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Susan Jaccoby brings up a major issue facing healthcare in America from personal experience. A third of the Medicare budget, she says, goes to the last year of life, and a third of this goes to the care in the last month. At the same time public opinion polls show Americans see the problem being too much medical intervention rather than too little. Especially when there is no hope except to prolong life for the patient with an highly deteriorated qulaity of life for a few months or a year, doing no service to the patient or future generations who may see their basic services cut when they most need it as a result of the unaffordable spiralling cost of Medicare. A Pew Research Center poll in 2006, shows 22 percent say a doctor should not always make efforts to save a sick person's life, and 70 percent believe that patients should be allowed to die in some situations, when it only prolongs life for a few months for instance and patients live in pain. The problem only gets worse in future years as an estimated 8.5 million Americans are expected to be over 85 years in 2030 with these same choices facing patients, their families, Medicare and the country....

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Sue Desmond-Hellmann, CEO of the Bill and Melinda Gates Foundation, describes her growing up experiences in Reno, Nevada, seeing her father help people struggling with some problem as he ran a drug store in the town. This has influenced her own style of managing people, showing care in teaching people so that they can operate in their sweet spot without fear of being overwhelmed by too big a challenge. The ability to bring out the best in a person who is struggling, is one of the things she looks for in people she hires. Innovation, failure, resilience, and the humility that brings care and respect for others, are other things she looks for.

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Leonhardt points out in the NYT that Hillary Clinton actually won in the popular vote by a substantial margin, by more than 2 million votes and more than 1.5 percentage points. He says that Democrats need to pay more attention to the working class in midwestern states- the job losses, crumbling infrastructure, and the plight of communities such as Detroit, Michigan which suffered through the bankruptcies of Chrysler and GM, and again with the foreclosure crisis, the financial crisis of the City of Detroit. With a similar situation in the neighboring states of Wisconsin and Ohio, in places like Toledo and other parts of communities facing industrial decline. While the Silicon Valley centred region powered the economy in California, and the financial industry and real estate powered New York, older midwestern communities never really recovered from a long decline stretching over 2 decades. The result was the loss of faith in Democrats among union workers and young people, leading to the loss of Wisconsin, Ohio and Michigan. For most of its history the Democratic Party was based on its union and working class base including a large number of white voters. Only under Obama because of his unique candidacy was the coalition so dependent on the minorities vote. Before minorities were part of the Democratic coalition, but not in the way under the Obama candidacy. A return to its historic and normal base among whites in unions and working class communities, liberals, minorities, is a way to go back to the historic and natural base of Democratic support. In a sense dependence on tech communities for election funding and the tech booms, globalization, may have distorted Democrats sense of their historic role as champions of the working class and middle class communities throughout the country. There is now an opportunity to restore this lost mission of protecting the interests of the middle and working class who have seen huge drop in net worth as reported by Janet Yellen of the Federal Reserve at the Inequality Conference on October 17, 2014-"62 million households with a net worth of $11,000 for the year 2013." Poorly covered in the media and not made the utmost priority by Democrats (or Republicans). In the words of Janet Yellen, this was in the past several decades "the most sustained rise in inequality since the 19th century after more than 40 years of narrowing inequality since the Great Depression." She added the shocking words "by some estimates, income and wealth inequality near their highest levels in the past hundred years, and probably much higher than much of American history before then." Even discussion in the media goes back to the Obama coalition and treats it as a way forward for Democrats, when history shows it was different and the situation described by Yellen calls for a serious response. ...

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Jack Hough points out the problem with TIPS, Treasury Inflation Protected Securities. The CPI-U that is used to calculate the inflation for TIPS is not representative of inflation for the average household. It understates the cost of gasoline, tution increases for kids in school, and price increases for prescription medicines. Prescription drugs have a weighting of only 1.25%, college tution only 1.53%. The CPI-U index went up by about 3.9% in 2011, and at the same time the gasoline portion increased by 33%, for households spending a lot on commuting to work. Another problem is slowing inflation- with inflation slowing to 2%. Compared to TIPS the alternative of dividend payments by cash rich companies with secure market positions are a better hedge against inflation.

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Americans are increasingly using messaging apps to post status and photos. In the last quarter of 2018 the users posting status and comments dropped by 10% to 23%, for photos posted it dropped by 10% to 28%. This shift means people are posting less on news feeds and more on privately encrypted messaging apps such as WhatsApp, and WeChat in China. WeChat also does payments and e-commerce. Facebook is making the change as it shifts away from news feeds that have faced a credibility gap.

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Angela Merkel of Germany and other EU leaders decided to back "global supply chains" and declined to support the EU Commission in Brussels at a virtual summit attended by 27 leaders of the EU states. It was also attended briefly by Joe Biden. Ursula von Leyen said 21 million doses of vaccine had been shipped from EU to Britain, of which 1 million were from Astra Zeneca and the rest from Pfizer and other makers of vaccines. A total of 77 million doses made in the EU wer shipped to 33 countries since 1 December 2020. Governments of Netherlands, Ireland, Belgium and Sweden were not in favor of blocking shipments from the UK because of the effect on supply chains. Pfizer is strongly opposed to the move to block shipments. Merkel emphasized the need to respect the global supply chains while making efforts to ensure EU countries get a fair share of vaccine supplies. The problems of UK vs Britain on vaccine supplies comes from the yield problems at a Belgium plant of Astra Zeneca and the company's refusal to divert supplies from the UK. Of the 120 million promised only 30 million could be delivered to EU. The UK's contract with Astra Zeneca states that supplies from its plants in Oxford and Staffordshire must be delivered to Britain first. The UK is facing an acute shortage of second doses even though it has given 31 million jabs. At this time 45 out of 100 people in the UK have jabs, compared with 13 out of 100 in the EU.   ...

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After meeting with Rishi Sunak, the Finance Minister and the Business Secretary Alok Sharma prime minister Johnson is keen on getting things to as normal as possible in the summer to save jobs. About 3 million jobs could be lost, some permanently if businesses cannot open by summer, especially in the hospitality industry. This could push unemployment up from 1.3 million  to 2 million. The Times reports that at one point in the meeting Johnson said "Christ!" In mid March after he had the virus and Britain saw a surge in cases Johnson made health a priority even quoting Cicero in Latin that the health of the nation was the priority. Now this is changing with the jobs situation becoming a major risk. Much of the loss of jobs is likely say experts in the red wall districts that Johnson took from the Labour party in the election, and the prime minister feels a special responsibility to these districts. Johnson also said at one point about youth unemployment 18 to 24 years that is bleak, that he wanted to have an apprenticeship for every young person. The critical R rate is higher in the northwest and the southwest of England, compared to London. In England overall it is between 0.7 and 0.9. It needs to be around 1 to avoid spreading the virus.  As part of the social distancing guidelines ministers are also discussing changing the distancing on public transport so that it is 1 metre instead of 2 metres, so that reopening to get back to close to normal can be done sooner.     ...

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Key Indian projects in Sri Lanka or Ceylon are the Kankesanthurai harbor in northern Sri Lanka and the Ind0-Japanses East Container Terminal at Colombo port. In Maldives it is the Greater Male Connectivity Port.With its expertise and leadership in solar energy India is also launching solar initiatives in Sri Lanka. India has focused efforts on developing human capital and employment intensive sectors. This contrasts with the non concessional loans that finance infrastructure projects often with Chinese labor that do not generate the jobs Sri Lanka or Ceylon so desperately needs. Earlier period of Chinese infrastructure projects led to the debt trap with building of Hambantota port and facilities which Sri Lanka could not effectively utilize, and led to buildup of interest on loans. Sri Lanka now has the opportunity to make a new beginning as part of the SAGAR (Security and Economic Cooperation for All). The whole range of intitiatives in many areas show India's long experience in working with Sri Lanka since 1900 when early development projects were initiated. India has a long list of projects to help Sri Lanka keep up with India in its development- two education tourism projects, ITEC Indian Technical and Economic Cooperation, and Technology Adoption Project. This opens a new path for Sri Lanka to make steady progress on a wide range of projects for the next 10 years for sustainable development. As India grows this will expand the range of possibilities for Sri Lanka that it could never achieve on its own. Many new projects can also be done with the economic cooperation and assistance of UK, U.S. Japan and India to broaden the range of possibilities and financing. ...

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Greg Ip points out that the stronger dollar in 2018 is creating serious problems for Argentina, and will have an effect on Turkey, Indonesia and other developing countries. Dollarization hurts because it increases debt as debt servicing becomes costlier with dollar denominated debt and imports denominated in dollars become costlier. The dollar has increased in importance in the global economy. This is why the economic growth has suffered in developing countries in 2018. It is also why president Trump believes he can cut off Iran from the U.S. banking system to increase chance of new negotiations to fix flaws in the Iran nuclear deal, says Ip.   Argentina has seen internal problems compounded by the rising dollar causing the peso to drop by 17% so far in 2018. 88% of Argentina's imports are denominated in dollars. A rising dollar means it costs more in pesos for imports. Argentina's different levels of government have $98 billion in dollar denominated debt, and private sector has an additional $68 billion, the total being a third of its GDP. A decline in the peso means this is harder to pay off. About 40% of world trade, according to Harvard economist Gita Gopinath, is invoiced in U.S. dollars, four times U.S. share of world trade, and developing countries together owe $2 trillion in dollar denominated debt according to BIS. This makes it harder for developing countries such as Indonesia, Turkey, India, Argentina, Brazil, as they now face rising oil prices in combination with a rising dollar. In Argentina a poor crop for soyabeans and other agricultural exports in 2018 creates additional woes.   ...

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Erich Scwartzel's exceptional account of Dreamworks going astray as its CEO went in a hundred different directions- a smaller studio trying to get into multiple platforms and industries, and trying to compete with much larger Disney in China- provides a unique insight into what happens when a CEO, especially one with creative talent, loses his primary focus. Extensive interviews by Schwartzel with insiders shows the creative people at the studio struggling to get Katzenberg's attention as he made many of his frequent trips to China. DreamWorks Animation CEO's effort to get into several related businesses, television, publishing, theme parks, children's toys, and enter the Chinese market in a big way to compete with Disney, has led to a loss of focus in its main business of feature films. The result is large impairment charges and several films from the "Rise of the Guardians" in 2012 to "Penguins of Madagascar" recently, that did not cover rising production costs at the box office. Four of six films since 2012, before the recent film "Home," failed at the box office since 2012. Katzenberg now says he realizes pursuing different directions led to spreading resources too thin, and he intends to make producing 2 or 3 good feature films every year his No. 1 priority. Restructuring underway and some box office flops led to 4th quarter loss of $263 million from $17 million profit the prior year. About 20% of the workforce or 500 workers will be laid off, a Northern California operation will be closed, and the Glendale headquarters sold and leased back to improve cash flow. DreamWorks shares were at $22.68, March 27, 2015, down from $44 Feb 2010, and IPO day close of $38.75. ...

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Melissa Eddy of the NYT provides this exceptional account of the debate in Germany on national priorities, as the child care educators represented by the Verdi service workers union go on strike for a 10% increase in wages. Workers at entry level jobs in manufacturing represented by strong unions earn the same pay as teachers in child care centers and early childhood education who have many years of experience. The child care education workers are supported by the federal family minister, SDP minister Manuela Schwesig, who says that the additional experience and education upto university level of the child care educators in early childhood education should be recognized. Schwesig said: "We need a debate in Germany on how much we value the work of those who take care of the early education of our children and with young adults." One aspect of the 240,000 child care educators strike has drawn less attention. This is the gender pay gap as a large percentage of educators in childcare centers are women. Equal Pay Day in Berlin was organized for June 5, to call for equal pay for women who have fallen behind in pay. Data from the European Commission in 2014 shows Germany ranks third to last in gender pay equality, with only Estonia and Austria trailing behind, as cited by Deutsche Welle. Schwesig who attended the rally pointed out: "When women, despite equal work and education, earn less than their male colleagues, it is not only unfair. It is wrong." While Germany has moved ahead in quotas for female employees, women in boardrooms, parental leave, this does not help women in critical areas such as early childhood education and elderly care, which suffer from a large pay gap with men working in manufacturing jobs. ...

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An obscure parliamentary precedent was used by Speaker Bercrow to end Theresa May's strategy of repeated votes in Britain's parliament to browbeat reluctant Brexiters to vote for her negotiated settlement with the European Union. The precedent was set as far back as 1604 and was designed to protect the powers of parliament in the face of a Scottish royal assuming the role of sovereign of Britain. Repeated votes on the same proposals are not allowed if the intention is to find ways to get reluctant members of parliament to vote in favor, essentially by bullying them into this. This is also why Brexiter MP's have hailed the Speaker's decision in their opposition to Theresa May. Britain's constitution is based not on a single document like the U.S. Constitution. It is based on a a collective set of laws and precedents. A parliamentary rule book published by Thomas Erskine in 1844 sets out these rules in 1097 pages, available for 439 pounds in parliament's bookshop. It has gone through 24 editions. Speaker Bercrow says of the rule he was referring to as a statement on page 397 of the 24th edition.  There is not much time, just 10 days, for prime minister Theresa May to end the current parliamentary session and call a new one to nullify Speaker Bercrow's decision. This would also further antagonize the 40 Brexiter MP's led by Mr. Jacob Rees-Mogg and Boris Johnson in May's own party, making it impossible for parliament to agree on a course of action. ...

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A NYT series on the forgotten men and women of the second world war includes stories on black women breaking the logjam of 17 million pieces of mail in Britain ready to be sent to allied soldiers in Europe. Read about Captain Adams from South Carolina who is the first black woman in the officer corps of the American Women's Auxiliary Corps, part of the American Army by 1944. By 1942 General Dwight Eisenhower had already found an equal role for black men in the war and American forces. He also included a role for black women in roles such as that facing Captain Adams whose unit made critical contributions to getting the mail to allied soldiers fighting in Europe. This included sorting mail in Birmingham, England, in difficult conditions, and in France as the Battle of the Bulge took place in France with heavy casualties, and after the war ended in 1945 in Rouen, France. Mail meant life and death correspondence between loved ones when there were no phones with connections we have today. In this sense it was a role that had great significance. These women worked 7 days a week, round the clock, in rotating shifts. It was an activity that meant as much to the army as anything else. ...

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This article by Saeed Shah and Syed Hasan describes the Taliban factions from the tribal areas that control parts of Karachi, Pakistan's main commercial city on the Arabian Sea. It provides a detailed map showing the outlying areas around the city centre, especially the shantytown areas and the areas with Pashtun majority population controlled by Taliban with roots in the tribal areas. The Taliban charge taxes and adminster law in the areas they control. A major operation was launched since Sept. 2013 by the Sharif government to free this key city of Pakistan from Taliban control and the wave of kidnappings, extortion and other violence from Taliban members. About 168 police officers have been killed in the efforts to control the city, but areas under Taliban control are still hard to patrol by government police and special Ranger force. Karachi anxiously awaits the result of peace talks of the Sharif government with Taliban. If the talks fail and an operation is launched against Taliban in tribal areas the repercussions will be felt in Karachi. Shah and Hasan provide a excellent picture of the tribal loyalties, religious extremism and entrenched culture of violent activity that extends from the border tribal regions of Pakistan into the commercial centres such as Karachi that is a vexing problem for the Sharif administration, police, business and ordinary citizens....

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Samuelson points to the risks to the American economic growth from excessive health care costs. This is hurting take home pay and shows up in consumer spending. It is hurting government spending in other areas such as needed infrastructure spending and efforts to reduce the deficit. This hurts private capital investment to create jobs because of lower demand from constricted consumer spending. The U.S. budget has as its largest single expense 27% on health care compared to 20% on defense the next largest expense, with growth in health care spending taking this to one third of the budget in coming years. Without addressing health care, says Samuelson, the Supercommitte in Congress even if successful at deficit reduction will basically have failed to do its job, and it did not have the time, resources or conviction to do this. According to a new study from the Organization for Economic Cooperation and Development (OECD), U.S. healthcare spending per person is $7,960 per person in 2009. This compares with Norway $5,352, Britain $3,487, France $3, 978, an OECD average of $3,233. Life expectancy in the U.S. is 78.2 years, compared to Japan 83 years, OECD average of 79.5 years. Chile and the Czech Republic have life expectancy equal to the U.S. Except for cancer care where the five year survival rate is 89.3% in the U.S. and the OECD average is 83.5%, the U.S. lags far behind in much needed critical areas such as diabetes and asthma. Rates of emergency hospitalization for asthma are 3 times that in France and 6 times that in Germany and Italy. The U.S. has fewer doctors per thousand population and higher cost per medical procedure- with more frequent use of the costliest procedures- creating a supply shortage that induces higher prices, and less preventive and early action care through physician visits. The number of practicing U.S. doctors is 2.4 per thousand population in the U.S. compared to 3.1 per thousand for the OECD average; and number of annual doctor consultations 3.9 per capita in the U.S. versus 6.5 for the OECD average. Appendectomy cost $7,962 in the U.S., $5,004 in Canada and $2,943 in Germany. Coronary angioplasty cost $14,378 in the U.S., compared to $9,296 in Sweden, and $7,027 in France. Knee replacement cost $14,946 in the U.S., $12,424 in France, and $9,910 in Canada. Knee replacements, angioplasties and MRI exams are twice as common in the U.S. compared to the OECD countries. ...

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How attitudes are changing towards bottled water as the Nestle bottled water plant for McCloud in Northern California arouses fierce opposition among townspeople and brings in people from all aound the country in opposition to it. A Links column cites the Oakland California based sustainability think tank's estimate that it takes about 17 million barrels of oil to produce all the plastic bottles for the water which is enough to fuel more than 1 million cars and light trucks for 1 year. Few people think of it this way.

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Electricity rates in France have been lower for years. As France generates 80% of its electricity using nuclear power which is less costly than using natural gas or oil, and as rates are set by the government , the rates rates have been lower. Now the French government has authorized rate increases of 8% to large users and 6% to midsize users in business. Rates will go up to roughly $57 a megawatt hour excluding transmission costs. The estimated cost per megawatt hour at the new nuclear plant in Flamanville, France, is $46.