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The Dean of Harvard Medical School says the Health Reform bill gets an "F" grade. He say its disingenuous to call this reform, and Congressmen and the White House are deceiving the public if they attempt to pass this off as reform. What it will do is accelerate health care spending in the US, and the bill has simply postponed most of the major health care problems, especially the ones that drive cost including the fee for service system and delivery of health care.There are no substantial efforts to control the growth in health care costs or improve the quality of care, which makes this effort unacceptable as reform. In his discussions with other health care leaders and economists, Dean Jeffrey Flier, says he has found the opinion unanimous on this point, that whatever the final legislation looks like in Congress, it will only serve to accelerate health care spending rather than contain it. On the present system's failings he is explicit- the current system he says promotes fragmented care making it difficult to assess outcomes, the true costs of care are disguised, and competition based on price and quality is made impossible. The new legislation while expanding access to coverage makes a terrible tradeoff of an accelerated crisis of health care costs and merely continues the current dysfunctional system. The experience of Massachusetts, where access to care was expanded but spending went up, is that this won't work. He points to the Special Commission on Health Care Payment System in Massachusetts recommendation, that the health care system there must be changed from a fee for service system to one with "capitated" payments. So what is really disingenuous about this whole affair? Congressmen making it look as if reform has happened and congratulating themselves on increasing access to health care, when many of the serious problems of funding health care, skyrocketing costs, and a dysfunctional system, have only been kicked further down the road for some future legislators to tackle. With the national debt about 12 trillon dollars when this plan is factored in, this is cause for serious concern. ...

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What does transformational liberalism mean? What does fairness mean? What does it mean to have unemployment insurance, to have health care, to have jobs, to open the door to the middle class for a college education. Is this transformational liberalism? Or is this "transformational liberalism" a part of a vocabulary of cliches that have lost meaning as the nation confronts job losses of the magnitude of 500,000 a month, and this is only the beginning. Much of the increased debt the nation is occurring is going to provide government help to financial institutions like the $177 billion that has gone to AIG so far, just one company, and there are the Citigroups and other companies like AIG. What does it mean to have "burden sharing," when the rest of the country is frightened, scared, losing jobs, losing savings, and at this juncture cliches may have lost meaning, as its those who profited most and got us into this crisis like the investment bankers and senior management of companies in industries like the mortgage industry, auto industry who will be paying their larger share not because of redistribution, but because they may be the ones who can most bear this burden wihtout great sacrifices like cutting down on necessities and basics. See the link to Countrywide's Kurland who plans to profit both by overselling mortgages and creating the tinder that started this fire, and now to profit by buying distressed properties at pennies on the dollar, with $200 million from Black Rock as an investor, and $200 million on stock he sold before the crisis. Is a Kurland who has not been subject to any regulatory action, or management of AIG, or Citigroup or GM or the other companies receiving federal money by the hundreds of billions of dollars about to ask the half amillion of unemployed and the others threatened with job loss each month, for "burden sharing"? Nobody wants to see any of this happen, what has happened, including the debt, but it has happened, and it was not engineered in the new budget or in the few weeks since early January 2009....

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

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

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Americans loaded up with debt may be turning to older thriftier ways of an earlier generation. This this will affect consumer spending, have an impact on Chinese exports, and on the Japanese economy which is dependent on China for growth. Some argue that there is a culture of consumer spending that runs through recent American history. Even after one boom was over the stock boom was replaced by a housing boom, each boom and easy credit offering free spending and borrowing lifestyles. Is it going to change now? But it could be that a point has been reached where the finances of households and of the nation's credit system can only go so far, and culture won't matter if banks tighten up credit. There is a limit for the Fed to act to lower rates, and household debt has reached highly serious proportions. The savings rate went from one tenth of income in 1984, to 5% in 1994, to slightly negative in 2008. Today for those who borrowed against their homes in 2003-2007, 34 million households or one third of the US households, savings rate was negative 13% in 2006 June. Thhis came down to 7% in end of 2007, according to Moody's Economy.com, which suggests that the cutback in consumer spending from this group of people had already begun. What will this mean for consumer spending in the USA? It means that even though the top fifth of American earners who generate half of all consumer spending according to Barclay's Capital, will continue spending though a bit more carefully than before. The rest of the American people will be cutting back, especially the one third of the nation that is heavily in debt, and the unemployed if job numbers aren't that good. Which could be why Goldman Sachs predicts that Japan is already in recession using the Japanese definintion of decline in output, and China may be slowing down more significantly than is understood because of the poor data that is coming out of China. The Chinese economic activity too chaotic to accurately measure, and with large time lags before what is actually happening is detected and quantified correctly. ...

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Complacency from the Bush Administration reflected in the remarks of Edward Lazear the Chairman of the Council of Economic Advisors in the outgoing Bush administration. He sees no recession in the USA. "I would be very surprised if the NBER looking back at this period would date this as a recession" is what he is quoted as saying to reporters. He went on to say that the $152 billion stimulus of government checks mailed to the people, and Fed interest rate cuts should make the second half of the year a "solid growth period." What this means is that the moves by Congress to help homeowners stave off a new wave of foreclosures through a bill that just passed through Congress on May 7, 2008, is likely to be vetoed by Bush and efforts along the lines suggested by Martin Feldstein, Chairman of Council of Economic Advisors under Reagan, and Sheila Bair at FDIC, to help homeowners avoid foreclosure in her proposal may remain just that as proposals. This situation is likely to be turned over to a new President and make for an election that may revolve around economic issues, as the next wave of foreclosures lead to the start of a declining spiral in home prices leading to further loses in the credit markets and corporate bankruptcies of weaker firms and resulting losses in employment. Rising crude oil prices may result in much of the stimulus being eaten up by paying of some of the debt burden of consumers and rising costs of gasoline at the gas pump. And Feldstein has been very vocal, as have others, about the ineffectiveness of interest rate cuts in the current situation, even doing an oped piece titled "Enough of Interest Rate Cuts." In this sense the current spell of calm in the financial markets may be deceiving, giving Paulson an others in the administration a false sense of hope, and deprive the world economy of some reasonable action to prevent the wave of foreclosures and falling home prices that could set things distinctly downward in the world's largest economy and impacting the rest of the world....

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Ghosn of Renault-Nissan used to be a skeptic about electric cars. Now he is on board. Nissan plans to sell an electric car in the US and Japn by 2010. It will be only hundreds of vehicles at first so it will take more time to take it to mass market, but the goal is to go for mass market. By 2012 Nissan will plan for a lineup of electric vehicles, so it will extend beyond small cars to small minivans and small commercial vehicles and small crossovers. 100% electric cars also are described as zero emission vehicles. But Nissan won't be the only company doing this. Mercedes is moving "very fast" in the direction of emission free vehicles, see the the interview with Daimler's Zetsche. Mitsubishi Motors and Fuji Heavy Industries are testing versions of electric cars. And GM plans to introduce the Chevy Volt in 2010. Toyota plans to have a plug in hybrid about this time. Mercedes will be the first to bring a lithium oin battery in its S400 coming out later this year which will be a hybrid. It is the cooling of lithium ion batteries that has been a major hurdle to development of electric cars and Daimler's Zetsche says they have solved this problem, have 24 patents, and developed a cooling system that works inside the car. Nissan has an electric car project that it is working on with California based Project better Place to produce electric cars for the Israeli and Danish markets. Ghosn has grasped the idea that the market is signalling a major and irreversible change towards smaller emissions and regulators are way behind on this curve. He says that if one is to sensibly participate in the growth of emerging markets which Nissan is doing in North Africa and India and Eastern Europe then one has to think in terms of sustainability and lower emissions, as putting tens of millions of more cars on the road around the world can damage the environment. And the only way this can be done to meet the aspirations of people in emerging markets is to lower emissions and to set this as the overriding goal. One gets the same sense from the Germans, see Zetsche, Daimler....

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How Lehman Brothers CEO underestimated the situation facing his firm and failed to realize the true extent of the economic environment that the country is facing. He did not move fast enough for the speed with things deteriorate in this new environment which is nothing like the environment they faced before. In the end he held out for a better deal when he was negotiating with potential partners till the other side walked away. As a trader who led the firm for 14 years he was used to snap decisions so when he negotiated with Korea Development Bank and things were difficult he grew frustrated according to the Wall Street Journal and threw up his arms and the meeting ended. After the two sides parted subsequent talks faltered. At that August meeting the Korea bank proposed to invest $4 billion to $6 billion into Lehman and on the other side the CEO of Korea Development Bank had once been the head of Lehman Brothers in South Korea. The Journal report says that the Koreans felt their approach was realistic and were prepared to move forward but that Mr. Fuld was holding out for a better deal. The Koreans would have received a large stake in the firm. But not reaching the deal in the negotiation with the Koreans in June and then again in August and not marking down the firm's large holdings of real estate to reflect new conditions, and relying too much on the access to capital from the Fed, may all prove to be the undoing of Lehman because its stock has dropped precipitiously in the last few days losing more than 40% of it value in one day and then continuing down a slippery slope. Mr Fuld has led the company for 14 years and is the decision maker in this company, being called by employees as "the chairman" or "the gorilla". In these 14 years he gained a reputation for driving hard deals and in this case he may have not realized the crtical situation the company faces required a more urgent approach and a willingness to consider different deals some of which may have led to giving up some of the complete independence with which he operated....

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This NYT report looks at the 20 counties within 5 battleground states in the midwestern states of Wisconsin, Michigan, eastern state of Pennsylvania, southern state of North Carolina and western state of Arizona. It shows the percentage of votes gained by the Republican and Democratic parties in the last 3 presidential elections. A look at the trend and direction of vote percentages gained by each party in each of the 20 counties in different states may be a better indication of the final result than polls alone as both parties are pushing hard in the 2020 election down to the last day. The Republicans strong in the ground game and organized effort, and Democrats in television advertising outspending the Republicans. Because of the clearly delineated positions the Democrats and Republicans stand in sharp contrast to each other both in image and substance.  Because of the Electoral College and states assigned electoral votes based on size the U.S. system is not based on the total vote count in the country. Who wins each state by vote count and gets the assigned electoral college votes assigned to that state, an builds up more than 270 Electoral College votes wins the election for president of the USA.  In Michigan there is the impact of the resurgence of the auto industry, with president Trump pulling out of TPP agreement and renegotiating NAFTA in favor of the U.S. auto industry bringing back jobs from Mexico. This puts the union vote in the auto industry- with Ford, GM and Chrysler located in Michigan- favoring these auto friendly policies from the current administration. The resilience of the auto industry sales during coronavirus is part of the economic story in Michigan. The renegotiated NAFTA treaty also helped dairy farmers of Wisconsin increase sales to Canada. In Pennsylvania the coronavirus and economic impact has hit harder than in Michigan with the decline in oil prices and effect on fracking industry. Closure of coal plants is also having a negative impact on the state. Tariffs on Chinese steel by the administration are helping the steel industry. Offsetting these economic stories is perception of how the coronavirus pandemic has been tackled by the administration. Added to this is the suburban women's vote and the shift of out of state liberal voters to suburbs in North Carolina (Wake county), and in Arizona (Maricopa county and Tucson area). States not covered here but also relevant are Minnesota which could be a battleground state in the midwest and Iowa. Racial protests in Minneapolis add another dimension with controversies about the policing in cities such as Minneapolis and recently Philadelphia. The sharp contrasts in image as well as policy, the coronavirus pandemic and the handling of the pandemic as well as the way rallies are being conducted differently by both candidates, and the economic stories, present an election like no other since the 1960's. The contrast is as sharp as between Gen. Dwight Eisenhower of the wartime allied effort and Adlai Stevenson a liberal and humanist in the 1952 election. That election saw some of the highest turnouts since the second world war, and this is now happening today. That election also determined the direction of postwar growth and dominance of American industry, the setting up of the National Highway system and important changes that were later continued under the Kennedy administration. It also marked the beginning of the Cold War following the Korean War under the Truman administration, a situation that is emerging in a different way today with the free world and the tension from relations with China. ...

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How will posterity view Angela Merkel. As she ends a fourth term this BBC News report says it will remain a contested legacy. Much of what went right has already been written. A woman, a pragmatic scientist who hewed to the center not just as a scientist but with a knack for politics. Much of her early period in office was one in which she had to tackle the eurozone crisis. The euro's weakness had its roots in the way Mr Kohl allowed eurozone membership for countries such as Greece without adequate entry requirements. Some of the other problems were also left behind by an overzealous mentor Helmut Kohl who pushed for German reunification that never really happened in terms of bringing all east Germans into the idea of the Federal Republic. These problems in a neglected eastern part of Germany around Dresden were never tackled by Merkel. They were social issues that Merkel's pragmatic thinking failed to grasp. Letting in migrants from Arab and African countries was a move that Merkel made without realizing the full implications. This policy was reversed but led to the emergence of extreme right wing sentiment in parts of the country. It is left to a future German leader to tackle the social and economic disparities that affect Germany today. As time passes people reflect and a more careful view prevails. Dr Rudiger Schmitt-Beck reflects this when he says that the Merkel years were about  a bizarre mix of modernization and backwardness. Merkel rejected nuclear energy after the events at Fukushima nuclear plant in Japan. As a scientist she was able to tackle such issues. Yet on the major social issues of the day Prof. Schmitt-Beck of the University of Mannheim, says she left Germany "grotesquely behind"- on child care, climate policy, digitization, infrastructure building, on demographic change. These are the issues that the Social Democrats and the Greens are standing up for today. Ironically Merkel may be remembered more for something that is not even mentioned in this BBC report. This is the European solidarity shown by action to financially support all EU countries including Italy with EU funding during the coronavirus pandemic.  This may be her biggest achievement because it will be lasting. Without it Europe would not be the better place it is today, resilient in the face of the pandemic.  Seen from outside Merkel will be seen as a German leader who failed to see the potential for India and other Asian countries with almost twice the population of China. Fascinated with 13 visits to China she studied Chinese history, politics and economics, says the WSJ. And did too little to balance Germany's close business and trade ties with China, with efforts in India and other countries. Seen from America as pointed out in the WSJ front page on September 23, Merkel made no effort to rebuild US relations with the Biden administration after the tumultuous period under presidents Obama with spying on her phone and with Mr. Trump over the EU's participation in NATO defense. She seemed resigned to a view that America had seen her best years, a belief that today does not exist anywhere in America. US president Biden's first phone call to Merkel was put off for a few days says the WSJ, and Merkel continued to build close ties with China, ignoring the fact that this was a new administration closer to that of presidents FDR and Harry Truman who did so much for Germany. And a president very different than any of Biden's five predecessors. ...

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Richard Cohen, Washington Post reporter, on the "no fly zone" option in Syria and how it could have prevented the loss of 300,000 lives, prevented millions of refugees, and moving politics in Europe in a direction that reverses the gains made in the post war period towards a more tolerant society.

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One of the major changes coming out of the coronavirus crisis is Germany's new willingness, even a new found enthusiasm, to support  other countries in the European Union. Merkel now supports a shared fund for the EU. Old positions taken for financial discipline for the euro are now placed in a new perspective now that this discipline has largely been achieved. Facing a new situation and a common danger Germany now wants to expand the EU budget and invest "much more." "In coming weeks and months it is important to show that we belong together," says Merkel. There is a realization that Germany cannot be strong industrially and economically, if economies are collapsing around it. Merkel now supports the use of shared funds between EU member states. The health services in all EU countries need to be boosted. The focus of Merkel's EU presidency is now to set up an efficient health system in all EU member states. ...

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The law in Germany says migrants seeking asylum can get jobs and benefits, training, yet if their asylum claim is rejected they have to be deported to their home country. Here a migrant from Gambia is shown having integrated with language classes, and training, yet his future is uncertain.  Germany's immigration policy under chancellor Merkel has changed first welcoming, and then to stave off challenge from the far right AfD party in elections it has set the task of deporting all those whose asylum applications are rejected. About 35% of applicants have been integrated by way of language classes, training for work. . Germany needed more people to both meet labor shortages, and to do jobs Germans did not want to do. Yet in the eastern part of Germany the mood has swung against such immigration policies and the Merkel CDU and CSU parties now see the best solution is for economic refugees to stay home and for Germany to help countries in Africa with aid and government help to stabilize the economic conditions.  ...

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A cricket club in Cranleigh, England. A leafy suburb of Surrey, near London. It is all picture postcard like in this report by Stephen Castle and Andrew Testa of NYT. Just 52 miles southwest of London, this is the parliamentary seat of Chiddingfold represented by Jeremy Hunt who is No. 2 in Rishi Sunak's UK Tory government. Jeremy Hunt, the finance minister of UK, says he is uncertain whether he will lose the seat, "its the toughest it's ever been" as he goes door to door. A professor at the University of Manchester says Hunt's personal contacts are not much of a life raft as Tories face a tsunami of people's discontent over the promises and now visible failure of Brexit, of the decades of Tory austerity under Cameron, Boris Johnson, May and Sunak, and the failure in public services, promises for infrastructure that were never delivered. The British economy is in poor shape as the people of Britain turn to Labor party of Keir Starmer in 2024. ...

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Jancee Dunn of NYT talks to Margareta Magnusson 86 years, author of The Swedish Art of Aging Exuberantly. Margareta says you can be young upstairs in your head even if your joints creak. Kart besavar means dear or cherished pain, taking on an annoying obligation, to see even something that is a nuisance as something that one must find a way to cherish. Laura Carstensen at Stanford Centre for Longevity calls it finding joy with a tear in the eye. Then there are the intuitive and simple things to do- be among younger people. It is to be in tune with the young person you yourself once have been. Just ask them questions, listen to them, give them food, says Margareta. Do not accept the internalized narrative that with ageism comes rigidity. Fight this narrative and build a younger person in you on your own. One way to do this is to say yes to new things and try them out, be willing to experiment with things, the way you did when you were young.

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Frank Rich on the ticking bomb in the banking system and the bank lobbying that has kept reform from happening. Phil Angelides leads the Financial Crisis Inquiry Commission which is due to begin hearings soon. But says Rich, Angelides who is following in the footsteps of Ferdinand Pecora who investigated the 1929 crash as chief counsel of the Senate committee that did the investigating, will have to deal with a lot of resistance as he tries to alert the public to the need for action before a new crisis develops. For this to happen there will be aneed for more awareness of what happened, and a serious investigation, and prosecutions where necessary. Interestingly National City Bank was investigated then by Pecora. It is the predecessor of today's Citibank. At the time National City repackaged bad Latin American debt as new securities which it sold eaily to investors who later lost badly. Weill and Rubin at Citigroup made a series of bad decisions at Citigroup leading to huge losses at the bank, for which they have not accepted responsibility....

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Ben Van Heuvelen documents in the Washington Post what Ali Nabhan and Bradley pointed out in the WSJ in May 2009, that the officers in the Iraqi army lacked the training and discipline to act as an effective fighting force. These early indications proved correct and were ignored by the Iraqi government and the Obama administration till it was too late with the fall of Mosul and the ensuing chaos in Iraq.

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Juan Montes of the WSJ describes the problems facing states in Mexico as the governors have accumulated power, debt has risen rapidly, and accountability of state officials is at a new low. Half of the states with elections in 2016 have doubled their debt in 6 years, according to government data. The federal audit office points to irregularities in $13 billion of federal funds transferred to states. Elections in states in 2016 shows public discontent with poor governance, corruption, and the lack of rule of law. This is leading to a close election in Veracruz with the PAN and PRD parties challenging the PRI in the state.

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Pasi Sahlberg, Finnish educator and author, describes Finland's education model.

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Chile's president Bachelet takes office for the second time in Jan 2014, after serving a term from 2006-2010. Her new administration will boost public spending and spending on education. Corporate tax rates will be increased and personal tax rates lowered. As growth slowed to 4% in 2013 from the 5.8% in prior years, Chile will have to look for new ways to boost growth.

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Prince Felipe uses Catalan in a visit to Girona. He praised the Catalan language saying Catalan "is in a permanent, sincere and enriching dialogue and co-existence with Spanish." Under the Spanish constitution following the Franco period divisions, the king is thrust into the role of "arbitrating and moderating" between institutions. The Partido Popular of former premier Anzar and current premier Rajoy, is seen as performing poorly in interaction with regions such as Basque and Catalonia. Spanish public opinion, as reflected in a 2014 poll of the newspaper El Pais, show 75% of Spaniards supporting the king playing a role in creating a dialogue and facilitating agreements between politicians.