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Vice admiral Henrique Gouveia de Melo, is a former submarine commander who has instilled confidence in Portugal's vaccination drive. The drive had a faltering start in January 2021. Gouveia has reminded Portuguese people of the vaccine campaigns that came before- against measles, polio and other deadly diseases. Public memories of these campaigns including the first national vaccination plan in 1965 have helped take the fully vaccinated percentage to 83%, highest in the European Union. Israel and UK are at 61% and 66% fully vaccinated after starting much earlier.  Spain is also close to Portugal in fully vaccinated people. In Portugal the focus remained on protecting people, and vaccine skeptics played a very small role. Portugal used large scale vaccination centers in sports facilities with the help of the military and municipalities.  Gouveia brought with him a team of 30 military strategists, mathematicians and doctors to work with health ministry officials to coordinate a network of 300 vaccination centers, mostly in municipal sports stadiums, with 5000 doctors, nurses and volunteers. 154,000 jabs were given daily. He is shown in military uniform talking to people, instilling trust and confidence day after day. ...

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DJT appeared on Oz's health show in 2016 as a presidential candidate, and sees OZ as a fellow tv show host, a kindred spirit with a passion for what he is doing. As head of Medicare and Medicaid after afailed effort for a Senate seat from Pennsylvania, Oz is still someone whit a keen sense for the politics as well as what is good for the healthcare of Americans. He shares apassion for good health as a goal for America that was held up by JFK, and his nephew Robert Kennedy Jr who now leads the Make America Health Again movement. Oz fervently believes the time for healthy America is now after many wasted years under Clinton/Bush/Obama when national interests were neglected for places like Bosnia in a historical conflict of Turks and Serbia that goes back centuries (Clinton), in the deserts of Iraq (older Bush), in the mountains of Afghanistan that claimed Brezhnev as a victim the younger Bush followed, two wars prolonged by Obama and closed by DJT and Biden. Something as basic as health and pharmaceutical prices was allowed to get as bad as it is in 2026 with prices through the roof. DJT's plan is to get the pharmaceutical companies to commit to certain prices, to the lowest price they sell the same medicine in Europe. This is what Dr Oz wants to see not just for the next 3 years but put into established practice for the future years.  Oz says about presenting the DJT plan on healthcare to Congress and the Nation- “We didn’t demand that they do it. We said, ‘This is something that is very popular and highly achievable.’ ” Healthcare costs, gas and automobile costs, energy costs, housing costs are all part of the 4-5 costs that are the key elements in the cost of living crisis or affordability crisis that is uppermost on the minds of Americans. Already the Medicare payments to insurers are going to be flat for 2026 compared to 2025, as part of policy to get costs down, push pharmaceutical costs down. ...

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Mayo Clinics 18 month long effort with 400 health policy experts working on the panel has a set of recommendations for the Presidential candidates. It suggests a private system with private insurance companies offering many options and nobody can be turned down. Those least able to afford it would get government help, individuals would pay for the insurance with some help from employers. Since once insured its not dependent on employer its permanent, changing a job would make no difference at all. Interestingly most of the panel experts cited here from Verizon, the Heritage Foundation and others all agree that the present system is coming to a close and a new one has to replace it with coverage for all Americans and a privately based system with contributions made by society and government, by all individuals, and also by employers. Mayo's study, the breadth of the number of experts participating (400 experts), the length of time to understand and come up recommendations (18 months), the respect the institution has among all sectors and groups, should give the consensus view of experts in the US, so that any future health plans do not simply get derailed by partisan opinion, controversy and lobbying....

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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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With 10.3 million workers unemployed according to the Bureau of Labor Statistics, and this includes 2.8 million added this year so far in 2008. Most of the people who lost their jobs also lost their health benefits. This increases the urgency for the Obama administration to come up with action in the health care area as the ranks of the uninsured will grow in 2009.

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What the French take for granted today- 99% of the French people are covered by national health care- started when Charles De Gaulle faced rising scial discontent in the postwar period, and accepted a demand for worker protections. During the postwar period Frenchmen are paying higher taxes, but in the first 30 years because French salaries were growing fast this was not noticeable. With slow growth and rising healthcare costs its getting harder to increase these tax deductions for overall social security, which have reached one third of apaycheck at the low end, say for ataxi driver in Marseilles. So you have the government running deficits of $15 billion in 2004, even after increasing co-payments for routine care and doctors visits. Experts say this could reach $40 billion in 2010 and $90 billion in 2020. In 2007 health care cost the government $300 billion, or 11 % of GDP, (OECD numbers) and the bureaucracy and rules are getting more complicated. This 11% is well below what Americans pay for asystem that leaves out about 50 million people. France ranked 8th on the OECD list in cost per capita, the US at the top. And the French life expectancy is higher at 80.98 vs. 78.11 for the USA, higher by about 3 years. For this cost the system is cost effective according to the OECD. And the French find the American debate abouthealthcare public option "altogether surreal", as the newspaper Le Monde put it. To keep the system in viable form the government is increasing copayments, such as the decrease in reimbursements from 80% to 65% for routine care and doctors visits in 2004. As aresult the deficit dropped to $6 billion in 2008. ut the global economic crisis and rising unemployment has made this grow to estimated $13 billion for 2009. Measures under consideration: increasing hospitalization copayments to $28 a day from $22. To fill this substantial gap for routine care and other costs the French system has private insurance companies called mutuals that offer different policies. Which is where the Fench notion for equal treatment in health care gets distorted because different people can have different coverage. The French though compare their system to the British system and say theirs is not as nationalized as it appears and the Brisih one is much more so. The French system though supervised by the government is different from government run health care as in Britain. French people are free to choose their own doctor who is often a private practitioner. ...

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Everyday activities like gardening, walking, using the outdoors, that are vital for health.

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Jonathan Gruber, the MIT professor, who has done extensive modeling of U.S. health care systems. Gruber advised Massachusetts Governor Romney in crafting the health care law in that state. He also advised the Obama administration in crafting the health care mandate that requires all Americans to buy health insurance to keep costs down. Gruber estimates the number of newly insured Americans could drop to 8 million from an estimated 32 million if the Supreme Court strikes down the health care law mandate. The result he believes will drive insurance premium prices even higher.

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Chile, Mexico and the U.S. rank high in the diabetes rate for top soda consuming countries. In the U.S. the diabetes rate is at 7.7% of the population, in Chile 9.6% and Mexico 9%. Soda consumption per capita was at 165 litres in the U.S., 146 litres in Mexico and 134 litres in Chile, and 145 litres in Argentina where the diabetes rate is at 3.9%, for 2012. A new public service ad in Mexico City subway stations says it all, showing an ad with a soda bottle and the words- "Would you take 12 teaspoonfuls of sugar? Soda is sweet, diabetes isn't." The new Pacto de Mexico agreed to by all major political parties includes the soaring diabetes rate in Mexico as a problem to be tackled, including lunches at public schools and the consumption of coke and sodas by children. A particular acute problem in Mexico is the lack of clean drinking water in many areas and the dependence on coke and sodas for liquids. But bottled water could be used in its place if available at lower prices. One proposal is for a soda tax which could generate $2 billion and be used for setting up clean drinking water fountains in schools and other places. Elected officals in Mexico are firm about the need for action, as Mexico recently became the first country over 100 million inhabitants with the highest obesity rates at 7 adults out of 10 over the age of 20 obese or overweight, and the consequently high diabetes rate. Diabetes is the No. 2 killer in Mexico, and a serious health danger. Coca Cola gets its second highest revenues from Mexico after Europe, and the situation has evolved after years of heavy coke advertising to the point where Coca Cola is taken at every meal by some Mexican families, and is a sign of prestige. The company's response is to fight the public service ads with ads showing people burning off 149 calories by walking. The country now faces a long and uphill fight. Russia is one of the countries which is also conducting a similiar fight against soda drinks. The Bloomberg Philanthropy is financing efforts against soda drinks in Mexico, as part of its campaign against smoking and sodas as health hazards, and this maybe Bloomberg's bigger contribution to society than his service to New York City. Developing middle income countries such as Mexico, Chile, India, China, Brazil, are the hardest hit by soaring diabetes. And the costs to their health systems in 10-20 years from uncontrolled obesity and diabetes will be enormous. The U.S. is a developed country with similiar high rates of obesity and diabetes, with soaring medical costs, and serious problems that strangely have not received the public awareness and efforts that one should expect. ...

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Signup on health exchanges for the Obama healthcare law, Affordable Healthcare Act, crosses 6 million by March 2014. Still unknown are how many have paid premiums, and how many are from the uninsured.

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President Trump says the U.S. could permanently cut off funding to the WHO and revoke U.S. membership if the group does not make changes in the way it operates showing a lack of transparency in its operations and dependence on China. Mr. Trump says the WHO has shown "alarming lack of independence" from Beijing. In a direct letter to the Director-General Tedros Ghebreyesus -"it is clear the missteps by you and your organization in responding to the pandemic have been extremely costly to the world." Mr. Trump gave the WHO 30 days to make "major substantive improvements" or he would cut funding and reevaluate U.S. membership. Mr. Trump said in the letter that the WHO ignored early reports of the virus spreading in Wuhan, failed to share information with other countries. The U.S. which has the largest contribution by far to the WHO was unable to influence the organization. The U.S. has influence in finance at the IMF, the World Bank, and in the tech world, yet this did not extend to important matters of public health. It could be that public health had become an afterthought in the rush to prominence in tech and finance. The contributions of the U.S. exceed anything any other country has made. During the 2 years 2018 and 2019 the U.S. contributed $893 million, according to WHO records, cited in the WSJ. During this period the contribution of China was $86 million with an additional $50 million added recently. The $2 billion Mr. Xi said China will contribute is incorrectly reported as for the WHO, it is what China says it will use to support Africa and other countries in the world to fight the pandemic. ...

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With use of the software technologies and cloud computing Athenahealth hopes to revolutionize the medical records of physician practices. Here Joseph Rago of the WSJ talks to Jonathan Bush, CEO of Athenahealth. Bush says the way things are done now in healthcare there is no choice and choosers, and ther is not thing like a market in health care and people in Washington DC don't understand remotely why a market might be remotely useful. The deep problem in American health care he says is that no one knows the actual value of the services doctors give, not even the doctors, and the complexity of the method of payments keeps everything hidden, as doctor's clerical staff bills your treatment to insurance companies picked by your employer, and pays the doctor through money taken from premiums or foregone wages. Athena designed a program to digitize records and automate billing and is moving into clincal record keeping. It now has 15,000 physicians in 43 states using its program as avirtual office and growth at 30%....

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Milan will host the World Cities Culture Summit in 2020, and the Winter Olympics in 2026 shared with the Alpine town of Cortina. The international book fair of Turin is moving to Milan. The left of centre Mayor Giuseppe Sala has promoted the city to increase tourism by 50%. And foreign investment is increasing for new construction projects with $21 billion to be taken up in the next 15 years. Experts are asking if this is coming at a price as the rest of Italy has stagnated for 20 years, and the rural large city gap is increasing throughout Europe. The flow of professionals to cities such as Milan, Paris, Munich, Berlin, from other towns and cities is creating a huge shift that experts at the Centre of European Reform see as a problem because of the political turmoil, and rising inequality with ever widening gaps between smaller cities and towns and rural areas with the big cities. This is compounded by ageing and demographics such as seen in the eastern part of Germany, and parts of France. Experts call it The Big European Sort, where a sifting or sorting process is increasingly transforming the demographics of European countries and driving polarisation. This process is also happening in the U.S. Experts say the big cities benefitted from the change with the European single market and the European Union. Places where working class people live are not seeing and increase in wealth which is disproportionately going to professionals clustered in big cities. Deindustrialisation has turned places like Mezio only 20 miles from Milan into industrial ruins. Towns that once voted socialist are now voting far right in these hollowed out industrial places. In the U.S. and in Europe the process was exacerbated by the flow of cheap imports from Asia hollowing out factories in regions around big cities, and by the growth of services industry in big cities with globalization in finance, legal, and other professional services. Fro 1980 to 1995 Paris region lost about $5.5 billion in industrial output and gained $20 billion in services output that also aligns with globalization in areas such as finance, according to CER, Eurostat. The process had accelerated in 1995-2020. By telling this story about Milan and the Lombard region around it like Mezio, The Guardian is saying it is time to look at how everything works together rather than breaking apart- citing the Finnish architect Saarinen about how a chair fits into a room, a room into a house, and a house into its environment, an environment in a city. So the question is how can we build the future by seeing that the city fits into a region, and a region fits into a country. As a young professional described this on BBC television interview recently this is a difficult period with the ability to design the future seemingly snatched away by the times, but also an opportunity to rethink and take the actions today for a better tomorrow for all. This is part of the coverage on Cities in The Guardian looking at how cities can work, and how cities can become part of healthy regions, for organic growth. ...

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The public and the NHS pay a lot for childhood obesity. Starmer is doing something about it. He plans to put junk food television ads past 9 pm, ban high sugar and salt, high fat food online ads. Ban on high cafeeine energy drinks. And giving councils power to prevent fast food outlets opening near schools.

The plan includes checkups at workplaces for adults.

Starmer said-

There’s diet, there’s healthy lifestyle, we are going to have to get into that space. I know some prevention measures will be controversial but I’m prepared to be bold, even in the face of loud opposition. Some of our changes won’t be universally popular, we know that, but I will do the right thing for our NHS, our economy and our children.”

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Senate Finance Committee chairman says Senate Democrats have found ways to reduce the cost of the health care plan from $1.6 trillion to $1 trillion. A tax on some employer provided health benefits, cuts in Medicare and Medicaid spending, employers helping to pay the cost of health insurance for low-income workers, and limiting the eligibility for subsidies to households with incomes at 3 times the poverty level or $66,150, instead of 4 times the poverty level. Also a reduction in the plan to give tax credits to small businesses to help them buy insurance. And expansion of Medicad would be delayed to 2013.

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Walmart is going to require employees to use certain hospitals for costly spine surgeries, an effort to weed out unnecessary procedures and lower healthcare costs. The retailer earlier used a voluntary scheme to get employees to use the hospitals offering lower cost quality care, but found that half of the people needing spine surgery who volunteered to travel decided not to undergo expensive spine surgery. A spinal fusion surgery costs $77,000 at Mayo Clinic which tries to first see if other options of physical therapy can do the job. Walmart has insurance coverage for 1 million people.

Costs are going up and up. The average cost of family health plans from employers is up 5% this year to $20,000, with workers paying one third of cost, a survey by Kaiser Family Foundation shows. 

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The vaccine cost varies with the company Astra Zeneca at $4 and Moderna at $25. Government money is taking away much of the risk for manufacturers. The U.S. government has allocated massive investments with different manufacturers to ensure that a vaccine is available. Worldwide demand is about 2 billion doses over 2 years. Seven manufacturers have joined together to reassure the public that a vaccine will be tested carefully for safety and effectiveness. Some manufacturers excluding Pfizer and Moderna have stated that the vaccine will be provided at cost.

To return to some level of normal economy and people able to live normal lives the vaccine has to be available to all people at an affordable and widely available level.

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President Biden signs the $379 billion Climate bill and tax legislation into law. Mr. Biden told a White House crowd to standing ovation "This is the biggest Climate Bill ever." At the signing event Mr. Biden tells Senator Manchin  "Joe, I never had a doubt." Senator Schumer quietly negotiated the final bill with Senator Manchin in one crucial week just recently to get it through a 50-50 split US Senate.