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The U.S. Supreme Court lets the Obama healthcare law stand in a 5-4 vote with Justice Roberts casting the deciding vote. The Court ruled that the government could impose the individual mandate that all people carry health care insurance not because of the commerce clause but because: The provision "need not be read to do more than impose a tax...This is sufficient to sustain it."

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Ron Wyden, Democratic Senator from Oregon, on maintaining competitive choice for 200 million Americans who have to buy insurance outside the Exchange proposed in many of the bills being put forward in the U.S. Congress. This lack of choice between seriously competitive plans will leave the situation in the same way that it is today, with little hope for controlling runaway costs and doom health care reform. The key to controlling costs says Wyden is introducing choice and competition. Wyden will introduce this plan as an amendment called Free Choice to legislation being debated in Congress.

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The failure of the 117th Congress to pass key parts of president Biden's agenda for hard hit families and workers in America is now taking place. The 50-50 standoff in the US Senate and failure of two Democrat senators Sinema of Arizona, Manchin of West Virgina to support Biden's Families and Workers Plan leaves key parts of the safety net being left out. This leaves out the education, and paid leave part of the agenda and provisions for utilities to accelerate shift away from coal out of the bill. It fails to implement a new national agenda for upward mobility, child care and paid leave to help stressed out mothers and families. The failure to include even a modest community college 2 years of support at a time when men's college enrollment is dropping to disastrous levels for America's economic competitiveness is a failure of the 117th Congress to grasp the needs of families and workers in America today. Only a new Congress in 2022 can take up the needed action for families and workers in education, health care, child care and help for families. The passage of the infrastructure bill and the current version of the social spending bill can only be seen as a first step in the right direction, after three decades of different administrations neglecting infrastructure, education, healthcare, childcare, elderly care, upward mobility, and climate change. On the plus side as the first step to restore dignity and health of families and workers in America it includes- $150 billion for rental assistance, home buying help, public housing repairs, and building 1 million affordable housing units. $150 billion for federal programs for home health care and community care for older Americans and people with disabilities $165 billion to reduce premiums for people under Affordable Health Care Act, cover additional 4 million through Medicaid, adding hearing coverage but not dental or vision to Medicare. $200 billion for child care tax credit to parents. $400 billion to reduce health care costs and give universal pre-kindergarden for 3-4 year old children. $40 billion for worker training $555 billion for fighting climate change including through tax incentives for sources of energy that are low emission and low carbon. It will be paid for by additional taxes on incomes of very high income earners in annual $1 million plus range, and by having a corporate minimum tax of 15% for large corporations, including on profits overseas, that previously did not pay this tax. A wealth tax on unrealized capital gains of billionaires or other wealth of the richest Americans is left for a future Congress to consider for financing the key parts of climate change provisions, education and health care that were left out. The education and healthcare provisions need to be expanded to restore America's historic mission of upward mobility for all. A provision for Medicare to comprehensively negotiate prices with pharmaceutical companies that would be taken for granted in any advanced country as in Europe, is also left for a future Congress that understands and responds to the dire needs of families and workers in America for affordable healthcare medicine neglected by administration after administration for the last three decades.   ...

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Focus on billionaires and remote parts of the world distract from the vital issues of infrastructure renewal, cost of living and incomes growth that affect everyday lives of Americans. In an economy the size of the US the $5 trillion of billionaires out of a $31 trillion US GDP, is about 15% of the nation's wealth. Many of the billionaires such as at Amazon lead product and service companies that generated new products and services. Five of the top 25 in the US are from Walmart a large retailer in the US, 2 from Amazon, three from Microsoft in personal computers, 3 from chemical industries.This accounts for 13 of 25 or half. Removing these billionaires would take out $2.5 trillion leaving the billionaires controlling 7-8% of the country's wealth. The focus by Bernie Sanders in the US and Jeremy Corbyn in the UK on remote spots in the world and on billionaires distracts from the real issues of cost of living, of incomes of ordinary families, of everyday issues of health and quality of life faced by all. It also does not help in the discussion because of the need to move away from the poor leadership of the Blair-Brown, Cameron- Johnson years and the Bush-Obama years in the UK and the US. Here no ideologies are needed just common sense solutions to common problems that affect lives of all the people, with the cooperation of all the people. ...

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Pearlstein quotes Dickens in "Oliver Twist," about the law being an ass, and the constitutional law exercize in the Supreme Court of the U.S. giving a sense of a failure of the so-called best and brightest in reasoning out the issues. He points out that a serious problem is that American business which is burdened with high health care costs for employees is seriously missing in this debate after years of complaining about high costs. The National Federation of Independent Businesses is actually one of the plaintiffs questioning the constitutionality of the Obama health care law. Pearlstein says business wanted an end to the fee-for-service medicine that increases consumption of medical services and pushes up cost relentlessly, and that Obama's health care law does this. This is not the case as both Democrats and Republican administrations have failed to resolve this side of the cost issue, and this is the hidden reason for the loss of credibility for both sides in this debate, leaving health care problems to be resolved in future administrations. ...

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US president's sweeping powers to use tariffs as a tool for policy when American people's jobs, communities, health, is threatened by fentanyl and concentration of manufacturing jobs in China, unfair trade by EU and Japan, is the issue presented to the US Supreme Court. The US president presented it in this way- tariffs as a foreign policy tool, not a way to impose economic policy in the form of a tax on American importers or buyers which is the power allocated to Congress by the US Constitution. Justices who mentioned these powers called them sweeping powers but would not say the word fentanyl or look back at the recalcitrant behaviour of Asian nations Japan and China when it comes to unfari trading practices, where the US could literally negotiate forever and get no result, or to the enormous concentration of manufacturing power and supply channels in China that not only ships out American jobs but leaves Americans at the mercy of foreign powers for cost of living. Nowhere was this more evident as during covid years and now in rare earths export restrictions from China. The Justices assumed it was just alright to ignore this or leave it unsaid.  The cost to American buyers is small because most of the tariffs are borne by foreign suppliers in China, Japan and Germany, who as in the case of automobiles unfairly benefitted for decades and are now bearing most of the cost of tariffs. The large business in the US have increased their margins so much in the 2020-2024 period that they are now bearing some of the cost of the tariffs, as reported in WSJ. So that inflation in the US is at 3.0 % in the US less than anticipated, when average tariffs are at about 10% overall, not what the headlines say of 15-20% because of the product exceptions made in the tariffs for each nation. Justice Roberts may be right when he says more care should be exercized in the placing of a tariff, but even Roberts and Justices Barrett, Gorsuch, Kavanaugh and others know that the US has used this as a last resort, as a policy tool to protect the American people. Sweeping powers need care and caution as Justice Roberts stated- “power to impose tariffs on any product from any country in any amount for any length of time. It does seem like that’s a major authority."   ...

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British MP and former minister in the Tory government resigns in a lobbying scandal for violating British parliamentary standards on lobbying. This report in The Guardian says he was found to have lobbied the government on behalf of two companies that were paying him over 100,000 pounds a year. Boris Johnson, Britain's prime minister initially supported Patterson but lacking support in parliament and with a backlash from his party's MP's decided to let parliamentary standards authority decide on Mr. Patterson's future. Lobbying in the US and Britain has resulted in a distortion of the national priorities. This is particularly true of the US where priorities in health care and providing access to reasonably priced pharmaceuticals, climate change shift away from fossil fuels, regulation of the internet companies, worker wages, and other issues critical to building a healthy nation are neglected with lobbying for support of members of Congress. ...

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The coronavirus variant surge has led to burnout for frontline medical workers in the US. It has been calamitous for the mental health of public health workers in the US. These are the data analysts, policy advisors and other workers in public health departments. Many have quit their job as reported here in The Guardian. A CDC survey of 26,000 public health workers in the US shows about half have problems of mental health. Public health workers have to face problems with elected officials as well as public resentment on issues such as vaccination.

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Year over year rise in prices in January 2022 that contributed significantly to inflation of 7.5% in the US are-

For power up by over 10%, gas prices up over 20%

For groceries bakery, cereals etc up by 1.4%

For housing prices up by over 4%.

For used cars over 40%, new cars over 12%.

Health care services costly in the US far above the other OECD countries not down significantly continuing to burden American households.

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U.S. president Trump's 2017 budget is an effort to reshape spending priorities by the Republican party. Apart from Medicare and Social Security all other entitlement programs from the days of Lyndon Johnson's Great Society are subject to cuts. Deep cuts to Medicaid and food stamps, including introducing work requirements. The philosophy behind it is that compassion will now be measured not by how large these programs are but by how much the government can get people "off these programs and back in charge of their lives,"  according to Budget Director Mulvaney.  The cuts are $616 billion to Medicaid and Children's Health programs, $193 billion in cuts to Food Stamps, $143 billion in student loans, $72 billion in disability programs. The overhaul of the Affordable Health Care Act is part of this change. The reallocation would put more money into infrastructure for $200 billion, and in tax cuts, $19 billion in a parental leave program and $29 billion for veterans programs, plus added spending on the military. William Hoagland of the Bipartisan Policy Center, a Republican who worked on budget issues says it will be politically difficult as the cuts to lower income groups come with tax cuts for small businesses and higher income individuals.  Beyond the policy priorities there is an area where both Republicans and Democrats are skeptical of the budget. This is how it impacts the U.S. debt. Under Congressional Budget Office estimates the U.S. debt as a percentage of GDP which rose to about 75% after the Great Recession starting in 2008, is projected to grow to about 85%. In sharp contrast the Trump administration estimates of the Office of Management and Budget are for it to drop to 65% based on rosier estimates of 2% inflation, 3% growth for the decade ahead. Experts say this is unlikely once the Fed raises interest rates and the unemployment rate currently at 4.4% leads to rising inflation, undercutting growth which has remained below 2% for a long period. These concerns are also voiced by Hilsenrath in the WSJ based on the experience of other countries such a Britain that cut corporate taxes without seeing an uptick in economic growth. ...

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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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Elizabeth Rosenthal looks at Obamacare's contribution to cost containment in 2013-2014. Rosenthal says its is a kind of delicate maneuvring at the edges, because serious work needs to be done. The fee-for-service and many of the drivers for increases in medical costs, the old system of pricing, are still in place. In 20 years at the current rate and after Obamacare health care will still take 25% of the U.S. budget if nothing is done. Healthcare costs are about half that of the U.S. in some of the advanced European countries. She calls Obamacare a trickle down theory of cost containment becaue it leaves most of the drivers for cost increase in place and works at the margins. Princeton economist Uwe Reinhardt calls it an ugly patch on a somewhat ugly system. Rosenthal cites the armies of consultants anticipating every move to reduce prices, and working on "strategic billing'' to increase revenues for hospitals and doctors. For those who say the prices are now up more slowly than in the past, Michael Chernew of the Harvard Medical School, has this to say- its like a diet, reminding us that that we haven't even lost weight, just gaining weight slower than before. ...

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Peter Orszag's role in the healthcare debate and the formulation of health care policy proposals. One proposal of Orszag, who heads the Congressional Budget Office, is to set up a new agency with powers to cut spending and implement changes in Medicare. Says Orszag, "one of the reasons we have such disjointed and skewed incentives is that we have an excessively political process." At a recent meeting with House Democrats, one Congresswoman said her top priority is winning higher payments for oxygen suppliers, and Orszag was taken aback. For years officials have been trying to cut payments to oxygen and medical equipment suppliers, which are said to be inflated. When a new competitive bidding process was set to take effect last year, industry supporters in Congress were able to delay the plan, and these supporters are still fighting to block changes says the WSJ. Here is a 40 year old Orszag, with degrees from Princeton and London School of Economics, who got his early experience in the Clinton adminstration at age 24. He then followed this with a number of policy oriented jobs, ending with appointment to head CBO in 2007. And he faces the whole system of Congressmen from both parties beholden to interests in the healthcare industry, who provide the donations for them to finance their election campaigns. Dan Eggen describes this in the Washington Post, 7/21/2009. Max Baucus of Montana, and to some extent Grassley of Iowa, are senators from both parties who Eggen points out are beholden to the healthcare industry because of large donations they receive from the interests in the healthcare industry. These interests want to see their payments system protected. The further escalation in health care costs, which would make the whole healthcare system unaffordable even as it delivers poor results, can only be prevented by making cost control an exercize that is not influenced by healthcare industry donations. Jackie Calmes describes the huge hurdles in achieving a deficit neutral move to universal health care in the U.S. in the NYT 6/26/2009. See the link. The exchange between Grassley and Orszag on the issue of the $177 billion in savings needed from the payments to health insurers under the Medicare managed care plans- which allow seniors to obtain Medicare coverage outside the government run program -went as follows. These are dubbed overpayments by outside experts and efforts have been made to cut them in Congress. When Mr Grassley raised concerns about the impact of such cuts in a hearing, -and Grassley has opposed the cut for this overpayment to insurers- Orszag responded saying: "I very firmly believe that capitalism is not founded on excessively high subsidies to private firms. This is what this system delivers right now." ...

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Eduardo Porter compares Italy's propensity to collect and invest tax dollars in healthcare and public services to a much greater degree than the U.S. In 2007 he points out Italy spent 25% of its output on social programs such as health, food and housing, compared to 16% in the U.S. He reflects on the possible reasons for this based on research. Italians see the tax dollars at work in a health care system that works for them and their children, as in this example of Eduardo and his child at a health clinic in Liguria, Italy. In the U.S. there is less evidence of this and the sense that government is likely to waste tax dollars, that the individual is better able to make choices. The less homogenous society in the U.S. also means there is less support for public services that might benefit other lingusitic and cultural groups.There is also the feeling that in American society there is greater oportunity for the less well off to join the upper class given the open capitalist framework, as compared to Italy where connections and traditional advantages matter. Some experts attribute this to smaller taxes leading to economic growth, but Porter says the examples of Sweden, Norway, and Japan showed growth was higher or similiar to that in the U.S. ...

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The Labor Department reports that the U.S. added 255,000 jobs in July 2016.Unemployment remained steady at 4.9%. Of the jobs added, 70,000 were in business and professional services, 43,000 in health care, 38,000 in government mostly in local education, 18,000 in financial services. Yet growth remains slow at 1.2%. Businesses are willing to hire new employees, but reluctant to make new investments in the prevailing uncertainty. Wage growth for average hourly earnings was about 2.6% for the year. Improvements in the jobs picture is likely to influence the U.S. presidential election.

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This Washington Post editorial says Obama and the politicians, both Democrats and Republicans, want something for nothing. The Ryan budget, Obama's health care plan, all require paying for it with higher taxes, but the mention of the word "tax" is the last word any of the politicians will say. These comments come as the U.S. Supreme Court considers the mandate that young Americans and others be forced to pay for health care along with the rest, as required by the health care mandate, with the idea of keeping costs down. The idea of getting something for nothing was also emphasized in an op-ed in the WSJ, March 29, 2012, by Mayor Bloomberg of New York City, where he called for letting the Bush tax cuts expire for all income groups, and an up or down vote in Congress on the Simpson-Bowles deficit reduction plan, as part of a two step plan.

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The people in the U.S. are shifting to widespread use of masks. There was some cultural resistance in Europe and the U.S. to use of masks, compared to Japan, South Korea and China where the use of masks in epidemics was common in earlier health crises. Europe changed first and now the U.S. is adopting masks as a way to avoid th spread of coronavirus. Health authorites in the U.S. now recommend use of masks to prevent asymptomatic people with infection from spreading the infection. Health experts say the widespread use of masks in Asia is one reason in addition to quarantines, contact tracing and isolation of clusters, is how China, South Korea, Taiwan and Singapore have controlled coronavirus to the point where it is no longer a serious danger.

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A WSJ study showing the plans offered under the new U.S. Health Care Law in the state of Oregon. For young people ages 18-34 earning about $17,000 and uninsured the law offers a bargain with insurance premiums monthly at about $52 and deductibles as low as $100, because of higher subsidies. The situation changes at incomes of $29,000 when the deductibles are about $6300 and the premiums per month at about $147 a month, because subsidies are much smaller, or deductibles dropping to $2500 at $172 in monthly premium. The federal subsidies disappear for single people under age 30 earning much more than $26,000 because of the way the law places them to specific plans on each state's exchange. According to the U.S. Department of Health and Human Services, there are 11.6 million people in the U.S. ages 18-34 who are uninsured. The federal government has to get as many of these people to get insurance so that the cost of medical care for the elderly can be supported.

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An excellent midlife health test for checking physical health, mental health and cognitive health. This can be done by anyone at home and is fairly simple to take. Also suggested are exercises that may help in each of 9 categories of the test. This includes the well known standing on one leg in yoga pose, press-ups, sitting and standing from a chair, linking fingers behind your back, calf raises. And for mental health drawing a clock face with the numbers, jotting down fruits and vegetables you can in 60 seconds.

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Having an adequate supply of N95 masks is critical for each hospital tackling the coronavirus pandemic. The lack of enough masks leaves health care personnel without the basic protection and is a grave emergency. Hospitals are resorting to reuse of the masks in this crisis and this is not a good practice as it increases the chances of infection. President Trump has invoked the Defense Production Act on April 2 against 3M. This gives the federal government more control over 3M's operations to ensure that it goes all out to make the healthcare N95 masks that the hospitals need in this grave emergency. This report in the WSJ covers the situation as of April 3 on the supply of M95 masks for health workers and others. N95 masks block 95% of very small particles. Supply in the U.S. is for 50 million N95 masks. Demand in the U.S. is for 300 million N95 masks as estimated by the Department of Health and Human Services. in March- this is how many are needed by health care workers to fight this pandemic in the U.S. The principal manufacturer is 3M. 3M company has doubled its production since January 2020. The trend before this pandemic was to send production over to China and other countries. This is changing now with the pandemic and the U.S. policy shifting to be self sufficient in medical supplies in the event of an emergency. A policy Peter Navarro, who heads the agency in charge of getting medical supplies, says President Trump is insisting be implemented. Hospital buyers supported the earlier trend to keep costs down, but this appears to be a costly mistake, putting health care workers in hospitals across the U.S. without the basic protection they need. Minnesota based 3M invented the first modern disposable masks in the 1960's. Interestingly 3M continued to make millions of masks in the U.S. even though competitors moved manufacturing overseas. The 50 million disposable masks 3M made globally went to workers in industries where it provided extra safety from metal shavings or other substances, and medical workers. Now 90% of masks go to medical workers. 3M ramped up production globally since January 11 when the pandemic first hit to 100 million masks a month globally, and 35 million a month in the U.S. at plants in South Dakota and Nebraska. 3M says that it will import 10 million masks from its factory in China, which earlier this year was restricted from shipping it outside China as China needed masks for the pandemic. About 10 million more masks are made by two other manufacturers Alpha Pro and Louis Gerson Co.  U.S. Department of Health and Human Services ordered 600 million N95 masks from 5 companies to distribute to hospitals and build up the national medical supply stockpile. 190 million each of this is from 3M and Honeywell and 130 million Owens & Minor Inc.  3M says it will make 50 million a month in the U.S. by June. Honeywell which had moved production overseas, plans to bring back production to the U.S. by making 10 million masks by May at its Rhode Island and Phoenix plants. There is a company in Singapore that makes one million masks a day in China and other Asian countries, Pasture Pharma Pte, but most of it is committed to government agencies in China.   ...

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Big changes are expected in energy markets after 2026 following the end of the war with Iran, the naval blockade and the Hormuz straits closure. Even when the Shipping returns to Hormuz there will be continued uncertainty and prospect of conflict. As a result China, India, Japan and the US and EU will look for new sources of supply in Latin America for oil and gas including in Guyana, Brazil, Argentina, and in Venezuela. This NYT Analysis  confirms the shift to renewables will accelerate after 2026 with 2-3 years return on investment for renewables, and in 2026 wind+solar+nuclear now generating more electricity worldwide than gas. OPEC stranglehold on oil prices is weakening with UAE's exit from OPEC, and the US+ Venezuela+UAE expanding production. This will benefit poorer countries in the world in Asia, Africa and Latin America, Middle Income countries like China and India, as well as US and EU through lower prices for the new overall energy mix, with a higher component of renewables from every year 2027-2030. Lower priced component for oil possibly at $50 a barrel holding steady to 2030. From this perspective Hormuz's importance will decline over this period to the point that the world's wealth sucked up for far too long in the Middle East through the twin mechanisms of  high oil prices and decades of wars will be shifted back to infrastructure in the EU, US, India and China, Brazil and Indonesia. For the poor countries like Pakistan, India, Indonesia, China and others this is a big deal because instead of the wealth going to princes in the Persian Gulf  it will benefit people in Egypt, Arab countries such as Morocco and Tunisia,Turkey, Pakistan and India, China. Long delayed infrastructure rebuilding in US and European Union can now take place.The shift and trend to renewable energy as a major component of the energy mix of over 50%-60% in India could be expected by 2030 and have a major impact on climate change. (India has already crossed 50% of its energy from renewable sources). China will have installed half of the new renewable energy capacity added by 2030 and this too will add to the fight against climate change. Overall this combination of events and changes underway are overwhelmingly constructive and are not anticipated in this way by most of the world's media including the NY, which see slower growth when the opposite is now the case with accelerating and steady growth expected 2027-2030, and 2030-2035. For the US and EU it could not come at a more opportune time with the determination to invest at home and reindustrialize, build new infrastructure, for India to build a modern country by 2040, and for China or Japan not to get stuck in middle income status with continued modernization to 2040. For the poorest countries to work with these major nations to improve standards of living. For the US it also means the end of the border migrations flows that happened in 2025 taken to the next stage in 2026 and 2027 ending all drug flows across its borders with Mexico- as more lives are lost to fentanyl and other illegal drugs substances (1.25 million since 1999) than were lost in the Korean War (36,000 deaths), Vietnam  War (58,000 deaths) and World War 1 (116,000 deaths) World War II (418,000) all 4 wars combined. Issues of unfair trade deindustrialized the US. This coupled with drugs destroyed small towns and communities (that were based on manufacturing and lost factories) across the US for over 3 decades. The tackling of these issues will also add to the general sense of well being of the people in the US- and also in the European Union. The modernization underway in China and India+Indonesia+Brazil is also part of these changes, promise a rising tide that will lift all boats if we continue together to carefully select the right path ahead and chart the course clear eyed and clear on purpose. ...

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This article in The Lancet published in February 2018 throws much light on how the ban on gain of function research on virus was lifted -research that carries with it the danger of increasing transmission of virus if something unexpected happens in the manipulation of a virus. It was lifted in 2018 in the US by officials in the US Health Ministry, NIH and HHS. The Cambridge group of scientists and experts opposed lifting the ban on such dangerous research that could make the virus more contagious through manipulation. Epidemiologist Marc Lipsitch of Harvard School of Public Health wrote at the time that the lab research to create a more lethal strain of virus could lead to "an accidental pandemic" yet he was ignored. The public in America and in the world is unaware of how this created serious risks for public health in the world through the coronavirus.  Did US health officials lift the ban on such research without consulting other countries such as India, Brazil, France, Germany, Italy, and the EU on its ramifications. Were public health experts and the publics themselves in the US and around the world not drawn into the discussion of public health and the dangers that existed. Not only did officials in HHS and NIH restart the research by lifting the ban but also sent funds overseas for such research- was this a proper or thoughtful action considering the risks involved.  Is enhanced surveillance of virus- a dubious benefit from manipulation of a virus- something a few health officials can decide for the whole world in addition to the US. How are health officials in one or two countries responsible to the people in India, Brazil, Europe and the poorest populations in the world in the world in Africa, Latin America, and Asia, people who have suffered devastating consequences from transmissibility of the virus, including children and older people with health problems. India, Brazil, Italy, Spain, France, UK, and other countries worst hit by the coronavirus must ask serious questions about how they can protect their people if institutions in the US and international institutions are seen as failing to protect world public health. ...

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Hospitals in Europe are filling up quickly in the second wave of coronavirus. Coronavirus patients had to be transferred by helicopter to Germany from the Netherlands because of overburdened Dutch intensive care units. National Guard troops were flown in from the U.S. to the Czech Republic to help. In France as cases approach cumulative 1 million about 2000 patients are admitted to hospital for coronavirus every day on October 29. At some point French hospitals could be overwhelmed this winter, and doctors having to choose which patients to save, says president Macron. In the Czech Republic a collapse of the health system is expected by mid-November says the prime minister. No one expected this to be this severe, he says.  About 40,000 patients are hospitalized for coronavirus in the U.S. During the last week the case are increasing by over 40% in the U.S. and increase in hospitalizations are expected. Recovery rate is improving from the first wave. At NYU Langone hospital system in New York with 5000 coronavirus patients hospitalized recovery rate is improving from 25% in March to 7% in October. Better handling of cases and knowledge gained by doctors is a big part of this. ...

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Germany, the UK and Canada offer additional models for health care insurance that vastly improve results for dollar spent over the dysfunctional U.S. model. Here Jamie Daw take a look at the German social health insurance system which dates back to hte period of Bismarck in 1884. The German system is funded through progressive taxation which charges for healthcare based on incomes not on health needs.

About 100 nonprofit health insurers provide insurance and all Germans are required to have health insurance. Contributions to sickness funds are centrally pooled and allocated using a formula to insurers. Insurers can only charge small out of pocket fees limited to 2% of income annually. Sickness funds combine market power to negotiate lower prices.

Administrative and governance costs are 3% in Canadian system and 5% in the German system. 

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The full text of the letter is given here. In this letter the U.S. sets out some important facts about events that happened during the coronavirus crisis during the crucial 4 month period from December 2019 to March 2020. Every week lost in this time due to reasons of a lack of transparency, openness meant hundreds of thousands of people more infected and tens of thousands of deaths worldwide. There are questions of transparency, of openness and this raises questions about the manner in which the World Health Assembly operates with hundreds of small countries in Africa and Asia having votes equal to that of the U.S., India, Brazil, Mexico with votes taken of over 200 countries. The entire election process can now be seen as questionable, when over a billion people in one country alone such as India or hundreds of millions in Brazil and Mexico would have to bear the consequences of poor decisions made by small countries that can be swayed in one direction or another based on political bias and other considerations that have nothing to do with global health.  At the conclusion of the letter by the U.S. to the current WHO shaped by a controversial election in 2017 the following is stated about the standards set by Gro Harlem Brundtland and which helped the world prevent the SARS crisis which originated in China in 2003 from spreading to the large countries of the world India, Brazil, Mexico, and other such countries in Asia and Africa, Latin America, and the U.S. European Union. "In 2003, in response to the outbreak of the Severe Acute Respiratory Syndrome (SARS) in China, Director-General Harlem Brundtland boldly declared the World Health Organization’s first emergency travel advisory in 55 years, recommending against travel to and from the disease epicenter in southern China. She also did not hesitate to criticize China for endangering global health by attempting to cover up the outbreak through its usual playbook of arresting whistleblowers and censoring media. Many lives could have been saved had you followed Dr. Brundtland’s example." Even this does not come to grips with the flawed way in which the election of WHO head is done. It can no longer be relied on when there is the danger that lack of transparency can emerge in the WHO leadership itself because of a flawed process. It risks endangering the lives and livelihoods of hundreds of millions in countries such as India, Brazil, Mexico, as well as in the relatively small countries of Africa and Latin America where even basic water supplies are at risk but which could tilt elections at the World Health Assembly. Consider that a cyclone just hit the Indian state of West Bengal and Bangladesh on May 20 just as the coronavirus pandemic is spreading. That this region of 1.5 billion people had just 2 votes out of over 200 cast at the World Health Assembly in 2017 shocking. And even these votes cast based on old geopolitical considerations not how good the candidate is, and how good the country he is coming from is in terms of its record  on public health. The irony here is that private foundations in the advanced countries in the U.S. and Europe some of whom are major donors to WHO did not think that more experienced candidates in their own countries with a better record of public health such as in France or Germany are better qualified, in a flawed NGO support mentality left from the Clinton years. Basically the people in these large countries such as India, Brazil, Mexico were disenfranchised, when the austerity policies were consuming the European Union, and the U.S. had just elected a new administration itself groping for ways to reverse years of neglect of public services and infrastructure priorities. They would trust good leaders no matter where they come from, who have a record of transparency, leadership, and all the values we cherish together no matter where we come from. ...