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U.S. healthcare spending of about $3 trillion comes with poor results. The cost per person is about three times that of countries such as France, Britain, yet the results show U.S. doing extremely poorly. The author points out that less spending on healthcare and more on social services in areas such as education, nutrition, housing and other services would improve the outcomes and results. It is this missing factor that is helping other countries in Europe, Japan and China achieve better outcomes and returns per dollar spent.  Social spending can affect such things as nutrition, exercize levels, lifestyles, housing and result in dramatic improvements in obesity levels for instance, or inflammation levels in the population that play a role in many diseases. The idea is prevention. This is not happening because higher health dollar spending has lobbies to support it. Social spending also is a dollar expense that shows up immediately whereas results are spread out into the future as a longer term benefit with healthier populations that need to consume less healthcare and treatment. Elizabeth Bradley, president of Vassar College is an expert on this subject. She says social services spending gives more bang for buck  in health outcomes.  The point is relevant also for countries in South Asia and Africa that have taken some on some aspects of the U.S. health system resulting in health care spending that does not deliver the most for the dollar spent, and ignores the critical role of prevention.  The solution lies in moving these health care dollars out of the health care spending and into education for health outcomes, lifestyles, exercize habits education, and into social services that enable prevention and better health. ...

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The suicide of celebrity chef Anthony Bourdain who had a popular television program, brings new attention to the increase in middle age suicides ages 45 to 64 in the U.S.  The CDC figures show a 60% increase for women and 37% for men between 2000 and 2016. A clinical instructor in psychiatry and medicine at Cornell, Ms. Boardman says life satisfaction is low at this age,a dip in satisfaction called the U curve. A 2016 study in the American Journal of Preventive Medicine  shows stress factors as problems with intimate partners job/finances, health, family, and criminal/legal problems.  The demographic group driving suicide rates up is mainly white people without a 4 year college degree, who have done poorly compared to that group in a previous generation, say experts at Columbia University. 

Generally isolation and loneliness is also a factor, and social connections a big antidote to depression type stress.

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When Manmohan Singh and Wen of India and China said in Beijing that the people of both countries were united in their aspirations for the future this was very real and sincerely stated. Geopolitics is somebody's game who does not know his own country, people and history in these long neglected parts of Asia. Here in India or China in different ways its these aspirations that matter. India is desperately trying now to improve schooling after years of neglect for the country's rural poor, where the quality of government schools is startlingly poor. The figures are dismal. In general only 1 in 10 college age Indians go to college. But its worst at the lower poorer parts of society. Among the poorest 20% of Indian men half are illiterate and only about 2% graduate from high school. For the top 20% of Indian people only 2% are illiterate and 50% are high school graduates. The problems even as the government pans to triple spending in the next 5 years run deep. There is no motivation among school teachers because for years the schools have been neglected and there is no education culture in poor villages, teachers are poorly trained if at all, they are late or absent and there islittle discipline and education ethic. Parents are very poor and do not understand the value of education and want to pull children out of school to earn wages for the family as migrant labor. The parents are illiterate or poorly educated so there is very little help at home. And there is corruption as some of the money to be invested in school buildings, equipment, lunches, teachers, etc is stolen or goes to bribes. There are some dedicated people but they get washed out in the midst of so much apathy, lack of conviction, corruption and lack of motivation among teachers parents and village officials....

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France with about 6 million Muslims and a history of colonial rule in North African Arab countries (Algeria, Tunisia, Morocco, and other countries) faces a challenge of integrating Muslims into French society. Germany with a large population of Turkish origin also faces a similiar challenge. The attack on the satirical weekly Charlie Hebdo for poking fun at Islam, in a manner similiar to its satirical work on Catholicism, leads to the death of 12 journalists, a policeman and a policewoman. Erlanger and Bennhold describe the reaction of people in France. Peter Neumann, director of the International Center for the Study of Radicalization at King's College , London, says about anti-immigrant sentiment increasing in Europe to the point where it is uncoupling working class families from the elites in Europe and reaching into the mainstream of society.

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The growing middle class in Brazil, new aspirations and the demand for better public services in transportation, education and healthcare. Alexandre Peppe, a 29 year old from the outlying parts of Sao Paulo, is a new member of the middle class, being the first to go to college in his family and finding a job in the state government. He was one of the protesters on the streets of Sao Paulo. The growing middle class has new hopes and aspirations that see serious shortcomings in the corruption of political leaders, neglect of public services such as transportation and overspending on the soccer stadiums for the FIFA and World Cup championships. Economic growth is slowing to about 1% in Brazil for 2013, creating new constraints for public spending just as demand for infrastructure and services is growing for the now large middle class.

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This interview by Michael Schmidt of the NYT with president Trump shows a more conciliatory mood following the passage of the Republican tax law. Trump says he feels Mueller will treat him fairly but that the investigation will drag along for some time. Trump says this is bad for the country.  On the tax law he says he would have tackled the local and state tax deduction either not touched it or worked out a compromise if Democrats agreed to talk to him about taxes. Democrats he says thought they had McCain's vote when he left for Arizona, yet that did not happen. He says expensing for investing in equipment should unleash growth through new investment in the U.S. On infrastructure he sees a hundred Democrats joining the Republicans in Congress to do a deal. He says Democrats need him for DACA on the Dreamers issue, and he will work with them.  Other topics covered were the election itself which Trump says he fairly won by focussing on the Electoral College and going frequently to small states like Maine, up and down the East Coast knowing he would lose New York. He says there was no collusion with the Russians for his campaign and says it was Democrats who did the collusion. Manafort worked longer for others including Reagan, says Trump, and was with him for only about 4 months. This interview shows a upbeat Trump following the passage of the tax legislation. ...

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About 11% of student loans outstanding amount were over 90 days past due in Sept. 2012, increasing from 8.9% at the end of the second quarter 2012, according to the Federal Reserve Bank of New York. This now exceeds the figure for credit cards. U.S. student loan debt is now at $956 billion for the third quarter 2012, increasing by 4.6%. About 93% of student loans made in 2011 were made by the U.S. government, which is promoting access to loans without asking for information about borrowers finances and education plans and ability to pay the loans back. Because student loans have to be paid back and are hard to discharge even in bankruptcy, this means many borowers who cannot find jobs are deep in debt, and unlikely to get loans for many years for cars and other needs. Moody's warns of a wave of student loan defaults in coming years.

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A surge in rural vote with anxieties about illegal immigration surges and little done by the Biden administration in the first two years when the surge from Venezuela became evident. The pandemic, vaccine was followed by two wars in the thrid and fourth year, yet the immigration issue was allowed to grow without forceful action to close the border and pass legislation early in the first 2 years, with an objective assessment of the situation as has happened in first Socialists in Denmark, northern Europe, and then Britain as the Labour party shifted to shut down illegal immigration in its policies by 2022. The unease in rural areas was accompanied by unease among younger people 18-34 years over cost of living, and the unease among Latinos in general and Black people  without a college degree.  Taking an approach to the wars that would remove them as distractions by looking for a settlement in Ukraine through negotiations, and prioritizing strong action on the border, price surges would have helped tackle pressing issues that caused so much unease.  ...

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Nathaniel Tapin says about China's debt laden economy and struggling property developers that this has been seen before. What matters most is the confidence household borrowers have in the country to buy homes and spend versus putting more money into savings. And this confidence that that has been the strength of the economy for three decades is fading. About 12 million jobs in the internet platform economy were lost in 2020-2022. This absorbed a fourth of the Chinese graduating from colleges each year. The manufacturing sector is affected by declining demand overseas and cannot pick up for this. Much of this is a result of Xi's government efforts to tamp down debt of housing developers, to reduce housing speculation, to limit the power of internet companies, and develop a fairer economy, and these were policy decisions not easily reversed. A pervasive pessimism is leading to a disinclination to spend or buy a house. Surveys of Bank of China show inclination to save increased by 15 percentage points to 58% in second quarter 2023. In the past Chinese put money in homes as a way to deposit money in a savings account, homes were sold even before they were built. This cash was passed on to property developers and in turn the local governments benefited by selling the land to property developers. After property developers could not pay interest on debt and collapsed the households decided to pay down their mortgages and $28 billion went to pay down residential mortgage debt in first 6 months of 2023.  ...

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Fears that India may be falling behind China, Mexico and Brazil in healthcare for the people. A planned budget increase was never implemented. Today the Indian government spends only $20 billion on healthcare for a population of over 1 billion people. Annual spending on healthcare is about 1.4% of GDP. Now the Indian government is planning to increase this to 2.5% of GDP. One senior health official Amarjeet Sinha, says other emerging economies such as Brazil, Mexico, Malaysia, now have better public health indicators than India. In 1990 India's public health indicators were similiar to those countries. Another serious problem in India is malnutrition with an estimated 4 of 10 children malnourished. Underinvestment in healthcare is a significant problem as needs grow but there is a shortage of resources and trained healthcare personnel. Arvind Singhal, chairman of consutancy Technopak, says India needs an additional 1 million doctors and 2.5 million nurses to meet the needs of the current level of the Indian population. To do this 600 new medical colleges and 1,500 nursing colleges are needed. The child care advocacy group Save the Children UK, points out that just to meet India's committment to reduce the infant mortality rate by two thirds of the current level by 2015- to meet India's commitment to the UN Millenium Development Goals- India will need 2.6 million additional trained health workers. This shortage is most acutely felt in rural areas, especially in the large states of Uttar Pradesh and Bihar....

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Peter Hotex of Baylor Medicine in the US is a pioneer and leader in getting low cost traditional vaccines to billions in Africa, Asia and Latin America.  Here Peter Hotez of the Baylor College of Medicine Tropical School is interviewed in The Hindu. He talks about how the new mRNA vaccines are "shiny toys" pushed forward in the US in 2020 under innovation drives, and that the vaccines made by traditional methods are just as effective and provide lasting protection. Without vaccinating the entire world population including the billions of people living in Africa, Asia and Latin America, there will be no end in sight for the pandemic, he says, and the best way to do this is through vaccines made by traditional methods, methods used by Bharat Biotech for Covaxin and Biological E for its vaccine. He said mRNA is a brand new technology  and "it will take years to scale it up to make 9 billion doses" of vaccine for poor countries. Baylor has developed the vaccine technology using traditional methods such as yeast fermentation expression technology used for Recombiannt Hepatitis-B vaccine. Its been around for 40 years. Baylor will transfer the technology to Indonesia, India, Bangladesh, all over the world. He says in terms of virus neutralizing anti-body immune responses it is as effective as the mRNA vaccines. Hotez is critical of some pharma companies- "the rest of them want to bicker about patents. we're not going to go down that direction." Baylor is providing its technology for manufacture to companies to fill the need in poor countries, without patent protection or quibbling about legal things such as indemnities, says Hotez. Hotez also thing recombinant protein technologies vaccine with its traditional approach could also overcome vaccine hesitancy, a key factor for unvaccinated in Europe and US which have stuck to mRNA vaccines. The newer technology behind mRNA could make parents hesitate to vaccinate their children with these technologies, and also be a part of the mental attitude of unvaccinated adults having hesitancy.   ...

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Kamala Harris describes her vision of The Opportunity Economy in an address at Wake Tech Community College in Raleigh, North Carolina. Like president Biden she wants to build America's Middle Class. When the Middle Class does well everyone does well, Biden says this many times. By contrast she said Trump's plan would cost Americans $3900 a year raising cost of living. Kamala Harris said- "And key — key to creating this opportunity economy is building up our middle class.  It is essential.  (Applause.) The middle class is one of America’s greatest strengths, and to protect it, then, we must defend basic principles — such as, your salary should be enough to provide you and your family with a good quality of life. (Applause.) Such as, no child should have to grow up in poverty.  (Applause.) Such as, after years of hard work, you should be able to retire with dignity.  (Applause.) And you should be able to join a union if you choose. Building up the middle class will be a defining goal of my presidency, because I strongly believe when the middle class is strong, America is strong. " (Applause.) Harris described the vision of president Trump, as a complete contrast- "Now compare what Donald Trump plans to do.  He wants to impose what is, in effect, a national sales tax on everyday products and basic necessities that we import from other countries.       That will devastate Americans.  It will mean higher prices on just about every one of your daily needs: a Trump tax on gas, a Trump tax on food, a Trump tax on clothing, a Trump tax on over-the-counter medication.       And, you know, economists have done the math.  Donald Trump’s plan would cost a typical family $3,900 a year.  ...

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Read the full speech of president Biden at an important time in the Nation's history, 76 days before a national election to decide the future of the Nation and the World. Excerpts from the speech selected by Lyrarc- "Look. Folks, how can we have the strongest economy in the world without the best infrastructure in the world? Donald Trump promised Infrastructure Week, every week for four years, and he never built a damn thing.  And now because of what Kamala and I have done—remember, we were told we couldn’t get it done? Remember, when we came into office, we couldn’t get anything passed?—but right now, we’re giving America an infrastructure decade not week. We’re modernizing our roads, our bridges, our ports, our airports, our trains, our buses, removing every lead pipe from schools and homes so every child could drink clean water. We’re providing affordable high speed internet for every American no matter where they live, unlike, not unlike what Roosevelt did with electricity. And so much more. We are uniting the country, we’re growing our economy, we’re improving our quality of life, and we’re building a better America. Because that’s who we are. How can we be the strongest nation in the world without leading the world in science and technology? After years of importing 90% of our semiconductor chips from abroad, which America invented those chips, our CHIPS and Science Act meant that private companies from around the world are now investing literally tens of billions of dollars to build new chip factories right here in America. And over that period, they’ll create tens of thousands of jobs. And many of those jobs in the so-called Fabs, the buildings that make the chips that are being constructed now. And guess what? The average salary in those fabs, size of a football field, will be over $100,000 a year, and you don’t need a college degree.  ...

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Problems with college health insurance. Problems cited for UnitedHealthcare.

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The rapidly changing demographics as the U.S. becomes more of a multicultural society. For the first time minority babies formed a majority in 2011 with 50.4% of new babies, according to the Census Bureau. The median age of the non-Hispanic White population is 42 compared to 28 for Hispanics. Hispanics are right at the child bearing age. This also raises the issue of how the U.S. will educate the minority population. Today 13% of Hispanics have college degrees, 18% of Blacks and 31% of Whites. High school graduation rates in places like New York City for Hispanics are lagging far behind other groups. The economic downturn after the 2008 financial crisis has worsened the educational prospects for Hispanics and other minorities. The education of minority children is essential to improve the competitiveness of the U.S. in a global economy, as the educational levels in emerging markets accelerates with more opportunities.

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Joshua Wong of the group Scholarism is 17 years old and just entering college. His arrest and detention of 40 hours for stepping into a government building area led to increased protests. In 2012 Wong was part of protests that led to the withdrawal of a "patriotic classes" plan for Hong Kong schools. Asked what Hong Kong would be like in 10 years, he says, "there will be universal suffrage." The age of the protesters is one remarkable aspect of these protests, as they are not just young, but very young. And this should give Beijing pause, as this is China's next generation. And what seemed right in your own day may not be right around the corner as time passes, as Mr. Jinping and his revolutionary veteran father experienced, struggled with, and overcame in their own lives because of the tolerance of others.

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A Taiwan based correspondent of BBC News reflects on how China has changed during the Singles day 11.11 on November 11. This is a huge promotion event for online retailer Alibaba. It was originally a day used by male college students without girlfriends, showing with the 11 their desire to have relationships. Alibaba has used it as a promotional day for online sales with discounts of 30% or more. About halfway though the day sales were larger than 2016 sales on Nov. 11.  Many retailers from different countries took part. and the sales reached $25 billion. Many people used it to buy household supplies for 6 months using the discounts, or apparel and clothing which could be delivered to their home. The old ideas of frugality are now replaced with a willingness to try new ways to live in a different period.  Use of mobile phones for ordering is widespread as a new urban middle class in China shifts to a materialist culture of buying on credit.

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Jeb Bush sees many who come to the U.S. looking for a better life as similiar to people who arrived here in earlier waves of immigrants all the way back to 1800. He described the actions of many who come to the U.S. illegally as an "act of love," and "act of committment to family," in a talk at College Station Texas, on the 25th anniversary celebration of the presidency of his father, George H.W. Bush. Its breaking the law, he says, but different, not a felony. Benjamin Franklin describes German immigrants to Pennsylvania in his writings at a time when immigrants were what made this country. They were different in some ways then but long since became part of the fabric of America, as have new immigrants in the different periods of the 19th and 20th century. Here is what Benjamin Franklin says about the German immigrants whom he praises for habitual "Industry and Frugality they bring with them," in a letter to Peter Collinson, May 19th 1753, addressing the fears as well as what they could bring to the new country, which throws light on todays immigration debates in a new light. "In short unless the stream of their importation could be turned from this to other colonies, as you very judiciously propose, they will soon so out number us, that all the advantages we have will not in My Opinion be able to preserve our language, and even our government will become precarious." And then saying in the same letter-"Yet I am not for refusing entirely to admit them into our Colonies: all that seems to be necessary, is, to distribute them more equally, mix them with the English, establish English Schools where they are now too thick settled, and take some care to prevent the practice lately fallen into by some of the Ship Owners, of sweeping the German Goals to make up the number of their passengers. I say I am not against the Admission of Germans in general, for they have their Virtues, their industry and frugality is exemplary; They are excellent husbandmen and contribute greatly to the improvement of a Country." ...

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This report in the NYT says Hillary Clinton has studied policy briefings, academic papers and taken advice from 200 policy experts, including experts from Bill Clinton's administration such as Alan Blinder, all in an effort to define her own policy positions on issues facing the U.S. This happens at a time different from the period of slow growth when Bill Clinton ran against George H.W. Bush. Since then middle class families face the added problems of not being able to keep up with the rising cost of college education, health care, child care, low interest rates on savings and volatile markets dampening savings growth. For working class Americans in the middle class during Bill Clinton's time in office the problems take the shape of a sharp decline in the manufacturing wages that once supported a middle class life in industrial states of the midwestern U.S., with global competition doing the damage, and few solutions available except improving technology and technical skill of the workforce to compete in higher end products. Consider the points made by Janet Yellen, the Fed chairwoman at a Boston Fed conference in Oct. 2014- Fed information for 2013 showing the average net worth of the lower half of American families representing 62 million households is $11,000. Only this conceals the situation facing one fourth of these families who have zero wealth or negative net worth, and a significant fraction owing more on their homes than they are worth. Hillary Clinton told a audience at the New School in Greenwich Village in New York, this is the defining economic challenge of our time. " We must raise incomes for hard-working Americans so they can afford a middle class life. This will be my mission from the first day I'm president to the last."...

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Daniel Bell at Tsinghua University in Beijing, Andy Xie, economist in Shanghai, Zhang Habin, professor at Peking University, and Michael Meyer, author and hutong expert, talk about what issues are important. Bell says Obama mania is absent among the young in China, though they respect his intellectual abilities, and Chinese are not looking to the USA for ideals. They are looking to Chinese culture and characteristics, and democracy is seen in this light with emphasis on Chinese characteristics. This means the US has to engage at a deeper level with China. Treat China as an equal with something positive to offer, says Bell. Andy Xie is concerned about the US-China relationship, based as it is today on tenuous grounds, where what happens in Florida and California can have a significant and immediate effect on what happens in Guangdong. With 70% of the furniture sold in the US made in China, the effects are immediate when housing slumps. So he says the US lost 3 million jobs since the subprime crisis, and China lost 20 million jobs. And for the 5 million college graduates coming out in 2009, they will be adding to the 5 million college graduates from previous years who are seeking jobs. Ten million unemployed college graduates mean China is seeing whole new conditions as the backdrop of US-China relations. Habin says its important for the US to set an example in climate change and emissions of greenhouse gases. The US should sign an agreement with China with binding targets, make its technology available to China, and provide development aid to make this technology and other assistance accessible to China. Cooperation on this issue is vital to future relations says Habin. Meyer says the hutong, small enclaves of old Beijing with lanes and small homes, that the city officials call neighborhood slums, but actually have a sense of community and a vibrant life, are worth preserving. He questions the Walmart and Pepsi commercial culture, and questions building of the American car culture urban plan that generates pollution, lacks community feeling, and is not energy efficient. In fact he has a point here, because the US is shifting away from its own older urban planning design that encourages urban sprawl, as in California. The new Sacramento urban plan that is being adopted for the future in America has energy efficiency, more community and easy interaction, less urban sprawl in mind. See the link to this. But Meyer says Chinese planners insist on their right to make the same mistakes American urban planners made. And Meyer quotes the head of the first Chinese environmental NGO, who says, "if the Chinese want to live the American way of life we need 7 earths to support them". Which raises a disturbing question of the US postwar way of life with its large SUV's, urban sprawl, and less sense of community. Wouldn't the US have to join India and China in the worldwide scramble for resources to preserve this way of life? Just this week China signed $51 billion of deals for natural resources, see the link. And is the rapid decline of the SUV, just the first sign of changes that are taking place, with the economic changes in coming years leading to grappling with issues of better quality of life, smaller quantity of things, health and obesity and lifestyles, community, all coming to the fore. ...

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Michael Porter who is an authority on competitiveness and national strategy, is a Professor at Harvard University. He last servedin a national economic strategy advisor capacity in 1983, as a member of the President's Commission on Industrial Competitiveness. His view is that the USA badly needs an economic strategy. And the political system of the USA discourages developing such a strategy. The political dialogue also discourages the discussion from focussing on the key aspects of a strategy and because of the ideological slant the discussion between Republicans and Democrats tends to cancel each other out leaving the important work undone. What is an economic strategy? Its thinking clearly what are the advantages or strengths America as a nation has and how best to preserve these advantages in the future? And its thinking clearly about the weaknesses, and how to address the weaknesses, and where money and other resources should be allocated and what actions need to be takento get results. As strategy is a long term thing, it requires patient and perseverent effort and allocation of resources. The strengths he goes on to list are, an unparalleled environment for starting new companies and the science and technology, and the regional universities and clusters of high tech workers and resources in different regions of the country,the educational institutions for higher education, and the committment to competition and free markets, efficient and deep capital markets, and the acceptance of the uncertainty and cost in the huge job churn (restructuring of industry that destroys millions of jobs per year with net positive job creation). The problems that have arisen with these advantages have compromised some of them. Free markets are not really free as anti-trust enforcement has been lax resulting in mergers dominating markets and weakening compeititon. Many times the "free market' talk has become rhetoric and distorted for individual purposes. And regulatory oversight has been weakened in the name of "free markets", as if the market system could be run with no government regulation at all. The weaknesses are: remaining an energy inefficient nation even as countries like Japan have become increasingly and way more energy efficient, and doing nothing about it, not having any policies to fix this and assign a big priority to it. In the area of access to education, which is critically important to national competitiveness, the US ranks poorly in the number of college graduates and in the opportunties for access to college across the middle and working classes. Says Porter, the US ranks 12th in the college or higher educational attainment for 25-34 year olds. And the US he says has made no progress in this area for 30 years. This is a disturbing trend in a economy that must have the education and skills to justify its high wages, and how will Americans compete for jobs that can be moved elsewhere in these circumstances he asks. Strategy requires honesty with ourselves in identifying and addressing the strengths to be preserved and the weaknesses to be fixed. Solutions have to go to the heart of the problem, with the patient effort needed for longer term solutions, when problems have become embedded in the system, and in the habits, culture, and way of doing things, that will produce disaster down the road. Wen it comes to spending on priority investments, Porter prefers to tax rebates the spending that goes into educational assistance and into logistical infrastructure. ...

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Dagmar Breitenbach of DW.com  discusses today's youth in an interview with Albert Wunsch, author of the book "The Pampering Trap." Wunsch is a psychologist and education expert, who says today's youth lack the perseverance of their parent's generation. When confronted with difficult situations today's young people in Germany are seen as lacking maturity, persistence, and patience. Part of the problem is that parents have shielded their children from life's realities, says Wunsch. Parents want to be their kid's friends, and not act like an authority figure. In Germany authority figures still have the taint of looking bad, and parent shy away from that perception. The avoidance of conflict, including constructive conflict leaves children and youth at a disadvantage, because they go through life not having had to experience difficulties and learn from these experiences. Lacking this sensible kind of conflict in which parents have to ask themselves what is of value that they can transfer, the transfer of what one generation has learned is not being transferred to the next. Another problem is that young people prefer to hedge, not make commitments, says Wunsch. Financial literacy on how to manage money is also at a lower level. Some of these problems are mentioned for young people in America in the best selling book by Ben Sasse- "The Vanishing American Adult." Developments in Germany are also evident in other places. The dropout rate in Germany is also high. Studies cited here show this to be about 25% to 33% of college students dropping out.   ...