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U.S. health insurance company WellPoint Inc. will offer higher payments to primary care physicians. This is part of new strategy to reduce emergency room visits and costs after deterioration in a patients condition by relying on primary care physicians for better care at the outset. Payments to primary care physicians will be increased by 10%, with higher payments when the results show better quality and preventive care. WellPoint has a network of 100,000 primary care doctors. Physicians who meet certain goals such as lowering the overall cost of a patient's health care costs will be given an incentive of 20-30% of the savings realized. The new effort will add 1-2 percentage points to the 6-8% of the $100 billion that Wellpoint pays for claims processed each year. WellPoint's management sees a reduction in medical costs of about 20% by 2015 as a result of such efforts.

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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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Food costs for eating at home have actually come down by half since 1960. Charts on the US Department of Agriculture site (USDA) show US food costs for family budgets at 13% of personal disposable income for eating at home in the Kennedy years the 1960's. This has come down by half to 5.7% in 2024. In that period eating at restaurants and outside has doubled to 5.7% of personal disposable income. When people complain about food inflation this is an important factor, eating outside also leads to less control of intake and right nutrition, consequently leads to poorer health outcomes, and a growing share of health expenditures in America's national budget. It hits both the family budget and the national budget and then comes back to hit health outcomes.

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Some young people in Germany, France, Spain, Italy and the U.S. who are ignoring the rules about social distancing and restricted social gatherings are seen as endangering the fight against coronavirus. Health authorites are highly concerned about carefree youths and young people not following the new rules.

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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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As Indian pharmaceutical industry sees drug testing in India as an opportunity, conditions for obtaining the best results are being established by taking necessary steps. With ashortage of experienced people to run drug trials, Indian government has stepped up training, setting up partnerships with the U.S. FDA, Health Canada, the World Health Organization, and other similiar organizations, The emphasis should be on credible dat and the safety of subjects says A.K. Pradhan, India's Assistant Drug Controller. After the death of an infant in a Wyeth Pharmaceuticals drug testing effort, the Drug Controller of India though supportive of Wyeth has raised certain issues that Wyeth is addressing.

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Savings and health concerns are playing a part in worker's reluctance to come back to work in the US.

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Business Week's Chad Terhune points out that the health reform bill that passed Congress will do little to restrain the overbilling by pharmaceutical companies, medical device and equipment makers. Chad cites numbers from the U.S. Health and Human Services Department that shows $47 billion in Medicare spending went to dubious claims in the year ending Sept 30, 2009. This is 10% of the $440 billion Medicare program. And 10% of the Medicaid program also goes to dubious claims. Consider then that Congres allocated $10 million annual increase to fight fraud. A suit filed by a former Siemens manager at the federal court in Philadelphia states that Siemens routinely overbilled the Veterans Affairs Department and other governmental agencies by humndreds of millions of dollars for MRI and CT scan machines.

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Some features of the U.S. health care law are likely to be retained even if the Supreme Court overturns the health care law- the feature that lets parents carry a teenager on their polcy till age 26, and the feature that private insurers cover preventive services without copays. These are very popular and preventive services make sense for the insurance companies to reduce higher costs later on. Other features such as the discount pharmaceutical companies must give to seniors falling under the Medicare gap, and annual physicals without copays may not be retained. 3.6 million Medicare benificiaries saved $2.1 billion on prescription drugs, $604 per person, from the Medicare gap discount. And 32.5 million Americans took advantage of the annual physical without co-pays in 2011. About 50,000 Americans insured temporarily for people with a pre-existing condition also may lose their coverage. Another provision which prevents states from tightening eligibility rules for Medicaid before 2014, may be questioned also as states feel burdened by these rules during a period of budget cutting in areas such as education....

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Retirement in America 2026- what to watch out for- $6500 per month full time home health aide. There is  $45.8 trillion in US IRA's 401 (K)  in 2026. It was half that in 2015. People are saving more 8-12% of income. A lot of it invested in arget dated mutual funds. Yet older Americans, seniors are facing poverty- 15% in 2025 compared to 10.7% of older Americans living in poverty in 2021. cost of living has hit this group the hardest. Removing the tax on Social Security could be prescient, popular and fair for these Americans, as suggested by DJT. If invested well this $45 trillion could give the US leadership in investment for decades to come as it grows with good management of investments raising living standards and financing the Nation's rebuilding of infrastructure in all areas.

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This article in The Guardian on the lifting of the ban on a kind of risky research on virus in labs that involves increasing the power of pathogenic virus, first appeared on March 9, 2016. It is called gain of function research. The ban was lifted in 2018. It shows how fiercely this decision was opposed in the scientific community, even as some virologists and bureaucrats went ahead. An agency National Science Advisory Board for Biosecurity, going by the acronym NSABB would make the recommendations to National Institutes of Health or NIH agency, and the Health Ministry in the US called the HHS.

 

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This report shows the level of coronavirus testing as of March 27, 2020 in different states in the U.S. The U.S. testing program and supplies of tests are being ramped up quickly. About 65,000 tests are being done on Americans each day. The need is for 150,000 tests a day say public health officials. Testing is slow in California compared to aggressive testing in New York which has 60% of all coronavirus cases. California with twice the population of New York has done 77,000 tests compared to 122,000 in New York. Texas has done only 21,000 states by comparison. Every week new testing technology is being developed in different labs, medical companies, and universities. Including tests that can be conducted quickly and not requiring health workers or health workers with protective gear. Speed of processing test, least point of testing contact, and the protocol for quarantine, are all part of the testing and isolating of clusters mechanism to tackle the virus. This is critical in the coronavirus action plan being developed by Dr Brx of the U.S. White House team. ...

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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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Only by drawing the real connection between climate and human health can real progress be made in tackling climate change. The planet is greater than we are, say experts, and it will survive us. It is people who have to save themselves.

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The rulings in Britain for "duty of care" protect a customer or worker from harm. The rule "to love your neighbor becomes in law "you must not injure your neighbor." This is the new idea that the British government is moving forward so that the internet as public space is protected for all who use it. It does not state how many fire extinguishers are to be installed in a public building. Britain's Health and Safety Act simply requires the owners to do all that is needed to protect the users and occupants from harm. Since 1945 this is the foundation for heath and safety laws in the U.S. and in the UK.  This is the principle that 2 researchers Mr. Perrin and Ms. Woods have come up to tackle the protection of the internet as public a space. Perrin is a civil servant and founder of Ofcom, the UK's version of the U.S. Federal Communications Commission regulator. Woods is a professor of internet law at Essex University. It is now part of the legislation proposed by Boris Johnson's government in The Queen's Speech outlining government priorities. A new regulator would have the power to require companies to protect users of public spaces (the internet) from online harms such as pornography, extreme content, cyber bullying. The 2017 suicide death of Molly Russell a British teenager made this a priority for the government. The French government is also proposing rules based on this principle. ...

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About a third of recent coronavirus infections in the UK are from schoolchildren ages 10-19. The UK after a headstart in its vaccination drive has fallen behind other European countries and the US in the vaccination of children and teenagers. UK began vaccinating children in August far behind the US and Europe. On top of this UK under Boris Johnson decided to drop almost all public health restrictions during the summer. The change in Health Secretary happened on June 26, 2021 with Matt Hancock's resignation. The new Health Secretary Javid was to review the health restrictions in place till July 19. The sense of caution and preparedness that prevailed earlier as fallen short since July 2021 with the lack of coronavirus prevention measures such as masks, social distancing and vaccine mandates that were taken in Italy, France, Germany and other European countries, as well as in the US.

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Krugman points out the gains on three fronts evident from the Census Bureau report of 5.2% gain in median income of households in the U.S. He says the first is the growth in incomes of ordinary working class and middle class families, second the large decline in the poverty rate, and third the further rise in insurance coverage in 2015 for people without health insurance. He points to the steady efforts of the Obama administration to improve lives of ordinary families as working based on the Census report though results have taken time, and could have been better. The Stimulus, says Krugman could have been larger following the blow of the 2009 financial crisis and increased unemployment at the time. Janet Yellen at the inequality conference of the Boston Fed in 2014 pointed out the problems of 62 million households having net worth of about $10,000, and why this was running against the American idea of a better life for all Americans. In that sense the Census report is a movement in the right direction but a lot remains to be done.   ...

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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 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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Elite universities with a third foreign student enrollment displacing Americans, are facing US government funding cuts. This report shows these universities turning to pharmaceutical companies and big tech monopolies that have placed added burdens on cost of living of ordinary Americans, and mental health of children, on the ability for basic literacy by 4th grade. Somewhere the basic goal of the university to educate Americans is being lost. For no more than 5 to 7% of funding these universities are willing to turn to companies that have exacerbated the cost of living crisis or monopolistic behaviours in the Nation, particularly the pharmaceutical companies, showing alevel of misguidedness in management that fails to understand the real interests of ordinary Americans. In pursuing science alone at the expense of everything else and derelict of leadership where it is needed such as cost and value, this behaviour ignores the fact that the greatest dangers to public health come from cutting chemicals in food, in healthy food and exercise habits cultivated in schools, raising the consciousness for healthy living and healthy environments in the Nation. The schools of public health at the Nation's leading universities needed to take a better stand on the dangers of proliferation of  research into viruses, and to single out breakdowns when they happened that are seen by many to have led to the pandemic.  ...

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Are there costs or are there savings from the Obama health care bill? Does it affect jobs and how? The Congressional Budget Office says the health care law will save $230 billion in ten years based on a whole set of calculations and assumptions. Commonsense and basic math leads others to question how spending $930 billion on insuring 32 million Americans could end up with significant savings. The different view argues that the Budget Office erred in making some calculations, by counting $70 billion in premiums from long term care because they would be used to pay benefits later, omitted $115 billion in spending to adminster the law, and omitted $208 billion needed to prevent scheduled reductions in Medicare payments to doctors. The money needed on the Stimulus, on two wars in Iraq and Afghanistan, and the uncertain prospects of the US economy in the longer term till debt and other issues are resolved, injects the critical element of difficult choices and priorities. If state and local budgets are severely strained in 2011-2012 would that require federal help and will there be other needs that will have to be met by the federal government that are critical such as another unexpected downturn, or a resolution of unresolved bad debt at the large US banks There is also a sense that the health care law does not do enough to reduce the cost of health care that will be needed over the next decade so that other priorities are not neglected. Both parties are not up to the task in this respect for running the country's finances withot using the numbers to tell different stories....

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On March 20, reports show that the testing facilities in states in the U.S. have had to set priorities on who gets tested first. High risk areas identified by authorites come first. For this reason Corlado health authorites moved a test centrer in Denver to Telluride a ski community that has been hard hit. In Minnesota health department commissioner identified priorities and limited testing to health care workers, inpatients at hospitals and people in group living facilities. A backlog means tests can take 5 days in Colorado, and Colorado has capacity for 250 tests a day (March 20). Testing was centred first by the U.S. government at the Centre for Disease Control. On reconsideration the state and local authorites, private companies, were allowed to conduct the tests, to speed things up. But local areas in many cases lack supplies or enough test kits and protective gear that is needed. This WSJ report says that the Trump administration is also shifting their strategy to social distancing to contain the outbreak. The federal government says it is aware of shortages in chemicals used in the tests. New York City officials say they have testing capacity for 5000 people per day, and New York State Governor Cuomo says the state can test 6000 people per day. (March 20). ...

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This editorial in the WSJ commends Congress for the $2 trillion U.S. aid package for households, small business and large corporations to keep workers on payroll, and aid to hospitals. It also commends the Federal Reserve for swift action to maintain liquidity in all corners of money markets. It was important to prevent a run on money market funds and municipal bond funds. The U.S. Senate bill adds $454 billion for Treasury that can support further Fed action if needed. This has also resulted in a recovery in the stock markets. The editors of WSJ caution Treasury from intervening too far up the risk curve to help companies that had overleveraged themselves with risk before coronavirus hit. It makes clear that the U.S. central bank the Fed should only offer liquidity against good collateral to companies that were healthy before the shock. As president  Trump never tires of telling listeners to his daily briefings from the Brady room in the White House- Boeing and the airlines were healthy before coronavirus hit. It was not their fault that coronavirus hit so suddenly. These companies deserve government help, says the president. By making the distinction between otherwise healthy companies and companies that overleveraged themselves on their own, the Fed, Treasury, and the U.S. government can get more bang for the buck. The WSJ editorial also says there is a bit of good news in the behaviour of politicians, media and the public in the way they are ignoring the trivial politics and self-centred behaviours, including indiscriminately being critical of the president, and focusing on the important matters that affect all our lives.  ...

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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. ...