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Rep. Paul Ryan tells Bill Keller that his ideas on Medicare and Social Security are not "the last word" but a way to start an "adult conversation." Keller describes what a Romney administration might look like with Ryan, Dan Senor, and Glenn Hubbard.

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The recent appointment of fast food executive Andrew Puzder as Labor Secretary has caused great concern among union leaders. Puzder supports a $9 minimum wage compared to $15 supported by Democrats. Unions now represent 7% of the labor force, down from a high of 20% during Reagan's time when Reagan appointed a construction company executive as Labor Secretary and cut regulations.  Globalization has thinned the ranks of workers in unions. And the failure of Democratic administrations to stem the shift of factories overseas to China, Mexico and other places, as part of global supply chains focussed on cost, has weakened Democratic support among workers since the period of Bill Clinton. It eroded to the point where Obama won 65% of support among unions and Hillary Clinton won 56% in 2016. Interestingly the Republican Romney gained 33% versus 37% for Trump, showing voters were more inclined to move away from Democrats and only a smaller number willing to support Republicans, but the shift enough to give Republicans a win in 2016 for the presidency. The figures are from a Election Day survey of trade union AFL-CIO, and a larger proportion in midwestern states showed disaffection with policies from Clinton to Obama. In fact Obama spent years promoting another free trade agreement TPP that favored tech more than auto and older industries, just as Bill Clinton had promoted NAFTA, without giving thought to what this was doing to its worker base of support. A similar situation happened with Social Democrats in Germany as a SPD administration moved to the centre and handed Christian Democrats led by Merkel a win in parliamentary elections. As Democrats such as former Labor Secretary Reich, a professor at UC Berkeley who served under Bill Clinton, describe the problems of working class people their is less reflection on the impact of the changes from globalization and how Democrats handled or mishandled it, and more on the politics between the two parties.   ...

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John Carney of the WSJ looks at the financial transactions tax proposed by 2016 U.S. presidential candidate Bernie Sanders to pay for high college tution costs.

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Krauthammer quotes Congressional Budget Office Director, Elmendorf, who said "we don't estimate speeches," when Elmendorf was asked about President Obama's April 13 debt plan speech. President Obama has failed to come up with specific ideas for debt reduction and not taken up any position on debt reduction, including removing tax expenditures as recommended by the President's Bowles-Simpson Commission report. Krauthammer says the President is using the discussion on debt reduction and the debt talks as a way to move forward with his reelection campaign. This President Obama has done by not putting forward any new ideas of his own or backing the ideas of the Bowles -Simpson Commission, and by putting Republicans on the defensive for coming up with any new ideas which may be unpopular. He calls the President's February 2011 efforts on debt issues a farce, and the April 2011 efforts empty, lacking any substantial specifics.

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Obama's closest advisor, David Plouffe. Asked about Plouffe's influence in the Obama White House one aide says that Plouffe's imprint is on "everything." For the last 18 months Obama has kept the 2012 election in mind in his actions and kept a campaign focus, on the advice of Plouffe. George W. Bush's advisor, Karl Rove, does not see this positively, as he says it kept the president from governing. One issue on which there is considerable questioning is why President Obama did not support the recommendations of the president's Simpson-Bowles commission on deficit reduction. Though it remains conjecture, it may be because of Plouffe's and other election related advice that reducing deductions- or what are called tax expenditures- as suggested by Simpson-Bowles would be politically unpopular. If true this may be ways in which running for office long before the election date may affect necessary action in governing. The political calculations when allowed to go rampant can distort the needed actions of responsible governing, and lead to timidity, indecision and lack of leadership. ...

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Under the McConnell-Biden fiscal cliff deal of Jan. 1, 2013, $620 billion is raised for deficit reduction over 10 years. This is made up of $395 billion from raising the top marginal income tax rate to 39.6% from 35% for the top 1% of filers who make $450,000 for couples or 400,000 for singles. Raising the top rate on capital gains and dividends to 20% from 15% raises $55 billion. Limiting the personal exemption and itemized deductions on incomes over $250,000 is a key component as it raises $150 billion. This reduction of tax expenditures was recommended by Simpson-Bowles deficit commission and Republican advisor Martin Feldstein, with more money raised under their proposals than the current proposal which follows the Pease format. Under the Pease limits named after a Congressman who proposed this in the 1990's, 3% of the amount above the threshhold income is deducted from the total deductions. Feldstein's proposal limited deductions to 2% of adjusted gross income. Romney offered a plan to limit deductions to $25,000. Finally, increasing the estate tax to 40% from 35% raises $20 billion....

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As remedies for the $1.6 trillion federal budget deficit for 2010, which says Hubbard threatens to compromise Americas economic future, set agggressive targets for reducing discretionary spending limiting growth to 2%. Hubbard also wants to see 1% reduction in projected entitlement spending growth for Social Security and Medicare. This can be done progressively, he says, by lowering the growth in spending for middle and upper income households and strengthening the safey net for lower income people. And third he would have a broad based consumption tax to pay for added social spending. Hubbard was adviser to president George W. Bush and is Dean at Columbia Business School.

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Tyler Cowen, Professor of Economics at George Mason University, points out some basic truths about health care as it is practiced today in the USA, and healthcare spending as it stands today. He questions whether starting out with extra spending plans to provide coverage to all will help solve the basic problems facing American health care. Too many tests and diagnostic procedures used by doctors is not aproblem that will be solved by spending more money to cover everyone. And government taking on more spending to cover all will not address all the other major shortcomings of the American way of practicing medicine, like prescribing a battery of tests, that tend to drive up costs, to just mention one of the problems. And it will not address any of the shortcomings in the way Americans take care of their health, diet, exercize and healthy lifestyles. THese are critical to get good health outcomes for the people, and which combined with careful spending of dollars where it will provide the greatest benefit, is the only way the health care solutions can be found....

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Lower prices have boosted unit sales for Microsoft and Autodesk for Chinese operations. Autodesk now sells its software for about half the price in the USA. Autodesk saw a doubling of licenses in China to 300,000 after slashing prices. Microsoft sells Windows 7 Home Basic for 399 yuan or $59, a third of the price in the USA. By reducing margins, Microsoft makes up for it in volumes, says Microsoft's China CEO. IDC and Business Software Alliance estimate that 79% of the PC software installed in China in 2009 was pirated, down from 86% in 2005. Lower prices make Chinese buyers more willing to invest, and education helps to increase the value of using legitimate copies. China's PC market is expected to be 67 million units in 2010, behind 78 million in the USA, but software sales in China are only $5.8 billion, behind the US sales of $143.6 billion. This makes the potential for software sales large at the right prices.

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David Brooks says the Paul Ryan Budget proposal is a bold step forward that is badly needed in this debate on health care, even though it has some grave weaknesses which need to be corrected. It is a bold step forward because he says Democrats say they want no middle class tax increases, or are not willing to say what kinds of tax increases they support, and yet they believe the Medicare and Medicaid and Social Security programs are worth preserving. This is'nt based on reality. He cites the weaknesses, beginning with the one discussed in David Leonhardt's column in the New York Times on April 7, 2011. Too many Americans pay too little into Medicare taxes and expect to collect several hundred thousand dollars more in Medicare benefits. The example given in Leonhardt's column is from a study that shows 56 year olds with average earnings pay about $140,000 in dedicated Medicare taxes over a lifetime, and then go on to collect $430,000 in benefits. Middle class and affluent boomers can't get off paying their share like everybody else. Its just the right way for their children and the nation's children. Ryan's plan excludes older people reaching retirement in ten years. The other major weakness is that the cuts are too deep. Things like the Pell grants which Ryan proposes to cut back to 2008 levels need to be preserved, and more money has to go into science, education and research and early childhood education for the U.S. to be competitive with China and India. The Ryan proposal places cuts that would be required so that tax revenues need to be at 18% of GDP. The number where a larger consensus exists is for tax revenues at 20% of GDP (also supported by business and the Wall Street Journal's editorial columns). This would preserve programs that are most productive for the economic future of the U.S. Ryan's proposal lets the hope for reducing costs of medical care rest entirely on future retirees deciding how much medical care (tests, procedures etc) they consume through larger cost sharing. Yet a structure and framework is needed to manage these costs effectively, and some combination of incentives to retirees to control costs and an effective structural framework is needed. ...

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House Majority Leader Eric Cantor rejects the McConnell plan for raising the debt ceiling. Senate Minority Leader McConnell says on a conservative talk show- "all of a sudden we have co-ownership of a bad economy. That is very bad positioning going into an election." McConnell's plan is to shift the responsibility for raising the debt ceiling to President Obama, by separating debt reduction talks from debt ceiling talks. Cantor believes its best to push on with cutting back spending. Obama's response was to offer $1.7 trillion in spending cuts, at which point he expected Republicans to support tax increases, telling Cantor in negotiations "enough is enough." The McConnell plan is supported by Senate Majority Leader Harry Reid and Republicans in the Senate. The details of the plan are being are being worked out, with one strategy being to add to it the $1.5 trillion in spending cuts identified in bipartisan talks with Vice President Biden. Both sides are looking at this jockeying for advantage for the 2012 election. At one point in the talks with Cantor, Mr Obama is reported to have told him- "Eric, don't call my bluff. You know I'm going to take this to the American people." Cantor for his part, wants to limit the duration of the debt ceiling increase so that it would be a short term extension and would come up for a vote before the 2012 presidential election....

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Leonhardt points out a couple of problems with Paul Ryan's budget proposal for Medicare. He says Medicare recipients, with the exception of the very affluent, currently haven't paid enough for the benefits they receive. He cites a study that shows Medicare pays out several hundreds of thousands of dollars for the average retiree more than they ever paid in. Medicare funds go for hospital expenses, the rest for doctors bills come from general government revenues. Government borrowing increasing the national debt to unsustainable levels so that current retirees do not have to pay higher taxes, is simply shifting the burden to the next generation. He says the Ryan plan shields those who will retire in the next 10 years because they are a powerful voting bloc, making this more of a political calculation than a bold reform step, as this means younger people will have to bear a disproportionate share of the burden. The other part of Ryan's calculus is that it has proven extremely difficult to reduce the volume of medical care that is consumed in terms of tests, lack of preventive care leading to graver problems, and surgeries. Simply by shifting a larger share of the cost to future retirees this will have an effect on the volume of medical care consumed and put a lid on costs. This is something that needs to happen says Leonhardt, but at the same time all Americans need to share in the higher taxes that are necessary to fund Medicare, exempting 75 million Americans only creates an imbalance in contributions. The other problem with this is that the costs of this exempted group will postpone serious deficit reduction for ten years....

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Speaker Boehner and Republican's backup Plan B is for Bush tax cuts to be given to taxpayers with incomes below $1 million. President Obama and Democrats have proposed a revised figure of $400,000 from the earlier figure of $250,000.

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The skills to navigate different personalities and work patiently on the issues surrounding changes to the U.S. tax system of Rep. Dave Camp (MI), chairman of the U.S House of Representatives Ways and Means Committee, will be immensely useful in the effort to make changes to the U.S. tax system. Camp works well with fellow House Republican leaders Boehner, Ryan, Cantor, and his Democratic counterpart in the U.S. Senate Max Baucus. Camp is a good listener, refuses to engage in partisan criticism, and has the patience to work through difficult issues of achieving savings and keeping fairness in the the tax changes. Earlier efforts to achieve consensus in late 2011 failed, making it even more important to have leadership which can create productive debate and bridge the differences. The tax changes are part of the overall effort for U.S. economic recovery by reducing the deficit.

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Shiller points out that statistical models used by economists can't quantify the risk of a double-dip recession. Confidence indexes show gradual trends so they too are poor at picking up the dangers inherent in the increasing levels of uncertainty and the increasing vulnerability of confidence in the economy. The potential of sudden events in derailing confidence is great. He cites the 10 percent drop in the U.S. stock market on May 6, as one example. And the potential of the BP oil spill creating havoc for the Gulf economy is another such event. Shiller says his definition of a douple dip recession looks at the long term, and doesn't see the short term as a way to correctly read the economic situation. He sees a douple dip recession as a rise in unemployment to high levels, and becomes sticky after that, only nudged down insignificantly. Before unemployment can be brought down a second recession occurs, and there could be years in between. Shiller's Buy-on-Dips stock Market Confidence Index prepared since 1989 shows a steady decline in individual investor confidence since 2009....

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David Wessel points to some problems with the Paul Ryan budget proposal. Ryan's plan does not balance the budget till after 2030, and Congress would have to raise the debt ceiling each year till then. The changes to Medicare Ryan proposes would limit how much the government spends, but the savings from this do not come for a decade, as people expected to retire in the next 10 years will still have Medicare. Ryan's proposal shows how deep the cuts will have to be if deficit reduction is done without raising taxes. Pete Domenici and Alice Rivlin who developed a deficit reduction plan, said they were disappointed that the Ryan plan "fails to address the need for new revenue," which they consider crucial for truly tackling deficit reduction. The Obama budget failed to offer a comprehensive deficit reduction plan, leading to openness for new ideas. The health care delivery system in the U.S. needs to be efficient and costs need to come down. Ryan's proposal gives no idea where the efficiencies will come from. Would they come from competition between private insurers? How will escalating healthcare costs be controlled. Another consideration is that even with its problems Medicare is less costly to administer than private insurance. Everything depends on seniors shopping vigorously for the best premiums because risks and costs are borne by seniors, with the idea that this will somehow control escalating medical costs....

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Harold Meyerson poses some difficult questions for those who like Mitt Romney say America's choice is between the merit based society Romney sees and the "European social democratic vision." In Romney's words- "a merit-based opportunity society- an American-style society- where people earn their rewards based on their education, their work, their willingness to take risks and their dreams." Meyerson cites several studies to show that European societies today are more dynamic on several measures of performance than America's. In intergenerational mobility he cites a Brookings Institution study by Julia Isaacs, that shows incomes are three times more likely to remain the same in America compared to Denmark, Norway and Finland, and one and a half times more frequently than in Germany. Another measure evident from Germany's experience is the degree of union-company-government cooperation to worker retraining, corporate boards that have representatives of workers and management, the "kurzarbeit" program of retaining employees to smooth out impact of cyclical swings in the economy on workers and companies, and worker's willingness to show restraint on wages especially because management wages are not way out of line as in America. Meyerson reminds readers that the U.S. had a more merit based society in terms of upward intergenerational mobility, distribution of rewards of work between workers in manufacturing and service sectors and management, educational mobility with the G.I. bill, in the first 30 years after the Second World War. In a separate article in the Washington Post on Jan. 5, 2012, David Ignatius poses questions about the effects of globalization in shrivelling the middle class. The access to lower wage manufacturing in China, India, Mexico, and other countries, and lowering of wages in the U.S. to be competitive, was part of globalization. The two tier wage structure in the U.S. automobile industry is one example, making middle class wages a thing of the past. Globalization opened up new markets for American companies. Yet many of the gains in employment were made in emerging markets, as the example of GM's expansion in China showed, with automobile manufacturing expansion inside China....

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Parallels between the Taft, Theodore Roosevelt and Woodrow Wilson election campaigns of 1910 and 1912, and the campaigns of 2010 and 2012, drawn by a T.R. biographer. He points to a tumultuous period ahead as lobbyists, outside interests, and the political parties and their supporters battle it out to set the direction of the country.

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Bowles and Simpson call for deficit savings along the lines they suggested as co-chairmen of the President's Deficit Commission- reducing the cost increases in Medicare, changes to Social Security, and cutting tax expenditures.

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Comparative effectiveness research will be conducted to evaluate what is the best treatment for any ailment or disease or health problem under the $1.1 billion allocated for this in the Stimulus Plan. What are the alternative methods of treatment, what is the effectiveness of each treatment, what are the comparative costs and so on. Is it better to treat neck pain with surgery or acombination ofphysical therapy, exercize and medications? If there is ablockage of arteries in the lower leg and leg pain, how does drugs and watchful waiting compare with surgery? For chronic heart failure how does home monitoring of blood pressure and weight and exercise in addition to medications provide an alternative route as opposed to just medications. Dr Fisher of Dartmouth Medical School cites these as examples of questions that can be asked in comparitive effectiveness research. The money will be available to the Health and Human Services Department and will be used over several years. About 15 federal employees will form a council to coordinate the research and advise President Obama and Congress on how to use the money. In 2007 the US spent $2.2 trillion, or 16% of GDP, on health care, and the Congressional Budget Office says it will grow to 25% of GDP at the rate its growing by 2025 if left to its own devices. ...

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Of the people asked the question "what issue do you see as the most important for health care" 44% in a NBC/WSJ poll said they considered Cost as the biggest issue, and 37% said that they considered the Uninsured as the biggest issue, 11% said quality of care was the biggest issue. The President is focussing on cost as he develops the health care plan. He is also saying that to provide health care for all and cover the uninsured without controlling costs would break the bank. Another thing that the White House shows it has learned from previous failed attempts, is that it is doing this with an open Health Care Forum with participation of different sides in the health care discussion. Clinton's effort in 1993 ran into problems because it was developed secretively, and without much discussion, and little effort to get different people's views. The previous attempt also waited too long after the election, and this time the President is moving quickly when he enjoys large popular support. Its also true now that there is serious concern especially in this downturn of what a threat spiralling costs of health care are becoming to the future prosperity of the American people. This time the leaders in Congress are setting an aggressive schedule to get health care palns legislation on the floor by June and get a floor vote in August 2009....