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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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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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This month president Biden signed into law 100% tariff on China made EV's and 50% tariff on solar panels. The Guardian describes the hollowing out of factory towns in England such as Sheffield and the same in the US and Europe, which was a disaster for these communities dependent on manufacturing. There is now a sense that heavily subsidized products made in Asia should not be allowed to deindustrialize the US and take jobs away from these communities across the US. Trade has to be fair before it can be called free trade. Wars in Asia,  trade that ripped up American manufacturing, monopolies and burdensome pricing of pharmaceuticals and healthcare, lack of investment in infrastructure and public services, shows the deeply flawed policy pursued by presidents from Reagan and Bush to Clinton and Obama that have reduced the standard of living of the American worker and the American people.

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Elizabeth Rosenthal looks at Obamacare's contribution to cost containment in 2013-2014. Rosenthal says its is a kind of delicate maneuvring at the edges, because serious work needs to be done. The fee-for-service and many of the drivers for increases in medical costs, the old system of pricing, are still in place. In 20 years at the current rate and after Obamacare health care will still take 25% of the U.S. budget if nothing is done. Healthcare costs are about half that of the U.S. in some of the advanced European countries. She calls Obamacare a trickle down theory of cost containment becaue it leaves most of the drivers for cost increase in place and works at the margins. Princeton economist Uwe Reinhardt calls it an ugly patch on a somewhat ugly system. Rosenthal cites the armies of consultants anticipating every move to reduce prices, and working on "strategic billing'' to increase revenues for hospitals and doctors. For those who say the prices are now up more slowly than in the past, Michael Chernew of the Harvard Medical School, has this to say- its like a diet, reminding us that that we haven't even lost weight, just gaining weight slower than before. ...

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Compare the presidential election spending in France and US one sees a huge, really huge difference. In France by law the first round it is limited to 16 million euros and second round to 22 million euros. Companies cannot donate and maximum donation is euros 4600 per year. All candidates must be given equal time by networks after official campaigns start usually March 28. If you get 5% of the presidential vote you get about 48% of the $22 million ceiling and if not only about 5%. Its a fairer system considering about $5 billion will be spent in US presidential election 2024. It keeps out lobbyists and donors looking for silent favors as the pharma industry and the tech industry in the US that has prevented any legislation on fair drug pricing or oversight of the monopolies of Apple, Google, Microsoft, Amazon, Meta and others, taxation of profits of tech and fossil fuel companies, or passage of healthcare for all. Indian elections cost of 1.35 lakh crores or $13 billion in 2024 are also similar to the US with parties spending leading to much corruption in the democratic process and defeating its best character.  ...

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One perspective of what Silicon Valley is focused on is shown by Reid Hoffman. It does not mention climate change, not one word on climate change, no words on cost of living action, little is said about factories and jobs for reviving American manufacturing, helping workers and families and redesigning the world's supply chains. It is critical of addressing monopolies and regulatory action by the FTC even where it is needed. It calls for huge investments in AI that would leave little for investments in science, education, healthcare and infrastructure, and says "trust us to do the right thing." It calls for pro-innovation direction when pro-innovation has been the thrust of policy for three decades with the results that we have seen leading to widening gas between the upper and lower classes and shrinking of the middle, a pharma industry out of control in pricing, and negligible investments in education by so called "tech" companies who like Apple have outsourced manufacturing to China. A return to tech and Silicon Valley is not needed as embedding it in the nation's policy making priorities is the Nation's problem. ...

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Brooks says no to the current health reform bill as most experts say it does little to control the bulging healthcare cost curve which will take it from 17% of GDP to 22% and beyond. He goes over the pros and cons. Passing this gets little done for health care reform in a fundamental way that is so badly needed today. Says Brooks the system today is rotten to the bone with opaque pricing and insane incentives, with consumers insulated from the costs of their decisions, this won't change with the current health care bill. In fact he says according to the chief actuary for Medicare it will cause health care spending to grow faster. At this rate we will be giving more money to insurance companies and programs that have great social value like expanded preschool and other needs that America has will be shoved aside. In coming years as the population of America ages there will be growing needs for health care. With no increase in supply, and the perverse incentives still in place, prices will continue to grow rapidly without the focus on efficiencies that is badly needed. Brooks points out that its not the politics is the chief obstacle to reform as most people say, but the reverse is the truth, unless one gets the fundamental incentives right politics will be terrible forever. ...

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EpiPen's price has jumped 550% over 8 years. Mylan Pharmaceuticals is dominant in the $1 billion market for treating serious allergic reactions. Mylan acquired reights to sell EPiPen in late 2007. A pack of two list price is now $608.61. Last Nov. Sanofi's competing product Auvi-Q was recalled giving Mylan price dominance. A problem for consumers is that EpiPen expires in one year. Mylan launched a campaign to make parents aware of the product for children with peanut and other allergies, and also lobbied the governments to make ready supply of EpiPens available in schools and other public places. Now the controversy over price increases, with Hillary Clinton citing this as an example of exorbitant pharmaceutical pricing, is likely to change the environment around EpiPen and other overpriced drugs or healthcare products.

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In a new twist drugmaker AbbieVie will bring out less costly versions of Humira in Europe where its patents have expired and still keep the U.S. market at higher Humira prices using a thicket of patents. Reports show pharmaceutical drug pricing as a major issue in U.S. midterm elections. Biologic drugs are costly. In this case Humira will sell at a 10-20% discount in Europe. Abbie Vie countered by getting hundreds of new patents in the U.S. to continue selling at high prices.

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Under a new program to increased spending on healthcare from 1.3% of GDP to 2.5% the Indian government plans to provide free pharmaceuticals at state run hospitals. This is expected to cost $5 billion over 5 years. Initially 350 drugs would be on a list of essential medicines and would be purchased from generics manufacturers in India. Dr. K. Srinath Reddy, heads the committee advising the Indian government on healthcare. He says this will help improve access to medicines for the vast majority of the people. Estimates show 70% of out of pocket medical costs for Indians come from spending on drugs. About 40 million people are pushed into poverty each year because of the high cost of medicines, says Dr. Reddy. He said that in 1984 31% of the medicines at government run hospitals were provided free to admitted patients, dropping to 9% in 2004. For outpatients this dropped from 18% to 5%. The free medicine program would be part of a larger universal health care program to be introduced over the next decade. India's large generics pharmaceutical industry makes the provision of free medicines on a large scale a feasible option in India because of the lower prices, with additional pricing advantages when purchased in larger volumes by the government. This would also have a major impact on the quality of healthcare in the country of 1.2 billion people for a relatively small investment. It also promotes a sense of fairness and equal access because the benefits of decades of modernization have been unevenly distributed and because of widespread poverty....

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This editorial in the Wall Street Journal says faster approvals at the Food and Drug Administration have helped bring more generic drugs to market lowering prices for the public. In 20 months the Trump administration approved 1617 generic drugs, 81 a month on average or a 17% increase over the preceding 20 months. Council of Economic Advisers in October said this was a saving of $26 billion for the public.

President Trump is looking at price controls as a way to bring down drug prices. With increasing outcry about high drug prices in the U.S. the Trump administration and Democrats in Congress are looking for new approaches to bring down prices.

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A health care practitioner says the real problem is the high cost of medical care in the U.S. when compared to other countries. She points out that the Obama bill in 2008 did not take effective steps to bring down the cost of health care before enacting legislation to cover the uninsured, leading to higher premiums for the middle class. The link between healthcare and profits is seen as the main problem. 

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Are high prices for pharmaceutical products and healthcare services putting a severe burden on U.S. finances and defunding education, infrastructure, R&D in new technologies, which provide the underpinnings for future U.S. competitiveness? Yes say experts. In 2009 Americans per person cost of healthcare was $7,960. By comparison Canada was $4,808, Germany $4,218, and France $3,978. And without necessary efforts for educating people about caring for health and preventive care, the health conditions of Americans are no better than these countries, and poorer in some dimensions. Klein says deficits would not be a problem for the U.S. if prices for pharmaceutical products and healthcare services in the U.S. were similiar to that of the largest developing countries. Experts say the Obama healthcare law simply postponed the addressing of this problem.

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As the coronavirus surges in India with over 300,000 cases a day on April 26, a clear picture on the vaccination drive in the country is critical. The following is the picture of the vaccination progress from Union Health Ministry in India as shown in The Hindustan Times. India has vaccinated 140 million people with at least one dose says this report in The Hindustan Times.  On Saturday 24th April 2.4 million doses were given for that day at 8 pm. This was done over 99 days. This means about 12% of the population of 1.2 billion has been vaccinated.  This compares with the vaccination in Germany for about 21% of people vaccinated with over 18 million getting the first dose in Germany by around April 25. Both Germany and India have suffered from vaccine shortages, some skepticism about vaccinations. Gradually sentiment is shifting in both countries so that once skeptical Germany now has about 75% of people willing to take vaccine on April 25, 2021. In India about 6 million healthcare workers have 2 doses of vaccine, and about 9 million have 1 dose. About 6 million frontline workers have 2 doses and 12 million frontline workers have 1 dose of vaccine.  There is a shortage of vaccine supplies and a bold decision was made by the Indian government on April 25th 2021, after the surge of cases to a world wide maximum of over 300,000 cases a day. The decision was to give immediate regulatory approval for the three major vaccines in the US to be brought and used in India. And delivery will be speeded up - no customs duties and fast processing of supplies access to speedy logistical supply routes. This is a huge step forward for the vaccination drive as this means Pfizer, Moderna and J&J vaccines can now be used in India. The government is also urging the companies to make in India or export to India with prices that provide flexibility in pricing for the private market. The locally produced Covishield Astra Zeneca based vaccine produced by Serum Institute will be allowed to be sold to the private market at 600 rupees or close to about $10. Pfizer and Moderna, J&J can price in a way that would be somewhere around this price range. The access to more vaccines and the ability of the companies to make a reasonable profit in the Indian private market means that vaccine supplies should open up in May and June.  This could give a huge boost to vaccination numbers so that India's vaccination percentage of population vaccinated should keep up with that in countries like Germany and France that were slower to get started in Europe but are now catching up quickly. This is a massive achievement because the population numbers are huge compared to Europe. ...

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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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NYT reports show the Republican health care bill AHCA 33 votes short of passing the House and likely to fail. Conservative Republicans were looking to whittle down the safety net in the Affordable Care Act, and moderate Republicans could not stomach the whittled down bill removing guarantees of essential benefits for instance. The basic problem- no real consensus among Americans about providing health care to all Americans, and no real solutions possible as long as there is acceptance of disproportionately high levels of medical care costs for treating each disease in the U.S. compared to Europe and other countries.

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According to the General Accountability Office inquiry, 28 drug products had price increases over 100% in 2000, in 2008 71 drug products had such large increases. Medicines like Adderall for attention deficit disorder, Inderal for chest pain, Sumycin for infections were in the list of 416 brand name drug products where makers or distributors raised prices at least once by 100% or more for period 2000-2008. As large pharmaceutical companies sold their marginally profitable drug products or small selling products to smaller companies, these smaller companies would immediately increase prices to recover the money they paid to the large pharmaceutical companies. 26 of the brand name products saw prices raised 10 fold. A third of the drugs with large price increases treat depression and disorders of the central nervous system.