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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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Questions about the true cost of the Obama health care legislation and the assumption that the legislation cuts the deficit by billions of dollars. This WSJ editorial says one has to look at this closely, and not merely look at CBO projections, which may be based in a certain context and not reflect the true costs, especially because many accounting gimmicks and use of numbers to present a particular picture is taking place. The information this editorial cites is that: it uses 10 years of taxes to fund six years of subsidies, Social Security and Medicare revenues are double-counted to the tune of $398 billion, a new program funding long-tem care frontloads taxes but backloads spending, and the assumption of an automatic 25% cut to physician payments that Congress is unwilling to authorize. Rep. Rand Paul has tried to present an alternative view which needs to be studied just as closely, because of the enormous impact of a jump in spending at a time when the public finances are fragile. WSJ also cites the work of Richard Foster, the chief Medicare actuary, as an alternate perspective of how things could turn out, Doug Holtz-Eakin, and Eugene Steuerle. It calls for common sense in evaluating programs, entitlements, defense or other government spending. They not only cost money, but costs escalate over time as history has shown over decades, till they eventually are discovered to be not affordable unless the middle class is willing to dig deeper into its finances to pay for them. Alternate perspectives from a range of informed opinion, Howard Dean, Martin Feldstein, and the head of Harvard's Medical School show that the issue needs to be looked at closely and carefully and cannot be something in which CBO numbers can be trusted to tell the whole story. Especially when common sense, history, and informed opinion across a spectrum of thought advises caution, and fragile public finances also suggest caution. Howard Dean, former Governor of Vermont, says the health care bill is not real reform, and may do more harm than good. He says in a Washington Post article, December 17, 2009, the Obama health care bill does not insert competition into insurance markets, does not significantly reduce costs, and does not improve the delivery and use of health services. It was he says done with a political calculus and crafted for votes not real reform. Jeffrey S. Flier, Dean of the Harvard Medical School, gave the Obama health reform bill an "F" grade, saying in a Nov 18, 2009, WSJ article, that it was disingenuous to call this reform, Congress and the White House were simply deceiving the public. He said the bill will accelerate US health care spending, postpone most of the major health care problems, expecially the ones that drive cost, including the "fee for service" system and delivery of health care. He says in his discussions with economists and other health care leaders the opinion was unanimous that the bill will accelerate health care spending. He cites Massachusetts as an example, where access to care was expanded under the same dysfunctional system, and spending went up, and it doesn't work. Feldstein, who in early 2008 suggested proactive solutions to the mortgage debt crisis which were never adopted, says that the Obama health care law means higher taxes in the long run to pay for the $1 trillion cost of health care for the uninsured group over 10 years. Feldstein says that the Obama plan is to cut Medicare to cut spending, and will reduce the amount of medical services, as reduced spending comes from fewer services, not reducing payments to providers. And he asks if the cost reductions are weighted too heavily towards reduced services and not reduced payments to providers ,would this result in large cuts to services to affect the quality of healthcare for the 85% of the American people who are accustomed to a different pattern of healthcare. ...

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It makes for good political rhetoric, but in reality the flow of money goes both ways. A lot of investments are made by American companies overseas. This time the flow of oil money because of high oil prices, from the USA and Europe to the Middle East is being recycled back to the USA in the form of investments in the US through small equity stakes in companies and more so through purchases of capital equipment and services to build Saudi infrastructure projects. The $500 billion investment plan over several years in Saudi Arabia is to build everything from new cities, aluminium plants, electricity generation plants and chemicals and plastics plants. The fears and rhetoric are overblown, as the USA also invests overseas with holdings according to the Treasury department of $6 trillion of foreign stock and debt. The acceleration of foreign investment in the US is to be seen in the numbers, as the dollar gets weaker, and its more advantageous for Canadians and Euuropeans to invest here. Last year $414 billion of foreign investors money went into buying stakes in American companies and building factories and purchasing stock, according to Thomson Financial. Thats up 90% from 2006 and represented one fourth of all announced deals. This year in just 2 weeks foreign investors poured $22.6 billion in just the first 2 weeks of January, and that represents one half of all deals. Shows how quickly the picture is changing. One way of looking at it is that Americans buy a lot of foreign goods and the money Americans use to pay for a lot of imports is now being returned to the USA in the form of foreign investments. Note that foreign investment is desirable because it brings new ideas and technology and new management methods to the host country from other countries. These foreign investors in many cases are able to make these investments overseas because they are good at what they do, having them in the host country benefits the host country and shakes up competition in the particular industry in the host country that is receiving the investment. This is why economies once relatively unfavorable to foreign investors like Japan and S. Korea are now passionately seeking foreign investment to make their economies thrive through the exchange and inflow of new ideas and ways of doing things. The same can be and is true for the USA. The other aspect is that most of the investment is still from countries like Canada, Germany, Japan, S. Korea which are big free trade partners of the USA. Manufacturing investment is heavily skewed to European and Japanese companies. Foreign multinational investment (Sony, Toyota etc) grew to $43.3 billion in 2007 from $39.2 billion in 2006 according to OCO Monitor, and will accelerate significantly as companies like VW and other German companies find it cheaper to build in the USA and shift more manufacturing here. To get an idea why the rhetoric is overblown Canada spent the most in buying American companies, $65 billion in 2007, according to Thomson Financial. Russia spent $572 million and India $3.3 billion. How will this improve the chances of the USA making it out of this recession? Five million American work for foreign companies in the USA. Of these one third are manufacturing jobs. These jobs pay about 30% more than jobs in American owned companies. Figures from Treasury Department. There will be more of these jobs as companies like VW build plants here. Roubini Economics estimates that an infusion of about $300-400 billion is needed for the USA to overcome the effects of the current mortgage and credit crisis. $414 billion was invested in the USA by foreign investors according to Thomson Financial in 2007, going up from something like $200 billion in 2006. If this pace continues becasue of some of the same underlying reasons as the weaker dollar, stronger economies overseas, then $200 billion additional investments this year would add that much to a stimulus package of $150 billion by one estimate, to provide a boost of somewhere around $350 billion. In the range of the needed boost. Companies like IBM and GE which have significant investments in India and China and investments in software or infrastructure industries that are growing rapidly or Caterpillar with growth in construction overseas, may keep growing through this downturn. This recession may hit selectively and differently, not be a complete hit to the USA economy, and could prevent it from going beyond 2009 with recovery in 2010. ...

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Under new proposed changes carbon emissions permits would be sold to industry and heavier polluters would have to pay more. And to make it fair to European companies exporters in other countries like China would have to buy these carbon permits to be able to export to Europe. There is similiar discussion about this in the USA which expects caps on greenhouse gas emissions in a few years. These changes wouldn't go into effect till 2013 at the earliest and industry will be trying to create a level playing field by then. Countries like China and India because they are developing have been exempt from the greenhouse caps under the Kyoto Protocol which expire 2012. Under the Kyoto Protocol which Europe signed and the USA did not sign, European companies are giving carbon permits free to emit a certain amount of greenhouse gas every year, the heavier polluters have to buy the permits from the ones that pollute less creating an incentive for companies to reduce emisssions.

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The WSJ's Kimberley Strassel says a Republican winning the White House in 2016 depends on how well the party appeals to white working class voters and the struggling middle class living from paycheck to paycheck. She says Speaker Paul Ryan is taking the right step in coming up with the idea of the Kemp Forum on Expanding Opportunity event in January 2016. Presidential candidates attending the forum are Jeb Bush, Marco Rubio, Chris Christie, John Kasich. Not attending are Ted Cruz and Donald Trump who are getting support from voters who are discouraged by establishment policies. Strassel says upward mobility for the midddle and working class is emerging as the No. 1 issue in the election, especially with Hillary Clinton leading the Democrats.

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Paul Tough's detailed and vivid account of the problems in Chicago's South Side in 1987 when Obama worked there as acommunity activist, in 2007 when Obama visited the area and expressed his vision about what was needed for the Roseland section, and in 2012 when Tough visits Roseland to document life today in this part of Chicago. He sees the same problems and a need for an all round approach to help kids of parents without work living below the poverty line to provide not just financial help but the kind of support and institutional help that would help them overcome the disabling effects of growing up in broken homes and counteract the destructive effects of a poor environment surrounding them. He left Roseland with a feeling that the President has not pushed hard to accomplish much of what he started out to do and let opportunities slip by.

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This editorial in the New York Times is strongly critical of former president Barack Obama for accepting $400,000 in speaking fees from Wall Street for a single speech. It says the news is causing people to question the ideas and words presented by Obama in his books about the dangers of losing sight of the interests of ordinary people. It gives the impression says the NYT, that Obama is cashing in like everybody else, and that his talk was empty. The editorial says the millions raised by Hillary Clinton led to her defeat in the election. Obama is reported to plan a foundation with the work of training a new generation of political leaders. This NYT editorial says it would be better to stay true to vision and purpose, to walk the talk for president Obama, especially now that a recent poll shows two thirds of voters, including about half of Democrats say that the Democratic Party is out of touch with the interests of the American People. By associating this closely with wealthy donors leading Democrats contributed to this. During a period when some of the remarkable achievements of the last fifty years such as the European Union are being called into question, when ordinary working people, young people and older people are struggling, this is all the more a tone deaf approach by politicians. The idea of helping train a new generation of political leaders through a foundation sounds bizarre in this context, and seems to suggest politicians believe there is always a solution through marketing their audacity and money.   ...

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Biden sees his plan for American workers and families put together in the $3.5 trillion spending package that covers child care, education, healthcare, services, climate change proposals, infrastructure building, as a way to show that democratic governments can work for the people. After two decades when American workers and families were largely put aside in the nation's priorities during a tech driven and capital markets driven expansion that benefited large corporations, America is returning to its core concept of government by the people, for the people, of the people. White House officials say this is to be seen even in the program he put forward in his upset victory many years ago for the US Senate from Delaware. Because economic strength of America depends on a strong middle class, and strong working class, strong families, and underpins the world leadership role of America, even Republicans and hesitant Democrats, cannot give in to the current situation of doing nothing or too little for workers and families which weakens America. And at a time when its leadership role in Asia and Latin America, Africa is sorely needed. The size of the package in $3.5 trillion is because too little was done in the past in the mistaken acceptance of Reagan policies of no government role in the economy- surrendering this role of guidance entirely to the capital markets driven from New York, London, and Silicon Valley. The rise of China today, and also of Japan and South Korea, and of India as it plans for 2030 shows that government guidance of the economy is needed in global competition. Trade entirely driven by capital markets, without a role for government to emphasize national priorities in spending can lead to disastrous results such as we see today where manufacturing even in critical fields such as healthcare, semiconductor driven technology, entire parts of the economic structure are ceded to China and supply chains outside the US. German elections are also leading in the same direction with Social Democrats emphasizing national priorities in child care, education, healthcare, and delivery of social services, building of infrastructure. And the Greens emphasizing climate change. Merkel in Germany and in the European Union, her predecessor Schroeder, pursued policies of no government role in emphasizing and articulating national priorities, in a way that past US presidents have done, resulting in the CDU falling to 20% support in the September German elections. Across all parts of the world, from India, China, to Europe and the US, the focus is on government voicing the national priorities  and allocating funding instead of capital markets driven from London, New York and Silicon Valley, or capital markets in Shanghai or Mumbai, as the pandemic runs into its second year. ...

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Many of the towns with manufacturing plants in 1992 have switched sides from Democratic in 1992 to Republican in 2016. This explains Donald Trump's success - he tapped into discontent with Democrats who supported trade agreements such as TPP and did little to take up the cause of workers in areas hit hard by foreign manufacturing and imports. It also explains why Republicans are now favoring protectionism and Democrats supporting free trade, traditionally the opposite was true.   As the U.S. manufacturing workforce diminished in size from 15% of the U.S. workforce in 1992 to 8% in 2017, it shifted from cities with unions to blue collar suburbs. Factories in traditional Democratic places were closed down and these cities ceased to be manufacturing centres. Pittsburgh ceased to be a major manufacturing centre as manufacturing jobs declined by 37000, and service industries increased by 168,000. This resulted in the manufacturing heartland going through Michigan, Minnesota, Wisconsin, through Ohio and the Carolinas and into the deep South. In these places whites without college education took up manufacturing jobs and identified with the Republican party's focus on social issues and abortion restrictions. So big is the shift that labor unions that represented 20% of manufacturing workers in 1992 represented only 9% of workers in 2017, according to economists at Georgia State University. Bill Clinton won 49% of working class counties where workers were at least 25% of the workforce. By 2016 the 860 such counties were down to 320 about two thirds now gone, and Mr. Trump took 95% of these counties. The change is dramatic. Voters that identify Democrat are now from cities, more educated, and less likely to be identified as blue collar. As the economies of these cities has shifted to finance and service industries, these residents have not accomodated the conservative cultural views. and have shifted to embracing more immigration, LGBT, gay rights on social issues. Before there was one mention in the 1992 Democratic platform of LGBT says the Journal, now there is 19 mention of rights for LGBT. Republicans have now shifted from privatizing Social Security, and now support some infrastructure spending. Republican platform now calls for free trade that is fair trade. And this has support from the left and the right. Factory owners and factory workers are united in their opposition to free trade rules that hit American factories. Union leaders say the Democratic Party left us. The Democratic Party gets more support and identifies more with Silicon Valley- Mr. Obama's TPP trade agreement benefitted Silicon Valley more than it did auto plants. The change happened over many years and Mr Trump capitalized on this. ...

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The U.S. trade agreement with Mexico is for 16 years, to provide business with a stable rules environment to operate in. It includes a clause for review after 6 years. The content made in the U.S. is increased to 70% from 62.5%. This has to be made by workers earning at least $16  an hour. Aluminium and steel going into the cars has to come from the U.S. helping push U.S. steel plant capacity utilization to 80%. Labor collective bargaining is strengthened in Mexico through new provisions, a provision supported by new Mexican socialist president Obrador. Free trade in agricultural products is maintained. $4.7 billion was added in help to U.S. farmers as aid for the effects of China's tariff retaliation. New rules are set for textiles, chemicals, and steel intensive products that set requirements to qualify for tariff free import into the U.S. This is intended to help bring more jobs and investment in these industries in the U.S.     ...

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Chancellor Merkel meets President Trump in a key summit in March 2017. The two leaders have different styles, one flamboyant the other reserved. Chancellor Merkel tells the German media "it is better to talk with each other than about each other." Trump called Merkel's refugee policy "catastrophic," Merkel has said that the Geneva convention requires countries to do this on humanitarian grounds. On trade German's Economy minister Brigitte Zypries says Germany would file a suit on any hike in import duties at the World Trade Organization, that WTO rules restrict import taxes to 2.5% on autos. Germany's BMW plant in the U.S. exports more autos than GM and Ford put together, and Merkel is likely to emphasize large German investment in the U.S.. The heads of BMW and Siemens and other industry executives are accompanying Merkel to the U.S. as trade will be a key topic.

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Martin Feldstein points out why the recent agreement for a "fiscal compact" is no more than an empty statement about fixing the eurozone's finances. In this respect it is no different than the Stability and Growth Pact it replaces, with serious weaknesses. Feldstein cites the weaknesses in the language of the agreement. Each eurozone country is required to limit its"cyclically adjusted" budget deficit to 0.5% of GDP and bring its debt down to 60% of GDP. Compliance will be performed by the European Court of Justice and fines imposed. In practice the questions loom large- for a country like Spain with a 23% unemployment rate, isn't all of the 6% budget deficit cyclical? Again the agreement says deficits are calculated "net of one-off and temporary measures." Under this provision a lot of the stimulus programs would be considered in the category of "one-off." Other language lets eurozone countries frame budgets based on "exceptional circumstances" and "periods of severe economic downturn." Italy has declining economic growth, does it make sense to have a large budget surplus in that situation to lower debt to GDP, and how does that goal relate to "exceptional circumstances."...

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This editorial in the WSJ points to Bernie Sanders 15% lead over Donald Trump in a Jan. 2016 WSJ/NBC poll- with Hillary Clinton having a 10 point lead- as proof that Sanders should be taken seriously. It says that electability of Sanders is no longer an issue, especially because the 2016 election is coming up with many surprises, including a changed election environment. Other possibilities raised in the editorial- the possibility that an independent like Bloomberg might run if Trump is nominated, further increasing the chance for Sanders to be elected president. By splitting the Republican party a Trump or Cruz nomination could also put the House in jeopardy for the Republicans, removing the House as a check if a Democrat is elected president.

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The Tax Plan of Jeb Bush, with the help of advisors Martin Feldstein and Kevin Warsh, lowers the top personal tax rate from 40% (including surcharges) to 28%, and reduces the corporate tax rate from 30% to 20%. The plan is designed to jumpstart the economy for higher growth by increasing business investment and incentives. Businesses are allowed to deduct 100% of new investment immediately. The idea is to increase capital investment so that benefits also go to workers in higher wages. The Bush economic advisors see 50% of the corporate tax burden as affecting workers wages- average compensation would go up by $2750 a year by 2020 and $6200 by 2025 in 2015 dollars. Companies can pay a one time 8.75% tax on money earned and held overseas, paid over 10 years- about $2.1 trillion of this income held overseas can be added to the pool available for business investment. As proposed earlier by Feldstein the itemized deductions including mortgage interest can be taken only upto 2% of adjusted gross income, suggestions during the reform effort not taken up by Obama. To reduce the excessive use of leverage in business decisions the field is levelled for use of debt and equity by removing the deduction for business interest expense. This editorial says that by putting in the details, which political leaders tend to leave vague on specific figures, Jeb Bush and his advisors have taken a crucial step forward. This it says, shifts the debate from current shallow posturing to how America can lay the groundwork for the kind of growth needed to help increase wages, increase economic growth to higher levels, and preserve America's position in the world....

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ECB president Draghi tells the European parliament on Jan. 16, 2012: "I cannot underline these points enough. Only a well-coordinated, coherent and properly timed strategy will yield the desired results." He made his comments as head of the European Systemic Board, which oversees systemic risks to the banking system in Europe. Speaking after a series of downgrades by S&P, Draghi said there should be "much less mechanical reliance" on ratings agencies. On Greece's debt burden and servicing costs he pointed out that the evaluation of Greek debt made in October 2011 "needs to be clarified whether its realistic," given the deteriorating economic situation in Greece. On Greece's talks with bondholder Draghi wants to see new servicing of debt conditions make it possible for Greece to bring down its current debt level of 190% of GDP to 120% by 2020.

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Cheng provides the basics of cloud computing and how best to use cloud services.

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China's trade surplus increased to $18.4 billion in April from $5.4 billion in March. Exports were up 4.9%, slower than expected and down from 8.9% in March. But imports went up by only 0.3%, much lower than March's 5.3% increase. The hopes for improving the trade balance in recent months may be dashed because of slowing imports for infrastructure development, as economic growth slows in China, even as export growth declines from its earlier high levels.

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The IMF report on Italy in July 2012 says Italy faces another year of recession. Debt as a percentage of GDP is expected to reach 126% in 2013. One bright spot is that Italy is expected to post a primary surplus by 2013- that is government revenues will cover promised services, excluding interest payments on oustanding bonds of $2 trillion. Because of the recession small shocks could change the outlook says the IMF, and it emphasized the importance of the changes being made to the labor market and for improving competitiveness. These changes need to be implemented early because of elections expected in spring 2013. A key concern is borrowing rates which are near 7% for Italy and Spain. The European Stability Mechanism, the rescue fund, was authorized to make purchases of Italian and Spanish bonds in the June 2012 summit. The ESM becomes operational in the summer of 2012, after the German Constitutional Court makes its ruling about it being legal and after ratification by national governments....