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The costs benefits and savings in a patient focussed practice. The new models of thes practices that are emerging such as amonthly payment of $54-129 per patient to the doctor and insurance only to cover hospitalization and catastrophic illness. The satisfaction of patients who avoid crowded doctors waiting rooms and avoid having to limit their questions. and get in and out quickly. The satisfaction doctors derive fom not having to rush through the day's schedule. The reduction in emergency care visits as patients better m=nderstand and manage their medical conditions.

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The failure of Basel 1 and 2 and the effects of the Asian market crisis in 1997 in creating a situation of current account surpluses in Asia and other countries that ended up in extra liquidity in the western countries where debt went out of control. The concerns about negotiations to enhance the role of emerging economies in the IMF, the Financial Stability Forum and other organizations, as these organizations play a larger role and need larger access to funds. The chance that with such a large agenda especially in the area of regulation and enlarged representation of emerging economies in international organizations like the IMF, the leaders of G20 may simply use this meeting and meetings in coming months to forward their own leader and country agendas, leaving these issues unresolved for now.

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This WSJ report shows Russian oil exports to European ports actually increased in April compared to March 2022. Some of the shipments are sent out with destination unknown, and some oil is transferred to bigger oil tankers further out at sea. Mixing of the oil blurs its origin says this report. It cites TankerTrackers.com showing that ports in European Union member states which are historically the largest buyers of Russian oil had seen exports of Russian crude oil to these ports rise to an average of 1.6 million barrels a day in April from 1.3 million a day in March. Companies such as Shell consider oil that is less than 50% Russian as not Russian oil. Countries such as Netherlands are seeing increase in oil from Russia according to charts shown here. Simon Johnson, professor at MIT and former chief economist at the IMF says until there is an oil embargo this is likely to happen, and it is all about cheap energy. Even with an oil embargo Johnson asks will they sanction tankers out at sea. ...

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The Ukraine war with increases in prices of oil and natural gas, and food imports has hit Bangladesh hard.  The currency has declined by 20% which also adds to the cost of imports. The government of Sheikh Hasina is seeking $1 billion each from the Asian Development Bank and the World Bank.  It is also seeking $4.5 billion for budgetary and balance of payments support through the new Resilience and Sustainability Facility set up by the IMF. The government is doing this in advance to avoid a situation in which most of the tax revenues go to paying for imports at high prices with little left for spending on development needs. Bangladesh imports cooking oil, wheat and other food, as well as fossil energy. The current account deficit is $17 billion and the foreign exchange reserves are about $39 billion in July, down from $45.5 billion in 2021, enough for 5 months of imports for a nation of 160 million people.  Action is being taken to curtail use of air conditioning at mosques. Power outages are increasing and electricity rationing is being done. ...

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AP/NORC poll March 2023 shows 7 out of 10 adults in the US feel that the US is spending too much on development assistance when the budget for USAID is $40 billion. In general Republican administrations prefer foreign aid to be adminstered by the State Department not a separate agency. USAID was setup during the Cold War with the Soviet Union by president John F. Kennedy in 1961. Today it adminsters programs for HIV/Aids and for pandemics, health programs that can be done through the State Department. Attitudes have shifted following the pandemic with 9 out of 10 Republicans opposed to foreign aid through USAID. Some of the criticism is that it funds bureaucrats favorite programs. The actual impact is now uncertain in the developing of an economy. For example Sri Lanka benefits more from aid and development assistance from neighbor India than from programs of USAID as it tackles the current economic crisis following the pandemic. India pulling together the aid through IMF for Sri Lanka, and the investment in energy from India is way more important than the small USAID programs.  ...

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Democrats in the House of Representatives need about five votes of moderate Republicans to get approval for spending that exceeds the debt ceiling if no agreement can be reached with the Republicans under Speaker McCarthy. This is one of the options Democrats under president Biden are keeping open if the spending cuts Republicans are asking for hurts workers and families in ways unacceptable to values of fairness to all segments of society supported by Lincoln, Wilson, FDR and Truman that have shaped America over two hundred years. T Though it is not readily apparent in an America where about 22% of 8th graders are able to get a passing grade in civics and history in NAEP tests, a rereading of the writings and speeches of Abraham Lincoln show the same concern for the rights of all segments of society that are found in Wilson and FDR or Truman. This is also what Biden means when he calls this a struggle for the soul of America. More not less funding for education, more not less funding for health after the pandemic and cost of living crisis, more not less funding for public services at a time like this where there is a fracturing of society as well as isolating certain segments of society from others such as the growing distance between workers and families from places such as Silicon Valley and capital markets in America.  ...

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Slowdown in drug sales growth in USA and Europe. Top seven emerging markets will account for 34% of global sales growth upfrom 7% in 2000. And the USA accounted for 40 to50% of growth in global pharmaceutical sales each year early in this decade, in 2009 the sales in the USA will account for just 9%. Forecasts and figures are from IMS consulting firm. USA sales will rise only 1-2% if at all, while emerging markets will grow by 4.5% to 5.5%. With the economic troubles American consumers are less likely to fill prescriptions and insurers are not covering new drugs and favoring generics. Intense competition among generics drug makers is reducing prices. IMS predicts that the global generic market will grow by 5 to 7% in 2009 to $68 billion, slowing from double digit growth. This is from total sales forecast for pharmaceuticals globally of $830 billion.

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President Trump says the U.S. could permanently cut off funding to the WHO and revoke U.S. membership if the group does not make changes in the way it operates showing a lack of transparency in its operations and dependence on China. Mr. Trump says the WHO has shown "alarming lack of independence" from Beijing. In a direct letter to the Director-General Tedros Ghebreyesus -"it is clear the missteps by you and your organization in responding to the pandemic have been extremely costly to the world." Mr. Trump gave the WHO 30 days to make "major substantive improvements" or he would cut funding and reevaluate U.S. membership. Mr. Trump said in the letter that the WHO ignored early reports of the virus spreading in Wuhan, failed to share information with other countries. The U.S. which has the largest contribution by far to the WHO was unable to influence the organization. The U.S. has influence in finance at the IMF, the World Bank, and in the tech world, yet this did not extend to important matters of public health. It could be that public health had become an afterthought in the rush to prominence in tech and finance. The contributions of the U.S. exceed anything any other country has made. During the 2 years 2018 and 2019 the U.S. contributed $893 million, according to WHO records, cited in the WSJ. During this period the contribution of China was $86 million with an additional $50 million added recently. The $2 billion Mr. Xi said China will contribute is incorrectly reported as for the WHO, it is what China says it will use to support Africa and other countries in the world to fight the pandemic. ...

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Malaysia's debt to GDP ratio increased to 242% in mid-2012 from 192% in 2008 according to McKinsey. As export growth has slowed the Malaysian government is relying on credit expansion to consumers and large capital projects such as the planned subway project in Kuala Lumpur to sustain growth. Similiar credit expansion is seen in other Asian countries- Thailand, Vietnam, Singapore, Hong Kong. The period 2008 to 2013 has seen a rapid acceleration in credit expansion in these countries and especially in China. China's debt to GDP ratio increased to 183% in mid 2012 from 153% in 2008, according to McKinsey. Nomura Holding's economist Zhiwei Zhang, and other economists say it is above 200% when government data on "shadow banking" lending institutions such as trust companies is included. IMF economist Giovanni Dell'Ariccia has studied of debt expansion and credit booms since the 1970's. He and other economists at the IMF have found that credit booms- the rapid increase in credit to GDP ratios- end up in crises one third of the time, result in below par growth in another third of the time, and only in one third of the time does growth continue at the high pace. Alex Frangos talks to government officials in Kuala Lumpur who do not take seriously the high vacancy rate for office buildings in the capital of about 20% even as new office towers are being built. Bob Davis gives the example of government owned Hunan Expressway company in China which has a huge road building program and doubled its 2009 debt levels. Another state owned company in shipping China Cosco Holdings increased total debt from 85 billion yuan in 2009 to 123 billion yuan in 2012. As export growth slowed in China in 2009 credit expansion is driving growth. The normal restraints of the market are absent in China's state owned companies. Charlene Chu, senior director of Fitch Ratings Inc in Beijing, says 2012 demonstrated that the Chinese government cannot slow credit growth without risking a decline in growth. China's GDP growth in the 1st quarter of 2013 slowed to 7.7% from 7.9% in the 4th quarter of 2012. This poses a serious problem for China. China has never experienced the kinds of problems seen in Asia after the 1997 banking crisis, in the eurozone today, and in the U.S. following the financial crisis of 2008, making government officials prone to complacency about the risks....

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Raghuram Rajan, Professor of Finance at the Graduate School of Business, University of Chicago, was appointed chief economist at the IMF in 2003. He presented a paper, titled "Has Financial Development Made the World Riskier," at the annual Jackson Hole meeting of economists and central bankers for 2005. Rajan says he had planned to write about how financial developments during Greenspan's 18 year old tenure had made things safer, but the more he looked the more evidence came up that the risk reward relationships in a normal functioning financial market had been terribly distorted. Market participants were being rewarded for wins but were not being asked to take on commensurate risks and impacts on their bonuses and rewards. He also cautioned about the use of credit default swaps which acted as insurance against bond defaults, and said insurers were generating big returns on this but with the appearance of little risk- even though the pain could be immense in a default. Banks were carrying credit securties on their books that posed risks to the whole financial system if things went wrong with the credit securities. Reaction from the gathering was unfavorable. Lawrence Summers, a former Treasury Secretary said, "the basic, slightly lead eyed premise of the paper was misguided."...

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Bondholders and the Greek government are stalled in talks and waiting for Germany and the IMF to come up with the 14.5 billion euros that is due on March 20, 2012. It may suit the bondholders holding out for a higher interest rate in the 4-5% range for the new bonds to be issued at 50% of face value with long term maturities, but is bad for Europe. This Journal editorial points out that this is bad for European taxpayers and points to other steps that can be taken which are being discussed in European circles. One step is for acollective action clause to be inserted for the existing Greek bonds under which all bondholders have to accept losses if two thirds of the bondholders agree to accept losses. To ensure the safety of the Greek banking system Greece would restructure the bonds held by Greek banks so that they continue to be acceptable as collateral with the ECB, and issue new bonds to the ECB with face values, interest rates and maturities matching existing holdings. The idea is to make it possible for Greece to reduce its total debt and its debt servicing costs- which is really the only way out of the crisis. The ECB and Greece would use the collective action clause to restructure the Greek debt to reduce interest and debt servicing costs on new bonds to be issued. The Journal editorial says it should also mean Greece and the ECB are not required to put up the 30 billion euros in up-front cash that was agreed to in a poorly devised agreement in 2011....

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Questions are being raised about the lack of fairness in the cuts imposed in Greece - and the IMF acknowledges this- where the minimum wage was cut by 22%, but the most highly paid civil servants had their salaries cut by 10%. Germany's finance minister Wolfgang Schauble told the German daily newspaper Der Tagesspiegel: "I really feel for the people of Greece. The vast majority now hard-hit by reform and austerity measures... can do nothing about the backup in reforms, the loss of competitiveness and the unproductive use of funds in the past." In Greece there is a separate wage scale for the highly paid public sector employees such as doctors, diplomats, professors, and uniformed personnel in the military and police. This is different from what the ministry bureaucrats, hospital support staff and local government administrators get paid. This group took only a 10% cut, even though it makes up one third of the payroll according to IMF and EU estimates. The cuts to the minimum wage were made to improve Greece's competitiveness and because in Greece during the last decade wages went up much higher compared to Germany. Brian Carney pointed out in a Journal article Feb. 14, 2012, that nominal private sector labor costs went up by 62% in Greece from 2000-2008 compared to 15% in Germany. Showing the nature of the fight to make the cuts more equitable, is the resistance to the IMF-EU insistence on cuts to the highest pensions which amounted to $178 million. In the end prime minister Papademos said the monthly pension of $1975 was reduced by $32 or 1.6%. The lack of fairness creates more uncertainty about the cuts as elections are expected in April, only 7-8 weeks from now, and fears that this may not hold when a new government is elected. For this reason the IMF-EU officials are considering putting the $170 billion bailout money in an escrow account....

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Messi uncertain if he will play for the World Cup in the US in 2026. It is 20 years since he played at the age of 18. The aging Messi says some days he feels good, on other days not so good, and it depends on his physical condition if he will play. He recalls with affection the chance to play in Argentina and score goals in the game against Venezuela 3-0 before retiring. He was thankful for the chance to play for Barcelona fans.

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With government bond yields at 12% in Jan 2012 Portugal is unlikely to be able to return to bond markets in 2013, even if fiscal targets are met, according to analysts. The S&P downdgrade of Portugal's debt to junk rating has worsened prospects. Portugal's economy is expected to contract 5.8% in 2012 and 3.7% in 2013, according to Citibank. Portugal has to repay 9 billion euros in debt due in Sept. 2013.

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Philipp Rosler, head of the FDP party and Germany's Economy minister, says he opposes further involvement by German taxpayers or the ECB in the debt restructuring for Greece. He pointed out that the current negotiations between Greece and the bondholders (mostly French and German banks) were about private sector involvement. Tax payers of Germany and other European countries are already making a contribution he said. The IMF is pushing for the ECB to take a haircut or writedown on the $40 billion of Greek bonds it holds to supplement the haircut taken by bondholders of over 50%. Rosler said in an interview with the Journal that Athens should keep its side of the bargain by implementing reforms and not letting them just be on paper. On Germany or the EU directly taking responsibility over the Greek budget, Rosler said this should be the responsibility of the Greek parliament. At the same time he pointed out that its important to have a specific and rigorous montiroing process just to be fair to taxpayers in the EU....

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Lecornu and Macron operate differently now with Lecornu making the decisions for negotiating with Socialists and putting aside pension reform. After his ouster Lecornu set conditions for his return - to have latitude to make decisions if he was to take the job of PM and to consult with Macron but make decisions to negotiate with socialists, to set aside pension reform, to use Article 49.3 when he thought it would be wise, on and on. Macron to be useful in his last year has agreed. Macron has dropped his Jupiterian presidency says Le Monde in favor of consultation and discussion and letting others make decisions to govern. One should not misread Macron's new style of opposing DJT- it is a way for him to bring all French parties, the movement of Melenchon, the Socialists, and the Le Pen National party, to agree on something, when even passing the Budget was difficult in a frayed political environment. Macron having lost trust and with low popularity, Le Pen and the Melenchon movement at odds every step of the way- an inability to govern. ...

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Phillipe Pons in Le Monde on social media and disinformation popular with young people who have fewer employment prospects in the middle of sluggish economic growth.  Japan's Ministry of Education erasing Japan's wartime atrocities in school books in the years LDP in power since 1950's. Sanae Takaichi's comment about Japan willing to intervene if China attacks Taiwan was popular in Japan. Among young people 18 to 39 surveyed by Yomiuri 64% support Takaichi. Broadly speaking straight talk and nationalism iis becoming popular in Japan. The LDP has lost its majority in the lower and upper house in parliament and the Sanseito party with 15 seats and other smaller nationalist parties are increasing in popularity. The Ministry of Education has for many decades kept the Japanese wartime atrocities such as at Nanjing in China of the 1930's, the harsh Japanese occupation in China and Korea, out of the textbooks. The result is that Japanese young people do not have the same level of grasp of what happened in the twentieth century. ...

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1.2-2 million barrels a day go from Iran's Kharg island through Straits of Hormuz for ship to ship transfers in South China Sea, then labeled Emirati oil and unloaded at refineries on Shandong coast. These refineries are called teapot refineries. In this way US sanctions are avoided. Shipments of oil were about 700,000 barrels a day before 2023. After 2023 this more than doubled. China gets this at a 10-15%  discount costing Iran about a third of revenues it would otherwise be able to sell this oil if it decided to work with the US in a new arrangement. This report in FR24 shows China as limiting it's relations with Iran to oil, careful to not let it affect more important trading relations with US European Union, and Germany. This is similar to the situation for Venezuela -which under a new arrangement the US has with Venezuela- now gets market prices for its oil increasing it's revenues substantially by about one third to benefit the Venezuelan people suffering from high inflation and economy wrecked by sanctions. ...

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Awesome, awesome advice from Diana Nyad- who did the 110 mile swim from Cuba to Florida when she was 60 years- on getting older and staying younger all the time. A better cognitive function and physical fitness is within reach after 40 years, after 65 years says Diana Nyad than when we were younger. All that is needed is a positive attitude, about not being self-absorbed and selfish like when we were in our twenties. Magggie Penman of the Washington Post interviews Diana Nyad, who says she is fitter, stronger at 76 than before. Part of this, says Nyad, comes from being nicer, more forgiving of people. One thing as you get older your connection with people around you means everything. You want to "embrace the chaos", says Nyad. It means getting to know the person next to you wherever you are, what is their life story. For Nyad even if you are an atheist like she is, be an atheist in awe at the sheer wonder of nature and the world. That gives you energy and gratitude that fills up your life. ...

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Analysts do not see how Greece could avoid restructuring its debt. Debt for Greece is expected to grow in coming years. The 110 billion euro bailout of Greece by the European Union and the IMF does not reduce Greek debt- as the bailout comes as more loans. The EU estimate is that Greece's debt will go up to 375 billion euros in 2013 from 298 billion euros in 2009. Kenneth Wattret, chief euro-zone economist at BNP Paribas, says the markets are already pricing in some form of restructuring. This would include some form of "haircut" for bondholders. A restructuring presents several problems. Brussels think tank Bruegel estimates 20% of Greece's government debt is held by local banks which are weak financially. These banks will need some help if they are to take new losses. About one third of Greece debt is held by pension funds and insurance companies and these institutions may have to be stress tested before taking losses. And 80 billion of the bailout money came from euro-zone countries as direct loans, this would mean losses for these lenders....

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This article in the Atlantic Council September 17, 2024, shows that the world may be fixating on the Straits of Hormuz when it should really be focusing on the Red Sea shipping for the Suez Canal. The Iranians ship 1.5 million barrels a day of oil through the Straits of Hormuz, and closing it off would close off the oil revenues that sustain its economy. Wald writes that even if the Iranians in a crisis would clsoe off its waters to shipping another route exists in the Straits of Hormuz through UAE waters when needed by oil shipping and it has been used by British ships. The Red Sea and Suez presents risks coming from Houthi rebels supported by Iran, who have attacked the US Navy ships in the region.