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This article in the NYT provides a look at the features of the Republican House Health Care Plan- Both the Affordable Health Care Act and the House Plan provide incentives for buying insurance- the ACA bases these incentives on income levels whereas the House Plan does not provide additional help for low incomes or elderly. Incomes at $20,000 would see a loss greater than  $2000 under the House Plan and as many of the elderly poor living in high cost areas may not have the resources to make up for this loss of subisidies they may forgo buying insurance or have insurance coverage that protects only in a limited way. President Trump has given assurances that all will be covered. For people with incomes of $50,000 or $75000 the loss of $2000 subisidies would also have some impact. At larger incomes or the well to do the subsidies are not handed out under either plan. Under the ACA the emphasis was on income levels and high cost insurance areas the subsidies were greater, under the House Plan the subisidies would be higher for the elderly compared to the young but very low income levels are not given additional help.     ...

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The NYT covers the GAESA tourism enterprise of Cuba (that operates independent of the government of Cuba) that overinvested in Tourism at the expense of agriculture industry and infrastructure during the Obama administration, leading to collapse with Trump's 2014 embargo on Cuba. GAESA controls about 50% of Cuba's economy, run by military and people from Castro's family.  That left 121 hotels built in the boom years of tourism at 30 percent occupancy. The Iberostar high rise hotel is one of these hotels that rises over dilapidated housing in Havana, the Cuban capital. The investment in tourism by the GAESA enterprise that runs about 50% of the Cuban economy is 13 times what is spent on healthcare and education, says the NYT. The Castro family, Raul Castro family, runs this business venture that was started when the Soviet Union as sponsor of Cuba had collapsed by 1991. The NYT says this 'devolved' the ideas and promise of the revolution. "Devolved?" What kind of word to describe a complete loss of faith, and enormous failure with severe hardship for the Cuban people? It means the whole idea of communism or Marxist revolution has been proven false, even as it survives in Mexico and parts of Latin America. One can be against the Batista regime- similarly against corrupt regimes in Latin America or Asia- that ruled Cuba before the Castro Cuban revolution and still look for better choices and alternatives than what Castro came up with as an answer to Cuba's needs. Much of Latin America is suffering from the same problems of dictatorships and turning to Marxist alternatives - particularly the alternative put forward by Castro in Cuba- that has also destroyed the Venezuelan economy with Chavez's turn to Castro's Cuban revolutionary slogans and ideology. That came up with temporary solutions for the poorer sections of society, yet failed badly for all sections of society in the long term. How else can one explain one fourth of Venezuela's population and about the same of Cuba's leaving the country, some of those who left the critical human capital that would form the core of the human input to combine with capital and technology for advancing the economy. If Cuba were like the Dominican Republic or other parts of the Caribbean to depend on tourism for its national income then would it not be better to have friendly relations with the US, the main source of tourism revenue. The Obama administration was only holding up a failed idea by holding out a helping hand to tourism in Cuba knowing full well that a change to a Republican administration would simply lead to heavy investments in tourism at the neglect of infrastructure, public services and the economy, of health and education, to become large economic losses. This is what has happened.  As China and India have proven and are proving there are no magical ways to economic development- the same route that was traveled by the nations of Northern and Western Europe with scientific advances, technological advances, have to be taken, the same route that was traveled by the US in its industrial revolution and building of infrastructure, that same route has to be taken by all nations. It does not have to take a time period of centuries as in Europe. The US accomplished it faster with new technologies and vast human and natural resources over 100 years, Japan in 50 years, China in 30 years. India in 25 years ongoing.There is room for intelligent solutions to problems, for speed and tapping into new technologies, yet the same inputs of land, labour, capital and technology have to be put together for development. For states or regions, cities, within China and India, the same inputs, the same access to foreign investment and new technologies is the only route to rapid development. Long range plans are set in motion, decades of stable efficient, clean governance is put in place, and alliances are built with the nations of Europe and with the US. This road is traversed though hard work as Japan and China have done, and India today is thoroughly engaged in. ...

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

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With the rushed approach adopted by the Trump administration not enough consideration was given to winning support in the House from 25 conservatives in the Freedom Caucus. Without their support the bill cannot be passed in the House of Representatives. The fight also includes one over what are essential health benefits including whether  maternity care would be included. As a result some moderate Republicans are also expressing opposition on the grounds that less people will be covered and fewer benefits will be provided under the Republican House plan called AHCA. President Trump has not involved himself in the details, and the bill comes very early in the first 100 days, leading to the perception that health care has become a partisan conflict without really grappling with the problems of high cost of health care and creating a solution that all can support. Democrats are seen as having made the same error early in Obama administration's first term. President Trump sees this as a much needed win with a drop in his approval ratings, making this even less of an effort to come out with a good plan.  ...

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The Republican House Health Care pLan in 2017 relies on tax credits of between $2000 and $4000 based on age. Under the Affordable Health Care Act the elderly poor in high cost insurance areas received additional help. These people would lose over $2000 per person and may forgo full coverage or coverage entirely under the Republican House Health Care Plan. A report by Standard & Poor's estimates about 2 to 4 million people who are in 50's and 60's not yet qualifying for Medicare might lose their coverage they now have under ACA. The Republican plan also gives incentives through tax credits higher for older people, $4000 for a 60 year ol and $2000 for a 25 year old. Under the ACA the insurers are not allowed to charge more than three times what is charged for younger people, under the Republican plan this goes up to five times. 

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

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Congressional Budget Office analysis that shows 14 million more people uninsured in 2018 under the Republican House health care plan, this increases to 24 million by 2026.

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

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This is an exceptionally humorous operating room story of Dr. Trump and Dr. McConnell by Kristof of the NYT. Sometimes humor tells the story- and Kristof does this using a story of a surgeon president Trump in the operating Room trying to address the concerns of the patient Janet, as he keeps telling her she needs a new heart with great benefits, great benefits, before she implodes or goes down failing. Flat out take the old heart out even if a replacement hasn't been found, believe me great benefits the surgeon tells her, just that the patient just isn't getting convinced as its happening to her. The analogy is with replacing a health care plan, not just the Obama plan, any plan without something to take its place. For a few days before this article by Kristof, the Republican effort to repeal the Affordable Care Act without having a replacement was presented as a good idea. Janet is like the three Republican women- Collins of Maine, Capito of West Virginia, and Murkowski of Alaska who wanted to keep the heart they had till a replacement was found, against the surgeon Trump's advice. In a way it is about politicians in the last decade who never had any discussions as they rushed through with their own agendas, as the Republican and Democratic health care plans were rushed through Congress with relatively little participation and debate to hear all viewpoints. ...

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

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Senators Mike Lee of Utah and Jerry Moran of Kansas declare their opposition to the Republican Health Care bill proposed by Senator McConnell. This decision by the two senators makes it impossible to begin debate on the bill. Earlier two other senators, Susan Collins of Maine and Rand Paul of Kentucky announced their opposition. This means the Republican health care bill has no chance in the Senate even after changes to the bill passed by the House of Representatives. Republicans have a thin majority in the Senate make it difficult to pass legislation. Collins met with residents in Maine and Moran with people in his home state of Kansas, and both senators heard a lot about the negative effects of the Republican bill on people in their state. The bill is seen as hurting people in rural areas, elderly, and not likely to do enough to bring down premiums. Its plan to slash Medicaid spending has drawn strong opposition from all Democrats.

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

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Elizabeth Warren's Medicare for All plan in the U.S. draws support from about 60% of people polled for the New York Times. Over 66% support Warren's 2% wealth tax on people with wealth over $50 million. The support is consistent among all groups, gender and race. Only a group of Republican men with college degrees which is likely to include the bulk of the people with wealth over $50 million oppose the wealth tax and Medicare for All. Over the past year wealth tax and Medicare for All support has grown with about 60% of people supporting Medicare for All, a plan similar to government plans in most of Europe and in Canada which have worked over many years.

Warren's plan wins support by showing how it will be paid for and why most people will pay no more than they are paying today, and overall much less because of unnecessary costs taken out of the system.

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The WSJ responds to president Biden ramping up renewable energy plans and linking Republicans with Senator Rick Scott's plan for sunset provisions on federal legislation every 5 years that Biden says would include Medicare and Social Security. WSJ is critical of Biden's renewable energy plans and calls for increasing production of oil and gas to meet energy shortages and price increases. It is also against a wealth tax, Biden's $2 trillion Workers and Families Plan, and Biden's plan for Medicare to negotiate drug prices. WSJ says real disposable personal income increased $4205 under the Trump presidency 2017-2020, and has since declined by $374 with high inflation depressing purchasing power. The impact of climate change requiring brave choices and strong action is missing in the Republican plan as Republicans focus on attacking Democrats controlling the presidency and Congress on the issue of inflation. The issue of remaking supply chains are on both the Republican and Democratic agendas with president Trump giving more rhetoric against China's role in dominance of supply chains and Mr. Biden taking stronger action in Theodore Roosevelt's style of carrying a big stick and quiet posture in restoring America as a manufacturing powerhouse. The impact of climate change is short term rather than long term as seen by the heat wave in South Asia today, the fires in North America and Europe. Republicans are losing sight of the importance of making the shift on renewable energy quickly with some short term pain, as they push for oil and gas solutions and a less effective program for renewable energy. Mr. Biden is taking on bigger risks in the short term in the midterms and beyond but following a sound policy of aggressively pushing renewable energy. This can also be seen in the importance renewable energy is being given even in countries with a need for coal and natural gas such as India. Modi's plans in India are to buildup renewable energy capacity with aggressive targets for 2030. ...

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Bump in the Washington Post cites the weekly poll from Gallup showing Trump's job approval rating with Republicans is at 84% among Republicans. Another poll from Survey Monkey shows 75% of Republicans are fine with the firing of FBI Director Comey by Trump. Republicans at this time see the firing as a distraction from other issues on the Republican agenda. Fox News presents a very different version of the story and it is what most Republicans watch. The health care bill from Republicans in Congress and the tax plan are also favored by a majority of Republicans in the polls, says Bump. Independents are wary and skeptical, Republicans see Trump as a way to get their own agenda implemented, and Democrats have serious issues with Trump.

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House Democrats in the U.S. see the Republican health care plan making the same mistakes in 2017 that the Democrats made in 2008. With the passage of the bill in the House of Representatives with a vote margin on May 4, 2017, rushed through in the way the Obama bill was also rushed through, the nation remains as divided as ever on the issue of health care. The Republicans favoring limiting subsidies and cutting Medicaid, and using some of the savings for a tax cut. The Democrats favoring mandated coverage for all and large subsidies to reduce the number of uninsured Americans, with expansion of Medicaid for very low incomes. Democrats in the House say the Republican House bill will result in Republicans losing seats in the House in midterm elections.

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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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CEO's of more than 80 large U.S. companies have come together behind a plan that would reduce the U.S. federal deficit with tax revenue increases and reduced spending. The CEO statement was organized by the Fix the Debt campaign, a bipartisan effort inspired by Republican Alan Simpson and Democrat Erskine Bowles of the 2010 Simpson-Bowles Deficit Commission. The CEO statement calls for an overhaul of the U.S. tax code to eliminate or reduce deductions, credits and loopholes (reduction of tax expenditures also referred to as "broadening the base"). The CEO statement says any fiscal plan to succeed has to control increases in health care spending, make Social Security solvent, and include "comprehensive and pro-growth tax reform, which broadens the base, lowers rates, raises revenues and reduces the deficit." This is the first time a large group of business leaders have supported raising taxes as part of an overall solution. This puts together elements of the Bowles-Simpson plan, reduces deductions and loopholes, lowers rates as part of overall tax reform and cutting spending. The CEO statement says the Simpson Bowles recommendations for $3 in spending cuts for every $1 in tax increases was an "effective framework" for tackling a problem that affects the economic well being and security of the U.S....

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

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The doubts among the unvaccinated and America's pandemic of the unvaccinated in the south and west of the country, difficulty reaching a consensus on things as basic as spending $45 billion or 2% of the $2 trillion Biden plan for workers and families on 2 years of community college, or finding a way to stem what is an alarming decline in enrollment in college of young men in America, all go back to a standoff between Republicans and Democrats. Tennessee in the South is Republican yet passed a bill supporting state paid community college with a supermajority, yet at the national level it is lacks support of Republicans and centrist Democrats. To see how this happens this NYT report presents the picture from the Democrats side of how Montana residents blocked a National Heritage area in the state. Other stories relate to distortions from the other side from the Republican point of view. One man, one vote is not entirely the way Democracy was designed by Jefferson, Madison and other founders. The Senate of the US is based on one state one vote, giving Montana an equal vote as California or New York. At one time Mike Mansfield, Democrat of Montana was the Senate majority leader. The intent was to design a system that looks not just for democracy but checks on majorities of the moment.  This means unity is the way to renewal of America, for building its infrastructure, education and health care. If Tennessee feels that way about community college it should express it, so should other states in supporting president Biden's plan to Build Back Better. ...