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Absurd is a word that would apply to many aspects of New York City- the subway system, the transport infrastructure, the dilapidated sidewalks, the garbage shown here without any proper system of storage and pickup that other cities in Europe and Asia have. It all goes back to indifference from New Yorkers, as this report says New Yorkers go about their business inured by all this. The root cause is lack of investment and the capital markets of the US and of New York crowding out  investment in ,the very things that are essential for the quality and ease of living, sanitation transport infrastructure, public services, education and health. And instead a massive diversion of capital into other areas. The so called Reagan revolution's domestic side, the so called "freedom to choose" domestic side, where a few people choose to make the decisions for capital allocation away from what is in the public's interest.

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Obama's 2009 Stimulus package sets aside money to promote new mass transit infrastructure building, but no money is set aside for operating budgets of existing mass transit systems. With prices of diesel fuel doubling in 2008, and revenue from state property sales and fuel taxes down from the economic downturn- on which the mass transit depends for operating budgets- many systems are considering service cuts and fare boosts. Transit agencies are facing huge shortfalls in New York, Washington DC, San Francisco and Chicago. Th Metropolitan Transportation Authority which runs public transportation in New York city and greater New York has a shortfall of $1.2 billion in a $11 billion operating budget. It will be forced to cut fares by 23% and severely cut services, including some lines like the Z line and shorten hours, to meet budget. All this is happening as use of public transportation is surging, and is at the highest level in over 50 years. In 2008 Americans took 10.7 billion trips on the country's 6,500 public transportation systems, according to the American Public Transportation Association's recent report. Some of the systems are old and need renovation. New York's operates 24 hours aday and handles millions of riders. Repairs are needed on its 90 year old signalling mechanisms. The MTA has maxed out the money it can borrowfor repairs, and debt service costs on its loans will reach $2 billion a year. Additional Stimulus needs to set aside money for the modernization of existing mass tranist systems, which would deliver value just as significant as the new mass transit infrastructure building that is planned....

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Democratic states face a sobering reality- can California, Minnesota, Illinois afford it? It turns out that they cannot and are diverting important funds away from the Nation's priorities in transportation, housing, education, rural healthcare. Here is what happened-- When California Gov. Newsom used state's Medicaid budget for poor citizens and disabled for illegal migrants to give free coverage, Medi-Cal went $6.2 billion over budget in 2025. In Illinois the program for Medicaid coverge to illegal migrants estimated at $112 million annually now costs $800 million and parts of it are now suspended. California had not thought this thing through, with free medical coverage not available to even citizens of the US, why would unrestricted borders not overwhelm a border state's Medicaid system signed into law by a Texan president Lyndon Johnson for the people of this Nation. Democratic States are running into a logical fallacy that the European Union and Germany are already experiencing, stretching straining public services, which has nothing to do with one's sentiments. Gov. Newsom now wants to give this benefit for $100 monthly premiums in 2027. ...

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A ban on TikTok in 270 days is plausible, with credit going to Republican senators in Congress, as they insisted on it being incuded in the Ukraine aid bill package. Not only because of security and democratic process concerns- then one asks why what other real even larger concerns?  A ban on TikTok by restricting its use that does not affect education is already in place in China, yet such a ban is easier implemented in state power centralized government for the benefit of China's young generation and not in the US system of government. Excessive time spent on social media apps in the US including TikTok as the largest are a serious problem in America today -for young people's educational activity such as reading, studies, and for mental health. Taking a large part of the young generation in a direction that is not beneficial for the US, for democratic process to function with young people taking time to be better informed and for the health of the younger generation.  People assume that TikTok audiences will shift to other social media apps such as Facebook, but a large part of the TikTok population may engage in other activities that promote health as the consciousness for food and its preparation increases, for the value of exercise, engagement in sports and viewing sports or music, engagement in Nature and hobbies, and in time spent on travel, all happening as the Nation shifts its attention and consciousness after these troubled decades from financial crisis of 2009 to the pandemic, a period of dismal failure to deliver public services with funding diverted and misallocation in capital markets collapsing or near collapsing infrastructure around us sapping the Nation's spirit and its energies.  A new spirit is emerging in the Nation and a shift in the attention of the younger generation as it feels the fatigue that is now felt for music idols such as Taylor Swift is entirely plausible so that TikTok would have risen and faded away both in the US, India, and even in China as it shifts its attention in a different world. ...

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In EU elections the German coalition parties of SPD, Greens and FDP barely get the vote percentage of the CDU/CSU of 30%. The SPD 13.9%, Greens 11.9% and FDP 5.2%. This is the lowest showing of the SPD. Much of the problems come from the SPD socialist democratic party that seeks to bring more social democracy by building infrastructure, public services as Biden is doing in the US, yet is prevented from doing this with the presence of the FDP which is against spending and seeks budget discipline as the charter of its party. The Finance minister Lindner is from the FDP. As a result the SPD and Greens are not able to do what they prmised in the last election to invest in infrastructure and public services. A visit to Germany shows this with the Deutsche Bahn, the rail stations with a dilapidated look as if built in the last century, trains late with old technology and less investment in maintenance. Not much construction is seen and public transport looks haggard and old. Germany's constitution makes investment difficult and court decisions limit spending or finding other sources for investment, the FDP acting as a brake on spending. The far right AfD vote was upto to15%. Without investment and offering a new vision of a modern Germany even after managing the energy crisis of which some of the fault lay with the way Merkel allowed over dependence on Russian supplies of oil and gas, even then the CDU is getting more of the vote. Another reason is the CDU under Leyen taking a strong stand on Ukraine with the SPD's history of maintaining better relations with Russia limiting its role in this crisis. As a result Germany under Scholz labors on with no solution to current problems requiring spending and investment. The next parliament election is in 2025. ...

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Tata Consultancy Services like other Indian UT companies is overly dependent on the US and on financial and insurance companies for sales, it gets 51% of its sales from the USA. Because of inflation running at 11% in India and the rising wages and the industries it is serving facing finacnail difficulties and cutting IT spending profits growth is not as strong as it used to be. In the last quarter ended June 30, 2008, TCS saw sales growth of 24% but profits growth of only 7%.

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As deflation takes hold in China, the lessons of US relations with China that were handled by business to maximize profits that caused climate change and destroyed the environment, and caused deindustrialization in the US show the need for a wiser approach on both sides. Consumer prices in China declined 0.8 of percentage point in January over previous year. People in Hong Kong cross the border to shop in city of Shenzen for lower priced goods. These are the first signs of deflation in China. This is the beginning of a repeat of Japan's experience of the last three decades. Rapid growth followed by unsustainable growth after 2000 in China created problems for the environment and climate change because the growth was compressed into a few years and China's size. The experience of Japan's growth in the 1980's was repeated but this time on a scale that reflects China's population of 1.4 billion people compared to 125 million for Japan. The result many American factories unable to compete with lower costs in China closed in 2000-2015 leading to a general decline in towns and communities across the US destroying livelihoods.The effect is magnified as the support services jobs and wages that go with factory jobs magnifies the effect on jobs by a factor of three or four. The result is a situation that did not have to happen this way hurting both the climate and supply chains, hurting both America and China as business interests in both countries made short sighted decisions. As America diversifies from concentration of supply chain in China, into India and Vietnam, the process needs to be such that it benefits both the American and Indian people not be allowed to be left to business alone to determine as happened with China. This is one of the lessons of this period. ...

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The wars in Afghanistan and Iraq by one estimate have already cost 1 trillion dollars. By comparison World War II cost 4 trillion dollars in inflation adjusted dollars. The figures are from the Congressional Research Service, and show the pressures to control spending. The reason that civil society is not very disturbed even as these wars cost so much, is that so far these costs in 2008 for example were 1.2% of GDP, creating the danger that these wars can be carried out by a political leadership without the nation feeling the strains of the war. This may change with higher unemployment, and the feeling that not much is gained, that this money can be used in better ways to rebuild the US economy and infrastructure.

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See stunning pictures of Denali and wild life in the snow in the Washington Post.

Denali means the "Tall One." Alaska Republican Senato Lisa Mukowski wants "Denali" and has Interior Secretary Don Borghum's approval to change the name back to Denali for Mount Mckinley. It was named Mckinley in 1917, but Alaskans and natives tribes have always known it for thousands of years as Denali. The irony some say is that Denali also means "the Great One," which fits in with MAGA. There is more concern in Denali Borough says this report, the area through which one goes to get to Mount Denali about funding for the National Park Service and park road repairs, renovations. Half a million tourists support the local economy and businesses. It is so important to Alaskans.

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The "Burning Platform" memo by CEO Stephen Elop, seeks to confront Nokia with the reality of what is happening, as it has fallen years behind competitors who have completely changed the space Nokia was in. Apple's iPhone has redefined the space for smartphones and Apple now owns the high end market. In 2008, Apple's market share in the $300+ price range was 25%, by 2010 it was 61%. Newcomer Android has in 2 years created a platform that by attracting application developers, service providers and hardware manufacturers, is winning the mid-range down to 100 euros. And in 2008, MediaTek provided complete reference designs for phone chipsets, so that Chinese manufacturers in Shenzen could produce phones at an astonishing pace. They now own the low end of the market, producing an estimated one third of the phones sold globally. A crtical part of the memo is about ecosystems. He says it is no longer about hardware and device to device competition, but about ecosystems that include not just hardware and software. It includes developers, applications, ecommerce, advertising, search, social applications, location-based services, unified communications and so on. And Elop says the decision confronting Nokia, is how to build, catalyse or join an ecosystem....

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The cost will increase the longer the effort for cleanup of PFAS chemicals used in military bases is delayed and could also lead to increased contamination of water in surrounding areas. In 2025 the cost is about $31 billion for 50 US military installations says The Guardian.  The Environmental Working Group policy analysis group senior analyst Jared Hayes is cited in The Guardian- "The DoD is facing a ticking cleanup time bomb as funding falls dramatically behind cleanup costs.” “The DoD has an obligation to its service members, the families living on bases, and the surrounding communities that have already been contaminated, so they need to clean up their mess." The adjoining article in Le Monde shows the awareness being created by Le Monde and its partners and The Forever Pollution Project in Europe about PFAS cleanup in France, and in Europe. ...

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In another sign of how the capital allocation system is failing America and how capital markets are malfunctioning, this report in WSJ shows how capital of $346 billion in 2021, much of it needed for vital investments in renovating crumbling US infrastructure, in chips and science, in education, is being wasted. Vital needs are being ignored in America in education when only one thirds of eight graders are passing NAEP test reading comprehension in the US. No one talks about it yet it is a fact that cannot be ignored. Yet underinvestment in education, health, infrastructure and public services happens as wasteful investment takes place as hundreds of billions of capital is diverted into ventures that have little meaning. Shown here is a robotic pizza maker that is going out of business. The Internal Rate of Return for venture firms was negative 7% in the third quarter of 2022. As president Biden said in The State of the Union this year "free markets without competition is not capitalism it is extortion." There is no competition in the planned misallocation of this type that fails common sense,  American families and children,  as well as financial rates of return. ...

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WSJ interview with Narendra Modi before he meets Joe Biden at the White House. This interview talks about India seeking larger role in world affairs, about Indian democracy. Seen from inside India the perspective is different. India is at the same stage where China was in 1990-2000 with the rising aspirations of a billion people, Japan in the Meiji period in 1900. It is all about jobs, investment, technologies and manufacturing on a scale that surpasses China in that period with newer technologies to meet the rising aspirations of 1.4 billion people. China's trade with the US was three times higher than the Indian trade with the US in 2022, India desperately wants to catch up and fast. The Danish ambassador to India was asked what he saw in India today and he said it was the rising confidence of people that struck him most. The digitalization that has changed the way government benefits are provided to 1.4 billion people and opened bank accounts for all, provided delivery of services to all parts of the population. The infrastructure that is being built at breakneck pace, and new colleges and universities expanding access to quality education, healthcare.   ...

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This report in WSJ shows a generational problem that is creating a shortage of workers in Vietnam and China, that will require factory owners to increase wages significantly. US and European government policy supports these higher wages so that some of the manufacturing can be returned to bring jobs back home.   Younger workers do not want to spend much of their lives behind factory walls, and prefer less strenuous jobs shorter working hours in the services sector. They are having fewer children and at later ages than parents, resulting in less pressure to work in their 20's for a steady income. Factories in Vietnam are offering glass walls, yoga classes, improving cafeteria food, and offering kindergarden for worker children to attract workers.  In China there is 21% urban youth unemployment at a time of factory shortages. South Asian countries such as Bangladesh have infrastructure problems, and in India factories are finding it difficult to sign up workers. In the next 2 years this will result in costlier goods in US and EU, over 3-5 years this will bring many jobs back to the home countries. ...

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California's economy is going through tough times during the coronavirus. Unemployment is up to over 20% which compares to 14.7% for the U.S., closer to that of New York. The state depends on the tourism industry, agriculture in the San Joaquin Valley, and entertainment industry around Los Angeles for jobs. Tech in the San Jose area does not account for as many jobs. The state also has a public university system and foreign students mostly from China bringing in $7 billion.   Its port system around Long Beach and Los Angeles connects with the Asian economies and China, for goods mainly transported to the rest of the U.S.  All these sectors are the ones most badly hit during the coronavirus.  California now has a deficit of $54 billion and was the first state to borrow from the federal government to pay $13 billion in unemployment claims. Undocumented Californians are not able to collect unemployment because of their immigration status, creating an American version of the informal economy that is found in India and Italy or Spain. California has 83 million people taking plane trips to the state for a tourism industry that normally brings in $145 billion. 600,000 travel industry jobs were lost in the state. Taxes related to travel are a significant source of revenue for cities in California bringing in $12 billion. The only sector that is less affected is the tech industry, yet this makes up only about 10% of the jobs or 1.7 million higher paid but fewer jobs. This tech sector at about just 15% of the California economy GDP, is of a precarious nature with a boom bust pattern, the last boom one that happened since the 2009 financial crisis. It in no way forms a significant support for employment or income for people in California or the U.S., and may even be responsible for distortions in the allocation of capital away from infrastructure and public services, through its disproportionate influence on how the nation's capital is allocated. The broader changes underway during coronavirus are likely to affect the state over many years, as supply chains shift away from China, and as infrastructure and public services investment assume their rightful role again in the nation rebuilding effort, agriculture and rural America become a part of the American renewal story.   ...

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In his monthly television address called "Mann Ki Baat" prime minister Modi apologizes to Indians for the complete lockdown of the country. Modi said "for a a country the size of India we need strong measures. Nobody likes to take strong measures, but it is the only option, seeing other countries and learning that the disease must be dealt with at the beginning before it becomes incurable."  He cautioned that social distancing did not mean emotional or human distancing. Sympathy and cooperation are needed. He called frontline healthcare and sanitation workers "warriors" and "soldiers," and promised Rs 50 lakh (5 million) insurance for 20 lakh (2 million) such workers. He also commended the work of shopkeepers, drivers, bank workers and others to keep essential services running. Modi suggested now is time "to not go out, but to look within yourself. Try to know yourself." He gave examples of recovering doctors and workers, and of finding new hobbies. In coming time he said every Indian will try to break barriers for the country's development, once this crisis has passed. ...

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Coronavirus pandemic is likely to have a permanent impact on the economy even after the pandemic has passed, says Justin Lahart in the WSJ. This is part of a 5 part series on the economic, social and cultural changes that are likely to be permanent even after the pandemic has passed. 

Working from home some of the time is likely to lead people to buy homes further into the suburbs and increase sales of country homes. People will now be able to stay longer distances from city offices and work remotely. This will change aspects of the real estate industry. Airlines are likely to see fewer passengers and some airlines may benefit at the expense of others. Even today Southwest Airlines is moving to expand, and other airlines such as Lufthansa are facing huge losses.

Tourism, travel, restaurants and some service industries are likely to be impacted more than other industries.  

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This article in the WSJ remembers Prince Philip for his remarkable service during World War II, coming from a generation that sees the British struggle against Germany in World War II in almost mythological terms. Prince Philip and Queen Elizabeth navigated both that period and the transition of the British Empire into free nations in Asia and Africa. The significance of this achievement is understated in America. It can only be fully appreciated in the nations of the British Commonwealth, for no other colonial nation has been able to make that kind of transition, not the Dutch in Indonesia, not the French in Algeria without war. Another significant achievement of that period was the sense of duty that pervaded Britain not only for this generation in Britain, but the generations that preceded it going back to the conflict with Napoleonic France and the British Navy under Admiral Horatio Nelson. It is forgotten that much of the sense of duty to country and the people, and one's fellow citizens, helped Britain prevail against Napoleonic France in the period around 1800. This shaped Britain and Prince Philip, and is also part of what India and other free nations in Asia and Africa can learn from. It is also what makes Global Britain not just a slogan but a way to bring together a partnership with UK, US, Australia, and India, the largest democracies with a common history. ...

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Biden calls ending the war in Afghnistan a "wise decision" for the American people. He says in his foreign policy speech that "it is about ending an era of major military operations to remake other countries." A Pew Research poll shows 54% of American adults support the decision.  In a sense the decision had already been made. Biden cited the Doha agreement president Trump signed a year ago with Taliban that called for the release of 5000 Taliban prisoners which included most of the top commanders, and no agreement on the future of Afghanistan. The decision had come much earlier than that when the wars in Iraq and Afghanistan from the period of George Bush were rejected by the American people for the cost and lack of purpose during the presidential election of 2016. That period marked the rejection of policies set under Reagan, Bush and Obama for starting American involvement in the Iraq-Iran conflict first on one side and then on the other side. All the time precious resources that were needed for infrastructure and services in education and healthcare were diverted to these wars, impoverishing America and also Europe. Looking beyond the words thrown around for political advantage both Trump and Biden and the American people, had decided to put these wars behind them 5-10 years earlier. Biden said assertively that America had made a tragic wrong turn, that was all he could say about Reagan, Bush, Obama policy. In the meantime he stated something else was happening- the US was losing its position in the world by wasting its resources in these wars that do not serve the interests of America. "There is nothing China and Russia would want more in this competition than the US to be bogged down for another ten years in these wars."  Biden was saying that he had the courage and tenacity to make a decision that was the right one and a wise one for America against all the transient opinion of people who lacked a grasp of what was happening to the American people- the increasing impoverishing of America in both rural and urban areas. And a similar situation in Europe. It was time to take a new turn, close this chapter, and write a new one in American history, brighter and with new sense of hope. ...

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The second lockdown in France that begins October 29 for 4 weeks is very different from the first. It incorporates many of the lessons learned during the first lockdown.  The construction industry will remain open after this made a large dent in the French economy during the first lockdown. Schools K-12 will now remain open, with children required to wear masks at age six, and stricter rules for masks and visiting parents. The universities will remain open with classes online, but physically closed. Buses metro and other transport will remain open. Churches will remain open but be limited to very small gatherings. Parks forests, gardens and beaches will remain open this time but one has to live within 1 kilometre to access them and limited to 1 hour. People are prohibited from travelling outside the region in which they are registered. People can exercize for 1 hour within 1 kilometre of their home. All are required to carry a signed form for any type of activity, including shopping, work, accessing essential services, or for their one hour exercize. Not having the signed form would lead to a fine of 135 euros. Because bars, restaurants will be closed people in these hard hit industries will get 100% of their pay from the government. In other industries companies will contribute 15% and the government 85% so that these people are covered. ...

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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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The Vice Chief of the Indian Army explains in detail how the scheme that is rolled out for Agnipath is a pilot project and how the lessons learned will be incorporated over the next 5 years. He says the recruits leave with something like 24 lakhs rupees for a second innings at age 22, with the opportunity to get 13 lakhs in preferential basis loans in government assistance to start an enterprise. Others could choose to enhance their education and go on to get degrees under preferential educational setup. The idea is not to set them up for life but get them off to a good start as they are only about 22 years and with special technical skills acquired during their 4 years in the armed services. Technical skills acquired in the airforce could be even more advanced. Private industry in an India almost twice the size of the economy that exists today and the fastest growing economy in the world would easily absorb 30,000 of such highly trained disciplined people in the scheme who leave. The US GI Bill and other similar programs for the military have shown that this works and private industry is eager to take in these people on a preferential basis. These in fact have proven to be even more attractive opportunities using the example of the US experience than a government job. Lt. Gen. Raju says about the All India regiments replacing the homogenous units of the past. The Rastriya Rifles  and similar units in the Army have shown that the bonding happens for people from different parts of the country. He could have said that it is seen in the cricket teams where the bonding is between people from different regions and places. These units have performed very well says Raju in the LAC, in Kashmir, in border areas and in other situations. ...

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Labour will introduce 40 bills in parliament to make changes in renewable energy, the environment, transport railways, and for cost of living action. Great Britain Railways and Great Britain Energy are two public companies to be set up to reach goals in public transport modernization and in getting a five fold increase in solar needed to meet 68% cut in emissions by 2030 (Paris Accords commitment). Great Britain Energy will be capitalized with 8.3 billon pounds. (Labour scaled down its 28 billion pounds Green Energy Plan because of Tory mismanagement of finances but will continue to invest in vital projects). The answer is to take a creative approach. More money will be released through the Crown estate bill that will have the crown estate use its auctions of offshore land for wind energy and make investments in green energy. National Wealth Fund will invest in low carbon projects.  Fro water Labour will hold the water bosses to account and put companies such as Thames Water in special measures. Renationalisation was considered but was considered costly at this time, other action is being taken.  Nine bills are part of the 40– the planning and infrastructure bill; the better buses bill; the three rail bills, which are the passenger railway services (public ownership) bill, rail reform bill and high speed rail (Crewe to Manchester) bill; the Great British Energy bill and crown estate bill; the sustainable aviation fuels bill; and the water (special measures bill) – that all focus on protecting the environment. ...

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Milan will host the World Cities Culture Summit in 2020, and the Winter Olympics in 2026 shared with the Alpine town of Cortina. The international book fair of Turin is moving to Milan. The left of centre Mayor Giuseppe Sala has promoted the city to increase tourism by 50%. And foreign investment is increasing for new construction projects with $21 billion to be taken up in the next 15 years. Experts are asking if this is coming at a price as the rest of Italy has stagnated for 20 years, and the rural large city gap is increasing throughout Europe. The flow of professionals to cities such as Milan, Paris, Munich, Berlin, from other towns and cities is creating a huge shift that experts at the Centre of European Reform see as a problem because of the political turmoil, and rising inequality with ever widening gaps between smaller cities and towns and rural areas with the big cities. This is compounded by ageing and demographics such as seen in the eastern part of Germany, and parts of France. Experts call it The Big European Sort, where a sifting or sorting process is increasingly transforming the demographics of European countries and driving polarisation. This process is also happening in the U.S. Experts say the big cities benefitted from the change with the European single market and the European Union. Places where working class people live are not seeing and increase in wealth which is disproportionately going to professionals clustered in big cities. Deindustrialisation has turned places like Mezio only 20 miles from Milan into industrial ruins. Towns that once voted socialist are now voting far right in these hollowed out industrial places. In the U.S. and in Europe the process was exacerbated by the flow of cheap imports from Asia hollowing out factories in regions around big cities, and by the growth of services industry in big cities with globalization in finance, legal, and other professional services. Fro 1980 to 1995 Paris region lost about $5.5 billion in industrial output and gained $20 billion in services output that also aligns with globalization in areas such as finance, according to CER, Eurostat. The process had accelerated in 1995-2020. By telling this story about Milan and the Lombard region around it like Mezio, The Guardian is saying it is time to look at how everything works together rather than breaking apart- citing the Finnish architect Saarinen about how a chair fits into a room, a room into a house, and a house into its environment, an environment in a city. So the question is how can we build the future by seeing that the city fits into a region, and a region fits into a country. As a young professional described this on BBC television interview recently this is a difficult period with the ability to design the future seemingly snatched away by the times, but also an opportunity to rethink and take the actions today for a better tomorrow for all. This is part of the coverage on Cities in The Guardian looking at how cities can work, and how cities can become part of healthy regions, for organic growth. ...

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Laffer says there is a big gap between the cost of health care and what people actually pay, which keeps cost escalating as there are no pressures from users of services to economize or bring reductions in the prices. But Laffer offers no effective solutions either his patient centred approach to health care reform does not address the problem that employers are paying for health care for the large part and these are not taxed as benefits leaving the employee free to load up on services and ignore the cost, which works just fine for the health care providers who increase revenues and profits- also called cost escalation upto the point now reached where the nation can no longer afford it.