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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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Moody's downgrades the credit ratings of 26 Italian banks in May 2012. Italy's largest retail bank Intesa Sanpaolo SpA, showed net profit of 804 million euros, up 22% from the prior year. Of this 183 million euros was from capital gains made using the ECB low cost loans under special ECB financing to buy government debt. The ECB financing was through the Long Term Refinancing Operation launched by the ECB in December 2011, which benefitted Italian and Spanish banks.

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Health and Education are the best bets for investment to revive the economy. BW's Mandel says the health and education fiscal channel is still functioning, while other ways of stimulating the economy are in breakdown mode. Taxpayer money given to banks, businesses and households will be saved to pay down high levels of debt and because of uncertainty. But funds directed to schools and hospitals will be spent to buy new equipment, modernize and update, put up new buildings, and hire workers. Health care especially is keen on hiring new nurses, medical technicians, home aides, and so on. And over the past year health care and education workers have risen by 500,000. In these hard times the hardest hit areas like Michigan have seen health and education make up 23.7 % of jobs, while manufacturing has dropped to half that, only 12.5%. And in the past decade health and education has had a stabilizing influence already. Nationally these areas have hired steadily, adding 5.3 million jobs since 1999. Meanwhile the rest of the economy has seen booms and busts, and off shoring and outsourcing overseas, with only 400,000 new jobs created in 10 years. Education has suffered neglect for needed infrastructure including broadband and internet capabilities for classrooms, and health care suffers inefficiencies such as computerization of records, and cost inefficiencies. These areas can be modernized and improved, adding to benefits years from now. They are large sectors employing 30 million workers or 22% of the workforce, and now badly needed to stabilize the economy as these employees are well paid and could help keep consumption from falling badly. A Gallup poll taken in February, shows 56% of Americans showed that education investments were "one of the most important items " for stimulus spending, coming out on top, and beating tax cuts....

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This report shows an alarming trend in China which is fueling a real estate bubble similar to the one that Japan, and more recently the U.S., experienced. State owned companies are actively speculating in real estate, and are buying real estate from local governments eager to profit from the real estate boom. Local governments obtain land and build infrastructure on it to raise the price that they can get for it in an auction. In many cases one state owned company outbids another state owned company from different sectors such as oil, chemical, military, telecom and highway. Land records reveal that 82% of land auctions in Beijing in 2010 were won by state-owned companies up from 59% in 2008. The National Bureau of Economic Research in Cambridge, Massachusetts, has estimated that land prices leaped by 750% from 2003, with half of this happening in 2008-2010. In many cities housing prices have doubled in the last 2 years. The National Bureau estimates that on average these state owned companies paid 27% more for the same piece of land than other bidders. China's $586 billion stimulus and its aggressive lending program by state owned banks may have helped in other ways after the 2008 economic crisis, but in this area it has fueled a real estate speculation boom, with the local government and state owned companies being the key participants in this speculation. Local governments earned an estimated $230 billion in land auctions in 2009. The demolition of older neighborhoods and poorly compensating residents are all part of the effort by local governments to profit from this speculative boom. The implications for the banks are serious. Local governments use other companies created for the purpose to engage in this investment in land. And off-balance sheet accounts create the danger that China's state owned banks may have enormous amounts of debt that is not showing up in the regular accounting. Analysts say that the $1.4 trillion in loans made by state banks in 2009 was twice that in 2008, and a large portion of this was diverted into real estate speculation with records set in land bids and booming prices. All this is happening as China's Ginni coefficient has deteriorated rapidly. And the simple fact remains that even as apartment prices exceeded $200,000 in Shanghai, the average disposable income is about $4000 per year. Prof. Shih of Northwesten University has followed the investment companies of the local governments closely and comes to similar conclusions about the size and implications of this real estate bubble in progress. Shih estimates LIC (local investment companies) debt owed to banks at $1.68 trillion or 34% of China's GDP. See the link to BW's Dexter Roberts. ...

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Spanish banks agreed to reforms and job cuts as a condition for a 37 billion euro loan from the eurozone bailout fund, the European Stability Mechanism. The restructuring plan applies to Bankia, Novagalicia Banco, Catalunya Banc and Banco de Valencia, with the largest job cuts at Bankia bank. Bankia will have 6000 job cuts, 28% of the total employees, and cut branches by 39%. Banco de Valencia will be absorbed into Caixabank and receive 4.5 billion euros of the loan payment approved.

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China's National Bureau of Statistics made an announcement in Beiijing that 51.27% of the Chinese people now live in urban areas. In 1949 the figure was 10.6%, in 1979 it was 19%. In the space of three decades China has urbanized rapidly. This has brought with it economic growth, infrastructure development and increased employment in the manufacturing sector as new workers moved from rural areas to the cities. With it also come major problems for the country and the leaders of the Communist party led government. Of the 691 million urban residents, 253 million are migrant workers- 37% of urban residents and 19% of the population are in this grey zone described as the "hukou" or household registration system. Under "hukou" these migrants from rural areas cannot access public services in the cities, and have rights to access them in their own villages where they are registered. Integrating these migrant workers who are different than their more affluent and better educated neigbors in the cities so that they become truly a part of the urban areas will remain a huge challenge for China. One of the ways China is addressing this is with the plan to build 36 million units of affordable housing for these migrant workers by 2016. Ever so gradually Chinese officials are relaxing the restrictions on migrant workers- such as Shanghai Mayor Han Zheng's announcement for allowing all migrant workers to rent subsidized housing in the outer parts of Shanghai and committing to "increase the migrant population's involvement in the community affairs, cultural life and show genuine care for them." Food security is another issue as more development on prime agricultural land means less land available for agriculture. Appropriation of agricultural land for industrial use is bringing the country down to the limit of 120 million hectares of agricultural land needed for self sufficiency in food, according to the Land Ministry. At the same time China's leaders want to avoid what the World Bank calls "the middle income trap," where a country reaches a level of modernization and urbanization, and then stalls at that level- the level being around $3000 per capital GDP, which is China's GDP per capita today, according to the National Bureau of Statistics in China. Li Keqiang, who takes over from premier Wen Biao, sees the building of affordable housing for migrant workers as a critical way to continue the urbanization process, and shift the country from its export focus by increasing consumption and the development of industries that support this. A slowing economy dominated by state owned companies focussed on a decelerating export model and an aging but still growing population- NBS says China's overall population was up by 4.8% in 2011 over 2010 and has reached 1.35 billion- presents a tougher set of challenges to the new leadership in China than was faced by the current leadership....

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This analysis of coal use using graphs shows a clear move away from coal in the world, except for two growth markets China and India which account for 60% of the increase in coal use since 2008. India has gone black in its shift to increasing use of coal. China has begun the shift away from coal to address the smog over large urban areas, poor air quality and health impact of coal use. Because China used five times the coal used by India in 2017, the overall impact in China and India is showing a shift away from coal to hydropower, other renewables including solar energy. It is likely that India will make the shift following China's example in the future. 

The trend is clear when one looks at the incremental terawatt hour and where it comes from. The shift is clear to renewables, hydropower, and non fossil uses in the rest of the World and China which account for most of the coal use in the world.

 

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Geeta Anand and Jaeyeon Woo of the WSJ give this heartwarming story of how South Korea achieved a remarkable transformation in attitudes towards women in society after 1990, and reversed a dangerous imbalance in the ratio of females to males. This was done by the release of extraordinary energy of woman activists after the end of dictatorship in 1990 made this possible, and the efforts of media, courts, government and society. Women won the right to be heirs in the family lineage, and perceptions of women as well as the opportunities open to women changed in this period. Today the Korean government provides $177 a month for the first 5 years for child care at home. The story of one mother and daughter and their experiences, of Ms. Lim and Ms. Ko, both teaching at the university and having daughters only, shows how South Korea has changed by 2016. Moving further South Korea's government now offers incentives to companies to make paternity leave policies generous, with municipal governments adding cooking classes and housekeeping courses for fathers. ...

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Greece's political parties negotiated through the night of Feb. 9, 2012, over the details of the 130 billion euro aid package from the EU and the conditions laid out by the troika of the EU, IMF and ECB. The political leaders Papandreou and Samaras agreed on wage cuts -with a 22% cut in the minimum wage- and public sector job cuts, but resisted deep cuts in pension benefits which would leave a 300 million euros shortfall in 2012 budget targets. This is part of 3 billion euros in austerity measures set by the EU finance ministers as a condition for further aid. Another sticking point was the serious consideration given by the EU, according to EU economics commissioner Olli Rehn, that the 130 billion euros be placed in a special escrow account so that Greece's private creditors would be paid from the account before money was taken out for the Greek budget. This was seen by Greek political parties as an infringement of Greek sovereignty. The EU is requiring all the main political parties in Greece give written pledges agreeing to the program and the Greek parliament voting to approve it. The language used by Greece's finance minister, Evangelos Venizelos, as he put the choice to Greece, shows the difficult choices facing Greece, Venizelos said: "If we see our future and the salvation of the country in the euro zone, in Europe, we must do what we must do in order for the program to definitely be approved...If our country, our people prefer another political decision that necessarily leads out of the euro zone and therefore outside European integration, we have to say this clearly to ourselves and to our compatriots." Because the agreement is designed to get Greece's debt to 120% of GDP by 2020- it asks for a decade of austerity measures. Some experts say Greece is better of defaulting like Argentina and going back to the drachma to recover export competitiveness. Another factor complicating this is the rapidity with which the Greek situation is deteriorating and the lack of political consensus on austerity measures, with all poltical parties enjoying less than 25% support in the country making political party pledges meaningless. Elections are due in April 2012. The EU and Germany may be too focussed on getting through a March 20 deadline for a bond payment of 14.5 billion euros- because of nervous financial markets- and not able to gets its hands around the problem of long term unemployment and deteriorating economic situation facing Greece. Greece's unemployment rate increased from 18.2% to 20.9% in just one month from October 2011 to Nov. 2011, according to Elstat, the government statistics agency. Another difficulty is that the EU ministers may see the achievement of European unity as progressing without any pauses and corrections of course, as if in a straight line, when achievements of a vision of this kind take many years and problem solving; where even a Greek withdrawal from the EU could be a temporary step towards eventually rejoining in a better EU framework. ...

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Andrew Roth describes a situation in Russia where president Putin is more popular than the ruling party. The United Russia Party was shown having support of 45% in pre election polls. The election campaign used Putin posters and the slogan "the party of the president," to increase voter support.  Some voters see Putin working really hard to improve the economic situation. Samuel Greene, director of the Russia Institute at King's College, London, says that even after efforts to increase support United Russia Party has failed to generate voter enthusiasm. Voter turnout was low especially in Moscow and St Petersburg. The election result is seen by experts as a way to give Putin support to tackle the economic problems facing the country, and ensure stability. About 343 members of the parliament out of total 450 are from the United Russia Party. The budget shortfall of 3% is being met by the government  by using state funds, and one of the sovereign funds is likely to be exhausted in 2017. One of the options is to cut back on social entitlements, increase the pension age. Prime minister Medvedev has already said state pensions cannot be indexed because "we don't have the money right now." ...

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Mikhail Gorbachev calls the Russian parliament Speaker Sergey Naryshkin's idea of looking into the reunification of Germany as an annexation of East Germany, a form of "nonsense." This was originally stated by a Communist member of the Russian parliament Nikolay Ivanov, who sees this as "a retaliatory step" to Chancellor Merkel's criticism of the annexation of Crimea. Merkel said at the Davos forum- "The annexation of Crimea is a violation of something that has made up our peaceful coexistence, namely the protection of borders and territorial integrity." Merkel and Putin now have profound differences. Putin sees the world of Russia in terms of its relations with border states such as Ukraine, the Baltics and Poland in terms of the Soviet Union and Czarist Russia's influence in Eastern Europe, as a part of Russia's legitimate interests. Merkel and Germans see it differently, with the collapse of the Prussian military state and Czarist Russia, and the collapse of Nazis and the Soviet Union, in succession, Germany is fully committed to a new view of relations between states in Europe based on democratic processes, respecting the views of people in Kiev to decide their own future. This reflects a new mood in Europe with increased funding for Deutsche Welle, Germany's broadcasting service to the world, in response to increased broadcasting by Russia Today, Russia's news service....

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Zweig of the WSJ points out that the Dow Jones average reached 22,000 but this happens as small investors move away from stocks to bonds. As a result the market is more stable than it used to be, with less speculative investment in stocks. He says investors are actually increasing investment in bond funds and moving away from stock funds as they reallocate to bonds using allocation strategies with fixed investment in stocks at a certain percentage. As the market moves up the portfolio becomes unbalanced requiring move from stocks to bonds. Since 2000 he says half a trillion dollars have moved from stocks to bonds and $17 billion in July 2017. Target date funds hold $998 billion and the $5.5 trillion in funds managed by financial advisers automatically reallocate to bonds as the market moves up. Experts say the question frequently asked now from investors is not which stock to buy but what is the right allocation between stocks, bonds and cash. This is a result of investors learning from the financial crisis of 2008-2009 and the decade that followed. The Dow at 22000 is three times what it was when it fell in the crisis. ...

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Spain's banks have government debt holdings as a percentage of bank assets of 6.8% compared to 13.1% for Italy's banks. This is based on data available from the IMF. But Italian banks are far better capitalized than Spanish banks. Bank shares of Italy and Spain hit post Lehman lows in July 2011, but Italian bank shares are likely to recover faster than Spanish bank shares. Italian banks raised 8 billion euros of capital in 2011 and most banks have an average core Tier 1 ratio of over 8%. By contrast Spain's bank sector is perceived by markets as undercapitalized and the IPO's of savings banks Bankia and Banca Civica will be affected by the unsettled markets.

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MaC Group, a risk advisor to Spanish banks, says Spanish banks hold about 30 billion pounds of distressed real estate and unsellable land. Prices are down 28% from the peak in 2007, according to a report by the IESE Business School, and are expected to fall a further 15-20 percent in the next 2-3 years by some experts. Much of the bank owned land is far from city centers and there is no demand for this. One Madrid based consultant R.R. de Acuna Asociados, says 43% of bank owned land is poorly located and there may be no demand for unfinished residential units for decades. The new government of Mariano Rajoy plans to take action to cleanup the banking system. Louis de Guindos, director of PricewaterhouseCoopers and IE Business School Center of Finance is expected to become the new finance minister. Guindos says strict rules need to be implemented, with some banks able to handle this and others that won't. MaC Group's Cantos, a managing partner, says the gap is huge between prices offered by banks and what investors will pay- as much as 70%. Prime assets can be sold for 30% discount but the land, residential and commercial real estate will require discounts of 70%. Banks have made provisions for losses of 30%, and are now facing the prospect of another 40% in losses. As a result many of the medium and small sized banks which operate only inside Spain may have to be shut down or consolidated by the government of Mariano Rajoy. Only the larger banks like Banco Santander, Banco Bilbao, La Caxia, and Bankia are likely to surivive....

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At Stuyvesant, the most selective of New York public schools the student body is 74% Asian, 19% WHite, 3% Latino, and 1% African American. Mayor Blasio of New York is using the Discovery Program to limit the entry to the program which accounts for about 5% of the overall admissions to kids from schools that have a poverty rate of 60% or higher instead of to economically disadvantaged children in the city.  Two views are presented here. One that of the New York schools chancellor, Richard Carranza who says "I just don't buy the narrative that any one ethnic group owns admissions to these schools." Mayor Blasio of New York says that only 10% of Black and Latino students get offers from the specialized high schools even though they account for nearly 70% of the city's high school population. The other view is that the state is failing in its secondary schools system because New York state tests show only 47% of the city's third through eighth graders proficient in English and 43% in Math, with the number for Black and Latino students dropping to 34% for English and 25% for Math. This means about half or two thirds of New York state's school children cannot read proficiently and the numbers decline with socioeconomic conditions. Even Mayor Blasio is working at the fringes as the problem is deeper and needs to be fixed at another level than by tweaking which segment of the economically disadvantage children should have access to the best schools such as Stuyvesant.   ...

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After creating new money at ablistering pace to try and slow down a precipitate downturn, and getting interest rates on Treasuries to a negative interest rate, (in effect people paying the Treasury to park money there), the Federal Reserve will now turn to quantitiative easing. The speed with which this has happened is shown by the fact that the Fed's balance sheet has gone fro $900 billion in September 2008 to just over $2 trillion by December 12, 2008. Till Septemeber 2008 the Fed had financed its lending to banks and other financial institutions by lending with its existing reserves, mostly Treasuy securities, by exchanging its cash or Treasury securties for hard to sell securities. Analysts fear unintended consequences from the kind of quantitative easing that the Fed will now have left by way of tools to address the crisis as the Fed funds rate is now close to zero.

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Elections for 500 members of the lower house of parliament in Mexico and for 15 governorships. Lopez Obrador won the presidency in 2018 with a huge majority, 30 points ahead of the rivals from the PAN and PRI parties. Average of five recent polls show he is still popular after the pandemic and winning 40% of the vote followed by PRI at 18%, PAN at 17%.  Obrador has increased pensions for the elderly by using savings from other parts of the budget, and increased the minimum wage several times. He seeks to reverse a 2013 law that privatized parts of the oil and electricity sectors. Obrador plans a large refinery project and rail infrastructure projects if he wins a strong majority in the lower house, in addition to social spending that would help the informal economy which has suffered during the pandemic. Across LatinAmerica, in Peru and other places the shift is to social spending to support the informal sector and anticorruption efforts so that good governance supports infrastructure spending. ...