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In a sign of the changes roiling the pharmaceutical industry the off patent business of American maker Pfizer is based in Shanghai. The generics business of Mylan Pharmaceutical is incorporated in Netherlands and run from Pittsburgh. Pressure is increasing in the generics industry from manufacturers in India and China. Pfizer announced the merger of its Upjohn off patent pharmaceuticals business with Mylan to fight pricing pressures. Pharmaceutical prices in the U.S. are the  highest in the world and generics offer only small relief compared to the government mandated pricing of the same pharma products in India. Generics drugs are also offered at lower prices by distributors who buy in bulk adding to pricing pressures in the U.S. The government rarely intervenes in the negotiated prices as it does in India or in other countries in Europe including Britain.  In fact many asthma patients young and old alike are forced to do without inhalers because of the exorbitant prices set by American manufacturers with scant help from government under Democratic or Republican administrations in the U.S. In this respect middle class customers in India have better access to asthma inhalers as well as hundreds of other medicines basic to healthy living. This has created a greater level of basic equity/fairness in India as well as in Europe in this regard than in the U.S.  In this sense the pricing of basic care medicines in the U.S. adds to the sense of a lack of fairness. To that is added the manner in which the banking and financial industry operated resulting in the financial crisis of 2009 and damage to the bank savings accounts of ordinary Americans hit by unemployment, underemployment, and lower savings accumulation with interest rates kept low to offset the damage done by the banks through bad lending. This is also why an astonishing percentage of Americans like never before in the last 50 years do not have basic funds for spending to manage a health crisis in the family. Just as in times of the Depression in the U.S. industry operates in a way that is oblivious to what ordinary Americans are experiencing only to be excoriated by FDR. ...

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Only upto a point does money make a difference and only in an highly unequal society that comes around every 100 years at times like this. This comparison here is with top 10% and bottom 10% when cost of things have gone up tremendously. It is a poor comparison and validates a society that does not value health and character over money. In a more normal situation where incomes are better laid out across the population for decent access to a good life, public investment for health facilities in every town or section of large cities, and looking at people in the middle from 20% to 80% in the income distribution -it is the choices made how much to spend on fruits,  vegetables, ancient grains, and the educational access in a fair deal society that teaches one to make good food choices, avoiding processed foods and eating less meat and poultry, exercizing, and avoiding alcohol and tobacco, meditation, yoga and spiritual life, and use of public health facilities for exercise, can gradually add up to better healthier living at moderate incomes.  ...

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Longevity and the habits of persistence, prudence, hard work, close involvement with friends and communties, being somewhat obsessive and not care-free. The ability to navigate life's challenges is another aspect of longevity. Having a high level of physical activity, a habit of giving back to community, a career and work that one enjoys, a healthy marraige and good family life, all help improve longevity.

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The difficult task facing Governor Jerry Brown of making the painful cuts in education, the state's university system and social services, as he faces a $15.7 billion gap in the state budget. The Republicans in the legislature have made it difficult for governors in the state to get the two thirds majority to increase taxes, and the Democrats have opposed the spending cuts, leading to chronic budget shortfalls. Governor Brown says unless temporary tax increases, including quarter percent rise in sales taxes and income tax surcharge on the wealthy are passed, California will have to make cuts of $6 billion in January 2013. This would include cuts in public schools and the university system. This would be in addition to cuts of $8.3 billion he has proposed for cuts in welfare, social services, and health care for the elderly. Experts say the political culture in the state is a problem, and is proving to be impervious to this governor's long years of experience and considerable skills. Jerry Brown says California, and the U.S. are both living beyond their means and need to take the medicine....

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WHO estimates $1 trillion in costs from mental health issues, from depression and anxiety disorders each year in the lost productivity for the global economy. The cost of mental health productivity loss is huge. Here a knowledgeable researcher and expert tells us that psychological avoidance makes things worse. If we are trying to squash discomfort hastily we are avoiding. It becomes a crutch says Luanna Marques, author of several books and a physician at Massachusetts General Hospital, a crutch that rather than alleviate anxiety exacerbates it. Understanding the patterns of avoidance its process is the first step. Science induced ways can help us sort this out. Reacting only makes things worse, it fuels the fire leading to even more problems like operating a pressure cooker without a valve. Replying hastily to an email that upsets us or raise our voices without considering the consequences. Retreating is an act of moving away or pulling back from anxiety inducing situations. This only tends to increase anxiety as the underlying situation is still there. Then there is Remaining which is sticking to the status quo to avoid the discomfort of change, such as clinging to a job or a relationship even when we know it is not good for us. Marques suggests three science based methods to fight all this, and fight psychological avoidance the powerful enemy. First Shifting by checking in with our thoughts, particularly when anxiety comes knocking. In these moments we often have black and white distorted thoughts when we are telling ourselves something is such and such. Shifting is taking off the dark, monochrome glasses and seeing the world in color again, says Marques. She asks one to challenge your thoughts, clean out your lenses. One says- I have a lot to bring to relationships, I have had successful relationships in the past. One can now sleep better at night and set you on a journey to follow what matters most to us. The opposite of avoiding she says is Approaching, which is not charging at your fears head-on, but taking a step that feels manageable. One asks oneself what is one small step I can take towards my fears and anxiety to overcome avoidance. Even the smallest step can rewire our brain. Aligning is living a values driven life, says Marques. The daily actions now align with what matters most to us- our values in life. In intense anxiety emotions not values dictate our actions. To lead a values driven life we need to first identify with our values, for health, family, work, or anything else. Then we dedicate time and effort to our values. In conclusion it is not about being fearless , but about not letting fear dictate our lives, says Marques in this excellent approach she has given. ...

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

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

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Democrats in the House of Representatives need about five votes of moderate Republicans to get approval for spending that exceeds the debt ceiling if no agreement can be reached with the Republicans under Speaker McCarthy. This is one of the options Democrats under president Biden are keeping open if the spending cuts Republicans are asking for hurts workers and families in ways unacceptable to values of fairness to all segments of society supported by Lincoln, Wilson, FDR and Truman that have shaped America over two hundred years. T Though it is not readily apparent in an America where about 22% of 8th graders are able to get a passing grade in civics and history in NAEP tests, a rereading of the writings and speeches of Abraham Lincoln show the same concern for the rights of all segments of society that are found in Wilson and FDR or Truman. This is also what Biden means when he calls this a struggle for the soul of America. More not less funding for education, more not less funding for health after the pandemic and cost of living crisis, more not less funding for public services at a time like this where there is a fracturing of society as well as isolating certain segments of society from others such as the growing distance between workers and families from places such as Silicon Valley and capital markets in America.  ...

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The mirage of progress presented from Silicon Valley in the form of FTX crypto exchange ends with $8 billion in losses to investors and a 25 year sentence for the founder in 2024. More proof of the excesses of the "free to choose" post-Reagan era with misallocation of capital leaving the vital needs and priorities of America unfunded, underfunded, or totally neglected from infrastructure, health, education to climate change action. An aversion to government taking action where it is needed that goes back to the 1930's when Franklin Roosevelt said in the State of the Union speech to Congress in 1935- "We have, however, a clear mandate from the people, that Americans must forswear that conception of the acquisition of wealth which, through excessive profits, creates undue private power over private affairs and, to our misfortune, over public affairs as well. In building toward this end we do not destroy ambition, nor do we seek to divide our wealth into equal shares on stated occasions. We continue to recognize the greater ability of some to earn more than others. But we do assert that the ambition of the individual to obtain for him and his a proper security, a reasonable leisure, and a decent living throughout life is an ambition to be preferred to the appetite for great wealth and great power."   ...

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Tyler Owen points out that the innovations that made areal difference in the standards of living and incomes of people in America came in the earlier decades of the 20th century. From 1947 to 1973, this pattern continued with the doubling of inflation adjusted median incomes in the USA. From 1973 to 2004, it rose 22%. Over the last decade it actually declined. The impact of automobiles, airplanes, anitbiotics and new household appliances was huge in the prosperity and incomes of the American people. The personal computer and the internet do not offer the same potential for improvement in incomes and standards of living. At the same time as society ages in the US and healthcare dollars are measured as part of GNP, the increasing GDP from such dollars does not reflect an improvement in the health care people receive.

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Kerala state of 35 million people who speak the language Malayalam, is one of the rare places today that has only 4 deaths from coronavirus, 524 cases confirmed and no community transmission. Here the Guardian looks at the reasons why. The Health minister KK Shailaja started very early on January 23, with a meeting of her rapid response team when the virus was still in China.  She setup a control room and instructed Kerala's 14 districts to do this on Jan. 24. When the first case arrived on Jan. 27 on a plane from Wuhan, Kerala had already adopted the WHO  protocol of test, trace, isolate and support. These passengers were checked for temperature, tested and quarantined. With some at a nearby hospital and others in home isolation. This is all the more amazing considering that Kerala is a state in southern India on the west coast that has a large number of people living and working overseas. Many are in the Gulf countries and the arrival of these refugees could have triggered a second outbreak. This was prevented by careful testing, and contact tracing of clusters.  When one group was evasive and concealed information from an airport surveillance team -arriving from Venice, Italy,  in late Feb- a case was detected back to them.  Contact tracers tracked down all of the hundreds whom they had been in contact with and quarantined them.  By 23 March all flights to 4 Kerala airports from overseas were stopped, including Cochin and Trivandrum. On March 25 India went into lockdown.  Some of the achievements in Kerala include quarantining 170,000 people early. with strict surveillance, which is now down to 21,000. Accomodating and feeding 150,000 migrant workers from other states, before returning them on charter trains to their home areas. A big reason for the success is the high literacy rate in the state. A big emphasis on education and healthcare is a part of the Kerala model. Shailaja is a secondary school teacher, and Health minister. From the days since independence of India in 1947 the state has a strong socialist tradition of taking care of the basics- health, education and public services. It also generates a part of its GDP with income from workers who are overseas.  Another reason for the success in dealing with coronavirus is experience. The state had a virus epidemic called Nipah in 2018 which has become the story for a movie called Virus in Malayalam. There is decentralized public health system in the state and people value their health care facilities, understand and trust the health care authorites. There are hospitals at every level of administration and 10 medical colleges. But trust and education, experience tackling the virus before, are key. Kerala is showing that poor countries can deal effectively with the virus, and create a better life by adopting the right model of creating good societies that value education, healthcare services, better economic structures and distribution of wealth, and  a degree of trust and responsibility found in a state that values public spiritedness. ...

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Growing protests in Brazilian cities of Sao Paulo, Rio de Janeiro, Salvador, Curitiba, Belem, Brasilia, over inflation and the cost of living, government lavish spending on soccer stadiums even as public services of transportation, education and health care are being neglected. Tens of thousands of demonstrators gathered with one estimate of 100,000 for protests in Rio. The protests started with the Free Fare Movement in Porto Alegre, which calls for lower transportation fares, organizing demonstrations against an increase in fares.

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Its unbelievable that the FDA in 1993 would even approve the use of hormones to get more milk from cows. And its unbelievable that Monsanto would promote BST or Posilac against the interests and wishes of millions of people for something as basic as milk. Unbelievable that Monsanto would lobby to prevent milk producers who chose not to use the BST hormone to say so on the label of the milk box. That the secretary of Agriculture banned such labels in Pennsylvania and the Governor had to reverse it after a public uproar shows how insensitive to public opinion and healthy living matters some companies have become.

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Three very important point about a soda tax. First, obesity was rated as the No 1 problem of concern for business leaders at a WSJ conference for business leaders at the beginning of the Obama administration in January 2009. If obesity related costs are taken out of health care, and even though they are not collected as statistics they must be significant, it would reduce the costs of providing universal health insurance. Especially considering that most diseases are exacerbated by obesity, and in some obesity figures as one of the leading causes. Second, Centers for Disease Control Data shows that a typical person now consumes 190 calories a day from sugary drinks, up from 70 a day in the late 1970's. That 120 calorie increase, an almost threefold jump in consumption of sugary sodas, represents one-half of the total daily caloric increase during that span per person, according to C.D.C. data. This is a crucial finding. Just one product alone can cause so much disruption in people's lives. Just as thrifty ways of living are becoming popular in America, better education in schools and communities on good nutrition and eating habits can become popular to reverse the bad habits acquired in the last 20 years, habits that are careless and reckless. Third, research shows that soda drinkers are price sensitive, so that in the past when soda prices went up by 10%, consumption dropped about 8%. So a tax on sugary sodas would make sense. The huge soda sizes at fast food places are one of the signs of the excess of this age with no regard for the consequences to health. living habits....

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The large inequalities in Chilean society are exposed after a transport fare increase leads to violent protests.  A climate tax and fare increases led to protests against inequality in France. The Chilean pension system does not provide the working lass with adequate pensions on which they can retire. Large inequalities in wealth under the Chilean model are seen as a result of free market principles which were enshrined in the constitution of Chile after the departure of Chilean dictator Pinochet. Some of the free market ideas worked to improve living conditions in Chile, others such as the financing of the pension system are seen as having failed to provide for a secure retirement for workers. some of Chile's success can also be attributed to demand and pricing of copper with Chinese demand in the past, a situation confronting Brazil and Argentina also. In Brazil the problem is just the opposite with politicians having granted extremely liberal pensions leaving little room in the budget for public services including basic sanitation.  There are also inadequacies in education and health care based on these free market principles, which favor certain groups and not society at large. Protest movement's goal is a rewriting of the Chilean constitution which president Pinera has declined. ...

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This is what our energy wars, our climate change wars are about in summary. Europe has moved faster than the US, India and China in cutting fossil fuels use over 20 years 2005 to 2025. Europe going from 1525 trillion watt hours to 792- cutting use by half. The US from 2900 to  2553 trillion watt hours just 12%. And China...China tripled its use. This has come at a price as the costs of renewables push up electricity prices beyond what homes and industry can support. UK electricity prices 80% higher than US and half of UK energy users plan to ration its use 2025. Half of electricity costs in UK come from cost and delivery, other half of costs from subsidies of renewables and other. In Germany high electricity costs are hobbling industry and reducing economic growth. Lower electricity prices make the US more attractive than Germany as a place to invest. Another way to look at it- US and Europe cut fossil fuel use by about 1100 trillion watt hours and China increased its use by 4200 trillion watt hours or 4 times what the US and Europe cut in 2024 over 2005. Adding India, Brazil this would be 5-6 times what the US and Europe saved in 2024 over 2005. The "And "strategy of combining reduction in fossil with building renewable capacity is working out compared to dumping fossil in one shove and going all out renewable. There is also the question of equity. China and India argue equity means we should be allowed to use some fossil with renewable for 2.5 billion people's needs. The other side of equity is the US saying the same as "no fossil period" strategy puts the needs of the large part of the population for lower costs of energy  pushed aside as wealthy classes say it is OK. Even when the savings through cuts and sacrifices in US and EU are cut down, cut down by 5-6 fold increase in China, India, Brazil alone. In this kind of climate change war it makes sense not to go with labels such as climate change denial DJT vs China climate change affirming, when China is diluting US-EU climate change entire twenty year savings of 2005-2024 by a factor of 4, 1100 trillion watt hours wiped out by China's 4200 trillion watt hours added. And India, Brazil taking this to a factor of 6. This is why a lot of the discussion with self-righteous indignation becomes less purposeful. What is clear is that every action to cut cost of living in US and EU for large parts of the people is an effort in the right direction as it frees up resources for the fight against climate change, the sense that we are all in the same boat and in the same struggle. The fight against cost of living is part of the long run struggle against climate change. ...

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Side work earns book royalties of $2 million for Barrett on "Listening to the Law" and Ketanji Jackson $3 million Sotomayor and Gorsuch also have books and royalty advances. This provides the public with a closer view of the Justices on the highest Court in the Nation. It also means Justices live a sheltered life away from the concerns of ordinary Americans about cost of living, cost of health care and pharmaceuticals, cost of childcare, cost of education, cost of fentanyl and other drug trafficking to American families and mothers. During the Depression only three Justices the most prominent of whom were Harlan Stone of New Hampshire and Wendell Holmes of Massachusetts supported New Deal legislation to provide government help with other Justices rejecting New Deal legislation right in the middle of the Great Depression when people were literally without food and shelter, without jobs and in despair. Today there is a permanent exhibition of Harlan Stone in the US Supreme Court for the longest service on the Court. It took till 1940 for FDR to appoint new Justices to get the Court to support the New Deal. Today Justice Barrett is a lone voice among Conservatives willing to listen to all opinions on both sides along with but more than Justice Roberts. This is heartening to both sides. Barrett like Justice Sandra O'Connor before her puts great importance on the Constitution's intent and wording, its pages are in her book. O'Connor from a rural ranch in Arizona carried the Constitution with her at all times and had her own books- the Lazy B about growing up on a ranch on the Arizona- New Mexico border in the middle of big country, big sky, so wide an expanse that she writes about it in her preface to her next book The Majesty of the Law citing Wallace Stegner. ...

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Socialist Party in Spain increases its share of the vote to 29%, and emerges as the largest party to form a government with the socialist leaning Podemos party in 2019 elections. It does this by returning to its labour base and working class roots. It pitches a platform of worker's rights, higher taxes on wealthy, environmental roots, issues important to its social democratic roots. The WSJ cites a 57 year old employee of Spain's health service Antonio Benitez, living in Andalusia who says people have a hard time making ends meet, and its about time socialist parties speak of the main pillars of being socialist, without all the deviations to the centre. As free market thinking entered the mindset of leaders in the UK such as Tony Blair and Gerhard Scroder in Germany, Clinton in the U.S., the shift began towards economic efficiency in the tradeoff with equality and social justice. This was aggravated by the effects of international trade and technology in worsening income disparities and unsettling communities in traditional manufacturing. This trend is now being reversed as Socialist parties or Labour allied parties in the UK, Spain,and increasingly in the U.S., take a new position different from the past. A political scientist at the Free University of Amsterdam says its like these parties got hit on the head and now decided to go back to core values around equality, reducing disparities, social justice and the environment. Jeremy Corbyn of the Labour Party in Britain increased Labour's vote in the 2017 elections to 40% up from 30% in 2015. Italy's Socialists won 41% of the vote in 2014 European elections, moved to the centrist positions that made firing workers easier, pension overhauls raising retirement age, leading to losing half its support with 21% ahead of European elections in 2019. Pedro Sanchez of Spain raised the minimum wage by 22% before winning the 2019 elections compared to his predecessor Socialist premier Zapatero who is reported to have said "cutting taxes is left wing." Now workers rights and higher taxes on corporation are on the agenda.  ...

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How Phillips is changing itself to focus on new areas such as elderly health care. The acquisition of Lifeline which is a call service for elderly patients that helps them for independent living. products are being redesigned for consumer health care. One such product is a HeartStart Home Defibrillator which costs $1200 without prescription at drug stores. Ivo Lurvink heads the consumer healthcare division formed in 2004 with the goal of tapping opportunities outside of hospitals. As Phillips new CEO sees it hospitals care is expensive and more and more people are becoming savvy and smart about taking care of themselves with products available and more products need to be designed with them in mind. In targeting needs of elderly Phillips has identified independent living as an important market and has developed a "senior solutions sweet spot" as the kind of customers in this group it would like to target. to get an idea what Phillips is trying to dream up in redesigned or new products, Ivo Lurvink is looking at the broken bones that 350,000 Americans who fall and break bones have to struggle with. Could Philipps come up with a product that detects motion and balance? Philips CEO Gerard Kleisterlee sees the trend as being health care is being increasingly pushed out of hospitals which are expensive and into homes and clinics, and patients are behaving more like consumers and asking smart questions of what will be best for them. Philips has closed most of its electronics factories, its components division, and sold its seminconductor business to private equity firms for $7.4 billion. Its a big shift for a technology company but lower priced Asian imports have convinced Philips that it must make a shift, especially after losses in 2001 of over 2 billion euros and in 2002 of 3 billion euros. The professional medical products division was a bright spot in a recovery with earnings growth of 40%. It sells large equipment to hospitals. Gerard Kleisterlee who took over as CEO of Phillips in 2001 is making a change that is also being made at GE and Siemens as health care becomes increasingly important. Kleisterlee is himself an engineer an after the post tech bubble asked himself "what is the hand of cards that I have and how do I playthem?" Changing its orientation and moving into new products with better margins and less competition in high growth markets such as elderly care is the result of this reassessment. ...

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The impact on polluted cities and urban areas in Asia especially China and India of the huge rise in pollution in recent years with industrial development that did not concern itself with the environment and other causes. How the current slowdown gives a chance to redirect growth on to sustainable and healthy patterns without losing improvements in standards of living, health, education, nutrition, and general well being.

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From the country of "Feierabend" the much appreciated German term for cutting off the workday to do something else like biking or running which is very healthy way of living during the pandemic and everyday, come more German expressions which tell us  more about how to live.  "Na Wie Lauft's" is the German expression most people learn because it means "how are you running", and shows people you care about them. Here DW.com, looks at other German expressions with wonderful pictures of people and scenery in Germany to accompany each expression that has a soothing, calming effect on all. The meanings are given by DW.com, the German national broadcaster which also helps people learn German. "Die Dinge Laufen Lassen," is another German expression that has a Zen nature and is one that one take comfort in for its calming effect. It means "let things run their course, and everything will be alright in the end." "Noch in den Kinderschuhen stecken It means things are only in the early stages, beginning to develop, unfold, the ball is only beginning to roll. With it goes "Laufen Learnen" which means you have to walk before you can run. "Lugen Haben Kurze Beine" means "Lies have short legs." It suggests walking or running. It says you won't get far with lying, you won't get ahead with it, somebody will see through you. "Auf dem Ruder laufen" means to lose control of an oar while rowing a boat to stay on course. It also means hang tight and things will right themselves eventually. And to go with this is the German expression about learning the procedure or techniques for getting the work whatever it is done correctly. Wie est der Ablauf" how will things run, what is the procedure for doing it? Positive expressions from the images of running or walking at the time of the pandemic when this can have a soothing and calming effect.   ...

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The distinction Walter Lippman had drawn in 1939 between New Dealers who were interested in social reform and making the system work better and the New Dealers interested in reducing the power of private business interests in the economic system. Their different interests made it harder to work out a social peace in which business and government developed an healthy partnership to deal with the crisis. These New Dealers clung to taxes, collective bargaining and labor legislation to reduce the power of business interests and altering the balance of social policy. Whereas the reformers only saw spending as the instrument for a recovery, and as a means of improving the living conditions of the people. How does that compare with today?

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Eri Machii, founded AfriMedico, a nonprofit organization designed to deliver medicine to remote regions in countries in Africa. She worked in Niger under a Japanese Overseas Cooperation Volunteers program after two years working as a pharmacist. There she learned about the dangers in Africa in remote villages where travel and delivery expenses were high and infrastructure lacking. She devised a method of Okigusuri for Africa where as in traditional Japan medicines were left in a kit in villages and people paid only for what they used. Payment is done by cell phone using the M-Pesa money transfer system. Maichii learned about okigusiri as a system used in Japan throughout its history in places where infrastructure was lacking, lack of universal health insurance, and large families living together. She found that this was true for distant villages in countries like Tanzania where she implemented the system under AfriMedico. 20 volunteers helped found the organization and Tanzania pharmacist network helped guide them in setting it up. Large amounts of medicine taken at one time reduce the cost of transport. Use of the system of medikits in urban areas helped subsidize the village use. This is a system that has great potential for medicine delivery in many parts of Africa and Asia that have the same problem of access to basic medicine kits- so that treatment can be done earlier in the process for quicker less costly recovery, improving general health conditions. One can think of Indonesia, Philippines, India, Pakistan, Bangladesh, West and East African countries as having potential for wider use of this system. As people pay for only the medicines used using cell phones the system has wide applicability from cost and access point if supported by private and governmental agencies in these countries.   ...

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In his 2019 State of the Union speech Mr. Trump calls for unity but continued emphasis on the border wall and strict immigration. Democrats offered little approval of the speech even when it sounded conciliatory on parental leave and infrastructure. The president continued his criticism of Democratic leaders Schumer and Biden in informal remarks.  The president called immigration a "moral issue," saying "no issue more illustrates the divide between America's working class and America's political class than illegal immigration," that wealthy donors and politicians call for open borders while living behind gates, walls, and guards. This is the first time a president goes into a State of the Union Speech with 37% of Americans supporting him according to a Gallup poll. The only time a U.S. president had less support was in 1983 when Reagan faced a recession and in 2007 and 2008 when Bush faced problems with the Iraq War. Another feature of this House of Representatives in 2019 after the 2018 Congressional elections is that 131 women are now in the House. The president congratulated the women to wide applause.   ...

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