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The private sector ignores health insurance. And state coverage in China is inadequate. More than two thirds of China's 1.3 billion people have no health insurance at all. If you have insurance you still pay up front in cash, if you do not have the cash up front you cannot get a surgery, treatment of any kind or any drugs, even if the insurance will later reimburse you. The Chinese health care system is dysfunctional and in a crisis because of the way it is structured, and the faulty policy incentives. It caps prices for basic drugs and procedures at below market rates, yet it lets hospitals profit from everything else from advanced drugs to sophisticated diagnostic tests. So hospitals invest heavily in technology and expensive testing. and drug sales account for 45% of revenues. And enforcement is lax. Doctors in Shanghai make monthly incomes of about $400, about what a taxi driver makes, so they supplement their income with bonuses earned by prescribing more expensive tests and drugs. There is no utilization review so the state reimburses for whatever the hospitals charge regardless of whether the test was needed or not. So the system is dysfunctional and lurching towards a crisis. In fact heavily burdening the middle class. The private outlays and burden of total health care spending has increased from 20% to 60% of total health care spending from 1978 to 2003, as the the health care system got the same dose of unfetterred capitalism as the rest of the system. The Government's share of total health care spending has dropped sharply. In addition there are design flaws that push expensive care and build in incentives for expensive care at the expense of good medical care. The government recognizes this problem and sees it as athreat to social stability. It has committed to increase spending on healthcare. ...

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The political risk in China as the change of leadership takes place in 2012, and with the removal of Chongqing party chief Bo Xilai. The slowing of manufacturing activity and slowdown in growth expected in 2012-2014. Export growth declines to 6.8% from 14.2% in the fourth quarter of 2011. Quarterly surveys by the central bank shows demand for loans is dropping. And the HSBC purchasing managers index shows a reading of 48.1 in March, declining from 49.6% in February, showing shrinking manufacturing activity in China- anything less than 50 means contraction is taking place.

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Prof. Cusumano of MIT, says that with the loss of Apple's Steve Jobs, the company has lost a great visionary, and it will be difficult for Apple's new CEO Time Cook to make up for this loss. Cusumano has talked to many Apple employees in 2013-2014, and is writing a book on innovation. In this piece Chen and Richtel point out the ways Tim Cook is trying to fill the role Jobs filled, by assembling a group of people within the company who can play the pioneering role for new products, and making new acquisitions such as the Beats acquisition to bring in outside talent. Cook pushed for the introduction of the iPad Air, which now accounts for 60% of all iPad sales. The constant push for the magic in new products that Steve Jobs obsessed with down to details, will be missing. Jobs met daily with design chief Jonathan Ive for lunch at the Cupertino headquarters. Cook meets Ive 3 times a week. And Jobs pulled all the pieces of the new product together in a way that others will have difficulty doing. Cook has brought a different dimension to leadership at Apple by talking about Apple in terms of "advancing humanity," talking about his own personal experiences in the South, and seeing racial discrimination barriers for minorities. He was challenged recently to address issues of working conditions at Apple supplier factories in China. Cook is bringing some manufacturing back to the U.S. with building of new plants in Arizona and Texas. These are areas which were gaps in Jobs record, which Cook is filling gradually, and asking shareholders, customers, to be patient....

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India and China agree to a legally binding deal on climate change and emissions that would be drafted by 2015, and take effect in 2020. This would bring them in line with or symmetrical with the U.S. and European countries for controlling emissions.

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Research by Matthew Slaughter of Dartmouth shows that only 4% of all American firms and 15% of American manufacturers export. Overall 80% of America's trade is conducted by just 1% of the firms that export or import. Exports as a share of GDP are 10.9% in 2009, much lower than other exporting countries. These numbers will increase as America focusses on exports to rebalance the economy.

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This report in the WSJ points to president Biden's speech to a joint session of the US Congress that providing two years of free community college would "change the dynamic" for education in America taking the first step to correct a dangerous drop in college enrollment for young men in America and ensuring working class families have access to college education. The last thirty years of skewed wealth distribution, loss of manufacturing in America, have created alarming distortions in  the access to college education for working class families. Mrs. Biden is a fervent advocate for community college access in today's America, as a community college teacher for 30 years. Biden's $45.5 billion 5 year plan would waive tution for 2 years of public community college. States would have to opt-in to participate, and federal government would provide 100% funding in the first year, decreasing contribution by 5% each subsequent year, with states picking up rest of the cost. It is quite shocking that this is being dropped from the Biden $3.6 trillion Families and Workers Plan that is now being whittled down to $2 trillion. Not because it is not badly needed for American economic competitiveness, and helping workers and families. But because following narrow parochial interests the National Association of Independent Colleges and Universities opposes it. And because the US Congress is evenly split between Democrats and Republicans 50-50 in the Senate. The Association of Independent Colleges sees a shift to community colleges and a sharp drop in its enrollment. Community colleges saw a dangerous drop in enrollment of 12% to 4.5 million students in 2020 from the spring of 2019, according to National Student Research Center. Never was a program more badly needed, as American men are alarmingly falling behind in enrollment. Here are some responses to the failure to take even the first steps to broaden college access so that America can return to economic competitiveness. "What kind of world do we want to live in?" Martha Kanter, College Promise. "That's kind of a devil's choice, isn't it? The whole system has to work from infant care all the way through." Senator Tina Smith, Democrat of Minnesota. This is because child care and children's education will be funded yet a struggling generation of college students will be left out. US Chamber of Commerce opposes a $45 billion program that is critical to American competitiveness with China and other countries. US Congress drops a program that at $45 billion is only about 2% of the $2 trillion package and which is critical to economic competitiveness. Former Republican Governor Bill Haslam of Tennessee supports community college access as a pillar of economic development and it passed the supermajority in 2014. Mike Krause, Republican former director of the state higher education commission says- "I have been surprised by the lack of enthusiasm for what is really a massive workforce development concept that also provides a path to the middle class. You'd think that would hold some appeal for Republicans and Democrats." The lack of clarity and concentration, lack of unity of purpose to get all vaccinated,  is visible in America's vaccination drive. That same lack of clarity and concentration, lack of unity of purpose, is visible in America's faltering efforts at correcting serious and alarming problems for access to college and American competitiveness in the world. Julie Bykowicz and Douglas Belkins wrote this article in the WSJ.   ...

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According to a report from China's Environment Ministry for the first half of 2013, only 4 cities met the acceptable air quality standards. The national grade 2 standard in China is for 35 micrograms per cubic meter for levels of airborne particulate matter smaller than 2.5 micrograms in diameter. WHO standard is for 25 micrograms per cubic meter in a 24 hour period. The 4 cities with acceptable air qualty out of 74 cities monitored by the Environment Ministry are Lhasa in Tibet, island city Haikou, coastal town Zhoushan, and Pearl River Delta city of Huizhou.

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Areddy describes the choices facing China's president Xi Jinping as he faces protests in Hong Kong demanding the resignation of Chief Executive Leung Chun-ying. Protestors are also calling for canceling of a plan to limit nominations for chief executive to a committee loyal to Beijing. Xi Jinping has experience with Hong Kong affairs as he held the portfolio for Hong Kong affairs as part of the leadership when he was vice president. There are precedents where Beijng has changed course, as it sees it important to put memories of Tiananmen protest suppression behind. In 2003 six years after Britain handed Hong Kong to China -under an agreement for "one country, two systems," that granted separate status and system of government to Hong Kong- an anti-subversion law was pulled back. And the unpopular Chief Executive Tung Chee-hwa, a shipping magnate, resigned after 18 months. Beijing has to balance its concern for the "contagion effect" of protests on other parts of China, with the need to maintain the right climate for business and investment in Hong Kong and other financial centres. With slowing growth and limits to overexpanding credit, a crackdown in Hong Kong would further exacerbate problems with the international community, and create tensions in Taiwan about future reintegration with China. China warned foreigners not to interfere, and the American Consulate in Hong Kong stated it "strongly supports Hong Kong's well-established traditions and Basic Law protections of internationally recognized fundamental freedoms, such as freedom of peaceful assembly, freedom of expression and freedom of the press." The British government also pointed to Hong Kong's "fundamental rights and freedoms, including the right to demonstrate," which were in the spirit of the 1997 transfer agreement....

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Experiment conducted at the Gujarat Electricity Board by researchers from MIT and Harvard on correcting the flaws in the audit process for compliance with pollution control regulations by heavily polluting plants. The experiment is conducted in the state of Gujarat in northwestern India. The heavy polluters faced a audit process where fees were paid out of a central fund, were told plants could be audited for a scond time for false reporting on pollutants emittted, and faced additional disincentives of cut off of electricity supplies for noncompliance in correct reporting. This type of improvement is relevant for pollution control in China, India, Indonesia and other developing countries with similiar reporting issues and non compliance with pollution laws. Noncompliance and cozy relationships with auditors and regulators is a major problem for implementing pollution laws in these countries.

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Pessimism about the pace of democratization in China with the continued dominance of the Communist party in the business and economc structures of the country. The interrelationships of the party with state owned companies and the role of its 80 million members in running all aspects of life in China. Experts in China say the 18th party Conress showed no signs of change in the party's control and no sign of experimentation to allow for change comng from within the system so that China could establish a constitutional democracy with the rule of law. Experts in China say the new leaders Jinping and Keqiang may not be able to make changes even if they wanted to, because of the party's control and the earlier presidents and prime ministers from the last two decades who still retain a strong influence on the direction of the country.

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There is strong cirticism from many quarters about low interest rates as a prime culprit in causing the bubble in housing prices. In comments before the American Economic Association, America's Fed Chairman Bernanke defended his role as Fed governor in 2003 when he along with Greenspan was an advocate of the decision to cut the Fed's target interest rate to 1%, and to leave it here for a year and raise it only slowly. Bernanke says countries like Britain, New Zealand, and Sweden had tighter monetary policy but there home prices rose more, and monetary policy explains only 5% of the variation in home prices. Analysis has shown he says that capital inflows such as those the U.S. received from China and other Asian countries explains 31% of the variation in home prices, supporting a contrasting theory that that its these global imbalances that drove the crisis. He also placed the primary fault for the housing bubble on relaxed lending standards and views that housing prices would rise forever. Alongside these comments Fed chairman Bernanke also said that bank supervisors and other financial regulators of which the Fed was one, has a better ability to contain the excesses that led to the economic crisis including housing bubble and other excesses, than the Fed as a monetary policy maker. By saying this Bernanke is acknowledging that the failure of regulation was a key part of what happened in the economic crisis. The failure to fix the regulatory system even now leads Bernanke to say that he is open to using monetary policy as a supplementary tool for addressing risks should another bubble develop, if the regulatory system isn't reformed. Still Bernanke and Greenspan were quite complacent at the time of the low interest rates and did not point out the dangers of global capital imbalances which were evident at the time, preferring to say that the United States could benefit from the inflows of capital from overseas without serious risks. And the Fed did not exercize its role of vigilance in alerting the country to excesses in the way the housing industry operated and in exercizing its own powers to that effect. Instead the Fed as regulator and in role as asafeguard for serious risks let itself become part of the cheering section as the worst excesses in housing were being exposed....

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David Brooks says the Paul Ryan Budget proposal is a bold step forward that is badly needed in this debate on health care, even though it has some grave weaknesses which need to be corrected. It is a bold step forward because he says Democrats say they want no middle class tax increases, or are not willing to say what kinds of tax increases they support, and yet they believe the Medicare and Medicaid and Social Security programs are worth preserving. This is'nt based on reality. He cites the weaknesses, beginning with the one discussed in David Leonhardt's column in the New York Times on April 7, 2011. Too many Americans pay too little into Medicare taxes and expect to collect several hundred thousand dollars more in Medicare benefits. The example given in Leonhardt's column is from a study that shows 56 year olds with average earnings pay about $140,000 in dedicated Medicare taxes over a lifetime, and then go on to collect $430,000 in benefits. Middle class and affluent boomers can't get off paying their share like everybody else. Its just the right way for their children and the nation's children. Ryan's plan excludes older people reaching retirement in ten years. The other major weakness is that the cuts are too deep. Things like the Pell grants which Ryan proposes to cut back to 2008 levels need to be preserved, and more money has to go into science, education and research and early childhood education for the U.S. to be competitive with China and India. The Ryan proposal places cuts that would be required so that tax revenues need to be at 18% of GDP. The number where a larger consensus exists is for tax revenues at 20% of GDP (also supported by business and the Wall Street Journal's editorial columns). This would preserve programs that are most productive for the economic future of the U.S. Ryan's proposal lets the hope for reducing costs of medical care rest entirely on future retirees deciding how much medical care (tests, procedures etc) they consume through larger cost sharing. Yet a structure and framework is needed to manage these costs effectively, and some combination of incentives to retirees to control costs and an effective structural framework is needed. ...

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The gradual fading of China's demographic dividend. This is the reason some analysts believe India's growth rate will surpass China's by 2013 to 2015. The World Bank reflects this in its growth rate estimates for China, which slow from 8.7% in 2009 to 7.7% in 2015, and 6.7% in 2020. One reason for this is that India's age dependency ratio, which reflects how many wage earners support older people, is rising, and China's is declining- with experts expecting that trend to continue till 2040.

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Hedge funds betting against China's currency in Jan. 2016 puts Wall Street at odds with China's central bank's effort to manage the decline in the currency. Some hedge funds see a large drop in the value of the yuan in 2016-2017. China also faces the risk of large capital outflows. This is happening against the backdrop of China's effort to cut overcapacity in steel and other industries, manage large debt and the slowing economy, to shift towards a less export dependent and more domestic consumption oriented economy. Hedge funds are taking short positions against the yuan, as they expect China will need to recapitalize its banks considering the rapid acceleration in debt, leading to further depreciation in the currency.