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During the years 2002-2008 the growth in doctors per thousand people at about 1.5, and hospital or clinic beds per thousand people at 3, are essentially flat. See graph. Figures from China's Ministry of Health. Now the State Council, China's cabinet is giving details on a $120 billion plus initial phase of a revamp of the country's health care system. Its a big step for China. A construction surge by 2011 is to give every village a medical clinic, and every county at least one hospital. Under this plan state subsidies for insurance premiums will aim at giving at least basic coverage to 90% or more of China's 1.3 billion people. For 30 years since China moved to a more capitalistic type system health care costs have been borne by the people, and these cost made access to health care difficult for a large number of people. These are steps to rebuild the social safety net in China in this crisis.

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Aryna Sabalenka describes her experience with the death of her father and going though it by keeping on playing tennis, and then with the loss of aclose friend finding that this no longer worked. An injury gave her time to pause to take care of her mental health. This has helped her regain the confidence in her game. This situation is something we all face keep going through a emotional crisis with the loss of a parent or family member, then thinking that the best way is to continue with whatever we are doing. Then something else happens, a health crisis or more stuff to tackle, and this time it makes sense to pause to give oneself time to recover. This is important to come back with the right frame of mind, the feeling of health and wellbeing essential for the next step. 

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Wealth and people migration in the US in 2020 is shown in this WSJ report. Latest IRS data released for 2020 shows migration of taxpayers and adjusted gross income from states in the midwest, on the eastern and western seaboard to states in the southern US and to mountain states in the west. Some of this is a result of the pandemic lockdowns and the shift to remote work which means that the trend for migration will continue for 2021 and 2022. The shift in income was as follows-Florida  23.7 billion, Texas $6.3 billion, Arizona $4.8 billion, North Carolina $3.8 billion, South Carolina $3.6 billion, Tennessee $2.6 billion, Nevada $2.6 billion, Colorado $2.3 billion, Idaho $2.1 billion, Utah $1.3 billion.  The biggest losses came from New York -$19.5 billion, California -$17.8 billion, Illinois -$8.5 billion, Masachusetts -$2.6 billion, New Jersey -$2.3 billion, Maryland -$1.9 billion, Ohio -$1.4 billion, Minnesota -$1.2 billion, Pennsylvania -$1.2 billion, Virginia -$1.1 billion. WSJ says the tax burdens in the southern and mountain states in the west are low. In four states there is no state tax- Florida, Texas, Tennessee and Nevada. By comparison says WSJ states losing wealth and population have high state taxes for property and income. Schools, quality of life and cost of living are also major considerations, with remote work opening up the opportunities to seek a better life in other states which offer more space for working at home.   ...

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The Dean of Harvard Medical School says the Health Reform bill gets an "F" grade. He say its disingenuous to call this reform, and Congressmen and the White House are deceiving the public if they attempt to pass this off as reform. What it will do is accelerate health care spending in the US, and the bill has simply postponed most of the major health care problems, especially the ones that drive cost including the fee for service system and delivery of health care.There are no substantial efforts to control the growth in health care costs or improve the quality of care, which makes this effort unacceptable as reform. In his discussions with other health care leaders and economists, Dean Jeffrey Flier, says he has found the opinion unanimous on this point, that whatever the final legislation looks like in Congress, it will only serve to accelerate health care spending rather than contain it. On the present system's failings he is explicit- the current system he says promotes fragmented care making it difficult to assess outcomes, the true costs of care are disguised, and competition based on price and quality is made impossible. The new legislation while expanding access to coverage makes a terrible tradeoff of an accelerated crisis of health care costs and merely continues the current dysfunctional system. The experience of Massachusetts, where access to care was expanded but spending went up, is that this won't work. He points to the Special Commission on Health Care Payment System in Massachusetts recommendation, that the health care system there must be changed from a fee for service system to one with "capitated" payments. So what is really disingenuous about this whole affair? Congressmen making it look as if reform has happened and congratulating themselves on increasing access to health care, when many of the serious problems of funding health care, skyrocketing costs, and a dysfunctional system, have only been kicked further down the road for some future legislators to tackle. With the national debt about 12 trillon dollars when this plan is factored in, this is cause for serious concern. ...

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The U.S. aid package to tackle the coronavirus includes $425 million for mental health and substance use disorders and $50 million for suicide prevention to ramp up mental health services. A telemedicine program for mental health providers is being expanded and a suicide prevention program at Veteran Affairs Department is being expanded to other Americans. Second lady Mrs Pence is supporting the suicide prevention program. 

Widespread anxiety and post traumatic stress disorder is expected by experts as a profound aftershock from the coronavirus.

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France has made the health pass for coronavirus mandatory for leisure and cultural venues starting July 21. The health pass will be mandatory for having a coffee, eating at a restaurant, or shopping in a mall from the beginning of August. The health pass is already in use in some form in many European Union countries. Denmark and Austria are using it for 2 months. Germany and Portugal are using it regionally depending on where the epidemic is severe. Greece which has a surge of tourism in summer from other EU countries is making it mandatory starting July 16 for entry into shops and restaurants. It was the absence of  any form of constraints on behavior in places such as Croatia with high tourism in summer that increased the surge in Germany and Austria last summer. Italy and Ireland are planning to make vaccination mandatory following France as the number of cases from the variants increase. Establishments that are violators of the mandatory rule in France will be fined 45,000 euros and persons responsible having to spend 1 year in prison. The mandatory rule has significantly increased the number of people seeking vaccination in France.      ...

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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 startling truth about health "reforms," - they won't control spending, and without that the whole system of health care will rapidly become unaffordable and unsustainable. Obama's Council of Economic Advisors points out in new report that since 1975 annual health spending per person, adjusted for inflation has grown 2.1 percentage points faster than overall economic growth per person. At this rate health spending which was 5% of the GDP in 1960, and is 18% of GDP today, would grow to 40% of GDP in 2040. Medicare and Medicaid would increase from 6% of GDP now to 15% in 2040, or equal to three fourths of federal spending. Employer paid insurance premiums for families which grew 85% in inflation adjusted terms from 1996 to $11,941 in 2006, would increase to $25,200 by 2025 and $45,000 in 2040. This would force employers to reduce take home pay. Samuelson says the uncontrolled health spending is singlehandedly determining national priorities, reducing discretionary income, raising taxes, widening budget deficits and squeezing other government programs, while it is producing large amount of waste in medical spending. See the link to Prof. Tyler Cowen of George Mason University in NYT, 6/14/ 2009, who cites the habit of doctors to write many expensive tests as one of the prime culprits in the wasteful spending. And in the process it delivers higher cost for lower overall quality of health for the American people. This at a time when many European countries provide live examples of doing it in a better way- lower cost, better health. The serious problem with the Obama health reforms says Samuelson is that it talks about restraining spending but may end up increasing spending. Its talk about controlling spending he says is good intentions, but based more on hopeful thinking, public realtions and risks becoming cosmetic reform. Because to really control spending will require coming to grips with its fundamental cause- hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, private or governmental. Such a system encourages doctors and hospitals to provide more services, expensive tests, favors heavy use of expensive medical technologies to increase profits, and for patients to expect them. Samuelson puts his finger on the root of the problem - there is no incentive and every disincentive for all the players in this game , doctors, hospitals and patients to seek reform of this system. For doctors and hospitals the hope would be that this cosmetic "reform" would leave the system basically unchanged, and patients to continue with a lifestyle and expectations that do not not acknowledge the fact that a lot of healthcare does not come from spending but from preventative care, education, good eating and exercize habits, and healthy lifestyles. And the uninsured are no exception, they would simply start consuming the expensive care for lower quality of overall health like everyone else. With this kind of situation confronting us, the views of Samuelson, and Professor Tyler Cowen of George Mason University, as welll as a growing chorus of informed public opinion on this subject, is that insuring the uninsured is a good idea, but doing it within the bounds of the present system, can only increase the costs. And too much is at risk, to rely on what Samuelson calls a scattershot of measures to control costs made up by Congress such as "evidence -based guidelines," "electronic record-keeping," "bundled payments to hospitals, to give the illusion of progress that won't make a serious difference. A sweeping restructuring of health care is needed, that would overhaul "fee-for-service" payment and reduce the fragmentation of care. It will also need what has not even be touched on adequately in the debate. This is the massive need for education in the schools about nutrition, eating, exercize, healthy lifestyles. It would also require opinion leaders in each field from sports and other fields to lead by example and with constant public presence, the media, and companies to form a partnership with private institutions to change existing eating habits and lifestyles that encourage obesity, smoking, fast food eating habits, large portions in restaurants....

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During this pandemic get out and walk. There is no such thing as bad weather, just unsuitable clothing says one health expert. Nothing, other than avoiding poor food choices, is more important than exercise during this pandemic. Walking means also getting a view of all the scenery outside which can do wonders for one's health, from the birds, trees, foliage and the landscape around you.

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Flat payment rates for Medicare Advantage to Insurers by the DJT administration which is questioning how health care needs of the country remain unmet and US healthcare comparing very unfavorably with other advanced countries in Europe and Japan and also in India. Some of this is because of the behaviour and practices of the health and pharmaceutical industries in the US. The 2027 payment by government for Medicare Advantage is 0.09 percent. In 2026 it was about 5%. In 2025 it was -0.16 percent and in 2024 it was -1.12% under the Biden administration showing a great deal of dissatisfaction with funding Medicare Advantage. Medicare Advantage was set up by the Bush Republicans in 2003 who set it up with the nice sounding name Medicare Modernization Act. It was an effort to help the insurance companies with government money. Today in the second term of DJT in 2026 affordability is what American people care about most and the DJT administration is unhappy with the insurance companies. Dr. Mehmet Oz is in charge of Medicare and Medicaid Services Agency of the federal government and he says about Medicare Advantage and new policy to save “taxpayers from unnecessary spending (on Medicare Advantage) that is not oriented towards addressing real health needs.” The DJT Kennedy-Oz approach is for comprehensive digital information linking all medical providers, making America healthy again, cutting through the dense fog created over the last 2 decades, making pharmaceutical costs as affordable as the best in European nations, and refusing to subisidize if delivery is poor and health results are poor.   ...

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China's healthcare system is overburdened and overwhelmed, says this report in the NYT. The changes in living and investment in infrastructure and housing are not matched by similar investments in the health system. Shortages of hospital beds and doctors is making tackling the coronavirus in the Wuhan region more difficult. A new hospital is being built in 6 days in late January 2020 in Wuhan for the coronavirus patients, showing how severe the situation is. 

The lack of strict regulation and lack of enforcement at the local level is leading to the situation where the virus was detected in twice- in 2003 in wild animal meat and again in 2019. Public anger and call for a ban on wild animal meat is happening today.

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Under the reforms of the British National Health Service, treatment decisions, including referrals to specialists, will be put into the hands of primary care doctors. The reforms include cutting out layers of bureaucracy.

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The astonishing and strange case of wellness and productivity being linked to nicotine pouches for tech workers. It reflects on the condition of the so called "Tech" industry of today. Scientific and technological change was the basis of advanced economies since the 19th century, today's so called "Tech" has misappropriated the name for things like social media in the last 2 decades of American decline which have nothing to do with scientific advancement, and are piggybacking on existing technologies for products that actually harm education, mental health and building healthy societies.

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Typical of so much of what is written about the World Health Organization and its role in the pandemic, this podcast in the WSJ fails to quickly convey the critical function of the WHO as an early warning system the world has depended on, including China. The H1N1 epidemic originated in Mexico. Asian countries including China and India depended on very quick response from the country where the epidemic originated  in allowing entry into the affected area for experts from advanced countries such as the U.S. The global response was then coordinated across countries quickly with complete transparency. The head of China's CDC himself faced a problem with transparency with the provincial authorites in Wuhan. 1.    Fundamentally this quick entry was denied the U.S. Request by U.S. to China was made on Jan. 6 for U.S. team to go to Wuhan, quick permission was denied and given only about 6 weeks later on Feb 16. This delay is the crux of the problem for the U.S.. Taiwan confirmed human to human transmission on Jan. 1, the WHO was saying this was not clear as late as Jan. 14. These costly delays are what the U.S.  letter is about.  The head of the CDC China Gao Fu called Dr. Redfield head of CDC in the U.S. on the next day after he suspected Wuhan provincial authorites were vague about what was happening. Gao Fu was alarmed when scanning the internet on December 30, 2019, about rumors of a vaguely worded lung disease in internal memos of Wuhan. He called Wuhan authorites and was not getting clear answers on that day, then deciding on December 31 to send his own team to Wuhan, as reported in German magazine Der Spiegel- Hackenbroch, Zand, 05/20/2020.  Der Spiegel says in its special report on the early period in Wuhan that Gao Fu was so alarmed about what was happening enough to be in tears in his series of calls with Dr. Redfield in the immediate days that followed. The date was shortly after the GAO Fu sent the team to Wuhan, December 31 and New Years Day 2020, as reported in Der Spiegel. See the link to Lyrarc gist of Der Spiegel's "A Failed Deception: The Early Days of the Coronavirus in Wuhan."  2.  President Trump points out the standards of the WHO- in the concluding point of his letter to WHO- when a three time prime minister of Norway, Gro Brundtland was head of the WHO during the SARS crisis of 2003. She acted quickly and decisively and no time was lost. It is this failure of the early warning system under the new president of the WHO after 2017 Dr. Tedros that alarms the U.S.  with about 100,000 deaths.  3.  This failure it can now be said was partly a result of a election in 2017 for the position of WHO president which was flawed. This was the first time a WHO head, an important position was put up for an election. The Executive Board was responsible for this appointment since the founding of the WHO as part of the UN, based in Geneva, Switzerland, after World War II. This system worked. The election was clearly a bad process for appointing the president of the WHO which should be done entirely on the capabilities of the person holding this position not on a flawed voting process. It is flawed because India and Bangladesh hit by a cyclone during the coronavirus have suffered greatly, as have other countries, but had only 2 votes for 1.5 billion people, when Barbados (385,000 population) and Laos (7 million) which had less than one  hundredth the population had the same number of votes. The U.S. had one vote. The election resulted in lobbying and a process in which many candidates stayed away because they simply would not go through such a process. The position was too important to the world- most of the advanced countries had forgotten about the danger of epidemics to let this happen by 2017, as shown in the way the austerity years led to cancellation of the preparations for pandemic in France and Britain. The austerity years and neglect of public health during these tech boom years in the western world made it possible for this to happen. 3.   Along with the 1 month ultimatum action is already being taken to restore the effectiveness of the importance of the Executive Board. The head of the health ministry in India, Dr. Harsh Vardhan, has been appointed the new chairman of the Executive Board on May 22. This restores the voice of billions of people in Asia in the process, and brings the major countries with the greatest risk in a pandemic into the decision process for tackling the pandemic, this includes the rest of the world.     ...

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A plan to postpone a 21% cut in payments to doctors for treating Medicare patients, and instead give a slight payment increase under a House proposal, at a total cost of $245 billion over 10 years, is raising questions about the the impact on the USA budget deficit in coming years. The Congressional Budget Ofice says the House health bill will increase the deficit by $239 billion by 2019. In past years the lawmakers in Congress have postponed the implementation of these cuts, and the administration would like to see this as a separate item and not showing increasing the deficit. The American Medical Association lobbied to have this provision in exchange for its support to the health care plan.

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A new study using ECB data by the German Institute of Economic Research shows rising inequality in Germany. The 45 richest households in Germany own wealth equal to the bottom half of the population- each group owning 214 billion euros in assets in 2014. The wealthiest 5 percent of the people in Germany own 51.1% of the country's wealth. ECB numbers are underestimating the inequality by showing that 5 percent control 31.5% of the wealth in Germany. The Institute's analysis shows Germany is worse than Spain and France when the wealthiest household's wealth is taken into account. 

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Most American states fare worse than China in life expectancy and a third of American states including even Michigan fare worse than Sri Lanka in life expectancy. This series by Nicholas Kristof of the NYT looks at the interwoven problems from reading comprehension for 4th graders to a broken health system and large disparities of income never before experienced in this way through loss of manufacturing that are devastating America. Among retired people over half have no savings at all and about 90% of retired people are income insecure, something never before seen in the two hundred years of American history. 

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The coverage of the Republican healthcare bill and how it affects the elderly, and people on Medicaid, people in rural areas, is likely to have changed public opinion in the U.S. about the necessity of ensuring all Americans have health coverage. The Pew survey cited here in this NYT report by Zernike and Goodnough was done in Jan 2017, and shows a shift. The shift would be much higher today after people look hard at the consequences of what were simply hypothetical positions or ideological positions taken without looking at consequences in daily living. On Medicaid that opinion by July 2017 compared to Jan 2017 has shifted 10 percentage points for Republicans to 53% who think Medicaid is important to them and their families, according to Kaiser research. There is stronger sentiment about people having benefits taken away.  [article-55059] The opinion has shifted to where people see that coverage is important and people should not have coverage denied or benefits taken away from them. Opinion remains strong in favor of changes to reduce the high premiums, but not to replace the existing health benefits and law with no law at all to replace it. That leaves 20 million more uninsured according to the Congressional Budget Office. Changes have to be constructive is the popular view today,  and this requires dialogue between Republicans and Democrats- which has not taken place. ...

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Questions being addressed to get health care to the uninsured and to all Americans at an affordable level.

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Laffer says there is a big gap between the cost of health care and what people actually pay, which keeps cost escalating as there are no pressures from users of services to economize or bring reductions in the prices. But Laffer offers no effective solutions either his patient centred approach to health care reform does not address the problem that employers are paying for health care for the large part and these are not taxed as benefits leaving the employee free to load up on services and ignore the cost, which works just fine for the health care providers who increase revenues and profits- also called cost escalation upto the point now reached where the nation can no longer afford it.