluded to here, many bad loans to infrastructure projects were rushed through by local governments. The Economist considers this one of the successes of the state directed banking system, that loans were quickly made and projects started in the post 2008 crisis period; and expresses the view that this hit will be absorbed just like the last hit. However the more detailed account by David Barboza and in Business Week, points to the working of a system of incentives gone astray in a capitalist system without the necessary controls or regulation. Local governments used investment companies to take on loans, which were then used to prepare properties to be auctioned off at a profit and speculative prices to state owned companies in different industrial sectors. This is part of rampant speculation in China in real estate markets. Can China with its high savings and growth absorb a second hit? This depends on the magnitude of the hit and the size of the bad debt, which depends on how long this speculative market continues to operate, and how bad debt is hidden in the books. The difference this time is that large state owned companies in different industrial sectors are engaged in this speculation. The other difference is that the high growth rates in China depend on continued large trade deficits with the USA and Western Europe, something which is not likely to continue for long, as consumers in Europe and the USA with high debt are becoming cautious spenders. This suggests that China, like the US with the mortgage crisis, faces the same effects of unregulated or uncontrolled speculative behaviours, that can endanger the banking system....

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Xi Jinping, president of China says at the Davos Forum that world leaders should "join hands and rise to the challenge" from protectionism coming from the new U.S. administration. He called on world leaders to support the Paris climate accords- "to stick to it instead of walking away from it."

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The WSJ Dollar Index , which shows the strength of the U.S. dollar against a trade-weighted basket of currencies, jumped up by 22% from July 1, 2014 to March 17, 2015, according to FactSet. Since that time the dollar has risen slowly by 2.7%. Scott Mather, chief investment officer, U.S. core strategies, PIMCO, says the dollar normally rises faster in the period when there is an expectation of rising rates than when the actual increase of rates takes place. Analysts say if the Fed raises rates in 2016 this could strengthen the dollar further, complicating the Fed's rate increase plans with slower increase in inflation. U.S. S&P 500 companies have reported lower earnings by 10-12% in the third quarter of 2015- when actual earnings dropped by only 1.5%- because of the stronger dollar, according to Binky Chadha, chief global strategist at Deutsche Bank. He says core goods inflation would have risen by half a percentage point more without the stronger dollar, meeting the 2% Fed target, had the dollar not strengthened....

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Shift of Toyota Highlander hybrid production from Japan to the U.S. with a $400 million investment in the Princeton, Indiana manufacturing plant. The Princeton plant will make 50,000 of the Highlander hybrid vehicles a year.

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Japan's new prime minister told the Japanese Parliament in a policy speech, that a crisis like that in Greece was possible in Japan, if trust in national bonds was lost and the policy of public spending to lift the economy was not reversed. This speech followed the resignation of Shizuka Kamei, as banking minister. Kamei was seen as an advocate of continued public spending. He cautioned that a policy of relying heavily on issuing debt could not be sustained for long. Japan has government debt of $9.7 trillion, which is close to twice its gross national product in 2009. Much of this debt is held by the public in Japan, but analysts have cautioned that with the aging population, it is possible that people who retire will need the cash from bonds, requiring the government to turn to the debt markets for financing. Among the proposals Kan suggested is raising the 5% sales tax to pay for rising social welfare costs for an aging population. Satoshi Arai, the new national strategy minister, says the government will draft a plan by June 22 to address the public debt. He said the government would not exceed $500 billion in bond issuance for fiscal year ending March 2012....

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With inflation running at 6.7% in Russia, the central bank has decided not to increase interest rates following the U.S. Fed's bond purchase tapering decision in Jan 2014. The ruble declined by 6% in Jan 2014 and 15% for the last year. With the economy slowing the central bank finds it difficult to raise interest rates, and with inflation the bank has less flexibility to lower rates and increase credit availability. The ruble's lower value is a result of a shrinking current account surplus, with the added effect of capital flight from markets seen as riskier by investors. Currency collapse is a sensitive issue for many Russians after the 1997 crisis and collapse of the ruble. Central bank chief Ms. Nabiullina was on television explaining the decline to ordinary Russians, saying- " It's not that the ruble is weakening but the dollar and the euro are rising in price." Economists say the ruble's weakening won't add as much to inflation as slowing demand will make it harder for retail chains to raise prices....

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Inflation in China and rising wages are pushing up costs for American manufacturers. The pressure on China, most recently in Congress, is helping to push up the value of the yuan. This combined trend is making it attractive for some manufacturers to bring factories home to the U.S. A trend in the U.S. towards non-unionized labor and the new trend to a two-tier wage level- with lower wages for entry level workers- and the shedding of legacy health care costs, is creating a more cost competitive labor force in the U.S. This extends from older industries such as furniture and auto components to newer industries and technology. The new factories setup in the U.S. use technologies that require a smaller number of workers, in most cases less than half the number of workers that were employed earlier. This adds another element in cost efficiency, though it means fewer jobs are created with new plants.

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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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The Obama idea is to use the need for investment and the need to create jobs constructively by turning it into an opportunity. The opportunity arises from the need for several things that the government is also best equipped to provide or is uniquely equiped to provide. Such things as first rate broadband access across the country, putting in asmart electric grid, putting in the new energy infrastructure of windmills, solar panels, energy efficient appliances and energy efficient heating and cooling systems. Such things as mass transit, work on schools, sewer systems, dams and public utilities, roads and bridges, in the state of the art infrastructure building that is needed. All these things create jobs and create a sustainable advantage for a 21st century economy in which US companies will compete with companies from other countries. It includes such things as education and making it possible for kids to go to college and investing in education. Two concerns are present from conservative economists about this investment on a large scale from $500 billion upwards. One is the large deficit and public spending which crowds out investment by the private sector. In this case with the danger presented by an economic crisis arises a unique opportunity for government to do the right thing if it grasps it correctly and do as President Eisenhower did in building the interstate highway system at a cost of $128 billion according to governemnt estimates in 1991. Would the private sector be crowded out? In these circumtances faced today many companies including the largest ones are faced with great uncertainties and a precarious existence, and with a climate of fear and disappearing credit are not likely to come forward with these investments, so the danger is not in crowding out but in the risk that no such investments will be made at all. The second concern is that a lot of this money is either wasted or each dollar is not spent efficiently. Obama in response to this concern says he will have new spending rules, and measuring the progress for investments made by the number of jobs created, energy saved and American competitive position in the world. As an indication of the jobs created for each dollar spent the nation's governors have $136 billion in road bridge, water and other projects in which the money can be put to immediate use. Their estimate is that each 1 billion dollars spent would create 40,000 jobs. The estimate is from the nation's governors who met with Obama in the 1st week of December 2008. Local and regional transit systems have $8 billion in additional projects that can begin immediately like buying hybrid buses ans expanding light rail systems. ...

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Republicans held onto 4 of 6 seats in recall elections following Governor Walker's spending cuts and restrictions on the collective bargaining rights of public sector unions.