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U.S. healthcare spending of about $3 trillion comes with poor results. The cost per person is about three times that of countries such as France, Britain, yet the results show U.S. doing extremely poorly. The author points out that less spending on healthcare and more on social services in areas such as education, nutrition, housing and other services would improve the outcomes and results. It is this missing factor that is helping other countries in Europe, Japan and China achieve better outcomes and returns per dollar spent.  Social spending can affect such things as nutrition, exercize levels, lifestyles, housing and result in dramatic improvements in obesity levels for instance, or inflammation levels in the population that play a role in many diseases. The idea is prevention. This is not happening because higher health dollar spending has lobbies to support it. Social spending also is a dollar expense that shows up immediately whereas results are spread out into the future as a longer term benefit with healthier populations that need to consume less healthcare and treatment. Elizabeth Bradley, president of Vassar College is an expert on this subject. She says social services spending gives more bang for buck  in health outcomes.  The point is relevant also for countries in South Asia and Africa that have taken some on some aspects of the U.S. health system resulting in health care spending that does not deliver the most for the dollar spent, and ignores the critical role of prevention.  The solution lies in moving these health care dollars out of the health care spending and into education for health outcomes, lifestyles, exercize habits education, and into social services that enable prevention and better health. ...

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Cia Mexicana de Aviacion, Mexico's largest airline filed for bankruptcy protection in July 2010. The airline says losses amount to $350 million since 2007, and the debt is about $1 billion. Mexicana and Aeromexico were given government bailouts in the 1990's, later merged into one government run airline holding company called Cintra. In 2005 Mexicana was sold to hotel chain Grupo Posadas SAB for $165.5 million. The Mexican government is trying to introduce more competition in the airline industry and opposes another merger of the two airlines.

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New winds in South Asia. Democratic change and peaceful economic development comes to Nepal as elctions are held for a new Constituent Assembly to write a new constitution. One leader says Nepal cannot ignore the winds of liberalization privatization and globalization. What are the effects of change in China, in India and recent changes in Pakistan on Nepal? And the changes and two transitions in Russia to Yeltsin and then to Putin. And again in Eastern Europe. All showing divergent paths to peaceful economic development They have to be significant.

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Questions raised about the government's committment to serious health care reform. New leaders of China who took power in 2002 and 2003 with concern for the poor, did not put discuss reform till 2006 and during this crisis there isn't the urgency that is needed. Recent documents, says the Economist, that were circulated secretly within the bureaucracy for 3 weeks before being made public, provide no clear target about how much people would be reimbursed for medical treatment. The other concern is that the central government provides only 40% of the 850 billion yuan allocated for additional spending on health care in the years 2009-2011. This is about $125 billion. Burt local governments may not be keen on spending on health care as officials are still judged by how much they can boost employment and GDP growth. Over three years the central government's annual share of the additional spending on health care of 850 billion yuan is 111 billion yuan, according to Caijing, a business magazine.But the 2009 budget on health care is 118 billion yuan, so its not clear that things add up. The central government's additional spending in each of the 3 years is only $16 billion. How this can provide help to the 200 million uninsured, the insured who still pay a large amount for health care, and pay for essential pharmaceuticals on a list prepared by the government, and pay a portion of the expensive diagnostic tests that hospitals like to make money from, is not clear. The whole system will have to be overhauled so that hospitals do not have the incentive to prescribe these expensive tests and pills that cost more. The government says it will be 2020 when 90% of Chinese are covered by agovernment financed health insurance system- 11 years away. This only means that domestic consumption may remain depressed for a decade or so. With export markets collapsing, this leaves China dependent on infrastructure spending for growth for a long time, and lower growth rates with higher unemployment. ...

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The language and tone of the leaders says something about what is likely to be the outcome of the G20 summit. Its a first for significant participation, as countries as diverse as Russia, China, India, Indonesia, Saudi Arabia, and the Netherlands are represented. The credible positions of both sides, the US, UK and Japan, and the European side of France, Germany and the Czech Republic, well presented, provide for some serious discussion and negotiations. France's Sarkozy and Germany's Merkel want to see a global regulator that would reach inside the borders of the US with stricter regulation. Sarkozy calls this "nonnegotiable." And he said that he would reject an agreement that puts off stringent new regulations on banks, tax havens, and hedge funds. He said "the compromise has to come from all countries around the world." US President Obama said that if there is going to be renewed growth it can't just be the US as the engine, everybody is going to have to pick up the pace," at the same time saying that the US had to be concerned about its own deficits. The fact is that the US stimulus will mostly help a severely impacted domestic economy recover with social safey net payments to local and state governments and unemployment insurance, as well as targeted investments in infrastructure, education, energy and health care. It will not mean anywhere near the kinds of imports the US made from other countries, especially China. And Obama made that clear when he said the US will never return to that situation, where the US had become a "voracious consumer market." For the Germans the major market for their middle companies is China, and China has its own stimulus spending on infrastructure spending, which should provide for continued imports of machinery from Germany at a much lower level. Thus Germany and France see a strong tendency to call the source of the crisis and repeat that call till the US listens, and refer to the failure of free market capitalism in its unregulated form. And to insist on fixing it through a global regulator with strict and systemwide rules. So you hear this in Merkel's words, "the foundation for this finacial architecture must be laid now, that is why we seem to be so tough." While the vivacious Sarkozy talks of compromise, and a US gesture in regulation in return for Franc's gesture of joining NATO, the mild mannered Merkel is clear and focussed about her concern. She rejects the idea of linking stimulus spending demands of the Anglo-Americans with the Franco-German demands for global systemwide regulation. "This is not a bargaining chip," she says. The media may mistakenly report lack of consensus as a failure of the summit. But in the long run in the presence of good positions on both sides, it could lead to some tough negotiations even if continued at another meeting. And result in something serious, credible and lasting in its impact, rather than something that was easy and did not in Andy Grove's useful words involve "constructive confrontation." ...

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China's economy has run out of road says Streetwise in the WSJ. Evergrande is the first of many implosions. This view is that Evergrande is China's economy in miniature, built entirely on borrowed money and credit. Real estate developers and other sectors run in the style of Evergrande with borrowed money will run out of credit.

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GM sells just 30,000 Cadillacs in China. It is one of 8 brands with total GM sales of 2.8 million vehicles in China. The luxury and premium vehicle market is growing in China with 8.5% of the total vehicle market in 2012. GM's 30,000 Cadillac sales makes Cadillac at only one tenths of one percent of its China sales volume, and way behind luxury car makers Mercedes and BMW. GM plans to take a larger share of this market and increase Cadillac sales to 100,000 by 2016. To do this GM will launch a new advertising campaign in China with actor Brad Pitt and increase dealers in China to 200 by the end of 2013. A new Cadillac will be introduced every year through 2016. Cadillac comes in the SRX, a small sport utility vehicle, and the XTS, a full size sedan. A 8 cylinder Cadillac, the SLS, will be discontinued.

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Friedman on the $43 billion infrastructure he saw in China and the crumbling infrastructure in New York City and driving from dilapidated La Guardia airport in New York city into the city vs the new Shanghai airport and the magnetic levitation trains into Shanghai. He says don't forget that they are mere snapshots. And he is very aware that you go 100 milews outside Beijing and you find a poor developing country. So which is the real China, no easy answers. Give credit to their dedication and all the hard work and the motivation and planning to Chinabut still ask the questions about what we should do here in America and what countries like India have to ask what they should do and go about doing it. China will have its own questions and problems to think about too as it has to figure out what their best allocation of capital will be, what their policies should be from the birth rate and demographic changes, to the environment, and to ways to bring the rest of the country and farmers into the picture and see that the gains from now on reflect the imbalances in growth. The country building the latest infrastructure will always have the latest infrastructure and that will be the next country around the corner with the capital and energy to do it, the USA or India or Russia or some other country. The real progress is in the quality of life, of health and the resources for living productive healthy lives for most of the inhabitants of any country or region and that goes beyond politics or nationalism or rivalries or vested interests of groups of people, as it depends on learning from the best that every productive mind anywhere in the world or any productive place anywhere in the world has to offer. And the thing about this is its never a goal only because in a true sense the road well travelled is the destination for this kind of progress. ...

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The resurgence of the Pudong District of Shanghai, with large investments, an industrial base, migration to the cities, and favorable location at the mouth of the Yangtze River. Since 1995, 70 skyscrapers and 120 million square metres of floor space according to official estimates, have been built in Pudong. Real estate agency Jones Lang LaSalle says occupancy and rates compare favorably with Manhattan in New York. New York has 10.3% empty space compared to 9.5% for Pudong, and space is leased for $693 per square meter annually in Pudong, 10% higher than in midtown Manhattan. The migration to the cities and a growing middle class have proved skeptics wrong over the years about the ability of real estate developers to fill the space they created. Also helping is the central government's plans to focus investment on Shanghai as the business capital of China.

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The Buick Regal is turning out to be just the car for going after younger buyers, and going after Gen Y buyers, buyers who have appeared so elusive for GM. It handles like European cars in its ride, and this reviewer compares it to a Peugeot. It was almost an accident in the way it was developed. It started as the development of a global, midsize front-drive platform at GM's Opel division in Russelsheim, Germany in 2004. At the time it was to be the next generation Saturn Aura for the US, but with Saturn closed down, it was renamed Buick. In Germany its called Opel Insignia. In China where Buick sales are growing rapidly, this car is called a Buick. This car is getting great reviews and is a part of the new rebirth of GM.

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Katsuya Okada is elected leader of the Democratic Party of Japan in Jan 2015. He is from a prominent business family. His brother is CEO of Aeon, a supermarket chain in Japan, which was founded in 1758. Okada says he supports Abenomics, saying: "I have no intention of completely rejecting Abenomics. On the contrary, there are many areas where I'd like to tell him, 'Go for it. Step up the pace.' " Policies he backs are deregulation to improve productivity, and Abe's policies to increase worker wages. He also supports being better prepared for regional conflicts, and said the DPJ would study Abe plans for legislation to strengthen the role of Japan's defense forces. Okada's comments reflects the changing sentiment in Japan about Abenomics since Abe's win in the snap election, and winning credibility for his economic policies.

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India's leading energy official, Anil Swarup, the Coal Secretary, says India has to depend on what is available, with slow progress on nuclear power there is not much else. As India increases its growth rate to 7-8% India will increasingly be dependent on coal. The Modi government plans to double coal production. About 300 million people in India have no access to electricity. The country faces energy shortages in other areas. Even with a push for renewable solar and wind energy, coal is expected to provide 60% of energy needs in India in 2030. One government model shows solar and wind increasing from 6% to 18% by 2030. India points to per capita emissions which are 1.7 for India, 6.2 for China, and 17.6 for the U.S., according to the Carbon Dioxide Information Analysis Center.

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Former Secretary of State James Baker III on the Obama administration's negotiations with Iran for a nuclear deal. He points out the importance of the U.S. making the removal of sanctions gradual manner as Iran fulfills its part of the agreement. Baker says Iran in the past has broken agreements to resume nuclear weapons research, making the verification process and snap back of sanctions critical. Baker does not address the issues related to how effective verification would take place, calling this the work of negotiators to work out the bureaucratic and cumbersome provisions. He also does not address the problems other critics have raised about any future snap back of sanctions because of the reluctance of European countries, saying only that the U.S. should maintain its credible position on the negtiations with its other partners- China, Russia, Germany, France and the UK.

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WSJ's Amol Sharma and Paul Beckett interview Chandrasekharan of Tata Consultancy Services. TCS underwent a reorganization to be customer centric and to listen closely to customers. It sees opportunities in financial services as banks berge, in retail and in pharmaceuticals for knowledge intensive work such as analysis of clincial trial data. His vision is to expand development centers around the world, to meet the global tech needs of customers. He also wants to develop a complete suite of services so it can sell end to end offerings, covering software application outsourcing to infrastructure management to consulting and products. He says he can't serve aBrazilian company or a Chinese sompany from India, there are language, cost and culture issues. TCS plans are to pick a strategic location and then scale it up, with some like Mexico scaling faster than China.

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The migration of Miexcans to the US, or Keralites to the Gulf states, are other ways in which the impacts of this recession are felt across countries. This is passed on through lower remittances to the home country from its workers overseas and in the people returning to their home country unemployed. Putting aside national borders its seen in the way huge migrations of workers from rural areas moving to the coastal areas of China is being reversed as export industries on the coast are collapsing. In that case there are no remitttances but the effects are just as severe as these people are unemployed. And in parts of rural China where there is a severe drought the rural economies and the farming areas are suffering from poor agricultural production. Kerala, a coastal state in southern India, is a state heavily dependent on the Gulf economies for jobs and remittances. The Keral Manpower Exporters Association says that about 500,000 workers from Kerala will be forced to return from the Gulf in a few months. Kerala contributes about half of the 5 million Indians working in the Gulf economies. The estimated $6 billion that these workers send to Kerala ia about a fourth of the state's economy and twice its government budget. Skilled workers doing jobs as carpenters, plumbers, painters and administrative staff working in the construction boom in the Gulg especially Dubai, are likely to remain unemployed. ...

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This is an high exceptional report in the NYT by Rosenthal, Fitzsimmons and Laforgia on the crumbling infrastructure in the U.S., taking the New York subway system as one of the most glaring examples of this failure of public administration since World War II. The woes of the system amount to a kind of defunding of the subway system for update, maintenance and technological improvement to meet the doubled ridership since 1950. Read this to understand why this is happening throughout the U.S. for clues to the possible causes, and what needs to be done. As this is now in the hands of ordinary citizens who suffer daily from the inefficiencies, delays, and rundown conditions on the subways compared to other subway systems in Europe, Japan and China. One report in the media in Nov. 2017 says Japan's Shinkansen railways apologized to customers for a train leaving 24 seconds early. Small details get accounted for in other countries, whereas they are ignored here in one of the largest cities in the world. A former New York transit system president from the 1970's calls it "heartbreaking" making him mad when he thinks about what is happening in the way New York subways are run. Financial deals have saddled the New York subway system with added $5 billion in interest on debt in return for  short term cash infusion. The result is that about 17% of the budget goes to paying interest on debt. In 1997 this was about 6%. So that needed maintenance and capital projects suffer. The New York subway system has only a 65% on time record,  the worst of any subway system in the world. And technology dates back to the 1930's with a signals system from that period,  says this New York Times report. Maintenance needs have suffered under the Cuomo administration says this report.  The system has suffered an enormous stagnation, leaving it in a shape that has not changed for decades. There are fewer miles of track than in 1950 after the war, while the ridership of 5.7 million today has doubled. The budget for maintenance has barely budged from 25 years ago. This report says the politicians who ran the city and the state of New York bear much of the responsibility for the crumbling infrastructure of the subways in New York.   ...

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A big factor in U.S. car sales, which reached 7.5 million in 2015, exceeding the 7.3 million in 2000, is that a large portion of cars on the road were about 11 years old following the recession in 2008-2009. As Dexter Ford pointed out in a article in 2012 many car owners on the road had replaced the earlier 100,000 mile mark before buying a new car, with 200,000. This pent up demand, and the better technological features including gasoline conserving technology, gave new impetus to demand in 2013-2015. Lower gasoline prices at the pump of about $2.00 a gallon in Jan. 2016 across parts of the country made it economical to own SUV's and pickup trucks. The U.S. car companies Ford, GM and Chrysler-Fiat had sales of 2 million full size pickup in 2015, with the Ford F-150 leading. Car companies have come through a severe crisis and are taking steps to avoid a repeat of the mistakes of the past on fuel efficiency- Ford has introduced a lighter aluminium based version of the F-150 for example. Gasoline prices also provide buyers with extra money to meet car payments which now have been stretched to longer periods and lower rates by auto companies to reduce the cost burden per month. AAA says the average price in 2013 for a gallon of gas was $3.49, in 2014 at $3.34, in 2015 at $2.40. AAA says that 71% of gasoline stations sell gas at less than $2.00 in January 2016, and gas prices are likely to remain low for an extended period with lower demand from China, higher fuel efficiency going forward with stricter standards, new technology for shale oil production, and the replacement of cartel pricing by competing production from Saudis, Iran and Russia. On average Americans saved $115 billion on gasoline, or $550 per licensed driver, according to AAA's Daily Fuel Gauge Report of January 6, 2016. In addition to the $550 saved the higher fuel efficiency with new technology adds a corresponding amount to savings per driver. Add to this the lower payment at low rates over longer periods and the car payment per month has been reduced significantly in a improving job market, to support car sales....

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India's Ministry of Finance predicts GDP growth of between 7 and 7.5% for 2018-2019, after faltering GDP growth in 2017-2018 following action on demonetization and introduction of a national Goods and Service Tax. The IMF predicts growth of 7.4% for India in 2018 compared to 6.8% in China in 2018, with growth of 7.8% predicted for India in 2019.  Chief Economic Advisor Arvind Subramanian says there are "robust and broad based signs of revival," though risks remain in rising oil prices and inflation. The level is below what it could be, yet robust considering the policy actions taken by the government for the long term such as the nationwide GST implementation, which was taken up by previous administrations of both parties in government but never implemented till 2017. In addition the government faces the tasks of recapitalization of banks, the issues of job creation as manufacturing in India in the global context is only beginning to take shape, and agrarian distress.  The new Budget takes up the issues facing rural areas of the country by compensating farmers to the extent of 150% of agricultural cost and introducing the largest health care security scheme in the world for poor families. This comes a year before new national elections. The Modi administrations's focus appears to be for taking steps that will generate growth over the long term and learning from errors, yet being bold enough to take the necessary action based on experience.   ...

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This article in NYT by a China expert based in Hong Kong points out that a key driver in the current developmetns in Korea are not understood. With the growth of China's influence in East Asia and a decline in American influence many of the countries in the region are rebalancing. Vietnam and Singapore are pushing back. In the same way North Korea under Kim Jong Un is concerned about its dependence on China with 90% of its trade conducted with China. The Chinese participation in the strong sanctions introduced by president Trump has increased this awareness of its dependence on China. President Xi Jinping has also ignored North Korea as China focuses on larger issues in international relations, including its relationships with the U.S., EU and India. This strategic development is what drives the current meetings between president Moon of South Korea and president Kim of North Korea, and the planned meeting of Kim with president Trump.  This China expert says the shift in better relations could be part of North Korea's effort to open up to the U.S, South Korea and Japan, in an effort to diversify its relationships to reduce dependence on China. This does not mean the unification of North and South Korea, he says, because it would mean loss of power for the Kim regime and would be too costly for the South. The nuclear missile development was part of an effort to preserve the Kim regime. The Kim regime is also focusing efforts on economic development which would be better achieved by opening up to the U.S., South Korea and Japan. ...

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The near-premium or near-luxury car segment that Honda is appealing to with its Acura ILX and Buick is appealing to with its Verano model. The European carmakers also plan to bring cars to the U..S. that are economically priced and have luxury features. White points out that baby boomer buyers in their fifties and sixties are particularly careful to compare these cars with the luxury features on a moderately priced Accord and Taurus, and can see any flaws in the near-luxury cars which indicate compromise such as afour cylinder engine or manual controls where electronic controls are expected. Honda's marketing people have looked at American buyers and see the new profile of a customer who is sophisticated but is also looking at price in today's more fugal environment for purchases, as the buyer they are targeting. But they will have to be careful as this category bumps up against the moderately priced cars that have some luxury features and are competitively priced to attract buyers.