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WSJ looks at the changes in the way medicine should be practiced in the light of what we have learned from the pandemic.  Medicine practiced before the pandemic and still today relies mainly on a visit to the doctor or specialist who is short of time. There is a shortage of doctors. Patients have many illnesses as a result of decades of neglect of proper nutrition, and exercize habits. Obesity is at about 40% in the U.S. about 30% in the UK and 17% in France, and high also in other parts of the world. These high rates were unknown throughout history and result in many illnesses and increase by four times the vulnerability to the coronavirus. One authority in medicine calls obesity pouring gasoline on a fire for effects of the virus.  A doctor's appointment with doctors short of time with no coordination around a whole range of factors related to obesity, illnesses, health checkups, mental health, is now seen as a heavily handicapped way to practice medicine or for patient healthcare and wellbeing. The alternative is discussed here as the way forward. A  team will be responsible for a patient's care not just an individual doctor. The team would care for general health after a patient's checkup, cover individual illnesses, weight issues, mental health, exercize nutritional needs and other good healthcare habits. Instead of relying on doctors at a time of shortages of doctors the team would be led by nurse practitioners.  A nurse practitioner is someone with a bachelors degree and a masters degree or doctoral degree in nursing with 1000 hours of clinical training. Studies have shown that they are effective and even more effective than individual doctors. Today particularly with the problem of doctors with limited time compounded by the built up problems of decades of bad habits in nutrition and exercize and poor "cultural" habits getting entrenched, there has never been a greater need for a better way to practice real healthcare for a person's wellbeing. Particularly in rural areas with an even larger shortage of doctors the health practitioner led team will play a big role. Patients will under this setting receive more care virtually and get more followup care by phone and video messaging. The numbers tell the story- there are shortages of doctors in USA, Europe, Africa, Latin America and Asia. In the U.S. shortage of doctors is 55,000 projected to 2033 by Association of American Medical Colleges. There are 290,000 nurse practitioners licensed in the U.S. and 131,0000 physician assistants. The goal will be to get an adequate number of nurse practitioners licensed in this decade to take care of these teams. The pandemic has made virtual visits to doctors and nurse practitioners popular. Medicine reimbursement should and would be practiced on the basis of how well a patient is doing not on a fee for each micro service that is delivered. For this to happen the teams led by the nurse practitioner have to commit to patient education of the benefits from good practices and good habits for nutrition, exercize, caring for oneself. A doctor short of time is hardly the person to carry on this patient education which is where the major opportunities for a new system arise. The virtual care also provides a new medium for patient education and awareness of the risks of getting illnesses, preventive actions to be taken in advance. One approach being tested in California and Texas is for a monthly fee for patients more payments by health plans to doctors or healthcare teams if the patient is healthier. Additional health professionals are added to the team including health coaches, dietitians and medical assistants to increase its effectiveness in counseling and education and monitoring.  The nurse practitioner team approach is already being practiced in parts of the U.S. including the example of New Hampshire shown here, and is predicted to be the approach for primary care in the next decade. ...

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One of the opportunities of this pandemic is that it offers a chance to think anew and act anew. Where in Lincoln's words "the dogmas of the past are inadequate for the stormy present, as our case is new we must think anew and act anew." Here Vladimir Putin offers his assessment of how the pandemic calls for a fresh approach to reviving De Gaulle and other postwar European leaders vision of Europe that spanned the entire continent culturally including Russia. He accepts mistakes have been made by all sides and the title of the article by Putin is "Be Open, Despite the Past." The Russian Embassy in Germany contacted De Zeit for publication of an article by Putin, and it can be seen as part of the Russian response to president Biden's effort to build a new cooperative relationship with Russia that is in the best interests of the US, Russia, Germany, the European Union and also of India which has a cooperative relationship with Russia. There is the danger that it could be seen as reported in The Times of London and comments posted seeing it against distrust built around Ukraine and Eastern Europe. The 670 Comments in Germany on De Zeit site on the article reflect a more German perspective of being a close neighbor that suffered so much from the war that left millions dead on both sides. One German commenter says his father and grandfather were forcibly recruited to fight in France and Russia and suffered much in wartime. The occasion is the 80th anniversary of the German invasion of Russia in World War II. Some of what Putin has to say- "We hoped that the end of the Cold War would mean victory for all of Europe. It would not be long before Charles De Gaulle's vision of a unified continent would become a reality, more culturally and civilizationally from Lisbon to Vladivostock." Russia has changed, Russians see themselves as European, as part of the larger European Union, culturally and civilizationally. This is not the old Russia of the Cold War or of the Soviet period. "NATO itself a relic of the Cold War, created out of a confrontation from that time." Not objecting to NATO but to the expansion of NATO to Russia's borders. But saying this has not got us anywhere where our heart not our brain says we ought to go. Lets try again to draw different conclusions from what we have seen. Its important to think anew because "we are all confronted with the common challenges of the pandemic and its extremely serious social and economic consequences." "The entire prosperity and security of our common continent are only possible through the combined efforts of all our countries, including Russia because Russia is one of the largest European states. Wed feel our inseparable cultural and economic ties to Europe." "We simply cannot afford to carry around the burden of previous misunderstandings, hurts, conflicts and mistakes. A burden that prevents us from solving current problems. We are convinced that we all have to admit and correct these mistakes. Our common and undisputed goal is to ensure the security of the continent without dividing lines. And to create a unified space for equal cooperation and collective development in the interests of the prosperity of Europe and of the whole world." President Biden was right to think anew and act anew in Geneva, and to "disenthrall ourselves" from old ways of thinking, and for rising to the occasion. Jill Biden said of president Biden's preparation for the meeting in Geneva- "Hell, he was overprepared," and it showed Biden's genuine feeling and effort that he owed it "in the interests of Europe and the world."       ...

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The ECB's executive board's proposal is for 50 billion euros ($58 billion) in bond buying each month for the next 12 months. The ECB's executive board meets on Jan 20, 2015, to discuss the proposal.

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As auto sales decline in Spain, France, Italy and other parts of Europe auto companies are looking at improving efficiency and closing inefficient plants. Italy is tackling labor laws that prevented a revamping of the auto industry to improve productivity. New laws make it possible for companies like Fiat to hire or fire workers rather than having to place them on a state backed temporary layoff program that pays workers two thirds of their salaries while not working. Chrysler-Fiat CEO Marchionne sees sales dropping below 10 million units from the 13.1 million in 2011 if the euro were to disintegrate. With the higher efficiency of Fiat's plants in Poland and other parts of Eastern Europe, Marchionne is not willing to make any exceptions for the Italian system any longer. In 2009 Fiat's plant in Tychy, Poland, making the Fiat 500, made 600,000 cars with 6,100 workers, whereas the five largest Italian plants made 650,000 cars with 22,000 workers. Marchionne put forward his 5 year revamp of Italian operations in April 2010 with an investment of 16 billion euros. Unions were asked to agree to new work rules in exchange- shorter breaks, reduced absenteeism, doubling of overtime hours if needed, and pay tied to performance in addition to seniority. In the fall of 2010 Fiat shifted the production of the Fiat 500L to Serbia. Following this unions agreed to the new rules. One of the plants revamped was the Pomigliano plant which would turn out lower cost Pandas instead of the Alfa Romeos at a cost of 800 million euros to redesign the plant for efficient manufacturing. The new plant requires fewer workers and only 3000 of the 5000 workers at the plant have been hired. Priority was given to younger workers. Marchionne sees the revival of the manufacturing plants in Italy closely linked with his plan to import Italian cars to the American market because of the declining sales in Europe. The transformation of the auto industry and Chrysler was achieved by changing work rules and reducing labor costs. A similiar process is now underway in Italy....

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The merger between U.S. based Omnicom Group and France based Publicis Groupe SA, two of the largest ad agencies. The merger is a response to the increasing shift to digital advertising, the shift to advertising being sold in automated trading, and data driven analysis. In all these shifts digital companies such as Google and Facebook have strong advantages. Around 22% of global ad spending is now digital, according to emarketer, with forecasts showing this going up to 27% by 2017. Automated buying of ad space is taking off. U.S. advertisers are expected to spend $3.4 billion on real-time bidding. Omnicom's CEO, John Wren tells analysts: "Digital buying of media is done by machines, as if you are standing on the floor of the Nasdaq as opposed to traditional media shop. I hold the long term belief that eventually traditional media, or a lot of traditional media is going to be purchased that way." Just as computers have upended the environment for traditional players such as the NYSE creating new opportunities for Intercontinental Exchange (ICE), computers and the internet are changing the advertising environment. CEO Levy of Publicis Groupe SA says the data explosion, Big Data, is also creating a new playing field in which companies such as Google and Facebook have advantages. In a statement about the deal he says: "the communication and marketing landscape has undergone dramatic changes in recent years, including the exponential development of new media giants, the explosion of Big Data, blurring of roles of all players and profound changes in consumer behaviour." The merger will provide the new company the scale to develop these resources to compete with digital companies like Google and new entrants such as Salesforce.com and Adobe Systems. Omnicom has agencies BBDO, TBWA Worldwide, media buyer OMD. Publicis has Leo Burnett and Saatchi & Saatchi, media buyer Starcom MediaVest and digital agency Razorfish. The new Publicis Omnicom Group will have combined revenue of about $23 billion for 2012, and passes WPP Group PLC's $15.95 billion revenue. It will still be much smaller than Google with about 3 times WPP's revenue, and Google's advantage in storing trillions of pieces of data about user behaviour....

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What Krugman makes of the $1.089 trillion dollar U.S. deficit for fiscal year ending in Sept. 2012. He points out that the U.S. can have a stable to declining debt to GDP ratio with $400 billion debt. He cites the Clinton years (1992-2000) when the debt to GDP ratio declined from 49% to 33% with steady growth. What about the remaining $600 billion. He attributes this mostly to temporary factors which are reversible as growth picks up. Of this remaining excess deficit he says $400 billion is from lower tax payments to Treasury because of the 2008 economic crisis and the recession that followed. This includes the payroll tax cut which is also temporary to keep up consumer spending in the recession. The $150 billion is from unemployment insurance, food stamps, and other aid which is also reversed once growth picks up. He places emphasis on restoring economic growth as early as possible and reducing unemployment and using the recession for business to continue to invest in R&D, productivity, and government to preserve the social fabric, invest in education, and provide incentives for growth. S&P Nov. 8 report says the net government debt to GDP ratio is estimated to be over 80% in 2013. It will have to stabilize at current levels for S&P to preserve the U.S. credit rating, says S&P executive Chambers. The higher debt to GDP ratio in 2013 and lower growth rates expected makes the situation different from the lower debt to GDP ratios during the Clinton period. Britain, France and other major industrialized nations with political parties at either end of the political specrum have also chosen to stabilize or reduce debt to GDP ratios rather than take on the risks of them going much higher. The U.S. has the added problem of health care costs out of control with an aging population and about 17.9% of GDP going to healthcare costs in 2010 expected to increase significantly, as Medicare actuaries estimate enrollee numbers jump to 80 million in 2030 from 50 million in 2012. Democrats and Republicans have largely sidestepped this underlying problem in fiscal cliff negotiations....

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Chrysler's net income increased in 2012 to $1.67 billion, up from the $183 million in 2011. Revenue was $65.8 billion in 2012, increasing 19.6% over $55 billion in 2011. To see what impact taking ownership stake in Chrysler over four years has accomplished for Fiat one has to consider the losses Fiat would suffer without Chrysler. In France the lack of a foreign presence required Peugeot Citroen to look for government aid. Even the initial investment in Chrysler by Fiat made use of the $2 billion in a breakup fee for an agreement Fiat signed with GM before 2007. Showing the huge dividends Fiat has gained from the new management team installed at Fiat in the last decade. This makeover of Fiat was done using younger managers under an executive from outside the auto industry. That alone would have not saved Fiat, leveraging the skills at Chrysler was a crucial opportunity. Fiat now has a 58.5% stake in Chrysler. Taken alone Fiat would lose $1.04 billion euros or $1.4 billion in 2012, and would need government aid, even after the turnaround under Marchionne, showing how crucial taking the initiative to make the early investment in Chrysler was to saving Fiat. Sensing this opportunity when first Daimler and then Cerberus private equity failed with Chrysler, taking advantage of the government aid to Chrysler after the 2008 financial crisis, and creating a partnership with the government on issues such as fuel efficiency, may be the biggest achievements of Marchionne and his team of managers. Sensing the opportunity to get geographical diversification by taking on Chrysler separated Fiat from Peugeot Citroen, which lacked this diversification and had to turn to the French government for aid. Taking on the Chrysler venture, sensing the timing and balancing the risk with management knowhow, securing the right kind of deal with the U.S. government to reduce risks in 2008, turning Fiat technology in small cars into a saleable asset, and managing the relationship with the Obama administration, separates Marchionne and his team from a management team that would have seen its role in a purely Italian turnaround which would have not lasted. ...

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How the IMF conditionality has changed in the 2009 global economic crisis. The IMF head, Dominique Strauss-Kahn of France, is aware how sensitive nations around the world have become to the word IMF. So much so that it has even suggested removing the word IMF from loans to get takers. The IMF conditons worsened the S. Korean financial crisis in 1998. See link to this. This time Kahn has advocated that the developed countries of Europe and the USA increase stimulus spending to 2% of GDP.And there are fewer calls for cutting spending in developing countries offered help by the IMF. Pakistan was asked to increase interest rates by 3% but actually increased them by 2% to fight inflation. But to get some idea how the IMF is viewed with suspicion and hostility in many countries one has to listen to comments made. The move for Pakistan was so unpopular in 2008 that Mohsin Khan a top IMF official says he met with agroup of generals to get their backing. Some IMF officials insistend on a 10% rate increase. Something like that would have led to riots in Pakistani cities. IMF loaned Pakistan $7.6 billion. When S. Korea said no to the IMF credit line, Lee Hyoung-ryoul, a Korean Finance Ministry official said that S. Koreans tremble and financial markets turn sensitive whenever they hear the word "IMF." This time Brazil, S. Korea and Mexico, were offered condition free credit lines. But it has found no takers from these three conuntries, so badly is the IMF viewed in developing countries. Even though it appears that Kahn, in the small club of western nation's officials and staff that form the governing body of the IMF, is trying to give the IMF a new image, its just so bad and the views of the old timers at the IMF on spending or interest rates so contrary to the needs of people in the developed and developing countries, that a new generation of people in finance and economics will be needed before real change is established. ...

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The Logan lower cost model produced by Renault's Romanian affiliate Automobile Dacia SA is setting a pattern that is being looked at as a model for the future throughout Renault. It is combining the advantages of Japanese manufacturing methods with their attention to detail and good practices evident at Nissan, Renault's partner company, with the cost conscious methods evident in operations in a Renault joint venture with Mahindra and Mahindra of India. Dacia Automobile was a Soviet era plant, and Renault has modernized it but keeps a more labor intensive attitude with good basics operation here, in contrast to the trend to automate everything and use robots extensively that became popular at other plants in Europe, U.S., and Japan. As Renault managers in France and its overseas operations look at both the expanding markets for lower cost cars and the profitability of the Dacia plant in Romania, it is becoming a model to be imitated. Other plants built earlier now look overautomated and costly for manufacturing cars in a cost conscious pricing sensitive competitive market that automakers face. Logan is contributing to Renault's bottom line, and may help it in reaching the 6% in operating margins that is a new goal for Renault for 2009. Dacia Automobile S.A. initally owned 55% by Renault is now 99% owned by Renault. It has sales of 2 billion euros ,in 2007 with revenue increase of 30% over 2006. The profit was 100 million euros in 2007. It employs 14,000 workers and Renault's investment has reached 1 billion euros upto this point. The plant turns out 60 cars per hour. Compare this with a similiar investment by VW in a Soviet era Skoda automobile plant in the Czech Republic, where VW started with an inital investment in part ownership and ended up in full ownership of Skoda with large investments in modernizing Skoda, and the success in selling Skoda cars known for their good quality. The Skoda is expected to sell at the million dollar sales level in 2010 and is the fastest growing brand in Europe. It ties with Honda in quality surveys. ...

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Privileged minorities ethnic or white among large native populations. Amy Chua argues that free markets that empower the white minority giving it special privileged status, and democracy that empowers the native peoples, leads to conflict and exacerbates tensions. She talks about the Venezuelan experience with Chavez. Before Chavez Venezuela had free markets and elections in which two parties alternately controlled the government. Even before Reagan era and post Reagan era promotion of free markets and democracy this existed. However people were fed up with corruption and the native peoples did not see their lives improve. They tried a populist politician in Chavez who redistributes petroleum wealth to the poorer classes. Some of this tension is inevitable, but if all sides use good sense and understanding, and manage this tension constructively there still exists a better situation than there was before- when looking at overall public welfare and considering the welfare of the people and the educated professional classes. When there is a failure to work together it shows the shortsightedness of both sides, the poor understanding and lack of joint effort for mutual benefits, and not the shortsightedness of free markets and democracy. And one is not talking of free markets as American type, but free markets as crafted for each individual country based on its own history, culture, time and place, as free markets are not the same in America, Britain, Germany, France, Japan and South Korea, China and India in the post war period. China is not even a democracy and has practiced one of the wildest kind of free market economy based on its own unique situation, calculated consensus to use exports, foreign investment, and domestic investment in infrastructure as engines of development- its own peculiar use of free market ideas for its own situation. If it works, for as long as it works its good. Now as the situation changes with loss of export markets expected in 2009, China is changing to another kind of use of free market ideas tailored to its idea of free markets for development of the Chinese economy and distribution of benefits to urban and rural areas. ...

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German chancellor Merkel will visit Greece in an effort to mend strained relations. She accepted an invitation from Antonis Samaras, the prime minsiter of Greece after recent elections. It gives Merkel an opportunity to show her support for Greece and makes it more likely that Greece will remain in the eurozone.

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Questions raised in Germany whether Chancellor Merkel is losing touch with ordinary Germans with her statements on immigration. Merkel was critical of the Dresden protests on immigration saying the protestors had "prejudice, coldness, and even hatred in their hearts." This will present a new challenge to Merkel in 2015 as more ordinary Europeans question whether openness in immigration policies have gone too far.

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A former deputy foreign minister of Germany, Ischinger, says the Germans support the European Union and the idea of an integrated Europe, but not the euro. Before the euro Germans had a stable currency. For Germans the euro by itself does not make a case for support. It is the idea of the euro as the way or means to achieve European integration that has support in Germany. This subtle difference is important, says Ischinger, and explains why Germans showed hesitation in backing a rescue effort, and yet the German parliament voted to support the European Financial Stability Fund. The German people are cautious after the experience of reunification and the global financial crisis, and are aware that their prosperity depends on the fragility of an export dependent model. For this reason the rescue effort has to be presented and seen as a way to save the European Union for it to get the backing in Germany that it needs.

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The 2015 budget for the European Union borders agency Frontex was increased by 17.5% from 97 million euros to 114 million euros, yet it remains underfunded with the huge influx of refugees through Greece and from Turkey. For 2016 the budget increases by 54% to 176 million euros. It is based in Warsaw, Poland. It does not have its own border guards, planes and ships, which are provided to it by the member states of the EU and paid for from its budget. It was not deisigned to address a problem of this magnitude at EU borders and some new form of the agency needs to be developed.