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New York City's 11 public hospitals have switched to plant based meals without meat or dairy. Just don't call them vegan, as it may turn off people, says an official of the New York City Health and Hospital Corporation. An Oxford University study shows that plant based diets account for 75% less greenhouse gas emissions than diets with 3.5 ounces of meat a day. Satisfaction is 90%. The hospital system reduced its carbon emissions food related by 36%.  It expects to turn out 800,000 plant based dishes this year at its hospitals. 

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New York's Brooklyn Hospital and other non profit hospitals in the state lack the funding of hospitals such as Northwell and Langone in Manhattan, and the funding of public hospitals in the state. Serving low income communities these hospitals face a severe funding crisis after elective surgeries were suspended during the worst period of the coronavirus. This will further compound the inequities in New York city and the state for access to health services.

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As winter approaches pollution reaches dangerous levels in New Delhi causing a public health emergency. Millions of anti-pollution masks are now distributed at schools, colleges, hospitals and local markets. As the weather cools a thick haze from car emissions and coal power plants builds up over New Delhi making it hard to see. The cool weather appears to trap the pollutants in northern India against the Himalayan mountains creating a stifling haze. Construction dust and smoke from paddy crop burned in the Punjab adds to the problem. This year it is getting worse than ever. Pollution levels are about 20 times what is considered healthy by the WHO. The air quality index hit 494 on November 3, 2019. Some parts of the city hit 1000 on the index. Over 500 is considered dangerous and "hazardous" to health. The government of Delhi and the state and federal authorites have taken some action to close schools, ban work at construction sites, implemented odd even license plates rule for cars entering New Delhi. A survey shows about 40% of residents of New Delhi wanted to move to some other city, and 16% want to travel this time of the year to escape pollution. ...

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Most people would not guess or recognize that this place where elderly people in society were treated shabbily is a country in northern Europe, and a country where citizens pay high taxes for precisely better healthcare across different age groups. Sweden is where about half of the 6000 people dead from coronavirus were elderly people.  Over the last two decades Sweden has cut hospital capacity and discouraged elderly people from entering hospitals during the early period of the pandemic, says this report in the NYT. The for profit nursing homes in the centre of Stockholm were unable to cope. Having turned the work in these homes to low wage workers, it put these workers and the elderly at risk with lack of staff, lack of adequate PPE oreven  basic masks, says this report in NYT.  One of the lessons of this pandemic is the failure not just in turning over manufacturing of health care equipment and pharmaceuticals to China, but also turning over the basic care of elderly to for profit institutions that were totally unprepared and could not give elderly the dignity and care they deserve. Year of cuts to public services and health services now showed in a glaring way what can happen when this is done. It has lessons for countries from Europe to North America, and to Latin America, India and other Asian countries as they redesign policy and allocate resources to public services in the next 10-20 years. ...

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Poland has a huge shortage of doctors and nurses. The ratio of doctors to every 100,000 of population is the lowest in the European Union. It is twice that in Germany whose relative success in tackling covid pandemic comes from having foreign doctors and nurses treat patients. Consider that the average age of Polish doctors is 53, only a few years from retirement. The situation in terms of immigration reminds pone of East Germany and its depopulation of young people who left for West Germany. Something like this has happened in Poland in health care.  In similar ways other countries in the EU, Hungary, Slovakia, Romania stocked up on ventilators but now have few doctors and nurses left to operate them. It is stretching the limits of human endurance as this report shows in WSJ, with doctors working 36 hour shifts and working 73 hours a week.  Here we see Dr. Rotnicki, who works these long hours at a hospital in western Poland and says that it is like the Second World War, that it is hard times in Poland for health care workers. This report says Italian and British hospitals, not just German ones, are tackling coronavirus with Polish, Hungarian and Romanian doctors and nurses. This report shows that headhunters in Germany drive in to western Poland blanketing windshields with pamphlets promising 5 times more pay, 2 years of free language classes and housing. In Slovakia a third of all nursing graduates leave the coutnry immediately after graduation. In Poland not nursing pay has lagged behind with fewer going into nursing schools. Staff remaining in the region are older and educated under communism when less English was taught, or have returned back home from years overseas. Forcing doctors to give up private practice and work in public hospitals during coronavirus pandemic is not working in Hungary, where surveys find 6 out of ten medical school graduates intending to leave Hungary. These doctors say they are better off working at Aldi and Tesco if needed and making more pay, plus getting weekends off. Poland only recently increased pay for healthcare workers, some even survived on cash given to them by patients. Not a good situation for a country to be in and reflecting the wrong priorities not just in the U.S. and western Europe, but also in eastern Europe, during the last 3 decades. These priorities shifted money away from health care, education and infrastructure priorities. The people simply lost control of their spending allocation to "financial markets" that shifted money in a way that benefited only small group in society neglecting others and national interests. ...

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The title may not reflect the content of this report on Admiral Giroir who heads the U.S. coronavirus testing effort. He is a pediatrician who worked for hospitals in Texas before heading a vaccine project at Texas A&M University.  Internal politics led to his resigning from the effort to build a vaccine development capability with pharmaceutical companies at Texas A&M. Most of the rest of this report shows a physician who is determined to pursue big projects such as the one he is tackling today. President Trump appointed him to lead FDA, and to be the Assistant Secretary of the Department of Health and Human Services. With the missteps of Secretary Azar testing suffered in the early months of the crisis as reported in the WSJ. Adm. Giroir has taken a leading role since  this period. He also heads the U.S. Public Health Service Commissioned Corps of 6200 staff playing a vital role. On March 13 he was asked to lead the effort in testing.  He comes to this role with experience in the field of vaccines realizing that "the challenges are not just biological but engineering." New technology would be needed to make massive amounts of vaccine. His idea is that transformational efforts are needed. His idea for a billion dose per month facility in Texas did not work, yet he worked on it for about 5 years from 2010 to 2015 at Texas A&M University, at one point being the vice chancellor. He was selected by Texas Governor Perry as chairman of the task force in Texas in 2014 to oversee the effort to fight the Ebola virus. He now is in a position to bring all his experience and aspirations to tackle the coronavirus, cutting through much of the red tape and bureaucracy, and pulling together the effort combining science of pharmaceutical companies with the technology of manufacturing billions of vaccine doses in a record time. Today he sees capacity for testing reaching 40-50 million tests a month by September 2020.   ...

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The tough job President Obama faces as he faces opposition from politicians who have interests to protect, and healthcare businesses with interests to protect. The President has to come up with a plan that is deficit neutral, because financial markets could see a healthcare bill that further widens the deficit as a signal for higher interest rates that would deepen the recession. At the same time each of the three sources of revenue puts him at loggerheads with political leaders in Congress or groups with interests to protect. Limiting income tax deductions for high earners could raise $267 billion in 10 years. It would require taxpayers in the top tax brackets deduct their mortgage interest, state and local taxes, and charitable donations, at the 28% tax rate instead of the 33% and 35% tax rates. The opposition is with democratic leaders that it would hurt charities, universities that depend on tax deductible donations, and taxpayers in high tax cities like New York city that are the home base of Democratic leaders. Yet only 1.4% of households would be affected says the nonpartisan Tax Policy Center. The Center on Philanthropy at Indiana University, says charitable giving would decrease by 2%. The other opposition on this comes from the preference of Senators Baucus and Grassley, who head the Senate Finance Committee, for tax increases or cost savings to come from the health sector. Specifically they want to see the value of workers' employer provided health benefits subject to income taxes. It is a situation in which every sensible person admits the need for healthcare reform and would see the current pace of healthcare costs as unsustainable and dangerous; and after that will just go back to his group and try to preserve as much of the status quo as possible, so as not to disturb by much the benefits or compensation they have secured from the system over the years. Then there are political leaders in Congress with their own preferences, and Congressmen who are the subject of heavy lobbying by these interests. The administration and the Presidents job is to navigate this stream with a workable deficit neutral plan, without any requirement for any group to make sacrifices, and in some situations even small sacrifices for the public interest. Would charitable institutions be hurt that much, what if charitable institutions were exempted, why would other interests the try to obtain the same exemption. Its like the unions trying to keep the old unsustainable goldplated healthcare and other benefits at GM even as the ship was going down. Taxing employer provided employee health benefits as income would raise $2.5 trillion over a decade. The opposition here is from unions which are a force in the Democratic party and which count tax free health benefits as a legacy of the labor movement. Employer provided health insurance covers 160 million American employed and their dependents under the age of 65, so it has a wide impact. Yet most economists favor ending the tax break. They say it mainly goes to upper income taxpayers, and discourages cost consciousness among consumers of health care, thus encouraging excessive spending and surging health care costs. Senior Obama advisors, Peter Orszag, the budget director, and economist Jason Furman favor this approach. So do Republicans in Congress. Senators Baucus and Grassley are not asking for the complete removal of the tax break, what they want to see is capping the value of benefits that go untaxed. If the tax-free limit is $13,000, a policy worth $15,000 would pay income taxes on $2000. A third spource is to spend less on Medicare. About two thirds of the $948 billion in savings Mr Obama has proposed over 10 years comes from a number of reductions in Medicare spending. $177 billion comes from insurance companies bidding for government reimbursements for offering private plans to seniors. $106 billion comes from cutting the subsidies to hospitals serving the uninsured as universal coverage should remove this need. And $110 billion in reduced payments to hospitals and doctors because of productivity gains. A range of industries insurance companies, hospitals, doctors drugmakers, nursing homes, home health care companies and medical device makers, all stand to lose from reduced payments from Medicare and Medicaid. And these groups with interests to protect are another factor in this process of working out a healthcare plan. ...

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Craig Smith, the head of Surgery at Columbia University's hospital in New York, and Craig Smith the writer using language that provides solace to many people at a difficult time. He is also poetic at times quoting from John Wooden, as well as Emily Dickinson. He is in the middle of this public health crisis that is New York City today. When he gave the presidential address to the American Association for Thoracic Surgery he opened and closed his lecture with meditations on a Yeats poem. Here he is as a human talking to humans caught in a most perplexing time for medicine.

He quotes Emily Dickinson in one note saying- 

"Not opening when the dawn will come/ I open every door." Doors are opening all over the place.

 

 

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The differences in the Democratic party between conservatives and liberals that make it difficult to get things done in healthcare, energy and other areas. The lack of White House leadership in a number of areas, and in anumber of instances. The lack of Senate leadership on these issues with the Senate not having done much in energy and healthcare legislation. Add to this the influence of the $133 million that lobbyists spent in the 2nd quarter 2009 alone. The failure of Republicans and Democrats in Congress to push vigorously for cost control in the health care industry adds to these problems.

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Under a new program to increased spending on healthcare from 1.3% of GDP to 2.5% the Indian government plans to provide free pharmaceuticals at state run hospitals. This is expected to cost $5 billion over 5 years. Initially 350 drugs would be on a list of essential medicines and would be purchased from generics manufacturers in India. Dr. K. Srinath Reddy, heads the committee advising the Indian government on healthcare. He says this will help improve access to medicines for the vast majority of the people. Estimates show 70% of out of pocket medical costs for Indians come from spending on drugs. About 40 million people are pushed into poverty each year because of the high cost of medicines, says Dr. Reddy. He said that in 1984 31% of the medicines at government run hospitals were provided free to admitted patients, dropping to 9% in 2004. For outpatients this dropped from 18% to 5%. The free medicine program would be part of a larger universal health care program to be introduced over the next decade. India's large generics pharmaceutical industry makes the provision of free medicines on a large scale a feasible option in India because of the lower prices, with additional pricing advantages when purchased in larger volumes by the government. This would also have a major impact on the quality of healthcare in the country of 1.2 billion people for a relatively small investment. It also promotes a sense of fairness and equal access because the benefits of decades of modernization have been unevenly distributed and because of widespread poverty....

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About 400 million or one in 4 people people smoke in China. State ownership of the tobacco industry only makes this worse. Enforcement of bans on smoking is lax. Experts warn that this would become a major healthcare problem in China.

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The House bill on health care cleared the House Committee on Energy and Commerce with a vote of 31 to 28. Five Democrats joined all 23 Republicans. Compromises were reached with Blue Dog Democrats, centrist Democrats who had concerns about the cost of the health care overhaul. The bill will be taken up again in September after the August recess, when Congress will be faced with the task of recociling the House and Senate versions and reaching common ground on a number of proposals. Some common ground has already been achieved between centris and Blue Dog Democrats and Democratic members who support Obama's proposals. Among the changes on which consensus was reached in the House version: 1. Access Insurers will have to accept all applicants and will not be able to charge higher premiums because of medical history or current illness. All insurers will have to offer a minimum package of benefits, to be defined by the federal government, and nearly all Americans will be required to have insurance. Insurers will have to get prior approval from the government before increasing premiums over a certain amount. About 95% of Americans will be covered this time. The cost will still be approaching $ 1trillion over 10 years. Federal subsidies will be given to those who cannot afford health insurance and Medicaid coverage will be expanded. And the insurance will be made more affordable for the uninsured. Democrats also reached a consensus on creating some sort of government insurance plan or nonprofit cooperative to compete with private insurers. 2. Mobility And under this new plan it will be easier to change jobs as one would retains one's health insurance. This should actually help the job market, and help promote the mobility that is needed, now that jobs are shifting out of sectors like autos to sectors like energy. 3. Cost The Energy and Commerce Committee voted 47 to 11 to set aprocedure for the government to give federal approval of generic versions of expensive biotechnology drugs. By one estimate this saves $9 billion over 10 years. The Democratic proposals from the Energy and Commerce Committee would authorize the Health and Human Services Secretary to negotiate prescription drug prices for Medicare benificiaries. The agreement and consensus among the conservative, liberal and centrist Democrats, and Democrats with ties and connections to the health care industry was reached after intensive negotiations, and adoption of a package of amendments that helped bridge the differences they had. ...

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Estimates show the 50 million Americans enrolled in Medicare today will increase to 80 million by 2030, according to the program's actuaries. Simple demographics as the baby boom generation ages is making controlling the deficit without controlling increase in health care costs as both sides in the fiscal cliff negotiations are attempting to do can only lead to defunding critical areas such as education, R&D and infrastructure, and breaching the safety net for lower income Americans. Health care spending took up 7% of GDP in 1960, increasing to 17.9% of GDP in 2010. Federal spending on healthcare has grown to about 25% in 2012 from 10% in 1960, and is projected to increase to about 33% in ten years by the Congressional Budget Office.

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The Fiscal Survey of States, a report put out by the National Governor's Association, says that Medicaid will become an increasing burden on state budgets as help from the federal government declines. The report points out that state general fund revenue remains $21 billion below 2008 levels, just as the states prepare for less federal help.

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A recent book "The Spirit Level" has become popular in Britain. It says that countries with greater disparities in income also do worse in a number of social indicators, from higher murder rates to lower life expectancy. It also affects the consensus in society which is a necessary underpinning for sustained economic development and economic growth. Inequality when it affects the middle class and reduces the size of incomes in the middle, or creates stagnation in incomes, poses large risks for society and affects economic growth. In the US the home foreclosure crisis and the lack of bargaining power of wage earners in the middle class has created this problem. This is exacerbated by the banking crisis and bad loans in the banking system. Studies show that slow growth in college graduating rates in the USA after 1970 compared to the period 1900-1970, has increased inequality, especially with today's knowledge economy. Germany is also affected by this problem as wages for workers have remained stagnant with the labor reforms. Interestingly a combination of economic growth and payments to the poor have increased the size of the middle class and its incomes in Brazil. The austerity policies in Britain will affect incomes and income growth in Britain for the middle class. In China the gap is widening quickly between the urban areas and the rural areas. And the policy of residency permits- the hukou system-which limits internal mobility from rural areas to the cities and towns, makes the inequality all the more glaring. The lack of democratic election makes the situation worse in China compared to Brazil, because free elections in Brazil enabled leaders from the working classes such as Luiz Inacio Da Silva and Ms. Rousseff to emerge as heads of government. These leaders pursued policies that would explicitly bring a more shared prosperity in Brazil compared to the leadership in China. In China policies are determined by entrenched interests in its model of development- the state-owned companies and banks and their managers, local and government officials of the Communist party, and businesses with the networks and connections with the Communist party and local governments. This is why the ginni coefficient which measures inequality has dropped significantly in China, putting it in the rank of developing countries with poor records in equality. Inflation in China, India and Africa also affects the poor and lower middle classes to a greater extent. Current trends suggest that rebuilding the middle class in the developed countries and providing fairer distribution in developing countries will be of serious importance in coming years. Especially with the likelihood of more economic crises which tend to adversely affect the middle and lower classes disproportionately....

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Peter Coy of Bloomberg Business Week points out that the debt ceiling and proposed deficit reductions in the range of $4 trillion really obscure the real size of the problem which is much larger. The real problems hit when the U.S. faces a larger graying population by 2020 with sharply higher per capita health care spending; and at the same time workers from this generation retire and become beneficiaries of Social Security and Medicare with fewer younger workers to support the system with tax revenues. Another problem is that older Americans are likely as a voting bloc to vote themselves benefits that will cost the younger generation, benefits that the younger generation will not be able to enjoy. Even the Paul Ryan plan with its cuts to Medicare insulated todays seniors from the sharp cuts, as it becomes political necessity for both Republicans and Democrats to shy away from touching the current beneficiaries.

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Efforts to boost the share of national income that goes to rural households and workers in China. The share of income taken by state owned enteprises and taxes paid by the enterprises would have to change for reducing the gap in incomes and reducing inequality in China.

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The skills to navigate different personalities and work patiently on the issues surrounding changes to the U.S. tax system of Rep. Dave Camp (MI), chairman of the U.S House of Representatives Ways and Means Committee, will be immensely useful in the effort to make changes to the U.S. tax system. Camp works well with fellow House Republican leaders Boehner, Ryan, Cantor, and his Democratic counterpart in the U.S. Senate Max Baucus. Camp is a good listener, refuses to engage in partisan criticism, and has the patience to work through difficult issues of achieving savings and keeping fairness in the the tax changes. Earlier efforts to achieve consensus in late 2011 failed, making it even more important to have leadership which can create productive debate and bridge the differences. The tax changes are part of the overall effort for U.S. economic recovery by reducing the deficit.