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Democratic states face a sobering reality- can California, Minnesota, Illinois afford it? It turns out that they cannot and are diverting important funds away from the Nation's priorities in transportation, housing, education, rural healthcare. Here is what happened-- When California Gov. Newsom used state's Medicaid budget for poor citizens and disabled for illegal migrants to give free coverage, Medi-Cal went $6.2 billion over budget in 2025. In Illinois the program for Medicaid coverge to illegal migrants estimated at $112 million annually now costs $800 million and parts of it are now suspended. California had not thought this thing through, with free medical coverage not available to even citizens of the US, why would unrestricted borders not overwhelm a border state's Medicaid system signed into law by a Texan president Lyndon Johnson for the people of this Nation. Democratic States are running into a logical fallacy that the European Union and Germany are already experiencing, stretching straining public services, which has nothing to do with one's sentiments. Gov. Newsom now wants to give this benefit for $100 monthly premiums in 2027. ...

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US president Biden has asked Democrats to first reach an agreement on a social and climate policy package and only then vote on an infrastructure bill. Republicans have supported investments in infrastructure, but not supported the social and climate policy package. Democrats progressive wing supports infrastructure but only after the social and climate policy package is approved. To pull together the different groups in the Democratic party and win support among some Republicans requires a skillful balancing act bringing in support from all sides in the national interest. The Biden plan for $3.5 trillion for Build Back Better has a$1 billion infrastructure plan, and a plan for workers and families on social issues confronting the country including child care, education, income related to reduce disparities, and healthcare. It also includes investments in green energy so reduce emissions to tackle climate change. Because Democrats have a thin majority in the Senate and the House of Representatives this balancing act will also require Democrats to reduce the size of the package to less than $3.5 trillion bringing in the most essential components for investment in 2021-2022 and making additional investments in the following years. ...

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In a new twist drugmaker AbbieVie will bring out less costly versions of Humira in Europe where its patents have expired and still keep the U.S. market at higher Humira prices using a thicket of patents. Reports show pharmaceutical drug pricing as a major issue in U.S. midterm elections. Biologic drugs are costly. In this case Humira will sell at a 10-20% discount in Europe. Abbie Vie countered by getting hundreds of new patents in the U.S. to continue selling at high prices.

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The point at which pensions begin and retirement begins is thought of normally as 65 years. This is changing. Experts on ageing at Britain's ONS, Office of National Statistics say 70 years is replacing 65 years as the age at which people can work and contribute to society, working later in their careers and doing voluntary work. This would help ease pressure on pension system financing and cost of social service to elders. Because of rising longevity and improvements in healthcare, diet and lifestyles people age 70 had characteristics of people age 65 in 1997, say ONS experts. ONS looks at a new way to measure ageing. Do not use chronological years from birth, work backwards from remaining life expectancy and operate on the basis of 15 years as the marker for old age. Under this method start of old age is 70 for men and 72 for women. As people over 65 years is approaching a fourth of the population this fresh thinking gives more room for pension system sustainability, and helping engage people at work for longer more productive lives. Both for the economy and personally for the individual. ...

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Compare the presidential election spending in France and US one sees a huge, really huge difference. In France by law the first round it is limited to 16 million euros and second round to 22 million euros. Companies cannot donate and maximum donation is euros 4600 per year. All candidates must be given equal time by networks after official campaigns start usually March 28. If you get 5% of the presidential vote you get about 48% of the $22 million ceiling and if not only about 5%. Its a fairer system considering about $5 billion will be spent in US presidential election 2024. It keeps out lobbyists and donors looking for silent favors as the pharma industry and the tech industry in the US that has prevented any legislation on fair drug pricing or oversight of the monopolies of Apple, Google, Microsoft, Amazon, Meta and others, taxation of profits of tech and fossil fuel companies, or passage of healthcare for all. Indian elections cost of 1.35 lakh crores or $13 billion in 2024 are also similar to the US with parties spending leading to much corruption in the democratic process and defeating its best character.  ...

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One perspective of what Silicon Valley is focused on is shown by Reid Hoffman. It does not mention climate change, not one word on climate change, no words on cost of living action, little is said about factories and jobs for reviving American manufacturing, helping workers and families and redesigning the world's supply chains. It is critical of addressing monopolies and regulatory action by the FTC even where it is needed. It calls for huge investments in AI that would leave little for investments in science, education, healthcare and infrastructure, and says "trust us to do the right thing." It calls for pro-innovation direction when pro-innovation has been the thrust of policy for three decades with the results that we have seen leading to widening gas between the upper and lower classes and shrinking of the middle, a pharma industry out of control in pricing, and negligible investments in education by so called "tech" companies who like Apple have outsourced manufacturing to China. A return to tech and Silicon Valley is not needed as embedding it in the nation's policy making priorities is the Nation's problem. ...

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African continent debt reached $1.1 trillion in 2024. About 900 million people live in African countries where interest payments on debt exceed money spent on healthcare and education. In Nigeria external debt is $40 billion, in Kenya $35 billion and Uganda $12 billion.  Take Nigeria with 220 million people. 40% of the revenue collected goes to meet interest payments on debt. For many African countries there is zero per capita income growth for a decade. During the 2010 crisis as interest rates reached new lows US and European Reagan era intellectuals including Democrats encouraged African countries to borrow at low rates and banks loosened restrictions putting more African countries into debt buildup borrowings. As interest rates went up the cost of paying the debt accumulated required more loans at higher interest rates. Nigeria paid a premium over that of 10% for a loan of $2 billion just for interest payments. The debt crisis means African currencies depreciate reducing purchasing power.  With war in Ukraine and Covid prices of food and energy rose. Only the strong and disciplined leadership and rapid industrialization provided breathing room as with Modi in India, Jinping in China, the African continent and Latin America lacked this and are feeling the pain. ...

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About one in 5 German workers are in minijobs- about 7.4 million people in May 2013, according to estimates from the WSJ and Germany's Federal Employment Agency. Minijobs are a form of part time work that gets a German worker 450 euros a month free from taxes. Many of these jobs are in retail, healthcare and offer these industries more flexibility. Jobs are done by women, elderly, immigrants without work. The intent was to move these workers into full time work, but this is not happening as most workers in minijobs end up in a deadend status.

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Voters took note of the quality of each candidate, and Democrats were scrappier  in the fight this time around to give a tight result. Voters did not know much of what Mr. Biden had done to cap healthcare costs in midterm elections for 36 governors races and for control of the US Congress. The pocket book issues mattered to voters with sharp increases in the price of oil and groceries, but less so than made out earlier and voters may have grasped the bigger picture.

The quality of candidates mattered and on the Republican side the influence of Mr. Trump in the primaries led to choosing weaker candidates because of their loyalty to Mr. Trump. In the end with a large turnout of voters on both sides the election was much tighter than expected. Democrats in each state did better using their own initiative and effort this time and were much scrappier in the fight for the Governors races and the Senate.

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The tough job President Obama faces as he faces opposition from politicians who have interests to protect, and healthcare businesses with interests to protect. The President has to come up with a plan that is deficit neutral, because financial markets could see a healthcare bill that further widens the deficit as a signal for higher interest rates that would deepen the recession. At the same time each of the three sources of revenue puts him at loggerheads with political leaders in Congress or groups with interests to protect. Limiting income tax deductions for high earners could raise $267 billion in 10 years. It would require taxpayers in the top tax brackets deduct their mortgage interest, state and local taxes, and charitable donations, at the 28% tax rate instead of the 33% and 35% tax rates. The opposition is with democratic leaders that it would hurt charities, universities that depend on tax deductible donations, and taxpayers in high tax cities like New York city that are the home base of Democratic leaders. Yet only 1.4% of households would be affected says the nonpartisan Tax Policy Center. The Center on Philanthropy at Indiana University, says charitable giving would decrease by 2%. The other opposition on this comes from the preference of Senators Baucus and Grassley, who head the Senate Finance Committee, for tax increases or cost savings to come from the health sector. Specifically they want to see the value of workers' employer provided health benefits subject to income taxes. It is a situation in which every sensible person admits the need for healthcare reform and would see the current pace of healthcare costs as unsustainable and dangerous; and after that will just go back to his group and try to preserve as much of the status quo as possible, so as not to disturb by much the benefits or compensation they have secured from the system over the years. Then there are political leaders in Congress with their own preferences, and Congressmen who are the subject of heavy lobbying by these interests. The administration and the Presidents job is to navigate this stream with a workable deficit neutral plan, without any requirement for any group to make sacrifices, and in some situations even small sacrifices for the public interest. Would charitable institutions be hurt that much, what if charitable institutions were exempted, why would other interests the try to obtain the same exemption. Its like the unions trying to keep the old unsustainable goldplated healthcare and other benefits at GM even as the ship was going down. Taxing employer provided employee health benefits as income would raise $2.5 trillion over a decade. The opposition here is from unions which are a force in the Democratic party and which count tax free health benefits as a legacy of the labor movement. Employer provided health insurance covers 160 million American employed and their dependents under the age of 65, so it has a wide impact. Yet most economists favor ending the tax break. They say it mainly goes to upper income taxpayers, and discourages cost consciousness among consumers of health care, thus encouraging excessive spending and surging health care costs. Senior Obama advisors, Peter Orszag, the budget director, and economist Jason Furman favor this approach. So do Republicans in Congress. Senators Baucus and Grassley are not asking for the complete removal of the tax break, what they want to see is capping the value of benefits that go untaxed. If the tax-free limit is $13,000, a policy worth $15,000 would pay income taxes on $2000. A third spource is to spend less on Medicare. About two thirds of the $948 billion in savings Mr Obama has proposed over 10 years comes from a number of reductions in Medicare spending. $177 billion comes from insurance companies bidding for government reimbursements for offering private plans to seniors. $106 billion comes from cutting the subsidies to hospitals serving the uninsured as universal coverage should remove this need. And $110 billion in reduced payments to hospitals and doctors because of productivity gains. A range of industries insurance companies, hospitals, doctors drugmakers, nursing homes, home health care companies and medical device makers, all stand to lose from reduced payments from Medicare and Medicaid. And these groups with interests to protect are another factor in this process of working out a healthcare plan. ...

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The debt brake put into the German Constitution by Angela Merkel's government in 2009 to limit the structural budget deficit to 0.35% of GDP during the 2009 financial crisis caused by poor banking behaviour, and in the 2015 eurozone debt crisis with overborrowing by Greece and Spain, is no longer relevant in 2024. It can be said that Merkel made some mistakes- not investing in digitization, in infrastructure and making the German economy dependent on low cost oil and gas from Russia. Putting the debt brake in the German Constitution and setting it at 0.35% of GDP except in emergencies adds to these mistakes, because it deprives policymakers and government of the minimum needed flexibility to meet changing situations in the interests of the German people.    It means there is no money to invest in the country's future, no money for infrastructure even when it is old and crumbling for roads, bridges rail stations and airports, no money for digitization of the economy in which Germany has fallen behind, not enough for defense, and no money to fund needs in education, healthcare, childcare. And not enough money to invest in climate change action. Absent this investment the German economy falls behind, jobs become precarious and public dissatisfaction leads to volatile political situation. ...

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This NYT editorial points out that the cuts to Medicaid amount to taking out a fourth of its budget and are sure to hurt low income Americans. The cuts are about $880 billion over 10 years for Medicaid. The $300 billion less in subsidies over ten years is likely to hurt the elderly. It also points out that removing the individual mandate will make it harder to reduce premiums as fewer healthy adults offset the costs of sick patients.

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The CBO annual report on the budget and economic outlook shows a deficit of $1.1 trillion for the current fiscal year, a decline of $200 billion from the prior year. Health care spending is a key factor driving the deficit. Cost of spending on healthcare programs is expected to double in the next 10 years, increasing by 8% a year and reaching $1.8 trillion in 2022.

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With a mere 1% of GDP invested in public healthcare India remains backward in its commitment to the welfare of the rural poor. Prime minister's Modi's plan is laudable says this BBC report, but the record of implementation is spotty at best at the state level for such plans. The new plan announced in the 2018 Indian Budget is for a health plan covering 500 million Indians with 5 lakh rupees coverage, something never tried before but with a cost of a mere $1.7 billion is something that the country woefully lacked or neglected to tackle.

This plan may be better implemented at the national level, and particularly where the reputation of the governing party and its plans for industrialization are at stake in the coming year's national elections. If accomplished and the Modi government is eager to take on these challenges it would be a significant step to balanced and overall development of the Indian economy.

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This article in the NYT provides a look at the features of the Republican House Health Care Plan- Both the Affordable Health Care Act and the House Plan provide incentives for buying insurance- the ACA bases these incentives on income levels whereas the House Plan does not provide additional help for low incomes or elderly. Incomes at $20,000 would see a loss greater than  $2000 under the House Plan and as many of the elderly poor living in high cost areas may not have the resources to make up for this loss of subisidies they may forgo buying insurance or have insurance coverage that protects only in a limited way. President Trump has given assurances that all will be covered. For people with incomes of $50,000 or $75000 the loss of $2000 subisidies would also have some impact. At larger incomes or the well to do the subsidies are not handed out under either plan. Under the ACA the emphasis was on income levels and high cost insurance areas the subsidies were greater, under the House Plan the subisidies would be higher for the elderly compared to the young but very low income levels are not given additional help.     ...

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That is before Wengfeng branched out into AI and his venture DeepSeek to do at a tiny fraction of the cost what these chaps at OpenAI had been openly propagandizing to take not billions, even trillions out of capital markets to leave us all worse of without funds for essential needs in education, schools, healthcare, childcare, transportation. Liang Wengfeng, who founded a $8 billion hedge fund and  invested in AI research fo Deppseek that does in $5.6 million what it takes OpenAI $100 million to do. It started with quant models to predict share prices. He wrote the introduction to the Chinese edition of Zuckerman's book on hedge fund manager Jan Simmons who was into advanced work on quantified modelling for share prices. It says-   “Whenever I encounter difficulties at work, I recall Simons’s words: ‘There must be a way to model prices.' " Liang also says “The publication of this book unravels many previously unresolved mysteries and brings us a wealth of experiences to learn from.” That is before Wengfeng branched out into AI an his venture DeepSeek to do at a tiny fraction of the cost what this chaps at OpenAI had been openly propagandizing to take not billions, even trillions out of capital markets to leave us all worse of without funds for essential needs in education, schools, healthcare, childcare, transportation. ...

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How the Drug Industry and Drug Companies will go through a complete change and look nowhere near what it looks like today. Huge changes are overtaking the Drug industry and old ways of doing things will go out the window. Patent expirations for blockbuster drugs, safety issues, increased regulation, rise of generics drugs, cost issues, outsourcing of manufacture and testing and some R&D, changes in marketing practices, slimming down of marketing and sales force personnel, new approaches to R&D- Novartis emphasizing science, Glaxo breaking up into smaller teams, and the growth of emerging markets. All this happens as the public in the USA looks at healthcare in anew way and the demand for healthcare expands quickly in growing developing countries of Asia, Africa and Latin America and Eastern Europe.

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Wal-Mart's efforts to boost its smaller stores as customers go to competitors when they make midweek trips for small basket size fill-in supplies. Sales at Wal-Mart for the year ending Jan 31, 2014, show flat sales. By comparison sales at its smaller stores and neighborhood markets were up 5%. Online sales were up 30% to $10 billion and are growing rapidly. Wal-Mart's sales forecast for 2014 are for sales to increase modestly by 3%. It will incur additional $330 million in benefit costs for healthcare under the new law for workers signing up for its healthcare plan.

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This view from the Guardian by David Adler from July 8 2019, gives a third perspective on Greece as it goes into elections. It looks at the turbulent period of 2015-2019 when a new leader Alexis Tsipras promised to lead Greece out of the eurozone crisis by standing up to the ECB and Germany, instead of looking at Greece's own responsibility in letting debt buildup till it overwhelmed Greece. Adler says Syriza was too much on one end blaming Germany for strict conditions on a loan bailout, and after this did not work embracing the loan program in a complete reversal causing much anguish to his own support base when this led to callous implementation.  Mitsotakis is careful to say in his interview with Reuters that the vulnerable have to be protected while also committing to a path of economic growth for Greece. It says 50 billion euros was provided to help people with the cost of living crisis, pensions were increased, minimum wage increased by 20%. It also shows the need to judge by looking at the situation not by labels of centre left or center right, are people better off, will people be better off in the future, are all the bases education, healthcare, public services, infrastructure covered? Is the government honest with the people and doing everything it can after listening to the people? ...

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Churchill came up with the idea of British restaurants that serve nutritious meals at reasonable cost so that no family would suffer from lack of access to healthy food at moderate prices. This would insulate people from the high prices during the war in the 1940's for food and energy. The Guardian shows these public diners in 1940's Britain. At its peak there were more British restaurants of this kind than McDonalds's or Weatherspoon's exist today. There is a need for this type of government supported food place that serves affordable meals serving quality food ethically produced as a new form of national infrastructure. Nourish Scotland is calling for reviving it today. It tackles health inequality and food insecurity. Abigail McCall, project officer at Nourish Scotland, says- "For other aspects of our wellbeing – water, transport, healthcare, even wifi – we have built the public infrastructure to ensure that everyone has quality, universal access. We are missing that in relation to food,” said Abigail McCall, project officer at Nourish Scotland. “Poor diets have overtaken smoking as the leading cause of preventable ill health for some time now. We need the government to make a bold intervention in our food environment, and invest in delivering what the market doesn’t: healthy, climate-friendly food in a convenient way and at an affordable price."   ...

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This editorial in the WSJ describes the sharp increase in premiums under the Affordable Care Act of president Obama. The average premium increase is about 24.2% according to a Barclay's analysis, and as high as 43.9% in states such as Illinois. Bill Clinton calls it the craziest thing with small business affected, and some premiums doubling. Of the 17 million people in the individual market eight million buy without subsidies. One in five enrollees cannot qualify for subsidies. Democrats say subsidies are too small. Hillary Clinton has proposed to have a Medicare "buy-in" for people ages 55-65, and a "public option" government run plan. Republicans want to rewrite the law. But this depends on which party wins the Senate, with the election in Missouri giving Democrats an opportunity to maintain a Senate majority.