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Arwa Mahdawi writes in The Guardian about issues facing the Democratic party in the US, and Labour in the UK, of turning their backs on the working class. And to the roots of their parties in the working class and rising middle class under FDR, Truman and Clement Attlee in the 1930's 40's and 50's. Woman's issues are about men's issues and issues of the people as a whole, of fairness in the economy, about correcting grossly poor misallocation of capital away from education, health, infrastructure and children, when seen in this larger and very real context.

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The Economist cites the Dartmouth Atlas Project which shows differences in cost across the country for health outcomes and spending involving Medicare. It cost $5000 per person in Salem, Oregon in 2006, $8000 in San Francisco, and more than $16,000 in Miami, with outcomes for health tending to be better in places where the costs were lower. This is one of the statistics that Peter Orszag of the Congressional Budget Office uses to come up with his estimate of 30% waste in health care spending in the United States. Prof. Skinner at Dartmouth and Prof. Garber at Stanford point out that of most health systems around the world the American system is "uniquely inefficient" and wasteful. The Economist cites information that the American system is twice as costly per person for healthcare than the Swedish system, and that it costs twice as much in Minnesota as in Miami. A poll done for the Economist shows 52% of the people in the UA are dissatified with the quality of care, 40% think the system needs fundamental change, and 29% think that it should be fundamentally rebuilt. The lack of uniform coverage is also causing turmoil in the system. About 49 million are uninsured, and a quarter or more are able to buy insurance and do not buy it because it is so costly, has exclusions and coverage is inadequate. But these people also end up in the emergency rooms along with the indigent costing the whole system tens of billion of dollars for costly late interventions that could have been avoided with preventive care early on. With the economic crisis and rise in joblessness, the dire condition of state and local budgets, the situation has probably drastically worsened, and the system near breakdown. ...

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Young people are the major source of transmission of coronavirus in the US with school sports as a major cause. Michigan, New York, Florida, New Jersey, Pennsylvania, makeup 42% of cases on April 11. Adults ages 20 to 39 are affected the most in Michigan. With cases for children under 19 quadrupling from a month ago. 301 reported school outbreaks in Michigan alone. A big problem is that the spread of the variant B.1.1.7  from the UK started in clusters earlier in February. It now has spread to the general population. India has seen a surge in the past 5 days and public health officials are learning from this experience in Europe and the US. The focus  should be on micro containment zones, prime minister Modi told state chief ministers in a virtual meeting on April 10, with screening, testing, tracking, and that health officials should not let higher numbers affect their persistent effort to screen, test and track as with the unceasing effort the results will come. ...

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US Senator Bernie Sanders and Shawn Fain of the United Auto Workers make the case for a 32 hour week.  No that's not right Sanders and Fain are calling for hours and wages that make for a healthy life after making significant contributions using technologies and higher productivity during a normal week more like 35 to 40 hours instead of 50-60 hours a reality today.  Even with this productive work effort they say workers have not benefitted as most of the gains have gone to the top with top managers and CEO's making hundreds of times more in compensation. In this years negotiations the UAW made long hours at work and its effect on worker health an issue. A 40 hour work week was established in 1940 under the Fair Labour Standards Act passed under president Franklin Roosevelt. Sanders and Fain point out that 28.5 million workers even today work over 60 hours a week and more than half of full time employees work more than 40 hours a week. It comes as a surprise that according to the authors US workers logged 204 hours a year more than employees in Japan, and 470 more hours than German workers. Sanders and Fain point out that today adjusted for inflation the average worker in America makes about $50 less a week than 50 years ago in 1974. There is definitely a need to consider the health of workers as the highest priority and wages that make it possible to raise families and educate children in decent living conditions. France and Denmark have a 35 and 37 hour work week. ...

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The US House of Representatives voted 245-189 in favor of repealing the health care law. Only 3 Democrats joined the entire Republican caucus in voting for repeal, compared to 34 Democrats who voted in March 2010 against the health care law. This is a largely symbolic move as the Democrat controlled Senate will not consider the repeal, and even if it did the President would veto it. Republicans favor some aspects of the health care law which allow children to be on the parent's insurance till age 26, and a ban on insurers denying coverage due to pre-existing conditions. Opinion polls show 46% of respondents opposed repealing and eliminating the law, and 45% favored repealing it. The health care issue ranks third among the economic issues important to respondents, behind unemployment and reducing the federal budget deficit.

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This essay in the WSJ by Louise Aronson, geriatrician, professor of Medicine at UC San Francisco and author of "Elderhood, Redefining Aging, Transforming Medicine, Reimagining Life," and Teva Brender, UC resident in Internal Medicine, says age should not be a factor  in electing leaders, as over the last century life expectancy has grown by 25 to 35 years. People can be healthy into their eighties and modern medicine provides ways to tackle small physical, auditory or visual impairments. In addition these can be handled with strength training, better nutrition and social support, says Aronson. His point is that there has been an increase in "health span" the years we define as being healthy, a compression of morbidity, the disease at the end of life. As a result people can be productive for many years, early retirement is a bad idea economically and for the people themselves when they feel better working. When there is so much wisdom and experience that they can bring to the job, and when that  wisdom and experience is sorely needed by the nation, that guiding light has immense unreplaceable value. President Franklin Roosevelt was at such a time able to steer the nation in the 1930's through the Great Depression and the 1940's through the Second World War, even though he had disabilities. Aronson says the work of elected leaders is fundamentally cognitive and when the basic physical demands can be met it is possible for leaders to work successfully. ...

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Bill Gates resigned his seat on Microsoft Board on March 13, 2020. This report in the WSJ looks at the situation at Microsoft in late 2019 when members of the Microsoft Board hired a law firm to conduct an investigation in late 2019 after a Microsoft female engineer's letter. This was a company that Gates founded and which expanded through acquisitions of other smaller companies.  The same day he resigned his seat on Berkshire's Board led by Warren Buffett. Mr. Gates started Microsoft in 1975, was CEO till 2000, and chairman till 2014. He then turned to work with his Bill and Melinda Gates Foundation.   Microsoft has market value of $1.8 trillion, Apple a value of $2.1 trillion.  The Bill and Melinda Gates Foundation has assets of $37 billion income of $53 billion, and the personal assets of Bill and Melinda Gates have an estimated value of $130 billion. One of the mistaken assumptions is that any one foundation such as the Bill Gates foundation has the resources, knowledge, technologies, expertise and leadership to tackle problems that confront large countries such as the US, India, or a bloc such as European Union. Imagine some billionaire taking on the role of a Franklin Delano Roosevelt in tackling the Depression or a billionaire tackling the problem India faces today in public health. It is only governments of the US, India and large nations such as the UK that can pull together the resources needed and the cooperation needed between its industrial base companies to achieve goals for public health. This type of effort can pull together resources of trillions of dollars that no one company or billionaire or group of billionaires can put together, and pull together massive resources of engineers, scientists, and other people across hundreds of companies that cannot even be measured. This is one of the lessons of this pandemic because the WHO was left with the job of handling the pandemic and governments of US, France, UK, Germany, India, Russia and leading nations had retreated from their essential role as guardians of the public interest in people's health and left much of the task to others. As they reassume this role this needs to be given a firm and solid footing and lessons learned. ...

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This essay from the Yale-Griffin Prevention Research Center which puts focus on preventive medicine looks at the food we eat in a different way. In order to have a real conversation on food it says ignore the latest fads on nutrition on keto, paleo or other diets, and think about how our ancestors ate in a healthy way that both prevented disease and provided the right nutrition. It was mostly plants as meat was not freely and easily available. So much so that the consumption of meat and animal protein may have gone up by as much as 90% today. Processed foods did not exist, and unprocessed plant foods were there in abundance. They were not called low fat low carb or vegan then. It is during the beginning of the 19th and in the 20th century that the production and marketing of shelf stable, nutrient poor, high calorie, high sugar and salt processed foods replaced the normal way our ancestors had their food leading to the public health crisis of today, both in health quality, outcomes and cost.  It says replace meat and where appropriate dairy healthier plant based beans, lentils, whole grains, and vegetables, fruits so that animal protein gets back to the levels of the centuries before the 20th century shift to processed foods. It says use common sense beans including soyabeans and lentil beans replace meat wherever possible and oats with berries and nuts replace eggs. Vegetable and garbanzo beans salad replaces cheese and yogurt reducing the cheese or yogurt to very moderate levels. Focus on wholesome food and eat like our ancestors did and exercize then everything else will fall into place. ...

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Germany faces serious problems in its vaccination drive and efforts to control the pandemic in November 2021. The rate at which people are getting vaccinated has slowed to 150,000 a day and the percentage of the population that is vaccinated is stuck at 67%. This percentage of 67% fully vaccinated in Germany as of November 3 is much lower than that in Spain, France and Italy.  Spain is at 78%, France at 69% and Italy at 72%. (Data from NYT) This report in the Guardian points out that most of the remaining one third of the population is not eager to get vaccinated as surveys show that the those who have refused to get a jab are unlikely to change their minds.There is also the problem of booster shots. Germany's 16 regions conduct the vaccination drives and with many of the vaccination centers not active since September staff has to be retrained or rehired. This makes it harder to give booster shots to everyone that was vaccinated early by the start of winter. Why is it that Germany lags behind Spain in vaccination? There is a great deal of trust in Spain and Portugal in the health service and people are 100% behind their health system. The other countries that have a low rate of fully vaccinated are the US at 58%, Brazil 57%, Russia at 33%. Even the UK with its well respected National Health Service remains at 68% fully vaccinated. Today the US, Russia, Brazil, European Union countries and India have many of the 5 million deaths from coronavirus. India's vaccination drive is approaching 1100 million vaccinated, yet there is along way to go in getting most of the population fully vaccinated because of the large population of 1.3 billion. This is why the Indian prime minister on the first day of returning from the COP26 climate summit devoted his time to meeting with leaders of different states and heads of districts with low vaccination rates to press home the idea that the effort had to be taken up vigorously in the coming months. ...

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Washington Post's new idea of developing content for social media platforms  (Third Newsroom) to cut losses of $77 million in 2023 by earning profit on social brand exercises, comes at a time when the risks of social media platforms to education of children and to their mental health are great. Social media platforms entry into the news business has led to old news companies first interacting with them over a decade and realizing that this was leading to gains for social media platforms and losses for the old news companies. For older news companies such as the NYT, WSJ, Washington Post and others in the US this was a period in which these companies lost control over their news content along with loss of revenues. Over the last five years the companies have become profitable managing their own content and increasing subscriptions. The Washington Post has run into problems and has a $77 million loss. It was sold to Amazon's Bezos for $250 million by the founding family in 2013.  It is now trying to revive its business by doing what failed for the NYT, WSJ and others- by embracing rather than rejecting social media platforms such as Instagram, TikTok, and others using the News Movement idea of UK journalist Lewis and Winnett. That News Movement makes content for Instagram and TikTok but has not generated profits. Under Lewis as head of Washington Post news division, Matt Murray formerly editor of WSJ would as head of Third Newsroom develop this kind of content for social media platforms. This runs the risks of aiding the work of social media platforms at a time when TikTok has raised national security concerns in the US, and along with Instagram is being cited as part of social media platforms that are affecting the mental health of children. Its disastrous impact on the health of the Nation and its future comes from reducing focus on education and studies by diverting an average of 4.8 hours each day away from educational activity for the children that make up the future generation of this Nation. ...

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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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Questions raised about the government's committment to serious health care reform. New leaders of China who took power in 2002 and 2003 with concern for the poor, did not put discuss reform till 2006 and during this crisis there isn't the urgency that is needed. Recent documents, says the Economist, that were circulated secretly within the bureaucracy for 3 weeks before being made public, provide no clear target about how much people would be reimbursed for medical treatment. The other concern is that the central government provides only 40% of the 850 billion yuan allocated for additional spending on health care in the years 2009-2011. This is about $125 billion. Burt local governments may not be keen on spending on health care as officials are still judged by how much they can boost employment and GDP growth. Over three years the central government's annual share of the additional spending on health care of 850 billion yuan is 111 billion yuan, according to Caijing, a business magazine.But the 2009 budget on health care is 118 billion yuan, so its not clear that things add up. The central government's additional spending in each of the 3 years is only $16 billion. How this can provide help to the 200 million uninsured, the insured who still pay a large amount for health care, and pay for essential pharmaceuticals on a list prepared by the government, and pay a portion of the expensive diagnostic tests that hospitals like to make money from, is not clear. The whole system will have to be overhauled so that hospitals do not have the incentive to prescribe these expensive tests and pills that cost more. The government says it will be 2020 when 90% of Chinese are covered by agovernment financed health insurance system- 11 years away. This only means that domestic consumption may remain depressed for a decade or so. With export markets collapsing, this leaves China dependent on infrastructure spending for growth for a long time, and lower growth rates with higher unemployment. ...

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A group of neurological expeorts in the UK help us with advice. Includes things like avoid hearing and vision loss that lead to not driving or isolating. Social interaction and learning are key so take up a hobby, find new interests , learn a new language, travel, and link this up with other people, new people you can meet. Get plenty of exercise, core building. Nature walks, hiking in the mountains, swimming, outdoor activity. Good sleep begins in the morning so that by the time it is 9.00- 9.30 pm one is ready to go to bed. It helps not to stay up late. Eating healthy, olive oil and Mediterranean diet instead of butter, and eating fruits and vegetables, nuts.  Mindfulness helps. There are four forms of mindfulness. On the leftside Menu for Lyrarc there is under Lyrarc Insights the section Mental Well-Being which gives a translation from the original Pali text of the Buddha describing the Four Forms of Mindfulness in the Sattipana Sutta. This spiritual training, a reading of the Bhagavad Gita or the Bible, nourishes brain health and gives clarity of mind. ...

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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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It calls for balancing it, taking into account tradeoffs and people's lives in 2025 after the pandemic, cost of living, health and housing vs net zero and speed of net zero targets. Opinion in UK on Net Zero cutting emissions changed over 4 years to split 50-50 on other spending priorities social care immigration NHS, in a focus group of The Times of London. In 2025 40% want to spend less on cutting carbon emissions net zero, large numbers favor more for NHS, then social care, policing and education in equal importance, followed by social housing. 

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The private sector ignores health insurance. And state coverage in China is inadequate. More than two thirds of China's 1.3 billion people have no health insurance at all. If you have insurance you still pay up front in cash, if you do not have the cash up front you cannot get a surgery, treatment of any kind or any drugs, even if the insurance will later reimburse you. The Chinese health care system is dysfunctional and in a crisis because of the way it is structured, and the faulty policy incentives. It caps prices for basic drugs and procedures at below market rates, yet it lets hospitals profit from everything else from advanced drugs to sophisticated diagnostic tests. So hospitals invest heavily in technology and expensive testing. and drug sales account for 45% of revenues. And enforcement is lax. Doctors in Shanghai make monthly incomes of about $400, about what a taxi driver makes, so they supplement their income with bonuses earned by prescribing more expensive tests and drugs. There is no utilization review so the state reimburses for whatever the hospitals charge regardless of whether the test was needed or not. So the system is dysfunctional and lurching towards a crisis. In fact heavily burdening the middle class. The private outlays and burden of total health care spending has increased from 20% to 60% of total health care spending from 1978 to 2003, as the the health care system got the same dose of unfetterred capitalism as the rest of the system. The Government's share of total health care spending has dropped sharply. In addition there are design flaws that push expensive care and build in incentives for expensive care at the expense of good medical care. The government recognizes this problem and sees it as athreat to social stability. It has committed to increase spending on healthcare. ...

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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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UK student survey shows 49% of students have  financial issues affecting their diet, missing meals or not having enough food or poor quality of food. It also shows 55% have financial issues that affect their mental health. Loans were falling short of covering living costs by 582 pounds a month in 2023, it was 439 pounds in 2022. Maintenance loans for students increased by only 2.8% in 2023-24 in Britain,for a maximum of 9978 pounds a year outside London. Shown here is an engineering student who gets up at 4am to do a supermarket shift, a law student who works 20-25 hours a week as a receptionist and missing one third of her lectures.

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HV.1 and EG.5 are the dominant Covid variants in November 2023 each taking up about 25% of cases in the US. Paxlovid works against these variants. The new Pfizer vaccine also works against these Covid variants. More than any single variant the rapid rate of virus evolution, the many mutations, are the chief concern of experts. Overall they combine to produce the threat we face in public health.

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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.

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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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CEO Ryan at CVS/Caremark. An unassuming man with a sharp focus on things, joined CVS right out of pharmacy school at University of Rhode Island. At 29, CVS owner Stan Goldstein gave him the chance to run pharmacy operations for CVS, then a regional drugstore chain in the eastern USA. Over the years CVS has made a number of successful acquisitions, the latest being the acquisition of Longs Drug store chain on the west coast, and it is now one of the largest chains in the USA. It has nearly 7000 stores and more than 50 million users of its CVS loyalty card in the US. As the pharmaceutical business evolved pharmacy benefit management (PBM's) companies like Caremark, Medco, and Express Scripts, came into being to manage burgeoning prescription costs. PBM's work with companies to save money, by filling recurring prescriptionsin 90 day quantities through the mail at reduced per pill cost. Now drug store chains instead of competing with PBM's are either creating or acquiring these larger PBM's. THe result is that a company like CVS which acquired PBM Caremark in 2007 for $27 billion, now has extensive computerized databases with patients information and drug usage histories. Ryan's clear focus is on these IT records as a distinct advantage, if he can use it to help the Obama administration's efforts to control health costs of chronic diseases like diabetes and arthritis, and back or neck pain, high blood pressure, and others, that end up clogging the hospital system and raising health care costs. By using these IT records to flag when a patient is not compliant or taking his medications and call the patient, Ryan can increase drug sales, get more visits into drugstores if the drugs can also be picked up at CVS stores, and increase sales through ancillary purchases during visits. This is now his strategy. It also includes setting up more clinics at stores and at corporate locations that divert the patient flow for small care like sore throats, flu and the like. As this is the way health care costs can be controlled, Ryan sees himself as helping achieve national goals while keeping CVS in the sales and profit picture for the US, even as health care as we know it goes through a complete transformation that removes the waste and unnecessary cost, and improves effectiveness and health. He sees CVS/Caremark right where it wants to be with its large patient drug database from about 1 billion prescriptions it fills each year, and as the largest single buyer and dispenser of prescription drugs in the country. ...

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Problems with China's health care system stem form years of underspending. About 1% of GDP went to healthcare in 2006,according to the WHO, ranking China at No. 156 of 196 nations. This underinvestment has caused great hardship to the rural poor who have postponed or been denied access to healthcare because of exorbitant expenses. It shows up in the number of trained medical workers- only 17% of China's medical workers are university graduates. In village and township clinics the number falls to 2%. The government has dedicated $121 billion for health care through 2011. But this may not be enough. Aobut 300 million in the rural areas have no coverage at all. The government's plan is to get farmers insured through county level rural- cooperative insurance plans. These programs begun in 2003, offer only scanty coverage. Outpatient services and medications are not covered and coverage varies from county to county for hospitalization bills. The goal of th health ministry is to get the coverage for hospitalization bills up to 50%....

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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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Betsy McKay reporting from Harper, Liberia, gives this exceptional report on the shattered health system of Liberia and how the country is coping following the Ebola Virus epidemic. The dilapidated poor state of health facilities in Liberia, and in neighboring Sierra Leone and Guinea, have made these areas especially vulnerable to the spread of Ebola Virus. With pictures and details about the lives of ordinary people McKay brings to life one of the poorest regions in the world, racked by years of war and neglect, showing people struggling to find their way with minimal health care. Tabeh Freeman, a professor of public health at William S. Tubman University in Harper, Liberia, says Liberia cannot cope if another epidemic takes place, with such a poorly equiped and broken health system. Liberia, Guinea and Sierra Leone estimate the need is for about $1.47 billion in the next 30 months to build and equip a new health system. The World Bank and other donors have come up with $1 billion for Ebola recovery. A particularly urgent problem is to see that adequate funding goes to build the infrastructure for the health system and to train people to provide health services....