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LNG prices have declined in 2024 to a fraction of what they were from $70 per mmBTU in 2022 with the Ukraine war to about $10 in Jan 2024. India's state owned Petronet signed a 7.5 million ton LNG deal for 20 years with Qatar at the reduced prices. For the world it is a good thing as India moves to natural gas from coal when about 60% of the increased pollution in 2013-2021 is coming from India by some estimates. This translates into climate change. The goal is to go from 6% for natural gas in energy mix in 2013 to 15% by 2030. Few people realize what this means outside India- that every additional dollar that was added to the nation's energy bill was a dollar not going to essential building of modern rail and transport infrastructure, into new colleges, into new health infrastructure hospitals, into logistics for manufacturing hubs, into digital and modernizing the economy. This during the pandemic has meant free rations of food for hundreds of millions in the rural areas which have been continued into 2024. It meant accessing at the lowest possible price, buying at the right time, and buying oil and gas from a wide range of suppliers. WSJ's Megha Mandavia looks at this effort.  ...

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From now on the vaccination program in India will be run nationally by the federal government. This will ensure fair access to vaccines to all parts of the Indian population. Earlier vaccine costs were bid up as states and private hospitals bid up prices. Under the new national program 75% of vaccines will be given out by the federal government and 25%  by private hospitals and other private health institutions. The government in New Delhi under prime minister Modi will offer adults free vaccinations. Modi said "We will increase the speed of procuring vaccines and also increase the pace of the vaccination program." Even in private hospitals the cost of vaccine will be kept at Rupees 150 or $2.06. Experts say this is the right policy and the government has learned from errors in letting states and other private institutions run vaccine policy, which made it too fragmented and subject to too many variables, resulting in inequity, and slowing vaccination drives. The Supreme Court stepped in asking for clarity, leading to the clear policy from the federal government announced today.  Advantage of the new policy is that the responsibility lies in one place, and the federal government also has the clout to make things happen, to negotiate with companies and other parties involved effectively. India has vaccinated 222 million people but because of the population being so large at 1.2 billion this comes out to be a small fraction of the population. This puts the task of getting vaccine supplies and getting the vaccination drives to work in the only place that has the determination and the resources to deliver results by vaccinating 1.2 billion people by December 2021. It has never been done before in history says Mr. Modi, and it is a challenge that India is now taking up for itself and for the global community. It also lays the ground for India to help its neighbors in Asia and in Africa, Latin America in 2022.   ...

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This self portrait by Vladimir Putin about his growing up years in Leningrad and the life of his father and mother during the siege of Leningrad by Germans may offer a better sense of the mind and thinking of the Russian president than the Dresden years when he was a junior Russian official in Communist East Germany (the GDR). It is an interview of the Russian president in 2000 by Nataliya Gevorkyan, Natalya Timakova, and Andrei Kolesnikov over twenty years back. Putin's father suffered severe injuries during the war in the fighting around Leningrad, twice being given up for dead and being dragged wounded across the frozen Neva river to a hospital by a neighbor. His mother was half dead from starvation and his father passed on his food given to him at the hospital. Having gone through the memories of this period affected Vladimir Putin's view of the world and no amount of US or German assurance about NATO's intentions may have erased these memories from childhood. The long period in power and the Covid isolation may have led to  perceptions that were less likely to change so that Putin did his own research and wrote a long paper on Ukraine in 2021 that reflected Russia and Ukraine's long history but did not reflect the changing national aspirations of Ukraine's people in 2022. This may have led to the miscalculation and the errors by both Putin and the leaders Merkel-Bush-Obama that the detailed WSJ report of 20 years of events show to have happened. The WSJ report of April 1, 2022, was titled "Vladimir Putin's 20 Year March to War in Ukraine and How the West Mishandled It." The Social Democrats in Germany under Schroeder and Steinmeier mishandled it by deepening economic integration with Russia as a way to make up for what had happened in the German invasion of Russia, and the Christian Democrats under Merkel with business interests never really grasped the different thinking of the Russian president relying solely on deep economic integration of the EU and Germany with Russia as well as China as an answer. Mr. Bush and Mr. Obama from a distance even less so.  This has led to the miscalculation by Russia under Putin leading to invasion of Ukraine, and the US and Germany being unprepared about taking action to prevent it.  Beyond the key participants and the war damage, there is the enormous damage that is taking place in the mental health around the world after Covid with constant barrage of images of war and refugees streaming into Poland. There is the problem of food imports, of food scarcity in the Middle East, and inflation in food prices for Africa and the Middle East. As Brendan Simms, a Cambridge historian has shown in his book "Europe The Struggle of Supremacy 1453 to the Present," which is now being read by German chancellor Scholz, this has happened before with the UK, Netherlands, Spain, Germany, Sweden, Denmark and Russia engaging in these conflicts that led to prolonged wars and eventually to only small shifts in power. Yet with huge effects for ordinary people caught in the wars such as today's refugees and people struggling to feed their families in Africa and Asia after the effects of Covid on income. Food prices have gone up by 50% to almost double in these countries.   ...

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US president Biden's 2024 Budget places great emphasis on aid to workers and families in the US and shores up the Medicare hospital-insurance trust fund. He will do this by raising taxes on the wages, investment gains and self-employment income of people making more than $400,000 a year. Additional savings come from increasing the drugs on which Medicare can negotiate prices from 20 to 50 drugs.  Childcare- families making less than $200,000 a year will get subsidized child health care, the lowest income families paying nothing. Housing- Building and preserving 2 million housing units. Series of tax credits to make buying homes more affordable. College education- Reducing the cost of going to education with $12 billion allocated for this. Offering tution free community college. Family and Medical Leave- Federal paid family and medical leave program. Retirees- a $2000 cap on out of pocket cost of prescription drugs for retirees. Reduced taxes for under $400,000 income households- This would be done without increasing the deficits to extend the tax reduction from the 2017 tax cuts to households making less than $400,000 a year.     ...

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Prince Salman's efforts to launch an IPO of Saudi Arabian National Oil Company faces resistance from Saudi bureaucrats. Prince Salman wants to reduce the country's dependence on oil revenue, and hoped to use the IPO generated $100 billion to make investments in other industries. Saudi technocrats see risks in the plan- as costing consumers billions of dollars in higher gasoline prices, legal risks and public scrutiny. The IPO has been pushed back to 2021. Large new investments such as solar generation hub also face passive resistance in the bureaucracy. New investments policies have led to a Saudi recession in 2017, and reduced investment and consumer spending. Prince Salman sees it differently, once telling Theresa May of Britain that even if he got 50 of the 100 things he wanted done, that would be 50 not done otherwise. Salman has a disdain for the bureaucracy and has tight control over the country. He has led popular social changes such as letting women drive and taking away the power of religious police to make arrests. The Economy Minister has slowed down a plan to sell state assets such as government owned hospitals,airports, because conditions are not ideal. A plan to invest $7 billion in Uber was shelved. Aramco chairman Mr. Falih has reduced the size of investmetns including for the solar energy generation project. A plan to have ARAMCO listed on the New York Stock Exchange preferred by Prince Salman has been changed with advisers suggesting the London Stock Exchange as a place with lower risks of law suits under U.S. tort laws. Saudi executives at ARAMCO also pointed out that to reach the $2 trillion valuation that the Prince has in mind for ARAMCO the company would have to sell gasoline to Saudis at market rates, tripling oil prices in the kingdom -costing consumers $98 billion. The advisers believe it is more prudent financially to raise debt. Under that plan ARAMCO could raise debt to buy the Public Investment Fund's (PIF) 70% stake in state owned chemicals company Saudi Basic Industries Corp. which would infuse PIF with $70 billion, almost as much as generated by a IPO for ARAMCO. On solar energy Mr. Falih lowered the plan from 1500 gigawatts to 200 at a cost of $200 billion. Under a new plan this is at 60 gigawatts from solar and wind with 70% produced by the Public Investment Fund, the state's investment fund.   ...

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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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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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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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How Phillips is changing itself to focus on new areas such as elderly health care. The acquisition of Lifeline which is a call service for elderly patients that helps them for independent living. products are being redesigned for consumer health care. One such product is a HeartStart Home Defibrillator which costs $1200 without prescription at drug stores. Ivo Lurvink heads the consumer healthcare division formed in 2004 with the goal of tapping opportunities outside of hospitals. As Phillips new CEO sees it hospitals care is expensive and more and more people are becoming savvy and smart about taking care of themselves with products available and more products need to be designed with them in mind. In targeting needs of elderly Phillips has identified independent living as an important market and has developed a "senior solutions sweet spot" as the kind of customers in this group it would like to target. to get an idea what Phillips is trying to dream up in redesigned or new products, Ivo Lurvink is looking at the broken bones that 350,000 Americans who fall and break bones have to struggle with. Could Philipps come up with a product that detects motion and balance? Philips CEO Gerard Kleisterlee sees the trend as being health care is being increasingly pushed out of hospitals which are expensive and into homes and clinics, and patients are behaving more like consumers and asking smart questions of what will be best for them. Philips has closed most of its electronics factories, its components division, and sold its seminconductor business to private equity firms for $7.4 billion. Its a big shift for a technology company but lower priced Asian imports have convinced Philips that it must make a shift, especially after losses in 2001 of over 2 billion euros and in 2002 of 3 billion euros. The professional medical products division was a bright spot in a recovery with earnings growth of 40%. It sells large equipment to hospitals. Gerard Kleisterlee who took over as CEO of Phillips in 2001 is making a change that is also being made at GE and Siemens as health care becomes increasingly important. Kleisterlee is himself an engineer an after the post tech bubble asked himself "what is the hand of cards that I have and how do I playthem?" Changing its orientation and moving into new products with better margins and less competition in high growth markets such as elderly care is the result of this reassessment. ...

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The lack of economic opportunities for an increasingly urbanized African younger generation is a major challenge. The median age of 19 makes Africa the world's youngest continent. Megacities are growing up in places such as Lagos and Kinshasha as millions leave subsistence farming to go to cities. Unlike Asia and Latin American countries men and women are coming to shantytowns in cities at a time when Africa is much poorer for a similar level of urbanization that Asian and Latin American nations reached decades earlier. In 1993 this WSJ analysis and graphs show the Asian emerging economies and sub Saharan Africa had similar GDP per capita of $2415, by 2019 this was $4000 for Africa and $12,000 for Asian emerging economies. Latin America was at $10,000 in 1993 and in 2019 was at about $15,000. The gap widened considerably between Asia and African countries. Asian emerging economies increased GDP to 5 time from the same starting point as Africa in 1993, Africa doubled GDP over the period of 25 years to 2019. Latin America started from a much higher point and increased GDP by only 50% over 25 years. Asian economies that performed better over this period did better because of stable even entrenched governments such as in Singapore with Le Kuan Yew and in China with stable successive governments under CPC leadership of prime minister Deng. The difference in Asia was a commitment across all classes and groups to development, a sense of development as a way to make up for the years lost under colonialism of foreign powers in the eighteenth and nineteenth centuries. A sense of correcting historical injustice and wrongs. This is a missing ingredient in the processes unfolding in Latin America and Africa in the last 25 years. ...

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About 1% of doctors account for 14% of Medicare's payments in 2012, according to WSJ analysis of data released by the Centres for Medicare and Medicaid Services.

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The $350 billon in proposed cuts to Medicare and Medicaid in the 2011 deficit reduction talks will do little to reduce the rapid rise in medical costs. Instead it shifts the costs to seniors, state governments and public hospitals. Gail Wilensky, former head of Medicare under the first President Bush and now a senior fellow at Project Hope, says this should not be confused with real reform to Medicare which reduces the rapid increase in costs. It does little in the way of fundamental changes that would reduce the growth in costs. About $53 billion comes from reductions to senior's ability to buy extra Medicare supplemental insurance or Medigap. Another $14-26 billion would have the government reduce payments to hospitals for unpaid debt. The few items to curtail fraud in the use of CT scans or purchase of power wheelchairs would provide savings of $2-3 billion over 10 years. $4 billion comes from lowering Medicaid payments to hospitals treating a high percentage of low income patients, hospitals such as Cook County Hospital in Chicago, San Francisco General Hospital, and Parkland Hospital in Dallas....

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The inflated costs for spinal surgeries at some hospitals in California. How surgeons, doctors, consultants, distributors and hospitals operated in a flawed system to make revenue gains through overbilling, and focus on increasing the number of surgeries performed.

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The health care system is designed to encourage procedure based specialist practices and discourages the patient understanding education and monitoring that occurs with a well designed preventive family physician practice. As a result a patient only spends 30 minutes ayear on average with family physician compared to one hour in other developed nations. In the USA there has been a steady decline in the level and quality and extent of family care and the close one on one rapport with well trained family physicians who enjoyed their work and understood their patients and kept up with their health conditions and provided good and regular advice on these conditions. There is no money in this care as a result first you provide an environment where a whole range of medical conditions can flourish and expand, and then you hit them with a whole series of tests to rule out specific medical conditions. It is a perfect way to expand the testing and let testing flourish, so it would appear that if someone had wanted to start with a goal of letting testing proliferate unhindered then this would be the perfect way to design it. ...

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Estimates show the 50 million Americans enrolled in Medicare today will increase to 80 million by 2030, according to the program's actuaries. Simple demographics as the baby boom generation ages is making controlling the deficit without controlling increase in health care costs as both sides in the fiscal cliff negotiations are attempting to do can only lead to defunding critical areas such as education, R&D and infrastructure, and breaching the safety net for lower income Americans. Health care spending took up 7% of GDP in 1960, increasing to 17.9% of GDP in 2010. Federal spending on healthcare has grown to about 25% in 2012 from 10% in 1960, and is projected to increase to about 33% in ten years by the Congressional Budget Office.

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Pearlstein quotes Dickens in "Oliver Twist," about the law being an ass, and the constitutional law exercize in the Supreme Court of the U.S. giving a sense of a failure of the so-called best and brightest in reasoning out the issues. He points out that a serious problem is that American business which is burdened with high health care costs for employees is seriously missing in this debate after years of complaining about high costs. The National Federation of Independent Businesses is actually one of the plaintiffs questioning the constitutionality of the Obama health care law. Pearlstein says business wanted an end to the fee-for-service medicine that increases consumption of medical services and pushes up cost relentlessly, and that Obama's health care law does this. This is not the case as both Democrats and Republican administrations have failed to resolve this side of the cost issue, and this is the hidden reason for the loss of credibility for both sides in this debate, leaving health care problems to be resolved in future administrations. ...

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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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An average of major opinion polls compiled by Real Clear Politics website shows 50.5% of Americans opposed to the Obama U.S. health care law.

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This editorial in the WSJ describes the sharp increase in premiums under the Affordable Care Act of president Obama. The average premium increase is about 24.2% according to a Barclay's analysis, and as high as 43.9% in states such as Illinois. Bill Clinton calls it the craziest thing with small business affected, and some premiums doubling. Of the 17 million people in the individual market eight million buy without subsidies. One in five enrollees cannot qualify for subsidies. Democrats say subsidies are too small. Hillary Clinton has proposed to have a Medicare "buy-in" for people ages 55-65, and a "public option" government run plan. Republicans want to rewrite the law. But this depends on which party wins the Senate, with the election in Missouri giving Democrats an opportunity to maintain a Senate majority.

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Krauthammer cites Congressional Budget Office numbers that show the Obama U.S. health care law continues the spiralling costs of health care with new government mandates at a time of severe budget cuts in education and other areas- for 2013-2022 the costs come to $1.76 trillion. The initial Obama administration figures of 10 year costs of $938 billion announced in 2010 reflected the fact that the new U.S. health care law would take 4 years to fully go into effect. Costs after 2021 are shown to be $250 billion each year in the CBO figures. The law is now before the Supreme Court in 2012, which has to decide on the basis of the limits of the Commerce Clause.

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Efforts to boost the share of national income that goes to rural households and workers in China. The share of income taken by state owned enteprises and taxes paid by the enterprises would have to change for reducing the gap in incomes and reducing inequality in China.

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The skills to navigate different personalities and work patiently on the issues surrounding changes to the U.S. tax system of Rep. Dave Camp (MI), chairman of the U.S House of Representatives Ways and Means Committee, will be immensely useful in the effort to make changes to the U.S. tax system. Camp works well with fellow House Republican leaders Boehner, Ryan, Cantor, and his Democratic counterpart in the U.S. Senate Max Baucus. Camp is a good listener, refuses to engage in partisan criticism, and has the patience to work through difficult issues of achieving savings and keeping fairness in the the tax changes. Earlier efforts to achieve consensus in late 2011 failed, making it even more important to have leadership which can create productive debate and bridge the differences. The tax changes are part of the overall effort for U.S. economic recovery by reducing the deficit.

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The Economist points out that China's total debt of government, corporate and households has grown by about 100% of GDP since 2008. The 2009 crisis led to rapid increase in debt. It is now about 250% of GDP, according to the Economist. Slower growth of below 7% risks reducing China's ability to service this debt. About half of this debt is owed by state owned companies and property developers. China can use its sovereign reserves to continue supporting bank and state owned companies. Investor's are pricing bank shares to reflect about 10% of this debt as bad debt even though government estimates are much lower. The reserves provided China time to fix the banking system since 2008, yet the debt keeps growing and China has failed to take strong action in the last 6 years. Complacency is a problem, and the incentives for local governments to continue prior practices that increase debt continue. As Krugman and other experts have pointed out at some point the rules of finance will apply to China as they have for other countries that faced a debt crisis- Japan in the late 1980's, South Korea and other Aisan countries in 1997, and the U.S. in 2008. Even without a crisis through deft managemen and use of reserves China risks zombifying the economy as old loans are backed up by new loans, with the further risk of misallocation of capital or poor use of capital. This lowers productivity of capital and hurts development. With poor statistics such as the figure of 1% of debt being bad debt cited here, the problems of complacency can be magnified, as there is less reason for a strong response....