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Medical device makers for heart like the stent and hip like replacement hips have margins of over 70%. THese and other medical devices may come under pressure from the changes that are anticipatd in the way Medicare reimburses hospitals for these devices, which are largely used by older patients under Medicare coverage. Stocks of these device makers like Boston Scientific, Stryker, and Zimmer, have fallen in recent weeeks

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Friedman describes the poor choices remaining in the Middle East with Iran, Iraq, Islamic State, Egypt, and the conflict in Libya. The last days of the election campaign in Israel have also worsened tensions in Israel with deep differences between the Likud and the Zionist Union.

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U.S. president Obama invited NYT's columnist Thomas Friedman to the White House for an interview on Saturday afternoon April 4, 2015. Here Friedman gives president Obama's response to his questions, and Obama's concerns about the heated rhetoric in the U.S. and Israel on the negotiations with Iran detracting and distracting from his key goals of protecting U.S. interests and Israel. On the Sunni states, Saudi Arabia and Egypt, Obama points out that there are some tough conversations needed about changes inside their societies which pose a greater threat to the governments than Iran. Obama says he understands perfectly that Israel and the Jewish people after their experience of the last hundred years are determined to not let Iran develop a nuclear weapon, and their right to be concerned that the agreement could let Iran clandestinely develop one. Obama says the verification is extensive and covers any facility in Iran, any suspicion about secret facilities, yet it leaves the subsequent decisions if Iran created difficulties, to a international body over which the U.S., UK, France, have no control. This is a principal issue for critics of the negotiated agreement. No mention is made of why Iran simply discarded the option of sending the atomic material to Russia to be processed into nuclear rods for the Bushehr nuclear plant built by Russia only a few days before the final outline was developed. And why the U.S., with allies Germany, France, UK and Japan, did not offer the Iranians an economic aid package if needed in return for the billions Iranians invested for that atomic material, to ensure that the atomic materials are shipped out of the country- to create a nuclear agreement that would be credible to all parties. The economic aid would benefit Iran modernize its oil industry, including refining operations, meet basic import needs, and provide tangible proof to the Iranian people of our best intentions for the future, that president Obama strongly espouses in the interview. The interview does show the quandary president Obama faces in Iran for strong action, that is a result of failed policies with Iran since the Eisenhower administration's intervention 1953 during the Cold War that displaced the elected government of Mosaddegh in Iran and setup the Shah's regime in 1956, the support of Saddam Hussein in Iraq in the war against Iran, which Obama mentions in this intervew. In the light of the repeated failures of the U.S. policies a Democratic party leader faces increasing reservations for taking strong action against Iran's development of nuclear weapons capabilities, preferring to exhaust every diplomatic channel, and take risks in the hope that time will give the Iranian people an opportunity to to reintegrate in the global community and pursue the peaceful development of nuclear energy. This strain in president Obama's thinking is evident throughout the interview with Friedman. Other aspects of president Obama's policy in the Middle East shared in the interview are about supporting the Sunni states in some areas, and Iran in some areas, at the same time as the nuclear issue is "put in a box" and separated from the regional conflicts. Friedman presents this as the Obama doctrine, yet it appears to be coming after a series of improvisations in foreign policy following a failure to act in 2011-2013, when the "once in a lifetime" opportunities presented by the Arab Spring were not taken up by the Obama administration, leading to the region's current disintegration....

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DJT 1.0 was led on the tariffs policy by USTR Robert Lighthizer, who had experience negotiating with the Japanese negotiators in the Reagan era. He is today respected by  Republicans, is seen in an important role in economic policy and to prepare the tariff policy actions of the new DJT administration. Lighthizer prefers to get Congress to take action with legislation. He also believes that domestic manufacturing will make gains with new and higher tariffs on Chinese imports. Lighthizer policy is falsely compared with Hoover Tariffs Act of 1930 when world trade was 9% of world GDP, today it is 63% of world GDP, and where under Hoover in 1930 the tariffs were across the board all countries 20,000 goods. Under Lighthizer on specific products where dumping is happening -steel, aluminium, autos, with Japan in 1960-70 or China 2000-2020 targeting American industries + technologies for takeover. And falsely when it comes to raising costs to each American family on average by $4000 a year by economists. The conventional view for business for 2000-2016 through Bush and Obama favoring free trade did not take into account the unusual experience of China which entered WTO in 1990, then expanded in a way unprecedented in history at 10-12% growth rates for 15 years destroying American manufacturing with dumping, having support of outshoring by companies in the US, and not giving reciprocal treatment for exports from the US to China. China also had unrestricted access to US technologies in this type of trade. Lighthizer's approach was to specifically address this problem not a general across the board tariffs on all goods (20,000 goods) on all countries as with the Hoover Tariffs Act in 1930. Lighthizer's approach adopted by DJT called for reciprocal trade response with China as the US had already done with Japan, not unilateral across the board tariffs, and when world trade had advanced to about zero tariff rates. And falsely compared to Hoover 1930 Act because under Hoover tariffs were 29-40%. raised to 60% when world trade was small, was 9% of GDP. The Biden administration has tacitly agreed with Lighthizer's vision by not reversing DJT tariffs. A new higher tariff will probably be selective based on the industry, country and what goals the US has set under the new administration for that industry. Some of the tariffs revenue may also be used for tax cuts. ...

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Prime minister Modi campaigning in his home state of Gujarat, and taking control of the campaign in the state. He has visited the state to launch the bullet train project, a new ferry service for Saurashtra, and for the Narmada dam completion.

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Crime by violent street gangs with whole sections of cities controlled by different groups, some a remnant of the guerilla wars, has fueled the migration crisis. Many people have left central American countries of San Salvador, Costa RIca, Guatemala, because of the crime and extortion experienced and the lack of law and order in these countries. Criminal violence by these gangs hurts business which leads to even fewer economic opportunities for young people. This leads to a steady flow of migrants to the borders of Mexico trying to enter the U.S. Experts say 95% of homicides in these central American countries are not tackled, with severe distrust of police.  There are fewer emigrants from Mexico as the economy has improved and population growth has slowed. Most of the faces of migrants are now from the Central American countries. A program is underway to create jobs skills in Honduras. But this a small effort in tackling a much bigger problem of violence, lack of economic opportunity, and the legacy of the civil wars in central America in an earlier period that have left whole sections of urban areas under control of former guerillas and militia turned into gangs.  ...

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900 million eligible voters in India means this is the largest election ever. The election will take place in 7 phases in April and May from April 11 to May 19. Votes will be counted on May 23. The election is for 543 seats in parliament, the Lok Sabha. Turnouts are high with 66% turning out in the last election that brought Mr. Modi and the BJP to power.  Unlike elections in Britain a lot is spent in each election, about $5 billion in the last election and double that this time. The U.S. elections in 2016 had spending of $6.5 billion as a comparison. Women vote at about the same rate as men and more women than men are expected to vote this time. Prime minister Modi won the last election with promises of development and infrastructure. He is delivering on infrastructure but building manufacturing and generating jobs in the formal sector remains a tougher task for any administration in 4 years. During the first term Mr. Modi made needed changes including introducing the GST tax to integrate India's fragmented market and get rid of a patchwork of regional state taxes. He introduced a whole range of projects and yojanas which are setting the stage for widening the middle class, and improving living conditions. Some of the problems such as the bad loans in the banking system date back to previous administrations and the government has taken steps to clean up this problem by refinancing banks and introducing a bankruptcy law. This has slowed GDP growth to about 7%. However this would have happened under any administration.  The brief war with Pakistan in February 2019 has added another dimension to this election with questions about whether this may help Mr. Modi because of his strong stand against terrorism camps in Pakistan.  In the end it all comes down to whether the public still believes the BJP party under Modi is best qualified to develop the infrastructure to modernize the country and improve services, and whether it can create enough of the manufacturing capabilities to generate jobs needed. It may not be that the BJP under Modi has  not made mistakes in the process of learning how best to tackle development, but whether a patchwork of regional parties led by the opposition Congress party is in a position to provide the strong decisive direction to make quick decisions on development. Getting the agreement of a number of regional parties such as the party in West Bengal state or the Uttar Pradesh state when it was under a previous administration of Mrs Mayawati means an even slower rate of decision making as it leads to lack of speedy decision making. Whether voters have short memories and forget the slow rate of infrastructure development under previous administrations or have a willingness to give the BJP a chance to show what it can do under Modi for development can eventually decide this election. An example of what this means is in how the Mumbai Metro is being pushed through to timely delivery- Metro Rail's head Mrs. Ashwini Bhide simply says she feels for the people of Mumbai who have suffered from delays in development of needed infrastructure for so long, with millions doing appalling rides in a creaky old rail system. In her view it should have been done yesterday. It is this attitude that can make or break the current administration, and whether it can get this message through to voters one more time. Most who have this attitude are aware that China is now laying enough concrete every two years than America did in the whole 20th century, as reported in the Guardian newspaper, and are equally passionate about delivery of services and rapid development of badly needed infrastructure.         ...

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WSJ committed to orthodox economic theory thinks of tariffs as tariffs such as Smoot Hawley from the 30's. This is why it is not true- It is about fentanyl flows that have led to 490,000 deaths over 12 years in the US and few in the US like to talk about it. Smoot Hawley had nothing to do with fentanyl, drugs trafficking and migrant trafficking that every nation not only has a right but a No.1 responsibility to its citizens to keep its neighborhoods and its children in neighborhoods safe. Smoot and Hawley were US Senators and US Congress was isolationist in mood. Their grasp of the world trading system was meager and they stepped in at a time when the world had economically not recovered from World War I, and the French against US General Pershing's advice had set the most punitive arrangement in Germany that crushed Germany after an armistice Pershing opposed that left the Kaiser's political structures intact. Tariffs is not DJT's idea. It is the solid experience of Deputy US Trade Representative, Robert Lighthizer under Reagan who conducted negotiations with the Japanese who stalled and stalled Lighthizer says, let negotiations drag on into endless nights, and Lighthizer and his team stood firm. The relentless Japanese relented and Lighthizer secured the agreements that ended this phase of trade relations in the 1980's. Lighthizer was Trade Representative in the DJT first term 2016-2020 and launched the negotiations with China. This is now 8 years since 2016 and 2016 itself was 35 years after Lighthizer negotiated with the Japanese. Today's US Trade Representative is Jamieson who was Deputy Trade Representative under Lighthizer in 2016. Each detail is carefully thought through to bring it to a fair conclusion in the interests of the world and the US. Information traveled slowly GM could not tell at any time how many cars were in inventory on its lots in 1920's. US lacked basic infrastructure for government that FDR and Labor Secretary added firt in New York in the 1930's and which was transferred to 50 states by 1940's. Today information is quickly at fingertips and consultation processes are built in between industry and government at all levels. A lot of information is carefully evaluated. USTR as DJT showed, the major study of USTR Office in the Rose Garden on April 2, 2025, has all trade barriers carefully analyzed in minute details for every country. And is working on this for 40 years. There isn't even a slightest  comparison between this and the Smoot Hawley crowd in the 1920's.  The goal not to beat anybody. Just to set the goal of a level playing field for world trade. That is the foundation of trade that is fair and respected, and is a win-win for all. WTO's basic foundation No. 1 principle is a level playing field. It is just that this was a kind of Marshall Plan for Asia of the US to let poor countries such as Japan war wrecked in 1950, and China colonial power wrecked by first Britain then Japan struggling and poor in 1990's, giving them some time to rebuild by ignoring unfair barriers to trade for 10-15 years 2005 for China. Barriers that never got dismantled and technology that leaked from the US 2005-2016 under the Obama administration. Smoot Hawley was not about the US Navy building its own ships and US shipyards in the 1920's. In 2025 US shipbuilding industry is stolen, this is why the words used "pillaged" "looted" were used in the Rose Garden. Little by little American private enterprise capitalism was superseded by a new form of capitalism in Japan then in China that combined state capitalism with private enterprise capitalism. This then was the threat America faced, and needed to redouble its energies and seek fair play.   ...

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Speaker Paul Ryan's effort to fix what he calls "a House that is broken," as he becomes the new Speaker of the U.S. House of Representatives in Oct. 2015.

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Dan Maffei won his Congressional seat from an incumbent Republican from Syracuse. Others of the 35 first term Congressmen represent a rural, small town and suburban areas like Maffei. And they are not about to lose their seats after tough congressional campaigns, they say, by voting the wrong way on health care reform. As one from Maryland put it he is not willing to foloow the lead just to follow the lead. These are the Congressmen that Steny Hoyer, Rep. from Maryland, who leads the Democrats in the House, wants to give more time as this is what they wanted. And these Congressmen are making themselves heard and making changes in the health care legislation where they disagreed.

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The Wall Street Journal's editorial columns have followed closely the working of Fannie Mae and Freddie Mac over the years. Especially during the last decade, when most of the excesses, missteps and failures in the operations of the two companies occurred at huge cost to the US economy and to taxpayers. The Journal quotes from the recent Treasury report on the planned winding down of the two agencies. And focusses attention on the question of what will replace Fannie and Freddie. Only the first of three options looks viable considering the goals of reducing misallocation of national resources, and winding down the federal government's role in housing, says the Journal. With this Option the federal government guarantees are limited to Federal Housing Administration (FHA) loans to low income buyers and VA assistance for veterans and farm programs- narrow segments that limits the guarantee strictly to 10-15% of the mortgage market. The Journal says that the conclusions of the Treasury report are what WSJ has been saying for 20 years: " The strength of this option is that it would minimize distortions in capital allocation across sectors, reduce moral hazard in mortgage lending and drastically reduce direct taxpayer exposure to private lender's losses." And the points about the benefits: " With less incentive to invest in housing, more capital will flow into other areas of the economy, potentially leading to more long-run economic growth and reducing the inflationary pressure on housing assets. Risk throughout the system may also be reduced, as private actors will not be as inclined to take on excessive risk without the assurance of a government guarantee behind them. And finally, direct taxpayer risk exposure to private losses in the mortgage market would be limited to the loans guaranteed by FHA and other narrowly targeted government loan programs: no longer would taxpayers be at direct risk for guarantees covering most of the nation's mortgages." This bit of wisdom is especially significant, as misallocation of capital that went on in housing for the better part of the last decade has hurt America and the American people. It makes sense to have explicit money allocated by Congress for housing help to the poor and have no housing guarantees that have hurt the economy....

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The Brazilian economy is growing too fast, and this pace not only won't be sustained, but it has signs of serious trouble ahead. The Brazilian economy grew at an estimated annualized pace of 10% in the last 6 months and generated 962,000 jobs between Jan-April of 2010. Growth in 2010 is expected to be 7%. The jump in growth is partly the result of the stimulus measures of the Lula government. But a consensus of experts is that Brazil still saves too little, has not invested enough in infrastructure,and its economy has the potential of 5% sustainable growth each year. The central bank has increased interest rates - increase of 0.75% in April 2010, and economists in Brazil think the rate will go up to 13% in 2011. About $10 billion in cuts in spending have been announced but they are cuts to an already growing budget approved by Congress, so in reality it will only slow the increase in spending. Public debt is at 42.7% of GDP. Real interest rates have fallen from close to 20% in 2003 to between 5-10%. Costs per unit of labor are increasing at about half the rate of real wages according to a finance official. The National Development Bank or BNDES played a role in helping the economy with subsidized loans when the financial markets ran into trouble. It has expanded lending by 50%, with money from the Treasury of 180 billion reais. Some of the measures of the Lula government has reduced the skewed income distribution Brazil, and in doing so has increased consumer demand. Meeting high consumer demand, and meeting the need for commodities like soyabeans and metals from China, has boosted growth in Brazil to twice the sustainable rate and it is now at a par with China and India. But this places Brazil too dependent on the boom in Chinese demand, especially as the stimulus in China slows and the property bubble threatens China's economy. See links to China. A new President after the upcoming Presidential election will have to tackle the high interest rates in 2011, lower commodity prices, and the need for better infrastructure, and make the adjustment to a sustainable pace of growth....

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Pearlstein says the major news stories of today all are about the same theme- of how the US was encouraged to live beyond its means by trading partners who prospered as this went on, with the tacit agreement of financial and political leadership in the US who raised no alarm about this. These stories are: the G-20 meeting in South Korea with the goal of rebalancing the world economy, the President's Deficit Commission Report recommending bold steps in changing the tax and spending policies of the US, the criticism of the Fed's decision on $600 billion of quantitative easing, and the renewed concerns about Ireland where severe cuts in public spending have failed to reverse a downward slide.These trading partners prospered by lending Americans the money to consume more than they produce. It was he says a wonderful arrangement while it lasted, because it helped bring millions out of poverty in Asia, while letting Americans enjoy a transitory period of a higher standard of living. This unsustainable arrangement converted the US from world's biggest creditor nation after World War II to the world's bigggest debtor nation. He credits Geithner for coming up with a more convincing and less confrontational way to correct the imbalances by setting limits on the deficits and surpluses of trading nations. He points out that the Chinese have barely budged on the issue of an undervalued currency, the world be damned. And the German and Chinese criticism rings hollow he says, as both countries are the main beneficiaries of the current system. The normal mechanism of correcting imbalances with a floating rate exchange system is hardly relevant, as it is incompatible with state run economy and strategy of export growth of China. Erskine Bowles and Alan Simpson have presented he says a bold deficit reduction plan that is credible, fair, economically sound. Even though it was received with the usual complacency and lack of awareness both in the media and in Congress. The simple reality after all the awfully complicated details and the painful implications is this: Americans have to consume less and produce more, and trading partners have to consume more and produce less. And this shift cannot be pushed into the future as our trading partners would like....

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The first budget of the Obama government makes a sharp swing away from decades of earlier policy, and puts America on a new direction focussed on priorities in education, health care for all, and energy. The 134 page doocument on the budget defines the governing principles and priorities of the new government. "This is the legacy that we inherit- a legacy of mismanagement and misplaced priorities, of missed opportunities and of deep, strutural problems ignored for too long," the document says. It declares that "government must lead" in contrast to Reagan's "government is not the solution, government is the problem." In contrast to "trickle down" policies of Reagan it proposes "trickle up" policies- shifting income from rich to the poor. It creates a $630 billion fund towards a national health insurance program built with the help of savings and cuts elsewhere. Government takes over most student lending, and dramatically expands Pell grants for poor college bound strudents, transforming it into something like Medicare that is automatic rather than approved each year by Congress. Businesses that emit carbon and heat trapping gases will have to purchase permits to do so starting in 2012. Hundreds of billions of dollars from these permits will pay for clean-energy technology and for tax credits for working couples. Income tax rates will rise for couples earning more than $250,000 beginning in 2011 and will have lower personal exemptions, lower itemized deductions, and higher capital gains tax rates. The estate tax will be preserved. Hedge fund and private equity managers wil have to pay income tax rates for that compensation as high as 39.6% after 2010, not the low 15% capital gains rate they pay now. The Defense Department would see a $20.4 billion boost or a 4% increase in 2010 over 2009, it will request an additional $75.5 billion in 2009 for the wars in Iraq and Afghanistan, and an additional $130 billion for 2010. The budget is for $3.6 trillion for 2009, and projects a deficit of $1.75 trillion for 2009, or 12.3% of GDP- a level see in 1942 when the US entered World War II. Under optimistic White House assumptions for a strong economic rebound, the deficit would drop to $533 billion by 2013....

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The use of fast track procedures under 510 K, for approval of Ren-Gen's Menaflex product to treat knee injuries. Under 510K rules for fast track no clinical trials are required, because the product is similiar to already existing products. Menaflex does not have asimiliar product, yet the FDA allowed Menaflex to be treated as fast track. The closest is orthopedic surgical operation, which is quite different. Menaflex is a C shaped pad used to repair a torn meniscus, a rubbery substance made from cow collagen that that acts like ashock absorber between the knee bones. Their is a booming market for meniscus repair among sports athletes. In fact originally Ren-Gen did not even apply as fast track, but only afte its clinical trials ran into trouble, did it try for fast track, which was turned down several times. At which point Ren-Gen got Democrats Senator Robert Menendez, Rep Frank Pallone, Chairman of the Health Subcommittee of the House Energy and Commerce Committee, Rep Rothman of Hackensack where Ren-Gen is based, and Senator Frank Lautenberg to intervene. At this point Senator Menendez and the others wrote to the FDA Commisssioner Dr Von Eschenbach, and Menendez spoke to the Commisssioner personally on the phone. After this intervention things started moving in Ren-Gen's dirtection, bypassing the FDA staffers who had reservations, and a special panel was appointed that again excluded anyone that had reservations, in an unusual procedure, which approved Menaflex. Now Congress and the Obama administration are being asked to review the whole process the FDA uses for medical devices because of the controversy this has caused about what is seen as unfair influence of companies in FDA approval process. Menaflex say those who had reservatoions faces alot of pounding and wear and tear between the knee bones and its safety and effectiveness needs to be proven before approval. It has been approved in Europe for afew years, but only 2800 patients have used it in Europe, only a small proportion of patients, and not enough is known about its effectiveness and any issues. ...

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How their strains in the the the Toyota manufacturing system and how Toyota's quality is not what it once was. Its image as a environment conscious company is also suffereing with its attempt to stall new fuel economy legislation in Congress like th Big Three American companies. And new hybrid engines are being introduced in joint development between Mercedes, BMW and GM so the novelty of Toyota hybrid may just wear out. And competitors from Germany and the US are now working harder to reduce Toyota's advantage by producing quality cars. As styling design and creative innovation has not been Toyota's strong point the Americans and the Germans have an opportunity to come up with something new. Even the incentives Toyota has to offer to sell its cars have now come up to what the Gm, Ford and Chrysler had to offer. According to CNW Marketing Research Toyota's dealer incentives have almost tripled in the last 3 years to an average of $3752 per vehicle. This is not a good sign. And we may have reached a point where the difference in quality between the GM Malibu and the Honda Accord from the Toyota Camry may really not be that much. No surprise that this is shaking up Toyota. The "Customer First Initiative" in response to quality issues and recalls is to have more power put into the hands of the chief engineer for any product launch to ensure quality problems are addressed early. And the dealers have EN2 (everything matters exponentially to address quality issues at the dealer level. And there aren't enough sensei or teachers of the Toyota Production System to meet the rapid growth of plants and the Global Production Centre was designed to meet this need by training teachers in an accelerated way in Japan. But there is a sense that a lot of the old Toyota magic may be fading just as Toyota reached te peak of its popularity sometime last year or 2005. Not because Toyota hasn't made the effort but because the whole dynamics of the car industry keep changing and Germans and the Americans are also pushing harder nowadays....

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Peggy Noonan in the WSJ comments on U.S. president Trump's effort to work in a bipartisan way with Democrats on government spending, raising the debt ceiling, and hurricane aid. Noonan says this may not last, because president Trump lacks steadiness or the understanding and depth needed to make it work. A major problem is the eight months of policy wavering moving in different directions, and endless tweets showing a lack of depth, that have alienated many. This has hardened opinion in some ways says Noonan, and is a hurdle to making things work in a bipartisan spirit. Not much is predictable in the Trump administration as lack of steadiness is a singular feature.  Other problems for this bipartisanship to work is that it could alienate the right wing of the Republican party and the Freedom Caucus, as well as the growing left wing of the Democratic party.  In this zany atmosphere things could soon be back where they were.