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This is huge- for Germany, for France, and for the European Union. After initial hesitation and a decade of not looking ahead, Germany under Angela Merkel is finally not just looking ahead to its vision for Germany but doing this as a part of the larger European community. And the European Central Bank after its initial lack of community spirit, is paving the way with its own actions for the Europe wide recovery with a significant increase in lending to EU countries.  Germany's finance ministry has agreed to spend 130 billion euros on more than 50 initiatives to promote growth in Germany. No longer is the government looking at the car industry as it did in the past. It is looking beyond to what Merkel calls the "profound upheaval" coming from climate change and digitisation. For Merkel after the changes caused by the pandemic something more had to be done- "We just could'nt introduce a traditional stimulus package. It had to be done with an eye to the future, so that is what we especially emphasized."  This also brings together France's Macron and Germany's Merkel in a combined effort to bring Europe up to face the future with confidence. It is amazing how the pandemic has changed minds in Europe. From the long drawn out period since 2008 when traditional policy ideas and austerity thinking prevailed, to the idea today that this is no way to face the future with confidence for Europe to be back on its own feet, for hope to return. Instead of partnering in austerity with the Dutch and the Swedes, the finance ministry is now looking to France, Italy and Spain, considering the common pain of the core European countries during the pandemic and looking to the future.  Merkel moved to circumvent the traditional Bundestag's refusal to permit debt sharing  across the euro area by producing 500 billion euros of grants for hard hit businesses across the European Union. As Macron says it was a necessary  step- " What is sure is that this 500 billion euros will not be repaid by the beneficiaries.... We are proposing to do real transfers (of money) ... that's a major step." Forecasts from Capital Economics and other forecasters show the European Union's major economies of France, Italy and Germany rebounding quickly in 2021 after the blow in 2020, in a V shaped recovery with growth of close to 6% in France, and higher in Italy because of the bigger hit taken there than Germany. The strong U.S. jobs report with addition of 2.5 million jobs for May shows that the rebound can be sharp upward swing if the policy, will and community spirit is summoned up by leaders and people, no matter what happened in the past decade. It is also based on having the right spirit that knows about investing where it really counts for the people - in infrastructure, health, public services, and avoiding the misallocation of resources and spending that happened before. ...

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Doctors face a 21% cut in the amount of Medicare payments for treating seniors having Medicare, though this cut will be delayed till 2011 under legislation in Congress. This issue goes back to 1997, when a budget law set spending targets, and stated that if they were exceeded formulas to reduce doctors payments would go into effect. The formulas seriously cut into doctor payments by Medicare in 2002, so the formula was put off. The result of this is that the cuts based on the formula now amount to 21%. The cuts are not expected to go through, but at the same time Congress has an headache on its hands with the growing deficit. In the Senate there is opposition to a $120 billion bill to extend long term unemployment benefits which lapsed in June 2010, for tax breaks, and other expenses. Senators want to pare down the bill's price tag, as $80 billon of this is unfunded and will be added to the budget deficit. For a primary care doctor in Washington state, Medicare pays about $95 compared to private insurers payment of $129, and a plan for state workers that pays $140....

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Medical device makers for heart like the stent and hip like replacement hips have margins of over 70%. THese and other medical devices may come under pressure from the changes that are anticipatd in the way Medicare reimburses hospitals for these devices, which are largely used by older patients under Medicare coverage. Stocks of these device makers like Boston Scientific, Stryker, and Zimmer, have fallen in recent weeeks

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Pakistan's economic delegation meets Christine Lagarde, head of the IMF, at the IMF and World Bank Annual meeting in Bali, Indonesia. Lagarde calls for transparency in accounting and complete understanding of Pakistan's debt. IMF delegation will visit Islamabad to discuss terms for a loan. The previous government of Mr. Sharif came under criticism for not providing transparency on Pakistan's total debt. There is concern about debt trap diplomacy in loans from China, as loans may exceed the country's ability to repay and the interest rate terms are not seen as favorable to Pakistan. The Sharif government is criticized for not negotiating better terms for loans from China. Pakistan faces $8 billion debt load in 2018, with first payments to China under Belt and Road Initiative of $1 billion due in 2019. Pakistan's total foreign exchange reserves fell to a low of $8.4 billion, according to the central bank. Pakistan is seeking $12 billion in IMF assistance, but experts say more will be needed to bridge the financial gap. The Pakistan rupee dropped by 10% during this week in October 2018, down to 137 rupees for a U.S. dollar. The new government of prime minister Imran Khan took office in August 2018 after election promises to bring transparency to Pakistan's debt situation. Promises were also made to improve low income housing and meet needs of poor and low income public. Imran Khan opened a public housing project to build 5 million new homes. IMF terms could restrict the money available for badly needed housing and other social projects.  Pakistan's small tax base with a small percentage of the population paying taxes, also restricts the ability of the government to fund social welfare projects and infrastructure. It makes the country more dependent on outside assistance and loans. India has moved to expand its tax base, and is implementing GST tax reforms to increase the tax revenues available to fund infrastructure, health, education and housing. The war in Yemen has complicated other sources of funding traditionally accessed by Pakistan from Saudi Arabia and the UAE. The financing gap is estimated by experts to be $20 billion, with the IMF assistance sought of $12 billion falling short of the financial needs. ...

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As Indian pharmaceutical industry sees drug testing in India as an opportunity, conditions for obtaining the best results are being established by taking necessary steps. With ashortage of experienced people to run drug trials, Indian government has stepped up training, setting up partnerships with the U.S. FDA, Health Canada, the World Health Organization, and other similiar organizations, The emphasis should be on credible dat and the safety of subjects says A.K. Pradhan, India's Assistant Drug Controller. After the death of an infant in a Wyeth Pharmaceuticals drug testing effort, the Drug Controller of India though supportive of Wyeth has raised certain issues that Wyeth is addressing.

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The House bill on health care cleared the House Committee on Energy and Commerce with a vote of 31 to 28. Five Democrats joined all 23 Republicans. Compromises were reached with Blue Dog Democrats, centrist Democrats who had concerns about the cost of the health care overhaul. The bill will be taken up again in September after the August recess, when Congress will be faced with the task of recociling the House and Senate versions and reaching common ground on a number of proposals. Some common ground has already been achieved between centris and Blue Dog Democrats and Democratic members who support Obama's proposals. Among the changes on which consensus was reached in the House version: 1. Access Insurers will have to accept all applicants and will not be able to charge higher premiums because of medical history or current illness. All insurers will have to offer a minimum package of benefits, to be defined by the federal government, and nearly all Americans will be required to have insurance. Insurers will have to get prior approval from the government before increasing premiums over a certain amount. About 95% of Americans will be covered this time. The cost will still be approaching $ 1trillion over 10 years. Federal subsidies will be given to those who cannot afford health insurance and Medicaid coverage will be expanded. And the insurance will be made more affordable for the uninsured. Democrats also reached a consensus on creating some sort of government insurance plan or nonprofit cooperative to compete with private insurers. 2. Mobility And under this new plan it will be easier to change jobs as one would retains one's health insurance. This should actually help the job market, and help promote the mobility that is needed, now that jobs are shifting out of sectors like autos to sectors like energy. 3. Cost The Energy and Commerce Committee voted 47 to 11 to set aprocedure for the government to give federal approval of generic versions of expensive biotechnology drugs. By one estimate this saves $9 billion over 10 years. The Democratic proposals from the Energy and Commerce Committee would authorize the Health and Human Services Secretary to negotiate prescription drug prices for Medicare benificiaries. The agreement and consensus among the conservative, liberal and centrist Democrats, and Democrats with ties and connections to the health care industry was reached after intensive negotiations, and adoption of a package of amendments that helped bridge the differences they had. ...

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Feldstein says that for the 85% of the people who have healthcare the Obama proposals are not a good deal. The Obama proposals mean higher taxes in the long run to pay for the $1 trillion cost of healthcare for the uninsured group over 10 years. This lower income group has no coverage despite the $300 billion Medicaid program. Feldstein says there surely must be better and less costly ways of getting this lowincome group healthcare. Raising the top income tax rate to 45% from 35%- as a result of letting the Bush tax cuts expire and adding aproposed health surcharge on higher income individuals- would actually lower revenues for the government, as it would change behavior of high income individuals in ways that lower their taxable inome. The result is higher deficits and higher taxes when even without this large deficits are projected for the future. How to slow the rapid growth in healthcare spending? The Obama plan is to cut spending on Medicare. Feldstein sees the govenment's effort aimed at reducing the amount of medical services, as reduced spending comes from fewer services, not reduced payments to providers. Will this result in enough of acost reduction to make the system work. And if the cost reductions are too heavily weighted towards reduced services and not reduced payments to providers would this result in large cuts to services to affect the quality of healthcare for the 85% who are accustomed to a different pattern of healthcare, even though it is structured to allow cost escalation. Feldstein offers no solutions to the problems of cost escalation except to suggest that the Obama plan does not really tackle the cost escalation issues directly with providers, and instead burdens the national finances to an extraordinary degree. And the need for apause and reflection....

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How diagnostic tests in portable toolskits, that patients can use themselves, are being developed at low cost in developing countries like China. This creates the kind of care appropriate for poor countries, where patients need something they can afford, and something that does not require repeat visits to doctors offices or clinics. Ustar Biotechnologies is a Chinese startup, that says it has the technology, costs that the founder says "no one can compete with," and affordable prices for poor countries. The sales of such diagnostic test portable devices or kits is expected to soar in coming years. Quimin You, the inventor and founder of Ustar, graduated in North America and worked with multinationals. His proposals for cheap diagnostic technologies were turned down by multinationals, who in their narrow focus saw these thechnologies undermining their existing products. Now Qimin is back in China with a startup that will do this.

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The Economist cites the Dartmouth Atlas Project which shows differences in cost across the country for health outcomes and spending involving Medicare. It cost $5000 per person in Salem, Oregon in 2006, $8000 in San Francisco, and more than $16,000 in Miami, with outcomes for health tending to be better in places where the costs were lower. This is one of the statistics that Peter Orszag of the Congressional Budget Office uses to come up with his estimate of 30% waste in health care spending in the United States. Prof. Skinner at Dartmouth and Prof. Garber at Stanford point out that of most health systems around the world the American system is "uniquely inefficient" and wasteful. The Economist cites information that the American system is twice as costly per person for healthcare than the Swedish system, and that it costs twice as much in Minnesota as in Miami. A poll done for the Economist shows 52% of the people in the UA are dissatified with the quality of care, 40% think the system needs fundamental change, and 29% think that it should be fundamentally rebuilt. The lack of uniform coverage is also causing turmoil in the system. About 49 million are uninsured, and a quarter or more are able to buy insurance and do not buy it because it is so costly, has exclusions and coverage is inadequate. But these people also end up in the emergency rooms along with the indigent costing the whole system tens of billion of dollars for costly late interventions that could have been avoided with preventive care early on. With the economic crisis and rise in joblessness, the dire condition of state and local budgets, the situation has probably drastically worsened, and the system near breakdown. ...

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Davey and Walsh tell the story of years of mismanagement in a city that lacked proper record keeping to keep track of costs. A municipal auditor brought in a financial consultant as far back as 2005. He found an additional $7.2 billion in retiree health costs that had never been taken into account. That warning was ignored. All the time the city was losing jobs with mismanagement at the auto companies and lack of labor-management cooperation. The Kilpatrick years as Mayor were largely wasted as problems piled up. The city was unable to borrow, and its revenue base was continually shrinking. Under Mayor Bing the city had a hard time meeting payroll. Other cities had faced financial crisis before, New York in 1975. Detroit was different in that two of the three major auto companies went into bankruptcy followed by the city itself facing bankruptcy, with mismanagement of finances and lack of a good plan for the city and the auto industry that brought everyone together behind a single goal of regeneration. ...

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The influence of lobbyist on members of Congress just as the Obama administration, having studied the failure of the Clinton submitted healthcare plan try a different strategy of letting Congress come up with a healtcare plan. $133 million was spent in the second quarter alone by healthcare industry lobby interests creating headaches for reform efforts and the Obama administration.

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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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How companies like United Health are lobbying aggressively to shape the new helathcare legislation to their benefit. BW says the health insurers like United Health, Aetna and Wellpoint are already winning through clever and effective lobbying of Congress. Former Senator Tom Daschle works as aconsultant for United Health. Senator Conrad who has led aeffort to replace the public plan with nonprofit medical cooperatives, which would be a weaker competitive threat to insurers, is also influened by the insurers. United Health's CEO Helmsley and its person working with Congress on healthcare Simon Stevens met with Conrad on June 4. When lawmakers in Congress cite consulting group Lewin Group, that 88 million or 56% of those with employer provided coverage would desert private insurance for a government run program, they are quoting acompany owned by United Health. The Congressional Budget Ofice says these numbers are too high. United Health has used savy presentations on how to cut costs, and help Blue Dog and other Democrats articulate their positions, to gain influence in shaping the plan to their interests. United Health thus counts a lot with Matheson, and Mike Ross of Arkansas, who are prominent with the 52 Blue Dog Democrats. and with Senator Mark Warner of Virginia. And United Health put together an effective lobbbying group, even hiring the chief of staff of House Democratic leader Steny Hoyer. ...

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This report in the WSJ on a Gallup study with 87,000 interviews points to Trump supporters being affected more by racial isolation and cultural anxiety, health prospect anxiety,  than merely by being working class or in lower income groups affected by the shift in manufacturing jobs overseas. The report confirms previous observations that these Trump supporters are more likely to be whites without bachelors degrees. The information does'nt show that they face abnormally high degree of economic distress as those who have lost jobs in this recession, as they are shown to be less likely to be unemployed, more likely to be self-employed. The Gallup study does not show areas more adversely impacted by trade competition to have higher support for Trump. This is a critical finding.  An interesting finding is that Trump supporters are more likely to live in areas with higher mortality rates and poorer health outcomes, higher obesity rates, and lower rates of intergenerational mobility. This combines with living in much higher rates of being surrounded by whites, whiter and more racially isolated. The finding is that they have high cultural and economic anxiety from not finding their well being and prospects for children meet expectations. This may also explain the tendency not to be able to reason out possible outcomes based on policies of each candidate, less openness and more inward looking behaviours.   ...

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Details of the $825 billion stimulus plan. Renewable energy does well under the plan including production tax credit for renewables, with $32 billion for a "smart" electrical grid for which GE makes components and lobbied for. Renewable energy producers win an extension of production tax credits now convertible into cash for companies whose losses leave them unable to use the credits. Transportation infrastructure green projects did not do so well, with $32 billion for transportation projects and only $10 billion for mass transit projects.The Natural Resources Defense Council had compiled a list of more than 80 environmentally friendly infrastructure and transportation projects worth about $405 billion. Only a small number of these projects made it. What is in the stimulus to create jobs and stimulate capital investment? Businesses get bonus depreciation, which speeds up depreciation deductions for companies that invest in plant and equipment. The stimulus doubles the amount small businesses can immediately write off for capital investments and purchasing new eqipment, and gives incentives for businesses to invest in renewable energy. States get help with $90 billion going to increase the federal share of Medicaid payments, and an additional $79 billion to help states avoid cutbacks in education and other services. And there is a "Make Work Pay" tax credit for $500 per worer and $1000 per couple. Experts say the effects of the stimulus will be felt in the latter part of 2009 and into 2010. Which is one reason the view of economists that there would be a second half recovery does not reflect conditions on the ground. Goldman has revised its view to 2010 and even that may be optimistic. One example of what has happened in the stimulus in this respect is that the earlier optimistic view of largeinvestments in science and technology, broadband networks, and transportation projects for fast rail and transit have all been trimmed down. Part of the reason may be that the bill for the nation's banking system revival may be larger than realized as an additional amount of $15-20 billion is being negotiated for Bank of America and more money will go to Citigroup. $6 billion is shown for highspeed internet access for rural and underserved areas. Science facilities get $10 billion. Repair of public infrastructure (read roads and bridges) gets $31 billion. School modernization gets $21 billion. And modernization of health information technology systems gets $20 billion which its hoped will provide equivalent or higher returns to pay for some of the universal health care costs, and preventative care gets $4 billion. There is a tax credit for R&D work on energy innovations and renewable energy production of $20 billion, and $32 billion for a "smart electricity grid." These are the proactive parts of the stimulus that create something new and make improvements. They add up to $144 billion. So much money goes to shore up the existing services and supplement incomes, and to relieve stresses on the banking system, and other ways to shore up the system, that the proactive expenditures are only a small fraction or 17% of the $825 billion stimulus. And all the time the federal deficit and debt increases with these huge outlays just to shore up the system. The Heritage Foundation Data Analysis Director Mr. Beach told Congressmen at a discussion chaired by Congressman Cantor (R), on January 16, 2009, that the federal debt would reach 92% of the nation's GDP in 2009 from 58 billion or 70% in 2008, with the $825 billion for stimulus. The federal deficit would go up to $1.31 trillion or 9.2% of GDP up from $541 billion in 2008. See the research paper on the Heritage website. ...

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The discussion on whether it is feasible to achieve any significant cost savings as long as middle class consumers are not cost conscious about their employer provided health insurance. This would be so as long as their health insurance benefits are not taxed as income. America suffers from a particularly strong case of not minding the price increases imposed by the health care industry as long as its not out of pocket cost. But Obama seems stuck on his insistence that the middle class not take on any burden, that there be no middle class tax in the form of this tax on health care benefits. Critics say even FDR did this by having the middle class pay with payroll contributions for Medicare and Social Security. And even if the 5% of Americans who make more than $280,000 are taxed it will not generate by itself the money to pay for the $1 trillion cost of the plan, as the prospects of cost reduction are uncertain- especially when the basic nature of America's health care system are not changed, like the lack of cost consciousness of consumers of health care when its perceived to be free and employer provided....

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China's Finance Ministry is having a difficult time controlling local governments using local government financing vehicles to invest in more infrastructure, airports roads and subways. One such city is Wuhan which plans six subway lines, three bridges over the Yangste river and a new airport. Much of the money comes from land sales. The Finance Ministry in a 2013 report pointed to the unreliability of land sales for future borrowing as the property market is slowing, and because it is highly unpopular to requisition land for land sales. This matters because the IMF says debt is growing faster in China than when Japan, South Korea and the U.S. fell into deep recessions at different times between the late 1980's and 2009. Local government debt accounts for one fourth of the increase in China's domestic debt since 2008. New rules by China's bond agency in Dec. 2014 prevents investors from using low grade debt to borrow cash. In the past local governments found a way around the central governments effort to curb growth of debt by restructuring the local government vehicles or some other way, as Wuhan has done. Wuhan Urban is the local government financing vehicle for Wuhan and its debt increased by 20% in 2013. Wuhan's mayor, Tang Liangzhi, is pushing construction to the point where he is known as Mr. Dig, Dig. One reason for China's slowing growth below 6-7% is the need to control the growth of debt. Local government debt in China reached 36% of GDP in 2013, double the figure in 2008, and will increase to 52% of GDP in 2019, according to the IMF. And the increase is not proportionally delivering the same results as before. JP Morgan estimates that over 4 units of borrowing are needed in 2015 for every unit of investment, compared to less than 2 units of borrowing for every unit of investment in 2007. PRC Macro Advisors of Hong Kong says half of the borrowing by financing vehicles goes to pay interest on existing debt in 2014. There are 8000 such local government financing vehicles in China today each competing to build infrastructure in its neighborhood, in the case of Wuhan to build a computing back office for financial companies and as transportation hub, even though its uncertain whether this will be realized or not. The problem is that alternative investments as an opportunity cost are being neglected, the hospital not being built as China's population ages with underinvestment in health care, and the private company with better returns that is unable to find financing. A classic example of crowding out of better return investments as a glut of housing and road/bridge/ airport infrastructure gets built. The central government is wary but faced with slowing growth pushes problems down the road, what experts call a Japan syndrome....

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Providing health insurance to the roughly 50 million people that are uninsured costs some $120 billion ayear. This will hae to be paid for through limiting the tax deduction on employer provided health insurance (something Obama campaigned against), or cost reduction in the bloated cost structure for health care in the country. But the same health care providers who committed to cost reduction in arecent conference at the White House are lobbying against some measures that reduce cost.

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Questions being addressed to get health care to the uninsured and to all Americans at an affordable level.

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Areas in which David Cameron shares the same thinking as Barrack Obama are generating green technology jobs, the importance of the voluntary sector and families all doing their bit so that its not just government that will be doing things. "That society should bring about change, not just government." He diagrees with Obama on the Stimulus and believes that the situation in Britain with the government borrowing 10% of national output already makes it difficult to have an extra discretionary stimulus without people losing confidence in then nation's finances. He makes some other points. Britain needs amore balanced economy so that it is not so reliant on financial services. And in Europe as awhole he says its important to deal with the huge dependence on welfare which is a drag on the economies of Europe. This has to be seen in the light of the huge emphasis placed by recent Labor governments on rebuilding the health and human serivces and infrastructure of Britain. In this crisis the social safety net provided by these services may be the reason that asmaller stimulus is needed in Europe. He talks of capitalism with a conscience, where markets are amean not an end to themselves and morality, ethics and asense of values are brough to bear at every turn. ...

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A detailed look and appraisal of the Tata's achievement and the vision and plans of Ratan Tata. See the Creation of Wealth a book about the Tata family and the epilogue written by Ratan Tata. And Conversations with Tata about Ratan's father Jamshedji Tata. Some of the achievements are the restructuring of Tata Steel, the acquisition of Corus, the Tata Motors Indica car and the first 1 lakh ruppee car the Nano a Ratna Tata vision coming true, the growth of Tata Consultancy in the software industry, the entry into retail, telecom, biotech, solar, and others, all meant to put Tata at the forefront of India's industrial development and to bring millions of Indians into the market economy. A lot of foresight is built into this, and now Tata believes in setting bigger goals following the example of China knowing that as India grows it will grow into Tata's larger projects. The Nano especially makes it possible to put a car in the reach of India's millions and by this way helping build a large auto manufacturing industry in India for the first time, and enlarging a number of other industries like steel. And Ratan Tata is not content with what tata achieved with the Nano, he wants Tata to reinvent the auto business. In the process of doing all this Tata has kept to its roots which is a strong social committment and a ethical foundation. Even the Jamshedpur Tata Steel restructuring was done by keeping the committments to education, health care etc for Jamshedpur. Tata is owned 66% by a charitable foundation and the ownership and management structure is designed such that even though the Tata family owns only 3% of the shares Ratan Tata manages the direction, goals and progress of the diverse companies which are independently run through management groups that oversee the companies. These management overseeing structures are the holding companies Tata Sons and Tata Industries staffs, and the Group Corporate Office headed by Ratan Tata and which has 9 senior executives who sit on the boards of the companies and act as mentors, nentoring managers and supporting corporate social responsibility values. ...

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Questions about the true cost of the Obama health care legislation and the assumption that the legislation cuts the deficit by billions of dollars. This WSJ editorial says one has to look at this closely, and not merely look at CBO projections, which may be based in a certain context and not reflect the true costs, especially because many accounting gimmicks and use of numbers to present a particular picture is taking place. The information this editorial cites is that: it uses 10 years of taxes to fund six years of subsidies, Social Security and Medicare revenues are double-counted to the tune of $398 billion, a new program funding long-tem care frontloads taxes but backloads spending, and the assumption of an automatic 25% cut to physician payments that Congress is unwilling to authorize. Rep. Rand Paul has tried to present an alternative view which needs to be studied just as closely, because of the enormous impact of a jump in spending at a time when the public finances are fragile. WSJ also cites the work of Richard Foster, the chief Medicare actuary, as an alternate perspective of how things could turn out, Doug Holtz-Eakin, and Eugene Steuerle. It calls for common sense in evaluating programs, entitlements, defense or other government spending. They not only cost money, but costs escalate over time as history has shown over decades, till they eventually are discovered to be not affordable unless the middle class is willing to dig deeper into its finances to pay for them. Alternate perspectives from a range of informed opinion, Howard Dean, Martin Feldstein, and the head of Harvard's Medical School show that the issue needs to be looked at closely and carefully and cannot be something in which CBO numbers can be trusted to tell the whole story. Especially when common sense, history, and informed opinion across a spectrum of thought advises caution, and fragile public finances also suggest caution. Howard Dean, former Governor of Vermont, says the health care bill is not real reform, and may do more harm than good. He says in a Washington Post article, December 17, 2009, the Obama health care bill does not insert competition into insurance markets, does not significantly reduce costs, and does not improve the delivery and use of health services. It was he says done with a political calculus and crafted for votes not real reform. Jeffrey S. Flier, Dean of the Harvard Medical School, gave the Obama health reform bill an "F" grade, saying in a Nov 18, 2009, WSJ article, that it was disingenuous to call this reform, Congress and the White House were simply deceiving the public. He said the bill will accelerate US health care spending, postpone most of the major health care problems, expecially the ones that drive cost, including the "fee for service" system and delivery of health care. He says in his discussions with economists and other health care leaders the opinion was unanimous that the bill will accelerate health care spending. He cites Massachusetts as an example, where access to care was expanded under the same dysfunctional system, and spending went up, and it doesn't work. Feldstein, who in early 2008 suggested proactive solutions to the mortgage debt crisis which were never adopted, says that the Obama health care law means higher taxes in the long run to pay for the $1 trillion cost of health care for the uninsured group over 10 years. Feldstein says that the Obama plan is to cut Medicare to cut spending, and will reduce the amount of medical services, as reduced spending comes from fewer services, not reducing payments to providers. And he asks if the cost reductions are weighted too heavily towards reduced services and not reduced payments to providers ,would this result in large cuts to services to affect the quality of healthcare for the 85% of the American people who are accustomed to a different pattern of healthcare. ...

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Pearlstein points to the need for the structural changes in the U.S., Europe and China to address the serious imbalances that are at the root of the problem. This process will be painful and mean a short term drag on the economy even if the right actions are taken. The process of unwinding the imbalances will take time. Lower growth in China will be good for the bubble in real estate markets and the reduction in the trade surplus, even though this will reduce imports of European and U.S. machinery. Higher savings in the U.S. and reduction of consumer debt will slow retail sales but this is healthy for longer term growth. The same is true for savings in deficit reduction that will result in more layoffs at the local level. The government needs to have similiar action take place at the banks to end their "extend and pretend" practices and finally write off bad loans in residential and commercial real estate. There is no easy way out, no solutions that can be made without a sharing of the pain. Policy makers around the world have tried to look for painless solutions for years and this may be the end of the road. There is some action that the governments and central banks can take. Pearlstein suggests that the European Central Bank buy up some of the sovereign bonds being dumped on the market even if it means printing money. The Fed, the Bank of Japan and the central bank of China can also swap some of the Treasuries they own for European sovereign bonds. This would give time for the EU leaders to give the European Financial Stability Facility the resources and powers to replace the sovereign bonds with more reliable European bonds. The Fed can take this opportunity to sell some of its huge pile of Treasury bills into the market so that it has more room for action in future years. The U.S. government can move up the spending for infrastructure in years 8, 9, and 10 to the next 2-3 years to give some support to the economy as these changes take place. The spending decisions should be left to an independent Infrastructure Bank. See the related article by Krauthammer in the Washington Post, August 5, 2011, which provides a companion policy prescription for U.S. deficit reduction based on the work done by the Bowles-Simpson Commission and by preserving efficiency and fairness....

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With 5.7 million jobs lost since December 2007 fewer people are paying payroll taxes to support Medicare and Social Security says Labor Secretary Solis. As aresult Medicare will run out of funds by 2017, 2 years earlier than predicted last year. Medicare and Social Security issued their annual report yesterday, suggesting the nation cannot afford the cost of Medicare at the rate of current expenditure growth. Social Security will run out of money by 2037 four years earlier than predicited before. The only way to keep Medicare solvent says Mr Geithner is to reduce the rate of growth of health care costs.

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Unemployment in the U.S. will be hard to bring down with the mismatch in skills for new jobs created. The National Skills Coalition, which works to promote job training, says in a report that 46% of the jobs in New York state in 2009 were in the middle skills category, and only 39% of New York workers had the skills for these jobs. Mid-skilled workers are workers with a high school diploma and training, an associates degree or vocational training. The problem is that students from public schools and community colleges who are not prepared with mid-skills and training, or lack a two year degree, are not prepared for these mid-skilled jobs in health care, transportation and other fields. This report says 40% of new jobs created in New York state will be for mid-skilled workers. In the low skilled workers category there is downward pressure on wages because there are more workers than jobs- 21% of new jobs are low-skilled and 23% of New York workers are low-skilled, according to the report. The problem is serious because funding for training programs has been cut over the years, and at the same time government policy- including that of the Obama administration- has focussed on getting people to college. Less attention has gone to training programs and vocational education. This at a time when a college education has become costly and difficult for families....