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The worst flaw in the health care bill says the Economist is that "fee for service" and doctors billing for each test done continues as before.The whole idea of medical services based on medical necessity and value for money has been left out of the billsin Congress. Alan Meltzer also pointed this out in his discussion of the deficits and debt over the next decade; that the 25% reduction in medical expenditures does not look anywhere closer to reality, worsening the deficits. This is also the view expressed in the discussion of health care reform in the November 2, 2009, issue of Business Week. Never mind said BW that the doctors and hospitals account for one third of medical expenditures and there is waste in Medicare spending. Congress said BW has made no changes in the "fee-for-service" system of medical care that has inflated medical costs, by paying doctors for the volume of services delivered and not the quality of services delivered.

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With a turnout of 80% Argentines voted in favor of the socialist Peronist party after just 4 years of government of centre right party Cambiemos, headed by Mauricio Macri, a former mayor of Buenos Aires. Alberto Fernandez was elected with 48% of the vote to Macri's 40%. People in rural areas and in  poorer parts of Buenos Aires were hard hit by the economic crisis and rise in fuel costs, giving the socialists over 50% of the vote. The failed economic policies of Mr. Macri with overborrowing building up debt of $115 billion in foreign currency denominated bonds, lack of prudent budgetary discipline, leading to inflation of 50% led to his failure to win a second term. A $57 billion bailout from the IMF which is highly unpopular in Latin America failed to stem the drop in the pesos value from 10 pesos to the dollar when Macri assumed office to 60 pesos by the time of the election. A drought in 2018 reduced exports of soyabeans, and a third of currency reserves about $20 billion were used by the central bank to defend the peso. The socialist administration returns to power under the leadership of Mr. Fernandez, a former the chief of staff of president Nestor Kirchner, Kirchner and Fernandez inherited a similar crisis resulting in deep depression in 2003. Mr. Fernandez left the administration after Nestor Kirchner's death in 2010 and Christina Kirchner headed the Peronist party till 2015 winning 2 terms in office as president. Higher social spending under the Peronist party and high commodity prices for soyabeans exports with demand from China helped restore the economy under the Kirchner administrations, later leading to higher budget deficits by 2015 that Mr. Macri inherited. A failure to adjust spending early followed by severe austerity cuts in fuel and electricity prices hurt the urban poor and people in rural areas leading to the return of the socialist party and the lost hope for Cambiemos (Lets Change) to free markets that Macri had generated in 2015. ...

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As the state of California changes governors from Jerry Brown to Gavin Newsom, both Democrats, there is a sense of continuity as both come from families that have deep connections going back to Jerry Brown's father Pat Brown, also a former governor of the state. This comes with a change of style between the conservative Brown who espouses social justice and careful spending after battling deficits, with the ambitious Newsom who is pushing for many social programs including universal health coverage that have wide support in the state, and can be funded with the $30 billion surplus Jerry Brown handed to his successor. Under Newsom California is also seen as a state that has a different vision of the future than president Trump. 

This comes at a time when California has become more expensive to live in, less and less affordable, with inequalities aggravated by the tech boom.

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Sheila Bair says she fears the next crisis will start in Washington. Bair points to the need for urgent action along the lines recommended by the Bowles-Simpson Deficit Commission. Areas identified by Bowles-Simpson should be tackled as early as possible, she says - tax subsidies for housing and health care that lead to misallocation of resources, defense spending, special-interest provisions. She points out that the increase in the deficit is a result of the unwillingness of governments over the last two decades to make the hard choices necessary to control the structural deficit. Total federal debt doubled in the last 7 years, to almost $14 trillion, or about $100,000 for every American household. Bair, as Chairman of the FDIC, played a critical role in the efforts to control the US financial crisis of 2008-2009. Relentless federal borrowing she says, undermines the confidence private investors have in US government obligations. The cost for bond investors and others to purchase insurance against a default by the US governmet went up from 2 basis points in January 2007 to 100 basis points in early 2009, and is now at 41 basis points. With 70% of US Treasury obligations held by private investors scheduled to mature in 5 years, a decline in investor confidence would lead to higher government and private borrowing costs. She writes this just as the debt crisis in Ireland is taking place, following the one in Greece, and contagion to Portugal and Spain is feared. Bair fears a similar loss of confidence in US public debt. High and volatile interest rates could lead to losses for financial institutions holding Treasury debt and raise funding costs for depository institutions....

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Moderating prices for oil and commodities and food combined with lower oil prices that help introduce fiscal restraint in the government's spending, would actually help Iran in controlling inflation running at 24% by IMF estimates. And Iran's foreign currency reserves of $82 billion would help cushion Iran as it incurs modest fiscal deficits and help it weather the global financial crisis. And Iran's oil and gas exports are rising for 2008 and 2009 by estimates of IMF and Iranian government with foreign currency reserves estimated at near $100 billion for 2009, though a lot depends on oil price levels for these estimates.

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The new Australian budget is designed to generate a slight surplus from the A$44 billion deficit for the fiscal year ending June 30. This prepares the Australian government of Julia Gillard for elections in 2013. The budget depends on the mining boom to generate the tax revenues for planned economic growth of over 3% in 2012-2013. This is based on the large number of projects planned for investments in oil, gas and other energy projects, valued at US$456 billion. GE as supplier of turbines and other products to the Chevron-Total gas project and other projects in Australia, has sales in Australia match its sales level in China in 2012-2013. This gives an idea of the extent of the boom in the mining and energy sector. Even the widening trade deficit to A$1.59 in March 2012 reflects large imports for the mining sector. The weakness of this approach is that too much is dependent on the mining and offshore gas boom. Retail spending is weak and Australia is increasingly looking like a two tier economy, subject to the boom and bust cycles that its mining companies have experienced in the past. A bubble in Australia's housing markets and uncertainties in the global economy pose other risks....

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Portugal's foreign minister, Paulo Portas, resigns in protest against continuity of austerity measures signalled by the selection of Ms. Albuquerque as the new finance minister. Portas's party is part of the coalition of centre right parties in the administration of prime minister, Pedro Passos Coelho. Cuts in public employee pay and spending on health and education, income and sales tax increases, have cut the deficit to 6.4% of GDP by 2013 from about 10% in 2010. The cost of this is an economy that is shrinking more than expected- by 4.8% in 2011 and 2012, and an additional 2.3% in 2013. Unemployment exceeds 17% in 2013. The loan terms negotiated for the 78 billion euro bailout with the IMF and E.U. in 2010, were renegotiated so that the 3% of GDP target for the deficit for 2013 was relaxed to 5.5%. Portas's party and other leaders are calling for a further renegotiation to take into account the economic conditions in Portugal and boost growth. Portas's party opposed the effort to cut labor costs of companies with a large increase in worker social security contributions, a measure seen as counterproductive even by business leaders that was later dropped. In financial markets the 10 year Portugal bond yield increased 0.22% to 6.615%....

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Concerns that the austerity cuts announced by Spanish prime minister Zapatero may not address the deeper causes of the financial crisis in Europe- taking on too much debt, government spending and the imbalances in the global economy. And the concern on the other side that even these small cuts and eventual larger cuts can squeeze domestic demand in countries with severe recession, weaken the tax base, test social cohesion, and dampen the prospects for recovery. Zapatero announced a 5% pay cut for public sector employees this year and a freeze for next year, cancelling index-linked pension increases, and cancelling a baby bonus tax break of 2500 euros, cutting back regional spending budgets, and postponement of infrastructure projects, all adding up to $15 billion in savings. This is intended to reduce the budget deficit to 6% of GDP from 11.2% in 2009. With Spain's unemployment at 20%, and the construction sector stalled, pain will be felt. Spain's large informal economy tied to tourism helps in this situation. Trade union Comisiones Obreras gave a muted response about a general strike saying that "it is the last thing this country needs at a time like this," after meetings with Zapatero. ...

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The EU has pushed the date for France to reduce its deficit to 3% once before -to 2015 giving France 2 more years. French president Hollande faced with unemployment at 11% in March 2014, has set the task of convincing Brussels to allow more time after losing badly in local elections and facing opposition to continued austerity in his own party. France is expected to come up with a plan to present to the EU for cutting public spending by 50 billion euros over 3 years 2015-2017. In the televised address on March 31, Hollande put the priority on growth, saying "Its not a question of cutting spending for the sake of it." After election in May 2012, Hollande and prime minister Rajoy of Spain went to Brussels together to push for a growth oriented policy in the eurozone. This time he has support from Socialist Party leader in Italy, Matteo Renzi, who is also introducing growth oriented policies to reduce unemployment and boost the economy. The two leaders faceoff with Angela Merkel on the need to relax austerity policies in the eurozone....

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Martin Feldstein on the U.S. economy in 2014 and the risks of the U.S. Federal Reserve tackling the economy on its own with monetary policy, without Congress taking on the task of policies to promote economic growth. Feldstein points out the 3.6% GDP growth estimate for the third quarter 2013 does not look that good considering that half of this is from buildup of inventory. GDP growth is about 2% as net result. With paralysis of Congress and the Executive branch the Fed's policy of huge buildup of long term bonds to reduce short term interest rates to zero and stimulate stock and home prices, he describes as the only game in town. The problem is that the size of the effect of increase in consumer spending from this increase in household wealth is small and not enough to contribute to significant GDP growth. The risks of this approach are that it contributes to destabilizing the economy as investors buy risky securities and bid up prices. He suggests a five year $1 trillion infrastructure development program, including defense, as a stimulus Congress should consider. Not the kind of stimulus that happened after the 2008 crisis. If not enough investment ready projects are available as in 2008 that will contribute to future growth, Congress should take another one year to prepare for this before moving forward. Debt reduction is key, and debt as a percentage of GDP should be reduced and set on a path to go where it was before 2008 to about 40%, deficits to below 2% of GDP. This should be done by slowing growth of Social Security and Medicare, and increasing revenues by limiting subsidies in the tax code that Feldstein as pushed for since 2010....

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Ruchir Sharma, head of emerging markets at Morgan Stanley Investment Management, provides insights into the economc problems facing Brazil in 2016. He points out that 41% of Brazil's GDP goes into public spending by local, regional and national government, crowding out private investment. The tax burden is high at 35% of GDP. And under the Rousseff administration budget discipline has been lacking. Compared to the Lula government running consistent surplus Ms. Rousseff ran a deficit of 10% of GDP. With a large welfare state, the budget has rigidities, says Sharma, with public pensions increasing since 2000 from 3% to 7% of GDP, and heavy state spending tending to push interest rates up and increase borrowing costs. Retirement age is 54 and 52 for men and women respectively, and pensioners get 90% of salary, compared to 60% in advanced countries. The decline in commodity prices has hit Brazil hard because 67% of exports are from commodities such as soyabeans in 2016 compared to 46% in 2000. Manufacturing accounts for only 11% of the economy. As long as high commodity prices supported the lavish welfare and public spending Rousseff's popularity remained high at 60% as recently as 2013. The collapse of commodity prices has hurt the economy leading to growth of negative 3.5% in GDP. Rousseff's popularity hit a low of 11% as public protests over poor public services, were followed by a series of corruption scandals. Even if impeachment led to new leadership the problems are deep rooted, with neglect of education, healthcare, public services, and manufacturing industries, and heavy public spending no longer supported by high commodity prices. Some of the problems existed in the boom years of the Lula administration, only covered up by the commodities boom cycle, and becoming evident in the down cycle of the Rousseff years. ...

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As Finland based Nokia's business declines the foreign investment from Sweden and other countries that see Finland as a stable location for operations in the eurozone is increasing. Swedish paper maker Billerud AB invested 130 million euros in a Finnish forestry group as a way to shift costs away from krona which is strengthening to the euro. This is a significant advantage for Finland, a small country with only 5.4 million people, and only 17% of Finns see an exit from the euro as a good option during the eurozone crisis, according to MTV3. Growth of the Finnish economy is expected to slow. The government of prime minister Jyrki Katainen, is planning spending cuts and tax increases of 2 billion euros in 2013, or about 4% of the government budget to reduce its deficit.

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Greece's economy is expected to shrink by 6% in 2012 by many private sector economists in Greece. This means Greece will have a deficit closer to 10% of GDP. Antonio Samaras, leader of the New Democracy Party, is expected to win the elections in Greece to be held by spring 2012. Opinion polls show his party getting 24% of the vote, and Papandreou's Socialists getting 15%, showing how little support any party can gather in Greece. Samaras told the Journal in an interview- the contagion is spreading rapidly, and what he fears is political and social contagion from high unemployment and austerity measures. Samaras says his government would continue with the spending cuts, but also reduce the tax burden on Greek households and businesses, which he views as having worsened the recession in Greece.

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The Italian government is making changes that would increase competition, provide funds for infrastructure and reduce red tape. Mario Monti, the Ialian prime minister, told a news conference: "Italy's economy has for decades been hindered in its economic and social growth by three big problems: insufficent competition, inadequate infrastructure and too much red tape." There are fears that the $40 billion in tax increases and spending cuts set in December 2011 to cut the deficit would lead to a sharp contraction in the economy. The IMF predicts a 2.2% decline in GDP for 2012, the Bank of Italy's estimate is 1.5%. Changes planned would permit gas stations to choose providers, improve the legal system, add 5,000 pharmacy licenses, and add 500 notaries. Industry minister Passera says the cabinet approved 5.5 billion euros for infrastructure projects.

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Brooks looks at the Obama and Ryan deficit reduction plans and sees something to like in both plans. He agrees with Ryan that modern medical technologies are becoming too costly to afford- especially with aging populations here and in Europe- and the need for consumers of medical care to shoulder some of the burden to control these costs. He agrees also with Ryan on the need for seniors and the middle class to share some of the burden of rebalancing benefit systems. He agrees with Obama in the need for a balanced approach combining tax increases with spending cuts, and the contribution government can make through targeted investments. He is pessimistic about the chances of bringing the two approaches together taking their best points because of the political climate which is increasingly partisan.

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France's Finance Minister Michael Sapin introduces a no-austerity budget in September 2014 as France's growth is forecast at 0.4% in 204 and not reaching 2% till 2017. Sapin says "we have taken the decision to adapt the pace of deficit reduction to the situation in the country." The government will put off large parts of the 50 billion euros in cuts in spending towards the latter part of the period to 2017. Critics on the left say the cuts are undermining the social welfae model of France. President Hollande's popularity has declined to very low levels in 2014. Prime minister Valls wins support in the National Assembly for the government's strategy to tackle the economy and growth- increase business confidence and postpone cuts till the economy recovers by 2016.

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The strong showing by National Front leader Marie Le Pen and her focus on the economy in France, and the lack of growth with austerity measures, is likely to change the way the eurozone countries respond to the deficits and German insistence on austerity cuts. Marie Le Pen's economic positions for more government spending to reduce unemployment and provide additional benefits is closer to Socialist candidate Hollande's position. The right wing party in Holland also voiced the same concern recently- that it did not want to hurt Dutch pensioners with austerity cuts- when it refused to support the Dutch government leading to its collapse and new elections.

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The relationship from college years at Amherst College in the U.S. of Greek political leaders Antonis Samaras and George Papandreou. The efforts to setup a national unity government that failed. The increasing support for the opposition New Democracy Party led by Samaras- with 16% unemployment- and the prospect of new elections. Samaras supports spending cuts. He also favors tax cuts, and a flat tax rate of 15% on business. Greece has a long history of tax evasion and distrust of central authority going back to centuries of Turkish rule. Samaras believes that the lower tax rate of 15% would help change the Greek cultural trait of evading taxes becaue it would be on the honor of people to pay such a basic tax. EU leaders are skeptical that lower taxes are the right policy to reduce the deficit. This adds to the political uncertainty as the new government would have to implement the measures agreed to between the current Greek government and the EU leaders. A similiar situation existed in Portugal but the recent elections there, participation of the opposition party in talks, and the newly elected government conducting its own negotiations, has removed that element of uncertainty which exists in Greece. ...

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Italy's prime minister Berlusconi is changing the terms of the 45.15 billion euro austerity package after political protests. He has to weigh what is doable in the political context with demands from the European Central Bank, which is buying Italian bonds to prevent a surge in borrowing rates for Italy. The new measures as the old package unraveled are: an increase in the value added tax to 21% from 20%, increasing the retirement age for women in the private sector to 65 from 60 in 2014, two years earlier than expected, and a 3% tax on Italians earning above 300,000 euros annually. The street protesters in Bolgna, Milan Rome and other cities, protested that the earlier package unfairly put the burden on the working class. The cuts in local government spending in the earlier package would have impacted spending on items such as nurseries for children, drawing protests from teachers. The debate on an equitable sharing of the burden of reducing deficits is ocurring both in the U.S. and Europe, especially with high unemployment and lack of economic growth....

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France showed zero GDP growth in the second quarter of 2012 compared to the first quarter, according to the national statistics office Insee. French president Hollande will have to raise 33 billion euros in spending cuts or higher taxes to reach the target for the budget deficit of 3% of GDPin 2013, according to a July report of Cour des Comptes, a body that audits public institutions. This will be harder now that the slowdown globally is leading to expectations of slower growth than the 1% growth forecast used in the audit. French president Hollande has so far received good marks from analysts and financial markets. French borrowing costs have reached new lows especially in short term maturity bonds where bondholders are lending money at zero interest rates, partly because of the flight to safety from Italian and Spanish bonds.

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Feldstein points out that Obama economic plans missed the real target, which was on the home front where it came down to addressing the problems of 15 million homeowners under water- with mortgages exceeding the value of their homes- and lack of solutions to deal with the $1.5 trillion in troubled commercial real estate loans. Administration plans really did not help more than a couple of hundred thousand homeowners to reduce their monthly mortgage payments. Getting banks to start lending again by selling impaired loans to nonbank investors, also failed to work, as banks were reluctant to do so and reduce their accounting capital. Health care legislation simply distracted attention from the real problems. See the links to Feldstein's repeated insistence that the new administration (and even during the late stages of the Bush administration) focus on these problems. Health care legislation that passed simply would not control the increase in health care spending, that the public correctly perceived as the real problem if the other health care issues were to be resolved. Instead Obama's health care legislation offered to increase the deficit to unsustainable levels, with no solutions to more pressing home front problems in sight. Feldstein, is one of the most eminent US economists....

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Greece spends 2.2% of GDP on the defense budget compared to 1.2% for Germany for 2014, according to the World Bank. Greece's Syriza government almost took Greece out of the eurozone over spending cuts for the poorest pensioners, submitted the proposed creditor terms for the cuts to a referendum in a manner reminiscent of the rejection of an ultimatum rejected by Greece from Mussolini for occupation of the country, using the term "Oxi" in Greek for "No." Greeks remember this with a postage stamp showing "Oxi," so embedded it is in the Greek memory. And about 85% of young people in Greece vote for "Oxi" in the July 5, 2015 referendum. Why is a NATO member spending so much on defense during a severe crisis, and is the EU right to insist on cuts in defense spending and some of the other reforms. Between 2000 and 2008 Greece's spending on military was about twice the euro area average- close to 3% for Greece compared to about 1.4% for Germany, and much lower in other countries in the euro area. The total Greece debt is not an issue the way it was earlier in 2010-2012, according to experts including Krugman and the former Greece finance minister in separate opeds in the NYT, as its now financed at very low rates, and the next step inevitably under any administration in Berlin and Athens would have been longer maturities and even lower rates- under any administration in Greece, including under Samaras- as the Germans, the Dutch and the French, know deep down it can never be fully repaid. The main issue of money transfer to creditors was tackled by changing the dateline for the surplus the largest issue according to experts, a similiar flexibility shown to Italy, Spain and France for their deficits as their economies suffered from spending cuts, high unemployment. This returns the focus for how Greece can manage its budget prudently including military, welfare, and other areas. The referendum did not change the way Greece will tackle spending under EU guidelines after the Syriza left government accepts the new 3 year package negotiated with the EU in Brussels July 12, 2015. The new plan will include $300 million in cuts for military spending by 2016, and shipowners will now pay taxes....