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The costs benefits and savings in a patient focussed practice. The new models of thes practices that are emerging such as amonthly payment of $54-129 per patient to the doctor and insurance only to cover hospitalization and catastrophic illness. The satisfaction of patients who avoid crowded doctors waiting rooms and avoid having to limit their questions. and get in and out quickly. The satisfaction doctors derive fom not having to rush through the day's schedule. The reduction in emergency care visits as patients better m=nderstand and manage their medical conditions.

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Robert Stavins of the environmental economics program at Harvard is cited in this NYT article by Coral Davenport. Stavin says that even with the change in policy favoring fossil under Trump administration the trend is towards using less fossil fuel and this trend is unlikely to change. This makes the claims of Trump that half a million jobs can be created with less regulation of the coal industry and shale oil industry, less likely. Industry is shifting away from coal for economic reasons and investors preferences, say experts. At the same time the progress away from fossil fuels is likely to be inadequate to avoid the worst effects of global warming, says Stavins. The change by industry is reflected in the decisions made by executives such as Nicholas Akins at American Electric Power, Ohio based electric power company. Akins tells NYT that he is making decisions for power generation 20, 30 and 40 years from now, and this assumes some form of carbon control. He says no question but that industry will move forward with cleaner energy and that means closing large coal facilities. The incoming Trump administration does not affect his policy. Another factor away from coal is dictated by economics- the availability of cheap natural gas from hydraulic fracturing. Incentives for renewable sources such as wind, solar, are not likely to change either say experts, because the solar panels and wind turbines are made in Republican and Democratic favoring districts and have support of Republicans in places like Arizona, Texas and Kansas. ...

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In a first at Davos World Economic Forum, China's president Xi Jinping uses the 2017 meeting to give a one hour long spirited defense of the world trading system, critical of U.S. president elect Trump's protectionist views without naming him. Xi pointed out that "no one will be winners in a trade war." And went on to add that restricting world trade was like "locking oneself in a dark room, keeping out wind and rain from outside but also light and air." For the first time Jinping stated that China would take the U.S. role of defending the world trading system from attack as needed. On climate change Xi defended the Paris accords, and gave China's commitment to pursue changes regardless of what the U.S. under president Trump does. This follows Chancellor Merkel of Germany's statements on the issue critical of the views of president elect Trump, and taking the lead to defend the world trading system. Xi also pointed out that many of the ills that led to voter discontent in the West were not really from the freeing up of trade but from the pursuit of excessive profit with the financial crisis of 2008.   ...

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The situation in Tampico, Mexico, with corruption, crime and dangers to public safety, show the problems Mexico is still grappling with to ensure a rule-of-law state right next to the U.S. The paradox is that of a breakdown in public safety with Calderon's war against drug gangs undermined by corrupt police and local government, and the continued foreign investment in the country. DuPont is investing $500 million in a new plant near the port of Tampico and South Korea's steel manufacturer POSCO is planning a $300 million investment to double production in this area.

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Spain provides 14 public holidays that are mostly Catholic holidays, and an additional 22 vacation days, which is similiar to the the EU average. Unlike the practice in the U.S. and Britain to have these holidays fall mostly on Fridays and Mondays, in Spain many of these holidays fall in the middle of the week. This disrupts productivity as Spaniards use bridge days or puentes to create long weekends during which many offices and factories are empty, disrupting productivity. Most companies cannot plan for meetings and work because counterparts may be using the bridge days during these holidays, and working with international clients is difficult and hard to explain. Spain's new prime minister is determined to increase Spain's competitiveness, and bring Spain to the level of competitiveness of countries that do well in this measure, including other European and Asian economies. He describes this in his book "En confianza. Mi vida y mi proyecto de cambio para Espana." ("In confidence. My life and project of change for Spain") In his inauguration address he said Spain should correct "the work calendar to make the rights of workers compatible with the competitiveness of our companies." Vacations are a sensitive issue in Spain because tourism generates 10% of GDP and employs 10% of the workers. Alberto Nadal, who addresses labor issues at the main business association in Spain, says a change of mentality is needed in Spain, and doing away with bridges shows Spain is grasping the idea that things should be done differently for the eurozone community of nations. This also shows some of the differences in the Iberian peninsula countries of Spain and Portugal, where the countries are embracing the change and there is less unrest even with high unemployment, as compared to Greece. In Greece the changes are being resisted by politically connected groups, where political parties enjoy little support and there is much unrest, making the project difficult. Mariana Rajoy, Sarkozy and Merkel are from centre right parties in Spain, France and Germany, and have had a close association for years before Rajoy was elected- during EU meetings of centre right parties, as is evident in Rajoy's book. They also share a similiar business and political orientation. ...

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Russia's government lowers its forecast for GDP growth in 2013 to 1.8%. Like other emerging markets Russia is facing a slowdown in economc growth. Government forecasts are for 3% growth for 2014 and 2015. About 50% of revenues in the budget come from oil exports and Russia is still dependent on higher oil prices. The budget is likely to have a 1% of GDP deficit in 2015. President Putin is not inclined to run a large deficit to increase growth. Budget revenues are expected to come lower for 2014 and 2015 by 3.3% and 6.9% compared to forecasts. Finance ministry policy is for hiking taxes on mineral extraction 16% by 2015, and increasing excise taxes on cigarettes and alcohol. State run firms will be asked to pay out 35% of profits as dividends compared to the current 25%, providing $39 billion from this action, according to the Finance ministry.

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Disappointment for those who had high expectations for the Obama Presidency. The slog of daily governance proves too much. Attempting too much in too short a time. Polarization in Congress. And the person Obama is -transformative but cautious.

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Abut 3 million homeowners are expected to default on their mortgages in the 30 months ending in mid 2009, and two thirds of this or 2 million will go into foreclosure, according to Moody's Economy.com. So what led to all this which eventually hit the financial markets in the U.S., and also to a lesser degree in Europe, through the opacity of the mortgage securities created from bad mortgages with falsely tagged triple AAA ratings that ended up in the assets of banks and investment firms? The motivations of each group were perverted as things unfolded. When the packagers of securties were not responsible for what they were doing they pursued profit before ethical behaviour and all sorts of securities were created. As these packagers were allowed to shop for ratings the ratings companies gradually lowered their standards to attract business. Politicians failed in the free market atmosphere of the Republican Bush administration and Republican led Congress. Senator Bachus and Congressman Frank introduced legislation during the later period of the bubble but failed to draw support to curb the bad lending. Republicans blocked a new antipredatory lending law in North Carolina from being enacted for the country from 1999 onwards. And Bush without realizing the ramifications prodded HUD to push Fannie Mae and Freddie Mac to require higher percentage of loans to go to low income borrowers. Fannie and Freddie in turn met this requirement by increasing the demand for these subprime loans by buying the mortgage securities, which the packagers of these securities backed by subprime mortgage loans and incorrectly rated AAA by conniving ratings agencies were happy to supply. It was a sad situation with a happy -everyone could say the were bringing home ownership and the American dream to low income people, and business was signing up for this ride with short term gain in mind. And in all this financial innovation lost its legs as packaging these securities and constructing new investment vehicles like the conduits were being used in perverse ways. The basics of labeling something correctly was torn apart. You could not turn a subprime loan to low income borrowers or a loan without documentation to flippers and speculators into something different by simply labeling it as AAA. What the confidence in financial innovation in the American system did was help spread these securities all over the globe, where they were held with confidence by towns in remote parts of the Scandinavian north country as well as financial centres in Europe and Asia. At the state level politicians in California saw this as one of the state's star industries and protected it from legislation to curb bad lending, as most of the big lenders were based in California. Due to a strange set of affairs the Department of Corporations was left with the tasks of oversight of mortgage lenders in the state. It was concerned more with issues like protecting senior citizens from financial scams and was not staffed to meet the supervisory role of a huge mortgage lending business. When it comes to the Fed's role Greenspan also took the laissez fairre stand of not interfering with free markets, even when a lot of the bad lending was obvious and one Fed Governor Gramlich was pushing for better lending standards. The Fed supervisory role was over banks and banks were required to follow lending standards, but most of this lending had shifted to mortgage brokers and financial companies which were beyond the supervision of the Fed. Had the Fed extended its supervision to mortgage affiliates of the banks this could have increased the level of supervision and made a difference. But state regulation mechanisms in California by Department of Corporations show that the regulatory mechanism did not take into account the realities of mortgage lending and how it had changed. ...

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Serious issues with China's export of drug and food related items. The same is true for the domestic use of drugs and food which has been contaminated by hazardous chemicals. Zheng eas head of China's FDA from 1998 to 2005. China is reviewing some 170,000 production licenses issued during this period.

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Spain's cabinet announced new changes to labor laws to provide incentives to business to hire. Spain has some of the most restrictive labor laws in Europe and high unemployment. The unemployment rate reached 23% in December 2011, and about half of the people under 26 are unemployed. The cost of downsizing is so high in Spain that Spain's representative on the executive committe of the European Central Bank, Jose Manuel Gonzalez-Paramo, says companies prefer to close rather than downsize. The World Bank has singled out the labor laws as one of the main reasons for Spain's rising unemployment rate. New rules will reduce severance payments to 33 days per year of employment from 45 days. Severance packages will be reduced to a maximum of 24 months from 48 months. To encourage companies to hire permanent workers and depend less on temporary workers the new rules say employers must switch temporary workers to permanent contracts after two instead of three years. As an incentive for companies with a maximum of 50 employees to hire young people the rules give a 3000 euros corporate tax break for each new person hired under age 30. If the hired person was jobless he can still collect 25% of previous unemployment benefits for a limited period with 50% of the unemployment benefits going to the employer. Companies having losses for three consecutive quarters are allowed to pay less in severance payments- only 20 days per year of employment. Companies will now find it easier to leave collective bargaining agreements and make deals with their own staff. Luis Garicano, a professor at the London School of Economics, says this is a good step forward. He finds missing from the new rules subsidies to train young and unemployed people given the high dropout rates in Spanish schools. The government approved the rules by decree, but they will be discussed in the Spanish parliament. The government of prime minister Mariano Rajoy was recently elected with an overwhelming majority in parliament. This makes making major changes different from the process in Italy where a consensus has to be established....

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The Public-Private Investment Program of the U.S. Treasury Department has not had a good start. With most banks passing the U.S.government's stress tests and raising $50 billion in the markets, PPIP which was intended to to help resolve the situation of all the toxic securites siting on the bank's books, has gone the way of all the prior efforts to solve this problem. Simply postponed this time hoping that the housing market recovers. With the Rogoff-Reinhardt study showing that it takes about 6 years or longer before housing recovers from such aserious crisis as this one, it would be 2012, before one sees an improvement. See the link to the Business Week analysis that shows housing markets in the USA having some aspect of normalcy in 2012. Yet even this analysis is using an optimistic scenario, because it assumes Moodys Economy.com estimates of economic growth for GDP of 4-5% in 2011- 2012. This assumes the consumer debt that has reached over 100% of GDP will be reversed quickly in 2010, and the the factory capacity utilization currently at 68% and expected to drop further in 2009- with more automobile manufacturing capacity remaining to be scrapped -will recover quickly in 2010-2011. This is unrealistic considering the combination of factors at work. Here Devin Leonard talks to PIMCO chief Bill Gross, who with Warren Buffett and PIMCO CEO Mohammed El-Erian, are key proponents of the PPIP program. Both El-Erian and Warren Buffett say they conceived independently of such a program, in which toxic securties are taken off bank's books with government help. As PIMCO is one of the largest traders of mortgage bonds in the country and has years of successful experience in dealing with mortgage bonds, the New York Fed under Geithner turned to PIMCO for advice in 2008. By this time PIMCO was under ownership of Allianz, a German insurer, which bought PIMCO for $3.3 billion in 2000, with $233 million and a $40 million retention bonus going to Bill Gross. Bill Gross describes how the program would function. PIMCO puts up $500 million, and Treasury matches this with $500 million. Analysts estimate that this partnership would be able to attract as much as $ 4 billion in low interest financing from Treasury and the Fed. Gross says that some of these securities pay as much as 14% interest, and even with a 70% default rate, this partnership could make $250 million a year on the $5 billion partnership, or a 5% return, with PIMCO making a 25% return on its original investment. This isn't exactly pro bono work as Buffett had originally suggested to Bill Gross in the midst of the crisis. But a more fundamental concern is that no one really knows exactly how much of toxic securties the banks have on their books, even though estimates have been made. If this is closer to $1 trillion, PIMCO's expertise and efforts will simply fall short of dealing with a problem of this size, and the window dressing of a problem of this magnitude could only hurt efforts for the eventual resolution of this problem. If housing does not recover as is expected till 2012 at the earliest, and the economy continues to deteriorate in unemployment and factory utilization, then the toxic securities on the bank's balance sheets may pose a bigger problem that will require serious action....

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A look at Department of Transportation data shows a downward trend in airline ticket prices. Average domestic fares in the U.S. declined 16%, adjusted for inflation, compared to 1995. A comparison shows a round trip ticket price of $410 in 2010 dollars in 1995, the same ticket is priced $338 in 2011, including $22 for bags and reservation charges that were added in recent years. Not including the $22 would give a 21% decline in prices in 2010 compared to 1995. Higher labor costs for American which could not shed legacy costs because it did not go into bankruptcy like some of its competitors, combined with higher fuel prices have posed a serious threat to American Airlines. American Airlines (AMR) experienced a 33% drop in share price on Sept. 3, 2011, with a recovery gaining 21% the following day to close at $2.39. UnitedContinental had a 2nd quarter 2011 average fare- revenue divided by number of passengers- excluding taxes, of $273. Southwest had an average one way fare of $143 for the 2nd quarter 2011. According to DOT figures, passenger tickets provide only 71% of total passenger revenues to airlines, compared to 88% in 1990. The remaining 29% comes from reservations charges, standby service, checked luggage, in-flight food service, transporting pets and other charges. ...

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Luigi Zingales of the University of Chicago Booth School of Business, compares the growing cronyism in the U.S. and the lack of social mobility to the situation in Italy where he grew up, and where the economy has stagnated over the last decade with fewer opportunities for the younger generation.

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President Obama in his speech at Georgetown, April 13, 2009, describes the thinking behind the decisions made in the first 12 weeks of his administration- why the actions are not aggressive and overreaching as some critics say, and why they are not timid as other critics have said. This was not a typical downturn of the business cycle, but a perfect storm arising from irresponsibility and poor decisionmaking in Washington, Wall Street and Main Street- in effect several crises colliding for something like an explosion, if not dealt with at once, and with strong action. He says "the key to dealing with our deficit and debt is to get a handle on out-of-control health care costs, not to stand idly by as the economy goes into free fall." The recognition that the crisis itself brings with it new possibilities, the opportunity for coming to grips with and forging a good solution to health care, energy and education issues that were neglected while Wall Street directed investments to areas other than investment in building for the future. To the critics like Krugman, Rosenfeld and others who say that the takeover of insolvent banks should be done quickly before the situation worsens, he says it is not because of any ideological or political judgement he has made about government involvement in banks, but because it is more likely to undermine than create confidence at this point. He goes on step by step, through the process of decisionmaking, first to step in and boost spending vigorously, second to get lending flowing again to businesses and families, strengthening the non-bank credit market for consumer purchases and loans, the housing plan, the auto plan, and the work at the G-20. Then President Obama goes on to project his vision and the road to getting there. The five pillars he sees for the future are: redirecting Wall Street and banking to constructive investments for the future, investments in education, investments in renewable energy and technology to create new industries and new jobs, investments in health care to cut costs for businesses and families, and new savings in the federal budget to bring down the deficit. Obama says he will look for savings line by line in every corner of the budget, and has already identified two trillion dollars in deficit reductions over the next decade. And the goal is to reduce discretionary spending for domestic programs as share of the economy by more than 10% over the next decade. Procurement reform will greatly reduce no-bid contracts and save $40 billion. Secretary Gates is attacking th problem of hundreds of billions of dollars in waste and cost overruns that have bloated the defense budget, without adding to the nation's safety. And education programs that don't work will be removed, and waste, fraud and abuse in the Medicare program will be controlled. Finally, Mr Obama points to the nation's political system as one more reason we are in this perfect storm- "a fundamental weakness in our political system." He cites the putting off hard decisions for another day, scoring political points instead of rolling up up sleeves to solve real problems, an impatience that is only worsened by the 24 hour news cycle, and a short attention span that focusses on the immediate results and on poll numbers. And there is too much responding to the "tempest of the moment until the furor has died away and the media coverage has moved on, instead of confronting the major challenges that will shape our future in a sustained and focussed way." After these 12 weeks President Obama says, for the first time there are glimmers of hope, and way off in the distance can be seen a vision of America's future that is far different than its troubled past. And citing the parable in the Sermon on the Mount about that "house built on a rock", he sees America's house built on a rock, a house for which we use this moment to lay a new foundation, come together and begin the hard work of rebuilding, persisting and persevering in the face of disappointments and setbacks that surely lie ahead. Then he has no doubt "that this house will stand and the dreams of our founders will live on in our time." Its a remarkable speech in its directness, its simplicity in approaching the subject, and its borrowing from the Bible for that story of that house built on a rock, and its Lincolnesque reference to the house that will stand. And more than a speech, it describes a vision, and the set of actions and steps taken and to be taken to get there. ...

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Donald Trump's economic advisory team includes in addition to Harold Hamm, shale energy billionaire, Steven Mnuchin, CEO of hedge fund Dune Capital Management, hedge fund billionaire John Paulson, Dan DiMicco, CEO of steelmaker Nucor, bankers Stephen Calk, and Andy Beal, tax expert Stephen Moore, and David Malpass, a columnist for the WSJ. The team is headed by Stephen Miller, an aide to Senator Jeff Sessions of Alabama. The Washington Post points out that the selection of the team with many hedge fund businessmen including John Paulson, who bet against faulty mortgages before the 2008 financial crisis, is at odds with his criticism of Hillary Clinton for her contacts with Wall Street and his message of not having any connections with Wall Street so that he could better represent the interests of ordinary Americans- people hurt by the 2008 financial crisis with the high jobless rate for older white men. In the 2008 election both candidates John McCain and Barrack Obama were shown in media articles to have connections to lobbyists for Fannie Mae and Freddie Mac. In the 2012 election Mitt Romney as a private equity executive at Bain, was a part of the financial industry. This time in 2016- after all the noise and tumult about who represents Main Street- is no different for Trump and Clinton's connections to the financial industry. Only Clinton has to respond to the movement within her party from Bernie Sanders for providing a genuine example, and breaking with the past. The team of economic advisors put together by Jeb Bush led by Glenn Hubbard may be little different in substance than the one put together by Trump in its connections to the financial and real estate industry. The only person who took on the financial industry to fight for homeowners interests shown in Lyrarc since 2008 is Sheila Bair of the FDIC, a Kansas Republican. She could truly represent the interests of working class and ordinary Americans simply from a notion of fairness that  is so much a part of the American experience. Yet she has said running for office and fund raising in the way it is practiced today makes the thought too difficult to accept. Recent developments do not offer encouragement. Yet ordinary Americans ought not to forget, and ought not to let anger affect a discerning view of things. ...

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This article in the NYT explains why the loss of jobs particularly in the auto industry to Mexico, with the experience of NAFTA passed by president Bill Clinton, has caused widespread opposition to the TPP trade agreement proposed by president Obama. Both Hillary Clinton and Donald Trump in 2016 oppose the TPP.

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Elsa Fornero is an economics professor who is Labor Minister in the government of Mario Monti. After several decades Italy has finally tackled the much needed changes to the 1970 Workers' Charter that forms the basis of Italy's labor laws. The Charter protected workers jobs but was designed during a different period and had long since lost its relevance in a modern economy. The laws led to Italy losing its competitiveness and entrenched small family firms in the economy. The new labor law protects the individual instead of jobs, by increasing the safety net to cover unemployed workers for shorter periods and lower benefits, and makes it possible for firms to layoff employees for economic reasons. Fornero says Italians need to recognize that work is not a right to be enshrined in laws but something that is earned through hard work. Article 18 of the Worker's Charter was originally intended to remove discriminatory practices in the workplace, but was enlarged to provide blanket protections to workers so that companies could not fire workers and avoided hiring. Under the new law discrimination is illegal, but now companies can layoff employees for economc reasons and not face long legal disputes and be forced to rehire the workers. The new law will increase productivity says Marcello Giustiniani, a labor specialist at Milan law firm Nonelli, Erede & Pappalardo. Italy's productivity gap with Germany has widened to over 30% since the introduction of the euro. The ASPI, new unemployment insurance plan, goes into effect in 2013, older programs will be phased out by 2017, giving time for the culture change in Italy for workers and business. Another major change is designed to help 2 million workers earning less than 18,000 euros. Businesses will have to give these workers proper contracts. Fornero's effort to tackle the pension system also includes linking retirement checks to how much is contributed over the lifetime- a practice common in other countries- not the final and highest salary. This simple change was not not implemented by 10 governments since a law was passed in 1995, showing why the Monti government was needed to get things done....