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About 1% of doctors account for 14% of Medicare's payments in 2012, according to WSJ analysis of data released by the Centres for Medicare and Medicaid Services.

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A decade after the 2004 speech at the Democratic National Convention, Obama's message of change and hope as seen by American voters in 2014.

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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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While communities with high unemployment and depressed areas like Rocky Mount in N. Carolina, with 14% unemployment -and many customers skipping prescriptions because they can't afford them- are the worst off, the national picture shows many similiarities. Even with Medicare drug benefit, lowcost generics, and Walmart type low cost drugs, many Americans cannot afford prescription medications for life threatening illnesses. Nationally a third of respondents say they are not complying with prescriptions as they cannot afford them, compared to a fourth three years ago.

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General Electric Co. GE says CEO Jeffrey Immelt will retire and be succeeded by John Flannery in August 2017. Flannery is head of the healthcare business at GE.

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The western pharmaceutical companies see the potential for a big increase in sales in developing countries with better pricing to reach a larger number of people. Earlier this year Glaxo said it planned to reduce prices to two thirds of the levels in western countries, and charge 25% of prices in western nations to people in the 50 poorest countries. As a result Glaxo now forecasts a 10% increase in sales in 2010 in the Asia-Pacific area, after a 9% increase in 2009. The overall impact on public health will however be limited as even with this price reduction these medicines will benefit a fraction of the people. Today the combined pharmaceutical sales in Asia, Africa and Australia are $90.8 billon. According to IMS seventeen economies including China, India, Russia and Brazil will see pharma spending grow by $90 billion in a five year period 2009-2014. Of this China's demand will grow by $40 billion in this IMS Report on "phamemerging" economies. The upshot: phamemerging will account for 20% of global sales by 2013, up from 16% in 2008....

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The old NASDAQ in 2000 cannot be compared to the new NASDAQ in 2015 because the companies in the index have changed, and the proportion of tech and health care companies has also changed. Healthcare and consumer companies are now 37% on the index compared to 18% in the NASDAQ index in 2000. Tech is a much smaller component of the NASDAQ, declining from 64% to 43%. And three companies Apple, Google and Microsoft, makeup 20% of the index, with Amazon, Facebook and Intel added making that 30% of the entire 2015 NASDAQ index. Only 3 of the top ten companies in the 2000 NASDAQ are around in 2015 NASDAQ index- Intel Corp., Microsoft, and Cisco Systems. Yahoo, Oracle, Dell, Sun, JDS, WorldCom are no longer the top 10 companies in the index as they were in 2015. The speculative momentum stocks such as Netflix and Tesla make up 0.38% and 0.33% of the NASDAQ in 2015. In healthcare part of NASDAQ 2015 companies such as Gilead Sciences and Amgen are in the top ten.

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A study by the National Employment Law Project shows most of the job creation in the economic recovery to 2014 in the U.S. is replacing the better paying jobs with lower paying jobs in fast food retail and similiar low paying industries.

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Krauthammer cites Congressional Budget Office numbers that show the Obama U.S. health care law continues the spiralling costs of health care with new government mandates at a time of severe budget cuts in education and other areas- for 2013-2022 the costs come to $1.76 trillion. The initial Obama administration figures of 10 year costs of $938 billion announced in 2010 reflected the fact that the new U.S. health care law would take 4 years to fully go into effect. Costs after 2021 are shown to be $250 billion each year in the CBO figures. The law is now before the Supreme Court in 2012, which has to decide on the basis of the limits of the Commerce Clause.

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Whats the breakdown of costs for Detroit's Three Auto Companies. The following infomation is from documents submitted by Ford Motor Company to Congress. Detroit Auto Companies Foreign Makes like Toyota Hourly cost Hourly cost Hourly wage for workers $29 $26 (Toyota Kentucky plant) Holidays and Vacation pay & pay for Detroit laid off workers $14 $9 Cost of Health Care and Pensions for $16 Toyota has only 300 retired retired workers workers Overall cost $71 $49 The biggest difference is in the cost of paying laid off workers, jobs banks, and in the cost of paying the health care and retirement pensions of retired workers. And for GM there are about 1 million of them, (96,000 active workers, 497,000 retired workers and also the dependents of retired workers) costing GM $4.8 billion on health care. At $1500 per car for GM costs on health care vs. $200 per car for health care costs at Toyota. The difference is $1300. If this is factored in to the profitability of small cars then the field is skewed one way. On a $23,000 car that is a 5% margin right there for adiffernce of $1100 in health care costs. If this is the way profit is calculated on small cars with this health care differential factored in then there is always a muddleheaded tendency to product he bigger cars and trucks because they can absorb this differential better. But it doesn't make sense that this should dictate how the business is run. And it could lead to serious mistakes which appears to be the situation at the Detroit companies, the way they went into the downturn right into 2008 with a product mix that was going to be hit hardest by a change in customer preferences. ...

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China's agriculture based on small farms is undergoing a change as the government pushes automated farming and large farms in the face of limited imports from the U.S. China put tariffs on agricultural imports from the U.S. in retaliation for U.S. tariffs on Chinese imports. China's Agriculture Ministry says it will build 254 "strong agricultural industrial towns" as models for the country. President Xi stated on a visit to northeastern province Heilongjiang, that "unilateralism and trade protectionism are rising, forcing us to take the road of self reliance." The yield per hectare in the U.S. for soybeans is about twice that in China. Mechanized farming is limited in China because it would eliminate many jobs in rural areas. As the state has ownership of land and farmers merely use land, farmers are less likely to take risks with large long term investments. It can be risky for farmers to rent their land use rights to others, which would lead to consolidation.  Now a separate "Made in 2025" plan makes upgrading farm machinery and equipment one of the 10 goals. China may lift ban on genetically modified seeds now that ChemChina has acquired Swiss seed company Syngenta. China plans to partner with Asian Development Bank to provide $6 billion of loans, grants and investment to fund a list of development projects in rural areas, to modernize agriculture. WSJ cites a project of consolidation into an 8200 acre farm in Shandong province that  has increased yields 43% by investing in new farm equipment and planting machines, pesticide spraying drones. Scaling up has made this possible.    ...

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Krugman points to some striking facts about China in 2011. Consumer spending in China is only 35% of GDP and has declined over the years. There are no signs of rebalancing the economy away from exports by increasing consumer spending. China's dependence on exports for trade surpluses is greater than ever. Beyond this there is another disturbing fact. With weak consumer spending and heavy investment spending at about half of GDP, Kugman raises the question where is all that increase in spending going? Real estate investment takes up about half of the increase in investment spending, as the share of GDP of real estate investment almost doubles compared to figures for 2000. Much of the rest of the increase Krugman attributes to firms selling to the construction industry. The speculative fever, the corruption at the local level, the shadow banking system which is not protected and unsupervised, the poor quality of statistics, suggest a bubble phenomena that may not be under control of policy makers, and risks damaging China economy and the world economy in 2012-2013. After all China's economic and financial planners and banks are no better than America's or Japan's, where asset bubbles burst causing serious damage....

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The large increase in auto sales in 2013 to 15.6 million follows a strong rebound in the U.S. market. The gains in sales over 2009 at the peak of the financial crisis, shows Chrysler at 93% gain in sales over 2009, VW at 92%, Nissan 62% and Ford 54%, according to Autodata. Smaller gains of 33% and 26% for Honda and Toyota. Chrysler's sales were 1.8 million in 2013- the company which depended on policymakers in the Obama administration for survival showed remarkable gains under Fiat's CEO Marchionne. VW returning to the market and stumbling repeatedly in the previous ten years, made serious gains with Jetta and Passat models designed and priced for the U.S. market. VW achieved sales of 0.6 million in 2013. Ford sales were 2.5 million, Nissan 1.2 million, Honda 1.5 million and Toyota 2.2 million for 2013. GM sales 2.8 million increasing by 35% in 2013 over 2009. The automobile story may be the biggest story in the U.S. manufacturing recovery. It also may have made a difference in the election campaign of 2012- with winning campaign points in key midwestern states such as Michigan and Ohio for the Obama administration's backing of a renewed auto industry around fuel efficiency improvements, new management, and new relationship with unions. In the period 1998-2007 average sales were 16 million in the U.S. market, with a nosedive to 10.4 million vehicles in 2009, and a rebound to 15.6 million in 2013, according to Autodata. Under previous union contracts with higher wages and pension costs, and a flurry of price incentives, car makers needed higher volume to make profits. Changes since the bankruptcy of 2 automakers include bringing in management from outside the auto industry- Marchionne at Chrysler, Whittaker and Akerson at GM came from other fields (telecom, finance) bringing new perspectives. Mulally at Ford was from Boeing commercial aerospace. Other changes were lower wages and pension costs with renegotiated contracts and relationships with unions, discipline to lower incentives, younger managers moved up and brought in from outside including Reuss and Barra at GM, Farley at Ford, lower sales to fleets, improved fuel efficiency for SUV's and pickups to change the cost of operating, a mix shifted to smaller and midsized cars, improved quality, and changing the buyer perception of American brands....

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11 Pacific Rim nations form the Trans-Pacific Partnership in 2018. The Obama administration supported the trade pact alienating supporters in its union base particularly in the midwestern states. Mr. Trump opposed the TPP in his election campaign and made it a significant issue for swing voters in midwestern states after job losses in the auto industry. With the opposition of president Trump the U.S. decided to withdraw from TPP.  The 11 nations agreeing to join a revised agreement are Japan, Canada, Mexico, Australia, Brunei, Chile, Malaysia, New Zealand, Peru, Singapore and Vietnam. So far six countries have formally approved the deal, Australia, Canada, Mexico, Singapore, New Zealand and Japan, setting the stage for two rounds of tariff reductions starting December 30, 2018. Agricultural products duties will be duty free within 3 to 7 years including for Japan and Mexico. Australia, New Zealand, Canada are major agricultural exporters. Japan supported the deal as a way to counter China's influence in the region. In the U.S. the gains would be in intellectual property rights but losses for workers in the auto and manufacturing industries, a point Mr. Trump recognized in his election campaign as he campaigned in the midwestern states. Mr. Obama pursued TPP over objections of workers organizations and unions including auto workers union, with his advisors suggesting this as a way to counter China's influence in the region. By 2018 the Democratic party support base fractured on this as one of the major issues.   ...