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Bob Kocher, special assistant to President Obama for healthcare policy in 2009-2010 describes how hospital mergers with the passage of the Obama Healthcare Law are not doing much to control health care costs in the U.S. This is contrary to what was expected during the policymaking in 2009. In 2015 there were 112 hospital mergers in the U.S.  He says smaller physician led health care organizations do better at taking steps to improve productivity, adopt technological improvements and control costs.

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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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Negative interest hurt the vulnerable the most- consider how much in interest would have to be deposited in retirement accounts savings of retirees to make up for lost interest over two decades. It could be in the hundreds of billions of dollars. It has added to the poverty in the Nation as interest income went gradually to negligible amounts. It also disincentivised savings,  and reduced the cost of capital so that hundreds of billions of dollars of retirees and other people's income was shifted into startups and dubious investments that did little to add to essential public services, education, healthcare, that would improve the quality of life for workers, families and children.It was in effect a misuse of economic policy to serve one section of the population at the expense of the large majority of the people in the Nation, and a shift of hundreds of billions of dollars over two decades from the vulnerable who needed it most to other uses. And aggravating the situation resulting from the failures in investing in manufacturing in the US that put whole communities at risk, neglecting the investment in infrastructure that helps ordinary people the vast majority in the nation the most. Only now are these investments being taken up by the Biden administration reallocating funds to infrastructure, manufacturing and clean energy, to retirees, and to communities across America. During this time of two lost decades for America, and into the future, the great nations of Asia, China and India, have advanced and are advancing with focused attention on the needs of all the people in their nations, and most importantly of all in advanced infrastructure and advanced manufacturing.  ...

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The health care system is designed to encourage procedure based specialist practices and discourages the patient understanding education and monitoring that occurs with a well designed preventive family physician practice. As a result a patient only spends 30 minutes ayear on average with family physician compared to one hour in other developed nations. In the USA there has been a steady decline in the level and quality and extent of family care and the close one on one rapport with well trained family physicians who enjoyed their work and understood their patients and kept up with their health conditions and provided good and regular advice on these conditions. There is no money in this care as a result first you provide an environment where a whole range of medical conditions can flourish and expand, and then you hit them with a whole series of tests to rule out specific medical conditions. It is a perfect way to expand the testing and let testing flourish, so it would appear that if someone had wanted to start with a goal of letting testing proliferate unhindered then this would be the perfect way to design it. ...

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The authors, Becker, Davis and Murphy, are from the University of Chicago. They point out that the uncertainty created by the Obama administration's programs including healthcare and social investments in education, energy conservation, and the desire to reduce carbon emissions, all tend to slow business expansion and investments to create jobs by putting additional costs on business. The expanding federal deficit and national debt also create additional uncertainty. Their point is that it was a mistake to start making major changes to transform the U.S. economy at this time, and that it would have been wiser to do these changes after the economy had recovered completely from the crisis. All efforts they say should have been concentrated on establishing conditions for a strong recovery. When combined with the lack of regulatory reforms to fix problems left behind from the crisis, and other failures, serious questions arise about how things will turn out in coming years. See Krugman- The Feeling of 1937, where Krugman takes this up from another angle, again with concerns about the future....

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U.S. health insurance company WellPoint Inc. will offer higher payments to primary care physicians. This is part of new strategy to reduce emergency room visits and costs after deterioration in a patients condition by relying on primary care physicians for better care at the outset. Payments to primary care physicians will be increased by 10%, with higher payments when the results show better quality and preventive care. WellPoint has a network of 100,000 primary care doctors. Physicians who meet certain goals such as lowering the overall cost of a patient's health care costs will be given an incentive of 20-30% of the savings realized. The new effort will add 1-2 percentage points to the 6-8% of the $100 billion that Wellpoint pays for claims processed each year. WellPoint's management sees a reduction in medical costs of about 20% by 2015 as a result of such efforts.

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According to the General Accountability Office inquiry, 28 drug products had price increases over 100% in 2000, in 2008 71 drug products had such large increases. Medicines like Adderall for attention deficit disorder, Inderal for chest pain, Sumycin for infections were in the list of 416 brand name drug products where makers or distributors raised prices at least once by 100% or more for period 2000-2008. As large pharmaceutical companies sold their marginally profitable drug products or small selling products to smaller companies, these smaller companies would immediately increase prices to recover the money they paid to the large pharmaceutical companies. 26 of the brand name products saw prices raised 10 fold. A third of the drugs with large price increases treat depression and disorders of the central nervous system.

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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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Michel Barnier is approved by 52% of French people in an Ifop poll, yet 74% think he will not last long. The NFP will call a no confidence motion when its candidate 37 year old Lucie Castets of the Finance Ministry was turned down by Macron. The RN of Marie Le Pen will support Barnier for now and Marie Le Pen says she expects new elections within 1 year. Barnier supports halting migration to France for 4 years, a position RN of Le Pen supports. Denmark with a socialist government has taken similar position. By taking strong action on migration as northern and southern Europe both shift to this policy including Socialist parties, the EU as is happening in the US can address fundamental issues of cost of living action, infrastructure investment and investment in education, healthcare, science and technology competitiveness, renewable energy. Removing the migration issue can put a clear focus on the action needed to address these problems.

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The US needs good manufacturing jobs for the jobs and income that it brings into communities, and also because of the tax revenues from the companies making products in America that provide the basis for local governments to provide good public services in healthcare, education, and transportation. To say comparitive advantage that helped first Japanese and now Chinese manufacturers is real and how society gains is to deny some basic facts that are self evident from observation that contradict textbook ideas in economics. Comparitive Advantage is a textbook economics concept that says countries are proficient in what they make best and should specialize in that product. But it is a static concept that exists only in textbooks. If Japan in 1960, China in 1980 and India in 2000 were each presented with this idea they would have turned down the idea of making steel and remained makers of lower end products such as footwear and textiles. If Japan in 1980, China in 2000, and India in 2020 were each presented with this idea they would have turned down the idea of making semiconductors and remained makers of lower end products such as steel. A senior vice president of US Steel in the late 1960's even told this writer a graduate student at Northwestern in Chicago- as the US can make steel better than India or China let us keep making it for you. He and much of the business faculty at Northwestern also could not understand in 1970 why Airbus was being setup to compete with Boeing who by the concept of comparitive advantage should have had the whole market to itself for commercial aircraft . By this kind of thinking Airbus would not exist today because it did not have the lowest cost or the manufacturing technologies Boeing had through its vast manufacturing operation. America would be still the only one making aircraft in 2023 if textbook concepts ruled the day. By indirect methods such as hidden preferential arrangements, provision of inputs such as land, capital and labor, tax relief, the costs can be represented in a way that shows it is cheaper to manufacture overseas. The lack of a level playing field is what president Biden is correcting by doing what first Japan, then South Korea, then China and now India are doing since the 1960's. By 1974 in four years after its founding in 1970 Airbus came up with its first model the A-300 using advanced technologies. America will regain its leadership in the cost and manufacturing of many products through Biden policy and the efforts of American companies by 2030, and do this in a transformative way that will benefit the world as a whole.  It is an enormous error to say the US does not need good manufacturing jobs, that local governments do not need the tax revenues from manufacturing plants to build services for communities where manufacturing workers live, and the US does not need the manufacturing experience curve that leads to reduced costs. It is this loss of the manufacturing experience curve that is the most vital aspect for understanding the need for the US government to compete effectively with the governments of Asian countries to keep manufacturing healthy and strong at home. Economics experts ignorant of how important this science and engineering principle is fail to grasp this. Related to this is the idea of a virtuous cycle in manufacturing- whoever braves the hard years of moving up the learning and experience curve gets rewarded because once that country has mastered that skill it gets better an better as the technology advances- making it harder and harder to prevent a new monopoly in manufacturing by the country (Japan, China or Taiwan) that had the highest costs and the least advantage ten or 20 years earlier but just persevered through it all with the government's help to gain cost competitiveness. This part does not make it into the economics textbooks which are mostly theory and much of it outdated by the time they are written. Observation is the best teacher and guide as it is in science, to guide policy and action. Obsessive attachment to theory that ignores observation becomes the enemy of progress. Comparitive advantage is one concept that needs to be retired even from the textbooks. Overseas manufacturing then is a piece of the overall picture that fits into what is good for the US. Macroeconomic principles determine microeconomic outcomes as opposed to microeconomic principles with companies out on their own being forced to compete without a level playing field, or handing out technology for special status in a recipient country as some do putting the US at a macroeconomic disadvantage. This is also healthy for the recipient country overseas, as recrimination with loss of manufacturing jobs in the US inevitably leads to the kind of recrimination that does not serve either country well as in the case of China today, and worse still can lead to conflict, even war. After the egregious situation of loss of manufacturing communities across the US leading to destabilizing the social fabric, it is hard to see such thinking prevail about the US not needing manufacturing as a vital part of its social fabric and industrial strength. China, it can be said, would have developed, and developed well over the past two decades without overconcentration of US and EU manufacturing in China. Without aggravating the problems of climate change and contamination of air, land and water, and destabilizing the social fabric in the US hurting workers and communities across the US, if macroeconomic policy was made to manage this process in the US government without it being left entirely to individual companies to decide. Instead China faces today a difficult situation through events such as destabilizing the social fabric in the US (the Trump tariffs), advanced economies in G-7 resistance to sharing of technologies, the damage to its environment from microeconomic locally determined policy at individual companies, and the global effects of climate change from climate unsustainable levels of growth since 2000.  ...

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What is behind Pew Research Report finding showing an unacceptable concentration of wealth that endangers democracy. Higher income groups making $244,000 a year in 2024 gained 19 percentage points of the total US Household Income moving from 29% in 1970 to 48% in 2024. About 50% of the nation's income going to 20% of its people and most of that to 2%-5% of the people of the US. The gains meant loss of 17 of these percentage points for middle income households making $106,000 a year that went from 62% in 1970 to 43% in 2024. Another 2 percentage points was suffered by vulnerable Lower Income groups making $35,000 a year who owned 10% of US wealth in 1970 went down to 8%.  The problems of divisiveness in the Nation come from three distinct areas. First money for state financed education for all being put into wars in the Middle East from Reagan through Obama and Trump and some wasted through capital misallocation to low priority investment by faulty capital market allocation. Second the high cost of pharmaceuticals and healthcare putting a heavy burden on low income and middle income households making $35,000 or 106,000 a year. Third the neglect of manufacturing that cutoff the opportunities for middle and lower income households and their one chance to move up the ladder. And the parallel shift of resources to technology and financial sectors that created opportunities for a smaller group of immigrant and higher middle income households with these skills.  These are the sources of America's distress and each problem is being attacked at its source by president Biden- exit from Afghanistan, canceling student loans that are egregious and prevent the investment in education America needs, large sustained investment in manufacturing and new supply chains, antitrust action on tech monopolistic behaviour, redrawing the shape of America's pharmaceutical sector to provide access to medicine to all parts of the population.    ...

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Einer Elhauge, professsor of law and founding director of the Petrie-Flom Center in Health Law Policy at Harvard University, says there are limits to Congressional powers under the Commerce clause such as enacting a law requiring Americans to eat broccoli. If the health care law required all Americans to subject themselves to health care this would be the case. But the law only requires all to buy insurance so that insurance can cover the costs of healthcare for all. He points to the "necessary and proper clause" as also authorizing the health care mandate. That clause gives Congress the power to pass laws that are "rationally related" to execution of constitutional powers, such as criminalizing the interference with mail, on the basis of the constitutional power to setup post offices. In this case the health care law mandate is related to the constitutional power to regulate premiums and prohibit rejecting the sick, says Elhauge.

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A study by AARP of 514 brand name and generic drugs between 2005 and 2009, shows that generic drug prices went down an average of 31% during this period, and brand name drug prices went up by 41%. One of the authors of the report says that it is important to look at individual drug prices and not studies showing total spending on drugs, because this is a significant cost for people paying out-of-pocket, It drives up insurance premiums, and pushes retirees into coverage gaps in Medicare Part D drug program. Analysts indicate pharmaceutical companies are increasing prices on drugs before patent expiration to get as much profit before the patents expire.

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A advisor to U.S. president Obama lists the gains in U.S. healthcare made by March 2014, after the passing of the Affordable Care Act or Obama healthcare law. He cites on access to care the reduction of the percentage of uninsured Americans from 18% in the middle of 2013 to 15.9% in the first quarter of 2014, according to a Gallup poll.

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The costs of fraud in medical care from spurious Medicare claims to kickbacks for unecessary services is estimated at $125 to 175 billion. Costs of unnecessary care from overuse to unnecessary lab tests are between $250-325 billion. The amount wasted for on treatment for preventable conditions such as heart disease and diabetes. is $25-50 billion. This number is much higher when all the complications from obesity are figured in. These amounts alone add up to $500 billion. Add to it the problems and the costs of medical errors leading to bad drug reactions or other misdiagnosed procedures which cost an estimated $75-100 billion and the the total is upto $600 billion. These amounts are not going to be tackled by computerization of medical records. The whole manner and ways in which medicine is practiced today and the manner in which the public takes care of its health would have to change for an impact to be made in these numbers.

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The inflated costs for spinal surgeries at some hospitals in California. How surgeons, doctors, consultants, distributors and hospitals operated in a flawed system to make revenue gains through overbilling, and focus on increasing the number of surgeries performed.

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This editorial in the WSJ points out that U.S. president Obama made economic inequality "the defining challenge of our time" in his State of the Union address in 2013, yet the U.S. has seen widening economic and social disparities in his two terms- creating the situation where Bernie Sanders is now in a virtual tie in Iowa with Hillary Clinton. It says Hillary Clinton wins handily over Sanders on three of four issues of the most concern for Democratic caucus voters in pre-entrance polls, healthcare, terrorism, and on the important issue of jobs and economy by 51% to 42%. Where she falls behind is on the issue of income inequality, and by a very wide margin reflecting voter disillusionment with policies that resulted in marginalization of some workers through globalization and long term unemloyment, and reduced access to education with high tution costs- there Sanders wins by 61% to 34%. Federal Reserve policies that kept rates low near zero hurt middle class savers, working class savers, and benefitted disproportionately upper class investors in the stock market, widening the social and economic disparities....

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The average U.S. light vehicle price was $30,303 in April 2012, up $1219 from the prior year. Incentives were also lower, down $146 to average of $2,446, according to TrueCar.com. This is happening even though cars account for a greater portion of sales of light vehicles. Used cars and trucks prices increased by 3.2% in March over the prior year, according to the Labor department data. Pent up demand is part of the reason. Another reason is the discipline exercized by auto manufacturers, especially the Big Three, in not letting supply exceed demand and therefore not having to offer higher incentives to get rid of inventory. These practices of oversupplying the market hurt the Detroit automakers in the period before bankruptcy, especially GM. Increases in used car prices and higher prices of new cars create a virtuous cycle for automakers to support higher margins. With the high retirement and healthcare costs reduced through bankruptcy and new agreements with the UAW, the Detroit automakers are now better positioned in the market to sustain margins by limiting production to demand. ...

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Tyler Cowen, Professor of Economics at George Mason University, points out some basic truths about health care as it is practiced today in the USA, and healthcare spending as it stands today. He questions whether starting out with extra spending plans to provide coverage to all will help solve the basic problems facing American health care. Too many tests and diagnostic procedures used by doctors is not aproblem that will be solved by spending more money to cover everyone. And government taking on more spending to cover all will not address all the other major shortcomings of the American way of practicing medicine, like prescribing a battery of tests, that tend to drive up costs, to just mention one of the problems. And it will not address any of the shortcomings in the way Americans take care of their health, diet, exercize and healthy lifestyles. THese are critical to get good health outcomes for the people, and which combined with careful spending of dollars where it will provide the greatest benefit, is the only way the health care solutions can be found....