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With the rushed approach adopted by the Trump administration not enough consideration was given to winning support in the House from 25 conservatives in the Freedom Caucus. Without their support the bill cannot be passed in the House of Representatives. The fight also includes one over what are essential health benefits including whether  maternity care would be included. As a result some moderate Republicans are also expressing opposition on the grounds that less people will be covered and fewer benefits will be provided under the Republican House plan called AHCA. President Trump has not involved himself in the details, and the bill comes very early in the first 100 days, leading to the perception that health care has become a partisan conflict without really grappling with the problems of high cost of health care and creating a solution that all can support. Democrats are seen as having made the same error early in Obama administration's first term. President Trump sees this as a much needed win with a drop in his approval ratings, making this even less of an effort to come out with a good plan.  ...

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Obama's politics of consensus face a test as some of the issues before the country require strong leadership in the face of competing interests, intense lobbying, and politics as usual. Wavering support from supporters during the primaries, as leadership is delegated to Congress heavily influenced by lobbying on healthcare. And loss of support from the centre and independents who are unconvinced by the lack of clear direction and the tendency for the debate to be carried by competing interests. These independents are also concerned about the costs of a not well thought out plan influenced too much by rival interests.

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The House healthcare bill that just passed by amargin of 220 to 215. The cost would be $1.055 trillion over 10 years, with cost of $894 billion factoring in penalties for individuals and businesses that don't buy insurance. Adding increased coverage for Medicare prescirption drug coverage for seniors its around $1.2 trillion. $460 billion is from new taxes on single people with income of over $500,000 or couples with inocme of $1 million. There are $400 billion in cuts to Medicare and Medicaid, and additional money coming from penalties for not buying insurance. First column here is Senate version, second for House version and third President's version. Other features individuals must have insurance or pay afee of 2.5% of income, hardhip waivers will be available. Employers must provide insurance to employees or pay a penalty of 8% of payroll. Small businesses with fewer than 10 workers get tax credits. The threshhold is $500,000 of payroll. To help families with lower incomes and the poor the bill provides: families earning $29,000 a year pay no more than 1.5% of income for premiums. Families with incomes of $88,000 ayear would pay no more than 12% of income for premiums. ...

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Gerry Adams of Sinn Fein in Northern Ireland says in the NYT that some way has to be found to respect the vote of 55% in Northern Ireland in favor of remaining in the European Union. He says Northern Ireland and Scotland should not be made to leave the EU because of a different preference expressed in England and Wales. He points to one of the most harmful effects of the Brexit i- the return to a hard  border between the EU state of Ireland and Northern Ireland. This will affect the economic, healthcare, tourism, business and cultural links of Ireland in the north and south, and reverses the gains of the 1998 Good Friday Agreement. He calls it a result of factional infighting in the Tory party, the rise of far right anti immigrant groups such as UKIP, and the Gove faction which never really supported the peace deal in Ireland that has brought two decades of peace. Adams says concurrent referendums for a united Ireland is one solution to this problem. Another is an All Ireland forum of political parties and civic partners to meet, and for the Irish Government to stand behind the Good Friday Agreement, so that the Brexit does not hurt the interests of Ireland as a whole. ...

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A study by AARP of 514 brand name and generic drugs between 2005 and 2009, shows that generic drug prices went down an average of 31% during this period, and brand name drug prices went up by 41%. One of the authors of the report says that it is important to look at individual drug prices and not studies showing total spending on drugs, because this is a significant cost for people paying out-of-pocket, It drives up insurance premiums, and pushes retirees into coverage gaps in Medicare Part D drug program. Analysts indicate pharmaceutical companies are increasing prices on drugs before patent expiration to get as much profit before the patents expire.

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This is an exceptionally humorous operating room story of Dr. Trump and Dr. McConnell by Kristof of the NYT. Sometimes humor tells the story- and Kristof does this using a story of a surgeon president Trump in the operating Room trying to address the concerns of the patient Janet, as he keeps telling her she needs a new heart with great benefits, great benefits, before she implodes or goes down failing. Flat out take the old heart out even if a replacement hasn't been found, believe me great benefits the surgeon tells her, just that the patient just isn't getting convinced as its happening to her. The analogy is with replacing a health care plan, not just the Obama plan, any plan without something to take its place. For a few days before this article by Kristof, the Republican effort to repeal the Affordable Care Act without having a replacement was presented as a good idea. Janet is like the three Republican women- Collins of Maine, Capito of West Virginia, and Murkowski of Alaska who wanted to keep the heart they had till a replacement was found, against the surgeon Trump's advice. In a way it is about politicians in the last decade who never had any discussions as they rushed through with their own agendas, as the Republican and Democratic health care plans were rushed through Congress with relatively little participation and debate to hear all viewpoints. ...

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NYT reporter Neuman takes a17 hour road trip across the island of Cuba in a 1956 Ford Fairlane. He heads west from Havana near the west end of the island to Guantanamo on the east end. He sees a changing Cuba with houses for sale, little sign of ideological signs in the countryside, old cars, oxcarts, horsecarts, a Cuba that looked like it was stuck in the past. In the five years that Raul Castro took over from Fidel Castro, money and business have gradually taken the place of politics. The average salary of $20 a month is not enough for most workers even with free healthcare and education, and most people dream of making more money to enjoy a better life. Many rely on relatives abroad for additional funds, or buying and selling on the black market, or a second job.

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The $350 billon in proposed cuts to Medicare and Medicaid in the 2011 deficit reduction talks will do little to reduce the rapid rise in medical costs. Instead it shifts the costs to seniors, state governments and public hospitals. Gail Wilensky, former head of Medicare under the first President Bush and now a senior fellow at Project Hope, says this should not be confused with real reform to Medicare which reduces the rapid increase in costs. It does little in the way of fundamental changes that would reduce the growth in costs. About $53 billion comes from reductions to senior's ability to buy extra Medicare supplemental insurance or Medigap. Another $14-26 billion would have the government reduce payments to hospitals for unpaid debt. The few items to curtail fraud in the use of CT scans or purchase of power wheelchairs would provide savings of $2-3 billion over 10 years. $4 billion comes from lowering Medicaid payments to hospitals treating a high percentage of low income patients, hospitals such as Cook County Hospital in Chicago, San Francisco General Hospital, and Parkland Hospital in Dallas....

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A advisor to U.S. president Obama lists the gains in U.S. healthcare made by March 2014, after the passing of the Affordable Care Act or Obama healthcare law. He cites on access to care the reduction of the percentage of uninsured Americans from 18% in the middle of 2013 to 15.9% in the first quarter of 2014, according to a Gallup poll.

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A report by pharmacy benefits managing company Express Scripts shows a 13% increase in the price of branded drugs in the U.S. from Sept 2011 to Sept 2012. Generic drug prices declined by 22% in this period. The report also shows that growing spending on specialty drugs for cancer, MS and other diseases is a big reason for the increase in prices of branded drugs. This report is from a random sample of six millon Express Scripts members using prescription drug coverage. Prof. Schondelmeyer of the University of Minnesota, who manages the drug benefits program at the university and conducts a similiar price report for AARP, says the potential benefits for these specialty drugs are not that good to justify the high prices.

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In Brazil's 2018 elections most candidates talk about shoring up crumbling infrastructure, and law and order. Yet no one talks about the budget crisis as there is no money left for doing this.  Shocking as this may sound after years of overspending and a recession, Brazil now uses borrowed money to pay pensions and salaries, and keep schools and hospitals open. Brazil's public spending exceeds revenue by about 7% of annual economic output. Taxes are already 40% of economic output, according to CIA's World Factbook website, making it hard to raise taxes.  This WSJ analysis says you cannot overstate the problem in Brazil as about two thirds of the budget goes to paying old age pensions, payroll of public sector and public healthcare. By 2020 these liablilities will grow to the point there is nothing left for discretionary spending such as roads, infrastructure, new hospitals, police equipment. Trimming pensions and freezing wages are likely options to tackle the problem. Still this leaves Brazil with the prospect of a lost decade.   Neighboring Argentina is experiencing a contracting economy and had to turn to the IMF for assistance.  The decline in GDP comes as a new conservative administration took over promising an improvement in the economy. The peso declined by 18% in 2018 so far leaving Argentina's public and private debt of $166 billion which is 80% denominated in U.S. dollars much harder to pay off. The stronger dollar has hurt Argentina leading to a $50 billion support agreement with the IMF.  Much of Latin America is now in an economic crisis. ...

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Generic version of Zocor by Merck to reduce bad cholesterol is now available and can substitute for Lipitor which costs $2 to $3 per day. This generic can be bought at Costco at 10 cents per day. Generics can have a huge impact on cost for patients and for the country's medical bill and for affordable health care its very important to achieve affordable health care.

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U.S. health insurance company WellPoint Inc. will offer higher payments to primary care physicians. This is part of new strategy to reduce emergency room visits and costs after deterioration in a patients condition by relying on primary care physicians for better care at the outset. Payments to primary care physicians will be increased by 10%, with higher payments when the results show better quality and preventive care. WellPoint has a network of 100,000 primary care doctors. Physicians who meet certain goals such as lowering the overall cost of a patient's health care costs will be given an incentive of 20-30% of the savings realized. The new effort will add 1-2 percentage points to the 6-8% of the $100 billion that Wellpoint pays for claims processed each year. WellPoint's management sees a reduction in medical costs of about 20% by 2015 as a result of such efforts.

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Most people would not guess or recognize that this place where elderly people in society were treated shabbily is a country in northern Europe, and a country where citizens pay high taxes for precisely better healthcare across different age groups. Sweden is where about half of the 6000 people dead from coronavirus were elderly people.  Over the last two decades Sweden has cut hospital capacity and discouraged elderly people from entering hospitals during the early period of the pandemic, says this report in the NYT. The for profit nursing homes in the centre of Stockholm were unable to cope. Having turned the work in these homes to low wage workers, it put these workers and the elderly at risk with lack of staff, lack of adequate PPE oreven  basic masks, says this report in NYT.  One of the lessons of this pandemic is the failure not just in turning over manufacturing of health care equipment and pharmaceuticals to China, but also turning over the basic care of elderly to for profit institutions that were totally unprepared and could not give elderly the dignity and care they deserve. Year of cuts to public services and health services now showed in a glaring way what can happen when this is done. It has lessons for countries from Europe to North America, and to Latin America, India and other Asian countries as they redesign policy and allocate resources to public services in the next 10-20 years. ...

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Martin Caparros describes the deadlock in Spain with no two parties on the right Ciudadanos and Partido Popular, and on the left, Podemos and the Socialist party, able to have enough seats i parliament to form a government. An agreement between Ciudadanos and Partido Popular of prime minister Mariano Rajoy, has brought the 2 parties close to 170, 6 short of a majority in the 350 member parliament. New elections will have to be held for the third time in December 2016 as a result of this impasse. The two main parties in Spain the Partido Popular and the Socialist party, alternated in forming a government during the period since the restoration of democrati government after Franco's dictatorship. Following the deep recession in Spain since 2012 two new parties have been formed Podemos on the left, and Ciudadanos a centre right party. Both parties are critical of corruption, and the cuts in spending for education and healthcare following the financial crisis in Spain and bailouts by the European Union. Caparros describes the cynicism that voters express about not just the two main parties, but also for Podemos and Ciudadanos, as voters voice their rejection of politicians and parties on the left and the right. A similiar process is taking place in other countries, in Britain most recently with Brexit and the departure of prime minister Cameron. In the U.S. with the Sanders and Trump movements, and the Beppe Grillo movement in Italy.  ...

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Under Mette Frederiksen immigration which reached 21,000 in 2015 was down to a little over 1000 a year. She is a strong fighter for workers and families and labor rights and yet tough on illegal immigration. She has been proven right about this as Britain and the US under Biden are seeing illegal immigration as a threat to workers and labour, are seeing the risks of distraction from illegal immigration doing a serious disservice to workers and families by making it hard to fight for workers and families on wages, cost of living and other issues.  Even with a strong record of fighting for workers and families, Frederiksen was one of the first European leaders to see the dangers of illegal immigration to society. It gave parts of the political spectrum that had no interest all along in workers and families doing well, an issue to run on that would come to cause grave harm to workers and families. This turned out to be the error of Angela Merkel a CDU leader brought up in Communist East Germany, who had no idea of the risks of her approach for open immigration. As Merkel let this chapter unfold it created fissures in Europe, with Tories and Nigel Farage taking Britain out of the EU and laying waste to its economy for 5 years till Labour's Starmer adopted a tough immigration policy and became prime minister in 2024. That danger then spread to the US in 2016 which also suffered as Republicans and Trump did the same in the US around rhetoric but without serious action on immigration till the Lankford- Biden legislation.  That bill would have closed the border with Mexico and ended immigration as an issue forever if passed into law in December 2023, as Senator Lankford says would have happened. Ending immigration as an issue forever alongside foreign wars as an issue, so that a concentrated effort could be made on improving badly damaged lives of workers and families. And on rebuilding badly damaged manufacturing in the US, rebuilding collapsing infrastructure, and competing with better education and healthcare with the large Asian countries China, Japan/ South Korea, India. ...

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Amazon expands during the pandemic when retail on line delivery has helped people reduce trips to the grocery or retail stores. Amazon hired 427,000 people to expand its workforce to 1.2 million people by November 2020, 9 months into the pandemic. Almost doubling the employee workforce. These workers are mostly at warehouses, with some software engineers and hardware specialists. This includes hiring in India and Italy and is worldwide hiring. This does not include 100,000 temporary workers for the holidays, and 500,000 delivery drivers working for contractors.  Only hiring of 230,000 people by Walmart about 2 decades a ago in one year comes close. Walmart hired 180,000 people during the pandemic. Walmart has 2.2 million employees. With the expansion underway Amazon looks to become the largest private employer in the world in 2 years, say experts.  Amazon pay is $15 an hour after an increase of $2 recently. Its coronavirus safety practices have been upgraded after early criticism in April and May. Recent expansion in Italy and in India are also part of worldwide expansion after Walmart has pulled back from its worldwide expansion. This also shows how quickly major aspects of life are changing during the pandemic as some companies in online business are becoming more prominent than others. Target and Walmart have also increased in size. Best Buy has changed its focus with its conversion into a company that leads with personal service in online plus store hybrid retail and a focus on seniors and older people for healthcare service and product delivery. Companies are changing the way they run or getting a new life in remaking their business. This is also a time when other aspects of business such as social media are becoming evident. Subtle aspects such as reports of higher rates of mental depression through use of social media platforms. There is also the awareness that information technology companies in Silicon Valley generate most of their money in advertising and this advertising of $100 billion is only a small fraction of the $12 trillion U.S. economy. Should Silicon Valley based in California decide priorities on where capital allocation should go through the part it plays in moving startups based less on America's priorities than other considerations. Healthcare, education, cities, and infrastructure have not received funding they need and capital allocation by financial markets has failed the American people, as it has failed in Europe and other parts of the world for similar reasons. This has hit hard communities and people across the U.S. and Europe and also in Latin America, Africa and Asia, with the loss of manufacturing to China and other countries from the U.S. India and Europe. ...

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Allan Blakeney was health minister of the Canadian province of Saskatchewan, and later premier of the province. Blakeney, as health minister in premier Woodrow Lloyd's government expanded a program in 1962 to cover the costs of doctor provided medical care. Earlier in 1946, the Saskatchewan government of Tommy Douglas setup a program of universal insurance coverage for hospitalization. This program of universal healthcare was extended to all of Canada in 1966. He later headed the provincial New Democratic Party and was premier of Saskatchewan from 1971-1982. During this period he introduced a New Deal for People, which included a dental program for children, prescription drug program, subsidized housing and a guaranteed income supplement for the elderly poor.

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The State Budget Crisis Task Force is co-chaired by former Fed chairman Paul Volcker and Richard Ravitch, a former lieutenant governor of New York. The Report of the Task Force says rising pension expenses and healthcare costs for public sector employees and Medicaid costs are severely reducing the ability of states in the U.S. to fund essential infrastructure improvements, education for low income students and other services. The report said there were six major threats to the fiscal situation of states- including Medicaid spending, underfunding of retirement, "budgetary gimmicks" to address the short term needs, and uncertain tax revenues. Ravitch told a news conderence: "It will be a hell of a lot more expensive to deal with theses problems in five or ten years than to deal with them now." The report focussed on California, New York, New Jersey, Illinois, Virginia and Texas. It was funded by the foundation of Blackstone Group co-founder Peter Peterson, and George Soros's Open Society Foundation....

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The Congressional Budget Office analysis of the Republican healthcare plan advocated by Mr. McConnell, Senate Majority leader, is that it would add 22 million uninsured if implemented. That plan ran into opposition from Republican Senators Collins, Capito, Murkowski, Paul, and Moran, and lacked enough support in the Senate. All Democrats opposed it and with the thin majority Republicans were divided. By taking away some benefits given under the existing Affordable Care Act the plan hurt the elderly and low income people, making some Republicans listen to their constituents in home districts and not the Republican leadership. The NYT profiled two in particular who astonishingly in a sign of today's strange politics were the only ones publicly holding townhall type meetings to hear the views of people in their voting districts- Susan Collins of Maine and Jerry Moran of Kansas. Both senators were listening to rural communities and Moran stated his opposition with the words- "I am a product of rural Kansas." With it the nation takes a breather and the message goes out that it is best to listen first and then to seek middle ground, not do what both parties Democrats and Republicans did in 2009 and 2017- rush serious legislation through without support across party lines and without serious discussion.   ...

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Pemex (Petroleos Mexicanos) CEO Emilio Lozoya is fired and replaced by Gonzalez Anaya, a close friend of finance minister Videgaray, as the company experiences a liquidity crisis by Jan. 2016. Anaya is known for cost cutting as head of Mexico's government healthcare institute. This report in the WSJ cites a Pemex official who says at one point in Jan 2016 Pemex was down to $8 million in cash. Under Lozoya Pemex failed to introduce financial discipline ahead of collapsing oil prices. Anaya is expected to cut spending by 19% or $5.8 billion. Mexico's governemt made a capital injection into Pemex of $4.2 billion to pay debts to suppliers, and offered tax relief of $2.8 billion. Pemex output is down to 2.2 million barrels a day in March 2016, decline of 4.5%. Pemex cuts will come in putting off exploraion spending of $800 million in one field in the Gulf of Mexico and paying less to rent oil platforms.

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An average of major opinion polls compiled by Real Clear Politics website shows 50.5% of Americans opposed to the Obama U.S. health care law.