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Three million additional Americans get access to Medicaid as a result of the Obama Healthcare Law (Affordable Care Act). Under the law states could expand Medicaid to people less than 65 years old with income of 133% of the federal poverty level of $15,521 for individual or $31,721 for family. About half of U.S. states expanded Medicaid and the rest kept the prior income guidelines. The figures are from a report by the Centers for Medicare and Medicaid Services, which show 58 million Americans on Medicaid in third quarter of 2013, and up to 61 million in March 2014.

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Areas for growth for the Indian drug Industry include the large growing domestic market, the outsourcing by US drug manufacturers, and sales in other developing countries of Asia, Middle East, Latin America and Africa. Analyst estimates are that India will spend $30 billion a year on drugs to improve care for its people in the next 10 years up from $8 billion today. And the distribution network is being developed by drug companies insdie India to reach more people. Also companies like Pfizer plan to double outsourcing of manufacturing drugs from 10% today to 20%.

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Samuelson points to the risks to the American economic growth from excessive health care costs. This is hurting take home pay and shows up in consumer spending. It is hurting government spending in other areas such as needed infrastructure spending and efforts to reduce the deficit. This hurts private capital investment to create jobs because of lower demand from constricted consumer spending. The U.S. budget has as its largest single expense 27% on health care compared to 20% on defense the next largest expense, with growth in health care spending taking this to one third of the budget in coming years. Without addressing health care, says Samuelson, the Supercommitte in Congress even if successful at deficit reduction will basically have failed to do its job, and it did not have the time, resources or conviction to do this. According to a new study from the Organization for Economic Cooperation and Development (OECD), U.S. healthcare spending per person is $7,960 per person in 2009. This compares with Norway $5,352, Britain $3,487, France $3, 978, an OECD average of $3,233. Life expectancy in the U.S. is 78.2 years, compared to Japan 83 years, OECD average of 79.5 years. Chile and the Czech Republic have life expectancy equal to the U.S. Except for cancer care where the five year survival rate is 89.3% in the U.S. and the OECD average is 83.5%, the U.S. lags far behind in much needed critical areas such as diabetes and asthma. Rates of emergency hospitalization for asthma are 3 times that in France and 6 times that in Germany and Italy. The U.S. has fewer doctors per thousand population and higher cost per medical procedure- with more frequent use of the costliest procedures- creating a supply shortage that induces higher prices, and less preventive and early action care through physician visits. The number of practicing U.S. doctors is 2.4 per thousand population in the U.S. compared to 3.1 per thousand for the OECD average; and number of annual doctor consultations 3.9 per capita in the U.S. versus 6.5 for the OECD average. Appendectomy cost $7,962 in the U.S., $5,004 in Canada and $2,943 in Germany. Coronary angioplasty cost $14,378 in the U.S., compared to $9,296 in Sweden, and $7,027 in France. Knee replacement cost $14,946 in the U.S., $12,424 in France, and $9,910 in Canada. Knee replacements, angioplasties and MRI exams are twice as common in the U.S. compared to the OECD countries. ...

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Bowles and Simpson call for deficit savings along the lines they suggested as co-chairmen of the President's Deficit Commission- reducing the cost increases in Medicare, changes to Social Security, and cutting tax expenditures.

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Krauthammer says there is reason for optimism that the super committee of the August 2 Debt Ceiling and Deficit bill can achieve major results. The reason he says is that much of the work in key areas has already been worked out by the Simpson-Bowles Commission. This has also received extensive public scrutiny and discussion. Its now upto the committe to make some choices for tax reform. For the sake of efficiency and fairness this needs to be done. Efficiency is gained by closing the loopholes and the tax exemptions for mortgage interest deductions, health-care exclusion, and subsidies such as the one for ethanol. And in its place moving to lower tax rates, the 23% envisaged by Simpson-Bowles, or the 28% from the Reagan days, down from the 35% today. Fairness is gained by removing tax breaks for special interest groups that do much of the lobbying. The mortgage interest deduction can be phased out starting at $500,000 in the inital phase or using the plan for tax expenditures proposed by Martin Feldstein. Feldstein's proposal outlined in the New York Times on May 4, 2011, (see group for Feldstein) was to limit the reduction in taxes from deductions and exclusions to 2% of the person's AGI or adjusted gross income. The other part of the Committee's focus would be the structural changes to Social Security and Medicare- raising the Social Security and Medicare ages and changing the inflation formula, and means testing Social Security. Obama has already considered the raising of the age for Social Security and changing the cost of living formula....

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Public opinion in the district of Steve King, a Republican in the House of Representatives favoring defunding of Obamacare healthcare law.

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The rarely mentioned origins of the U.S. Medicare reform proposal of Rep. Paul Ryan and Rep. Ron Wyden, which includes work done at the Hoover Institution and liberal think tanks, in a debate subject to distortions on all sides.

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Lipton, Austin and LaFraniere of the NYT tell the story of how the serious differences between the prime contractor for the federal healthcare website, CGI Federal, and the Obama administration officials handling the website, evolved into conflicts that could not be resolved. This led to the flawed website being rolled out on schedule ignoring serious problems with the website. The detailed report comes after interviews with Obama administration officials and specialists who worked on the project and looking into government and contractor documents. A month ago in October 2013 the healthcare website for the Obama healthcare law was up only 42% of the time with 10 hour failures happening frequently. Basic steps for the functioning of website backup systems in case there is a failure, testing to ensure negligible or no outages, were not secured. The government officials responsible for the rollout did not have the capabilities to handle such a project. Henry Chao, who worked in the Medicare agency for 19 years was left to oversee day to day questions for the website HealthCare.gov, but lacked a formal background in software engineering and no authority to make the decisions needed. The $630 million project was setup inside the Medicare Agency, instead of a separate agency specially setup for this project and staffed with the appropriate skills as originally proposed. Five different lower level government officials made decisions without the authority needed and no one person with the necessary skills was given overall responsibility and decisionmaking. A series of missteps were allowed to take place- settting many added requirements that made it difficult for contractors to focus on basic steps and get them right, use of the MarkLogic database system instead of systems from IBM or Oracle against the advice of contractors, multiple contractors without a way to control the overall project, shifting requirements from the government and bureaucratic delays for resolving basic issues such as use of social security numbers, all worked to create delays. With the delays came a deterioration of relations between Obama administration officials and the contractors. The government officials response was to stick to the deadline of Oct. 1 rollout, with Michelle Snyder, chief operating officer of Medicare agency telling people she would fire the contractor if possible. In the end no one took responsibility for a safe reliable rollout, even though the system failed a test of 500 users in late September and was down half the time in mid-October. President Obama or his advisors were either not kept fully informed, or did not grasp the significance of the collapse in relations between contractors and the government and a project out of control. His aloof distanced approach was not an asset in such matters- saying about the rollout and use of the website: "this is real simple" like using the Kayak website for travel bookings- and he saw no need to take action leading to the major failure for the administration that followed....

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An average of major opinion polls compiled by Real Clear Politics website shows 50.5% of Americans opposed to the Obama U.S. health care law.

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Estimates by the Congresssional Budget Office in January 2011 show the federal budget deficit in the US at nearly $1.5 trillion in 2011. The deficit would equal 9.8% of the US gross domestic product. In 2009 the budget deficit was $1.4 trillion or 10% of GDP. The CBO estimates show the debt held by the public increasing from 40% of GDP at the end of fiscal year 2008 to about 70% at the end of fiscal year 2011. Republican senators Orrin Hatch of Utah and John Cornyn of Texas called for a constitutional balanced budget amendment in an op-ed published in Politico.

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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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Epic Systems of Verona, Wisconsin, is one of the companies engaged in digitizing health records. It has helped develop records for 40 million patients in hospital systems such as Cedars-Sinai Medical Center in Los Angeles, Kaiser Permanente, the Cleveland Clinic, and John Hopkins Medicine in Baltimore and the Weill Cornell Physicians Organization of New York. Epic provides the software, the IT systems, the training and support. Epic is one of the pioneers in this, having been in the business for 30 years. About 40% of primary care doctors in the U.S. and 25% of hospitals use electronic patient records. The Federal government has provided $2.7 billion in funding from $27 billion of Stimulus funds assigned for the purpose of conversion to electronic medical records. This is likely to speed up the conversion. Other providers are Cerner, Allscripts, Meditech, Siemens Healthcare, G.E. Healthcare, and IBM. Epic Systems is considered the defacto standard in the industry for medical schools and some of the major hospital systems in the country. New contracts are leading to a major expansion of Epic Systems which employs 5100 people. Epic plans to hire an additional 1000 people. Revenue for the privately owned company are estimated at $1.2 billion, a 45% increase over the prior year. Epic is expected to have 127 million patients under medical records by mid 2013. To get the feedback essential for such a large conversion, CEO Faulkner relies on feedback from 250,000 doctors who use the Epic systems software, and on nurses and doctors from Epic who visit customer's sites to see first hand how it works and what needs improvement. Judith Faulkner started Epic more than 30 years ago. A project for the Psychiatry department led to other projects after she graduated in computer science from the University of Wisconsin. Epic continues to attract programmers to Wisconsin by making the Epic campus a fun environment and a great place to work. ...

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Fed's Bernanke sees cuts and higher taxes by state and local governments combining with higher oil prices slowing the U.S. economy. He told the Citizen's Budget commisson in New York, that in the long run the most important issue in fiscal matters will be whether the composition of the federal budget serves the public interest. And in saying this he emphasized the benefits of early childhood education, preschool programs and lifelong acquisition of skills. He advised states to take anticyclical steps to avoid the impact of boom and bust spending. One way to do this is to build rainy day funds that are then used for capital investment when times are bad.

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

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The publisher of the Wall Street Journal, Dow Jones & Co., is working to overturn a court injunction that prevents the public from seeing the Medicare billing records of individual doctors. Dow Jones & Co., filed court papers in January 2011, to overturn the court injunction. The American Medical Association has fought to keep secret the amounts of money individual doctors get paid by Medicare. The AMA filed a lawsuit against the government to keep secret these Medicare records, on the grounds of privacy rights, and won a court ruling in 1979. This court ruling still stands. The position of Dow Jones in its efforts to change this situation, is that giving the public access to the records is essential to the monitoring of so large a public expense as Medicare. These records would then be available to state medical boards, nonprofit organizations, universities and newspapers who can act as watchdogs over the $500 billion Medicare program. Such transparency and monitoring is an essential feature for the proper functioning of such programs and to prevent misuse of public money. For a program like Medicare, fraud and waste has enormous implications, as it adds to the spiralling cost of healthcare and to the unsustainable budget deficits. In one of the largest cases so far, the FBI, Justice Department, 700 state, federal and local agents, worked together to charge 114 defendents nationwide with Medicare fraud in February 2011. A senior law enforcemet official says Medicare fraud is so rampant, "there's no way in hell you can prosecute your way out of this problem, no way." He says the the answer is more effective monitoring of the money that goes out. And a key part of that is transparency and public access to how the money in Medicare is spent, what individual doctors and healthcare providers are getting paid by Medicare. The lack of this transparency for a program the size of Medicare can only lead to a lack of monitoring as the Dow Jones suit asserts, and make it difficult for the government to check abuses in the way money goes out. At a time when teachers and public workers and seniors are expected to make their share of the sacrifices to fix the budget deficits, it is incomprehensible that money should then be allowed to go out of the Medicare system through fraud and waste, because of a lack of transparency....

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As Obama faces the situation FDR faced, between political popularity after election in 1932, and loss of some political capital in the first year by 1933, and a lot depends on political will and courage. He has to execute and implement plans for efficient government spending that builds jobs to replace those lost, and to use the investments in really productive ways including projects that provide returns for years into the future. As David Axelrod points out in the Frank Rich column in the NYT, people sometimes live in a parallel universe, which may be completely at odds with what the rest of the country caught in the economic currents of layoffs and collapsing businesses is thinking.

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The differences in the Democratic party between conservatives and liberals that make it difficult to get things done in healthcare, energy and other areas. The lack of White House leadership in a number of areas, and in anumber of instances. The lack of Senate leadership on these issues with the Senate not having done much in energy and healthcare legislation. Add to this the influence of the $133 million that lobbyists spent in the 2nd quarter 2009 alone. The failure of Republicans and Democrats in Congress to push vigorously for cost control in the health care industry adds to these problems.