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How Integrative Medicine, changes in lifestyle and diet, yoga and exercize, meditation, no smoking habits, can add up to changes in the nation's health that work more effectively than new drugs to prevent or delay the onset and progression of chronic diseases like diabetes, asthma, heart disease and of obesity, etc that consume 75% of the costs in the $2.1 trillion spent on medical care in the USA. Shockingly 95% of these costs are incurred after the onset of the disease, proving that prevention is simply not an important part of the equation.

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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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Jack Hough points out the problem with TIPS, Treasury Inflation Protected Securities. The CPI-U that is used to calculate the inflation for TIPS is not representative of inflation for the average household. It understates the cost of gasoline, tution increases for kids in school, and price increases for prescription medicines. Prescription drugs have a weighting of only 1.25%, college tution only 1.53%. The CPI-U index went up by about 3.9% in 2011, and at the same time the gasoline portion increased by 33%, for households spending a lot on commuting to work. Another problem is slowing inflation- with inflation slowing to 2%. Compared to TIPS the alternative of dividend payments by cash rich companies with secure market positions are a better hedge against inflation.

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The Commission on Race and Ethnic Disparities in the UK in its report published on March 29, 2021, says Britain has become a more open society and that racial inequalities in education and employment have narrowed. Bangladeshi, Indian and African backgrounds children are performing better across eight GCSE's using scores on average, than white British children, an amazing story. It says "this should be regarded as a model for white majority countries."  Much of this could be the result of strong families, ethic of hard work, help from the idea that hardship brings virtue, and single minded determination of families and children to excel in studies, showing that obstacles such as language and other economic barriers can not only be overcome but actually be a motivational influence. This should translate into more success in the workplace. The report says this is happening in the workplace with diversity in the professions of medicine, law and teaching, and shrinking pay gap with white population. Criticism persists and is true for the top of the public and private sectors, the report says. Yet it should be uppermost in mind that in terms of number of people benefitted it is important- that the process be strong at the ground level so that the talented individual can then move to the higher ranks. To do this the report says British employers should go for more "evidence-based alternatives" than let "unconscious bias training" prevail without quite realizing that this is happening in the absence of initiative. Much of what happens in Britain is also true for the US and other places with British based educational systems such as Australia, Canada, New Zealand, and India, Bangladesh, Pakistan, Sri Lanka. In South Asia there are disadvantaged minorities because of old caste based inequalities and bias. There the problem also has its perverse forms in which politically motivated moves to assign quotas are made before the emphasis on education and investment in education for disadvantaged minorities. This is leading to a general decline in education in government or public schools and reliance on private sector schools to provide quality education. A process seen in Latin American countries such as Mexico and Brazil that also involves public sector unions and their control of who gets hired and how. The result is that huge problems not entirely visible like an iceberg that cripples ships or economies is happening in these countries, and the focus is almost entirely on the disparities in British schools where progress is actually being made with results, intentions backed by will to accomplish. ...

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The Washington Post survey of 1200 readers on how the Republican healthcare plan of Speaker Ryan and the House of Representatives looks to them, how it affects them in their lives. Here Somasekhar of the Post gives the stories of 5 Americans. Some see the prospect of losing their insurance under the Republican plan even as they reach an older age, others a smaller segment says the Post, whose premiums jumped under the Affordable Care Act say they faced high premiums and high deductibles. The Post says the large majority of opinions have expressed anxiety over the proposed Republican Ryan House plan for healthcare. One of them is an uninsured poor farmer, Mr. Woosley,  income about $18000 who gained benefit from expanded Medicaid under the Affordable Care Act,  one Mr. Smith, 32 years, a personal injury attorney who faces paying $10,000 if he did not take insurance and $10,000 if he took insurance because of high premiums so a wash either way deciding to do without it, one a tech worker Mrs. Powers, 62 years, income $22,000 on year and $4000 the next, from middle class during the tech boom but facing fewer opportunities and uncertain income from part time work, hit by the deep recession facing fewer opportunities as she gets older and now the prospect of losing insurance without government subsidies, one who is from the middle class who sees little benefit from the Affordable Care Act and is forgoing insurance because of the high premiums yet faces a penalty for not being insured under the ACA, another Mr. Blanchard, 52 years, is from the middle class, a computer programmer who lost his job in downsizing, earns $100,000 as a consultant self-employed, pays $767 in premium a month and relies on the Affordable Care Act which helps him gain freedom from working at a company that could downsize,  another is a middle class programmer Mr Riffle,age 44, and his wife, who does not qualify for a subsidy with a $71,000 family salary from working 4 jobs between himself and his wife- this person finds it too expensive for his salary to buy insurance $900 a month and $14,000 deductible under the Affordable Care Act. His views are worth listening to as they go to the crux of the problem- he says he may not be any better with the Republican plan. He sees the real problem as the high cost of health care in the U.S. and the only way this can be fixed is for members of Congress to be asked to use the insurance exchanges they create. If this sample is representative it shows that there are real problems with both the Affordable Care Act and the Republican plan, that the high cost of health care the problem lurking behind every plan that does not squarely address this, and till that happens and members of Congress experience what ordinary people face, this problem can never by fully solved.   Woosley, Smith, Powers, Blanchard, Riffle, and their personal experience is at the crux of what is right and wrong  with the Affordable Care Act, and also with the new Republican plan of Speaker Ryan and the House of Representatives. For every Woosley, Powers and Blanchard who benefit, there is a Smith and a Riffle who are indifferent or are affected by the high cost under Affordable Care Act and the current system of medical care with its high cost. The Affordable Care Act does not  tackle high cost, for that to happen the culture in America that makes it possible and acceptable to charge high prices must change. Another problem apart from bringing health care costs is that any solution needs to have the whole country behind it. If the notion that all people are entitled to basic health care is to stand, the whole country needs to believe it as they do in countries like France, Britain, Germany and Japan. If this has to be made a workable proposition health care has to be offered at a price that makes this possible to achieve, and that idea also needs the deep and broad sense of support from the culture in America similar to that in these other countries. Until that happens politicians in America will get elected and turned out of office in turns on issues such as health care, based on which side they take and which problems they choose not to face squarely and responsibly. ...