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WSJ looks at the changes in the way medicine should be practiced in the light of what we have learned from the pandemic.  Medicine practiced before the pandemic and still today relies mainly on a visit to the doctor or specialist who is short of time. There is a shortage of doctors. Patients have many illnesses as a result of decades of neglect of proper nutrition, and exercize habits. Obesity is at about 40% in the U.S. about 30% in the UK and 17% in France, and high also in other parts of the world. These high rates were unknown throughout history and result in many illnesses and increase by four times the vulnerability to the coronavirus. One authority in medicine calls obesity pouring gasoline on a fire for effects of the virus.  A doctor's appointment with doctors short of time with no coordination around a whole range of factors related to obesity, illnesses, health checkups, mental health, is now seen as a heavily handicapped way to practice medicine or for patient healthcare and wellbeing. The alternative is discussed here as the way forward. A  team will be responsible for a patient's care not just an individual doctor. The team would care for general health after a patient's checkup, cover individual illnesses, weight issues, mental health, exercize nutritional needs and other good healthcare habits. Instead of relying on doctors at a time of shortages of doctors the team would be led by nurse practitioners.  A nurse practitioner is someone with a bachelors degree and a masters degree or doctoral degree in nursing with 1000 hours of clinical training. Studies have shown that they are effective and even more effective than individual doctors. Today particularly with the problem of doctors with limited time compounded by the built up problems of decades of bad habits in nutrition and exercize and poor "cultural" habits getting entrenched, there has never been a greater need for a better way to practice real healthcare for a person's wellbeing. Particularly in rural areas with an even larger shortage of doctors the health practitioner led team will play a big role. Patients will under this setting receive more care virtually and get more followup care by phone and video messaging. The numbers tell the story- there are shortages of doctors in USA, Europe, Africa, Latin America and Asia. In the U.S. shortage of doctors is 55,000 projected to 2033 by Association of American Medical Colleges. There are 290,000 nurse practitioners licensed in the U.S. and 131,0000 physician assistants. The goal will be to get an adequate number of nurse practitioners licensed in this decade to take care of these teams. The pandemic has made virtual visits to doctors and nurse practitioners popular. Medicine reimbursement should and would be practiced on the basis of how well a patient is doing not on a fee for each micro service that is delivered. For this to happen the teams led by the nurse practitioner have to commit to patient education of the benefits from good practices and good habits for nutrition, exercize, caring for oneself. A doctor short of time is hardly the person to carry on this patient education which is where the major opportunities for a new system arise. The virtual care also provides a new medium for patient education and awareness of the risks of getting illnesses, preventive actions to be taken in advance. One approach being tested in California and Texas is for a monthly fee for patients more payments by health plans to doctors or healthcare teams if the patient is healthier. Additional health professionals are added to the team including health coaches, dietitians and medical assistants to increase its effectiveness in counseling and education and monitoring.  The nurse practitioner team approach is already being practiced in parts of the U.S. including the example of New Hampshire shown here, and is predicted to be the approach for primary care in the next decade. ...

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Bret Stephens on the foreign policy debate about supporting or not supporting dictators. On the big one today of Iraq after the large gains with Maliki in Iraq it could be said that its not an easy path either way with each path fraught with dangers, but in the long run if one perseveres and again in the spirit of democracy and with the people in the region themselves and their leaders having good sense and good judgement and putting the interests of the whole region before their personal interests, given this you are always going to do better by your people and the people in the region affected, by respecting democratic ideals and principles. Pakistan is not a good example because its leaders have put their personal interests before the interests of their people but even there things are changing. Zardari's dirtier and clumsier hands are mentioned by Stephens but even here this time the opposition led by Nawas Sharif decided that its more important to respect the electoral process and democratic ideals and let Zardari run Pakistan. Administrations like the Bhuttos and Zardari's have alway been corrupt so there are no high expectations but even here the people of Pakistan will find a way to make the progress they desperately need and find the leadership that can provide it. The military muffling and jailing dissent and not respecting the independent judiciary may not affect the person on the street in Des Moines or Delaware but for people in Pakistan who have suffered under military rule this may be a different story. And in the Middle East things were not that much better with dictators in power either in Palestine and its an area where the conditional part of leadership in the region having good sense and judgement should be considered as well as history. In Iran its not between the Ayatollah and the Shah, before the Shah an elected government in Iran was overthrown when its anti western oil company stance was seen in the light of the cold war. It was the overthrow of that government that brought the Shah in. Had it continued the internal politics of Iran would have been resolved by the people there. In other words western oil interests and lobbies and the cold war distorted the process there. Without the two Iran's politics would not be of much interest to people in the USA and governments there also would have no reason to be especially friendly or especially hostile to the USA. So once one removes the distorting factors and takes out the countries which cannot be used as good example like Palestine and Iran, on the big one Iraq where the people and the leadership in the region did not fail even in very difficult situation and the US persevered, respecting democratic ideals and principles was the best course with the best results. The improved Libyan relations should not be chalked off as a point in favor of dealing with dictators. With better or worse relations with Libya it made little noticeable difference or probably no difference to the people in Des Moines or Delaware. For Iraq it makes a big difference to get it right by both peoples. Libya which had closed itself off from western technology and ideas now opens itself up because this way it can improve life for people in the region, this may be the only thing that has changed. And Stephens puts it another way its more sustainable. But why is it more sustainable to respect democratic ideals and principles given that the leadership of people in the region affected and the people themselves have good sense and judgement? Because in doing so one is respecting oneself one is more true to one's own people's idea of a good and just society and one is respecting other people....

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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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David Brooks on the candidacy for U.S. President of Senator Rick Santorum. He says Santorum genuinely represents the working class- a grandson of a coal miner and the son of Italian immigrants who has represented workers of the steel manufacturing region of western Pennsylvania. Santorum has pushed hard in this campaign largely ignored by the media. He has visited 370 towns riding in a pickup truck trying to cover as much ground as possible and talking with great conviction about his positions distant from the corporate and financial wings of the Republican party, about family, and communities. Bring someone like Sherrod Brown of Ohio together with someone like Rick Santorum and you have good representation of the working class across the political spectrum to win this election for the working class of America, says Brooks, who sees this as a lot better alternative today than Harvard Law.

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The move by Peugeot and Fiat Chrysler to merge is seen as an effort to use consolidation as a way to tackle depressed demand. Ford and GM are struggling in foreign markets, as Toyota and VW have expanded in foreign markets, and Geely has expanded in China with stakes in Daimler and Volvo AB. Added costs for the shift to electric cars, higher emissions standards,  are also hurting car makers. Global new car sales of 96 million in 2018 are expected to decline by 4% in 2019, and remain sluggish, with the U.S. China trade war and Brexit taking its toll. Some car companies are particularly affected. Chrysler's European car factories ran at about 52% in 2018, well below European industry average of 73%.

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Kenneth Volpert, head of taxable fixed-income at Vanguard Group in Valley Forge, Pa, says the weak economy and the Fed's easy monetary policy could lead to higher inflation. Inflation bonds strategists at Barclays Capital says the consumer price index after taking out food and energy is running at an annualized rate of 2.5% over the past 6 months and 2.9% over the past 3 months and is expected to go higher. The yield gap between 10 year TIPS and 10 year nominal Treasury notes, was trading at 2.24 percentage points on August 12, 2011 This means investors expect an annualized average rate of inflation of 2.24% in the U.S. over the next decade. This figure has declined from 2.65% in April, it is up from 1.5% in October 2010.

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The percentage of Americans snacking more than 3 times a day increased to 56% by 2010, according to government data. This was at 20% in the 1990's and 10% in the 1970's. And with this comes higher rates of obesity, as this has made for unhealthy eating and reduced the number of healthy meals. 48% of Americans skip meals 3 times a week and 53% decide what to eat for a meal less than an hour before eating, according to a Hartman Group survey. Not all snacks are unhealthy as food companies are introducing healthier snacks than before. The discipline of earlier generations for having a healthy meal at meal times has eroded with single person households, two career families, and the generally hectic pace of life.

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The economic crisis is global because with a few exceptions like Germany the housing prices have seen a bubble around the world, worse than in the US in places like Ireland and the UK, and similiar to Florida and California in Spain, and also in places like China and India whwere a stock market bubble helped sustain housing price increases. In China and India the crisis comes in the shape of higher inflation, food prices, and huge stock market declines, along with the housing declines, and lower economic growth as China shifts from an export model to domestic consumption letting a third of the low cost factories in Guangdong province close down. Look for serious effects and global economic slowdown from a series of intertwined crisis housing credit and in Asia stock markets.

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The airlines are hit hard by the coronavirus crisis. Reservations have declined as fewer people travel. There is a sense that a recovery will take time, several months. Delta is cutting international capacity by about 25% and domestic flights by 15%. It is also offering voluntary leave options to employees.

Southwest CEO Kelly says the severity of the decline is being felt with loss of $300 million in revenue in March. One piece of good news for airlines that offsets the severe demand decline is the fall in oil prices. American Airlines estimates the cost savings as much as $3 billion. A decade of industry profits have put the airlines in a better position to tackle the crisis. Other cost savings moves are reducing capital expenditures and managing cash flows efficiently.

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Chipotle's casual fastfood chain that tries to bring natural ingredients and a different appeal was started by a Chef trained in New York at Culinary Institute of America school. It opened in 1993 in Denver. It uses a novel approach by not advertising, instead offering free burritos and food and promoting its healthy food in a personal atmosphere image - fast food without its drawbacks, meals in a short time span do nort have to be unhealthy or be served in a atmosphere that is impersonal without the small touches and courtesy that promote digestion.

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Blake of the Washington Post says president Trump finds himself in the same situation as president Obama, who came into office wanting to scale down the effort in Afghanistan, and early in his presidency signed off on a troop surge under commander McChrystal. Trump in the election campaign expressed strong disapproval of interventionist policies. The deteriorating situation in Afghanistan makes it necessary to make an infustion of American troops- a policy being developed by Gen. Mattis. The change now is to insist vigorously on anti-corruption measures and good governance in return for aid. 

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A 20 minute train ride east of Brussels you find yourself in the oldest university in Belgium, in the Flemish town of Leuven. With 60,000 students the university buildings resemble Oxbridge except their are no enclosures. The university was founded in 1425. 

Leuven is a cosy, cobble stoned, easy for walking city, less known than Bruges which means less crowds, and a chance to explore without tourists in sight. A good pre Christmas break says The Times.

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WSJ reporters Corkery and Yoon give a remarkable account of the individual homeowners and investors inside one toxic subprime mortgage security from Countrywide Financial Corp. named CWABS- 2006-2007. There is Amanda Gavini of Fort Myers who continued making mortgage payments against the odds after a illness and death in the family. And a couple Donald Mudd- Patricia Starr who were approved by Countrywide for a $171,000 adjustable rate mortgage loan at 8% with a $10,000 down payment for a home in Port Charlotte, Florida. The approval came only 3 months after the couple emerged from personal bankruptcy in 2006, and by 2009 Mudd was missing payments. Other borrowers such as Mrs. Gavini in Florida took out two loans at 7% and 11% in 2006, have continued making payments and are still unable to refinance under the HAMP or HARP government programs. It is because of these homeowners who continue to make payments helping the security price recover, that one of PIMCO's funds which owns a stake in this security has made good returns. Hedge fund Marathon Asset has also made good returns on this security because of the U.S. government's Public Private Investment Program to help banks recover by providing government incentives for purchase of these securities from banks. This was a way to get banks holding these subprime securities to resume normal lending in financial markets....

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Starbucks introduction of hot breakfast sandwiches may not have been such a good idea, especially since Mr Schultz did not like the smell from the sandwiches in some stores. And the smell, the aroma of strong flavorful coffees is what was a big part of the Starbucks cafe experience.

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The pandemic and ensuing lockdowns, unemployment in the US separated workers from their jobs just long enough to give them a chance to rethink how bad their jobs, incomes, and working conditions were before 2020, says this expert in the NYT. The aid to unemployed workers through long term unemployment benefits, moratorium of rent payments, direct money to households, gave workers enough financial room to make the choice not to go back to poor paying jobs with huge contact risks from coronavirus in the restaurant, fast food franchise, travel and entertainment industries, related industries.  With the Biden administration investing in child care, maternity leave, care for elderly leave, new opportunities for relocating and looking for work were opening for women, and for men who had stuck to old jobs and put up with lousy conditions because of a lack of alternatives. Biden administration's Families and Workers Plans, the effects of the pandemic, helped to shape a new culture of what was possible for workers- a sense that dignity in the workplace was part of culture in America. Restored by FDR/Truman and now again by Biden after two tech booms in the 1920's and the 1990's. A similar situation of a change in culture respecting the dignity of workers and of work is taking place in European Union as stated by SPD leader Olaf Scholz in his election campaign in Germany. Scholz is now incoming Chancellor replacing Merkel. European Union countries have better laws and rules in place for worker retention, and also better worker protections so that the great resignation that happened in America took place in a milder version. ...

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Anne Lukits brings this exceptional bit of evidence about improved parenting and family life. Only about 15% of families in a University of British Columbia research study had fathers who shared equally in household work with mothers. About 65% of fathers and 14% of mothers reported inconsistent behaviour about their beliefs in gender roles and how they acted at home. Girls were seen as more likely to pursue careers in science and nontraditional fields if fathers played out their beliefs in real life by taking active part in household work, from doing the laundry, washing dishes, vacuuming and cooking meals. The study is discussed in the August 2014 issue of Psychological Science. This means that only one in four fathers who believe women should not have to do all the household work and work outside in paid jobs, actually play their beliefs out in real life roles in the home by sharing in the household work. Other aspects of this that are still to be researched are how much an active role by fathers in the home can improve the number of meals that are home cooked with fresh ingredients, with fathers taking daughters or sons out to fresh food markets, which have a significant bearing on how families can eat healthy and pass this onto the next generation. An unnoticed aspect of this is that it improves the overall quality of life for families through healthy eating and healthy living. When companies recognize this and encourage their employees with some extra time for family acitivity and work the overall benefits would include- healthier employees able to do more productive work in shorter time, less paid for employee medical coverage, and healthier members of society....

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Affordability should be a major factor in figuring out what is the best place to retire. Climate gets Arizona and Florida the top two spots. Yet considering today's higher cost of living and smaller retirement savings in the U.S., Britain, and European countries, and the higher cost of living in India, China, and other Asian, African, and Latin american countries, affordability should play a much larger role so that savings stretch out and one can afford a better standard of living, more travel and room for better choices in food and other things.  Bankrate for instance gives 40% importance to affordability in its retirement assessment of locations. Climate gets only 15% in this assessment of location. Places which are friendlier, with which you are familiar ar attractive for other reasons. Bankrate gives Nebraska, Iowa and Missouri top ratings in this commonsense approach.  Also important after affordability, are access to healthcare, weather, culture and crime. Bankrate analysis gives affordability 40%, wellness and healthcare 25%, culture 15% weather 15%, and crime 15%. Access to healthcare is a factor that is also included in Affordability as the premium in Florida for Medicare Supplement, is $286  month vs $90 a month in Nebraska. Using a similar approach places in India, China, other African, Asian and Latin American countries countries that are in high demand and have rising cost of living may not be the best places to retire. Using Affordability, wellness and healthcare, culture, and friendly atmosphere and familiarity with having lived there for a time, may be the best criteria with less importance to weather. A better standard of living and access to better things in life with one's dollars or rupees or whatever currency one uses stretch is important.   ...

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A personal account of a visit to a flood stricken area of Pakistan near Islamabad in 2010.

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 For the first time in 16 years a candidate is mounting a serious effort to challenge Mr. Erdogan's politics in Turkey. Muharrem Ince of the Republican People's Party says he favors reconciliation, end to discriminatory state hiring practices, end to politics of prestige, and a return to openness. Here a Republican party MP describes visits to parts of Turkey that were traditional and supported Mr. Erdogan as religious faithful since 2002, but which today are increasingly looking for a new path for Turkey. Mr. Ince has a flair in connecting to voters in a unique way, He is what he is- willing to debate Erdogan on television, visiting a opposition leader in prison, speaking out against the changes in Turkey under Erdogan and the failure of leaders in government to send their children to the Muslim schools they support. Inviting his sister to rallies where she wears a head scarf showing he also shares the same faith as a Muslim as Mr. Erdogan and does not put too much faith in symbols as he does in practice of humility. ...

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The eight member panel of experts led by a retired judge gets high marks from the youth movement, and all oppositon parties. All have a good grasp of the legal theory to build a good system of democratic processes with checks and balances and necessary protections. The chief of the panel, Tareq-el-Bishri, is a retired senior judge, and an author of a book titled: "Egypt: Between Disobedience and Decay." Bishri wants to see prosecutions done in civilian courts, and wants a balance of power between government institutions. Members of the Youth Movement say they encouraged military leaders to setup the tasks of writing a new constitution in several steps, the first being rewriting the key articles and holding an up or down referendum. It was felt that a better constitution would emerge once elections were held, and enough time and debate could occur for the new constitution.

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The European automobile market staged a recovery in 2014 with sales up 5.7% to 12.6 million, according to the European Automobile Manufacturers Association. The big gains were made by the lower cost brands such as Renault's Dacia made in Romania, and VW's Skoda made in the Czech Republic. Dacia sales increased in 2014 by 24% to 359,141 and Skoda's sales increased by 14% to 554,479. A Dacia Sandero without air conditioning, power locks or radio is priced at 7,990 euros in France compared to a better equiped Skoda Fabia at 12,640 euros and a VW Golf at 17,388, a big price difference for budget car buyers. The major brands continue to dominate with the Golf model continuing as the best selling model in Europe. GM and Ford with the Opel Corsa and Ford Fiesta also increased market share. VW's market share is 12.7%, Skoda's 4.4%.

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Mandel of BW has done some calculations that show that consumers in the USA have spent $3 trillion more than if they had spent with the spending patterns of the 1990's. This acceleration in spending is an overhang that has to be cleared up and he thinks its going bring a nasty surprise in the next few months to the cosnumer stocks and also bring down the rest of the stock market in the next couple of months. Mandel is making a good point here that should be listened to carefully and which makes a lot of sense. its not about predicting the stock market but about using good common sense that the debt is just so large and the signs of consumers in a pinch so widespread in reports throughout the media that something like this just may be likely to happen.

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The basics that promote health and productivity in the workplace. Kinds of boss behaviour that destroys productive work and relationships- lack of close rapport and face to face discussions, lack of good directions and feedback, loud behaviours and too short responses, not enough time to get the job done right.