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The loss of state support in the 1980's resulted in the gradual withering of the health care system in China as individuals bore the brunt of health care costs. Hospitals and clinics shifted to pay as you go system, with the emphasis on prescribing treatment that would boost income including costly tests.

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U.S. auto sales including cars and light trucks reached 17.5 million in 2015, a 5.7% increase over 2014. Larger vehicles including pickup tucks and SUV's account for about half of all auto sales in 2015, with gas prices below $2.00 a gallon in Jan 2016 in most parts of the U.S. The average transaction price was up to $34,428, according to Kelley Blue Book. Auto incentives were up to $3063 per vehicle compared to $2809 ten years earlier, according to Kelley Blue Book. Analysts say automakers will reduce margins to subsidize zero interest loans in 2016 to increase sales. Lower sales are forecast after 2017 as the market will have caught up with much of the pent up demand by then. A plus for the automakers is the lower cost of steel and other material costs, and the better cost structures after bankruptcy, and renegotiated lower union pay scales. Additional plus is new management at U.S. automakers and at Toyota, and the technological advances this management is pushing, including fuel efficiency. Ride sharing, and other services developed by Google, are seen as disrupting the traditional car model to a limited extent. Countering this new development are millenials who are accounting for a quarter of Toyota sales in the last quarter of 2015, according to a Toyota executive....

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As auto sales decline in Spain, France, Italy and other parts of Europe auto companies are looking at improving efficiency and closing inefficient plants. Italy is tackling labor laws that prevented a revamping of the auto industry to improve productivity. New laws make it possible for companies like Fiat to hire or fire workers rather than having to place them on a state backed temporary layoff program that pays workers two thirds of their salaries while not working. Chrysler-Fiat CEO Marchionne sees sales dropping below 10 million units from the 13.1 million in 2011 if the euro were to disintegrate. With the higher efficiency of Fiat's plants in Poland and other parts of Eastern Europe, Marchionne is not willing to make any exceptions for the Italian system any longer. In 2009 Fiat's plant in Tychy, Poland, making the Fiat 500, made 600,000 cars with 6,100 workers, whereas the five largest Italian plants made 650,000 cars with 22,000 workers. Marchionne put forward his 5 year revamp of Italian operations in April 2010 with an investment of 16 billion euros. Unions were asked to agree to new work rules in exchange- shorter breaks, reduced absenteeism, doubling of overtime hours if needed, and pay tied to performance in addition to seniority. In the fall of 2010 Fiat shifted the production of the Fiat 500L to Serbia. Following this unions agreed to the new rules. One of the plants revamped was the Pomigliano plant which would turn out lower cost Pandas instead of the Alfa Romeos at a cost of 800 million euros to redesign the plant for efficient manufacturing. The new plant requires fewer workers and only 3000 of the 5000 workers at the plant have been hired. Priority was given to younger workers. Marchionne sees the revival of the manufacturing plants in Italy closely linked with his plan to import Italian cars to the American market because of the declining sales in Europe. The transformation of the auto industry and Chrysler was achieved by changing work rules and reducing labor costs. A similiar process is now underway in Italy....

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Krugman talks about the misunderstandings and the whole lot of misinformation that comes from advertising and political commentary. With one man telling a Congressman at a town hall meeting: "keep your government hands off my Medicare." In apolitically charged atmosphere this makes rational decisions in acalm thoughful environment difficult or impossible- when the influence of lobbying by the health care industry and the influence of interests on behalf of patients and other interests have already created a difficult situation.

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GM's new Cruze to be built in April 2010 in the Mahoning valley area of Ohio hit hard by shuttered steel mills, will give 45 mpg. It will be smaller than a Malibu and larger than a Cobalt, and will be built also in Gm's European and Asian markets, so unlike models from before the car will be sold everywhere and being built on the same platform will share common parts and engineering, which is the automakers are now making their cars. GM will spend $150 million in developing the Cruze and an additional $350 million in building the Cruze plant in Ohio. GM's car strategy is now to increase production of the Malibu which had a sales increase of 79% compared to last July, shut down the Cobalt once the Cruze come in 2010, Cobalt sales increased only by 4% this July over July last year, and have a third shift producing the Impala next year in Oshawa, Ontario. Auto figures from Autodata. GM's CEO Wagoner says he sees small cars making a profit for GM as now the new union agreement helps to reduce GM's costs and he sees customers willing to spend more on small cars. This is evident in the way affluent buyers have signed up to buy the Smart car, once shunned there is now a 1 year waiting list, and Daimler is expanding production at its French plant for the Smart car. See the link to the Smart car. The committment by GM to build the plant in Ohio is seen by the UAW union as GM keeping its part of the bargain to bring new models and new cars with new ideas to capture the next generation of customers to GM plants that were seeing a decline like the Lordstown plant area in Ohio....

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Justin Lahart points out that concealed in the good profit performance of Ford Motor for the third quarter 2012 is a cause for concern. Ford market share of light vehicle sales in the U.S. market declined to 15.3% in the first 9 months of 2012 from 16.6% in 2011, according to WardsAuto. Ford's quality in the Consumer Reports' annual reliability survey shows Ford ranking 27th of 28 brands.

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Over half of all Americans don't care about age, and many voters see it as benefitting the country because of the experience. In Biden's case the longest serving Senate record in the US means getting things done. It all depends on the choice voters have. With Trump 78 years old as Election Day approaches, and Biden 81 years, the difference between the two becomes slight- result a wash. If Mr. Trump brings it up as "sleepy Joe" as he did in 2020 it may sound as old hat. A polling research firm Navigator showed Mr. Biden to a group and found 35% approval on the grounds of age, after being shown the State of the Union address with a feisty Biden energized to take on the Republicans the approval jumped to 55% on age alone. Other experts point to the deciding factor being not age but accomplishment. It is true for all Democrats and for the significant voting group of Independents and Moderates. Biden's list of accomplishments in making trillions of dollars of investments in the US trump all other concerns.  ...

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Care home care or nursing home in Germany goes from $1700 a month in 2018 to $3760 in 2025 doubling in 7 years. Most of it is from increase in nurses pay and training that has gonu up after years of stagnant pay levels.

In Germany 85% of older citizens elder care is in their own homes with help of relatives and outpatient care assistance is covered from a nursing care insurance fund that pays $330 to $990 a month depending on level of care required. The average pension is $1100 a month.

Statutory long term care insurance is part of German Social Security System with long term care insurance compulsory paid for by employers and employees and 3.6% of pay income going to contributions for this long term care.

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About two thirds of American 4th graders lack Reading Proficiency in English as shown in this report in NAEP. Resources are needed in this work when $346 billon went into investments in new ventures with much capital wasted in 2021. And a negative return of -7% for venture firms in 3rd quarter 2022, as reported in WSJ. The entire capital allocation system is flawed and not doing what it is supposed to do, to invest in America and the potential of its people.

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India is fast becoming an auto manufacturing centre with exports expected to hit half a million vehicles in 3 years. Hyundai puts out 500,000 cars a year in India. India has the local market, the qualit and the companies. And the Tata Nano is just getting started and should be on full stream after a shift of manufacturing plant to a southern location.

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Simply put Ford sells 800,000 F150's a year but sales are dropping at about 100,000 a year, and where has it put Ford? Ford is losing money, $12 .6 billion in 2007, lost market share from 25% at one time to 15%, and a stock price about to go below $6. Turn to the fuel efficient cars Mullaly wants to have, the same car sold in the US, Europe and elsewhere and designed by worldwide collaboration between engineers and designers in Europe and the USA and emerging markets. The Verve a fuel efficent small car is one example and it will also use globally made parts. Why is the Verve though going on sale in Europe this year and not in the US, is not clear. And why won't it be called the Verve in the US? The idea that it could be called the Fiesta may not make sense, as the old Fiesta model in the USA did not have that great an image for quality and value.

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Prime minister Boris Johnson says at an event before the coming UN climate change conference in Glasgow that Britain will bring forward a ban on the sale of gasoline and hybrid cars to 2035 from 2040, to promote efforts to fight climate change.

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During the coronavirus the market is pushing some buyers out of the market while other buyers are willing to pay higher prices. Limited stock, cheap financing, and low fuel prices are pushing buyers into more expensive models with higher prices. The average new vehicle sold in August in the U.S. was at $35,420 according to J.D. Power. The auto market is following the housing market in this sense where limited supply is pushing up prices. Auto sales declined by 20% in August. Younger buyers are being priced out of the new vehicle market and auto makers are focusing on higher margin vehicles.

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The most important segment with future implications for growth is the young people segment, and here American companies are really weak. Of the "millenials" or people born between 1979 and 1985, those who consider a Ford when shoppng for a small car are only 7%. These are Ford's own numbers according to the Wall Street Journal. Ford and GM are moving their emphasis to small cars. Ford did this at the Los Angeles Auto Show with the new Fiesta arrriving in the market in early 2010, and GM will compete with the Honda Civic with its Chevy Cruze due in August in showrooms. To do this Ford and GM are remodeling their showrooms. To do this 3000 Chevy stores are taking on a new focus on small cars and 26,000 sales people are being retrained by end of 2009. Kurt Mcneil, Chevy's sales chief, says their emphasis is on giving a good response to online customers by having salespeople able to talk fluently about fuel efficiency and compare with Honda and Toyota. For Chevy the showroom remodeling involves having a greeter at the reception desk not a salesperson, this is who one first sees when walking into a dealership. The improvements costing $200,000 to $600,000 per location are being paid by dealers with GM offering financial incentives for the work. The way Ford is approaching it is to use social media like Facebook to a bigger extent. It will send a social media consultant to its largest 800 dealerships or one fourth of all stores to build an online infrastructure to connect to local buyers and offer online updates, videos, and games related to small cars. Ford, GM and Chrysler have only 21% of the small car market, according to Autodata, and Ford has only the aging Focus to offer today. In 10 months of 2009, 19% of 8.65 millon light vehicles sold were small cars up from 14% in 2006, while the percentages for SUV and pickups dropped 53% to 46%. ...

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During the years 2002-2008 the growth in doctors per thousand people at about 1.5, and hospital or clinic beds per thousand people at 3, are essentially flat. See graph. Figures from China's Ministry of Health. Now the State Council, China's cabinet is giving details on a $120 billion plus initial phase of a revamp of the country's health care system. Its a big step for China. A construction surge by 2011 is to give every village a medical clinic, and every county at least one hospital. Under this plan state subsidies for insurance premiums will aim at giving at least basic coverage to 90% or more of China's 1.3 billion people. For 30 years since China moved to a more capitalistic type system health care costs have been borne by the people, and these cost made access to health care difficult for a large number of people. These are steps to rebuild the social safety net in China in this crisis.

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Senators Mike Lee of Utah and Jerry Moran of Kansas declare their opposition to the Republican Health Care bill proposed by Senator McConnell. This decision by the two senators makes it impossible to begin debate on the bill. Earlier two other senators, Susan Collins of Maine and Rand Paul of Kentucky announced their opposition. This means the Republican health care bill has no chance in the Senate even after changes to the bill passed by the House of Representatives. Republicans have a thin majority in the Senate make it difficult to pass legislation. Collins met with residents in Maine and Moran with people in his home state of Kansas, and both senators heard a lot about the negative effects of the Republican bill on people in their state. The bill is seen as hurting people in rural areas, elderly, and not likely to do enough to bring down premiums. Its plan to slash Medicaid spending has drawn strong opposition from all Democrats.

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A couple of things can be noted about the burgeoning Chinese market for cars. Most car buyers are first time buyers. But that is to be expected as China started with a small bases of cars to begin with. What is interesting about these first time car buyers is that they ask a lot of questions do their research and are looking for the best car for the money in terms of features, safety, reliability. So its also a sophisticated first time buyer that carmakers are dealing with. This car buyer is also looking at waiting to save enough to buy a better car as far up the ladder as the car buyer can go in terms of features and value in safety, reliability, design, even if this means waiting longer and saving for longer periods.In this sense the Asian car buyer may be different and less bent on instant gratification to get into a 4 wheeled vehicle. What this is doing is putting the domestic manufacturers under a lot of pressure to match the overseas manufacturers. Geely and Cherry the larger domestic makers have to come up with just as good or better a product to get new customers. At this time the overseas makers of cars like the Buick Excelle, the Toyota Camry and the Volkswagen Jetta have the advantage as they are established brnads. Its interesting to compare this with the experience of japan the other large Asian carmarket. In Japan Toyota, Nissan and Honda were the only carmakes available because of trade barriers in the Japanese market in postwar Japan. China is a relatively open market and China's approach seems to be to get the Chinese carmakers to do better in an intensely competitive market as opposed to giving them favorable treatment. Another aspect of this first time car buying in a country where car sales have increased eight fold since 2000 and now exceed sales in the Japanese market, is that this market is abit precarious as the example of the Li family shows. Li Rifu purchased a Geely for $9000 but later after he contracted cancer and had $40,000 in medical bills had to sell the car. China has no social safety net so that if there is a medical or other emergency or crisis in the family there is nothing to fall back on and the family ends up selling the car to pay for expenses....

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In December 2021 China's government ended tax cuts for buyers of automobiles, and ended long running electric vehicle subsidies. China's car sales are sluggish in 2023 leading to price cuts.

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Howard Dean, former Governor of Vermont, where Dean helped set up health care improvements, says the bill currently in Congress for health care reform does not deserve to be called reform and may do more harm than good. He points out that it does not insert competition into insurance markets, does not significantly lower costs, and does not improve the delivery and use of health care services. And few Americans will see any benefits till 2014, by which time premiums will have increased significantly. He sees insurance companies as winers in this bill, and the American taxpayer about to be fleeced with a bailout in a situation that dwarfs even AIG. One of his keen criticisms is already apparent to the public in this health care bill, that clear thinking has been thrown out in favor of compromise and political calculus, and by political moves the bill has been stripped of real reform , the end result being a bill crafted for votes and not to reform health care. It also then sets an irreversible course of how future healthcare reform is done, doing more harm in the future. ...

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China's BYD started in electric batteries and expanded into electric cars. It has emerged as the dominant electric car company in the world as China now has half of the electric cars on the road in the world. 35% of exports of electric cars are from China. Keith Bradsher of NYT reports from Shenzen that its first car was made in 2007 of poor quality, similar to Toyota in the 1930's as it tried car manufacturing for the first time. It has surpassed Tesla in making electric cars. In each of the last 2 years it has increased electric car sales by one million to reach electric car sales on 3 million. EV sales in China were up in 2023 to 9.49 million cars giving BYD the largest share of 31%., by comparison US electric car sales were 1.2 million. New assembly lines are being built in Brazil, Hungary and Thailand. And new lines are planned for Mexico and Indonesia. This kind of growth was seen only by General Motors in 1946 after the end of the war. It also shows the progress China is making. In solar panels something like the addition of 900 million solar panels meeting the entire increase in electricity demand for each year, so that emissions targets can be met earlier than planned to tackle climate change.  The same changes are happening in electric cars. China now has 40% of electric cars or gasoline/electric plug in cars going up to 50%. For export China is building large carrier ships, the first that will take 5000 cars for export to the Netherlands. The lowest priced electric car model the Seagull was priced at $11,000. BYD's lowering of manufacturing costs have given it the ability to price the cars to attract new car buyers.  Wang Chuanfu who studied at Central Southern University in Changsha known for its battery research, was an engineer who started the company in the 1990's to make batteris for Motorola. Between 2003-2006 he experimented with making cars in the hope of making electric cars. Stalled efforts in 2009 and 2011 were met with arenewed effort in 2016 trying a new approach to cut costs by developing a battery where supplies of lithium or cobalt would not be a constraint. He developed a new battery using iron and phospate to replace lithium cobalt batteries. A big break came in 2020 with the Blade battery that increased range to the level of cobalt lithium batteries at a much smaller cost. BYD hired German Audi designers for new model design. This time BYD was in the right position to build a car company matching all others with costs lower by about 35% than VW for some models. This comes from- lower costs to make in China, making its own parts inside the company for 75% of parts compared to VW only about 35%, and by the savings from its battery research.  BYD has shown ability to shift with market needs and opportunities. In 2022 assisted driving was facing hurdles, BYD had second thoughts about the new technology, by 2023 as it was increasing in use BYD committed $14 billion in autonomous driving technology. Driving range is a problem for people in urban areas going back to their villages in China. BYD has an advantage here compared to Tesla- it makes hybrid plug ins that account for half its sales. Toyota has also had emphasis on hybrid plug ins where it missed the opportunity was that it moved very slowly on all electric cars not realizing how fast things were moving outside it's world. This is the situation America also faces in 2024 and beyond who can deliver on the infrastructure capabilities, new research ,and tap American potential to compete in this new world where one innovation will follow another. ...

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Today GM announced that it is eliminating lifetime health coverage for about 100,000 white collar salaried retirees, as it is rapidly running out of cash to run operations. Also white collar salaries of current employees will be cut by 20 percent and the $1 a share dividend eliminated. This with other savings will save $1.5 billion annually GM estimates. Union contracts prevent this from taking effect for former factory workers even as the company is truly running out of cash. In paying the lifetime costs of hospital stays, surgeries, expensive drugs for retirees GM spends$4.6 billion in 2007 on health care for its one million employees and retirees and their dependents. This is larger that GM's entire active work force and a big reason GM has got into trouble. It also skewed management decisions in the wrong way. Management let it affect their strategy in the marketplace, they continued to run the company by emphasizing sales volume with frequent sales and discounting in the belief that the size was needed to support all these retirees goldplated medical care, care which does not exist in other industries and companies, even when GM coud least afford it. By carefully shutting down plants earlier as demand for some of its cars and vehicles was shrinking, and closing down some brands, GM could have focussed its efforts on the areas including smaller passenger cars and midsized cars and other models which were gaining popularity, and shifting ahead of the curve out of pickups and large SUV's in the face of higher gas prices. Its the collapse of the pickup and SUV market that exaggerated the impact even in October 2008, instead of the about 30% decline that the industry faced and GM faced in its cars, GM's dramatic drop in pickups and SUV's gave it an overall loss of 45% October 2008 over same month 2007. Without this aberrration of health care benefits from a previous growth era and a dominant GM - an anachronism in the present when GM was in decline and health care costs had mushroomed and company health care benefits cut back in industry after industry- and without the intransigence of the unions and the failure of management to build credibility, share the pain and convince the unions in good faith that this was unsustainable, GM could have had a much better shot of developing a strategy for renewal. Instead it sealed GM's fate, along with lack of foresight in taking decisive action to shift to higher fuel efficiency cars early in the curve, and closing unneeded plants and brands to focus on this task. In the end the gold plated benefits which were terminated today are lost for salaried retirees, and sooner or later the same is likely to happen inside or outside bankruptcy for union workers. Union workers who might then say what the salaried retirees are saying now, that if the company goes out of business, they would lose everything anyway, and could not blame GM for cutting them off. If only they had understood this earlier and accepted these facts, and if only managment had built the credibility and shared the pain so that company's interests came above union or management interests, as they should be for a company to grow or renew itself and grow. In the end union workers in the auto industry were living beyond their means, just as consumers in the USA were living beyond their means, and the outsized executive compensation also a kind of grab from another era. Renewal starts with getting a grip on reality, and reality slipped away from their hands....