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Flat payment rates for Medicare Advantage to Insurers by the DJT administration which is questioning how health care needs of the country remain unmet and US healthcare comparing very unfavorably with other advanced countries in Europe and Japan and also in India. Some of this is because of the behaviour and practices of the health and pharmaceutical industries in the US. The 2027 payment by government for Medicare Advantage is 0.09 percent. In 2026 it was about 5%. In 2025 it was -0.16 percent and in 2024 it was -1.12% under the Biden administration showing a great deal of dissatisfaction with funding Medicare Advantage. Medicare Advantage was set up by the Bush Republicans in 2003 who set it up with the nice sounding name Medicare Modernization Act. It was an effort to help the insurance companies with government money. Today in the second term of DJT in 2026 affordability is what American people care about most and the DJT administration is unhappy with the insurance companies. Dr. Mehmet Oz is in charge of Medicare and Medicaid Services Agency of the federal government and he says about Medicare Advantage and new policy to save “taxpayers from unnecessary spending (on Medicare Advantage) that is not oriented towards addressing real health needs.” The DJT Kennedy-Oz approach is for comprehensive digital information linking all medical providers, making America healthy again, cutting through the dense fog created over the last 2 decades, making pharmaceutical costs as affordable as the best in European nations, and refusing to subisidize if delivery is poor and health results are poor.   ...

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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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Insurance premium rise 2022-2025 is costly for employee wages with employers slow to increase wages when so much money is going into healthcare premiums for their employees. Each year employee premiums in the US have increased by 7% for the last 3 years. $27000 is the cost of health insurance premium for American family in 2025 which is exorbitant and shows a breakdown in the health system that is affecting the cost of living, the wages of workers, and the money left in the economy for other essential needs.

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Germany, the UK and Canada offer additional models for health care insurance that vastly improve results for dollar spent over the dysfunctional U.S. model. Here Jamie Daw take a look at the German social health insurance system which dates back to hte period of Bismarck in 1884. The German system is funded through progressive taxation which charges for healthcare based on incomes not on health needs.

About 100 nonprofit health insurers provide insurance and all Germans are required to have health insurance. Contributions to sickness funds are centrally pooled and allocated using a formula to insurers. Insurers can only charge small out of pocket fees limited to 2% of income annually. Sickness funds combine market power to negotiate lower prices.

Administrative and governance costs are 3% in Canadian system and 5% in the German system. 

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The U.S. House of Representatives votes to repeal and replace the Affordable care Act 217-213. Moderates were won over by an addition of $8 billion  to add coverage for a popular feature of the ACA that covered people for pre-existing conditions.  The bill that passed gives credits of $2000 to $4000 a year, depending mostly on age, upto $14,000 for a family. Credits are reduced for individuals making over $75,000 a year or families making over $150,000. There is no mandated insurance coverage. This trims the federal budget deficit, yet also is expected to keep 24 million more Americans without health coverage after 10 years. The bill now goes to the Senate where moderate Republicans are worried that this may increase premiums for older people, one of the drawbacks of the earlier version of the House Republican bill.

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A critical part of the Affordable Care Act is the setup of marketplaces or exchanges to let people without insurance buy individual health plans. Some states setup their own exchanges, and some states let the federal government step in and run them. To help the lower middle class and poor the Act provides health subsidies to buy insurance in the exchanges, and 85% of customers in the exchanges qualify for this benefit. The U.S. Supreme Court voted 6-3 in 2015, compared to a tight vote in 2012 on the Affordable Care Act, to maintain the health subsidies. Justice Roberts wrote the majority opinion, saying "Congress passed the Affordable Care Act to improve health insurance markets, not destroy them." Justice Scalia dissented calling it "interpretive jiggery-pokery." Justices Clarence Thomas and Samuel Alito Jr. dissented. Voting in favor were Justices Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor, Elena Kagan, Justice Kennedy dissented in the 2000 case. The challengers petition to the courts was based on a reading of phrases in the Affordable Act which had not occurred to the writers of the law. The reading suggests only people enrolled in state setup exchanges are eligible for subsidies. If the Supreme Court ruled in favor of the plaintiffs the 6.4 million Americans who are enrolled in the federal exchanges would lose the subsidies provided under the law and lose health insurance. And the economic foundations of the Affordable Act would be undermined with insurance companies required to provide insurance to all regardless of pre-existing conditions and subsidies removed, leaving the companies with sicker pool of customers resulting in destabilizing the exchanges and higher premiums. The court ruled in favor of an interpretation that is compatible with the whole law and the intentions of the statute to help the middle class and the poor buy health insurance. The chaos in the insurance markets that would result in going with the plaintiffs because of a careless writing of a phrase, was uppermost in the majority's mind. Chief Justice Roberts emphasized this, saying- "The statutory scheme compels us to reject petitioners' interpretation, because it would destabilize the individual insurance market in any state with a federal exchange and likely create the very 'death spirals' that Congress designed the act to avoid." This case originated with 4 plaintiffs from Virginia who challenged the IRS regulation that said subsidies were allowed regardless of whether the exchanges were run by the state or the federal government, arguing that this was at odds with the particular phrase in the law that was ambiguous about federal exchanges eligibility for health subsidies. Judge Roger Gregory of the Fourth Circuit Court of Appeals in Richmond, Virgina, ruled that the phrase was indeed ambiguous, but the IRS was owed deference in its opinion. Chief Justice Roberts made it clear that this was not a case for the IRS, saying "it is instead our task to determine the correct reading." ...

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The details of a $2 trillion rescue package for business, the economy and households which was passed in the U.S. Congress. The U.S. government plans to take stakes in airlines in return for assistance. Some of the aid $25 billion is in the form of direct grants and some $25 billion in the form of loans. This is how it breaks down in the legislative text as shown in WSJ. To keep businesses open and from laying off employees- $454 billion loans for large companies, and $349 billion for small business loans. Safety net for families. Payments directly to households $301 billion. Unemployment insurance payments $250 billion. Support for the public health systems in states, and private health systems to tackle the health crisis and meet new needs of $117 billion. Aid to states  $150 billion To maintain flow of goods. Direct grants to cargo carriers and airlines of $29 billion. Other $198 billion.     ...

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The WSJ looks at Elizabeth Warren's Medicare for All plan that marks a major shift for the U.S. economy.  Households would see their costs go down by $11 trillion, boosting their ability to spend on other goods and services. Because income and wealth was highly skewed in the past three decades in one direction, the spending capacity of lower and middle income households was pushed down. This and other similar plans would help restore a higher level of spending and with it an essential element of inflation of 2-3% to the U.S. economy which was missing in the last decade. This sets the tone for the kind of broad based recovery that happened after 1950 that strengthened America's middle class and made it the core of the economy, the core of the post World War II recovery in America and Europe. The plan would be paid for by higher taxes on corporations, tax rate of 21% for corporations going back up to 35%, and reverse depreciation schedules in the 2017 Republican tax law. The argument that this would reduce business investment does not hold that much says the WSJ because amid new trade tensions business investment has declined over the last 2 quarters, and has been sluggish overall. The other source for the estimated $13 to $20 trillion cost of Medicare for All plan of Elizabeth Warren is a 6% annual wealth tax on billionaires, in an attempt to have all pay their fair share and reduce wide disparities in wealth. Mark Zandl, chief economist of Moody's Analytics, says his sense is at the end of the day from a macroeconomic view- because $11 trillion in the hands of 80% of households who could boost spending after lagging behind in the last decade- the negative effect on business investment will be cancelled out by the higher consumer spending. The overall effect and today's context is infused in this analysis. Private insurance, premiums for insurance, and out of pocket cost that the public pays would disappear in this new system where all health payments pass through the government. Health insurance premiums paid by employers would convert into a new employer Medicare contribution to the government starting at an amount employers pay now and adjusting gradually toward national averages over time. Smallest businesses are exempted. Mr. Zandl says the most important aspect of this now is that Mrs Warren has shown that her plan's revenue sources match the cost so that the plan would not lead to deficits increasing and pushing interest rates higher, leading to negative effects on the economy. Republicans under Mr. Trump have paid little attention to expanded deficits caused by their tax law, and economists across the landscape have also shown less concern. Still attacks are made if the plans don't add up. For this reason a sound assessment in today's context of depressed consumers and an overall impact becomes essential. The WSJ quotes from a pre- assessment of Warren's plan by Simon Johnson, a Massachusetts Institute of Technology economist who co-wrote it with Mr. Zandl and Betsey Stevenson of the University of Michigan. What they point out is that putting cash in the pockets of the lower and middle class for spending makes a lot of sense today, and taking money out of the pockets at the way upper wealthy end,  does not contract the economy at all. Other effects they say are constructive by letting all workers get health coverage from the government instead of employers, this makes it easier to change jobs increasing labor mobility and productivity. A worker getting a better job and better utilization of skills could then shift without looking at the employer health care plan. Warren says there would be a five year transition so that workers in health care insurance industry can work in other insurance fields and in Medicare, no one would be left behind. The important thing being to build America's middle class again. ...

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One in six dollars generated by the U.S. economy goes to pay for health care, almost twice the average for rich countries. It hurts America in many ways; by being a burden on the taxpayer when it comes to Medicare and Medicaid paying for the poor and the elderly, on companies being one reason GM went bankrupt, it eats up federal and state budgets, rising costs make any form of future coverage for all unsustainable, and it robs other priorities such as infrastructure building and other national scale investments. The Economist says that if it had to design a system from scratch, it would go for a system based mostly around publicly funded health care. For the uninsured the solution of an employer mandate is now well accepted, so this is not an issue. What is an issue is how to make the new system affordable? Here the Economist says that whether in stages or in one move, the tax deductability of employer paid health insurance, which is costing the U.S. government $250 billion ayear, has to go. It is necessary to remove this deduction, and its something all interests involved will have to swallow, as other savings are smaller and will not be adequate. The deductability of insurance makes the true cost of insurance transparent, so it supports gold plated insurance. This does not make cost control the pressing priority it needs to be. So the deducatability of employer paid health insurance hurts both ways. The other necessary action is in the area of moving out of the current culture where most doctors work on a fee-for-service basis, where the more tests they prescribe or procedures they perform the greater their incomes. This acts as a perverse incentive, and has aruinous effect in mushrooming health care costs in America. Cutting back on unnecessary tests and procedures, and prescriptions , would save 10% to 30% of health costs says the Economist. And it says this has been proven with the Mayo Clinic in Minnesota and Kaiser Permanente in California showing that cutting back doesn't hurt care and outcomes., so much so that cutting back would occur along with improved outcomes. But Americans with employer paid insurance just take things for granted as its not much out of pocket expense for them. THis creates the lack of a force for controlling costs even as employers are shouldering abigger and bigger burden, and the employee who thinks he is doing fine actually is seeing more of his salary dollars going to pay for his health insurance. In a way the consumers of health care are stuck with the perception that they are not somehow paying for these mushrooming costs and too manytests, procedures and prescriptions. This perception leads them a false sense of comfort with the system they are in, and a fear of something new fanned by the medical lobbies, that any change will impact users negatively. This makes the whole discussion on health care or the process of finding solutions to become an exericize in which terms like "rationing" and "choice" play a distorting role. ...

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A WSJ study showing the plans offered under the new U.S. Health Care Law in the state of Oregon. For young people ages 18-34 earning about $17,000 and uninsured the law offers a bargain with insurance premiums monthly at about $52 and deductibles as low as $100, because of higher subsidies. The situation changes at incomes of $29,000 when the deductibles are about $6300 and the premiums per month at about $147 a month, because subsidies are much smaller, or deductibles dropping to $2500 at $172 in monthly premium. The federal subsidies disappear for single people under age 30 earning much more than $26,000 because of the way the law places them to specific plans on each state's exchange. According to the U.S. Department of Health and Human Services, there are 11.6 million people in the U.S. ages 18-34 who are uninsured. The federal government has to get as many of these people to get insurance so that the cost of medical care for the elderly can be supported.

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This NYT report shows the extent of frustration with delay, dispute and denial as a practice in the US health insurance industry. Much of the comment in social media focused on this frustration. Between 2020-22 the number of denials doubled to 25% for UnitedHealthcare in its handling of claims by patients.

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Medicare Supplemental insurance (also called Medigap) covers out of pocket cost that are not covered by Medicare Advantage. Over long period of retirement thes plans offer the best protection from unanticipated costs. The Plans use alphabetical leters A B C D F G K L M N with F discontinued. And are standardized, meaning regardless of insurer or state you are in they are the same being set by the US federal government. These plans are sold by private insurers the largest being AARP plan by United Healthcare. One can join when enrolling for Medicare Part B when premiums are usually better yet one can also join afterwards. About 36% of Medicare holders have Medicare Supplemental or Medigap policies for health insurance.

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Under a plan called "premium support" Paul Ryan's U.S. budget proposal would have seniors choose a private insurance plan from a federally operated exchange. Each year the government would pay private insurers a specific amount to cover the cost of premiums with the rest borne by seniors. The total amount paid by the government would go up only at the rate of overall inflation, it would not go up at the higher rate of health care inflation. By doing this the government would take off the trillions of dollars of projected spending on health care that are largely the result of the higher inflation rate in health care costs. This higher inflation rate on health care costs is something that both parties have failed to control, and remains a major weakness in all health care proposals to date, including the Obama health care legislation. Allowed to continue growing at this rate when U.S. debt to GDP is nearing 100%, health care inflation costs pose major risks to the nation's finances.

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Obama ACA subsidies to go directly to the people through Health Savings Accounts proposed by Republican Senators Graham, Scott and Cassidy in 2017, and again in 2025, and not to Insurance companies. In a post on his social media site DJT tells Congress that the ACA subsidies given directly to people rather than money sucking insurance companies would lead to a better result of people getting their own and better coverage for less money than under Obama type subsidies sent to insurance companies.  Much of Obamacare was done under a campaign from insurance companies and other health vested interests that undermined the original objectives so that however good the original objectives the watered down, disincentivising of reducing unproductive costs, led to a hotch potch band aid result. A common sense approach with the courage to get the right result that works for the people of the Nation to get good health care similar to Japan and other nations in Europe at reasonable cost is not a goal that an advanced nation like the US should see as unreachable or beyond our efforts, skills and wisdom. Obama and Bush failed, Bush in a major error to remove the negotiating power of government Medicare agency with pharmaceutical companies that Democrats failed to push back. ...

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Mayo Clinics 18 month long effort with 400 health policy experts working on the panel has a set of recommendations for the Presidential candidates. It suggests a private system with private insurance companies offering many options and nobody can be turned down. Those least able to afford it would get government help, individuals would pay for the insurance with some help from employers. Since once insured its not dependent on employer its permanent, changing a job would make no difference at all. Interestingly most of the panel experts cited here from Verizon, the Heritage Foundation and others all agree that the present system is coming to a close and a new one has to replace it with coverage for all Americans and a privately based system with contributions made by society and government, by all individuals, and also by employers. Mayo's study, the breadth of the number of experts participating (400 experts), the length of time to understand and come up recommendations (18 months), the respect the institution has among all sectors and groups, should give the consensus view of experts in the US, so that any future health plans do not simply get derailed by partisan opinion, controversy and lobbying....

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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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How the French health care system works. France comes in first and the USA 37th in aWHO health care ranking. THe difference in deaths from respiratory disease is half that in the USA, and lower rates of death from heart disease and diabetes. IT has more hospital beds and doctors per capita than the USA. 65% of French people are satisfied with their health system compared to 40% in the USA, and yet France spends 10.7% of GDP on health care and the USA spends 16% for poorer results. THe French system is more generous to its seniors. Unlike Medicare there are no deductibles, just modest co-payments that are often dismissed for chronically ill. And diabetes and critical surgeries are covered 100%. French also buy supplemental insurance like Medigap for extra expenses like dental and eyglasses. Cancer patients are treated free of charge. Avastin treatments costing $48,000 a year are provided at no charge. France's PMI or Protection Maternelle et Infantile, is rated highly. It is anetwork of thousands of healthcare facilities, that ensure that every mother and child in the country receives basic preventive care. Mothers even receive afinancial incentive for attending their pre and post natal visits. France makes this care affordable by reibursing doctors at a much lower rate. The average yearly net income for doctors is around $55,000, about athird of what doctors in the USA make. But French doctors don't have to pay back huge student loans as medical school is paid for by the state and malpractice insurance premiums are only a tiny fraction of that in the USA. And again the French government pays two thirds of the social security tax for most French physicians- which is typically 40% of income. So the $55,000, is more like $92,000 taking that into account and more like $110,000 when student loans and malpractice is taken into account at US levels. Specialists who have 4 or more years experience can charge what they want, but as one gastroenterologist says, there in an unspoken and undefined limit to what you can cahrge or what is socially acceptable. Yet even in France there is inflation in health care costs that the government deals with through price controls and more spending. The French national insurance system is running increased deficits each year and this is now $13.5 billion, and it has led to higher taxes for employers and workers. ...

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How artists, musicians are doing in Germany vs. the USA is shown here. In Germany funding for arts continues and a musician shown here continues as before with the same income and benefits. In the U.S. a musician with the same background has no work and has no health insurance for years. The contrast between two societies and cultures, between European concern for social cohesion and sense of sharing vs. a culture in America that helps some in society, and leaves out others. Where government of the people, by the people misses something called for all the people.

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

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The Affordable Care Act subsidies are basically a band aid approach to a fundamentally broken health care system in the US, says Washington Post Editorial Board on Nov. 1, 2025. The 22 million ACA subsidies will cost $350 billion over 10 years. Democrats have the government shutdown over this issue of extending Obama ACA subsidies where enrolment increased in the covid and Biden years with generous subsidies. The Washington Post looks at how we got here since 1945, decisions made about employer insurance plans that created a patchwork of plans from private sector and other plans outside it with perverse incentives and inefficient subsidies. It calls the system stupid, and politicians looking to the next 2 year midterm elections wary of addressing the whole problem in the proper way for a system that will benefit all the people of the US.

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Krugman points out the gains on three fronts evident from the Census Bureau report of 5.2% gain in median income of households in the U.S. He says the first is the growth in incomes of ordinary working class and middle class families, second the large decline in the poverty rate, and third the further rise in insurance coverage in 2015 for people without health insurance. He points to the steady efforts of the Obama administration to improve lives of ordinary families as working based on the Census report though results have taken time, and could have been better. The Stimulus, says Krugman could have been larger following the blow of the 2009 financial crisis and increased unemployment at the time. Janet Yellen at the inequality conference of the Boston Fed in 2014 pointed out the problems of 62 million households having net worth of about $10,000, and why this was running against the American idea of a better life for all Americans. In that sense the Census report is a movement in the right direction but a lot remains to be done.   ...

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The U.S. Census Bureau shows incomes of American households, the median household income, surged in 2015 by 5.2%. This increased by $2800 to $56,500. This is the largest increase since 1967. It shows that steadily improving employment and hiring is leading to improvement in incomes for the middle and working class. Ris in minimum wage has also helped . The largest increase was for the lowest 20% of the income tiers. Full time working women did better than men, with increase annually of 2.7% for women, and 1.5% for men. Nocitizen incomes increased 10.5% to $45,100, native born households went up 4.4% to $57,200. The number of people without health insurance also declined from 33 million or 10.4% of the population to  29 million people or 9.1%. Another way the changes are helping lower income households is the decline of the official poverty rate to 13.5% in 2015 by 1.2 percentage points from 14.8% in 2014. Through a series of small incremental steps the path is being set for a recovery of household incomes for the middle class and working class. A bright spot is that the improvement has affected all age groups, household types, regions and ethnic groups, though among full time workers women did better than men. In this recession older white men have had more difficulties getting back into the workforce. This is reflected in the political scene in 2015-2016 for the election season. ...

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The startling truth about health "reforms," - they won't control spending, and without that the whole system of health care will rapidly become unaffordable and unsustainable. Obama's Council of Economic Advisors points out in new report that since 1975 annual health spending per person, adjusted for inflation has grown 2.1 percentage points faster than overall economic growth per person. At this rate health spending which was 5% of the GDP in 1960, and is 18% of GDP today, would grow to 40% of GDP in 2040. Medicare and Medicaid would increase from 6% of GDP now to 15% in 2040, or equal to three fourths of federal spending. Employer paid insurance premiums for families which grew 85% in inflation adjusted terms from 1996 to $11,941 in 2006, would increase to $25,200 by 2025 and $45,000 in 2040. This would force employers to reduce take home pay. Samuelson says the uncontrolled health spending is singlehandedly determining national priorities, reducing discretionary income, raising taxes, widening budget deficits and squeezing other government programs, while it is producing large amount of waste in medical spending. See the link to Prof. Tyler Cowen of George Mason University in NYT, 6/14/ 2009, who cites the habit of doctors to write many expensive tests as one of the prime culprits in the wasteful spending. And in the process it delivers higher cost for lower overall quality of health for the American people. This at a time when many European countries provide live examples of doing it in a better way- lower cost, better health. The serious problem with the Obama health reforms says Samuelson is that it talks about restraining spending but may end up increasing spending. Its talk about controlling spending he says is good intentions, but based more on hopeful thinking, public realtions and risks becoming cosmetic reform. Because to really control spending will require coming to grips with its fundamental cause- hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, private or governmental. Such a system encourages doctors and hospitals to provide more services, expensive tests, favors heavy use of expensive medical technologies to increase profits, and for patients to expect them. Samuelson puts his finger on the root of the problem - there is no incentive and every disincentive for all the players in this game , doctors, hospitals and patients to seek reform of this system. For doctors and hospitals the hope would be that this cosmetic "reform" would leave the system basically unchanged, and patients to continue with a lifestyle and expectations that do not not acknowledge the fact that a lot of healthcare does not come from spending but from preventative care, education, good eating and exercize habits, and healthy lifestyles. And the uninsured are no exception, they would simply start consuming the expensive care for lower quality of overall health like everyone else. With this kind of situation confronting us, the views of Samuelson, and Professor Tyler Cowen of George Mason University, as welll as a growing chorus of informed public opinion on this subject, is that insuring the uninsured is a good idea, but doing it within the bounds of the present system, can only increase the costs. And too much is at risk, to rely on what Samuelson calls a scattershot of measures to control costs made up by Congress such as "evidence -based guidelines," "electronic record-keeping," "bundled payments to hospitals, to give the illusion of progress that won't make a serious difference. A sweeping restructuring of health care is needed, that would overhaul "fee-for-service" payment and reduce the fragmentation of care. It will also need what has not even be touched on adequately in the debate. This is the massive need for education in the schools about nutrition, eating, exercize, healthy lifestyles. It would also require opinion leaders in each field from sports and other fields to lead by example and with constant public presence, the media, and companies to form a partnership with private institutions to change existing eating habits and lifestyles that encourage obesity, smoking, fast food eating habits, large portions in restaurants....

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Jonathan Gruber, the MIT professor, who has done extensive modeling of U.S. health care systems. Gruber advised Massachusetts Governor Romney in crafting the health care law in that state. He also advised the Obama administration in crafting the health care mandate that requires all Americans to buy health insurance to keep costs down. Gruber estimates the number of newly insured Americans could drop to 8 million from an estimated 32 million if the Supreme Court strikes down the health care law mandate. The result he believes will drive insurance premium prices even higher.

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Leonhardt points out that public workers receive lower salaries and higher benefits than private workers. They are being paid in the wrong ways. For example with health insurance coverage that require little or no co-payment, which lead to overuse of healthcare services that don't necessarily improve health. Politicians and unions appear to have accepted this practice over the years. Public sector unions have blocked efforts to improve efficiency and find better ways of doing things from the classroom to work in government offices. Reforms in states such as Indiana have produced some results. But even these improvements do not address the magnitude of the problems facing the U.S. which stem from the public's desire to have it all- from large defense spending, public services, low taxes and no changes to Social Security and Medicare. Polls show Americans want to reduce deficit spending, but the same polls show Americans unwilling to make some difficult choices.