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Where do you place a winner of the Democratic primary in Maine, Graham Plattner, an oyster farmer who dropped out of college at George Washington University, served briefly in the Middle East wars of Bush and Obama, and had PTSD. Is he working class, middle working class or is he from a downwardly mobile professional class considering he has parents who are well educated and father a prominent lawyer in Maine? Plattner easily defeated a 3 term governor of Maine with his average working class demeanor and language. He is for universal health care, (Medicare for All) universal child care, affordable housing, affordable college. Politics in the US has been moving away from the simple divisions before 1950 created by the Industrial Revolution- the workers in factories and the owners of capital allied with the professional middle class. The few owners of capital mostly college educated allied with people from the non college educated workers in factories who are conservative in their values and beliefs and on the other side the college educated professional middle class now downwardly mobile because of the many recessions and high unemployment from frequent financial crises, with college costing $80,000 a year putting them in deep debt. There is today in the WSJ a story of a professional worker who at $194,000 a year salary is not able to payoff $15000 debt which owners of capital have set at 26% interest and is in downward spiral. Some of this comes from large college and other debt. There is says WSJ Analysis $1.25 trillion in credit card debt alone with highest delinquency rates in decades in 2026. Cost of living has only made things worse and some of this happened as Biden poured money into the economy to help people hurt by the pandemic, yet with some short run consequences with demand strong businesses including hotels, restaurants and grocery stores, auto dealers, jacking up their prices by over 20% in 1 year and Biden failing to respond, getting overwhelmed by open borders migrants under Mayorkas and Harris (also hit by a sudden Venezuelan migrant influx). This is the America one has today- a confusing mix. This in reality means Democrats may take issue with Democrats, Republicans take issue with Republicans, and Democrats join with Republicans on issue by issue basis. It might actually be rational than irrational. On cultural issues if the country has gone over its head and moved too fast on some issues that are not for the general public good, people of different backgrounds can come together to get the best path. On economic issues things are never so straightforward, there are unpredictable consequences and the rules of economics are really not so straightforward either.  Providing relief can mean the government shouldering the burden as during the pandemic which it should, yet with caution as businesses can use the excess demand to raise prices and one is back to square one with everybody worse off as happened with Biden. Migrant flows and fears of insecurity in public spaces can lead to a severe public "discomfort that can waylay the best intentions of a Harris or Biden, leading to public "backlash." In fact the title of a recent book is "Whiplash." Current books include Floridan Marco Rubio's "Decade's of Decadence- How our Spoiled Elites Blew America's Inheritance of Liberty, Security and Prosperity." Rubio means it. Its authentic because as Rubio says repeatedly, his parents could make a living in the 1960's working in a factory with decent wages, low cost of living and low cost of college, the arithmetic between salaries and what you needed for decent home in suburbs and sending children to good public schools, then to college, all adding up. The result is that Rubio could go to college and serve in the Florida legislature. Rubio says in 2026, after the elites under Bush and Obama and faulty economic theory shipped all of our factories to China, that the story of his parents and his education would simply be impossible. This is what he told people in India on his first visit last week. His parents were Cuban immigrants, yet he identifies with Spain and with western civilization, a devout Roman Catholic. Rubio is a Republican, and is in large contrast with Alejandro Mayorkas, also from Cuba, and Biden's Head of Homeland Security. This is the mix of people and representatives in Congress,  business people, small business owners, professionals, that we have today in 2026 in the US. Plattner and Rubio, one a Democrat and one a Republican- both have something in common. Plattner also has general disdain for "the corporate interests, the billionaires, the Washington DC elites, and the establishment politicians."  The winds are blowing in the direction of getting things right- remembering that Eisenhower continued the work of the Kennedy and LBJ administrations (Eisenhower built the Interstate Highway System for instance, and LBJ gave America Social Security and Medicare). Before that Franklin Roosevelt a Democrat built on the work of his uncle Republican Theodore Roosevelt (TR gave America the idea of good governance and built the US Navy, FDR fought the Depression and stabilized a faltering economy after mistakes made by Republican Herbert Hoover could have happened even if Hoover was a Democrat. FDR was himself from a wealthy New York family and when he first met fellow New Yorker Frances Perkins before his struggle with polio, a haughty New York gentleman. That was before Frances Perkins as FDR's Labor Secretary joined forces with Roosevelt to give New York a modernized administration governance structure by 1940 that was applied to all 51 states after 1950. It allied labor with capital with fairness for all, and was the first such modern structure of this size the world had ever seen, which was the fundamental strength of the United States of America. It was imitated in Asia, first in the Shanghai region then China, and first in the Ahmedabad region and now India. The US is faced with the challenge of recreating and rebuilding this today, as first China, then India remind America of its roots which they have followed in their own style and culture.  First good governance, then good institutional structures, alligning labor and capital with fairness for all, strong affordable + accessible educational and healthcare systems, and investments of capital and labor for infrastructure + industrial development. ...

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Frances tax system places 40% tax on single earner family with 2 children compared to 20% in the US. France debates how to pass the budget and how to meet budget shortfalls in revenue, where to tax. France's top tax bracket is already at 55%, the second highest in Europe, which does not make the job of setting taxes easier. Additional 1.9 billion euros was to be raised by raising the tax rate for families that had tax liability of 20% if they made over 250,000 euros. This has raised 400 million euros only in 2025. This editorial in the Washington Post is critical of the French tax structure and says it is not just the rich who end up with higher taxes. It says that the average French single worker gets to keep only 53% of income after taxes, whereas American average single worker who gets to keep 70%. The extra 20% could be what the American worker pays for health care if as in some cases health care has become so costly in the US as to cost more than a mortgage, as reported in the WSJ in January 2026. Can government buy healthcare more efficiently and distribute it than families on their own. In the case of pharmacy products would removing the power to negotiate  prices with pharmaceutical companies conducted in government run by special interest groups as happened under US president Bush make it so expensive to buy pharmaceutical products that the advantage of smaller taxes is destroyed by a perverse healthcare system run by special interest groups with help of lobbyists. This is just to show that yes the US tax system with lower taxes can fail when other things go wrong in managing crtical costs such as healthcare and housing.   ...

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How the French health care system works. France comes in first and the USA 37th in aWHO health care ranking. THe difference in deaths from respiratory disease is half that in the USA, and lower rates of death from heart disease and diabetes. IT has more hospital beds and doctors per capita than the USA. 65% of French people are satisfied with their health system compared to 40% in the USA, and yet France spends 10.7% of GDP on health care and the USA spends 16% for poorer results. THe French system is more generous to its seniors. Unlike Medicare there are no deductibles, just modest co-payments that are often dismissed for chronically ill. And diabetes and critical surgeries are covered 100%. French also buy supplemental insurance like Medigap for extra expenses like dental and eyglasses. Cancer patients are treated free of charge. Avastin treatments costing $48,000 a year are provided at no charge. France's PMI or Protection Maternelle et Infantile, is rated highly. It is anetwork of thousands of healthcare facilities, that ensure that every mother and child in the country receives basic preventive care. Mothers even receive afinancial incentive for attending their pre and post natal visits. France makes this care affordable by reibursing doctors at a much lower rate. The average yearly net income for doctors is around $55,000, about athird of what doctors in the USA make. But French doctors don't have to pay back huge student loans as medical school is paid for by the state and malpractice insurance premiums are only a tiny fraction of that in the USA. And again the French government pays two thirds of the social security tax for most French physicians- which is typically 40% of income. So the $55,000, is more like $92,000 taking that into account and more like $110,000 when student loans and malpractice is taken into account at US levels. Specialists who have 4 or more years experience can charge what they want, but as one gastroenterologist says, there in an unspoken and undefined limit to what you can cahrge or what is socially acceptable. Yet even in France there is inflation in health care costs that the government deals with through price controls and more spending. The French national insurance system is running increased deficits each year and this is now $13.5 billion, and it has led to higher taxes for employers and workers. ...

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The French system what works and what does not work compared to the Anglo-Saxon systems of Britain and the USA. Health care works, public transport and high speed rail works, nuclear energy and the energy industry works, education works for small elite universities but fails in the larger system. The large public projects are executed well, and France has done well with its long tradition of the state building infrastructure projects. But when it comes to individual initiative and starting up new companies such as in computers and high tech of that kind, France does not do so well. And the state collects a larger proportion of taxes than in other countries to finance these benefits. France is also good at rule making, which serves it well in controlling the kinds of bubbles that regularly hit the Anglo-Saxon countries. And with 21% of jobs of all workers in France in the public sector and government, with 49% when one includes related sectors protected from economic downturns, the French workers are much better protected than workers in Britain, USA and other countries from economic downturns. Unemployment stays high in upturns and at 8%, and in downturns does not go too far above 8%....

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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. ...

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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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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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What is the right retirement age for health is an important question. Dana Smith points out that the number 65 that started with the system of social security started in US  by Bismarck in Germany in 1889 and Social Security in the US in 1935 by president Franklin Roosevelt has no basis on the grounds of health of the population and longevity. Since that time people live much longer to about 74 years and for 45% of the people in the US who are in the knowledge based work the ability to work continues past 65 or 67 years.  For the remaining people who are in professions involving physical work such as construction or in the restaurant industry the situation is quite different, requiring a category based retirement age that takes this into account. For these people health outcomes would deteriorate if they continued to work in stressful work for longer. Another factor to be considered is to ask what this means as a national goal. Would a nation aspire to give its citizens an opportunity to travel, broaden their minds and engage in other activities they would like to do which they could not do while working full time. In this situation these years after retirement could give people a chance to live happier lives. It is not to be taken lightly as the current protests in France show. Age discrimination in France also plays a part as there may be fewer years of work opportunity if employers stay away from people over 50 years or discriminate against women. With childcare and care for elderly, part time jobs, women work longer for smaller pensions than men, leading to a sense of unfairness. French protests show that the outcomes need to be weighed carefully from a health and national goal standpoint and the retirement age set accordingly with flexibility for harder work.  Following the pandemic years and the cost of living crisis the protests in France show the need to develop a national consensus on the issue of retirement age, and rules plus culture change in industry that ban age discrimination for workers. Special provisions for women and people in construction so that the system is seen as fair to all parts of the workforce. ...

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Hospitals in Europe are filling up quickly in the second wave of coronavirus. Coronavirus patients had to be transferred by helicopter to Germany from the Netherlands because of overburdened Dutch intensive care units. National Guard troops were flown in from the U.S. to the Czech Republic to help. In France as cases approach cumulative 1 million about 2000 patients are admitted to hospital for coronavirus every day on October 29. At some point French hospitals could be overwhelmed this winter, and doctors having to choose which patients to save, says president Macron. In the Czech Republic a collapse of the health system is expected by mid-November says the prime minister. No one expected this to be this severe, he says.  About 40,000 patients are hospitalized for coronavirus in the U.S. During the last week the case are increasing by over 40% in the U.S. and increase in hospitalizations are expected. Recovery rate is improving from the first wave. At NYU Langone hospital system in New York with 5000 coronavirus patients hospitalized recovery rate is improving from 25% in March to 7% in October. Better handling of cases and knowledge gained by doctors is a big part of this. ...

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Asylum hotel protests and illegal migrants in Britain filing for asylum at 111,000 cases in first 6 months costing $5.4 billion in first half 2025 alone. The Times of London says Starmer is cautious by nature, but strong action is needed going back to the source of the problem that illegal migrants do not belong in any European nation including Britain. The stark truth says Cowley in the Times of London is that having a battalion of British infantry on the coastline of France as it was during the Paris Olympics in France, is needed to keep the boats out of Britain with Britain moving out of the European Convention of Human Rights. That convention was not intended for this situation, just as the British system of justice was not intended for this situation for the people of other countries on other continents illegally migrating over oceans. Just as much as there is no Asian Convention of Human Rights for Europeans migrating over oceans to China, Japan or South Korea now industrialized nations with high standards of living and social protections for health care. ...

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U.S. healthcare spending of about $3 trillion comes with poor results. The cost per person is about three times that of countries such as France, Britain, yet the results show U.S. doing extremely poorly. The author points out that less spending on healthcare and more on social services in areas such as education, nutrition, housing and other services would improve the outcomes and results. It is this missing factor that is helping other countries in Europe, Japan and China achieve better outcomes and returns per dollar spent.  Social spending can affect such things as nutrition, exercize levels, lifestyles, housing and result in dramatic improvements in obesity levels for instance, or inflammation levels in the population that play a role in many diseases. The idea is prevention. This is not happening because higher health dollar spending has lobbies to support it. Social spending also is a dollar expense that shows up immediately whereas results are spread out into the future as a longer term benefit with healthier populations that need to consume less healthcare and treatment. Elizabeth Bradley, president of Vassar College is an expert on this subject. She says social services spending gives more bang for buck  in health outcomes.  The point is relevant also for countries in South Asia and Africa that have taken some on some aspects of the U.S. health system resulting in health care spending that does not deliver the most for the dollar spent, and ignores the critical role of prevention.  The solution lies in moving these health care dollars out of the health care spending and into education for health outcomes, lifestyles, exercize habits education, and into social services that enable prevention and better health. ...

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Warnings to governments and leaders in industry and pharmaceutical research about epidemic preparedness by Bill Gates were ignored. He spent hundreds of millions of dollars to develop new vaccines and create disease tracking systems. But only governments could tackle this problem. He tells the WSJ in an interview that he feels terrible and that he wishes he had done more. His fear that a once in a century pandemic has come true. Governments did respond to the public health preparation needs as reported in France 24 to both SARS and the H1N1, both in Britain and France. It was the disbanding of this effort in the period of the global financial crisis and the eurozone financial crisis that led to the level of unpreparedness that Western Europe finds itself in today. This was caused by irresponsible banking practices. The response was austerity measures in Britain, France, Germany and Spain that led to leaving public health system investment being neglected, without fixing the original source of the problem. Misallocation of capital and lopsided priorities continued through most of the period leading up to the pandemic. There is a lot that Gates and other public spirited leaders could do now do in the new reordering of priorities and shifting the allocation of capital to public services and investments in infrastructure, and supply chain renewal to safeguard national interests. Today he is working with pharmaceutical executives and governments to produce billions of doses of vaccines while they are being tested. His foundation has reserved space in a manufacturing plant so that production can begin quickly once an effective vaccine is found. He says nobody has made 7 billion vaccines so that it will need all the help that it can get and international cooperation.  In an earlier interview with WSJ he told the interviewer in November 2014 that the world as a whole did not have preparedness. France and Britain prepared and then abandoned the effort for epidemic response by 2012 following the global financial and eurozone financial crises. Gates repeated the warning to 2016 presidential candidates in the U.S.  In 2017 at the Munich Security Conference he reminded people- "getting ready for a global pandemic is every bit as important as nuclear deterrence and avoiding a climate catastrophe." One focus of Gates was to come up with faster ways to a vaccine by using ready made components and then customizing it. This is an approach being adopted today by Oxford scientists and by Quidel Corp. in the U.S.   ...

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A long transport strike and street protests have not affected the pension overhaul of president Macron in France. The French parliament will review the changes to the pension system that consolidate 42 different pension plans into one universal pension plan that seeks to be fair, reflect current conditions including longer life expectancy, and to make the plan financially viable. Other benefits are that it would be more transparent and enable workers to change jobs or careers, says Health Minister Ms. Buzyn.

Macron's new system for pensions calculates pension payments based on the entire salary history of an employee. Previously pension payments were calculated based on 25 highest paying years for private sector employees, and for civil servants on the last 6 months of salary before retirement.

Parliament will debate the new rules in February and the plan is likely to be passed by this summer because Macron has a large majority.

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Now that finance ministries around the world are trying to save their economies with trillions of dollars in aid packages their finances are stretched to the limit. The so called digital tax is not really a digital tax. And efforts to recover lost tax revenues in Europe are being opposed by the U.S. because tax levies by France go only to France, not the U.S. The U.S. Treasury or U.S. government or the American people would not turn down tax revenues that it normally gets when its finances are stretched to the limit with trillions of dollars for cornavirus leaving little for crumbling infrastructure and essential public health services, other services that determine quality of life in America.  This Washington Post report shows that there is greater awareness that the right approach is to pay taxes based on where revenues are located and by the number of users in each country. But the problem goes deeper than that. The coronavirus changes the entire perspective and take this back to roots. Companies pay taxes because it is the right thing to do. In Japan Panasonic's founder Matsushita felt that it was a national duty to pay its share of taxes as it too was sharing in the benefits provided by society- in the health, sanitation, education and transportation, parks, and hundreds of services provided by government. Once this is seen as dispensable or somebody else's problem, then these very services and infrastructure can be starved of capital. Coronavirus changes this perspective. People crave for outdoor spaces- who is going to maintain them and set up new spaces. People crave for not moving around on crumbling bridges, roads, subway systems. Who is going to provide them? People crave for good schools, community colleges. Who is going to provide them? People crave for good sanitation systems? Who is going to provide them? People crave for good public health systems. Who is going to provide them? Its just good common sense. Is it possible for common sense to be missing? It is- just ask people today, and it is good common sense to have good critical infrastructure such as sanitation, medicine, public health, and local manufacturing of medicine, yet economic experts and economic theories thought it made sense not to do this.  ...

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

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The U.S. bans travel from most of  Europe and India imposes quarantine on visitors and overseas citizens entering the country for 14 days. Countries around the world reacted quickly to the situation in Italy, France and Germany. The strict measures taken by China are gradually being adopted by other countries. Quarantine done early has worked limiting the spread of the coronavirus. Countries with strong public health systems are better positioned to weather the health crisis. Where strong action is taken early and in anticipation, with a strong public health response, there is better control over the spread. This comes with some economic cost as it has hit the Chinese economy, yet the rebound is likely to be that much quicker and done with more confidence. For instance air travel in China declined by 85% in February from a year earlier to 8.3 million journeys according to Chinese aviation officials. Moves to keep social interactions to a minimum have yielded results. Only food stores and pharmacies remain open in China till March 25.  ...

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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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Bernie Sanders presents the case for Medicare for All, healthcare for all legislation in the U.S. Congress introduced in September 2017. It has the support of 15 Senators. He says the current system is costly, wasteful and bureaucratic. It is time says Sanders for the U.S. to join the rest of the industrialized world, join Britain, France, Germany and other countries of Europe, Japan and Australia, Canada, with healthcare for all Americans. After all he says only 50 miles north of his electoral district in the Burlington, Vermont area is Canada, where the system of healthcare for all works better than in the U.S.  And the Canadians, Germans, French, and British do this spending less than half the U.S. does. In 2015 the U.S. spent $10,000 per person for healthcare, this means that it cost less than $5000 per person in these advanced countries and the way they do it can be studied and its best aspects adopted by the U.S.  He says this is because the U.S. healthcare system is designed to maintain profits for the medical-industrial complex. A major problem is the manner in which the issue is distorted by different sides on the issue of health care in the U.S., without a consensus being developed on what the common interest is in a civilized society. Mostly because the U.S. unlike other societies is still grappling with the issue of what values it embraces on healthcare being made available to all. Under this legislation the transition to healthcare for all would take place over 4 years. In the first year eligibility for Medicare would start at age 55 years, and children under 18 would be covered. In the second year the eligibility starts at 45 years, in the third year at 35 years, in the fourth all are covered.  ...

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Germany faces the possibility of a pandemic surge of the unvaccinated, something that is happening today in the southern United States.  For days the percentage of people that are fully vaccinated remains at 62%. Some vaccination centers are closed. A vaccination center outside the train station in Cologne offers passersby free vaccinations. Berlin's Social Democrat mayor Michael Muller is very frustrated. He says "I am now coming to a point where I think we have exhausted what we can do in politics."  At 62% the rate of fully vaccinated people in Germany is too low to prevent a surge of the Delta variant in the way that it has hit the southern US, and California. Vaccination rates of close to 85% are needed to tackle the risk of another surge in highly contagious delta variant. Not everyone remaining is die hard opposed to vaccines. The Robert Koch Institute estimate is that 5 to 10% of people are in that die hard category. The remaining 20-30 % are people who have various other concerns and fears, hesitancy, that may be changed.  The chairman of the World Medical Association Frank Ulrich Montgomery favors a vaccine mandate, what he calls a 2G rule, that should be introduced in Germany requiring vaccination to attend events, sports, restaurant visits, adopted nationwide. German government has rejected idea of mandatory vaccination of health personnel, that was adopted in France. Vaccination drives are regionally based. Some are ineffective such as the Deutsche Bahn train system vaccination drive for commuters that only had a few hundred doses of J&J vaccine and ran out quickly in Berlin. One prick J&J some say is better for vaccine skeptics. Vaccine skeptics think they may get away without getting covid infection. How does one get over this misconception? Others including members of the Greens party say vaccine needs to be delivered where people are- transit points, bus stops, doses offered in evening and early morning hours, trying new ways to reach people and inspire confidence. Germany now ranks behind France but ahead of Bulgaria in terms of vaccination percentage in September 2021, not a good situation. ...

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A major problem for President Hollande of France in the 2014 budget is how to handle the deficits in the country's Social Security System. Over the years the deficits were transferred to a vehicle called the Cades, which is approaching its legal ceiling of 270 billion euros. The vehicle was originally set up in 1996 with the idea of separating past deficits, so that the state could balance its budget every year for the Social Security System, which covers health care, pension and family allowances. Previous governments have for the most part bypassed this and added new deficits to Cades instead of making cuts in spending. The Hollande administration says it is controlling health care expenses and increasing pension contributions as a way to bring the deficits under control. It will not assess a special tax for the deficit in Social Security in 2014, as new taxes are highly unpopular. Cades lifetime has been extended twice, first in 1997 to 2014, and during the 2009 financial crisis to 2025. In 2010 following the crisis, Cades chairman, Ract Madoux says, the short term borrowing had reached 60 billion euros. It is down to 30 billion euros, which he still considers too high....

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A health care practitioner says the real problem is the high cost of medical care in the U.S. when compared to other countries. She points out that the Obama bill in 2008 did not take effective steps to bring down the cost of health care before enacting legislation to cover the uninsured, leading to higher premiums for the middle class. The link between healthcare and profits is seen as the main problem. 

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It took a week longer for each country to impose a lockdown. In China first Wuhan then the whole country went into lockdown and quarantine. The same process is repeated in Europe and in America as authorites see numbers of infections increasing rapidly without strict controls. First the Lombardy region in Italy around Milan, then the provinces in Northern Italy, followed by a complete lockdown in the country on March 10 as infection spread faster without lockdown and enforcement of lockdowns. Germany and Britain follow Spain and Italy on March 20. France followed Spain in the days after Italy's complete lockdown. Macron ordered the lockdown on March 16 with stringent enforcement. Infectious Disease specialists at Imperial College warned of "unintended consequences for the entire nation" if a lockdown of Britain did not take place. The goal is to limit the spread of infections from rapid to slow as public health systems and economic measures are ramped up in preparation for the crisis. Most countries were lacking the preparatory steps having lost time waiting to see what happens next or analyzing data in the vain hope the virus does not spread.  Bad economic results of lockdowns were initially a concern, but this concern became less important as the coronavirus spread rapidly in Europe. Decision makers in Europe decided that not acting forcefully would lead to equally or worse economic outcomes. Public health systems overwhelmed would diminish public confidence rapidly and lead to equally bad or much worse economic outcomes. The European Union executive body has supported state aid, stimulus action and border controls in this crisis. In America and in Europe the hope is that shoring up the safety net with massive aid to businesses and households would buy time to tackle and overcome the coronavirus through a combination of lockdowns, quarantines, contact tracing, large scale testing and medical technology measures. The examples of China, South Korea, Taiwan showed this pathway exists for phased control and reducing fatalities to zero. ...

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What is the difference between South Korea and the U.S., Europe in the handling of coronavirus? It is tracking and testing.  President Trump and health adviser Dr. Fauci, see South Korea as the successful model to be followed in controlling the coronavirus. What has happened till now it is accepted with shortage of basic medical supplies and equipment, stress on hospital systems, are merely mitigation actions. South Korea was prepared for the coronavirus crisis because of the MERS and other epidemics, and failures resulting in corrective actions. Labs were centralized and better equipped for testing and tracking the infected. One of the key tools is testing. President Trump says the goal is for the U.S. to exceed and far surpass tests per capita in South Korea. Five million tests are planned by the end of April in the U.S. Where the U.S. falls short is in use of multipronged digital tracking using data from people's use of mobile phones, credit card usage, and use of apps designed to separate infected people from others. South Korea is a democracy with a population of 52 million people, about the size of France. People who were student activists in the democratization era in South Korea say the use of digital technology is a need today. We have to adapt in emergency situation they say. Ki Mo-ran, epidemiologist, and adviser to South Korean government says this is a key part lacking in the European and U.S. efforts to control coronavirus. She says in South Korea we know the patient's contacts, where he goes and stays, so we don't have to lock down everybody. Without digital tracking one cannot know which place is contaminated, which place is clean, so that there can be a lockdown of just that area and not the whole country, says Ki Mo-ran. She asks the question- is one person's privacy more important than the lives of a family or other people who are affected. Is it OK to lockdown every child in the country in a home as in Spain for over a month so that particular people's privacy is respected? These are serious questions for western society, are they exceptions or is democracy not just a western idea but equally cherished in Asian societies, people talk about Confucianism in China and the Asian culture forgetting that the biggest democracies are quite large and functioning well in India in addition to South Korea, Taiwan Indonesia, Malaysia, Bangladesh and Japan, far larger in area and population than China. The French government has chosen the app TraceTogether as the least intrusive one adaptable to France for use there. The U.S. is having Google and Apple develop one of its own. India will be developing one of its own. The NYT raises the question will it be watered down so much in France or in the U.S. and UK to be less effective than the  dire need for an alternative to lockdowns? ...

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As the pandemic continues to spread and numbers grow with reopening of the economy the question remains -what can we learn from other countries positive experience in controlling spread? Here the Times provides the example of German contact tracing- chancellor Merkel has emphasized that a lot depends on "total" contact tracing, and contact tracing "above all else." Germany's experience is that even if you don't get everything right, you make an honest effort with everything you've got and do it early it makes a real difference. Some of the offices across Germany are stretched and short of staff but they have been working since the beginning of March, sometimes in the early days 7 days a week. Only 33% or one third of the offices throughout Germany for contact tracing have the required 5 person team for every 20,000 people, and 35% are overstretched or at their limit, according to one survey. No apps, just a low tech effort with people from the state administrations who were not working during lockdown trying doing something else, or volunteers. Mainly using the phone, talking to people and tracing the contact chain of people testing positive. Putting this information on the computer with a central database.  The Berlin office has 115 workers and has tracked down every one of 666 virus cases it was given. Because of privacy concerns at the Munich office sometimes even the patient's name is not given and office staff have to locate the name and the person. It requires dedication, flexibility and above all resilience, says Harold Rau, the deputy Mayor of the Cologne office, cited in this Times report. The doctor alerts the local office with a test result. The office calls the person and finds out who he has been in contact with for the last 14 days. Then the people who were in contact with are grouped based on the directness of contact, face to face, so on. These people are asked to quarantine for 14 days, sometimes with the rest of their household. They get daily call to find out how their doing for symptoms. The effort goes back to Robert Koch in the 1892 cholera epidemic in Hamburg. Robert Koch, microbe hunter in Germany, was called in after the epidemic spread from Moscow. It devastated Moscow and Tokyo, but Hamburg suffered far less about 8605 deaths as a result of the contact tracing and strict closing off quarantining of affected chains after isolating them, closing off affected parts of the city. Bit by bit the cholera epidemics sparks were put out before turning into flames, says Koch. In the current pandemic Germany has suffered 8241 deaths and 178,000 confirmed cases. So far this is in line with the cholera epidemic in Hamburg 1892, and this for all of Germany. And it is not just affluent nations that can do this. where there is a will there is a way. In Kerala state in southwestern India, similar efforts have worked to limit spread  with even better results than Germany. ...

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Germany has shown that low tech contact tracing efforts work- no apps needed, a phone, a desktop computer with a centralized database, and most important the human relations skills of the person doing the calls. The  sensitivity to the situation facing each person being called, being able to talk to the person in the language they speak in a multilingual environment such as California, is shown here. A 40 person team operates in San Francisco consisting of public health officials, clinicians, medical students and librarians. They call the contacts of people with coronavirus, arrange tests, and as needed send packages of food and medicines to hotel rooms or homes. Every call is expected to last 15 minutes but all sorts of questions are handled.  English and Spanish are used. Here one of the persons doing the contact tracing says she does not use apps, just an open source software used in the fight against Ebola. Definitely low tech, no waiting, get going is the message to every city in the world. She says apps software such as what Google and Apple are putting out can tell you whether the person went to some place, but cannot tell you more about that person, cannot tell you about problems the person is having being tested, and how they are having difficulty providing for families. One of the big lessons from Germany and efforts such as this one in San Francisco, and in other places such as Paris, Singapore, Taiwan, is that there is a complex nature to contact tracing that cannot be solved by tech. In fact the best thing to do is to get started immediately, with a phone and a database on a computer, as long as you have a person who has the motivation and skills, empathy with people, a lot can be done. Waiting for apps is a dangerous waste of time is shown by the low tech German experience, and the experience in other places. Most important is starting immediately. The example shown here of working with migrant workers in contact tracing shows in the most vulnerable places it is these human relations skills that count, that no tech app can do. It requires detective skills to find out and get people to share their history of movements and contacts for 14 days . In Singapore crowded dormitories house 300,000 of 1.4 million migrant workers. Singapore using an app also but its use is secondary. Apps don't work in many situations but fail in the most critical situations such as these dormitories and other eccentric or atypical situations such as faced by South Korea with religious groups and gay communities, elderly people in Europe, that generate the worst dangers of spread and need to be cluster isolated quickly. Human contact tracing has a history of being an effective method and was used in China and South Korea during the 2003 SARS epidemic. More countries need to adopt the method used in Asia and in Germany, particularly Britain, the U.S., France and India. It is OK that Britain's NHS and India's national government with Aarogya Setu app have put out their own apps which balance privacy concerns with the need to act immediately and cover the entire country, but the hard slog of human contact tracing teams in each district is indispensable. This is why the former Health minister in Britain calls it Britain's national mission to do this. Speed is key- putting together teams across the country in every district from skilled volunteers or government workers, and pulling together the phone and a centralized database on a computer as basic equipment. The fact that this is easily doable and people with human skills needed can always be recruited as they have been in Germany- from public officials in local government who are less busy in lockdowns, medical students, clinicians, volunteers, people from different professions- makes it inexcusable not to learn from others experience and get going. Just Do It. You want to reopen business, professions, offices and public services- Just Do It, it makes this possible. You want to prevent spread of the virus- Just Do It, it makes this possible. You want to limit damage to the economy and get the recovery going- Just Do It, it makes this possible. People of all shades of opinion can agree on this- its the only thing that works, even when there is a lack of enough proper accurate testing. ...