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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. ...

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Vauban is a "car- free" upscale communitynear Freiburg, Germany, close to the German-Swiss border. Except for the main street where atram to Freiburg runs, and two parking lots outside the community, there is no place to park cars. About 70% of the people there do not have cars and 57% sold their cars to come here. There are no car garages or parking places with each home. Bicycles are hte main means of transport. Vauban hasd 5500 residents in one square mile. The basic concept of having stores placed only awalk away is being followed more and more as America and Europe shifts away from intensive auto based use of space for living. The whole post war location of housing and stores and community activities was based on large use of the automobile. This is now going through big changes. David Goldberg, of Transportation of America says " how much you drive is as important as whether you have ahybrid." A fast growing coalition of hundreds of groups is advancing the cause of building communities with stores only a walk away and less need for the automobile to get around. Outside Hayward, California, Quarry Village is anew development that is trying to reduce autos to one per home. So car based is American culture that most zoning laws require 2 parking spaces per residential unit, and in the federal transportation bill 80% of appropriations in prior years used to go by law to highways and only 20% to other transport. This even though passenger cars are responsible for 12 percent of greenhouse emissions in Europe , and upto 50% in some car-intensive areas of the USA. One solution to the problem is to use smart planning to avoid the suburban sprawl, and shift to smaller more fuel efficient automobiles, and build better mass transit and rapid transit and fast rail linking most towns and cities, that will moderate all the excess that took place after the war. This may be the direction smart planning is taking us, and places like Vauban remaining niche communities for green advocates and a sort of reminder that its possible to go in this direction....

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Wounded or maimed veterans get psychological closure by visiting the scenes where theywere injured. Here wounded veterans visit locations in Dyala province under Operation Proper Exit, eight wounded men- five amputees and one blinded soldier- places tey left while unconscious or in agony. This is the second such trip and the results in development, stopping night tremors for the wounded men, and psychological closure have been phenomenal. Rick Kell, head of of Troops First, who got General Ray Odierno to agree to the idea says wounded soldiers said they wanted to go back, and he kept hearing it repeatedly. Sgt. Luke Wilson, 29, from Hermiston, Oregon. He lost his left leg above the knee in agrenade attack in Baghdad in 2004. Kell arranged that they fly in Business Class for the 13 hour flight so they could lie down or take their legs off. When they walked off the helicopters they walked under their own power to be greeted by American officers and soldiers, clapped on their backs and welcomed as old friends. All in uniform and none of their injuries or prostheses visible except up close. Sgt. John Hyland, 38, from San Antonio, who lost his left leg and sufffered back injuries when an improvised explosive device hit his Humvee in 2007, and Specialist Craig Chavez, 29, from Temecula, California blinded by a2006 I.E.D. blast that destroyed his face- which was reconstructed- injuries which meant losing his left eye and most of the vision in his right. Specialist Chavez says it was apoint of special pride for him to walk around the base without any help. And Sgt. Hyland was amazed by the silence, the silence from no sounds of mortar shells going off and exploding L.E.D. devices. In the memorial hall Sgt. Hyland pauses at a picture of Specialist Jonathan Rivadeneira, 22, from Queens, who saved his life in an Humvee attack on Sept. 11, 2007, only three days later Rivadeneira was killed. Sgt. Hyland began crying quietly and lowered himself in pain onto his right knee and began to pray. Outside he was still shaken by the experience and the other wounded soldiers gathered around him till he recovered ....

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Ghosn of Renault-Nissan used to be a skeptic about electric cars. Now he is on board. Nissan plans to sell an electric car in the US and Japn by 2010. It will be only hundreds of vehicles at first so it will take more time to take it to mass market, but the goal is to go for mass market. By 2012 Nissan will plan for a lineup of electric vehicles, so it will extend beyond small cars to small minivans and small commercial vehicles and small crossovers. 100% electric cars also are described as zero emission vehicles. But Nissan won't be the only company doing this. Mercedes is moving "very fast" in the direction of emission free vehicles, see the the interview with Daimler's Zetsche. Mitsubishi Motors and Fuji Heavy Industries are testing versions of electric cars. And GM plans to introduce the Chevy Volt in 2010. Toyota plans to have a plug in hybrid about this time. Mercedes will be the first to bring a lithium oin battery in its S400 coming out later this year which will be a hybrid. It is the cooling of lithium ion batteries that has been a major hurdle to development of electric cars and Daimler's Zetsche says they have solved this problem, have 24 patents, and developed a cooling system that works inside the car. Nissan has an electric car project that it is working on with California based Project better Place to produce electric cars for the Israeli and Danish markets. Ghosn has grasped the idea that the market is signalling a major and irreversible change towards smaller emissions and regulators are way behind on this curve. He says that if one is to sensibly participate in the growth of emerging markets which Nissan is doing in North Africa and India and Eastern Europe then one has to think in terms of sustainability and lower emissions, as putting tens of millions of more cars on the road around the world can damage the environment. And the only way this can be done to meet the aspirations of people in emerging markets is to lower emissions and to set this as the overriding goal. One gets the same sense from the Germans, see Zetsche, Daimler....

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Women do twice as much of the caregiving for elderly parents and small children as men. About 41% of mothers say this makes it harder for them as working parents. About 20% of the female workforce in U.S. is giving elderly care. This adds up to more stress, decreased working hours, decreased income, needing leave of absence, and missing promotions or training. Only 14% of working people in the U.S. have even one day of paid leave to care for a new baby or seriously sick family member- a startling statistic for America, showing lack of family friendly policies at most companies.

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Texas law written into the constitution of the state when it was founded in 1845 banned home equity loans. This was a result of a bank panic and foreclosures of that period when many homesteaders lost their land. The change banned lenders from selling mortgages to homesteaders. Till 1998 Texans could not take out home equity loans. New laws restricted the total debt on a home to 80% of its appraised value. This loan to appraised value limit plus the restriction that home equity loans could not be used to pay other debt kept homeowners in Texas from facing a high rate of foreclosures. Fed studies show that in 2005 U.S. homeowners took out $500 billon from their home's appraised value through home equity loans and cash out refinancing. Of this $263 billion went into consumer spending and paying off debts. This Fed study co-authored by Greenspan shows that 80% of the three fold increase in American mortgage debt between 1990 and 2006 came from home equity taken out on rising home values.

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Google increased the bid for Motorola Mobility by 33% on a single day in August 2011- adding $3 billion to the cost.

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Municipal yields are back up. The Center on Budget and Policy Priorities says states in the USA will have to close budget gaps of $140 billion in fiscal year 2012, ending in June, down from $160 billion this year. But real shortfalls will increase because federal stimulus funds that helped state and local governments will fall from $59 billion this year to $6 billion next year. Local governments depend on states for one third of their revenue, according to a Congressional Budget Office report, which makes them vulnerable. Property taxes account for a quarter of local government revenue and this too will be declining with declining assessed values. The Federal Reserve Act limits open-market purchases of munis to ones with maturities of less than 6 months, which reduces the scope for help from the Fed.

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About 1% of doctors account for 14% of Medicare's payments in 2012, according to WSJ analysis of data released by the Centres for Medicare and Medicaid Services.

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Nevada, Georgia and Alaska have some of the highest unemployment in the U.S. in July 2013. It grew by 0.3 percentage points in Georgia and Alaska. to 8.8% and 6.3% respectively. Nevada's unemployment is at 9.5%. North and South Dakota with the booming energy industry have the lowest unemployment at 3.0% and 3.9% respectively. The unemployment rate showed improvement in Mississipi declining 0.5% to 8.5%. According to the Labor Dept, 162,000 jobs were added in July 2013. The U.S. unemployment rate declined to 7.4% in July 2013 from 7.6% in June reflecting the increase in employed people as well as some who left the labor force. But the progress is uneven, as 28 states and the District of Columbia saw the unemployment rate go up in July 2013, 14 states showed it steady, and the rate fell in only 8 states.