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Athenahealth, a provider of software for physicians, is intervewed by Jon Kamp about the efforts to promote digitization in physician's offices.

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The coronavirus pandemic and the disaster in nursing homes, the chaotic conditions in the first wave, the lack of staff and poor attention to residents during the pandemic, has exposed the major weakness of nursing home care in western countries. Much of this sector is in the hands of private operators seeking a profit.  The staff is paid low wages and lacks the experience and empathy needed for care of older people. During a virus all these factors turn deadly. With some staff sick the other staff is overburdened. If the sick turn up for work they are likely to risk the safety of other staff and the residents. With the incubation period lack of testing there is no way to know. When deaths occur and the nursing homes are sealed from the outside world the deaths happen with no goodbyes as happened in U.S., Britain and Sweden. This has exposed the scandalous and shocking way in which the elderly are treated in today's environment where ridiculous amounts of money are being spent on other things and the the most basic "one's parents" are neglected and allowed to die in horrific manner in a pandemic. The new trend for home care for the elderly is a welcome trend and long overdue as one of the worst aspects of the system in the west is the treatment of elderly parents in nursing homes run for profit. The new technology tools available for monitoring a elderly person at home, and the help of stores such as Best Buy which are serving elderly at home, is making this more and more a choice for the elderly. Even older patients and ones needing significant care can recover and spend time at home in a better environment, a less costly one, as hospital managers and families have learned in 2020. Some hospitals in the U.S. say they never want to go back. That the drive to get every patient home who can be home is the right one for patients and families and for the government paying for the care so that dollars are well spent in quality of care. Home health care companies are working on providing new services for sicker patients recovering at home. Technology helps do better monitoring. Medicare now pays for digital doctor visits and intense hospital type care at home after coronavirus showed this as vitally needed.  Both the Biden and Trump administrations are firmly focused on this issue. Seema Verma as head of Medicare is clear about the need for a national conversation on how we take care of the elderly, of our parents. And Mr. Biden wants to spend $450 billon to make certain that people who need long term care can get the support they need in the home and the community. This report looks at the home health care companies and how they are improving their services. This and telemedicine are two of the major constructive changes coming out of the pandemic, clearing out some of the worst aspects of the old system of living the older years in the western world.  Nothing speaks more about humanity and a human world than the story here of Savanna Hollar, 90 years old and almost blind. She broke her shoulder in August, Her sons decided not to send her to a the rehab facility she went to after a broken hip 3 years earlier. The sons brought her home to recover in the farmhouse near Yadkinville, N.C., where she has lived since 1951. One of her sons himself 63 years says that at a nursing home she would be lonely, scared and afraid to move. The sons hired two people to help her during the day and a rotating system was used for having people help her. At home Mrs. Hollar could enjoy her gray cat, Buddy, her favorite recliner and tomato sandwiches made with produce from her garden. Really, if we can't do this much what good is the U.S.A.? or Britain? or Sweden? or India? ...

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Google's head of operations in India, Rajan Anandan, cites estimates of 200 million new internet users in India by 2014. An estimated 100 millon Indians were online in 2010. The surge in internet use is expected with the roll out of high speed internet technology and expected sales of low cost smartphones using Android software. Most of the Indian advertising dollars go to print and television advertising. As a result online advertising spending is only about 200 million dollars. One aspect of Indian user behaviour is the preference for the internet as the first source for research when it comes to buying cars or other products. Google has 63 million Indian users for its search service, according to ViziSense, an Indian web metrics firm. Anandan says Indian advertisers could benefit from an Internet first strategy to reach affluent urban consumers.

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Experts view Countrywide as being at the core of the problems at Bank of America, which has lost 60% of its share price in 2011.

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David Cote, CEO of Honeywell International, says U.S. corporations have $1 trillion sitting on the sidelines ready to be invested if business can be provided with more certainty about U.S. finances through successful deficit reducion negotiations. He is the most active CEO behind the Fix the Debt organization and is respected by both sides. In the fiscal cliff negotiations he has taken messages in both directions from Democrats and Republicans. Cote is a former executive of General Electric, who has led a turnaround at Honeywell. Large business stayed out of the deficit negotiations in 2011 which brough on the fiscal cliff arrangement of deep cuts in defense and automatic tax increases if no agreement is reached by Jan. 1, 2013. Cote and CEO's behind Fix the Debt have decided to engage with both political parties in the negotiations in 2011-2013.

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The government of president Hollande in France added about 7 billion euros of new taxes after May 2012, and an additional 20 billion euros in the 2013 budget. Spending cuts totaled about half the tax increases. France's taxes are the highest of the major EU countries and there is concern that this may hinder the economic recovery. French businesses are cutting back on capital spending. Insee survey for April 2013 showed French manufacturing businesses planning cuts in investment of 4% for 2013. The government says spending cuts go up in 2014 to about two thirds of the deficit reduction and tax increases about 6 billion euros. France's statistics agency Insee says economic growth was 0.5% in the second quarter of 2013 compared to the prior quarter. The recovery was supported by consumer spending, with private capital investment lagging behind. This is about 1.9% growth in GDP on an annualized basis, according to J.P. Morgan.

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A major change is taking place. Automakers around the world are shifting to smaller engines. Hyundai's Sonata for 2011 and the Tucson crossover for 2010 are going to have only 4 cylinder engines. Many V-6's offered by Detroit carmakers are being replaced with 4 cylinder engines and V-8 with V-6 engines. Ford is using the EcoBoost a turbocharged V-6 to offer new options for its Taurus, Lincoln MKT and other cars.

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The WSJ/Vistage U.S. Small Business Confidence Index ends 2013 at a new high of 108.4 reflecting optimism of small business owners. The Index for 2013 shows a sharp drop by November 2012 to about 82 followed by a sharp increase for Dec. 2013 to about 94, and a similiar pattern is observed as it declines to about 95 in October 2013 and increases to 108.4 in December 2013. The sequester and deadlock in talks by Nov. 2012, and the government shutdown and its resolution by Dec. 2013 are likely causes. The Dec. 2013 Ryan-Murray budget agreement points the way out of political uncertainty that Vanguard CEO McNabb pointed to as a primary obstacle to investment and growth. This may be the strongest indicator of what lies ahead for 2014- 52% of 937 small business owners surveyed online in the Index in Dec. 2013, say the economy has improved in 2013, an increase from 36% in 2012. And 38% say they expect conditions to be still better in 2014, from the prior years 27%. Small business owners polled have sales less than $20 million and fewer than 500 employees. They are the main engine for growth in employment. Loten cites small business owners in construction and other industries who have increased hiring and expect to see a significant improvement in 2014. One owner who represents the pattern taken by small business, cut back employees by 2010, and held back on investment till 2012, increased investment in 2013 and is now expanding. Availability of credit with improved bottom lines and banks more willing to lend will be another positive in 2014-2015....

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The Editorial Board of the Washington Post on the challenges facing Mario Monti, the new prime minister, and the Italian people in 2012-2015.

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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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Reliance Jio launches a high speed broadband service in India with annual plans for subscribers ranging from $10 to $118 a month for speeds from 100 Mbps to 1 Gbps. The prices are about one tenth of prices in Europe and the U.S. In 2016 mobile network prices dropped after Reliance introduced lower pricing. The new launch provides streaming services using high speed internet. Reliance Jio is taking on telecom companies, as well as streaming platforms. It is now the largest telecom company in India with revenue of $1.6 billion in the quarter ending June 30, 2019.  The free trial offer from Reliance Jio is 100 Mbps connection free, along with Jio apps. There is a 100 Gigabyte quota, with free 40 GB at a time 24 times- a total of 1000GB free. The only charge is a refundable deposit of 2,500 rupees ($35) for the router. Giveaways include high definition or LED television  and 4K setup box. 15 million people have registered for the service. Reliance Jio is aiming for 20 million residential users and 15 million businesses across 1600 towns in India. Reliance playbook is to launch aggressively with low prices and establish a dominance in the market. It did this in 2016 with free trial offer bringing in 100 million customers in the first 6 months. Today Reliance Jio service has 340 million customers who spend 30% more than other operator's such as Airtel and BSNL.   By cutting data prices in India sharply to one tenth of world prices Jio has created a completely different market and one in which there are only 3 or 4 smaller competitors in that space. Bringing down prices for users and enabling India to jump ahead in internet use in ways similar to that of South Korea, Finland, China.   ...

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The changing attitudes to regulation after serious regulatory failures in the last years of the Bush administration. The temper and mood of the new Obama administration.

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The story of how prime minister Naoto Kan's distrust of TEPCO, the electric power company operating the nuclear power plant at Fukushima, and of the bureaucrats in the government, played out in the first days of the nuclear crisis in 2011. Kan bypassed the crisis management system set up for just such a situation because of a deep mistrust of the collusion between industry and bureaucrats. Instead he relied on a close group of advisors, who felt that the company was not sharing all the information but could do little about it. This led to lack of direction in the crisis from the highest levels of government, including a lack of response to U.S. offers of support and assistance with nuclear experts and technology.

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A dispute in Brazil between the government committing part of the oil royalties from new oil discoveries in coastal oil producing states such as Rio de Janeiro to improving education in Brazil. Coastal producing states fear the loss of an estimated 3 billion dollars under this plan. Some of the money goes to states in the interior of Brazil such a Goias lacking educational facilities and funding for teachers.

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This editorial by the Washington Post says private equity taking risks on troubled firms is Capitalism 101, and fulfills the role of "creative destruction" in capitalism as it functions in the American system as compared to the European system. It says private equity's gains in its investments are taxed as "carried interest," at a lower rate than ordinary income, and this needs to be changed so that government does not favor private equity investments.

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Today GM announced that it is eliminating lifetime health coverage for about 100,000 white collar salaried retirees, as it is rapidly running out of cash to run operations. Also white collar salaries of current employees will be cut by 20 percent and the $1 a share dividend eliminated. This with other savings will save $1.5 billion annually GM estimates. Union contracts prevent this from taking effect for former factory workers even as the company is truly running out of cash. In paying the lifetime costs of hospital stays, surgeries, expensive drugs for retirees GM spends$4.6 billion in 2007 on health care for its one million employees and retirees and their dependents. This is larger that GM's entire active work force and a big reason GM has got into trouble. It also skewed management decisions in the wrong way. Management let it affect their strategy in the marketplace, they continued to run the company by emphasizing sales volume with frequent sales and discounting in the belief that the size was needed to support all these retirees goldplated medical care, care which does not exist in other industries and companies, even when GM coud least afford it. By carefully shutting down plants earlier as demand for some of its cars and vehicles was shrinking, and closing down some brands, GM could have focussed its efforts on the areas including smaller passenger cars and midsized cars and other models which were gaining popularity, and shifting ahead of the curve out of pickups and large SUV's in the face of higher gas prices. Its the collapse of the pickup and SUV market that exaggerated the impact even in October 2008, instead of the about 30% decline that the industry faced and GM faced in its cars, GM's dramatic drop in pickups and SUV's gave it an overall loss of 45% October 2008 over same month 2007. Without this aberrration of health care benefits from a previous growth era and a dominant GM - an anachronism in the present when GM was in decline and health care costs had mushroomed and company health care benefits cut back in industry after industry- and without the intransigence of the unions and the failure of management to build credibility, share the pain and convince the unions in good faith that this was unsustainable, GM could have had a much better shot of developing a strategy for renewal. Instead it sealed GM's fate, along with lack of foresight in taking decisive action to shift to higher fuel efficiency cars early in the curve, and closing unneeded plants and brands to focus on this task. In the end the gold plated benefits which were terminated today are lost for salaried retirees, and sooner or later the same is likely to happen inside or outside bankruptcy for union workers. Union workers who might then say what the salaried retirees are saying now, that if the company goes out of business, they would lose everything anyway, and could not blame GM for cutting them off. If only they had understood this earlier and accepted these facts, and if only managment had built the credibility and shared the pain so that company's interests came above union or management interests, as they should be for a company to grow or renew itself and grow. In the end union workers in the auto industry were living beyond their means, just as consumers in the USA were living beyond their means, and the outsized executive compensation also a kind of grab from another era. Renewal starts with getting a grip on reality, and reality slipped away from their hands....