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Poland has a huge shortage of doctors and nurses. The ratio of doctors to every 100,000 of population is the lowest in the European Union. It is twice that in Germany whose relative success in tackling covid pandemic comes from having foreign doctors and nurses treat patients. Consider that the average age of Polish doctors is 53, only a few years from retirement. The situation in terms of immigration reminds pone of East Germany and its depopulation of young people who left for West Germany. Something like this has happened in Poland in health care.  In similar ways other countries in the EU, Hungary, Slovakia, Romania stocked up on ventilators but now have few doctors and nurses left to operate them. It is stretching the limits of human endurance as this report shows in WSJ, with doctors working 36 hour shifts and working 73 hours a week.  Here we see Dr. Rotnicki, who works these long hours at a hospital in western Poland and says that it is like the Second World War, that it is hard times in Poland for health care workers. This report says Italian and British hospitals, not just German ones, are tackling coronavirus with Polish, Hungarian and Romanian doctors and nurses. This report shows that headhunters in Germany drive in to western Poland blanketing windshields with pamphlets promising 5 times more pay, 2 years of free language classes and housing. In Slovakia a third of all nursing graduates leave the coutnry immediately after graduation. In Poland not nursing pay has lagged behind with fewer going into nursing schools. Staff remaining in the region are older and educated under communism when less English was taught, or have returned back home from years overseas. Forcing doctors to give up private practice and work in public hospitals during coronavirus pandemic is not working in Hungary, where surveys find 6 out of ten medical school graduates intending to leave Hungary. These doctors say they are better off working at Aldi and Tesco if needed and making more pay, plus getting weekends off. Poland only recently increased pay for healthcare workers, some even survived on cash given to them by patients. Not a good situation for a country to be in and reflecting the wrong priorities not just in the U.S. and western Europe, but also in eastern Europe, during the last 3 decades. These priorities shifted money away from health care, education and infrastructure priorities. The people simply lost control of their spending allocation to "financial markets" that shifted money in a way that benefited only small group in society neglecting others and national interests. ...

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In parts of Mexico sugary softdrinks are easier to access than clean tap water, says this report in DW.com. This is a problem that existed in Mexico for many years. Amy Guthrie in the WSJ August 28, 2013, described the problem in -Health Problem over Soda Flares in Mexico- which was shown in Lyrarc.com in 2013, showing the US, Chile, Mexico and Argentina with high consumption of sugary softdrinks and high rates of diseases related to this. Mexico's government has made efforts to increase awareness about the risks and dangers of overuse and Bloomberg philanthropy has made efforts to increase awareness. Yet the problem has persisted. The risks are high for countries such as India, China, Vietnam. One ad in Mexico City subways showed 20 ounce sugary softdrink bottle and asked "Would you take 12 teaspoonfuls of sugar?" Mexico passed the US in countries with high obesity rate over 100 million people in 2013. Higher all cause mortality was shown in a European study of 451,000 people for people drinking more than 2 glasses of sweetened softdrinks a day, with data collected between 1992-2000 and supporting public health campaigns limiting the use of such sweetened softdrinks. ...

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US president Biden's multi-trillion dollar spending plans for infrastructure, climate change plans, education and healthcare, are based on a changing perception about the effectiveness of the public sector spending initiatives. The Reagan period idea that the public sector is not as efficient as the private sector that lingered through the Clinton, Bush and Obama, Trump administrations is no longer accepted. After the pandemic another perception is taking root that when it comes to health infrastructure the government has a leading and indispensable role to play. Gone are the doubts about this that hung like a cloud over the nation's plans for infrastructure in health, education and supply channels. Following the global competition with China a new factor is also playing its part. The need for government to play an active role in trade, in protecting technological resources, and in supporting US technological firms in competition with other countries. There is a new perception that the government should be determined to play this role. In the effort to be self-reliant after the pandemic the government is expected to play a role in redesigning the supply channels and providing the direction and incentives for supply channels worldwide that give America a competitive advantage and less dependence on other nations. ...

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DJT says Iran does not want to talk to the Europeans, it wants to talk to the Americans. He says it is hard to stop the war when one side is winning. Russia and the US have better relations than under the Biden administration which is proving to be an important factor in this war. As it is about nuclear proliferation, not regional powers- the Israelis, the Saudis and the Iranians. Both Russia and the US are technologically sophisticated powers with different interests, they are world powers because they have first and foremost important responsibilities in nuclear non proliferation and the health of the planet. By allowing regional conflict in Eastern Europe to cloud this fact and not engage with Russia as a world power the US under Obama and Biden had failed to grasp a key principle of peaceful relations since World War II. We argue that "western powers" is a concept of colonial powers France and Britain, and western civilization is the reliable concept that includes Russia, and includes China and India that have embraced the creation of the modern world by western civilization. ...

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The India- U.S. trade deal after the negotiations and the visit of the Indian prime minister to the U.S. is expected to take additional time. The U.S. wanted to see a 20% duty on mobile phones and ethernet switches to be reduced, greater access to the Indian market for medical devices such as stents and knee implants, and greater access for dairy, agricultural products. Making these products affordable in India is a goal of the government preventing it from making concessions. India wants preferential access to the U.S. market as a developing country restored under the Generalized System of Preferences.  A comprehensive trade deal would have to include issues of intellectual property, e-commerce, and the sensitive issue of H1B visas. Commerce minister Piyush Goyal led negotiations for India and Foreign Secretary Vijay Gokhale said the two sides "narrowed" down their differences. India's Jio from Reliance Group has hugely reduced the price of mobile phones and mobile data making it accessible with 4G across the country at prices that are the lowest in the world. The introduction of a universal health care program requires bringing down the price of medical products to improve access to modern medicine. This means less room for American products that would increase the price and reduce access in a vast developing country. India is also playing catchup in these technologies so that there is less room for unrestricted entry in the Indian market.  Efforts were made to increase trade and investment in India with the help of Mr. Bloomberg during the visit of the prime minister, and the Bill Gates Foundation continued its commitment to public welfare gains in India in the fields of sanitation, hygiene and healthcare.  ...

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The $3.5 trillion bill of president Biden to help America get back on its feet after the pandemic and after years of neglect of infrastructure, manufacturing technologies, child care, health and education, is that much only if offsetting tax increases and spending cuts are not included. When this is taken into account the US is spending about $871 billion to rebuild its economy and for a better life for Americans. That is the estimate provided in the report September 13 by the Congressional Joint Committee on Taxation.

Experts say that if president Trump's bill- Tax Cuts and Jobs Act of 2017 was calculated without offsetting cuts and tax increases the same bill would be $5.5 trillion package.

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The figures are huge and it takes the World Health Organization Framework Convention on Tobacco Control to do something however small in Japan about smoking. Now the half million vending machines that dispense cigarettes to some 26 million Japanese smokers can only dispense to adults because users have to have a special card called Taspo or tobacco passport that they insert into the vending machine. This will shift sales to convenience stores like the Lawson's chain. In Japan 29.2% of all adults and probably an even higher percentage of men smoke according to OECD data. In the US its about 17%. Like obesity and poor eating habits and the availability of fast food in the USA, smoking in Japan remains largely untouched by any efforts to educate young people and the public about the great dangers, with companies largely uninterested and the government and schools and universities largely apathetic about what are really huge health concerns that reverberate in so many ways across the fabric of society. For example a obese person consumes more health care dollars, a smoker also consumes more health care dollars. And health care dollars are scarce dollars and need to be spread out in better ways than wasted on preventable things like obesity and smoking through partnership in education and other measures between all groups and organizations in society and the government. ...

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US law now supports turning back migrants at the border. Under public health policy Title 42 migrants are denied asylum, a federal appeals court ruling supporting this. It is also now supported by the Biden administration. It is a key tool used by both the Trump and Biden administrations to combat illegal border crossings. It also reduces one more area in which differences were mistakenly created between Republican and Democratic parties, that distracted from focus on much needed infrastructure and other priorities for the American people.

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Judo4Balance exercise for falling down safely are popular in Sweden and Netherlands where volunteer instructors help seniors practice falling safely. This is important for older adults so that they can live lives to the fullest without the fears that restrict activities and lead to mental heath issues from isolation or restricted activity. There are no judo based fall prevention programs in the US and this report shows the need to help seniors in the US with similar programs.

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

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This NHK documentary looks at the idea of "Cheap Japan" as wages and prices have stagnated for over three decades. Where the US has grown by 58% for wages over that period Japan has declined by 12%. Japanese companies wages offered even in Thailand and Malaysia, and for low wage products in factories of Vietnam and Bangladesh are cheap and uncompetitive. A Japanese apparel brand is shown looking for factories in Bangladesh that can make shirts at $1.65 to be sold in Japan at $6. Japan's wages and prices are now falling behind developing countries and a Japanese economist calls it "declining Japan." Foreign investment is key to reviving growth by attracting new talent, changing business thinking and style of managing that is more open to new ideas and expansion. It may be of interest to note that Chinese companies in Japan may be focused on electronics and advanced technologies than American private equity in Japan focused on hotels and health care simply to boost profits. ...

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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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Two parts per million of lead in cinnamon is the maxiumum that is considered normal. Five parts per million of lead in cinnamon is considered bad for health. Children are particularly affected by lead contaminated products. High lead contamination in applesauce product pouches lead to recalls by the US FDA recently. In the case of the cinnamon applesauce pouches this Washington Post report says federal investigators have called it "an act of economically motivsted adulteration." The European Union limits lead to 2 parts per million. McCormick & Company says it adheres to strict safety protocols and procures whole cinnamon bark rather than ground cinnamon to control adulteration and contaminant. Frontier Coop which sells brands Simply Organic and Aura Cacia says it tests for heavy metals and follows New York standard of one part per million of lead in spices. People are discouraged from buying in bulk for turmeric and cinnamon as this creates risks of contaminated or adulterated product. ...

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Dirk Kurbjuweit of Spiegel says Merkel needs to show strong leadership to overcome the challenges with the rise of right wing populists in the U.S., Britain and France. He points to the leadership shown in the latter part of Kohl's term in office to promote German reunification after the fall of the Berlin Wall. The challenges include talking to the German people directly in a convincing way, and meeting the day to day challenges of life for the people with investments in education, health care, infrastructure so that people see real significant improvement. It is even necessary to reorder priorities such as the shift from nuclear energy so that this challenge is met. It is not enough to hope that more Christian Democrats turn out to vote than Social Democrats, that the fifth of Germans who feel the economy is not working for them and feel threatened by immigration see real changes being made to address their concerns.

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Germany faces serious problems in its vaccination drive and efforts to control the pandemic in November 2021. The rate at which people are getting vaccinated has slowed to 150,000 a day and the percentage of the population that is vaccinated is stuck at 67%. This percentage of 67% fully vaccinated in Germany as of November 3 is much lower than that in Spain, France and Italy.  Spain is at 78%, France at 69% and Italy at 72%. (Data from NYT) This report in the Guardian points out that most of the remaining one third of the population is not eager to get vaccinated as surveys show that the those who have refused to get a jab are unlikely to change their minds.There is also the problem of booster shots. Germany's 16 regions conduct the vaccination drives and with many of the vaccination centers not active since September staff has to be retrained or rehired. This makes it harder to give booster shots to everyone that was vaccinated early by the start of winter. Why is it that Germany lags behind Spain in vaccination? There is a great deal of trust in Spain and Portugal in the health service and people are 100% behind their health system. The other countries that have a low rate of fully vaccinated are the US at 58%, Brazil 57%, Russia at 33%. Even the UK with its well respected National Health Service remains at 68% fully vaccinated. Today the US, Russia, Brazil, European Union countries and India have many of the 5 million deaths from coronavirus. India's vaccination drive is approaching 1100 million vaccinated, yet there is along way to go in getting most of the population fully vaccinated because of the large population of 1.3 billion. This is why the Indian prime minister on the first day of returning from the COP26 climate summit devoted his time to meeting with leaders of different states and heads of districts with low vaccination rates to press home the idea that the effort had to be taken up vigorously in the coming months. ...

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A few events in the last 50 years are rewriting the rules for business, finance and economics, says the WSJ in this analysis. The admitting of China to the World Trade Organization under president Clinton in 2001 was one, another was the global financial crisis in 2009 with the selling of bad mortgages by the financial industry, the euro currency financial crisis with the bad accounting, real estate industry speculation, and lack of financial oversight in countries such as Greece, Ireland, Spain. The coronavirus pandemic is one more addition to this string of crises and events that have made the working class and middle class in US and Europe poorer and in worse shape after the recovery following World War II.  The changes indicated here are some of the surface changes- such as the shift to the suburbs for cleaner air and better living, the work at home as a serious option, the new focus on health care, wellness, exercise, nutrition and mental health, remote learning and community college as a realistic option to high tuition costs by the education industry, and a pharmaceutical industry refocused on public health and vaccines as it was in its early years before its shift into a simply profit driven industry. The underlying thread for all these changes on the surface is a deeper change in the public mind- a change that redefines what the people believe in just as happened after World War II. Rebuilding the devastated economies of Europe, America and Asia required a new vision at the time after World War II. And reconstruction could only happen with all the people involved and working for the public interest.  This also created a new hope for the future. President Biden's vision is for a new set of priorities that make child care, women's position in the economy, community college education as a right for all as a first step to opening the access to education that existed after the war in 1945. Investment in infrastructure, in building new roads, bridges and rail, water, internet connections, public services in transport, better layout of urban areas, better lives for retirees, are all part of an effort to improve quality and ease of living for all parts of society, not just those who can afford it.  This is uppermost on people's minds and administrations or governments that fail to deliver or simply talk with no action, will not have the support of ordinary working men and women in all countries. This is true for countries and regions as varied in their level of development as the US, Northern Europe, Southern Europe, Japan, India, Brazil and Mexico, and African nations. Democracy, government adminstration, technology and business structures exist for the people, to improve the ease of living, quality of life, through better health, education and public services.  ...

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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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President Trump on a three day visit to the UK promised a free trade deal with Britain if it made a decisive break with the European Union. Such a free trade deal could take years, offer small benefits compared to the loss of the much larger trading relationship with the European Union. It would face hurdles in passage through Congress because Democrats controlling the House of Representatives see a decisive break with the European Union including the customs union arrangement as affecting the open border in Ireland risking the hard won peace in Northern Ireland.  Prime Minister Theresa May proposed a withdrawal arrangement that would keep the customs union arrangement but has failed to secure the support of a faction within her Conservative party that favors a decisive break from the EU. Such a break that Mr. Trump and Boris Johnson the leader of this faction -and a favored candidate to succeed prime minister May after her resignation- would reduce Britain's GDP over the next 15 years at the higher end of the range of 0.1% to 9% a year. A decisive break called a no deal Brexit with no arrangements or agreement for withdrawal with the EU, would lead to a loss closer to the 9% estimate. British experts to the EU are about $275 billion or 44% of its total exports compared to about $44 billion to the U.S., according to HMS Customs source, showing how important it is for Britain to maintain a close trading relationship with the European Union. British farmers would also face competition through agricultural imports from the U.S. in a free trade deal. During his visit Mr. Trump also stated the National Health Service, everything would be on the table in a free trade deal with the U.S.  Theresa May responded by saying that the NHS would not be open for negotiation to American corporate involvement. Public sensitivity is high on any change to the National Health Service. The trip of president Trump to London in which he supported Boris Johnson as candidate to succeed Theresa May, with discussions between Trump and Johnson for 20 minutes, and a visit by Nigel Farage to the U.S. embassy, and no meeting with Labour party leader Corbyn, only shows the widening of differences on the issue of British withdrawal from the EU making any deal for withdrawal even less likely. Labour party leader Jeremy Corbyn now favors a second referendum on whether Britain should leave the EU.  ...

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Upward mobility in China was weak and income growth for average workers sluggish during the years before the coronavirus outbreak. In this sense China is similar to the U.S. and Europe where upward mobility gains after the second world war were lost in the last 30 years partly from the loss of manufacturing to China. It is much worse now as the effects of the coronavirus lead to drops of as much as a third in income for ordinary workers. Lower income workers, the vast majority of Chinese numbering hundreds of millions now suffer from lost work or diminished wages. Small businesses cannot afford to pay the salaries paid before and as workers dip into savings or increase borrowing the retail spending is taking a hit. As a result economists see a vicious cycle of lower spending and lower incomes for the hundreds of millions of ordinary workers in construction and smaller businesses. Some small businesses could just close down because of weak demand affecting the economy over the long term. Before the coronavirus China went over three decades from being a Communist country with relatively equal distribution of wealth but lack of growth and technological development to a capitalist country with the structure of state control of the economy from the Communist period. The result is that 1% of the people control 33% of the wealth and the bottom 25% having 1% of the wealth, according to a 2015 Peking University study. China's president Xi Jinping, head of the Communist party, tried to reverse some of these trends by attacking corruption and making changes that began the task of reversing decades of unequal distribution of wealth under state sponsored capitalist growth. Investments were made in rural medical care, infrastructure and basic services. This did not have much impact because much of the pattern of growth over three decades continues including the housing bubble.  With coronavirus the trend is set for even more unequal distribution of wealth as many workers at the bottom half of the population in incomes either lose work, or see drop in incomes as businesses that hire them struggle from shoe factories to other retail business. Reports of informal economy and street markets in Chengdu in western China and bringing this part of the economy back by the state are effort to get people work in other ways. Researchers estimate that China's bottom 60% of household in incomes lost about $200 billion in income in the first half of 2020. In May premier Li Keqiang said 600 million people in China earn only about $140 a month. Many who lost income or jobs do not have support from the government as China lacks a program of comprehensive unemployment insurance as in Europe and the U.S. to help people get over bad times. 300 million migrant workers are particularly vulnerable to loss of income and dipping into savings.   ...

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Sebarros of the WSJ takes a closer look at the key words used by U.S. president Trump in rallies in city after city during the 2016 election campaign and in the months before the Congressional elections in 2018. Analysis by the WSJ counted the unique two word phrases, how often Trump highlighted topics, the content of audience respones in 48 post election rally speeches through Oct 27.  In 2018 the words "tax cuts,"fake news," and "health care," appeared more often than in 2017 after the Republican party's win in passing a tax cut. Other phrases used frequently were "law enforcement," "North Korea," and "Supreme Court" after the win in nominating Judge Kavanaugh. The use of the 2 word phrases are carefully done. The words "fake news" were not used during sensitive periods such as when pipe bombs were mailed to government offices, yet resumed few weeks later. His own name is the seventh most used word, even for someone such as Mr. Trump, showing that behind the impromptu remarks there is a carefully worded effort to steer voters in a particular direction with carefully developed appeals. Another example is when the Dow Jones averages were reaching new highs in September and October Mr. Trump highlighted the stock market growth, and then when volatility increased by November said much less on this topic. Graphs by Jessica Wang provide a good look at how frequently and in what manner Mr. Trump has continued his unique campaigning style before the 2018 Congressional elections, with two word appeals to already receptive audiences. The audience participation is a singular feature and the words "U.S.A." were used in 85% of the rallies with "Build that Wall" at 65% as the next most frequent.  Much of it is repetitive in city after city and the WSJ analysis shows that the major television networks including Fox News are not covering the speeches from beginning to end as they did before, only C-Span public network does. To receptive audiences in carefully scripted surroundings, including larger ones such as the Toyota Center Houston, where larger numbers of supporters worried about immigration, health care, trade, and other issues can come together, president Trump has rallied core supporters with this kind of appeal. ...

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The public health emergency announced for the pandemic ends on May 12. Title 42 is a law that uses the public health emergency and pandemic to turn people back from Mexico who cross the border illegally. Democrats and Mr. Biden were critical of the way people were treated at the border under the Trump administration. Yet when faced with higher numbers crossing illegally as Title 42 ends on May 12, Biden and Democrats see the need to replace Title 42 with rules that will tighten controls at the border. It is essential in several ways. It blunts the Republican message to voters that Democrats are not handling the border issue and uncontrolled immigration well. Mr. Obama did this for 8 years by continuing a high rate of deportation of illegal migrants before Mr. Trump.  What makes it possible for migrants crossing the US Mexico border illegally to seek to stay in the US, are US asylum laws that were passed after the refugee crisis during and following World War II. The next step is that the US will now end these asylum privileges as they are being used for economic reasons by huge numbers of migrants crossing from regions in Central America because of economic problems. When a coffee growing region in Guatemala was affected by a bad harvest there was a surge in migrants, with similar patterns repeating themselves over decades.  Just as Mr. Biden closed the Afghanistan war because he could see that it was the right thing to do and essential for the US to build abetter future for its people, Biden now sees the need to end rules and policies from a previous era that led to illegal immigration. Biden is also doing this by increasing legal pathways for immigration to the US where it is done officially and in a proper way. ...

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A ban on TikTok in 270 days is plausible, with credit going to Republican senators in Congress, as they insisted on it being incuded in the Ukraine aid bill package. Not only because of security and democratic process concerns- then one asks why what other real even larger concerns?  A ban on TikTok by restricting its use that does not affect education is already in place in China, yet such a ban is easier implemented in state power centralized government for the benefit of China's young generation and not in the US system of government. Excessive time spent on social media apps in the US including TikTok as the largest are a serious problem in America today -for young people's educational activity such as reading, studies, and for mental health. Taking a large part of the young generation in a direction that is not beneficial for the US, for democratic process to function with young people taking time to be better informed and for the health of the younger generation.  People assume that TikTok audiences will shift to other social media apps such as Facebook, but a large part of the TikTok population may engage in other activities that promote health as the consciousness for food and its preparation increases, for the value of exercise, engagement in sports and viewing sports or music, engagement in Nature and hobbies, and in time spent on travel, all happening as the Nation shifts its attention and consciousness after these troubled decades from financial crisis of 2009 to the pandemic, a period of dismal failure to deliver public services with funding diverted and misallocation in capital markets collapsing or near collapsing infrastructure around us sapping the Nation's spirit and its energies.  A new spirit is emerging in the Nation and a shift in the attention of the younger generation as it feels the fatigue that is now felt for music idols such as Taylor Swift is entirely plausible so that TikTok would have risen and faded away both in the US, India, and even in China as it shifts its attention in a different world. ...

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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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Wuhan has announced  only 3 new confirmed cases since March 18. Restrictions on travel were lifted after a 77 day lockdown on the city, allowing inbound and outbound travel. Some restrictions on housing complexes have been tightened after reports of dozens of asymptomatic cases. The number of asymptomatic cases remains unknown. There is a fear of a second outbreak and authorites are staying vigilant, as it is feared that the first outbreak was worse than previously thought. Epidemiologists, intelligence agencies, and health experts believe the number of cases reported in Wuhan and China are undercounted. This could be they say a result of local officials wanting to present a better picture, of not enough testing in the early stages, not counting people who died at home, and including people who died of pneumonia under pneumonia instead of coronavirus. Dr Birx, head of the U.S. response effort,  says the U.S. lists people who died of pneumonia in New York as coronavirus deaths because of how widespread it is there, hitting seven people in a thousand. In addition there is a problem for all countries in counting people without symptoms. No one even knows how big that is, and Dr Birx in the U.S. says it is important to find out. ...

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Samuelson shows why the Ryan Plan needs serious consideration because it brings in competition from the private sector to control medical costs. The Obama plan does not reduce Medicare costs he says because it merely transfers the costs to mandated Affordable Care Act spending. And the Independent Advisory Board of 15 experts given the job of reducing Medicare spending if it exceeds a certain amount is ineffective- it cannot increase patient cost-sharing, restrict benefits or modify eligibility or cut spending by more than 1.5% in any particular year according to the Kaiser Family Foundation. Important points to remember about health care are: 1) sustainable Medicare for current and future generations can only be on the basis of sound finances 2) sound finances mean first and foremost controlling health care costs 3) private sector competition is the better way to control health care costs in todays environment where cost reduction needs to be large enough to make Medicare sustainable especially when competition shifts health care delivery away from the cost increasing fee-for-service system 5) Obama Affordable Health Care Act does little to change the costly fee for service system and the basic mechanism of cost escalation in U.S. health care. The Ryan plan's voucher option injects this dose of competition into the system and only for those who choose this option, it was also drafted with the help of Democrat Ron Wyden, and is cautious because it does'nt start this till 2023- giving time for discussion and improvement, and therefore a constructive effort to look at serious ways to control uncontrolled fee-for-service spending....