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This report in the WSJ by Peterson and Hackman shows how the American Health Care Act proposed by Speaker Paul Ryan provides less financial support and allows premiums to go higher for seniors approaching retirement in the 50-64 year age group. Premiums are allowed to go up 5 times that of premiums of young people in the Ryan House  plan compared to 3 times in the Affordable Care Act. Subsidies in the form of tax incentives provide $2000 to younger people going up by age not income to $4000 in the Ryan House plan. By contrast someone 60 years old making $20,000 a year can get Affordable Care Act credit of $9874, and making $40,000 a credit of $6752, according to analysis by Kaiser Family Foundation. The Ryan plan makes health care costs lower for young people in an effort to bring more young people who use less services into the system to support its overall financial condition. Another feature of the Ryan Plan is that it allows only for CPI index +1% even if health care costs are rising faster. Deep cuts to Medicaid affect lower income seniors on Medicare. As a result the AARP organization representing seniors has come out in opposition to the Ryan bill. The GOP plan wants to reduce premium costs yet in the process it makes vulnerable seniors with lower incomes pay more, which is likely to hurt Republicans who won by winning a large part of the senior vote. ...

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In this insightful essay Peggy Noonan, former spokesperson for president Reagan, says that Republicans like Speaker Ryan with the Republican Health Care bill are making the same error made by president Obama.. Noonan says she had suggested a different way for president Obama to show compassion for the uninsured- first wait till the 2008 financial crisis was tackled, tackled waste and fraud in Medicare first, then look at the option of expanding Medicare to help the uninsured, and not the approach taken of swiftly focussing on the Affordable Care Act early in the first term disregarding Republican objections. She says Republicans are making the same mistake now by ignoring the impact the bill would have on Trump's base of working class Americans who may be affected by the bill's provisions not taking into account incomes in offering incentives or subsidies. Noonan says Trump did get one thing right in calling it a "carnage" for the worsening opioid epidemic in America which has hit rural areas and parts of the midwest hard. Noonan says Eberstadt has correctly documented the collapse in working class Americans wages and standard of living, and Caldwell the opioid epidemic at another level to their health. She also supports journalist Carlson who questioned Speaker Paul Ryan's judgement about eliminating the tax on wealthy investors in new legislation in a Fox News interview, as she says responding to the sense of America at the moment means listening to the sense of being left out of ordinary Americans, who have done not as well as the wealthy who have benefitted from a surging stock market.  ...

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The Washington Post survey of 1200 readers on how the Republican healthcare plan of Speaker Ryan and the House of Representatives looks to them, how it affects them in their lives. Here Somasekhar of the Post gives the stories of 5 Americans. Some see the prospect of losing their insurance under the Republican plan even as they reach an older age, others a smaller segment says the Post, whose premiums jumped under the Affordable Care Act say they faced high premiums and high deductibles. The Post says the large majority of opinions have expressed anxiety over the proposed Republican Ryan House plan for healthcare. One of them is an uninsured poor farmer, Mr. Woosley,  income about $18000 who gained benefit from expanded Medicaid under the Affordable Care Act,  one Mr. Smith, 32 years, a personal injury attorney who faces paying $10,000 if he did not take insurance and $10,000 if he took insurance because of high premiums so a wash either way deciding to do without it, one a tech worker Mrs. Powers, 62 years, income $22,000 on year and $4000 the next, from middle class during the tech boom but facing fewer opportunities and uncertain income from part time work, hit by the deep recession facing fewer opportunities as she gets older and now the prospect of losing insurance without government subsidies, one who is from the middle class who sees little benefit from the Affordable Care Act and is forgoing insurance because of the high premiums yet faces a penalty for not being insured under the ACA, another Mr. Blanchard, 52 years, is from the middle class, a computer programmer who lost his job in downsizing, earns $100,000 as a consultant self-employed, pays $767 in premium a month and relies on the Affordable Care Act which helps him gain freedom from working at a company that could downsize,  another is a middle class programmer Mr Riffle,age 44, and his wife, who does not qualify for a subsidy with a $71,000 family salary from working 4 jobs between himself and his wife- this person finds it too expensive for his salary to buy insurance $900 a month and $14,000 deductible under the Affordable Care Act. His views are worth listening to as they go to the crux of the problem- he says he may not be any better with the Republican plan. He sees the real problem as the high cost of health care in the U.S. and the only way this can be fixed is for members of Congress to be asked to use the insurance exchanges they create. If this sample is representative it shows that there are real problems with both the Affordable Care Act and the Republican plan, that the high cost of health care the problem lurking behind every plan that does not squarely address this, and till that happens and members of Congress experience what ordinary people face, this problem can never by fully solved.   Woosley, Smith, Powers, Blanchard, Riffle, and their personal experience is at the crux of what is right and wrong  with the Affordable Care Act, and also with the new Republican plan of Speaker Ryan and the House of Representatives. For every Woosley, Powers and Blanchard who benefit, there is a Smith and a Riffle who are indifferent or are affected by the high cost under Affordable Care Act and the current system of medical care with its high cost. The Affordable Care Act does not  tackle high cost, for that to happen the culture in America that makes it possible and acceptable to charge high prices must change. Another problem apart from bringing health care costs is that any solution needs to have the whole country behind it. If the notion that all people are entitled to basic health care is to stand, the whole country needs to believe it as they do in countries like France, Britain, Germany and Japan. If this has to be made a workable proposition health care has to be offered at a price that makes this possible to achieve, and that idea also needs the deep and broad sense of support from the culture in America similar to that in these other countries. Until that happens politicians in America will get elected and turned out of office in turns on issues such as health care, based on which side they take and which problems they choose not to face squarely and responsibly. ...

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Weigel of the Washington Post compares how the Affordable Care Act was passed in Congress in 2012 with the push by Speaker Ryan and the Trump administration for the American Health Care Act in 2017. Republicans he says are making the same mistake as Democrats by rushing this through Congress. There is no broad consensus on whether all Americans should be entitled to health care as in Europe and Japan for their citizens, and health care is priced in a way to make it expensive for the state to provide- until the twin problems are solved by creating a new culture in the U.S. that sees things differently, politicians will come up with their own plans based on their interests and which groups they serve.

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The Congressional Budget Office analysis of the Republican House health Care bill shows 24 million Americans would lose health insurance over 10 years. In terms of budget savings the bill saves $337 billion over 10 years. The increase in uninsured comes from the roll back of expansion of Medicaid under the House plan, the reduction of tax credits, plus the removing of income based credits replacing it with tax credits based on age. President Trump is promoting the bill saying it will reduce the premiums that have gone up since Affordable Care Act was passed and increase competition. House Speaker Ryan in promoting his plan says he is not in "some coverage beauty contest." The House Plan says Ryan, does not mandate that all be covered, but simply says coverage is in a free market giving people the option to buy insurance that they want, so that the numbers of insured would not be as many as under a mandate.

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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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The 2016 primaries with Sanders and Trump have brought to the forefront voter dissatisfaction with the agenda of both parties, especially so for Republicans with the lack of specifics and personality driven campaign of frontrunner Trump. On a whole host of issues from poverty, wages and inequality, regulatory reform, to trade, borders, security, ISIS, both parties are facing questions from voters. Particularly the Republicans who have lacked specifics during the two terms of the Democratic Obama administration with a divided Republican Congress, and the risks for Republicans running for Congress under frontrunners Trump or Cruz who have provided few details on their agenda. The Agenda project of Ryan will have about 25 meetings and prepared specific agenda, including white papers and legislation, that would give Republicans hope to run on positive proposals that are placed before the Republican Convention in Cleveland. Chairmen of House standing committees were assigned 6 areas- health care, taxes, national security, regulatory reform, poverty, and Congress reasserting constitutional authority. Ryan told the Ethics and Public Policy Center on April 19, 2016- "A lot of people don't like conservatism as they know it. For too many people Republicans seem to be caught in a time warp. They're thinking, 'We don't control our borders. Wages are going nowhere. College and healthcare keep getting expensive. ISIS continues to spread. And what are Republicans going to do about it?' So we need to adapt our policies to meet the challenges of the 21st century."...

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Paul Ryan asks President Obama to put forward his plan for deficit reduction the day after the passage of the August 2, 2011 Debt Ceiling and Deficit Reduction bill in Congress. Ryan points out that health care cost increases are on an unsustainable path with costs going up by 8% in 2011 and projected to go up by 8.5% in 2012. The Obama Health Care legislation tries in Ryan's view the same failed bureaucratic efforts of the past to cut health care costs. Without a genuine and sure plan to cut costs the only way to pay for Medicare with new mandates is to increase taxes again and again. He cites the CBO's Long Term Outlook in June that total tax revenues would have to double by 2050 to finance the current rate of spending on Medicare and other programs. For Ryan the failure of the Obama administration to come up with its own plan for deficit reduction after passing the Health Care legislation- with expanded mandates and no certain cost control in the reform - is the most difficult to swallow. ...

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Research done by the WSJ shows people who sped time on fitness and are older are happier. More females than males by a wide margin. Community involvement rates are higher and faith in God is seen in people who are happier. Aaron Zitner shows the lives of 3 people including an 80 year old who ran a health clinic for 25 years who find happiness through community involvement and many projects including one that cut ten pregnancy in her county and is now writing grants to restore an old YWCA building in Cortland, N.Y.

A 77 year old civil engineer on a 7 acre farm in Chesapeake, Virgina, has good relationships, community involvement, and the same house for a generation, whose belief in God helps him be happy and find serenity in life.

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Shear of the NYT says president Trump is taking risks of losing support from low income people who supported him in the presidential election by making aggressive cuts in programs that help low income people. In his first budget plan deep cuts to social programs and increase of 10% in defense spending of $54 billion is planned. The new health care plan of the Republicans House and Speaker Ryan is seen by the Congressional Budget Office as increasing uninsured people by 14 million. Trump has left Social Security intact, but he sees other cuts as cuts to the "administrative state' and overreach on entitlements. The budget plan is titled "America First," and shrinks foreign aid, cuts state department budget by about a third, and cuts funding to PBS, other agencies, and cuts social program spending.

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The experience of Pintung county in Taiwan with a coronvirus outbreak is shown in The Guardian. Home quarantining of a couple from Peru leads to an outbreak. Community cooperation, a speedy response from local health authorities, testing and quarantining help to limit and control the outbreak. When it started this county on the coast, one of the poorest in the country, had limited health resources and no one was vaccinated. Most of the control response was through testing and quarantine, with vaccination assistance from the Taiwan government. Local people say strict quarantine is essential as the source of infections was from a couple who visited Peru and were allowed to home isolate. Taiwan government is now enforcing quarantine at hotels for all persons returning from overseas. WHO Emergencies program head, Dr Michael Ryan, says it is important to act quickly. He says "Be fast, have no regrets. You must be the first mover. The virus will always get you if you don't move quickly."  This happened in this Taiwan county as the local health authorites setup a soft lockdown of the two affected villages within 3 days of detecting the first case of Delta variant. This was announced over loudspeaker and food plus daily necessities were delivered to each household. A command centre was setup to take and coordinate the action daily. Taiwan authorites have enforced repeat testing and extended testing. ...

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Samuelson shows why the Ryan Plan needs serious consideration because it brings in competition from the private sector to control medical costs. The Obama plan does not reduce Medicare costs he says because it merely transfers the costs to mandated Affordable Care Act spending. And the Independent Advisory Board of 15 experts given the job of reducing Medicare spending if it exceeds a certain amount is ineffective- it cannot increase patient cost-sharing, restrict benefits or modify eligibility or cut spending by more than 1.5% in any particular year according to the Kaiser Family Foundation. Important points to remember about health care are: 1) sustainable Medicare for current and future generations can only be on the basis of sound finances 2) sound finances mean first and foremost controlling health care costs 3) private sector competition is the better way to control health care costs in todays environment where cost reduction needs to be large enough to make Medicare sustainable especially when competition shifts health care delivery away from the cost increasing fee-for-service system 5) Obama Affordable Health Care Act does little to change the costly fee for service system and the basic mechanism of cost escalation in U.S. health care. The Ryan plan's voucher option injects this dose of competition into the system and only for those who choose this option, it was also drafted with the help of Democrat Ron Wyden, and is cautious because it does'nt start this till 2023- giving time for discussion and improvement, and therefore a constructive effort to look at serious ways to control uncontrolled fee-for-service spending....

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Peter Coy of Bloomberg Business Week points out that the debt ceiling and proposed deficit reductions in the range of $4 trillion really obscure the real size of the problem which is much larger. The real problems hit when the U.S. faces a larger graying population by 2020 with sharply higher per capita health care spending; and at the same time workers from this generation retire and become beneficiaries of Social Security and Medicare with fewer younger workers to support the system with tax revenues. Another problem is that older Americans are likely as a voting bloc to vote themselves benefits that will cost the younger generation, benefits that the younger generation will not be able to enjoy. Even the Paul Ryan plan with its cuts to Medicare insulated todays seniors from the sharp cuts, as it becomes political necessity for both Republicans and Democrats to shy away from touching the current beneficiaries.

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CEO Ryan at CVS/Caremark. An unassuming man with a sharp focus on things, joined CVS right out of pharmacy school at University of Rhode Island. At 29, CVS owner Stan Goldstein gave him the chance to run pharmacy operations for CVS, then a regional drugstore chain in the eastern USA. Over the years CVS has made a number of successful acquisitions, the latest being the acquisition of Longs Drug store chain on the west coast, and it is now one of the largest chains in the USA. It has nearly 7000 stores and more than 50 million users of its CVS loyalty card in the US. As the pharmaceutical business evolved pharmacy benefit management (PBM's) companies like Caremark, Medco, and Express Scripts, came into being to manage burgeoning prescription costs. PBM's work with companies to save money, by filling recurring prescriptionsin 90 day quantities through the mail at reduced per pill cost. Now drug store chains instead of competing with PBM's are either creating or acquiring these larger PBM's. THe result is that a company like CVS which acquired PBM Caremark in 2007 for $27 billion, now has extensive computerized databases with patients information and drug usage histories. Ryan's clear focus is on these IT records as a distinct advantage, if he can use it to help the Obama administration's efforts to control health costs of chronic diseases like diabetes and arthritis, and back or neck pain, high blood pressure, and others, that end up clogging the hospital system and raising health care costs. By using these IT records to flag when a patient is not compliant or taking his medications and call the patient, Ryan can increase drug sales, get more visits into drugstores if the drugs can also be picked up at CVS stores, and increase sales through ancillary purchases during visits. This is now his strategy. It also includes setting up more clinics at stores and at corporate locations that divert the patient flow for small care like sore throats, flu and the like. As this is the way health care costs can be controlled, Ryan sees himself as helping achieve national goals while keeping CVS in the sales and profit picture for the US, even as health care as we know it goes through a complete transformation that removes the waste and unnecessary cost, and improves effectiveness and health. He sees CVS/Caremark right where it wants to be with its large patient drug database from about 1 billion prescriptions it fills each year, and as the largest single buyer and dispenser of prescription drugs in the country. ...

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Quiet quitting has become a phrase that means workers are working hard and doing things the way they did before, except that they are not letting a work culture that may have gone astray because of bosses  who set the wrong rules guide their lives. Even as companies such as Stellantis are taking on a new culture because of a new respect for workers work-life balance and getting a lot more from them, other companies are following older set patterns that did not include work-life balance or rejected work-life balance outright without saying this openly. Stellantis, Europe's largest car company itself shows why this is dependent on who is the CEO and what he believes in. The previous CEO had poor health habits including frequent smoking and irregular long hours without a structure of any sort that led to this being carried over into the work culture. The CEO changes and new rules are set and soon it permeates who is hired at different levels that are consistent with his habits and sense of work life balance. A new culture develops over time and gradually you have new work ethic that respects the mental health and fitness of workers and of managers, and that of the CEO. This report in WSJ starts with the premise that workers should'nt feel bad because worker are "quiet quitting" anyway after the pandemic. But in reality the statement is a bad one, as it does not say there are better models out there few as they are, that need to take pre-eminent place after the pandemic rejecting the old ones that recklessly ignored health and mental health and were less motivating for workers, and leading to less productive culture in the workplace. At Stellantis a lot gets done in regular hours so that the time after 5 or 6 pm is devoted to workers getting into exercize taking a bike ride, doing things that revitalize and build a healthy body and mind so essential for productive and good thinking type concentration in work. Emails over weekends need not be replied till Monday, and bringing up work during the weekend is discouraged. And still a lot gets done, the company will take the leading role in EV vehicles in Europe and has aggressive plans for 2030 for new EV models. See the link to Stellantis to see how this new CEO runs a company of about 100,000 employees around the world. His name is Carlos Tavares and he took charge of Fiat, Peugeot, Chrysler combined operations called Stellantis in January 2021. This is important as it is the new trend that will take hold of the work culture after the pandemic only if workers and managers ask that it be so and as the word spreads that better more productive companies that can get a lot more done is the result of such an educated workplace that respects health and mental health, and the dignity of workers and families. Look, how can it not be so when the word still has to be spread on climate change in the business world? How can one take place without the other? There is a new sense of dignity in respecting the dignity of the environment, of water, soil, and air, how not so for the mind, the body and its connection to nature around it? And no better place than Stellantis and its CEO Carlos Tavares where the old CEO ran himself down with poor work and health habits and passed away while at work in 2018, to show a new way.  In Germany this new way of work-life balance based work culture is called by a more respectful term "Feierabend" than "quiet quitting" showing that what is wrong is with the work culture and bosses who do not grasp the importance of health, mental health, and what it means to be revitalized for truly productive and thoughtful work. Quiet quitting has that sense of workers having to feel a bit of guilt about this and still thinking it is right  doing it anyway. In Germany"feierabend" is popular and accepted, it means breaking away from work at normal times such as 5 pm or 6 pm when a workday ends so that one can go out and relax with a bike ride  or something that is good for health and fitness and rejuvenates. No email, no nothing so the mind can rest and revitalize. ...

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Chile's new constitution was drafted after a vote on a constitutional convention in which many people not involved before and on the fringes of society including indigenous groups were elected. More than half are independents and from different groups of society not well represented before. As a result of this the lack of experience has led to enshrining every single right that one could think of instead of focusing on what the protests were about about - the pension system, unfairness in access to health housing and education in the way funds are allocated from the budget, and promoting fairness in government.  At this time there is no certainty that it will be passed. A 36 year old student protest leader Gabriel Boric is the president elected after two years of protests about the unfairness of the system that took shape under a constitution written by a military dictator Pinochet who ran the country from 1973 to 1990. Pinochet came to power in a coup that is common in the history of South American Republics such as Brazil, Argentina, Chile and other countries. During the period of the government of Marxist president Salvador Allende the country was polarized resulting in the military taking over.  If the constitution is rejected a new convention will be formed to write a new constitution. In following the Structure of the US, Canadian, or British constitution, or the Indian it is important to look at the document so that it will stand the test of time rather than simply enumerating the rights of man. It is also important to focus on how to make the basic rights such as food, housing and education be well funded and society to be run along lines of basic fairness in incomes, while protecting enterprise and industry that can create new wealth for the country. The large South American economies are mainly dependent on commodities for export and there is a need to fund new business sectors which are not in commodity products- copper in the case of Chile- so that the economy can develop in a way that funds progress in incomes. ...

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The Republican House health care bill AHCA  keeps some some of the more popular parts of the Affordable Care Act such as not taking pre-existing conditions to deny insurance, keeping children covered on parents insurance till age 26, and increase contributions to Health Savings accounts. It is different in that the expansion of Medicaid at 138% of poverty rate threshold is rolled back. Age is used for tax credits instead of income, hitting those approaching Medicare age harder. The maximum charged to older people is now set at  5 times compared to 3 times what young have to pay. In general the Republican bill is seen as targeting the elderly to keep premiums down. The elderly on low incomes are hit hardest. Fox News O'Reilly Show showed the host questioning House Republicans, citing the CBO estimates that elderly on low incomes may have to pay as much as $14,000 a year for insurance making it basically unaffordable, and 52 million Americans would be affected adversely. Large companies are no longer required to offer mandatory health insurance under the new bill. Conservatives from Freedom Caucus wanted to see the essential areas of benefits covered by the law limited to fewer than the ten areas in the Affordable Care Act. The ACHA Republican bill leaves to states to determine what are required essential benefits. At one point maternity benefits were to be dropped but this was changed to let states decide. As a result the bill is 33 votes short of the number needed for passing the house in March 2017.   Neither the Democrats Affordable Care Act or the Republican House bill of Speaker Ryan do much to tackle the real problem- the absolute amount and increases for health care dollars for treating each disease in the U.S. compared to European and other countries. As a result health care has become more of a partisan struggle between the two parties than a real effort by all to overcome the problems that have to be tackled. Republicans want to see premiums drop and keep the burden on the deficit down- but with the level of U.S. health care costs disproportionately high compared to Europe and the rest of the world the arithmetic is tough and ends up leaving out vulnerable groups such as the elderly on low incomes, thus making the whole proposition prone to fail. For the same reason the Democrats failed to keep premiums down with a wider safety net leading to calls for repeal of their version.   ...

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New information from the recordings of the World Health Organization as reported by Associated Press, show that during the week of January 6 WHO's lead experts were having difficulty getting information about the coronavirus outbreak in Wuhan, China. Maria Van Kerkhove, an epidemiologist and the WHO technical lead for coronavirus says she was going on very minimal information. The WHO's top official in China, Gauden Galea, says in one of the recordings that they were in the situation where information was given to WHo officials in China only 15 minutes prior to it going on China's state television CCTV. In early January Michael Ryan, the WHO's chief of emergencies, says he feared a repeat of the SARS epidemic in 2002, which was initially covered up by Chinese officials, according to the AP report shown in the Guardian. Ryan says he found himself in the same situation as in 2002 SARS, endlessly trying to get updates from China about what was going on, and adds that WHO barely got out of the SARS with its reputation intact given the transparency issues, in the AP report shown in the Guardian. By June 1 about 6.3 million confirmed cases are reported of coronavirus in the world and 375,000 deaths, and huge losses to economies and people. China's authorites did not lockdown Wuhan till January 23, by which time this report in the Guardian says at least 5 million residents had left. China denied entry requested by the U.S.on January 6 for a team of experts into Wuhan, The team was not allowed into Wuhan for a crucial period of 6 weeks during which the virus had time to spread in the western world. This is taken up in Mr. Trump's letter to the WHO, and the work of Gro Harlem Brundtland is clearly stated in the conclusion of that letter. Brundtland was head of the WHO at the time of the SARS epidemic in 2003, and acted decisively with early warnings to prevent its spread.  Because of the extremely contagious nature of the coronavirus the failure of early warning systems resulted in enormous damage to lives and economic losses worldwide.  ...

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Will reminds readers about what King wrote in his "Letter from Birmingham Jail," about being labeled an extremist, the same words that he sees Democrats saying about Ryan's plans as being extreme for Medicare and Social Security, now that he is Romney's running mate in the U.S. presidential race. "But though I was initially disappointed at being categorized as an extremist, as I continued to think about the matter I gradually gained a measure of satisfaction...Perhaps the South, the nation and the world are in dire need for creative extremists." Will's point is that Ryan is unfairly being labeled an extremist for coming up with creative solutions because "ending Medicare as we know it" will happen though the laws of arithmetic for the U.S. deficit with runaway health care spending and uncontrollable medical care price inflation. This would produce more drastic results than through the kinds of creative changes that Ryan is proposing. Will's other point is that the entitlement spending increases cannot be solved by simply raising taxes on the rich especially at a time when costs are out of control. This is especially true because the U.S. economy depends on private sector confidence and investment for growth, and even more so now that the stimulus has had limited results and served its purpose in crisis management. Ryan has also modified some of his ideas in discussions with other voices in his party, a process which will continue to evolve with the infusion of ideas from Dave Camp, Romney, and others in his party....

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This Washington Post editorial says Obama and the politicians, both Democrats and Republicans, want something for nothing. The Ryan budget, Obama's health care plan, all require paying for it with higher taxes, but the mention of the word "tax" is the last word any of the politicians will say. These comments come as the U.S. Supreme Court considers the mandate that young Americans and others be forced to pay for health care along with the rest, as required by the health care mandate, with the idea of keeping costs down. The idea of getting something for nothing was also emphasized in an op-ed in the WSJ, March 29, 2012, by Mayor Bloomberg of New York City, where he called for letting the Bush tax cuts expire for all income groups, and an up or down vote in Congress on the Simpson-Bowles deficit reduction plan, as part of a two step plan.

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Eleven members of the panel on the US Deficit Commisssion supported the plan, and seven opposed it, in a 11-7 vote. The panel members supporting it include Senator Durbin, Senator Coburn, Senator Crapo, Senator Gregg, and Senator Conrad. In the House the following House members voted against it- Rep. Becerra, Schakowsky, Camp, Hensarling, Paul Ryan. The House Democrats opposed it because of the changes to Social Security, and the House Republicans opposed it because they said the report did not tackle federal health-care spending sufficiently.

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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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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....

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This report in the Economist points to the improved situation for Mexico after the scare from Trump's plans to build the wall and deport large numbers of immigrants. The peso dropped by 15% between mid November 2016 and January 2017, but has since recovered, and non-oil exports were up 5.5% in February 2017 over prior year with the manufacturing growth in the U.S.  Growth forecasts are now up from about 1% GDP growth previously to 2% for 2017, close to the 2.3% in 2016. Much of the change in mood in Mexico is a result of the failure of the early travel bans being blocked in the courts, the failure to get health care legislation through Congress, and the effort by the trade advisers and economic advisers around Trump to move Trump's positions more to the centre and closer to traditional Republican party positions. Wilbur Ross, the Commerce Secretary, says " a sensible agreement" can be reached with Mexico. Peter Navarro, trade adviser, talks about making "a mutually beneficial regional powerhouse." Robert Lighthizer, a veteran from the Reagan days, is likely to be made the new U.S. Trade representative. Still as the Economist points out the "20% border adjustment tax" continues to be supported by Paul Ryan in Congress to pay for tax cuts. But certainly the mood has lifted in Mexico in the first 100 days. This is true for economic policy in relation to China and Germany, and the close circle of Ross, National Economic Council head Gary Cohn, and Secretary of State Tillerson is moving Trump to the centre in policy statements to get things done. Mexico is faced with internal challenges of reestablishing the rule of law, improving infrastructure, reducing red tape and corruption, addressing problems in the education system, to promote economic growth. These challenges may prove to be as large as the external challenges were once thought to be. ...

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This Economist magazine editorial says the Republican plan for health care with its roll back of Medicaid expansion by limiting funding to states after 2020, and by scaling back subsidies especially for older Americans and not basing them on income levels, is likely to have its own problems just as the Affordable Care Act. One concern is that keeping healthy people in the market with a mandate that everyone have insurance is present but in a milder form with premiums going up by 30% in one year if they change their mind. There is concern that this may not work among insurers leading to an increase in premiums, pricing people out of the market in "a death spiral." This could lead to more people being priced out of the market as premiums rise. About 12 million people were added to Medicaid by increasing eligibility level to $16400, or 138% of poverty line- this reduced the uninsured from 16% in 2010 to 8.8% today. The Economist concludes that the Republican health care bill has its own problems, and that this bill does not clear up the problems in Obamacare by substituting Ryancare as the Republican bill is called. Peggy Noonan writing in the WSJ says this may have negative consequences for the new Republican base shift to populist support. Critics on the right like Rand Paul see even the reduced subsidies as an entitlement program, yet the Republicans can only change parts of the Affordable Care Act as they need 60 votes in the Senate where they only have a small majority.   ...