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Spain's Budget minister, Cristobal Montero, said the government would have a new credit line and provide an early infusion of $10 billion to aid financially troubled regions. Many of the regions are in such financial straits that they are unable to pay suppliers, and this is putting many small businesses in serious difficulties. Spain's prime minister Rajoy says the Spanish government needs to be concerned about what is happening in the regions, and that he would help regions as long as they meet their budget goals. Spain adopted a decentralized model after the years of the Franco dictatorship, and regions handle education, health care and social services, culture and providing services. With the economic crisis following years of free spending by the regions, the extent of this autonomy and the lack of budget controls is being called into question. Officials from regions such as Aragon, Valencia and Murcia have called on the federal government to play a bigger role.

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Voter awareness and discomfort about the $1.6 trillion deficit this year, does not translate into wanting to see spending cuts in Medicare, Social Security and popular programs. It is the view of public opinion that is determining political leaders inaction on these issues, which are at the heart of controlling spending and the deficits. It is no surprise then that the Obama budget showed no action on these issues. Both parties are careful not to talk about cuts to popular programs without broad public support. The Pew Research Center survey shows 12% of Americans want to cut spending on Medicare or on Social Security, only 6% want to reduce spending on veterans benefits. Politicians can do the math from these numbers. They may be sending loud signals to Democrats and Republican politicians that voters will punish those who cut these popular programs. Polling done by the Wall Street Journal and NBC News produced similiar numbers.

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U.S. exports reached $2.34 trillion in 2014, increasing by $760 billion over the figure in 2009, according to the Commerce Department. Exports accounted for one third of the U.S. economic growth since 2009, say Pritzker and McNerney. Goods and services for exports supported 11.7 million U.S. jobs in 2014, and a Commerce Department 2010 paper shows these jobs pay 18% higher than jobs unrelated to exports. Commerce Department Secretary Pritzker, and McNerney, chairman of the President's Export Council, say free trade agreements and investment by private business is critical to supporting export promotion, but make no mention of the effect of the stronger dollar on future exports. In a period of a few months in 2015 the euro is approaching parity with the dollar and the yen is now 120 to the dollar, giving European and Japanese business a significant advantage, and raising questions about the strength of the U.S. recovery going forward.

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A simple sentence from Ms. Aslam, Pakistan's Foreign Ministry spokesman -as she confirms Pakistan prime minister Nawaz Sharif will attend the swearing in ceremony for prime minister Narendra Modi in New Delhi, May 26, 2014- says it all: "Pakistan sees peace with India as a precondition for economic development." A long established truth that applies to a large degree in reverse, that peace with Pakistan is also a precondition for a singleminded focus on economic development in India. How else can India tackle the problem of 1 million young people joining the labor market every month for the next 15 years, according to the UN Department for Social and Economic Affairs. The figure is much larger when including Pakistan, Bangladesh, Sri Lanka and Myanmar (Burma). And would approach 2 million a month if Indonesia is included, the entire region sharing the Buddhist-Hindu-Muslim legacy and lacking the strong engine for growth provided in East Asia by Japan and China.

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With only 44% of Catalan people supporting independence and 48% opposed there is considerable division in the Catalan region about independence from Spain. The WSJ looks at different neighborhoods in Barcelona some working class and others more affluent and sees a sharp division along lines of class, age and language. People in the working class neighborhoods of Ciutat Meridiana are opposed to separation from Spain. The independence movement is mostly popular among younger, middle class and Catalan speaking people. Meridiana in northern Barcelona is one of the poorest neighborhoods. In the hip central neighborhood of Gracia with leafy squares dotted with art galleries and vegan restaurants the pro-separatist movement has major support. Support for independence is highest under age 25 and declines with age and is lowest for people at 65 years. More popular with middle class and less with people earning less than 1300 euros. Today Spain has a constitution that gives greater autonomy to individual regions such as Galicia, Basque and Catalan regions that have their own language and traditions. This was suppressed during dictator Franco's rule after the Spanish civil war in the 1930's. The Spanish constitution was written after Franco's death and ratified under King Carlos in 1978 providing freedom with self-government for all nationalities and regions, and an unusual degree of autonomy.  Poorer people in Barcelona feel the young people supporting separation are spoiled brats and dismiss charges that the state is fascist as a lack of knowledge of what fascism really is.  As the division and dispute drags on following the 2017 referendum that was declared unconstitutional, support for independence is declining, as reported in the Guardian recently.  All this has hurt the Catalan economy and foreign investment adding an economic dimension to this as Catalonia is now seeing growth lower than the national growth rate in Spain. In addition to this the new socialist government of Pedro Sanchez and some Catalan separatist parties are supporting new negotiations to address Catalan grievance. Catalans have felt that they are not getting a fair share of revenues that can be invested in housing, health and other services, that they are giving more in tax revenues than they are receiving. The 2009 financial crisis has also affected Catalonia in ways that increased support for an independent state as Catalonia was growing more than the rest of Spain at that time.  ...

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Uber and Lyft, ride-hailing apps are adding to the traffic in downtown areas of major cities in the U.S. It is getting worse to the point where cities are looking for ways to ease the congestion in downtown areas of Chicago, San Francisco, New York, New fees are being enacted in these cities on Uber and Lyft, and regulators are also considering fees. The problem is that ride sharing apps customers prefer not to pool or share rides as the ride sharing apps said they would to prevent congestion. Another problem is that Uber and Lyft are actually pulling people away from buses, subways and walking creating new waves of congestion and poor utilization of public transportation designed to ease travel for most of the post war period. Worse they are not supporting healthy living because it is harder to walk on traffic congested streets and some people become lazy and just grab a ride rather than walk a short distance or walk to public transportation. Another issue is that an estimated 40% of the time the Uber and Lyft drivers in major cities cruise around for fares without passengers. San Francisco county officials have found in a study that over 60% of the slowdown of traffic speeds in San Francisco between 2010 and 2016 was due to the introduction of ride hailing apps. In Chicago, the policy director in the mayor's office says there is exponential growth in traffic congestion from these ride hailing apps.  A December report by the California Air Resources Board found that ride- hailing cars are driving with no passengers 39% of the time, and New York city estimates cruising at 41%. Mr. Schaller, a New York City official who has studied this issue says surveys in many cities show about 60% of riders in Uber and Lyft would have walked, biked or taken public transit or stayed home if a ride hail car was'nt available. More and more so called disruption by Silicon Valley in the interest of rapid and chaotic growth is looking like a bad thing, says this report in the WSJ, creating a whole new set of problems. What is not even understood here is the vast misallocation of resources, the billions of dollars that could have improved public transportation, bike paths and other means of getting around, improvements in cities downtowns to make them friendlier and with new park spaces with those dollars invested there instead of in ride hailing apps.   ...

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This article in The Indian Express shows that even though Subhas Chandra Bose differed with Mohandas Gandhi during the late 1930's, Bose had a deep respect and affection for Gandhi in mobilizing the Indian people for Swaraj. Bose's relationship with Nehru and Patel were of people at the same level and appeared to compete for attention compared to the relationship with Gandhi which was one of mentor and follower. In the end Bose's restlessness at British refusal to negotiate Swaraj and Gandhi's patience led to Bose actively resisting British rule in 1940.  Mohandas Gandhi had deep faith in the Bhagavad Gita and believed the lines in the Bhagavad Gita where it says- "Whenever, O descendent of Bharata, there is decline of Dharma, and rise of Adharma, then I embody Myself. For the protection of the good, for the destruction of the wicked, and for the establishment of Dharma, I come into being in every age." Gandhi wrote in his Discourses on the Bhagavad Gita on November 11, 1930- "God dwells in our hearts as the holy spirit within us, and when yearning for knowledge, like Arjuna, we take our spiritual difficulties to Him, and seek his guidance, seek refuge in Him, He is ever ready to instruct us." The other way in which Gandhi differed was in his deep insights and views of the British as a people that Bose lacked. Some of this came from his days in London and some of this from his days in South Africa working with and negotiating with the British. Mohandas Gandhi says in Hind Swaraj in 1910- "The English merchants were able to get a footing in India because we encouraged them. When our princes fought among themselves they sought the help of Company Bahadur. That corporation (British East India Company) was vested alike in commerce and war. It was unhampered by questions of morality. Its object was to increase its commerce and make money. It accepted our assistance, and increased the number of its warehouses. To protect the latter it employed an army which was utilized by us also. Is it not then useless for us to blame the British for what they did at that time? The Hindus and the Mahomedans were at daggers drawn. This too, gave the Company its opportunity, and thus we created the circumstances that gave the British control over India. Hence it is truer to say that we gave India to the British than India was lost. The causes that gave them India help them retain it. Some Englishmen say they took India and they hold India by the sword, both these statements are wrong. The sword is entirely useless for holding India. We alone keep them." Gandhi''s view of India was of a nation of shopkeepers, even citing Kruger of South Africa when he was asked if there was gold on the moon. Kruger said likely not, for if there was the British would have annexed it. By 1945 when Gen. Wavell, the Viceroy wrote back to London that he would require more army divisions to control India than Britain could afford, or the British people had the will to support or had commercial interests worth protecting after the war, the British moved up the year of their withdrawal. And began the negotiations with Gandhi for independent India.  Gandhi also says that in his reading of Vivekananda's writings the love that I had for my country became a thousand-fold. Gandhi looked to Vivekananda for inspiration in some of his ideas on Swaraj. Bose says Vivekananda's writings sent him into raptures yet saw Vivekananda "simple as a child" not realizing the spiritual strength Vivekananda had drawn from which overcomes all. As the Lord says in the Bhagavad Gita- "I am the Self, O Gudakesa, existent in the heart of all beings, I am the beginning, the middle, and also the end of all beings. Of the Adityas, I am Vishnu, of luminaries, the radiant Sun; of the winds I am Marici; of the asterisms, the moon."   ...

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German chancellor Merkel and France's president Hollande meet in Notre-Dame de Reims cathderal for a service that commemorates the 50th anniversary of a mass held at Reims cathedral. That Mass was held at Reims in May 1962 with the hope for a lasting reconciliation between Germany and France in a region affected by recurring wars, and was attended by Konrad Adenauer and Charles de Gaulle. The service in July 2012 brings together two leaders after tense discussions at eurozone summit meetings on the future of the eurozone and austerity measures. It is also a reminder of the deeper ties that bring the two countries together after a century of conflict, and the resilience in the face of difficulties shown by a previous generation of leaders in building these ties. It needs to be remembered that it was German chancellor Kohl, Angela Merkel's mentor, one of the postwar leaders who promoted European unity during the period of German reunificaton, who speeded up the agenda for the creating the eurozone and euro currency without the necessary underpinnings of deposit insurance and a eurozone financial regulator with powers to examine the books of European banks and exercize financial supervision. ...

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As credit shrinks the property market has borrowers borrowing from hedge funds that are lightly regulated and charge higher interest rates as much as 12% on some loans. The market for commerical mortgages issued by banks has all but dried up, last year 2007 it accounted for 70% of financing commerical property. Before this hard money lenders like these hedge funds operated at the fringes targeting desperate investors and developers who needed cash fast or had poor credit, now commericial borrowers with good credit and track records are scrambling for funding. Its a sign of the times.

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Protectionist sentiment in the USA is keeping tariffs high on ethanol to keep out Brazilian ethanol. Some of the arguments used for keeping it out are concern for the Brazilian rainforests, for food prices, for labor. Are these concerns real or just a way of keeping out imported ethanol by farm lobbies in the USA. Brazilian ethanol packs 8.2 times as much energy as the energy used to make it compared to just 1.5 times for corn ethanol, according to the Woodrow Wilson Center. It is grown in Sao Paulo state or the northeast miles away from the Amazon so it is not deforesting the Amazon. About 65% of it is grown on land that was previously pasture, the rest was used for other crops according to Conab, a government agency. Also sugar cane occupies only 7 million hectares or 17 million acres of Brazilian farmland compared to 200 million hectares for cattle ranching so it is not pushing cattle ranchers into the Amazon. So it does not have a noticeable impact on food or beef prices. And sugar cane production may benefit from higher yield varieties with more research. In 2005 of the 440,000 workers, 453 died, 17 were killed in accidents according to a study by a researcher at the the University of sao Paulo. In the same year of the 2.16 million workers in other branches of Brazilian farming, 2900 died and 135 were killed in accidents, so the situation in the sugarcane industry is not much worse than the rest of Brazilian agriculture. Moreover cane cutting is getting mechanized. At Santelisa Vale 60% of cane cutting is mechanized. So the arguments of protectionists in the USA about environmental impact, labor situation, and others do not carry much weight. The tariff on Brazilian ethanol makes it less attractive to import ethanol from Brazil and it creates uncertainty about future imports if the prices of corn based ethanol drop in the USA. Removal of the tariff is supported by John McCain. The tariff is 54cents on each gallon of imported ethanol. Importing ethanol from Brazil would have less impact on corn supply in the USA and on on corn prices so it would put less pressure on the world food supply and world food prices. ...

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US agricultural exports (corn soyabeans, grains, frozen pork, oilseeds etc) have surged 20% by weight in the 6 months ending Feb 29 according to the Dept of Agriculture. But facts on the ground, at railyards and ports suggest that without the shortage of containers the exports would be much higher. Ports are already congested and one shipping line based in Singapore is divering 10 of its 120 ships away from US ports. One agricultural commodities trader pays truckers to spend the night at railyards in the hope of picking up empty containers. And containers have to be sent hundreds of miles to where they are needed instead of being right nearby as used to be the case. Shipments of lentils and peas are being delayed by months. And in this situation cargo ship operators are raising prices.

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As many politicians and commentators deride programs by the government in the infrastructure area as " mere spending programs", Robert Frank, an economist at Cornell and NYU offers some much needed clarfication. High savings rates are not bad for the public, savings go into investment int he economy, and higher savings properly channelled can lead to higher productive investments that in turn generate a virtuous cycle of more investments. There is thus no conflict between private savings and economic growth. China's and India's higher savings rate leads to savings going into investments in the economy for higher economic growth. Only in sharp economic downturns does the paradox of thrift operate, here lower consumption leads to lower production and layoffs, and the economy goes into a tailspin as consumers hoard their cash and postpone purchases. There is an element of fear in that kind of downturn. So its aunique animal. With the government stepping in to provide investment, make up for jobs lost, and restoring confidence, the paradox of thrift does not operate. ANd its ok and desirable to have consumers save especially when they are so overstretched as they are today. A real world example is that much of the US credit card debt is at 20% interest rates or more. In just 5 years says Robert Frank each dollar invested in reducing debt would support more than $2.50 of additional consumption, in 10 years more than $6. Savings matter. The wastefulness of spending is not a given. It depends on where the government is spending. If there are productive investments like infrastructure that are waiting to be made, then with some due diligence and care the investments can be very efficient....

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Italy's prime minister, Mario Monti, in an interview with Britain's Guardian newspaper, June 22, 2012, says the detailed blueprint for action will not come out of the meetings in Rome of European leaders at the end of June. But he added: "there will be some strong elements and a short road, I hope, short, a few months, to get from there to the overall project." Separately Christine Lagarde, head of the IMF, said after meeting European financial leaders in Luxembourg: "A determined and forceful move towards complete European monetary union should be reaffirmed in order to restore faith. At the moment, the viability of the European monetary system is questioned." Monti is a former senior EU official, and Christine Lagarde was France's finance minister under president Sarkozy. The difference now compared to meetings in 2010, is the changes in France, Italy, and Spain, and at the IMF, with new leaders Hollande in France, Monti in Italy, and Rajoy in Spain, and Lagarde at the IMF, and a new context in that the austerity policies by themselves are seen as failing to produce the desired results. A further change in the dynamic is the win by Social Democrats in regional elections in Germany and Hollande opening a dialogue with the German Social Democrats. The dialogue with Merkel has been enhanced by appointing seasoned EU officials in key positions in the Hollande administration in anticipation of a tighter fiscal union in the EU....

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A serious problem for higher education, for universities and colleges in the US is the failure to focus on reducing cost. It costs $120,000 for a 4 year education at Michigan State University.Tution fees for one year have gone from about $10,000 to $20,000 over 12 years 2012- 2024 for state universities. Another priority should be reading comprehension as shown in Lyrarc's Movement for Global Literacy. This opinion piece describes the problems with colleges and universities further aggravating the fragmentation of the electorate into college educated and non college educated, with focus on theories of race and history when it should be focused on cost that makes it unaffordable to the vast majority of Americans. Priorities are misplaced and do not reflect the need to give good reading and math skills beyond high school in an advanced country where by 2010 about half the young population lacked reading comprehension in the ACT tests going further downhill since then. ...

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Yuka Hayashi gives an exceptional account of the rise of nationalism in Japan. This is especially true of the younger generation. As examples of the changing mood, he gives the popularity of Will magazine with circulation of 100,000 among younger readers, including large numbers of women. Other examples are the movie "Eternal Zero" remaining on the top of box office charts for 2 months, neto uyo or right wingers on the internet are popular, and bookstores display titles responding to China and S. Korea's criticism of Japan. Fringe candidates such as Toshio Tamogami have won 24% of the vote in Tokyo's gubernatorial race, with large proportion of younger voters. The younger generation is not accepting quietly the criticism of Japan's prewar record in the same way as the older generation with memories of the war. It sees itself free to respond to what it sees as China and S. Korea's constant criticism of Japan, even when Japan has apologized repeatedly for its aggressor role in Asia. Weekly magazines such as Bunshun and Shincho carry Japanese criticism of China and S. Korea with sensational headlines about lies. Abe's recent visit to the Yasukuni war shrine- the main object of S. Korean and Chinese criticism and America's concern expressed to Japan- is shown in an Asahi Shimbun poll recently to get favorable support from 60% of people in their 30's. Many of the 119 freshmen members of the Liberal Democratic Party of Mr. Abe also provide support, and some even see Japan needing to defend itself with or without the U.S. Is this level of nationalist sentiment similiar to the twenties and thirties, or to periods of tension in the 1990's and other post war periods? Only recently in 2010 the Democratic Party of Japan under a young prime minister Hatoyama and premier Naoto Kan, a civil rights activist, presented another side of Japan seeking closer ties with China- even distancing itself somewhat from the U.S. on the issue of bases in Okinawa. Naoto Kan also enjoyed a 60% level of popularity as premier Abe has in 2014. Which is the real Japan, or is it a reflection of fatigue among younger Japanese with always having to say you are sorry, as has happened to the younger generation in Germany. Hatoyama resembled Obama as a younger politician bringing a new optimism in Japan after years of LDP rule. Unfortunately president Obama distanced himself from Hatoyama on the base issue and failed to support Hatoyama at a time of tensions with N. Korea, leading to his fall in ratings and resignation. This may turn out to be a lost opportunity for the U.S. for building peaceful neighborly relations in Asia. In 2007 Chinese premier Wen Biao a speech to the Japanese parliament, the Diet, saying: "With history as a mirror it does not lead to long-lasting hate, it points to a better future." Japan's premier at the time? Shinzo Abe. What has changed? China's economy has doubled in size, and so have global Japanese corporations such as Toyota with advanced technologies, economic insecurity is unfounded in a globally linked interdependent economic system. ...

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Walmart comes out in favor of requiring employers to provide health insurance to all workers, a central feature of President Obama's effort to provide near universal coverage in the USA. As the country's largest private employer, employing 1.4 million Americans, this change is significant. In a letter to the President, Walmart CEO Mike Duke, joined by Andrew Stern of the Service Employees International Union, and John Podesta of the Center for American Progress, who also signed the letter, say they are for an employer mandate which is fair and broad in its coverage. Walmart had a couple of reasons for doing this. For one Walmart needed to join the negotiations, as the Senate Finance Committee is considering other proposals that are less favorable to Walmart than employer mandate. Already Walmart is covering 52% of its employees, and has improved health benefits in recent years in response to criticism of the company. The industry average is 45%, according to a 2008 Kaiser Foundation study, and some companies do not provide the health benefits that Walmart does, so this helps level the playing field by requiring all large companies to share the burden. Walmart wants to see effective cost controls to keep costs down, and Rahm Emmanuel, the President's chief of staff, assured Walmart that "cost control and employer mandate are heads and tails of the same coin." Under the plans considered by the Senate Finance Committee under Max Baucus, small businesses are exempted from the employer mandate. Republicans have opposed employer mandate. And the U.S. Chamber of Commerce has opposed it saying it would make companies lower wages and cut jobs. Walmart's shift has been gradual. From a company used to providing skimpy benefits, it has evolved as it improved benefits, and two years ago it joined the SEIU union to call for affordable health care for all Americans by 2012. It has Mr Dach as its governmental affairs vice president, and this is significant, as Dach is an advisor to Democratic party politicians....

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Spain's construction industry is hit hard and half of immigrants who make up 11% of the workforce have lost their jobs. Spain is hoping to give them alump sum payment to induce them to return home. Economic growth will be below 2% in 2008. Zapatero pledged to return 400 euro from the budget surplus and this helped him get reelected at a time in March when the economy was looking a lot better. Zapatero has no control over interest rates which the ECB raised on July 3, 2008 and no control over commodity prices, and the housing downturn in Spain will continue.

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A Dreamers deal between president Trump and Democrats looks less likely now after meetings between the two parties show Democrats and Republicans have little they agree on. A meeting on January 11, 2018 was convened to discuss a proposal from Senator Durbin, Senator Graham and four other senators that would allow children who arrived in the U.S. with their parents (the Dreamers in the DACA Act of president Obama) to stay in the country with a path to citizenship, give $1.6 billion for a wall or fence on the U.S. southern border with Mexico, and change the diversity visa lottery to move to a merit base system.  President Trump's remarks at the meeting disputed by the president and confirmed by some senators have created added animosity. Trump is reported to have made some remarks derogatory to immigrants from Haiti, while saying why not get more immigrants from Norway, as Trump prefers a merit based system. The remarks have alienated African countries and were refuted in Norway. This also complicates the situation for the U.S. image overseas as diplomats struggled to represent the U.S. in a different light. In Congress the presidents remarks make it more likely that Democrats and some Republicans will make it harder to pass spending bills including on defense. As a result short term spending approval action will be taken, and there will be a prospect of government shutdown. ...

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Damian Paletta of the Washington Post says that credit goes to Gary Cohn a former Goldman Sachs president, and head of the president's National Economic Council for the way he has quietly built up a group of leading experts on major initiatives of the Trump administration such as tax reform, infrastructure plans. Compared to the infighting and other problems in the first 100 days of the Trump presidency, Cohn is credited with building a core of ideas and experts that bring Trump more to the centre and with the prospect of winning Democratic party support. He has helped shift the president to set up a more balanced approach, less confrontational with China and not calling China a currency manipulator, getting support for the Export Import Bank, and more receptive to the Federal Reserve led by Janet Yellen. This report says an alliance of moderates is centering around Adviser Jared Kushner, Cohn, and in other reports Tillerson in foreign affairs is seen as being part of this group. On NAFTA the president has moved to a less confrontational approach with Mexico, which has helped the Mexican peso recover and improved prospects for the Mexican economy.  On infrastructure new ideas to find financing are needed and a plan to tax carbon emissions is intended to draw Democratic support as well as provide some of the funding. About $200 billion in taxpayer money and $800 billion from private investors is being discussed at the National Economic Council. This report says Cohn suffered from dyslexia in childhood, graduated from American University, and joined Goldman Sachs in an unconventional way. He shares a passion for deal making with president Trump, yet at the same time values the views of experts he has brought to formulate concrete plans for the way ahead. About 25 experts with extensive experience in government helped put together new tax changes, infrastructure plans, and international trade deal plans. His predecessor at the NEC, Gene Sperling, gives him credit for quietly pulling together the experts and doing the planning that the Trump administration now depends on. ...

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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. ...