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The $500 million jury award to two persons getting hepatitic C as a result of "unsafe practices" at the Endoscopy Center of Southern Nevada. The jury decision for punitive damages was made against Health Plan of Nevada for $270 million, and Sierra Health Services for $230 millon in Clark County District Court in Las Vegas. The plaintiffs argument was that the insurers paying the health care provider had a responsibility to monitor the quality assurance of providers in its network.

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Under a plan called "premium support" Paul Ryan's U.S. budget proposal would have seniors choose a private insurance plan from a federally operated exchange. Each year the government would pay private insurers a specific amount to cover the cost of premiums with the rest borne by seniors. The total amount paid by the government would go up only at the rate of overall inflation, it would not go up at the higher rate of health care inflation. By doing this the government would take off the trillions of dollars of projected spending on health care that are largely the result of the higher inflation rate in health care costs. This higher inflation rate on health care costs is something that both parties have failed to control, and remains a major weakness in all health care proposals to date, including the Obama health care legislation. Allowed to continue growing at this rate when U.S. debt to GDP is nearing 100%, health care inflation costs pose major risks to the nation's finances.

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The private sector ignores health insurance. And state coverage in China is inadequate. More than two thirds of China's 1.3 billion people have no health insurance at all. If you have insurance you still pay up front in cash, if you do not have the cash up front you cannot get a surgery, treatment of any kind or any drugs, even if the insurance will later reimburse you. The Chinese health care system is dysfunctional and in a crisis because of the way it is structured, and the faulty policy incentives. It caps prices for basic drugs and procedures at below market rates, yet it lets hospitals profit from everything else from advanced drugs to sophisticated diagnostic tests. So hospitals invest heavily in technology and expensive testing. and drug sales account for 45% of revenues. And enforcement is lax. Doctors in Shanghai make monthly incomes of about $400, about what a taxi driver makes, so they supplement their income with bonuses earned by prescribing more expensive tests and drugs. There is no utilization review so the state reimburses for whatever the hospitals charge regardless of whether the test was needed or not. So the system is dysfunctional and lurching towards a crisis. In fact heavily burdening the middle class. The private outlays and burden of total health care spending has increased from 20% to 60% of total health care spending from 1978 to 2003, as the the health care system got the same dose of unfetterred capitalism as the rest of the system. The Government's share of total health care spending has dropped sharply. In addition there are design flaws that push expensive care and build in incentives for expensive care at the expense of good medical care. The government recognizes this problem and sees it as athreat to social stability. It has committed to increase spending on healthcare. ...

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The P1 coronavirus variant from Brazil is seen in 200 of 877 cases in ski resort in Whistler, British Columbia. Helath officials have little knowledge of how this variant entered Canada's western province. This report says the housing shortage for hospitality workers is worsening the pandemic with 6-8 hospitality workers living together and no chance to limit the spread.   The decision by the state health officials not to screen with testing for which variant is responsible for an infection of covid is coming under criticism, as reported in The Guardian. This allows the variant to spread with no knowledge about where it is happening so that countermeasures can be taken. In the absence of this type of screening and testing one is flying blind, says this report. Recent steps to contain the spread in India advocated by prime minister Modi in India give micro-containment a big role, with screening and testing and detection of incidence of mutation becoming critical. To do this the health system has to be well prepared and have full support and direction from a unified authority bringing together every arm of government at the federal, state and local levels. Response has to be very quick and resource allocation proper from testing labs, people on the ground, vaccine supplies, and vaccination drive effective. ...

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The discussion on whether it is feasible to achieve any significant cost savings as long as middle class consumers are not cost conscious about their employer provided health insurance. This would be so as long as their health insurance benefits are not taxed as income. America suffers from a particularly strong case of not minding the price increases imposed by the health care industry as long as its not out of pocket cost. But Obama seems stuck on his insistence that the middle class not take on any burden, that there be no middle class tax in the form of this tax on health care benefits. Critics say even FDR did this by having the middle class pay with payroll contributions for Medicare and Social Security. And even if the 5% of Americans who make more than $280,000 are taxed it will not generate by itself the money to pay for the $1 trillion cost of the plan, as the prospects of cost reduction are uncertain- especially when the basic nature of America's health care system are not changed, like the lack of cost consciousness of consumers of health care when its perceived to be free and employer provided....

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This very exceptional report from the city of Recife in Brazil's northeastern state of Pernambuco, comes from WSJ reporters Johnson and Jelmayer. It is about the physicians Vanessa van der Linden Mota, and Ana van der Linden Mota, her mother, who first alerted health authorites in Pernambuco about the cases of encephaly and the links to the mosquito Zika Virus in Recife, Brazil. From 147 recorded encephaly cases, and babies born with shrunken skulls or calcified brain structure in 2014 in Brazil, the cases reported jumped to 4,180 suspected cases. Estimates of cases by 2020 for such cases run up to 50,000 to 100,000 if the problem is not tackled. The family of the van der lindens come from Dutch-German immigrants settled in northeastern Brazil, a less developed region of the country. The family is unique with five doctors including neuro pediatricians Ana and Vanessa working in public hospitals in Recife , and father Helio a neuro surgeon. The entire state of Pernambuco has a total of 15 neuropediatricians, according to this report. The Ebola Virus emerged in countries such as Sierra Leone and Liberia which suffered from war and neglect of health infrastructure. Here in Pernambuco state, as reporters Johnson and Jelmayer point out, the problem stems from neglect in public health infrastructure, especially sanitation and drinking water for shantytown dwellers and vast majority of poor residents in a city of 3.5 million, typical of developing countries in Latin America and South Asia, where development in some parts of the country have lagged far behind, and where needed public health infrastructure investments have not been made. Lack of dependable drinking water means collecting water in containers that are susceptible to breeding mosquitoes, such as the mosquitoes carrying the Zika Virus. A public debate on the lack of attention by socialist and worker's party led governments to this type of infrastructure and transportation services was already underway in Brazil leading to widespread protests in 2013. A $226 million investment in a soccer stadium in Recife, and similar investments in other smaller cities in the northeast were made under the Worker's Party government. Large investments for the Olympics now come as the economy contracted in 2015, and Brazil is hurt by another boom-bust cycle with the slowdown in China- with fiscal austerity policies, a loss of a third in the value of its currency, and the popularity rating of the newly elected government from the Worker's Party in single digits....

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US Senator Bernie Sanders and Shawn Fain of the United Auto Workers make the case for a 32 hour week.  No that's not right Sanders and Fain are calling for hours and wages that make for a healthy life after making significant contributions using technologies and higher productivity during a normal week more like 35 to 40 hours instead of 50-60 hours a reality today.  Even with this productive work effort they say workers have not benefitted as most of the gains have gone to the top with top managers and CEO's making hundreds of times more in compensation. In this years negotiations the UAW made long hours at work and its effect on worker health an issue. A 40 hour work week was established in 1940 under the Fair Labour Standards Act passed under president Franklin Roosevelt. Sanders and Fain point out that 28.5 million workers even today work over 60 hours a week and more than half of full time employees work more than 40 hours a week. It comes as a surprise that according to the authors US workers logged 204 hours a year more than employees in Japan, and 470 more hours than German workers. Sanders and Fain point out that today adjusted for inflation the average worker in America makes about $50 less a week than 50 years ago in 1974. There is definitely a need to consider the health of workers as the highest priority and wages that make it possible to raise families and educate children in decent living conditions. France and Denmark have a 35 and 37 hour work week. ...

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Grady Cash is an active runner at age 71. A sports hernia sidelined him at age 50 but he has found his way back into running. After a 2 year hiatus he returned to the track. He entered his first national track and field competition in 2004, and by 2015 eleven years later he was running in the 200 metres at the 2015 USATF Masters Indoor Track and Field Championships. Here he cam in last and had a revelation. Most of the runners were shaped differently than the long distance 1500 metres runners. These people were V shaped with tiny waists, broad shoulders and big leg muscles. From this he learned to do weightlifting at a local gym in Nashville and hired a trainer. After his retirement from financial planning he set up his own routine. He runs with a group at the Vanderbilt University track two afternoons a week ages from mid 20's to 76. A typical workout is eight repetitions of 200 metres that are sequentially faster. He does easy recovery runs on the trails. Mot important he tries to remain injury fee in the kind of routine he selects and listens to his body all the time not to overwork it and run  injury free the next day.  ...

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Wal-Mart is expected to announce a five year plan to meet specific targets for lowering sodium, trans fats and aded sugars in a whole range of foods- including rice, soups, canned beans, salad dressings and snacks foods- in packaged foods sold under its house brand, Great Value. Other moves towards healthy foods are to move to eliminate the extra cost to consumers for healthy foods made with whole grains. It will also lower prices on fresh fruits and vegetables. This plan is similiar to other plans announced by companies such as Con Agra Foods which set a target of reducing sodium content in foods by 20% by 2015. New York City also has a public health initiative for healthy foods. another move by Wal-Mart is to get major food suppliers like Kraft, to follow the example set by Wal-Mart. Kraft sells 16% of its global sales through Wal-Mart. The move will be gradually introduced over five years which makes for slow progress, and the targets set for sugar reductions are much less than they should be, says Michael Jacobson, executive director of Center for Science in the Public Interest. Another serious drawback is that Wal-mart has not proposed to tackle the major cause of childhood obesity, which is the added sugars in soft drinks....

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This essay in the WSJ by Louise Aronson, geriatrician, professor of Medicine at UC San Francisco and author of "Elderhood, Redefining Aging, Transforming Medicine, Reimagining Life," and Teva Brender, UC resident in Internal Medicine, says age should not be a factor  in electing leaders, as over the last century life expectancy has grown by 25 to 35 years. People can be healthy into their eighties and modern medicine provides ways to tackle small physical, auditory or visual impairments. In addition these can be handled with strength training, better nutrition and social support, says Aronson. His point is that there has been an increase in "health span" the years we define as being healthy, a compression of morbidity, the disease at the end of life. As a result people can be productive for many years, early retirement is a bad idea economically and for the people themselves when they feel better working. When there is so much wisdom and experience that they can bring to the job, and when that  wisdom and experience is sorely needed by the nation, that guiding light has immense unreplaceable value. President Franklin Roosevelt was at such a time able to steer the nation in the 1930's through the Great Depression and the 1940's through the Second World War, even though he had disabilities. Aronson says the work of elected leaders is fundamentally cognitive and when the basic physical demands can be met it is possible for leaders to work successfully. ...

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Leonhardt says that there is little reason to think that the flatter rates are better always. With the need to finance Medicare and health care for all, the government can use the extra dollars from taxing the very wealthy, the very rich in different tax brackets. The top bracket in 2008 started at 357,000, and you paid 35% whether you made 400,000, or $4 million, or $40 million. So basically the upper middle class was lumped in with the extremely wealthy. And considering the cost of college tutions for 2 or 3 kids, the upper middle class is only middle class. It makes sense not to lump the two together. Considering that there has been a lot of wealth accumulated at the the very high end, it would also reduce inequality, generate tax revenues for health care, and not have much effect in the incentives for generating economic growth. It is something he says the Obama adminisstration may and should consider.

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This article is a must read for everyone to know where our plastic and other paper waste is ending up. With China's ban on importing plastic waste the stuff is being shipped to India, Malaysia, Philippines and Vietnam. Now these countries are turning it back. Who needs sometimes contaminated waste. In the U.S. it ends up mostly on landfills. It is a health hazard as one recent story of waste shipped out to a part of Chile shows- with health problems for people in the vicinity. The WSJ has done an excellent story with diagrams and pictures in this exceptionally good story we recommend for our readers to know what is happening worldwide with plastic waste.  There is increasing education of the harmful effects of plastic and there is a government campaign in India supported by the prime minister Modi to reduce use of plastic bags and find ways to dispose off local plastic waste. In the light of this why would India or Malaysia or any other Asian or Latin American or African country want any other country's plastic waste, particularly when it is a health hazard. In fact China for so long allowing importing of plastic waste till recently so it could be processed with low cost labour and reused for plastics production is incomprehensible, considering the health risks involved. ...

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Dangers of democracies that turn into failed states in Latin America with production activities that damages health of western democracies, a problem the US has never experienced since 1776.