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Issues of work-life balance are growing for doctors as more doctors ages 40-54 years face burnout or negative effects on health. Nearly half of doctors in the U.S. 40-54 years of age in a survey of 15,000 physicians report feeling burned out from work hours and administrative tasks. Younger doctors 25-39 years, and older ones 55-73 years also reported high rate of burnout at 38% and 39%. Overall for all physicians about half of all physicians said they would take a substantial pay cut to get a better work-life balance. What this survey and report by Medscape shows is that no age group, career stage, gender or specialty is immune to this problem, says Colin West, professor of Medicine and researcher on physician well being at the Mayo Clinic.

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Of the people asked the question "what issue do you see as the most important for health care" 44% in a NBC/WSJ poll said they considered Cost as the biggest issue, and 37% said that they considered the Uninsured as the biggest issue, 11% said quality of care was the biggest issue. The President is focussing on cost as he develops the health care plan. He is also saying that to provide health care for all and cover the uninsured without controlling costs would break the bank. Another thing that the White House shows it has learned from previous failed attempts, is that it is doing this with an open Health Care Forum with participation of different sides in the health care discussion. Clinton's effort in 1993 ran into problems because it was developed secretively, and without much discussion, and little effort to get different people's views. The previous attempt also waited too long after the election, and this time the President is moving quickly when he enjoys large popular support. Its also true now that there is serious concern especially in this downturn of what a threat spiralling costs of health care are becoming to the future prosperity of the American people. This time the leaders in Congress are setting an aggressive schedule to get health care palns legislation on the floor by June and get a floor vote in August 2009....

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During question time in the US Congress US Senator Rand Paul stated that the US money was used to fund research at the Wuhan Institute of Virology. A ban on gain of function research on virus was lifted by the US in 2018. Following the lifting of this ban which was strongly opposed by scientists at Cambridge, Massachusetts, research was conducted that many of these scientists considered dangerous and risky. This report in the BBC shows Dr. Anthony Fauci. director of the NIAID, the Institute for Allergy and Infectious Diseases responding to Dr. Rand Paul, Senator from Kentucky. Much of the discussion goes into definition of "gain of function research" and misses the broader implications. Scientists in Cambridge had warned early of the danger of doing research because of earlier mishaps such as the one involving anthrax research from accidents that are always a risk. Epidemiologist Marc Lipsitch of the Harvard Chan School of Public Health warned of just such an "accidental pandemic" in Three Questions, Three Answers in the January 2018 issue of the Harvard Chan School of Public Health journal. He stated that an "accidental pandemic" could result from the lifting of a ban on a risky kind of research favored by some virologist professionals. Most of the medical and scientific community in Cambridge fiercely opposed the lifting of the ban on what they saw as risky research with little benefit in 2018.    ...

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Seniors helping seniors is the subject of this report by Clare Ansberry in the WSJ. This is a growing trend. Worker shortages increased in the home care industry during the pandemic. Now older workers such as Diane Richards, 81 years, a registered nurse, are filling some of these positions. Ms. Richards worked as a nurse for 59 years and after her husband's death decided to join Right at Home in Bend, Oregon. Some are retirees like Linda McCallum, 79 years, who are taking positions to supplement Social Security income at $20 per hour. Right at Home depends on her, as it lost half its workers during the pandemic. Over 20 years the broader workforce grew by 13%, yet the workers over 65 years working or seeking work increased by as much as 144% or 6.4 million in the US, according to the Labor Department. WSJ shows pictures of these older workers who are dependable and can relate to mobility issues, care of loved ones, need to take health medications in ways that younger workers cannot. ...

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This view in the Economist shows that president Trump actually represented the instincts of the Republican party base by 2018- anti-immigrant, anti-elitist, and to the right on social issues. As a result it says it is no surprise that he has taken over the Republican party. As the elections for Congress get closer most candidates are trying to get Trump's support and many of the older senators and Congressman from the earlier period of the party are retiring. It cites polls showing Trump has support of 85% of the Republican party base. In 2018 Mr. Trump appointed new members of his cabinet who more closely represented his views on China, Iran, NATO, and business issues. Remaining party leaders such as Mr. Romney running for Senate seat from Utah are now seeking and getting Trump's endorsement. The Republican National Committee is also run by Trump supporters. On issues of foreign affairs Trump has combined alternate shifts between demands and pragmatism in relations with China, Iran, and other countries on trade, politics, coming up with a new way international relations are tackled. Part of the reason for their appeal is the nature of the intractable problems such as the imbalances in trade, nuclear weapons, and the idea that an alternative approach might work when other approaches have failed.  On social issues such as issues facing workers in globalization and free trade the parties to the left in the U.S. and countries in western Europe have failed to deliver, leading to the appeal of Mr. Trump, Brexiters, National Front in France.  The immigration issue has also worked against the socialist parties.  In Britain dissatisfaction with Theresa May and hard core Brexiters is growing, leading to Labor Party getting 40% of the vote in the recent election. Suggesting that the changes induced by the Brexiters and the Trump administration may lead to other changes in the future that may shift the focus back to basic issues and delivery on infrastructure, health and education which are fundamental for the future.   ...

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A worldwide trend to shorter term borrowing means that institutions and sovereign governments will compete in the capital markets, as they try to roll over existing borrowing by 2012. The US has $1.3 trillion to roll over by 2012. Worldwide about $5 trillion has to be rolled over, and of this $2.6 trillion is in Europe. With the European financial crisis which started in Greece it is becoming harder for sovereign governments to borrow in capital markets at favorable rates. A former economist of the Bank of England says this is of the highest importance for lending and for growth. The implications are reduced lending by banks to businesses and consumers, reducing output and growth, and limiting reductions in unemployment. It is a big issue say analysts, as debt needs to be rolled over over shorter periods. Moody's study shows new bond issues by banks during the last 5 years matured at an average 4.7 years. The stress say experts is likely to be on the less healthy banks like the savings banks in Spain, Landesbanks in Germany. Stress tests on European banks will be out July 23, 2010....

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The India- U.S. trade deal after the negotiations and the visit of the Indian prime minister to the U.S. is expected to take additional time. The U.S. wanted to see a 20% duty on mobile phones and ethernet switches to be reduced, greater access to the Indian market for medical devices such as stents and knee implants, and greater access for dairy, agricultural products. Making these products affordable in India is a goal of the government preventing it from making concessions. India wants preferential access to the U.S. market as a developing country restored under the Generalized System of Preferences.  A comprehensive trade deal would have to include issues of intellectual property, e-commerce, and the sensitive issue of H1B visas. Commerce minister Piyush Goyal led negotiations for India and Foreign Secretary Vijay Gokhale said the two sides "narrowed" down their differences. India's Jio from Reliance Group has hugely reduced the price of mobile phones and mobile data making it accessible with 4G across the country at prices that are the lowest in the world. The introduction of a universal health care program requires bringing down the price of medical products to improve access to modern medicine. This means less room for American products that would increase the price and reduce access in a vast developing country. India is also playing catchup in these technologies so that there is less room for unrestricted entry in the Indian market.  Efforts were made to increase trade and investment in India with the help of Mr. Bloomberg during the visit of the prime minister, and the Bill Gates Foundation continued its commitment to public welfare gains in India in the fields of sanitation, hygiene and healthcare.  ...

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After the Biden executive order closing the Mexico Border following 2500 illegal border crossings a day there remains the challenge of increased funding for DHS Border Control for Asylum processing officers and immigration judges, so that the intent of the executive order can be implemented effectively. Making the claim of asylum requires being in the country, a process that provides an incentive to cross the border from Mexico. Bipartisan legislation is required as the duty of Congress to address these immigration problems so that the Border issue does not become one on which all other problems facing the US can be put on hold and not tackled making the US fall behind in development, infrastructure, climate change action, education, supply chain, and health care, resulting in reducing the standard of living in the US.

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WSJ analysis of NatCen data from whatukthinks.org show much has changed since the last general election in Britain. Boris Johnson's popularity is at a negative 20% and Theresa May's at negative 35% in July 2019. By the time of the general election May's popularity was at negative 1%.  Another major change is that the popularity of Leave has dropped.  By July 2019 the situation is reversed Remain now has 52% support and Leave is at 48% support. During the referendum it was just the reverse.  Also significant is that some of the claims of Leave's Mr. Cummings that were used in the campaign such as $436 million going to the EU in Brussels that would be diverted to National Health Service are now not credible. The migration issue has also become less important as migration into the EU is now down to a trickle and Germany has reversed its policies to trying to keep migrants at home in Africa through aid and other means. The migration issue was played up in the campaign. Germany was seen as pursuing the austerity policies that hurt the working class as these policies made headlines daily for Greece and other countries during the period of Britain's referendum. In 2019 Germany is taking a less active role in the European Union and the leader of the CDU Kamprauer has openly called for Britain to remain in the EU alongside other Germans from all walks of life. In short the mood is now different in Europe as there is disillusionment with leaders from the far right or the far left and the centrists on the right (Merkel)and the left (Blair) who had used politics to stay in power instead of tackling the tough problems of wages, middle class decline, infrastructure and family friendly policies. The Irish backstop is now in the picture when Brexit comes up as Mr. Johnson wants to drop it. The Irish backstop is the term for the agreement reached with the EU so that Ireland's return to peace with open borders ending Catholic vs Protestant conflict would not be disturbed by Britain's leaving the EU. This could also swing voters who are undecided to maintain what has been achieved so far. The Labour party leaders who were fed up with the austerity policies of the European Union driven by Ms. Merkel and the CDU now have a situation where the issue of Brexit can be seen not in terms of the past- austerity, dependence on Brussels for Britain's economic future and working class decline. Other issues such as unity of the UK, the end to austerity policies in the EU and in the U,S. with the Trump economic policy of dropping deficit targets in budgetary outlays, also signal a different climate for the Labour party in which to campaign for remaining within the EU and continue Britain's policy of working to improve conditions for the working class and middle class after the Blair/Clinton/Merkel years.    ...

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The new Jinping-Keqiang administration is making the initial changes in China by restructuring cabinet ministries. The Railways Ministry is being merged with the Transportation Ministry, separating the operation of the rail system from its regulation. The National Population and Family Planning Commission is being merged with the Health Ministry, in a gradual phase-out of the one-child policy after considering the demographic changes underway in China. The State Administration of Food and Drug is being given new powers to fight contamination of food and drugs. The two agencies that manage the media, the General Administration of Press and Publication and the State Administration of Radio, Film and Television are to be merged. The National Energy Administration is to be reorganized to change the way the energy industry regulation takes place. The ministries fall under China's cabinet, the State Council. Mai Kai, secretary general of the State Council, said the ministries remain overly focussed on micro issues. The changes are based on a look at overall development in China and correcting some of the glaring shortcomings in pollution, managing of the rail system, changing demographics, contamination of food and drugs, and other issues that affect the Chinese people in the new industrial and urbanized society....

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With Republicans elected to a majority in both chambers of the state legislature and a Republican governor, Wisconsin is moving ahead with a sweeping plan to fix its budget deficit. Walker promised he would get public workers' compensation in line with other workers. He is now proposing a plan which will go to the legislature for swift approval that will simply go ahead and cut public employees benefits without negotiating. He says he doesn't have anything to negotiate with, because with the growing deficit he has nothing to give. His plan: limit collective bargaining for most state and local government employees to the issue of wages (instead of to many issues such as vacations, health coverage), require government workers to contribute 5.8% of pay to pensions, and have state employees pay at least 12.6% of health care premiums (instead of the 6% most pay today). The plan will save $30 million in the current budget and $300 million in the next budget. Republican leaders are saying the alternative is to lay off some 6000 state workers, and take away Medicaid coverage for thousands of children, which is a much worse alternative....

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The Nation's Healthcare takes a huge hit in August 1997 by opening up television to a surge of drug ads. The president is Bill Clinton who reappointed Bush appointment Kessler as the Food and Drug Administration chief 1990-1997. DJT and RFK Jr. are finally tackling issues the Bush and Clinton/Obama Republicans and Democrats failed to bring up or address for the Nation's Health.

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Trump at 77 has serious issues of age for the US presidency says Frank Bruni, professor of journalism and public policy at Duke University. Age is a very personal journey, says one expert, and it depends on how good you are taking care of yourself. On this score Trump has serious drawbacks. Nutrition matters, exercise matters. Bruni says Trump's diet is garbage, and he is overweight. Biden is only 3 years older than Trump, and he is known for healthy eating habits and regular exercise. This is a serious difference that the press has paid little attention to. Another factor in aging is doing something for a purpose in life that extends beyond one's self. Trump's obsessive attention to himself means there is a lack of purpose beyond one's own egoistic pursuit of office which acts as a negative factor in aging.

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Farming vegetables causes less greenhouse than livestock production. Climate experts say people should eat more vegetables for better health and for slowing greenhouse gas emissions that cause climate change.

Consider that studies show farming and other land use account for about a fourth of all greenhouse gas emissions, and about half of methane gas emissions are released into the atmosphere from cattle and rice fields. Meat in particular has more greenhouse gas emissions. 

Climate experts say the nutritional value of wheat grown in higher CO2 areas is 6% to 13% less for protein, and 5% to 8% less for iron. Another problem aggravating the situation is that drought has grown 1% a year between 1961 and 2013, IPCC researchers have found. This is a result of the growing climate change issues. Drought and nutrition is a major problem in India and Africa.

 

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The Senate passed the Kids Online Safety Act 91-3. It is now upto the House and Speaker Johnson to pass it quickly. Safeguards are already in place for communities. It is an appalling and dangerous sign of the reckless behaviour of tech companies in this social media space, the tech company lobbying conducted here. Ordinary Americans need protection, children in America need protection from the unacceptable risks to mental health in the social media space. Surgeon General Vivek Murthy has called for a warning label similar to the one on cigarette boxes to be placed on social media outlets. Senator Blumenthal and Senator Blackburn from northeast and southern states have come together on this issue to protect the Nation's children. It is now upto the House to take action in 2024 to protect the Nation and its children.

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Bernie Sanders who won in 23 states running for president says the American system is broken and this is why DJT won in 2026. He says Biden genuinely wanted to bring the changes to help workers. Other Democrats simply wanted to patch the system, a little here a little there. This he tells Reid Epstein of the NYT is not working and Bernie Sanders says DJT is right that the system is broken. Sanders excoriated billionaires in his speeches. Yet the tech billionaires at Apple, Google, Microsoft, and Amazon have over the last two decades supported Democrats and yet paid a lower tax rate than firemen, police, teachers. Apple paid less than 15%, Google less than 16%, Microsoft less than 18% and Amazon less than 9%. This also constitutes an oligarchy similar to the oil companies and pharmaceutical companies. This makes it difficult to have a fair system of taxes that can fund the Nation's crumbling infrastructure, its manufacturing, its chips and advanced technologies, health and education of children. Sanders is focusing his efforts or 2025 to 15 Congressional districts where Republicans won by very thin margins. And he is on his way to Iowa City and Omaha, Nebraska, where the margins were so thin to get his message to workers.  This interview also provides a hint of how DJT has approached the issues with a willingness to try unconventional approaches and people who did not fit the mold. RFK Jr. at Health, Tulsi Gabbard at Intelligence, Lori Chavez at Labor. Something that Democrats have failed to do to look at different ideas and find solutions to intractable problems in unconventional ways. Epstein asks why Tulsi Gabbard who supported Sanders bid for president is now in the DJT cabinet.    ...

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The CEO of the New York Times and the former director general of the BBC, takes a look at the public discourse in the 2016 U.S. presidential election and in the Brexit campaign, and finds some troubling changes. The use of words that can eaily be picked up by Twitter and social media to attack opponents, the complete disregard for facts, and outright attempts to denigrate and destroy using rhetorical tactics, and a section of the public that has turned away from the facts or is disinterested in facts, is deeply troubling for Mark Thompson. When the public discourse fails, then the politics as a whole starts to collapse, says Thompson. We are children of the enlightenment, says Thompson, and were taught to look underneath statements to discern the truth. This is a crisis in public discourse. Worse it is one in which truth telling by people who say they are outsiders and tell it like it is, is not about telling the truth. Which is what makes it so dangerous. Thompson cites the statement by Michael Gove that "people in this country have had enough of experts," as another dangerous sign. He says it is time that experts make themselves understandable and talk in a way the public can understand. The media needs to explain issues in clear ways, and professional policymakers language of discourse needs to be conveyed in better ways that the public can grasp, in which the Brexit Remain campaign failed, says Thompson. Its important to acknowledge the problem, as the health of our democracies depends on finding solutions to what has happened in 2015-2016 to change the public discourse and let it deteriorate to unimaginable levels.  ...

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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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In the third Democratic presidential debate in Dec. 2013 Hillary Clinton came out looking much stronger than Sanders and Malloy. She described the Sanders government programs to make helath care and college free as too expensive requiring a 40% increase in federal spending, or $18 trillion-$20 trillion. Clinton said "we have to be really thoughtful about how we're going to afford what we propose." And said she would not increase taxes on those making less than $250,000 a year. On foreign policy issues she differed with Sanders and Malloy on the Assad regime and civilian deaths in Syria, saying Sanders had supported the removal of the Qaddafi regime in Libya. She used her long experience as Secretary of State to display a better command of the issues. On Hillary Clinton's comment about Donald Trump's statement for barring Muslims from entry into the U.S., that it was becoming a recruiting tool for ISIS videos, a NYT fact check shows no proof of this. Clinton said she preferred not to turn the issue of terrorism into a clash of civilizations with Islam, as her Republican opponents have done....

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What is the right retirement age for health is an important question. Dana Smith points out that the number 65 that started with the system of social security started in US  by Bismarck in Germany in 1889 and Social Security in the US in 1935 by president Franklin Roosevelt has no basis on the grounds of health of the population and longevity. Since that time people live much longer to about 74 years and for 45% of the people in the US who are in the knowledge based work the ability to work continues past 65 or 67 years.  For the remaining people who are in professions involving physical work such as construction or in the restaurant industry the situation is quite different, requiring a category based retirement age that takes this into account. For these people health outcomes would deteriorate if they continued to work in stressful work for longer. Another factor to be considered is to ask what this means as a national goal. Would a nation aspire to give its citizens an opportunity to travel, broaden their minds and engage in other activities they would like to do which they could not do while working full time. In this situation these years after retirement could give people a chance to live happier lives. It is not to be taken lightly as the current protests in France show. Age discrimination in France also plays a part as there may be fewer years of work opportunity if employers stay away from people over 50 years or discriminate against women. With childcare and care for elderly, part time jobs, women work longer for smaller pensions than men, leading to a sense of unfairness. French protests show that the outcomes need to be weighed carefully from a health and national goal standpoint and the retirement age set accordingly with flexibility for harder work.  Following the pandemic years and the cost of living crisis the protests in France show the need to develop a national consensus on the issue of retirement age, and rules plus culture change in industry that ban age discrimination for workers. Special provisions for women and people in construction so that the system is seen as fair to all parts of the workforce. ...

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U.S. states want flexibility in applying the Medicaid program which covers 53 million Americans earning lower levels of income. This amount was $11,616 a year for working parents in 2009, according to the Kaiser Fondation. Some states have a higher income level, as high as $48,400. The problem for states are serious budget deficits, with Medicaid comparing with education as a major cost. The recession and job losses has added 8 million Americans to Medicaid rolls. The Federal government supports 57% of the Meddicaid budget on average. A provision in the 2010 health care law says states cannot limit Medicaid eligibility, or they would lose funding by the federal government. The Obama adminstration's position is that eligibility or provider cuts will not bring in large savings, and will allow larger cost-sharing by Medicaid users, with only minor cuts in eligibility. Its position is also that the law does not give the federal government waiver authority. Some of the issues raised relate to the structure of Medicaid cost and its rapid escalation. Health and Human Services says 1% of benificiaries, especially the long term care, use up 25% of the Medicaid expenditures. One astonishing fact is that two thirds of all U.S. nursing home residents are on Medicaid. The total cost is rising, from $187 billion for Medicaid in 2000, to $346 billion in 2009, according to the Centers for Medicare and Medicaid Services. In July 2011, $26 billion in additional federal Medicaid funding expires, which will be added to state expenses as they struggle with large deficits. In states like Maine, with generous benefits, about one fourth of all residents are in the Medicaid program. ...

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To increase the appeal of the Conservative party and help it stage a comeback, party leader and now prime minister Cameron, made a pledge not to reduce the budgets for health care and the National Health Service. By sticking to keeping this pledge Cameron is committing to much deeper cuts in government agencies, public sector jobs, and other areas. Carl Emmerson of the Institute for Fiscal Studies, says that because of this the cuts elsewhere will rise to a much deeper 25%. Phillip Cowley, a political scientist, says that the NHS is a totemic issue with the British people, and helped Cameron get the top job, as the Labor party could not hit the Conservatives on the issue of the National Health Service.

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US president Biden announces a plan that makes it mandatory for all employers with more than 100 employees to require their workers to be vaccinated. The Labor Department's Occupational Safety and Health Administration will issue an emergency temporary standard for implementing the new rule. This will cover 80 million private sector employees. Businesses that fail to meet the standard will face fines of up to $14,000 per violation. Employers must also give workers paid time off to get vaccinated or recover from any side effects.

Federal government workers and contractors also must meet the new requirement or face regular testing. In all 100 million workers or two thirds of American workers will be covered. 

To meet testing needs the Biden administration is procuring $2 billion in rapid point of care and over the counter at home Covid tests, using the Defense Production Act for accelerated production.

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Two leading funds Jana Partners and the Cal State Teachers Retirement System raise questions about the iPhone addiction among young people turning into a health crisis. The Wall Street Journal asks readers to comment on the issue how to respond, what teachers and parents need to do, what Apple needs to do. Many teachers say the drift is towards shorter and shorter attention spans for children, and children lacking the essential ability to delve deeper into learning topics. One teacher says the iPhone does not belong in high schools. One response is that it is the responsibility of parents, yet another response says parents are getting exhausted in the process. This parent calls it like playing a game of whack--a-mole from hell. Take away the iPhone and the same thing goes on in the computer, then on smart TV, finally the parent has to return the laptop because lessons are done online.

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Hillary Clinton narrowly loses the Michigan primary to Bernie Sanders in March 2016, as the Sanders campaign focusses on Clinton's support for trade agreements that hurt American workers and lead to loss of manufacturing jobs. About three fifths of voters in the Michigan primary considered this a major issue. Many less educated younger workers see their job prospects diminish and wages drop with free trade that hurts American manufacturing jobs. Bill Clinton signed the NAFTA agreement with Mexico, and as a member of the Obama administration Clinton supported the Trans Pacific Trade Agreement, later opposing TPP when she left the cabinet. Sentiment against trade that hurts manufacturing jobs in the U.S. is strongest in midwestern states such as Michigan, Ohio and Illinois. This was also a major issue benefitting the Liberals under Justin Trudeau who won in Canada's industrial Ontario province which has suffered hollowing out and loss of manufacturing jobs under the Conservative Harper administration. In the U.S. the issue goes back to the Clinton Administration for two decades. New jobs created by Apple, Google, and other tech companies pale in comparison with the industrial jobs created in another era that benefitted working class families. This issue and high unemployment or under employment, lower wages for working class families, was a major issue in the 2016 U.S. presidential election campaign. Widening wealth disparities, and lack of upward mobility, high tution and healthcare costs for ordinary families, dominated the campaign in the U.S....