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Pearlstein quotes Dickens in "Oliver Twist," about the law being an ass, and the constitutional law exercize in the Supreme Court of the U.S. giving a sense of a failure of the so-called best and brightest in reasoning out the issues. He points out that a serious problem is that American business which is burdened with high health care costs for employees is seriously missing in this debate after years of complaining about high costs. The National Federation of Independent Businesses is actually one of the plaintiffs questioning the constitutionality of the Obama health care law. Pearlstein says business wanted an end to the fee-for-service medicine that increases consumption of medical services and pushes up cost relentlessly, and that Obama's health care law does this. This is not the case as both Democrats and Republican administrations have failed to resolve this side of the cost issue, and this is the hidden reason for the loss of credibility for both sides in this debate, leaving health care problems to be resolved in future administrations. ...

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U.S. president Trump announces U.S. withdrawal from the World Health Organization on May 30, 2020. Earlier the president had sent a letter to the WHO as a 30 day ultimatum and that he would reconsider membership if the WHO did "not commit to major substantive improvements within the next 30 days." The U.S. has given $450 million a year to the WHO compared to $50 million by China, yet China president Trump says has "total control over the WHO," showing deep seated dissatisfaction at the way the WHO has under current leadership has handled the coronavirus crisis and failed to take early action for an early warning system as were taken by earlier heads of the WHO such as Gro Harlem Brundtland of Norway during the H1N1 crisis in 2003, who was cited in Mr. Trump's letter.

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A WSJ study showing the plans offered under the new U.S. Health Care Law in the state of Oregon. For young people ages 18-34 earning about $17,000 and uninsured the law offers a bargain with insurance premiums monthly at about $52 and deductibles as low as $100, because of higher subsidies. The situation changes at incomes of $29,000 when the deductibles are about $6300 and the premiums per month at about $147 a month, because subsidies are much smaller, or deductibles dropping to $2500 at $172 in monthly premium. The federal subsidies disappear for single people under age 30 earning much more than $26,000 because of the way the law places them to specific plans on each state's exchange. According to the U.S. Department of Health and Human Services, there are 11.6 million people in the U.S. ages 18-34 who are uninsured. The federal government has to get as many of these people to get insurance so that the cost of medical care for the elderly can be supported.

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A critical part of the Affordable Care Act is the setup of marketplaces or exchanges to let people without insurance buy individual health plans. Some states setup their own exchanges, and some states let the federal government step in and run them. To help the lower middle class and poor the Act provides health subsidies to buy insurance in the exchanges, and 85% of customers in the exchanges qualify for this benefit. The U.S. Supreme Court voted 6-3 in 2015, compared to a tight vote in 2012 on the Affordable Care Act, to maintain the health subsidies. Justice Roberts wrote the majority opinion, saying "Congress passed the Affordable Care Act to improve health insurance markets, not destroy them." Justice Scalia dissented calling it "interpretive jiggery-pokery." Justices Clarence Thomas and Samuel Alito Jr. dissented. Voting in favor were Justices Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor, Elena Kagan, Justice Kennedy dissented in the 2000 case. The challengers petition to the courts was based on a reading of phrases in the Affordable Act which had not occurred to the writers of the law. The reading suggests only people enrolled in state setup exchanges are eligible for subsidies. If the Supreme Court ruled in favor of the plaintiffs the 6.4 million Americans who are enrolled in the federal exchanges would lose the subsidies provided under the law and lose health insurance. And the economic foundations of the Affordable Act would be undermined with insurance companies required to provide insurance to all regardless of pre-existing conditions and subsidies removed, leaving the companies with sicker pool of customers resulting in destabilizing the exchanges and higher premiums. The court ruled in favor of an interpretation that is compatible with the whole law and the intentions of the statute to help the middle class and the poor buy health insurance. The chaos in the insurance markets that would result in going with the plaintiffs because of a careless writing of a phrase, was uppermost in the majority's mind. Chief Justice Roberts emphasized this, saying- "The statutory scheme compels us to reject petitioners' interpretation, because it would destabilize the individual insurance market in any state with a federal exchange and likely create the very 'death spirals' that Congress designed the act to avoid." This case originated with 4 plaintiffs from Virginia who challenged the IRS regulation that said subsidies were allowed regardless of whether the exchanges were run by the state or the federal government, arguing that this was at odds with the particular phrase in the law that was ambiguous about federal exchanges eligibility for health subsidies. Judge Roger Gregory of the Fourth Circuit Court of Appeals in Richmond, Virgina, ruled that the phrase was indeed ambiguous, but the IRS was owed deference in its opinion. Chief Justice Roberts made it clear that this was not a case for the IRS, saying "it is instead our task to determine the correct reading." ...

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Now that finance ministries around the world are trying to save their economies with trillions of dollars in aid packages their finances are stretched to the limit. The so called digital tax is not really a digital tax. And efforts to recover lost tax revenues in Europe are being opposed by the U.S. because tax levies by France go only to France, not the U.S. The U.S. Treasury or U.S. government or the American people would not turn down tax revenues that it normally gets when its finances are stretched to the limit with trillions of dollars for cornavirus leaving little for crumbling infrastructure and essential public health services, other services that determine quality of life in America.  This Washington Post report shows that there is greater awareness that the right approach is to pay taxes based on where revenues are located and by the number of users in each country. But the problem goes deeper than that. The coronavirus changes the entire perspective and take this back to roots. Companies pay taxes because it is the right thing to do. In Japan Panasonic's founder Matsushita felt that it was a national duty to pay its share of taxes as it too was sharing in the benefits provided by society- in the health, sanitation, education and transportation, parks, and hundreds of services provided by government. Once this is seen as dispensable or somebody else's problem, then these very services and infrastructure can be starved of capital. Coronavirus changes this perspective. People crave for outdoor spaces- who is going to maintain them and set up new spaces. People crave for not moving around on crumbling bridges, roads, subway systems. Who is going to provide them? People crave for good schools, community colleges. Who is going to provide them? People crave for good sanitation systems? Who is going to provide them? People crave for good public health systems. Who is going to provide them? Its just good common sense. Is it possible for common sense to be missing? It is- just ask people today, and it is good common sense to have good critical infrastructure such as sanitation, medicine, public health, and local manufacturing of medicine, yet economic experts and economic theories thought it made sense not to do this.  ...

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A new CBS-New York Times opinion poll in June 2012 shows 44% of those polled approve the job the Supreme Court is performing and about three fourths say the decisions of justices of the court are influenced by their political and personal views. By comparison only 15% approve of the job done by the U.S. Congress in the most recent poll. Only one in eight say the justices make decisions based solely on legal analysis. About 60% say they agree that life tenure for justices is bad because it gives too much power to justices. On the health care law two thirds of those polled say they hope some or all of the 2010 Obama health care law is overturned.

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Maps of U.S. coronavirus by state as of April 1, 2020, that reached 189,000. How coronavirus is surging worldwide with 75,000 added on March 31 to reach 874,000 coronavirus cases detected worldwide. China's numbers have not included coronavirus cases that are asymptomatic. 

China continues to see coronavirus cases with 166 new cases on March 31, showing that it public health authorites have to be vigilant about a restart of the epidemic once it comes under control.

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Chile, Mexico and the U.S. rank high in the diabetes rate for top soda consuming countries. In the U.S. the diabetes rate is at 7.7% of the population, in Chile 9.6% and Mexico 9%. Soda consumption per capita was at 165 litres in the U.S., 146 litres in Mexico and 134 litres in Chile, and 145 litres in Argentina where the diabetes rate is at 3.9%, for 2012. A new public service ad in Mexico City subway stations says it all, showing an ad with a soda bottle and the words- "Would you take 12 teaspoonfuls of sugar? Soda is sweet, diabetes isn't." The new Pacto de Mexico agreed to by all major political parties includes the soaring diabetes rate in Mexico as a problem to be tackled, including lunches at public schools and the consumption of coke and sodas by children. A particular acute problem in Mexico is the lack of clean drinking water in many areas and the dependence on coke and sodas for liquids. But bottled water could be used in its place if available at lower prices. One proposal is for a soda tax which could generate $2 billion and be used for setting up clean drinking water fountains in schools and other places. Elected officals in Mexico are firm about the need for action, as Mexico recently became the first country over 100 million inhabitants with the highest obesity rates at 7 adults out of 10 over the age of 20 obese or overweight, and the consequently high diabetes rate. Diabetes is the No. 2 killer in Mexico, and a serious health danger. Coca Cola gets its second highest revenues from Mexico after Europe, and the situation has evolved after years of heavy coke advertising to the point where Coca Cola is taken at every meal by some Mexican families, and is a sign of prestige. The company's response is to fight the public service ads with ads showing people burning off 149 calories by walking. The country now faces a long and uphill fight. Russia is one of the countries which is also conducting a similiar fight against soda drinks. The Bloomberg Philanthropy is financing efforts against soda drinks in Mexico, as part of its campaign against smoking and sodas as health hazards, and this maybe Bloomberg's bigger contribution to society than his service to New York City. Developing middle income countries such as Mexico, Chile, India, China, Brazil, are the hardest hit by soaring diabetes. And the costs to their health systems in 10-20 years from uncontrolled obesity and diabetes will be enormous. The U.S. is a developed country with similiar high rates of obesity and diabetes, with soaring medical costs, and serious problems that strangely have not received the public awareness and efforts that one should expect. ...

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RFK Jr. Report on nutrition, pesticides, overmedicalization, other threats to children's health. Critics cited in the NYT about action raises the question why the critics never made this their top priority all these years, and raising public awareness of the issue has been already accomplished, with the next steps to follow requiring the efforts of all of us. 

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Attorney General Barr tells American business leaders that business with the PRC has short term rewards but ultimately hurts U.S. interests. FBI Director Christopher Wray says the transfer of U.S. technology "is so massive that it represents one of the largest transfers of wealth in human history." All this has happened as communities and towns across the U.S. lost jobs as they were shifted out of the U.S. in large numbers over twenty years in accelerated manner leaving U.S. manufacturing weak. The pandemic showed the weakness of existing supply chains for delivering benefit to the American people.

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Much of the reward for Labour goes to Health, Nutrition (food choices), and Education (schooling choices for children). This is the backbone for any Nation that is going to be strong and have a good future. Yet economic structures in 2026 and for decades has swung too far in one direction away from Labour and more and more for Capital, creating grave risks for the Nation, and setting the US as the wrong role model. Labour and Capital in 1980 vs 2026- increasing reward for Capital from 7% to 12% of GDI decreasing for Labour 58% to 52% in same period. In some areas this is not so because other regions have set their own priorities and this is a good thing Europe has a strong and fair access healthcare system, India has a strong and fair access pharmaceuticals healthcare system, which act as role models for the US. In 2026 RFK Jr, Dr. Oz at HHS and DJT are focused on getting US pharmaceuticals prices down to levels in the European Union. The real dangers of the skewing in the direction of Capital of rewards is creating a class that is not sensitive to the lives of ordinary people resulting in fracturing of society. Something like that happened in 1600-1800 in India and China leading to the disintegration of society and becoming overcome by foreign European powers which had more dynamic societies from the bottom up that led to discoveries in science leading to the industrial revolution. One detects something like this happening by accident by poor governance and bad decisions for wars (Bush-Clinton-Bush-Obama), and the same administrations pushed by bad advice from economists to ship the productive manufacturing resources of the Nation to China. If not reversed it would lead to the kind of decline Asia witnessed after 1600- hitting all classes of society and destroying the economic structures as foreign powers get the upper hand. The surrendering of research labs and higher education in advanced science fields to foreigners at US and European universities poses similar risks as fractured society with Capital dominant and unaware of the risks. Such societies have less perception of such risk than a bottom up built social, economic and political framework with large numbers of aspiring local citizens seeking these positions in science and technology in the Nation. ...

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US president Biden's $2 trillion infrastructure spending plan is being compared to the New Deal infrastructure plans of Franklin Delano Roosevelt in the 1930's. FDR was preceded by Republican administrations under Hoover and other presidents who followed policies that can be compared to the Reagan administration policies when public sector spending was not seen to be as efficient as private sector spending. By the time of the economic collapse in the 1930's it had become clear that only the federal government could save the country in the depression. During the pandemic and collapse of the health systems it was clear that only the federal government could save the country. It is now also evident that infrastructure building led by the government can rebuild America. In the 1930's and during other periods in American history such as the building of the Erie Canal and other public sector infrastructure projects in the 19th century it was the federal government that led the way to building America. ...

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U.S. Health and Human Services Department officials say one has to be "appropriately paranoid" about protecting the vaccine from theft in transit and at distribution centers. Very tight GPS tracking and even dummy trucks are planned. Hospitals vary in their approach to safety with some practicing normal security lockups and some treating the vaccine as they would a controlled substance with multiple checks before release. 

Brazil and Mexico followed by Peru and Argentina have experienced the most pharmaceutical theft incidents. The U.S. is also in the top five countries for pharmaceutical theft. U.S. marshals will accompany shipments of vaccines. Five large hospital systems in the U.S say the challenge is still keeping the vaccine refrigerated at extremely low temperatures and getting people vaccinated than theft.

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Elizabeth Rosenthal looks at Obamacare's contribution to cost containment in 2013-2014. Rosenthal says its is a kind of delicate maneuvring at the edges, because serious work needs to be done. The fee-for-service and many of the drivers for increases in medical costs, the old system of pricing, are still in place. In 20 years at the current rate and after Obamacare health care will still take 25% of the U.S. budget if nothing is done. Healthcare costs are about half that of the U.S. in some of the advanced European countries. She calls Obamacare a trickle down theory of cost containment becaue it leaves most of the drivers for cost increase in place and works at the margins. Princeton economist Uwe Reinhardt calls it an ugly patch on a somewhat ugly system. Rosenthal cites the armies of consultants anticipating every move to reduce prices, and working on "strategic billing'' to increase revenues for hospitals and doctors. For those who say the prices are now up more slowly than in the past, Michael Chernew of the Harvard Medical School, has this to say- its like a diet, reminding us that that we haven't even lost weight, just gaining weight slower than before. ...

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This WSJ editorial looks at the dangers of legalization by American states of marijuana use and the cultural acceptance in the light of evidence about vaping illness. It is not just e-cigartettes but vaping from marijuana use that poses risks for the health of a whole generation. One argument for legalization used by politicians is that it would shrink the black market- the WSJ says there is little evidence of this. Only 16% of the 15.5 million pounds of marijuana grown in California is used in the state, according to the California Department of Food and Agriculture. With cultural acceptance says the WSJ comes another major health crisis after the opioid crisis in the U.S.

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The Trump Accounts for children born 2025-2028 and the Dell $6.5 billion expansion to include earlier born children may be one of the single biggest actions to rebuild the bank accounts of the next generation. It looks at the shrivelled bank accounts of today's older generation with lack of enough savings for a medical crisis and says it has got to be different from now on. The median bank account of Americans over 65 and over is $13400 which means there is little for medical health emergencies and little for needs of older Americans. Median means half have less and half have more than $13400. This is astounding for the wealthiest nation at a time when the total wealth is the highest ever in history. This report by WSJ unfortunately does not mention this at all and dwells on how this is an opportunity for banks and investment companies to get in the door to get your business. DJT as US president with a mandate from lower income Americans has designed this so that it shows the value of careful investments of small seed money. With $1000 to begin with from the government, added amounts from parents and grandparents and invested in a mutual fund that tracks the S&P 500 it will grow with the economy for 18 years, doubling two to three times on the way. It would provide funds for education increasing enrollment in higher education, increase financial literacy by showing how money grows in broad S&P 500 type index funds such as Vanguard type funds. Much of the shriveling of bank accounts for the shocking figure of $13400 median for American 65+ year olds is a result of job losses, high health care costs, wage decline  with factories outshored, hits from 2009 financial crisis caused by bank irresponsible behaviour, drug epidemics and fentanyl allowed to pour into the country, covid pandemic and stock bubbles, decline in higher education enrollment, other. The US president DJT is seeing his mandate as one that reverses these adverse situations one by one to take America back to post war prosperity and rising incomes, rising bank acocunt savings and rising hopes and aspirations for the next generation. ...

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Aging does not happen gradually but happens in waves at early 40's and early 60's and at 78 years, say Stanford scientists. This means we should be proactive and act by having a regimen of exercises that we take extra care to do when we are at these ages so that we compensate for rapid muscle loss or other aging related issues including balance, posture, skin health, cardiovascular, and other health issues. Nutrition can also be geared to specific foods that will strengthen us.

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How the French health care system works. France comes in first and the USA 37th in aWHO health care ranking. THe difference in deaths from respiratory disease is half that in the USA, and lower rates of death from heart disease and diabetes. IT has more hospital beds and doctors per capita than the USA. 65% of French people are satisfied with their health system compared to 40% in the USA, and yet France spends 10.7% of GDP on health care and the USA spends 16% for poorer results. THe French system is more generous to its seniors. Unlike Medicare there are no deductibles, just modest co-payments that are often dismissed for chronically ill. And diabetes and critical surgeries are covered 100%. French also buy supplemental insurance like Medigap for extra expenses like dental and eyglasses. Cancer patients are treated free of charge. Avastin treatments costing $48,000 a year are provided at no charge. France's PMI or Protection Maternelle et Infantile, is rated highly. It is anetwork of thousands of healthcare facilities, that ensure that every mother and child in the country receives basic preventive care. Mothers even receive afinancial incentive for attending their pre and post natal visits. France makes this care affordable by reibursing doctors at a much lower rate. The average yearly net income for doctors is around $55,000, about athird of what doctors in the USA make. But French doctors don't have to pay back huge student loans as medical school is paid for by the state and malpractice insurance premiums are only a tiny fraction of that in the USA. And again the French government pays two thirds of the social security tax for most French physicians- which is typically 40% of income. So the $55,000, is more like $92,000 taking that into account and more like $110,000 when student loans and malpractice is taken into account at US levels. Specialists who have 4 or more years experience can charge what they want, but as one gastroenterologist says, there in an unspoken and undefined limit to what you can cahrge or what is socially acceptable. Yet even in France there is inflation in health care costs that the government deals with through price controls and more spending. The French national insurance system is running increased deficits each year and this is now $13.5 billion, and it has led to higher taxes for employers and workers. ...

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The U.S. Senate passes a motion that allows the chamber to proceed with a debate on a health care bill. The motion passed 51-50 with Vice President Mike Pence casting the deciding vote. Republican Senators Collins and Murkowski voted against the motion. This report in the WSJ says this sets in motion a process in which debate will take place and amendments will be made. It is not clear what shape the bill will take. Under the process used only a simple majority is needed in the Senate, yet this allows for many amendments to be made.  Only hours after this motion passed by one vote, a bill replacing major parts of the Affordable Care Act failed to pass 57 votes against and 43 in favor. Senator John McCain who arrived in Washington from Arizona following brain tumor surgery, delivered strong criticism of the way the Republican healthcare bill was rushed through allowing very little debate. Experts have commented on the way the bill was rushed through with a thin majority for passage, with very little debate, first by Democrats in 2009 and now in the House by Republicans. With the same pattern now followed in the Senate by Mitch McConnell, the Republican leader in the Senate. A backup bill would remove just the individual and employer mandates and a tax on medical devices- the elements Republicans agree on, if no majority can be put together for the healthcare bill. ...

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Obesity is a problem today of global dimensions. In the U.S. this problem has reached a new high and increased U.S. risks in the face of the coronavirus. This author and her nutrition organization say the U.S. dietary guidelines put out by a government agency have failed over decades to do what they were supposed to do - guide people in the right direction to make good food choices. People at this time of the coronavirus need to make their own choices, independent of these guidelines that have failed. Intuitive choices for healthy eating by increasing vegetables and fruits in the diet, increasing use of healthy herbs such as turmeric, basil and ginger, eating carbohydrates and fat in a sensible way, increasing ancient whole grains in the diet, reducing meat in the diet in favor of plant based foods such as lentils and a large variety of whole grains. 

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US president Joe Biden says he will allocate $80 billion additional funding to the IRS in the US so that it can get $700 billion owed by the wealthiest in the US. This is part of his "American Families Plan,' increased funding of health, education, improving upward mobility, and opportunity for the American people.

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Daniel Altman's proposal for a tax on wealth over $1 million. He makes the case for taxing wealth not incomes to reduce inequality as this is where the situation in terms of inequality has worsened for the U.S. in recent decades. To support this proposal Altman cites the change in the U.S. Ginni coefficient, which measures inequality. The Ginni coefficient is anumber from 0 to 100 which goes up with higher income inequality. From the late 70's to the 1990's, the Cnesus Bureau showed this to be in the low 40's. By 1992 the Ginni coefficient went up to the mid-70's, according to the Federal Reserve data. It increased to about 80 in 2010. In 1992 the top 10% in the U.S. population controlled 20 times the wealth of the bottom 50%. By 2010 this figure triples to 65 times. and the graduated income tax even if it redistributes a small share of the wealth does little to affect the trend of wealth extremes from building up and threatening the social fabric of America, reducing mobility and opportunities for the bottom 50% to unprecedented levels since the 1950's. ...

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Europe has few options on Greenland beyond a statement that "Greenland belongs to its people" knowing Denmark was a colonial power, says Le Monde. Peary  of US Navy discovered northern Greenland and claimed it for the US in 1880's, US offered to buy it in 1867 with Alaska Purchase. And under several administrations including Harry Truman in 1946. As the US commanders in chief in 1946 it is "completely useless for Denmark," vital for the US and security on the eastern seaboard of the US.  Denmark has done little for Greenland or the Inuit population of Greenland, in health, education and transportation.

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Comparative effectiveness research will be conducted to evaluate what is the best treatment for any ailment or disease or health problem under the $1.1 billion allocated for this in the Stimulus Plan. What are the alternative methods of treatment, what is the effectiveness of each treatment, what are the comparative costs and so on. Is it better to treat neck pain with surgery or acombination ofphysical therapy, exercize and medications? If there is ablockage of arteries in the lower leg and leg pain, how does drugs and watchful waiting compare with surgery? For chronic heart failure how does home monitoring of blood pressure and weight and exercise in addition to medications provide an alternative route as opposed to just medications. Dr Fisher of Dartmouth Medical School cites these as examples of questions that can be asked in comparitive effectiveness research. The money will be available to the Health and Human Services Department and will be used over several years. About 15 federal employees will form a council to coordinate the research and advise President Obama and Congress on how to use the money. In 2007 the US spent $2.2 trillion, or 16% of GDP, on health care, and the Congressional Budget Office says it will grow to 25% of GDP at the rate its growing by 2025 if left to its own devices. ...