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Obama Affordable Care Act ACA and its downfall are covered by two experienced authors over 2 book written over 2 decades. The authors are James Morone and David Blumenthal followed the healthcare issue over 25-30 years through the Clinton, Edward Kennedy and Obama efforts and wrote two books. The first was "The Heart of Power" on the healthcare situation from FDR to 2008. The last titled "Whiplash" in 2026, for which the authors are interviewed in Harvard Medicine magazine. C-SPAN has a book program on this book at a Washington DC bookstore. From the discussion on C-SPAN between Senator Michael Blumenthal, borther of one of the authors, James Morone and David Blumenthal physician, couple of conclusions are seen that may be new to readers. Q. What was the one single factor that doomed the Affordable Care Act? A. The deep antipathy towards the Obama administration influenced the response to the Obama handling of healthcare. The likelihood of Republicans accepting healthcare from a black person was simply not there say the book's authors in the discussion and Q&A on C-SPAN. Yet there were other reasons for the ACA failing. Obama had not gauged the mood of the nation well. UK Labour's Starmer won by a big majority in 2024 yet that does not reflect the mood of the British nation just 2 years later- by election year 2012 Obama's campaign was faltering and had to be rescued with Hispanic votes and a weak candidate in Utah's Mitt Romney. Obama lacked maturity and came in the way Bush came in when the list of candidates were mediocre in the US, similar to the period in the UK with David Cameron and Boris Johnson. To take on the health care issue required someone with the experience and caliber of LBJ, which Obama clearly lacked, coming from the minority community was not going to help in credibility. Obama's presidency was thus premature and to gain experience he would have done better in a key cabinet position such as at Department of State where an intellectual could have influenced world opinion in favor of emerging countries, a doable and necessary. Obama's lack of experience showed when he told Republicans two words in the first months in 2008- "We Won," perceiving arrogance it would set Republicans against him. The years 2008-2016 cost the US dearly in that the US needed a withdrawal from all of the Middle East which would require a strong president  with deep roots of support in all parts of the country including the south, to avoid recriminations. In the end by continuing the wars Obama weakened the US and let China move ahead. Q. Did Obama consider Medicare for All? A. Obama told Congressmen of his party according to Morone- if you can get 60 votes in the Senate for Medicare for All we can try.  Q. Would it take a major upheaval for Medicare for All to be accepted now that the health system is failing all Americans in 2026? A. It will take a world war or a economic depression- some major disaster for Medicare for All to be accepted in the US, say the authors. A pandemic happened in 1918 and again in 2019 the results were not positive, as the authors believe it unleashed the war on science after the vaccination for and against camps, leading to the culture wars in America seen today. Q  Obama's analytical mind thought he learned from the Clinton efforts in healthcare that failed. But he did not see things from the heart. There is good reason to think that the lessons learned of moving fast, letting Congress write the legislation, settling for what can be done not what needs to be done, were exactly the wrong lessons to be learned as opposed to writing off the Clinton experience entirely as Clinton's, and starting from scratch without preconceptions. In the end Obama if he was older, had more experience, and listened to the mood of the country would have realized that healthcare was for another day, and got right down to the most difficult challenge, to end the wars in the Middle East. Even small steps in the right direction would still have earned appreciation him today. Instead Bush and Obama, the most inexperienced of presidents will be remembered for wars they continued that weakened America.       ...

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Where do you place a winner of the Democratic primary in Maine, Graham Plattner, an oyster farmer who dropped out of college at George Washington University, served briefly in the Middle East wars of Bush and Obama, and had PTSD. Is he working class, middle working class or is he from a downwardly mobile professional class considering he has parents who are well educated and father a prominent lawyer in Maine? Plattner easily defeated a 3 term governor of Maine with his average working class demeanor and language. He is for universal health care, (Medicare for All) universal child care, affordable housing, affordable college. Politics in the US has been moving away from the simple divisions before 1950 created by the Industrial Revolution- the workers in factories and the owners of capital allied with the professional middle class. The few owners of capital mostly college educated allied with people from the non college educated workers in factories who are conservative in their values and beliefs and on the other side the college educated professional middle class now downwardly mobile because of the many recessions and high unemployment from frequent financial crises, with college costing $80,000 a year putting them in deep debt. There is today in the WSJ a story of a professional worker who at $194,000 a year salary is not able to payoff $15000 debt which owners of capital have set at 26% interest and is in downward spiral. Some of this comes from large college and other debt. There is says WSJ Analysis $1.25 trillion in credit card debt alone with highest delinquency rates in decades in 2026. Cost of living has only made things worse and some of this happened as Biden poured money into the economy to help people hurt by the pandemic, yet with some short run consequences with demand strong businesses including hotels, restaurants and grocery stores, auto dealers, jacking up their prices by over 20% in 1 year and Biden failing to respond, getting overwhelmed by open borders migrants under Mayorkas and Harris (also hit by a sudden Venezuelan migrant influx). This is the America one has today- a confusing mix. This in reality means Democrats may take issue with Democrats, Republicans take issue with Republicans, and Democrats join with Republicans on issue by issue basis. It might actually be rational than irrational. On cultural issues if the country has gone over its head and moved too fast on some issues that are not for the general public good, people of different backgrounds can come together to get the best path. On economic issues things are never so straightforward, there are unpredictable consequences and the rules of economics are really not so straightforward either.  Providing relief can mean the government shouldering the burden as during the pandemic which it should, yet with caution as businesses can use the excess demand to raise prices and one is back to square one with everybody worse off as happened with Biden. Migrant flows and fears of insecurity in public spaces can lead to a severe public "discomfort that can waylay the best intentions of a Harris or Biden, leading to public "backlash." In fact the title of a recent book is "Whiplash." Current books include Floridan Marco Rubio's "Decade's of Decadence- How our Spoiled Elites Blew America's Inheritance of Liberty, Security and Prosperity." Rubio means it. Its authentic because as Rubio says repeatedly, his parents could make a living in the 1960's working in a factory with decent wages, low cost of living and low cost of college, the arithmetic between salaries and what you needed for decent home in suburbs and sending children to good public schools, then to college, all adding up. The result is that Rubio could go to college and serve in the Florida legislature. Rubio says in 2026, after the elites under Bush and Obama and faulty economic theory shipped all of our factories to China, that the story of his parents and his education would simply be impossible. This is what he told people in India on his first visit last week. His parents were Cuban immigrants, yet he identifies with Spain and with western civilization, a devout Roman Catholic. Rubio is a Republican, and is in large contrast with Alejandro Mayorkas, also from Cuba, and Biden's Head of Homeland Security. This is the mix of people and representatives in Congress,  business people, small business owners, professionals, that we have today in 2026 in the US. Plattner and Rubio, one a Democrat and one a Republican- both have something in common. Plattner also has general disdain for "the corporate interests, the billionaires, the Washington DC elites, and the establishment politicians."  The winds are blowing in the direction of getting things right- remembering that Eisenhower continued the work of the Kennedy and LBJ administrations (Eisenhower built the Interstate Highway System for instance, and LBJ gave America Social Security and Medicare). Before that Franklin Roosevelt a Democrat built on the work of his uncle Republican Theodore Roosevelt (TR gave America the idea of good governance and built the US Navy, FDR fought the Depression and stabilized a faltering economy after mistakes made by Republican Herbert Hoover could have happened even if Hoover was a Democrat. FDR was himself from a wealthy New York family and when he first met fellow New Yorker Frances Perkins before his struggle with polio, a haughty New York gentleman. That was before Frances Perkins as FDR's Labor Secretary joined forces with Roosevelt to give New York a modernized administration governance structure by 1940 that was applied to all 51 states after 1950. It allied labor with capital with fairness for all, and was the first such modern structure of this size the world had ever seen, which was the fundamental strength of the United States of America. It was imitated in Asia, first in the Shanghai region then China, and first in the Ahmedabad region and now India. The US is faced with the challenge of recreating and rebuilding this today, as first China, then India remind America of its roots which they have followed in their own style and culture.  First good governance, then good institutional structures, alligning labor and capital with fairness for all, strong affordable + accessible educational and healthcare systems, and investments of capital and labor for infrastructure + industrial development. ...

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The Big Beautiful Tax and Spending Bill in the US Congress faces close votes in the US Senate with Senators Rand Paul of Kentucky, and Thom Tillis of North Carolina, both Republicans against it.  The Senate version has additional cuts to Medicaid funding. Tillis expressed concern about these cuts. Senator Rand Paul is opposed to increasing the deficit for enlarged spending and tax cuts. Republicans and DJT have close votes in the Senate and in the Congress. Republicans Murkowski of Alaska and Curtis of Utah want to change the early phaseouts of tax credits to the renewable energy industry in the Senate bill, and the excise tax after 2027 to avoid buying from China and develop American manufacturing in renewables. Senator Collins of Maine has an amendment to add $25 billion for rural healthcare and rural hospitals to offset the effects of large Medicaid cuts. Collins plan also lets taxes revert to 39.6% from 37% for married couples incomes over $50 million.  The bill then heads back to the House for changes by Wednesday, July 2, for a goal to have it on the president's desk by July 4th, Friday. ...

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Asked about it yesterday January 16 DJT tells the press outside the White House after a meeting announcing his Great Healthcare Plan, it is a good thing that Canada has signed a trade deal with China. It reflects the new view not clearly understood or told in the press what US trade policy is about. US trade policy in 2026 is about bringing investment and jobs back to the US to rebuild communities and towns across 51 states- once destroyed by the foolish trade policies of the Bush-Clinton-Bush-Obama 3 destructive policy decades. Supplementing this with the investment favorable policy of instant depreciation for investments in plant and equipment in the Big Beautiful Bill of 2025. Using tariffs to level the playing field and ensure fairness in business practices by industries and nations towards America after over 3 decades all else has failed. All the time protecting Rural America, and communities and towns across the US devastated by outshoring. Using Tariffs to make certain that drug and migrant trafficking, and hostile unelected governments in the western Hemisphere cannot take place with direct and  indirect intervention in the western hemisphere by foreign powers. To do this with the Monroe Doctrine Corollary set by Teddy Rooosevelt in his Annual Message to Congress of 1905- "A great free people owes it to itself and to all mankind not to sink into helplessness before the powers of evil." Under such a policy Canada can pursue trade deals with China as the US has done. The clear rationale for the US policy is nowhere evident in the press today, how trade and domestic policy and foreign policy converge to protect all Americans, even though this was something that was pursued under the Biden administration with mistakes made in handing the Border management to Mayorkas and Harris incompetence. In the use of Tariffs doing this in such a way that US economic interest, investments, capital and stock markets are protected by carving out areas of exemptions in the policy. This has given the US an highly advantageous use of Tariff policy in ways not reflected in the press version of Tariffs. As TR pointed out, as Lincoln pointed out over a century ago, the interests of both Labor and of Capital are both legitimate and vital for the Nation. It is time to see this as one whole and not separate to rebuild America.   ...

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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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Bernie Sanders presents the case for Medicare for All, healthcare for all legislation in the U.S. Congress introduced in September 2017. It has the support of 15 Senators. He says the current system is costly, wasteful and bureaucratic. It is time says Sanders for the U.S. to join the rest of the industrialized world, join Britain, France, Germany and other countries of Europe, Japan and Australia, Canada, with healthcare for all Americans. After all he says only 50 miles north of his electoral district in the Burlington, Vermont area is Canada, where the system of healthcare for all works better than in the U.S.  And the Canadians, Germans, French, and British do this spending less than half the U.S. does. In 2015 the U.S. spent $10,000 per person for healthcare, this means that it cost less than $5000 per person in these advanced countries and the way they do it can be studied and its best aspects adopted by the U.S.  He says this is because the U.S. healthcare system is designed to maintain profits for the medical-industrial complex. A major problem is the manner in which the issue is distorted by different sides on the issue of health care in the U.S., without a consensus being developed on what the common interest is in a civilized society. Mostly because the U.S. unlike other societies is still grappling with the issue of what values it embraces on healthcare being made available to all. Under this legislation the transition to healthcare for all would take place over 4 years. In the first year eligibility for Medicare would start at age 55 years, and children under 18 would be covered. In the second year the eligibility starts at 45 years, in the third year at 35 years, in the fourth all are covered.  ...

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US is shutting down 10% of airport traffic because of government shutdown in November 2025. Democrats are holding up the passing of the new budget till Obama's Affordable Care Act healthcare subsidies for low income Americans are restored. Republicans who control both houses of Congress are unwilling to restore these subsidies saying it will cost $350 billion over 10 years. Editorials in the Washington Post in November see Obama's Affordable Care Act as a bandaid approach for a broken healthcare system in the US. Public opinion in the US supports this assessment. Trade unions and labor have called for an end to the government shutdown. Democrats are acting as though the party is for low income Americans and labor yet this is not the party of FDR who fought hard for labor over vested interests, Democrats today are the vested interests whether from Tech which is taking a disproportionate share of the Nation's wealth and resources and pouring it into projects that do not reduce the cost of living or rebuild crumbling obsolete infrastructure, or from Banks which were not sanctioned for their part in the 2009 financial crisis, or from healthcare interests that oppose restructuring the entire healthcare system for fairness in insurance, pharmaceutical pricing and wellness. Republicans are making an effort to displace Democrats in the role of FDR and Lincoln under newcomer DJT who rejects both the incompetent Bush (Republican) and Obama (Democrat) administrations that wasted money and resources in foreign wars while overlooking America's many challenges and strengthening foreign powers including China, while weakening the US. The US government is cutting airport traffic to relieve unpaid traffic controllers. Also at risk are SNAP benefits which are for the loew income Americans. The US president is asking the Senate to drop the filibuster rule which requires 60 votes in the Senate for the biudget to pass it and pass it by majority vote. The Senate Majority Leader Republican Thune wants to keep the filibuster because it acts as a brake for hasty legislation passed by whichever party is in government. ...

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The second wave of the coronavirus is bigger than the first with the U.S. exceeding 100,000 cases a day for many days in November and hospitalizations doubling to 93,000 from the beginning to the end of November. There is also the fatigue with the virus for healthcare workers and the people, and loss of income for workers leading to income and food insecurity. In this situation a second stimulus to help people and businesses is a urgent priority for Congress. A group of bipartisan senators have put together  $908 billion stimulus plan to get through the Congress by December 11. This is a compromise between the two parties. Supporting the bill are Cassidy, Romney, and Collins for Republicans and Manchin, Warner, Cassidy for Democrats. It would provide- 1. $300 a week in federal unemployment benefits for 4 months. 2. $160 billion for state and local governments. 3. Temporary moratorium on coronavirus related lawsutis. 4. Additional funding for small business, schools, health care, transit, student loans. There is growing agitation among influential senators against the leadership in both parties of McConnell and Schumer, with the sense that the leadership has failed to recognize how critical the issue of emergency relief is for tens of millions of Americans. This is its only hope for passage with the bickering of the leadership on both sides. ...

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Peter Orszag's role in the healthcare debate and the formulation of health care policy proposals. One proposal of Orszag, who heads the Congressional Budget Office, is to set up a new agency with powers to cut spending and implement changes in Medicare. Says Orszag, "one of the reasons we have such disjointed and skewed incentives is that we have an excessively political process." At a recent meeting with House Democrats, one Congresswoman said her top priority is winning higher payments for oxygen suppliers, and Orszag was taken aback. For years officials have been trying to cut payments to oxygen and medical equipment suppliers, which are said to be inflated. When a new competitive bidding process was set to take effect last year, industry supporters in Congress were able to delay the plan, and these supporters are still fighting to block changes says the WSJ. Here is a 40 year old Orszag, with degrees from Princeton and London School of Economics, who got his early experience in the Clinton adminstration at age 24. He then followed this with a number of policy oriented jobs, ending with appointment to head CBO in 2007. And he faces the whole system of Congressmen from both parties beholden to interests in the healthcare industry, who provide the donations for them to finance their election campaigns. Dan Eggen describes this in the Washington Post, 7/21/2009. Max Baucus of Montana, and to some extent Grassley of Iowa, are senators from both parties who Eggen points out are beholden to the healthcare industry because of large donations they receive from the interests in the healthcare industry. These interests want to see their payments system protected. The further escalation in health care costs, which would make the whole healthcare system unaffordable even as it delivers poor results, can only be prevented by making cost control an exercize that is not influenced by healthcare industry donations. Jackie Calmes describes the huge hurdles in achieving a deficit neutral move to universal health care in the U.S. in the NYT 6/26/2009. See the link. The exchange between Grassley and Orszag on the issue of the $177 billion in savings needed from the payments to health insurers under the Medicare managed care plans- which allow seniors to obtain Medicare coverage outside the government run program -went as follows. These are dubbed overpayments by outside experts and efforts have been made to cut them in Congress. When Mr Grassley raised concerns about the impact of such cuts in a hearing, -and Grassley has opposed the cut for this overpayment to insurers- Orszag responded saying: "I very firmly believe that capitalism is not founded on excessively high subsidies to private firms. This is what this system delivers right now." ...

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Vigorous and eloquent testimony before Congress by Treasury Secretary Scott Bessent, answering questions from Republicans and Democrats. Bessent had just landed from London at 3 am in the morning and after 3 hours of sleep took the time to answer over 5 hours of questioning by members of the House of Representatives. In question after question he explained how the certainty offered by the tax cuts bill would help small business and job creation in the US. The permanence of the 100% expensing of buildings and equipment would help farmers and small business , regulations would be cut, and manufacturing would take off. Manufacturing employs 9% of the workers in the US and their wages will rise faster than for service workers. The combined effects of the improvements for small business, farmers and for manufacturing workers will help the American middle class, America's working class, and increase the growth of the economy. Bessent points out that in the original bill of which the new tax bill is an extension the top 10% paid 7% more in taxes in 2017. He also points out that workers were hurt the most by the slower rise in wages and the rise in cost of living of 21% in 2021-2022, which he says was in essential goods with the actual impact of about 30%. With higher jobs creation by small business and more investment in the economy more able bodied men can join the workforce and gain healthcare benefits under new rules. He pointed to low inflation at 2.1% and to higher job creation, and to higher growth in the economy of 2.6%, that with other savings could lower the deficit. ...

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The failure of the 117th Congress to pass key parts of president Biden's agenda for hard hit families and workers in America is now taking place. The 50-50 standoff in the US Senate and failure of two Democrat senators Sinema of Arizona, Manchin of West Virgina to support Biden's Families and Workers Plan leaves key parts of the safety net being left out. This leaves out the education, and paid leave part of the agenda and provisions for utilities to accelerate shift away from coal out of the bill. It fails to implement a new national agenda for upward mobility, child care and paid leave to help stressed out mothers and families. The failure to include even a modest community college 2 years of support at a time when men's college enrollment is dropping to disastrous levels for America's economic competitiveness is a failure of the 117th Congress to grasp the needs of families and workers in America today. Only a new Congress in 2022 can take up the needed action for families and workers in education, health care, child care and help for families. The passage of the infrastructure bill and the current version of the social spending bill can only be seen as a first step in the right direction, after three decades of different administrations neglecting infrastructure, education, healthcare, childcare, elderly care, upward mobility, and climate change. On the plus side as the first step to restore dignity and health of families and workers in America it includes- $150 billion for rental assistance, home buying help, public housing repairs, and building 1 million affordable housing units. $150 billion for federal programs for home health care and community care for older Americans and people with disabilities $165 billion to reduce premiums for people under Affordable Health Care Act, cover additional 4 million through Medicaid, adding hearing coverage but not dental or vision to Medicare. $200 billion for child care tax credit to parents. $400 billion to reduce health care costs and give universal pre-kindergarden for 3-4 year old children. $40 billion for worker training $555 billion for fighting climate change including through tax incentives for sources of energy that are low emission and low carbon. It will be paid for by additional taxes on incomes of very high income earners in annual $1 million plus range, and by having a corporate minimum tax of 15% for large corporations, including on profits overseas, that previously did not pay this tax. A wealth tax on unrealized capital gains of billionaires or other wealth of the richest Americans is left for a future Congress to consider for financing the key parts of climate change provisions, education and health care that were left out. The education and healthcare provisions need to be expanded to restore America's historic mission of upward mobility for all. A provision for Medicare to comprehensively negotiate prices with pharmaceutical companies that would be taken for granted in any advanced country as in Europe, is also left for a future Congress that understands and responds to the dire needs of families and workers in America for affordable healthcare medicine neglected by administration after administration for the last three decades.   ...

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The US Senate filibuster rule that requires 60 votes for the budget to pass is a relic of the civil rights days, today it prevents Republicans from ending the shutdown by majority vote. Republicans used it when Democrats controlled the House and Senate and Senate Majority Leader Thune does not want to drop the filibuster as it acts to ensure no hasty legislation or budget is passed without some form of overall consensus. It also means that situations such as a government shutdown can happen when the opposition party in the Senate uses it to make it demands be met. In this case Democrats Schumer and Jeffries are asking Republicans to include money for subsidies for the Obama Affordable Care Act enrollees- about 22 million people signed up for this part of the ACA to receive generous subsidies for healthcare. These subsidies are not part of the Big Beautiful Bill of DJT that passed Congress and was signed into law. Unions and airline executives are calling on Democrats to end the shutdown as it disrupts air traffic at airports, and leads to cuts in SNAP and other benefits, and to lack of pay checks for government employees. ...

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Voters took note of the quality of each candidate, and Democrats were scrappier  in the fight this time around to give a tight result. Voters did not know much of what Mr. Biden had done to cap healthcare costs in midterm elections for 36 governors races and for control of the US Congress. The pocket book issues mattered to voters with sharp increases in the price of oil and groceries, but less so than made out earlier and voters may have grasped the bigger picture.

The quality of candidates mattered and on the Republican side the influence of Mr. Trump in the primaries led to choosing weaker candidates because of their loyalty to Mr. Trump. In the end with a large turnout of voters on both sides the election was much tighter than expected. Democrats in each state did better using their own initiative and effort this time and were much scrappier in the fight for the Governors races and the Senate.

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This report in WSJ looks at the Biden education, healthcare and climate change plan. It is part of the Families and Workers Plan put forward by president Biden for $3.6 trillion. This figure has now been lowered to $2 trillion and may drop crucial provisions for education such as the cost free community college which poses serious risks for working class families unable to afford community college, and skews education access even further to higher income families. It also lowers college attendance of American men, which is falling to alarming levels. The reason the plans are being whittled down is the 50-50 split between Democrats and Republicans in the Senate and the failure of Republicans and two Democrat senators Manchin of West Virginia, Sinema of Arizona to support community college access. Parts of the current bill support child care, access to affordable housing and in home care for elderly Americans. New elections for Senate and House of Representatives in 2022 would have to settle the issues related to financing assistance for families and workers as the Senate today is divided 50-50 between Democrats and Republicans. A separate Bipartisan Infrastructure package has the support of all in the US Congress to build bridges and roads, other infrastructure badly neglected by different administrations over the last 2 decades. ...

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John Cochrane, professor at the Booth School of Business, University of Chicago points to the simple truths about U.S. healthcare- out of control pricing because of the pathologies created by previous laws and regulations. He points out that costs are high in healthcare because regulations keep them high. Supply of new doctors is controlled because Congress and the AMA made it that way with a cap on residency programs and AMA opposing the expansion of medical schools. In a system of open competition new hospitals and health care businesses would challenge old ones which is not happening in a regulated market with regulations working to limit competition for the firms already in the business and with the influence to limit competition. Insurance costs for major expenses in an open and deregulated competitive market without the regulations would be so much lower than todays costs that its likely we would not even need a mandate such as the one the Obama healthcare law imposes.

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Rappaport of the NYT asks how it is possible that the U.S. Treasury is critical of the EU Commission's ruling that Apple pay back $13 billion in taxes because of its low tax rate of .005% in Europe, when Treasury is strongly critical of tax avoidance. The negligible tax by Ireland, base of Apple operations, is seen as a state subsidy not available to competitors. It also, as the EU Commission says, does not correspond to economic reality because the revenues are mostly made outside Ireland. An arrangement that is basically a strategy of tax avoidance. Today the leading candidates for president, Trump and Clinton, the major parties, and Congress, all are critical of tax avoidance strategies which deprive Treasury of much needed revenues. Restoring upward mobility is a priority today and programs to provide tution free access to public colleges, healthcare access, and infrastructure development, require public funding. Then why is the U.S.Treasury critical of the EU ruling? It is because Treasury sees this as money that should be coming to Treasury not the EU. However Treasury has failed to make this clear. The Financial Accountability and Corporate Transparency Coalition's Clark Gascoigne, calls it very ironic. And other experts say the money would not be coming to the U.S. anyway unless a low tax rate induces Apple to repatriate profits to the U.S. One expert calls it hypocritical. Senator Schumer says he agrees with Paul Ryan that tax legislation for a low tax rate for repatriation of profits back to the U.S. should be the next step, so that an infrastructure fund can be setup. Senator Levin and transparency advocates sees the EU action as normal and to be expected, as the anti-establishment sentiment today comes from such dealings that create the impression that the system is rigged in favor of some corporations. ...

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Samuelson points to the risks to the American economic growth from excessive health care costs. This is hurting take home pay and shows up in consumer spending. It is hurting government spending in other areas such as needed infrastructure spending and efforts to reduce the deficit. This hurts private capital investment to create jobs because of lower demand from constricted consumer spending. The U.S. budget has as its largest single expense 27% on health care compared to 20% on defense the next largest expense, with growth in health care spending taking this to one third of the budget in coming years. Without addressing health care, says Samuelson, the Supercommitte in Congress even if successful at deficit reduction will basically have failed to do its job, and it did not have the time, resources or conviction to do this. According to a new study from the Organization for Economic Cooperation and Development (OECD), U.S. healthcare spending per person is $7,960 per person in 2009. This compares with Norway $5,352, Britain $3,487, France $3, 978, an OECD average of $3,233. Life expectancy in the U.S. is 78.2 years, compared to Japan 83 years, OECD average of 79.5 years. Chile and the Czech Republic have life expectancy equal to the U.S. Except for cancer care where the five year survival rate is 89.3% in the U.S. and the OECD average is 83.5%, the U.S. lags far behind in much needed critical areas such as diabetes and asthma. Rates of emergency hospitalization for asthma are 3 times that in France and 6 times that in Germany and Italy. The U.S. has fewer doctors per thousand population and higher cost per medical procedure- with more frequent use of the costliest procedures- creating a supply shortage that induces higher prices, and less preventive and early action care through physician visits. The number of practicing U.S. doctors is 2.4 per thousand population in the U.S. compared to 3.1 per thousand for the OECD average; and number of annual doctor consultations 3.9 per capita in the U.S. versus 6.5 for the OECD average. Appendectomy cost $7,962 in the U.S., $5,004 in Canada and $2,943 in Germany. Coronary angioplasty cost $14,378 in the U.S., compared to $9,296 in Sweden, and $7,027 in France. Knee replacement cost $14,946 in the U.S., $12,424 in France, and $9,910 in Canada. Knee replacements, angioplasties and MRI exams are twice as common in the U.S. compared to the OECD countries. ...

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US House Republicans are pursuing cuts in spending of as much as 50% in many programs that are considered essential, such as a 50% cut in foreign aid at a time of global food insecurity, deep cuts in the FBI's counter intelligence budget, deep cuts in healthcare services and housing to low income Americans following the pandemic and high inflation, and other cuts to services benefiting workers and families. Democrats in Congress and president Biden oppose such cuts and hope to eliminate the deficit with cuts that do not place an unfair burden- taxes on the wealthiest with over $100 million and on stock buybacks would generate about $2 trillion to cover the whole deficit which is in the range of $1.4 trillion in 2023 moving to $2 trillion a year. Much of the Republican plan is being shaped by Mr. Trump's former Budget Director, Russell Vought, says this report in the NYT. Mr. Vought calls it an attack on the bureaucracy and woke spending. Other Republicans see this as an ideological approach that does not address today's problems. Chuck Schumer, Democrats Senate Majority Leader asks Republicans to spell out their plan. ...

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"I’m going to make sure that the richest among us, who can afford it, pay their fair share in taxes. It is not right that teachers and nurses and firefighters are paying a higher tax rate than billionaires and the biggest corporations, and I plan on making that fair.” Kamala Harris will finance child care tax credit, aid to small businesses and for first time home buyers, homecare for seniors, and other benefits by everyone paying their fair share and from savings in what Medicare pays out. "When you talk quietly with a lot of folks in Congress, they know exactly what I’m talking about because their constituents know exactly what I’m talking about. Their constituents are those firefighters and teachers and nurses.” For three Reaganite decades America has neglected access to all for child care, education, healthcare, seniors care, the very things that makes America a strong Nation, a Nation where the future belongs, going against the warnings of George Washington in the Draft of the First Inaugural in 1789 that - "I rejoice in the belief that intellectual light will spring up in the dark corners of the earth...That mankind will reverse the absurd notion that the many are made for the few." Absurd notion it was in 1789, absurd notion it is now in 2024. ...

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Progressive caucus in the US House of Representatives led by Pramila Jaypal, a first time Indian American Congresswoman defeats an attempt by Josh Gottheimer of the Problem Solvers caucus to separate much of the president Biden's agenda in health, education and social policy and risk it being defeated by Senators Manchin and Sinema in the US Senate. Without the efforts on child care, education and health, climate change and social services part of the Biden Workers and Families Plan much of the Biden agenda would remain unfinished and Democratic party promises not kept. This also means that Manchin a Senator from West Virginia with a population of 1.8 million and Arizona with a population of 7.2 million, both conservative leaning Democrats could sink the entire agenda of president Biden to support American families and workers for a population of 331 million people. That two states with a population of less than 3% of the American population could sink the entire agenda of president Biden shows how fragile a situation has been created within the Democratic party to support workers and families even during the pandemic following the leadership of Carter, Clinton, and Obama Ms. Jaypal, a three term Congresswoman from Seattle, Washington state, was first elected in 2016 with an endorsement from Bernie Sanders who was the Democratic Party's leading candidate for president till the late stages of the 2020 US presidential primaries. Bernie Sanders says of Jaypal- "I think she is doing an extraordinary job. And I think the Progressive Caucus is doing an extraordinary job." Sanders founded the Progressive caucus after getting elected to the Senate from Vermont 30 years ago. Even though it is hard to imagine the Democratic party being the Democratic party without bold policies in climate change, affordable housing, reducing income disparities,  investing big in childcare, education and healthcare, attempts were being made to sink the entire Democratic party and national agenda going back to Franklin Roosevelt. Jaypal is described in the WSJ as diplomatic and firm, saying "I am so proud of our caucus; I have never seen our caucus so strong. And I am a very good vote counter also." Fifty members of the 100 member Progressive Caucus held firm in support of president Biden's original agenda without which the president would have little to show in keeping promises he made to the American people in the election and little to differentiate him from Mr. Trump who also supported infrastructure spending. Separating the infrastructure bill would have risked sinking Mr. Biden's plan for recovery of America from the pandemic and the devastating policies pursued by American presidents in the last two decades. Policies by previous presidents that have impoverished the country, created huge income disparities, weakened America in the world in trade and technological leadership, and wasted resources in foreign wars. There are no centrists or far left- these are just labels. When Ms Japal said "Let's just remember the Speaker (Nancy Pelosi) is a great champion of this agenda. I think she was trying to do as much as she could to get this done," she could have said it is Mr. Biden's own agenda pushed forward with conviction to help workers and families during the pandemic, and build a solid American recovery, restore American leadership in the world. Pramila Japypal is the first Indian American woman in the US Congress, and one of only two dozen naturalized American citizens in the US Congress. That she could play such a critical role for good in the US Congress shows that with the right convictions, determination, experience, much can be done for the common good in America and the world.   ...

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It is not a story that most people grasp or understand- the long term effects of the US immigration surge of 2023 and its source mostly from Venezuela. The  US Congressional Budget Office says labor force in 2033 ten years from now will be larger by 5.2 million people and younger as a result of the immigration surge in 2023 from about 1 million immigrants each year in the 2010's to 3.3 million. About 2.5 million crossed the southwestern border in 2023. Much of it the result of the collapse of the Venezuelan economy and its middle and upper classes leaving the country. This was worsened by the US sanctions on the Maduro government including under president Trump, say experts in an adjoining NYT article on the 7 million people who left Venezuela to go to Colombia, Peru, Ecuador and Chile since 2012, then making their way up the Darien Gap to the US. Something that could have happened under a Republican president if the US Congress could not reach bipartisan agreement on correcting asylum and parole policy. As a result of this surge US Gross Domestic Product  in 2033 will be 3% larger. When the large Asian economies are seeing a aging workforce, Japan for the last decade and China now following Japan, the US labor force will be younger than it would be without this unusual surge in immigration of the last 2 years. The federal deficit will be smaller at 6.4% instead of 7.3% in 2033 as immigrants will pay taxes on income. Another aspect of this larger infusion of immigrants is that after the pandemic shut down immigration entirely there were severe shortages in the hospitality and restaurant, construction, healthcare industries. And with the trillions of dollars in investment that the Biden administration is making with more factories - this will absorb most of the immigrant surge by 2033. With some positive effects in the competition with rising Asian economies China and India. Particularly consider with the younger demographic India of 1.4 billion people. It will mean more factories can be built in the US and there will be workers for these factories in the US at wages that keep the US economy competitive years from now in 2033. This is a sobering aspect of the current situation viewed from what will be seen by America's younger generation. And under the bipartisan compromise in Congress correcting asylum and parole policy that was shut down by the former president, Republican senators understood very well that the immigration surge of 2023 would have some constructive effects for the long term, while its effects on the short term would be mitigated by Biden's commitment to close the border in 2024. This did not happen, yet the future for America's younger generation is bright under the Biden plan for massive investment in manufacturing and jobs in the US, and with the millions of immigrants needed to fill the jobs that investment will create by 2033. It will make America with a younger work force than Europe or China, only India having a younger workforce in 2033. ...

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The Federal Trade Commission says food companies in the U.S. spent $2.3 billion in 2006 for advertising to children. With the epidemic in childhood obesity in the U.S., this raises serious questions about how product packaging, images and themes affect the eating behaviour of children. New guidelines have now been written at the request of Congress. They were written by the F.T.C., the Food and Drug Administration, the Agriculture Department, and the Centers for Disease Control. The regulatory agencies say they will take comments and consider changes before submitting a report to Congress. The guidelines call for foods advertised to children to include healthy ingredients such as whole grains, fresh fruits and vegetables, or low fat milk. The foods cannot contain unhealthy amounts of sugar, saturated fat, trans fat and salt. The sugar requirement would have cereals contain no more than 8 grams of added sugar per serving. Fruit Loops for example contains 12 grams of sugar per serving. The guidelines apply to both children and teenagers. However these guidelines are voluntary. At this time an industry led effort has not produced results. The Children's Food and Beverage Advertising Initiative, which is operated by the industry, lets each company set its own nutritional criteria. The regulatory agencies see the need for the food industry to follow a uniform set of standards. Without serious action on this issue the U.S. healthcare system will continue to be burdened with high rates of obesity related illnesses in the general population, and out of control costs. And the U.S. will continue to face the urgent problem of a lack of healthy eating habits of children teenagers, and adults....

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Experts say Chief Justice Roberts somehow found a path through in bridging the ideological divide and avoiding a show of partisanship in an election year. He somehow navigated and found a path through in his vote on the U.S. healthcare law letting it stand. Early on Roberts advocated "judicial modesty and humility" in jurisprudence. He compared the judge's role to that of an umpire in baseball during the 2005 confirmation hearings. The umpire would not pitch or bat, his job would be to call balls and strikes. It was seen as a determmined show of independence at a time when Justice Kennedy was seen as the swing vote. He has also earned political capital to be able to vote independently on other issues before the court instead of becoming embroiled in controversy about the role of the Court in overturning the work of Congress during the early part of the Obama administration.

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The Medicare for All movement in the U.S. gathers momentum after the U.S. midterm elections with states. Governor Newsom of California says he will seek federal authority to setup a state single payer plan for health insurance. An expert at Georgetown University says there is a new burst of energy for broader coverage or universal health coverage. States with new governors or seeing this momentum are California, Washington, New Mexico, Maine, Nevada, Delaware, Oregon, Connecticut, Wisconsin, Michigan, Illinois. Polls show a large majority of Americans now support Medicare for All as a form of universal health coverage for all Americans, a system that prevalent in Canada for the last 50 years. Two hearings will be held in Congress on Medicare for All in 2019.

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The major provisions of the Republican House healthcare bill that passed by a vote of 217-213 are- 1. To help people buy insurance coverage the bill offers $2000 to $4000 a year, upto $14,000 a year in credits based mainly on age, reducing them for families making $150,000, individuals making $75,000. 2.  Under the Affordable Care Act insurers cannot charge older Americans more than 3 times for same coverage they offer to younger people, the new bill makes this 5 times. This would increase premiums for older Americans and reduce it for younger Americans. This is the most controversial part of the bill. Older Americans supported the Republican party in the presidential election. 3. The new bill ends Medicaid as an open ended entitlement and places this on a budget with cuts of $880 billion over 10 years. 4. To mollify conservative Republicans a provision allows state to opt out some provisions of the ACA that requires minimum benefits such as maternity care and emergency services. It retains coverage for pre-existing conditions to mollify moderate Republicans. The bill provides states with $138 billion over 10 years to subsidize premiums, provide coverage for pre-existing conditions, mental healthcare and drug addiction. 5. The bill removes the taxes imposed under the Affordable Care Act (ACA) on high income people of about $300 billion over 10 years by repealing a payroll tax increase and tax on investment income. This bill and the ACA offer 2 competing visions on healthcare, both bills passed only by a margin of 4-5 votes in the House. The ACA overlooked the impact on premiums causing discontent among middle income Americans. The new bill lets premiums rise for older Americans in order to keep premiums down for other Americans. This shows the many tradeoffs involved and choices being made, and the lack of a consensus on the issue of healthcare in the U.S., becoming a highly politicized issue instead of the way it is treated in western Europe.     ...