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The Health Exchanges set up under the Affordable Healthcare law (Obama Healthcare law) reaches 5 million by mid-March 2014. The Congressional Budget Office estimate is for 6 million enrollment in 2014 compared to a previous estimate of 7 million.

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The effects of loneliness during the lockdown period and various ways in which people learned to cope with it- including cultivating positive feelings of hope and better times ahead. This includes overcoming social conventions and talking about things to oneself and others that acknowledge what is happening and how efforts can be made to cope with it and move forward. A doctor in Barcelona says on BBC television that most healthcare workers are coming out of this crisis in hospitals with feelings that have not been acknowledged and sometimes just avoided for lack of time. She says talking about it, even with the BBC and others helps bring things out in the open, hidden feelings acknowledged and expressed so that one can emerge whole out of this experience. Though much of this article is about climate change the efforts to express feelings are now even more urgent for people in health care and people who live with them. 

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Interview with Gerard Kleisterlee, retiring CEO of Philips Electronics. Kleisterlee led the effort to focus on emerging markets where sales of health care, lighting and consumer products are accelerating. Second quarter sales in emerging markets went up 29% for 2010 over the prior year, and now are 34% of total Philips sales. As part of this strategy Philips is increasing its staff and research divisions in China, to capture part of the $125 billion that China plans to spend on healthcare in the next 3 years. Kleisterlee talks about local competitors in emerging markets who are trying to get a regional or global presence. How Philips is increasing local responsibility, and how it is designing, engineering and manufacturing products specifically aimed at local markets in emerging market countries- as away to compete effectively in these markets. He also points out that it is no longer sufficient to be in the major cities, Philips has to move into smaller cities and into the rural areas to increase sales. He sees consolidation opportunities in Asia where the lighting manufacturing is still fragmented. Responding to a question about Philips still being too old, too male, and too Dutch, Kleisterlee agrees that it is too male and too Dutch for his comfort. Women are a bigger part of his health-care team, but not that much progress in other areas of the company. And he would like to see more local leaders in emerging markets. He sees consumer behaviour changing in one respect- there is an increasing consciousness among buyers for value, and not just for low price points, but at all price points....

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The US House of Representatives voted 245-189 in favor of repealing the health care law. Only 3 Democrats joined the entire Republican caucus in voting for repeal, compared to 34 Democrats who voted in March 2010 against the health care law. This is a largely symbolic move as the Democrat controlled Senate will not consider the repeal, and even if it did the President would veto it. Republicans favor some aspects of the health care law which allow children to be on the parent's insurance till age 26, and a ban on insurers denying coverage due to pre-existing conditions. Opinion polls show 46% of respondents opposed repealing and eliminating the law, and 45% favored repealing it. The health care issue ranks third among the economic issues important to respondents, behind unemployment and reducing the federal budget deficit.

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Education policy reform and serious action expected from the government. Obama has agood grasp of what is needed and what actions to take to improve the quality of education in our schools, and the support from parents.

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Treatment costs with Praluent for cholesterol control are extremely high at $14,600 a year.

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About 400 million or one in 4 people people smoke in China. State ownership of the tobacco industry only makes this worse. Enforcement of bans on smoking is lax. Experts warn that this would become a major healthcare problem in China.

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 This message from Pope Francis is especially relevant today during coronavirus. Francis says of the mistaken priorities of today away from healthcare, education, infrastructure and "coherence" in society and the pain and hardship this is causing in society, there is much that can give people thought to reflect on. Francis  new book, "Let us Dream: The Path To a Better Future" will be out December 1. "If we are to come out of this crisis less selfish than when we went in, we have to let ourselves be touched by others’ pain." He cites a line in Friedrich Hölderlin’s “Hyperion” that speaks to him, about how the danger that threatens in a crisis is never total; there’s always a way out, that where the danger is, also God plants the saving power, a way out. And not simply a way out, God also gives human beings a chance to grasp for and hold onto renewal if only one makes the endeavour. As it says in the Bhagavad Gita God gives man a chance to warm himself near the fire, only those who make the effort to go to the fire can feel the warmth, it is a choice man has to make. And again God says in the Bhagavad Gita that he is not partial to any man. Ever since the global financial crisis hurt working families in the middle and lower classes hard in 2009 because of banks misbehaviour and greed, Pope Francis has called for countries in the western world to heed his warnings about the dangers of greed and corruption to us all. Even George Washington warned of this in his inaugural address, so the warnings are not new. Reminding people once again he says "we cannot return to the false securities of the political and economic systems we had before the pandemic. We need economies that give to all access to the fruits of creation, to the basic needs of life: to land, lodging and labor. We need a politics that can integrate and dialogue with the poor, the excluded and the vulnerable, that gives people a say in the decisions that affect their lives. We need to slow down, take stock and design better ways of living together on this earth." The pandemic has exposed the paradox that while we are more connected, we are also more divided. Francis is never tired of warning that the present political and economic structures and people who staff them have not felt others pain, so he reminds us it is hard to build a culture of encounter in which we meet as people with a shared dignity, within a throwaway culture that regards the well-being of the elderly, the unemployed, the disabled and the unborn as peripheral to our own well-being. Where only self preservation counts. Francis reminds us of the Christian concept that no one is saved alone. This is not just an abstract concept. When Francis was only 18 years and a second year student he was admitted to a Buenos Aires hospital for a severe respiratory disease, so severe that he lost a part of his lungs. He remembers the day August 13, 1957. He understands this pandemic from personal experience. He knows what it is like to be on a ventilator. Surgeons removed the upper right lobe of his lung. Francis struggled to breathe. He was  saved Francis says not even by the doctors, but by a Dominican sister, a senior ward matron, who had been a teacher in Athens before being sent to Buenos Aires. She understood that Francis was dying and after the doctors left asked the nurse to double the prescription dose of penicillin and streptomycin. Sister Cornelia Caraglio, knew better than the doctors from her regular contacts with sick people what they needed, and she had the courage to act on that knowledge.      ...

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Political activism and grassroots efforts- other than street protests - are increasing in eurozone countries facing high unemployment and austerity cuts. The focus is on cleaning up the political system rife with cronyism, corruption and wasteful spending. Brat and Bjork describe one such effort in the town of Torrelodones, Spain, 18 miles from Madrid. Criminal investigations in many Spanish cities have increased public awareness and participation in local government. European Social Survey based in London, reports political activity of this kind in Spain jumped from 27% in 2008 to 39% in 2010. There is an increasing sense that the political elites of the two main parties, the Partido Popular and the Socialists have failed to bring clean government and transparency to Spain. As a result progressives are joining conservatives in an effort to clean up years of wasteful spending, cronyism and corruption in government. The Union for Progress and Democracy, representing an alliance of such groups would win 13% of the vote in a national election, and the ruling conservative Partido Popular would lose half of its support and get only 22.5%, according to independent Spanish polling firm Metroscopia. The new push for transparency is one of the welcome changes at a time of austerity cuts and 27% unemployment in Spain. Many of the perks of public officials such as chaeuffer driven cars and police escorts, contracts for favored few at higher prices, are out in many cities, and accounts made public for scrutiny and change. Transparency International's transparency index shows 33 out of 110 of Spain's biggest cities scoring top grades on the 2012 index, jumping from only one. Following the example of the regional government in Navarra, the central government is drafting the first open-records law. Castilla-La Mancha, the area around Toledo, run by a clean government advocate Maria Dolores de Cospedal from the Partido Popular has taken aggressive steps to clean up the local government and wasteful spending- see the link to Castilla La Mancha. Her long term approach is to clean up government spending and accounts with the idea of preserving spending where it is most needed, in education, healthcare and vital services hit by cuts, an approach being taken in other Spanish cities. ...

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The French system what works and what does not work compared to the Anglo-Saxon systems of Britain and the USA. Health care works, public transport and high speed rail works, nuclear energy and the energy industry works, education works for small elite universities but fails in the larger system. The large public projects are executed well, and France has done well with its long tradition of the state building infrastructure projects. But when it comes to individual initiative and starting up new companies such as in computers and high tech of that kind, France does not do so well. And the state collects a larger proportion of taxes than in other countries to finance these benefits. France is also good at rule making, which serves it well in controlling the kinds of bubbles that regularly hit the Anglo-Saxon countries. And with 21% of jobs of all workers in France in the public sector and government, with 49% when one includes related sectors protected from economic downturns, the French workers are much better protected than workers in Britain, USA and other countries from economic downturns. Unemployment stays high in upturns and at 8%, and in downturns does not go too far above 8%....

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The U.S. Senate passes a motion that allows the chamber to proceed with a debate on a health care bill. The motion passed 51-50 with Vice President Mike Pence casting the deciding vote. Republican Senators Collins and Murkowski voted against the motion. This report in the WSJ says this sets in motion a process in which debate will take place and amendments will be made. It is not clear what shape the bill will take. Under the process used only a simple majority is needed in the Senate, yet this allows for many amendments to be made.  Only hours after this motion passed by one vote, a bill replacing major parts of the Affordable Care Act failed to pass 57 votes against and 43 in favor. Senator John McCain who arrived in Washington from Arizona following brain tumor surgery, delivered strong criticism of the way the Republican healthcare bill was rushed through allowing very little debate. Experts have commented on the way the bill was rushed through with a thin majority for passage, with very little debate, first by Democrats in 2009 and now in the House by Republicans. With the same pattern now followed in the Senate by Mitch McConnell, the Republican leader in the Senate. A backup bill would remove just the individual and employer mandates and a tax on medical devices- the elements Republicans agree on, if no majority can be put together for the healthcare bill. ...

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The Economist points out (in this cover issue on India-Pakistan relations) several fundamental facts. The first is that the current state of relations betweeen India and Pakistan hurts Pakistan the most. It makes a much smaller country and smaller economy bear the burden of defense against a large neighbor- defense takes up much needed allocation of funds for infrastructure and development, education and healthcare. It also weakens democratic institutions and their development by an overdependence on the military for governance. Poor India-Pakistan relations have significant adverse effects on the U.S. In fighting the Taliban U.S. forces are fighting a force that Pakistan's military helped create and support from its early beginnings as a way to counter Indian influence. With an Indian-Pakistani peace settlement of issues in Kashmir and other outstanding issues the U.S. would be in a significantly better position to disengage from the region, especially when the entire Middle East is moving in a new direction in 2011. Consider the difficulties in establishing peace in Northern Ireland, and between Turkey and Greece, and the difficulties of establishing peace between India and Pakistan cannot be considered even more difficult. Pakistan and India muddle along- neither side is doing much to take the initiative. For the U.S. disengagement from South Asia can be best achieved by pushing for a settlement between the two countries. Pakistan and India have much to gain from a settlement. Considering the progress made in Ireland, such places as Yugoslavia, and in Turkish-Greek relations, there is a lot more that can be done and should be done to bring India and Pakistan together. In Ireland diplomatic efforts were made by U.S. envoy George Mitchell, and in Yugoslavia U.S. envoy Holbrooke made diplomatic efforts towards the Dayton accords. Greek-Turkish relations have advanced to the point where Erdogan and Papandreou, the Greek and Turkish prime ministers, discuss solutions to the Greek debt crisis. This includes options to reduce Greece's defense expenditures in the light of Turkey's new foreign policies. The lack of such efforts to break the deadlock between India and Pakistan by the U.S,. the U.K. and other countries involved in the NATO mission in Afghanistan, the emphasis on a military solution supported first by Gen. McChrystal, and then by by Gen. Petraeus, all show a lack of understanding of the real issues that need to be tackled- issues relating to a peace settlement between India and Pakistan....

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A joint article by Robert Rubin, Clinton era Treasury Secretary and Jared Bernstein of the Economic Policy Institute. Rubin was senior adviser to Citigroup during the period that Citigroup leveraged itself and invested in lower quality securities that have left the firm exposed to substanital losses, and led to hiring a new CEO Vikram Pandit to clean up the mess. And this may explain the joint article with a less well known economist Jared Bernstein, and the tentative nature of their advice as the two differ on the important issue of long term fiscal deficits and still agree on investing heavily in healthcare, education infrastructure, worker training and energy. In a short recession they may be complementary and you could have the best of both worlds as in the other postwar recessions. But this is unlike any of the postwar recessions and is shaping up to be a long and deep downturn unlike anything seen in the postwar period. That Rubin does not even mention this shows that probably he is out of touch, as he was during his years when Citigroup was acting much like the other banks that were in serious trouble this year. Some of the decisions for lax regulation during the Clinton years were taken with the support of Rubin and Greenspan. What Rubin calls the longest expansion could have been for the most part good fortune and a steady period for the economy with Rubin's contribution being fiscal discipline, stewardship of the Mexican rescue package and committment to free trade policies, but not facing upto huge headwinds in the economy that required challenging leadership and judgement. Here Rubin mentions nothing that suggests bold vision and judgement, instead hoping that old policies that worked during the good times would somehow work today. And on some issues like labor being squeezed and getting a smaller portion of the economic pie with no support for unionization, a drop in the number of unionized workers and weakened labor bargaining strength, Rubin who now sees this as a bad trend for the working middle class incomes, did little in his years in the Clinton administration to reverse or slow this trend. He cites productivity growth of 20% from 2000 to 2007, and yet the real income of working age middle class households was falling $2000 or 3%. ...

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Janet Yellen Fed chairwoman, says many obstacles still exist for women in the workforce. Bringing more women into the workforce will increase the productive capacity of the American economy. The increasing participation of women in the workforce was factor in the growth and prosperity of America by the middle of the 20th century. In a speech sharing her personal narrative at Brown University, her alma mater, she described how other nations had passed the U.S. in women's participation in the workforce, and how it remains stalled at 75% for women either working or looking for work. Her speech was at a conference "125 Years of Women at Brown." The U.S. is now 17th among 22 developed nations in participation of women in workforce, mostly because of government and business policies that relate to paid maternity leave, affordable child care, and flexible work schedules.