Category Archives: Global

Global, Citizen, Global Citizen, Nation States, Democracy, Oligarchy, United Nations, Europe, European Union, EU, ASEAN, LATAM, Africa, Brazil, Mexico, U.S., Canada, Russia, India, China, Singapore, Australia, New Zealand

CVS Minute Clinic

I have written before about the trend toward convenience well-being centers (like convenience stores but for all things health and wellness-related). Every big box – most especially Walmart, CVS, and Walgreens – wants their store to be the convenience store for well-being. See all posts tagged BeWell or Well-Being.

There is a retail component – and CVS is an example of best practice. And there is a back-end component. Iona Heath and Arivale are examples there of best practice.

In any event….

Yesterday, with my daughter insisting I had pink eye, I decided to check out the CVS Minute Clinic in my neighborhood. I had a great experience.

There was the usual “set-up/registration” time. It was acceptable and on-line – at a kiosk outside the clinic rooms themselves. Took me about 10 minutes to tell them about me. At the end of registration, they asked online whether I wanted to be in line to see a clinician. I said yes.

There was no wait! Amazing. Not sure how this could be – but true.

The clinician was a “nurse practitioner”. That worried me until I watched her work with all her online and in-clinic diagnostic tools. She gave me a viral pink eye test – negative. So all that was left was the possibility of bacterial pink eye. For this possibility, I needed to take seven days of drops.

How to get the drops? She offered to provide a prescription at the store. I said “yes, please”, and she literally called the pharmacy next to her, and said ‘Josh, I need 7 days of drops in five minutes. Can you handle that. Josh said yes, and I was on my way – so simple!

So here is what I also loved. She took all vitals, she checked my ears and eyes with a laser light (or whatever it is called), she even checked my eyesight! But I am sure she would not have done all these things if I had said I was busy.

So what’s up with this trend? Here’s one mom’s take:

One Mom’s Take on CVC Minute Clinics

I left convinced that a good nurse practitioner could handle 95% of my medical needs – saving the tough stuff for my primary care physician.

References:

Here is my July 11, 2015 blog post about CVS Minute Clinics – printed here in its entirety:

This update about CVS is from today’s NYT:

Strategic Summary:

CVS is placing a very big bet, and my guess is it is right:

That the future consumer of health care in the US will:
– rarely have a primary care physician
– have “high deductible” insurance (so they will be very tough buyers)
– demand services closer to home (convenience is a premium)
– demand services with great frequency of visits (shorter waits, no hassle)
– value convenient treatment for routine illnesses, basic screenings and vaccinations.

So these consumers still need a “front end” to the health care system that allows them to get what they need, when they need it – when it is routine. They also want to crisis services, and other backend services – arranged when the need arises. They think CVS is the answer to those consumers. They want to be the one-stop shop for those consumers.

Their push to retail clinics can be seen in their 900 MinuteClinics and plan to have 1500 by 2017. A typical CVS clinic staffed by nurse practitioners sees 35 to 40 patients a day; those patients pay $79 to $99 for minor illnesses and injuries, and most insurance plans are accepted. Analysts estimate each clinic typically brings in $500,000 a year..

And … just a few months ago …they bought all of Target’s 1900 pharmacy locations. Assuming that some of these become clinics, there could there be even more retail clinics in the future.

So they want to be the one-stop-shop for a consumer’s health, with a front end that is both behind the counter (traditional pharmacy) and in-front-of-the-counter (the store with lotions and magazines and diagnostic equipment etc).

On the back end, they want to best prices for everything that is health-oriented. They also are partnering with Rush University in Chicago to make sure that more-critical needs are serviced properly.

Highlights:

– The Company started in 1963 as Consumer Value Stores (Lowell, Massachusetts)
– CVS under CEO Larry Merlo (who came to CVS when they acquired People’s Drug) has moved aggressively to rebrand the company as a health company. This move began in 2004, when they bought Eckerd Drug.
– They now have 7800 stores, and 900 “MinuteClinics” within their stores …. and plan to have 1500 soon.
– “Its MinuteClinics diagnose and treat patients, and its pharmacies dispense medicine to more than two million prescriptions a day. It negotiates the price of medicines and helps 65 million people navigate drug coverage under their insurance plans.”

Last year, the company changed its name from CVS Caremark to CVS Health.

Acquisitions history is:

2004: The shift toward health care started in 2004, when CVS acquired Eckerd Stores and Eckerd Health Services, giving CVS a foothold in administering drug benefits to employees of big corporations and government agencies.

2006: CVS acquired MinuteClinic, a pioneering in-store health clinic chain that was offering treatment for routine illnesses, basic screenings and vaccinations.

2007: $21 billion merger between CVS and Caremark, which gave birth to the country’s leading pharmacy benefits manager.

2012: CVS struck a deal with the medical products distributor Cardinal Health to form the country’s largest generic drug sourcing operation.

2012: $2.1 billion acquisition of Coram, a business that allows CVS to dispatch technicians to patients’ homes to administer pharmaceuticals through needles and catheters.

2015: In May, it paid $12.7 billion to acquire Omnicare, which distributes prescription drugs to nursing homes and assisted-living operations.

2015: In June, CVS announced it would buy Target’s pharmacy and clinic businesses for $1.9 billion and left open the possibility of pursuing further deals. Once the Target deal closes, CVS will operate about 9,600 retail stores, or about one out of seven retail pharmacies, according to Pembroke Consulting.

= = = = = = = = = =
Article begins here:

How CVS Quit Smoking and Grew Into a Health Care Giant

Michael Gaffney’s throat was scratchy for days, and lemon tea was not helping. So he dropped into a MinuteClinic above a CVS store in Midtown Manhattan on a lunch break. Within minutes, a nurse practitioner tested him for strep throat (negative), suggested lozenges and a regimen (ample fluids, no spicy food), collected a co-payment ($25 cash) and sent him on his way.

“That was quick,” said Mr. Gaffney, 26, an account executive for Indeed.com, who, like millions of Americans, does not have a primary care physician, even though he is covered by health insurance. He has been meaning to find a doctor since moving to New York last year, but his sore throat did not seem serious enough to warrant what was sure to be a time-consuming search and a long wait for an appointment.

The CVS MinuteClinic, on the other hand, was just blocks away from his office. “I waited longer for my bagel this morning,” he said.

With 7,800 retail stores and a presence in almost every state, CVS Health has enormous reach. And while shoppers might think of CVS as a place to pick up toothpaste, Band-Aids or lipstick, it is also the country’s biggest operator of health clinics, the largest dispenser of prescription drugs and the second-largest pharmacy benefits manager. With close to $140 billion in revenue last year — about 97 percent of that from prescription drugs or pharmacy services — CVS is arguably the country’s biggest health care company, bigger than the drug makers and wholesalers, and bigger than the insurers.

Even before the Affordable Care Act created millions of newly insured customers in the almost $3 trillion health care industry, CVS saw that there were more profits to be made handling prescription drugs than selling diapers. But while its transformation from drugstore to health care company began a decade ago, CVS has more recently taken on a new advocacy role, that of a public enemy of cigarettes.

Last year, CVS became the first major pharmacy chain to stop selling tobacco, a business that brought in $2 billion a year. And on Tuesday, CVS said that it would resign from the United States Chamber of Commerce after revelations that the chamber and its foreign affiliates were engaged in a global lobbying campaign against antismoking laws.

Its stand against smoking has allowed CVS to make alliances with health care providers and rebrand itself fully as a health care company. But with smoking rates on a steady decline, and cigarettes sales slumping, CVS also saw that future profits lie not with Big Tobacco but in health and wellness.

Taking the high road for health has its challenges. For one thing, it means new competitors in a rapidly changing industry. And, for a major retailer with tens of thousands of products on its shelves, it leads to an uncomfortable question: If we cannot sell cigarettes, what does that mean for potato chips?

Road to Growth

The Consumer Value Store started as a scrappy discount health and beauty outlet in Lowell, Mass., in 1963. Four years later, the small chain opened its first in-store pharmacies, and those became the core of the company — and its growth — for years. Larry Merlo, the chief executive, is a pharmacist by training and came into the company when it bought People’s Drug, a drugstore chain based in a suburb of Washington.

In a phone interview, Mr. Merlo spoke mostly in corporate platitudes, but when the conversation turned to the subject of pharmacists, he spoke passionately about pharmacists’ role in delivering health care.

“Hypertension, diabetes, osteoporosis,” he said. “It’s the same story — people don’t take their medication as prescribed.”

Pharmacists, who see patients more frequently than doctors do, can make sure patients stay on their drug regimens, he said, keeping them out of the hospital and saving the health care system billions of dollars down the road.

“I think back to my own personal experience,” he said. “Sometimes, it’s as simple as answering questions to get people to stay on their prescription therapies.”

Mr. Merlo said the company stood out in the breadth of products and services it offered: Its MinuteClinics diagnose and treat patients, and its pharmacies dispense medicine to more than two million prescriptions a day. It negotiates the price of medicines and helps 65 million people navigate drug coverage under their insurance plans.

The shift toward health care started in 2004, when CVS acquired Eckerd Stores and Eckerd Health Services, giving CVS a foothold in administering drug benefits to employees of big corporations and government agencies. Two years later, CVS acquired MinuteClinic, a pioneering in-store health clinic chain that was offering treatment for routine illnesses, basic screenings and vaccinations. CVS also expanded its very profitable specialty pharmacy business, which focuses on expensive drugs to treat complex or rare diseases like cancer or H.I.V.

Then in 2007 came the $21 billion merger between CVS and Caremark, which gave birth to the country’s leading pharmacy benefits manager. Three years ago, CVS struck a deal with the medical products distributor Cardinal Health to form the country’s largest generic drug sourcing operation. It followed up with a $2.1 billion acquisition of Coram, a business that allows CVS to dispatch technicians to patients’ homes to administer pharmaceuticals through needles and catheters.

The acquisitions keep coming. In May, it paid $12.7 billion to acquire Omnicare, which distributes prescription drugs to nursing homes and assisted-living operations. Just weeks later, CVS announced it would buy Target’s pharmacy and clinic businesses for $1.9 billion and left open the possibility of pursuing further deals. Once the Target deal closes, CVS will operate about 9,600 retail stores, or about one out of seven retail pharmacies, according to Pembroke Consulting. Last year, the company changed its name from CVS Caremark to CVS Health.

The growth of CVS comes at a time when the way Americans get access to and pay for health care is evolving quickly. Surveys show that many of the estimated 30 million people who gained insurance coverage last year under health care reform do not have a primary health care physician or do not use one. Many, too, opted for high-deductible health plans and are expected to become picky with the dollars they spend, and less tolerant of the opaque pricing that is still the industry’s norm. And consumers in general are starting to demand more convenient, on-demand access to health care, closer to home.

In that fast-changing world, CVS’s strategy is to be a one-stop shop for health care.

“Say you have diabetes, and you go into a pharmacy to get your insulin, how great is it if, in the same aisle, there’s a cookbook for people with diabetes?” said Ceci Connolly, managing director of PwC’s Health Research Institute. “And maybe there’s some foods that are already approved for you, and a place to check your feet, and a clinician to check your eyes,” she said.

“Consumers are saying: I want all of that at a place near my house that’s open on Saturdays, when it’s convenient for me. I want that place to post prices. It’s in CVS’s interest to pull in more and more pieces of that puzzle.”

A typical CVS clinic staffed by nurse practitioners sees 35 to 40 patients a day; those patients pay $79 to $99 for minor illnesses and injuries, and most insurance plans are accepted. Analysts estimate each clinic typically brings in $500,000 a year, representing just a fraction of CVS’s revenue. Still, the clinics are an important part of the company’s health care proposition.

Other retailers are also getting into the business. The number of retail clinic sites grew to 1,800 locations nationwide in 2014 from 200 in 2006, though they still represent just 2 percent of primary care encounters in the United States, according to a report published this year by Manatt Health, a health advisory practice, and the Robert Wood Johnson Foundation. But CVS is by far the leader. Walmart, which charges just $40 a visit, has fewer than 100 clinics, compared with the more than 900 in CVS’s portfolio. Walgreens, the second-largest, has half as many clinics as CVS. And CVS plans to add more, reaching 1,500 by 2017, the company has said.

Whether these clinics provide the best kind of care is a question sometimes raised by doctors in more traditional practices, like Robert Wergin, president of the American Academy of Family Physicians and a doctor in Milford, Neb.

“These retail clinics, they’re run by competent folks, and they probably have some role to play,” he said. “But you’re being seen at a clinic next to the frozen food section by a stranger. And if you go back for a follow-up, you’re going to get seen by someone else.”

For employers and insurers, however, the clinics offer a way to reduce costs for noncritical conditions. A study by researchers at the RAND Corporation estimated that more than a quarter of emergency room visits could be handled at retail clinics and urgent care centers, creating savings of $4.4 billion a year.

Reducing health care spending, however, may turn out to be complicated.

“You might imagine that they keep people out of E.R., so that’s one way you could save money,” said Martin Gaynor, professor of economics and public policy at Heinz College, Carnegie Mellon University. “On the other hand, just because they’re more convenient, people might go and obtain care in circumstances where they otherwise would not have sought care.”

CVS might have more sway reducing health care costs in its role as a middleman between drug companies and patients with drug benefits. The company is expected to start shifting the balance between end users on one hand, and drug manufacturers and wholesalers on the other.

CVS and other large dispensing pharmacies — Walgreens, Express Scripts, Rite Aid and Walmart — made up about 64 percent of prescription-dispensing revenue in the United States in 2014, according to Pembroke Consulting. That year, CVS was also the leading provider of specialty drugs in North America, with $20.5 billion in revenue, representing 26 percent of the total market.

“Scale is a big factor in pharmacy,” said Joseph Agnese, senior equity analyst at S&P Capital IQ. “There’s a lot of pricing pressure from drug manufacturers and one way for retailers can come back at them is to become larger, and become a more significant purchaser of drugs.”

Dr. Gaynor of Carnegie Mellon said, however, that cost reduction varied greatly by type of drug. “If there’s a drug that is very important for CVS to carry, and there are no alternatives, they aren’t going to have a lot of negotiating power,” Dr. Gaynor said. “But of course, the bigger CVS gets, the more they can move product, the more important it becomes.”

The company’s size also creates significant competition issues, says David A. Balto, an antitrust lawyer and former policy director at the Federal Trade Commission who often represents independent pharmacies. CVS’s ownership of Caremark could restrict consumers’ access to rival pharmacies, he said, and CVS’s acquisition of Omnicare, already a dominant player in long-term care, could reduce competition in that industry.

“There are tremendous concerns when you see someone becoming so terrifically large,” Mr. Balto said. “The acquisitions might conceivably be efficient, but whether those efficiencies are passed on to consumers really depends on the level of competition in the market.”

Quitting Cigarettes

Helena B. Foulkes, who leads CVS’s retail business, swept past the sales counter at a newly renovated CVS in downtown Manhattan. Where cigarette packs once lined up in neat rows, now there were nicotine gum and patches to help smokers quit. (There are no e-cigarettes either, much to the chagrin of that industry, which had hoped CVS would embrace its products as a lower-risk alternative.)

Ms. Foulkes, who lost her mother to lung disease, leads the retail business, which is starting to change to fit the company’s health care bent better.

The move to forgo $2 billion in annual tobacco sales has bolstered CVS’s health care bona fides. The White House lauded CVS’s move. “Thanks @CVS_Extra, now we can all breathe a little easier,” Michelle Obama wrote in a Twitter post. The praise seemed to give Mr. Merlo a jolt of confidence. At a TEDx talk this year in Winston-Salem, N.C., he declared: “CVS kicks butts across the U.S.”

“When we exited the tobacco category, it was the most important decision we’d made as a company,” Ms. Foulkes said. “That decision really became a symbol both internally and externally for the fact that we’re a health care company.”

It also made economic sense. Adult smoking rates have dropped to 18 percent in 2014, from 43 percent in 1965, according to the Centers for Disease Control, and experts predict that rate to dip below 10 percent in the next decade. Ditching cigarettes allows CVS to trade a small — less than 2 percent of revenue — and shrinking part of its business for an instant enhancement of its credentials in the faster-growing health and wellness space.

In October, CVS announced that its Caremark arm would require some of its customers to make higher co-payments for prescriptions filled at pharmacies that still sold tobacco products — in effect driving more traffic to the now tobacco-free CVS pharmacies. While that move encourages pharmacies to quit selling tobacco, it also raised the ire of an antitrust law research firm, which called the announcement “a smokescreen” that masks higher costs for those who fill prescriptions at competing pharmacies.

“CVS’s use of its market power to bludgeon consumers and rivals into ending tobacco sales is not a legitimate form of competition,” the American Antitrust Institute said in a statement. It has urged the Federal Trade Commission to investigate.

In general, CVS’s new anti-tobacco stance has helped it forge affiliations with regional hospitals. Before CVS went tobacco-free, negotiations with local health systems were awkward, Mr. Merlo said during a recent analyst conference call.

“That question would always come up — ‘You guys sell tobacco products, don’t you?’ — and that literally sucks all the energy out of the room,” Mr. Merlo said. But since the company stopped selling tobacco, he said, “We’ve been able to accelerate partnerships with leading health systems across the country.”

A new partnership with Rush University Medical Center in Chicago will involve patient referrals and shared electronic health records. Anthony Perry, vice president for ambulatory care and population health at Rush, said that traditional health care providers and companies like CVS could be natural allies.

“Take people with high blood pressure. That’s the type of thing you manage steadily over time, and you work on things like diet and exercise, and lifestyle changes, and if those things don’t work, you get into the world of medications,” he said. “What we asked was: If we’re going to do a series of visits with somebody, might they be able to do some of that closer to home?”

The flip side, he said, is that CVS can refer people with more serious ailments, but no primary care doctor, to Rush. “So CVS can now say: You need to see a primary care doctor, and we can connect you.”

The anti-tobacco stand has had other effects. Notably, the company has had to start thinking about other unhealthy items on its shelves. If it is a company that promotes health, can it also sell sugary sodas and candy bars?

The downtown Manhattan store where Ms. Foulkes walked the aisles is one of 500 locations that CVS is remodeling to emphasize healthy fare.

“I was in Long Island the day after the tobacco announcement, and I ran into a store manager who said: ‘I’m so proud of the company,’ ” she recalled. “But he also said, ‘I’m hearing customers now saying, why don’t you have healthier food?’ ”

“Customers quickly made the leap. They expected more from us,” she said.

Ms. Foulkes pointed to a prominent snack corner at the front of the store.

“What you’ll see in our stores are brands that convey healthy without being overly edgy. It’s Chobani yogurt, it’s Kind bars, it’s lots of proteins and nuts,” she said. “Health for the masses.”

At this point, there are no plans to stop selling high-fat or high-sugar snacks, still a big part of CVS stores’ sales. But they might be harder to spot.

When asked where the Oreos were, she smiled. “You’ll find them, but you’ll have to look for them.”

Dubai and Well-Being

Dubai: Dubai Healthcare City , a health and wellness destination, today announced the launch of the world’s largest wellness concept in its Phase 2 expansion in Al Jadaf Dubai.

World’s Largest Wellness Village

Jan 25 2016

World’s largest wellness village to launch in Dubai Healthcare City Phase 2

Dubai: Dubai Healthcare City , a health and wellness destination, today announced the launch of the world’s largest wellness concept in its Phase 2 expansion in Al Jadaf Dubai.

Strategically located on the waterfront, the WorldCare Wellness Village will occupy an area equivalent to roughly the size of 16 football fields, and is estimated to be significantly larger in scale and offerings to current wellness properties in Europe and the US.

Tapping into the growing demand of people looking for evidence-based and holistic care, the wellness concept is driven by US-based WorldCare International and developed by the Dubai-based MAG Group. WorldCare is renowned for its online medical consultation service that digitally connects millions of members worldwide with over 20,000 specialists at world-class medical centers.
MR_Story

The Wellness Village concept contributes to the vision of Dubai Healthcare City to become an internationally recognized location of choice for quality healthcare and wellness services. With DHCC ‘s Phase 2 expansion, over land area of 22 million square feet, the free zone will drive the global trend of preventative healthcare taking into account local and regional healthcare demands and demographic changes.

Increasing access to preventative care is important to improve wellbeing and lower healthcare expenditure in the long term, said Her Excellency Dr Raja Al Gurg, Vice-Chairperson and Executive Director of Dubai Healthcare City Authority.
IN_READ

“By enabling access to wellness services, we are strengthening the health system and bringing patient centered care to the forefront. We are confident that Phase 2 will drive wellness tourism together with medical tourism, boosting Dubai’s diversified economy. It will bring together unique wellness concepts and specialized services such as rehabilitation, counseling, sports medicine and elderly care for both residents and visitors.”

The WorldCare Wellness Village will be anchored by a 100,000 square feet Wellness Center that will focus on prevention and management of diseases such as obesity, hypertension, diabetes and other physical conditions.

The Center will provide diagnosis and treatment plans, offering comprehensive two-to-six week medical programs built around patient education and lifestyle change. More than 100 healthcare and allied professionals are expected to work at the Center.
Nasser Menhall, Chief Executive Officer and co-founder of WorldCare International, said “We are proud to bring to Dubai a diversified wellness capability that will aggregate leading technologies and best practices in wellness programs in an unprecedented manner. Benefiting from economies of scale and our broad medical network, we hope to deliver a unique package of services that will raise the bar and set high standards.”

The Wellness Village, occupying 810,000 square feet of built up area (gross floor area /GFA) on a 900,000 square feet plot, is also conceptualized to include customized living spaces such as residential villas and apartments, as well as rental units to support long-term stay for both for local and foreign patients.

The eco-friendly living spaces will be designed to serve wellness and rehabilitation needs through features such as therapy zero-gravity pools, personalized spas, and rigorous exercise and diet facilities.

Bader Saeed Hareb, Chief Executive Officer (CEO), Investment Sector, Dubai Healthcare City , said, “We welcome our new wellness partner WorldCare who brings international systems and healthcare expertise that will strengthen what we already offer within the free zone. Unique concepts like WorldCare are a step in the right direction to ensure long-term sustainability and to develop a health and wellness destination that improves quality of life and sense of community.”

Hareb added, “As projects take shape, there will be a significant impact on the overall health of our communities, giving impetus to more opportunities to develop unique wellness concepts.”
-Ends-

About Dubai Healthcare City ( DHCC )
Dubai Healthcare City ( DHCC ) is a free zone committed to creating a health and wellness destination.

Since its launch in 2002 by His Highness Sheikh Mohammed Bin Rashid Al Maktoum, Vice-President and Prime Minister of the UAE and Ruler of Dubai, the free zone has worked towards its vision to become an internationally recognized location of choice for quality healthcare and an integrated center of excellence for clinical and wellness services, medical education and research.

Located in the heart of Dubai, the world’s largest healthcare free zone comprises two phases. Phase 1, dedicated to healthcare and medical education, occupies 4.1 million square feet in Oud Metha, and Phase 2, which is dedicated to wellness, occupies 22 million square feet in Al Jadaf, overlooking the historic Dubai Creek.

The free zone is governed by the Dubai Healthcare City Authority (DHCA) and regulated by the independent regulatory body, Dubai Healthcare City Authority – Regulation (DHCR), whose quality standards are accredited by the International Society for Quality in Healthcare (ISQua).

DHCC has close to 160 clinical partners including hospitals, outpatient medical centers and diagnostic laboratories across 150 plus specialties with licensed professionals from almost 90 countries, strengthening its medical tourism portfolio. Representing its network of support partners, close to 200 retail and non-clinical facilities serve the free zone.

DHCC is also home to academic institution the Mohammed Bin Rashid University of Medicine and Health Sciences, part of the Mohammed Bin Rashid Academic Medical Center. The free zone’s integrated environment provides leverage for potential partners to set up operations to promote health and wellness.
To learn more, log on to www.dhcc.ae.

About WorldCare International, Inc.
WorldCare’s mission is to improve the quality of health care worldwide by maximizing timely, efficient and strategic access to the best in health care. For over 20 years, WorldCare has empowered members and physicians with the clinical information and resources needed to make more informed medical decisions. WorldCare’s online medical second opinion service does this by digitally connecting millions of members worldwide with specialists at world-class medical centers within the WorldCare Consortium®. These teams of specialists and sub-specialists, with the experience that best matches each member’s needs, review the member’s medical records and diagnostics, confirm the diagnosis, recommend optimal treatments and empower members and their treating physicians with the information and resources needed to make informed medical decisions. WorldCare’s services are available through health plans, employers or insurers. 


For media enquiries, please contact:
Dubai Healthcare City
Carolina D’Souza / Awad Al Atatra
PR & Communications Department
+971 4 391 1999 / +971 4 375 6264
media@dhcc.ae

Smart Meters Globally

Energy companies are using the ‘Internet of Things’ to increase efficiency and save billions

JOHN GREENOUGH

Aug. 26, 2015, 10:20 AM
BI Intelligence

The lowly energy meter is becoming a leading device in the transition to the Internet of Things.

Government officials and utility executives are creating smart energy grids that will help make energy use more efficient, provide real-time billing information, and reduce the number of workers needed to check meters.

In a recent report from BI Intelligence, we size the smart meter market globally and in regions and countries through the world. We look at how smart meter installations will create smart energy grids that have a significant impact on energy usage and cost saving. Additionally, we conduct a cost-benefit analysis looking at how much it will cost to install smart meters and weigh it against the monetary and non monetary benefits the devices can provide.

Access The Full Report By Signing Up For A Full-Access Trial>>

Here are a few of the key findings from the BI Intelligence report:

Globally, we estimate the smart meter installed base will reach 454 million this year and more than double by 2020, making it a leading IoT device.
Asia will lead the transition to smart energy grids, followed by Europe, North America, South America, and Africa.
China has aggressive smart meter plans. Beijing is expected to have 100% of its residential homes equipped with smart meters by the end of this year.
The cost of installing these smart meters will be over $100 billion. But the financial benefits will reach nearly $160 billion.
There are three primary security risks associated with smart meters: physical risks, electrical risks, and software risks.
In full, the report:

Provides a regional breakdown of the smart meter market and includes forecasts from the major smart meter countries within that region.
Includes an analysis of the savings generated from smart grids
Provides an average cost of installing a smart meter over the next five years.
Assesses the other benefits to IoT-based meters and grids beyond revenue gains.
Discusses the security risks of smart meters and provides solutions from leading tech firms.
To access the full report from BI Intelligence, sign up for a 14-day full-access trial here. Full-access members also gain access to new in-depth reports, hundreds of charts, as well as daily newsletters on the digital industry.

NOW WATCH: This small landfill in New York turns trash into electricity for 400 homes

More: Internet of Things Energy Costs Energy Report Smart Grid

Read more: http://www.businessinsider.com/companies-utilities-save-with-iot-2015-5#ixzz3jxXhMpjJ

CVS Well-Being Focus – Update

This update about CVS is from today’s NYT:

Strategic Summary:

CVS is placing a very big bet, and my guess is it is right:

That the future consumer of health care in the US will:
– rarely have a primary care physician
– have “high deductible” insurance (so they will be very tough buyers)
– demand services closer to home (convenience is a premium)
– demand services with great frequency of visits (shorter waits, no hassle)
– value convenient treatment for routine illnesses, basic screenings and vaccinations.

So these consumers still need a “front end” to the health care system that allows them to get what they need, when they need it – when it is routine. They also want to crisis services, and other backend services – arranged when the need arises. They think CVS is the answer to those consumers. They want to be the one-stop shop for those consumers.

Their push to retail clinics can be seen in their 900 MinuteClinics and plan to have 1500 by 2017. A typical CVS clinic staffed by nurse practitioners sees 35 to 40 patients a day; those patients pay $79 to $99 for minor illnesses and injuries, and most insurance plans are accepted. Analysts estimate each clinic typically brings in $500,000 a year..

And … just a few months ago …they bought all of Target’s 1900 pharmacy locations. Assuming that some of these become clinics, there could there be even more retail clinics in the future.

So they want to be the one-stop-shop for a consumer’s health, with a front end that is both behind the counter (traditional pharmacy) and in-front-of-the-counter (the store with lotions and magazines and diagnostic equipment etc).

On the back end, they want to best prices for everything that is health-oriented. They also are partnering with Rush University in Chicago to make sure that more-critical needs are serviced properly.

Highlights:

– The Company started in 1963 as Consumer Value Stores (Lowell, Massachusetts)
– CVS under CEO Larry Merlo (who came to CVS when they acquired People’s Drug) has moved aggressively to rebrand the company as a health company. This move began in 2004, when they bought Eckerd Drug.
– They now have 7800 stores, and 900 “MinuteClinics” within their stores …. and plan to have 1500 soon.
– “Its MinuteClinics diagnose and treat patients, and its pharmacies dispense medicine to more than two million prescriptions a day. It negotiates the price of medicines and helps 65 million people navigate drug coverage under their insurance plans.”

Last year, the company changed its name from CVS Caremark to CVS Health.

Acquisitions history is:

2004: The shift toward health care started in 2004, when CVS acquired Eckerd Stores and Eckerd Health Services, giving CVS a foothold in administering drug benefits to employees of big corporations and government agencies.

2006: CVS acquired MinuteClinic, a pioneering in-store health clinic chain that was offering treatment for routine illnesses, basic screenings and vaccinations.

2007: $21 billion merger between CVS and Caremark, which gave birth to the country’s leading pharmacy benefits manager.

2012: CVS struck a deal with the medical products distributor Cardinal Health to form the country’s largest generic drug sourcing operation.

2012: $2.1 billion acquisition of Coram, a business that allows CVS to dispatch technicians to patients’ homes to administer pharmaceuticals through needles and catheters.

2015: In May, it paid $12.7 billion to acquire Omnicare, which distributes prescription drugs to nursing homes and assisted-living operations.

2015: In June, CVS announced it would buy Target’s pharmacy and clinic businesses for $1.9 billion and left open the possibility of pursuing further deals. Once the Target deal closes, CVS will operate about 9,600 retail stores, or about one out of seven retail pharmacies, according to Pembroke Consulting.

= = = = = = = = = =
Article begins here:

How CVS Quit Smoking and Grew Into a Health Care Giant

Michael Gaffney’s throat was scratchy for days, and lemon tea was not helping. So he dropped into a MinuteClinic above a CVS store in Midtown Manhattan on a lunch break. Within minutes, a nurse practitioner tested him for strep throat (negative), suggested lozenges and a regimen (ample fluids, no spicy food), collected a co-payment ($25 cash) and sent him on his way.

“That was quick,” said Mr. Gaffney, 26, an account executive for Indeed.com, who, like millions of Americans, does not have a primary care physician, even though he is covered by health insurance. He has been meaning to find a doctor since moving to New York last year, but his sore throat did not seem serious enough to warrant what was sure to be a time-consuming search and a long wait for an appointment.

The CVS MinuteClinic, on the other hand, was just blocks away from his office. “I waited longer for my bagel this morning,” he said.

With 7,800 retail stores and a presence in almost every state, CVS Health has enormous reach. And while shoppers might think of CVS as a place to pick up toothpaste, Band-Aids or lipstick, it is also the country’s biggest operator of health clinics, the largest dispenser of prescription drugs and the second-largest pharmacy benefits manager. With close to $140 billion in revenue last year — about 97 percent of that from prescription drugs or pharmacy services — CVS is arguably the country’s biggest health care company, bigger than the drug makers and wholesalers, and bigger than the insurers.

Even before the Affordable Care Act created millions of newly insured customers in the almost $3 trillion health care industry, CVS saw that there were more profits to be made handling prescription drugs than selling diapers. But while its transformation from drugstore to health care company began a decade ago, CVS has more recently taken on a new advocacy role, that of a public enemy of cigarettes.

Last year, CVS became the first major pharmacy chain to stop selling tobacco, a business that brought in $2 billion a year. And on Tuesday, CVS said that it would resign from the United States Chamber of Commerce after revelations that the chamber and its foreign affiliates were engaged in a global lobbying campaign against antismoking laws.

Its stand against smoking has allowed CVS to make alliances with health care providers and rebrand itself fully as a health care company. But with smoking rates on a steady decline, and cigarettes sales slumping, CVS also saw that future profits lie not with Big Tobacco but in health and wellness.

Taking the high road for health has its challenges. For one thing, it means new competitors in a rapidly changing industry. And, for a major retailer with tens of thousands of products on its shelves, it leads to an uncomfortable question: If we cannot sell cigarettes, what does that mean for potato chips?

Road to Growth

The Consumer Value Store started as a scrappy discount health and beauty outlet in Lowell, Mass., in 1963. Four years later, the small chain opened its first in-store pharmacies, and those became the core of the company — and its growth — for years. Larry Merlo, the chief executive, is a pharmacist by training and came into the company when it bought People’s Drug, a drugstore chain based in a suburb of Washington.

In a phone interview, Mr. Merlo spoke mostly in corporate platitudes, but when the conversation turned to the subject of pharmacists, he spoke passionately about pharmacists’ role in delivering health care.

“Hypertension, diabetes, osteoporosis,” he said. “It’s the same story — people don’t take their medication as prescribed.”

Pharmacists, who see patients more frequently than doctors do, can make sure patients stay on their drug regimens, he said, keeping them out of the hospital and saving the health care system billions of dollars down the road.

“I think back to my own personal experience,” he said. “Sometimes, it’s as simple as answering questions to get people to stay on their prescription therapies.”

Mr. Merlo said the company stood out in the breadth of products and services it offered: Its MinuteClinics diagnose and treat patients, and its pharmacies dispense medicine to more than two million prescriptions a day. It negotiates the price of medicines and helps 65 million people navigate drug coverage under their insurance plans.

The shift toward health care started in 2004, when CVS acquired Eckerd Stores and Eckerd Health Services, giving CVS a foothold in administering drug benefits to employees of big corporations and government agencies. Two years later, CVS acquired MinuteClinic, a pioneering in-store health clinic chain that was offering treatment for routine illnesses, basic screenings and vaccinations. CVS also expanded its very profitable specialty pharmacy business, which focuses on expensive drugs to treat complex or rare diseases like cancer or H.I.V.

Then in 2007 came the $21 billion merger between CVS and Caremark, which gave birth to the country’s leading pharmacy benefits manager. Three years ago, CVS struck a deal with the medical products distributor Cardinal Health to form the country’s largest generic drug sourcing operation. It followed up with a $2.1 billion acquisition of Coram, a business that allows CVS to dispatch technicians to patients’ homes to administer pharmaceuticals through needles and catheters.

The acquisitions keep coming. In May, it paid $12.7 billion to acquire Omnicare, which distributes prescription drugs to nursing homes and assisted-living operations. Just weeks later, CVS announced it would buy Target’s pharmacy and clinic businesses for $1.9 billion and left open the possibility of pursuing further deals. Once the Target deal closes, CVS will operate about 9,600 retail stores, or about one out of seven retail pharmacies, according to Pembroke Consulting. Last year, the company changed its name from CVS Caremark to CVS Health.

The growth of CVS comes at a time when the way Americans get access to and pay for health care is evolving quickly. Surveys show that many of the estimated 30 million people who gained insurance coverage last year under health care reform do not have a primary health care physician or do not use one. Many, too, opted for high-deductible health plans and are expected to become picky with the dollars they spend, and less tolerant of the opaque pricing that is still the industry’s norm. And consumers in general are starting to demand more convenient, on-demand access to health care, closer to home.

In that fast-changing world, CVS’s strategy is to be a one-stop shop for health care.

“Say you have diabetes, and you go into a pharmacy to get your insulin, how great is it if, in the same aisle, there’s a cookbook for people with diabetes?” said Ceci Connolly, managing director of PwC’s Health Research Institute. “And maybe there’s some foods that are already approved for you, and a place to check your feet, and a clinician to check your eyes,” she said.

“Consumers are saying: I want all of that at a place near my house that’s open on Saturdays, when it’s convenient for me. I want that place to post prices. It’s in CVS’s interest to pull in more and more pieces of that puzzle.”

A typical CVS clinic staffed by nurse practitioners sees 35 to 40 patients a day; those patients pay $79 to $99 for minor illnesses and injuries, and most insurance plans are accepted. Analysts estimate each clinic typically brings in $500,000 a year, representing just a fraction of CVS’s revenue. Still, the clinics are an important part of the company’s health care proposition.

Other retailers are also getting into the business. The number of retail clinic sites grew to 1,800 locations nationwide in 2014 from 200 in 2006, though they still represent just 2 percent of primary care encounters in the United States, according to a report published this year by Manatt Health, a health advisory practice, and the Robert Wood Johnson Foundation. But CVS is by far the leader. Walmart, which charges just $40 a visit, has fewer than 100 clinics, compared with the more than 900 in CVS’s portfolio. Walgreens, the second-largest, has half as many clinics as CVS. And CVS plans to add more, reaching 1,500 by 2017, the company has said.

Whether these clinics provide the best kind of care is a question sometimes raised by doctors in more traditional practices, like Robert Wergin, president of the American Academy of Family Physicians and a doctor in Milford, Neb.

“These retail clinics, they’re run by competent folks, and they probably have some role to play,” he said. “But you’re being seen at a clinic next to the frozen food section by a stranger. And if you go back for a follow-up, you’re going to get seen by someone else.”

For employers and insurers, however, the clinics offer a way to reduce costs for noncritical conditions. A study by researchers at the RAND Corporation estimated that more than a quarter of emergency room visits could be handled at retail clinics and urgent care centers, creating savings of $4.4 billion a year.

Reducing health care spending, however, may turn out to be complicated.

“You might imagine that they keep people out of E.R., so that’s one way you could save money,” said Martin Gaynor, professor of economics and public policy at Heinz College, Carnegie Mellon University. “On the other hand, just because they’re more convenient, people might go and obtain care in circumstances where they otherwise would not have sought care.”

CVS might have more sway reducing health care costs in its role as a middleman between drug companies and patients with drug benefits. The company is expected to start shifting the balance between end users on one hand, and drug manufacturers and wholesalers on the other.

CVS and other large dispensing pharmacies — Walgreens, Express Scripts, Rite Aid and Walmart — made up about 64 percent of prescription-dispensing revenue in the United States in 2014, according to Pembroke Consulting. That year, CVS was also the leading provider of specialty drugs in North America, with $20.5 billion in revenue, representing 26 percent of the total market.

“Scale is a big factor in pharmacy,” said Joseph Agnese, senior equity analyst at S&P Capital IQ. “There’s a lot of pricing pressure from drug manufacturers and one way for retailers can come back at them is to become larger, and become a more significant purchaser of drugs.”

Dr. Gaynor of Carnegie Mellon said, however, that cost reduction varied greatly by type of drug. “If there’s a drug that is very important for CVS to carry, and there are no alternatives, they aren’t going to have a lot of negotiating power,” Dr. Gaynor said. “But of course, the bigger CVS gets, the more they can move product, the more important it becomes.”

The company’s size also creates significant competition issues, says David A. Balto, an antitrust lawyer and former policy director at the Federal Trade Commission who often represents independent pharmacies. CVS’s ownership of Caremark could restrict consumers’ access to rival pharmacies, he said, and CVS’s acquisition of Omnicare, already a dominant player in long-term care, could reduce competition in that industry.

“There are tremendous concerns when you see someone becoming so terrifically large,” Mr. Balto said. “The acquisitions might conceivably be efficient, but whether those efficiencies are passed on to consumers really depends on the level of competition in the market.”

Quitting Cigarettes

Helena B. Foulkes, who leads CVS’s retail business, swept past the sales counter at a newly renovated CVS in downtown Manhattan. Where cigarette packs once lined up in neat rows, now there were nicotine gum and patches to help smokers quit. (There are no e-cigarettes either, much to the chagrin of that industry, which had hoped CVS would embrace its products as a lower-risk alternative.)

Ms. Foulkes, who lost her mother to lung disease, leads the retail business, which is starting to change to fit the company’s health care bent better.

The move to forgo $2 billion in annual tobacco sales has bolstered CVS’s health care bona fides. The White House lauded CVS’s move. “Thanks @CVS_Extra, now we can all breathe a little easier,” Michelle Obama wrote in a Twitter post. The praise seemed to give Mr. Merlo a jolt of confidence. At a TEDx talk this year in Winston-Salem, N.C., he declared: “CVS kicks butts across the U.S.”

“When we exited the tobacco category, it was the most important decision we’d made as a company,” Ms. Foulkes said. “That decision really became a symbol both internally and externally for the fact that we’re a health care company.”

It also made economic sense. Adult smoking rates have dropped to 18 percent in 2014, from 43 percent in 1965, according to the Centers for Disease Control, and experts predict that rate to dip below 10 percent in the next decade. Ditching cigarettes allows CVS to trade a small — less than 2 percent of revenue — and shrinking part of its business for an instant enhancement of its credentials in the faster-growing health and wellness space.

In October, CVS announced that its Caremark arm would require some of its customers to make higher co-payments for prescriptions filled at pharmacies that still sold tobacco products — in effect driving more traffic to the now tobacco-free CVS pharmacies. While that move encourages pharmacies to quit selling tobacco, it also raised the ire of an antitrust law research firm, which called the announcement “a smokescreen” that masks higher costs for those who fill prescriptions at competing pharmacies.

“CVS’s use of its market power to bludgeon consumers and rivals into ending tobacco sales is not a legitimate form of competition,” the American Antitrust Institute said in a statement. It has urged the Federal Trade Commission to investigate.

In general, CVS’s new anti-tobacco stance has helped it forge affiliations with regional hospitals. Before CVS went tobacco-free, negotiations with local health systems were awkward, Mr. Merlo said during a recent analyst conference call.

“That question would always come up — ‘You guys sell tobacco products, don’t you?’ — and that literally sucks all the energy out of the room,” Mr. Merlo said. But since the company stopped selling tobacco, he said, “We’ve been able to accelerate partnerships with leading health systems across the country.”

A new partnership with Rush University Medical Center in Chicago will involve patient referrals and shared electronic health records. Anthony Perry, vice president for ambulatory care and population health at Rush, said that traditional health care providers and companies like CVS could be natural allies.

“Take people with high blood pressure. That’s the type of thing you manage steadily over time, and you work on things like diet and exercise, and lifestyle changes, and if those things don’t work, you get into the world of medications,” he said. “What we asked was: If we’re going to do a series of visits with somebody, might they be able to do some of that closer to home?”

The flip side, he said, is that CVS can refer people with more serious ailments, but no primary care doctor, to Rush. “So CVS can now say: You need to see a primary care doctor, and we can connect you.”

The anti-tobacco stand has had other effects. Notably, the company has had to start thinking about other unhealthy items on its shelves. If it is a company that promotes health, can it also sell sugary sodas and candy bars?

The downtown Manhattan store where Ms. Foulkes walked the aisles is one of 500 locations that CVS is remodeling to emphasize healthy fare.

“I was in Long Island the day after the tobacco announcement, and I ran into a store manager who said: ‘I’m so proud of the company,’ ” she recalled. “But he also said, ‘I’m hearing customers now saying, why don’t you have healthier food?’ ”

“Customers quickly made the leap. They expected more from us,” she said.

Ms. Foulkes pointed to a prominent snack corner at the front of the store.

“What you’ll see in our stores are brands that convey healthy without being overly edgy. It’s Chobani yogurt, it’s Kind bars, it’s lots of proteins and nuts,” she said. “Health for the masses.”

At this point, there are no plans to stop selling high-fat or high-sugar snacks, still a big part of CVS stores’ sales. But they might be harder to spot.

When asked where the Oreos were, she smiled. “You’ll find them, but you’ll have to look for them.”

Africa Grid lags economic growth

New York Times reports…and here is the essence:

Nigeria’s leaders have promised a stable power supply since the end of military rule in 1999, spending about $20 billion and dismantling the state National Electric Power Authority, better known as N.E.P.A. — and widely derided as “Never Expect Power Always.”

Yet the country’s power generating capacity has remained virtually unchanged, about six gigawatts for a country of 170 million. The United States, with 310 million people, has a capacity of more than 1,000 gigawatts

—————–

Here is what keeps hope alive:

Post on Elon Musk and his powerwall factory

Note Musk is in record that his real vision is to sell battery factories….like the factory he is building in Nevada.

—————–

For Many in Africa, Lack of Electricity Is Barrier to Growth

JULY 1, 2015

JOHANNESBURG — In the darkened and chilly parking lot of a mall, a suburban family huddling around a shopping cart shared a snack on a Friday evening out. After finding their favorite restaurant closed because of a blackout, Buhle Ngwenya, with her two sons and two nephews, settled for meat pies from one of the few stores open in the mall.

“It’s like death, this load shedding,” Ms. Ngwenya, 45, said, referring to the blackouts imposed by South Africa’s state utility to prevent a collapse of the national electricity grid.

With winter here in South Africa, the worst blackouts in years are plunging residents into darkness in poor townships and wealthy suburbs alike. The cutoffs have dampened South Africa’s economy, Africa’s second biggest, and are expected to continue for another two to three years.

Despite a decade of strong economic expansion, sub-Saharan Africa is still far behind in its ability to generate something fundamental to its future — electricity — hampering growth and frustrating its ambitions to catch up with the rest of the world.

All of sub-Saharan Africa’s power generating capacity amounts to less than South Korea’s, and a quarter of it is unproductive at any given moment because of the continent’s aging infrastructure. The World Bank estimates that blackouts alone cut down the gross domestic products of sub-Saharan countries by 2.1 percent.

The crippling effect on sub-Saharan Africa was recently on display in Nigeria, which overtook South Africa as the continent’s biggest economy last year.

Nigeria’s electrical grid churns out so little power that the country mostly runs on private generators. So when a fuel shortage struck this spring, a national crisis quickly followed, disrupting cellphone service, temporarily closing bank branches and grounding airplanes.

The power shortages and blackouts have cast a harsh light on elected officials, causing rising anger among voters for whom reliable electricity was supposed to be a dividend of democracy and economic growth.

Experts say that the appointment of politically connected officials with little industry expertise at the South African state utility, Eskom, has led to mismanagement just as it has at other state-owned enterprises.

“It’s not only a symbol of failure when the lights go off,” said Anton Eberhard, an energy expert and a professor of management at the University of Cape Town. “It’s experienced directly by people. If you’re about to cook or if your child is studying for an exam the next day and your lights go off, people feel this very directly. There is a very concrete and dramatic expression of failure.”

The demand for power in Africa has become a major international issue. China has taken the lead in financing many power projects across the continent — mostly hydroelectric dams, but also solar power plants and wind farms. Private companies from Asia, the United States and Europe are also supplying power to an increasing number of countries.

China has taken the lead in financing many power projects across the continent, and independent power producers are now supplying some countries with electricity.

President Obama, in a visit to Africa two years ago, highlighted the importance of improving the continent’s power supply with a $7 billion initiative called Power Africa. The American government, partly through entities like the Millennium Challenge Corporation, is focusing on improving the electricity infrastructure in several countries, including Ghana, Malawi and Tanzania.

But investments and changes in the electricity sector on the continent have yet to yield significant gains, and experts predict that it will take decades before sub-Saharan Africa enjoys universal access to electricity.

In his inaugural address last month, Nigeria’s new president, Muhammadu Buhari, said that his nation’s attempts to overhaul its electricity sector “have only brought darkness, frustration, misery and resignation among Nigerians.” He singled out unreliable power service as the biggest drag on his country’s economy.

Nigeria’s leaders have promised a stable power supply since the end of military rule in 1999, spending about $20 billion and dismantling the state National Electric Power Authority, better known as N.E.P.A. — and widely derided as “Never Expect Power Always.”

Yet the country’s power generating capacity has remained virtually unchanged, about six gigawatts for a country of 170 million. The United States, with 310 million people, has a capacity of more than 1,000 gigawatts.

“Most companies don’t have four hours of power a day from the national grid,” said Akpan Ekpo, the director general of the West African Institute for Financial and Economic Management in Lagos, Nigeria’s commercial capital. “If they do, they’re lucky.”

Most of the $20 billion spent to overhaul the power sector is believed to have gone into the pockets of corrupt officials, Mr. Ekpo said.

“With the advent of democracy, we were promised constant power, or at least improved power,” he added. “But much to our surprise, things have only gotten worse. In some middle-class parts of Lagos, people are lucky if they now get 30 minutes of power a day.”

Yet the country’s power generating capacity has remained virtually unchanged, about six gigawatts for a country of 170 million. The United States, with 310 million people, has a capacity of more than 1,000 gigawatts.
“Most companies don’t have four hours of power a day from the national grid,” said Akpan Ekpo, the director general of the West African Institute for Financial and Economic Management in Lagos, Nigeria’s commercial capital. “If they do, they’re lucky.”
Most of the $20 billion spent to overhaul the power sector is believed to have gone into the pockets of corrupt officials, Mr. Ekpo said.
“With the advent of democracy, we were promised constant power, or at least improved power,” he added. “But much to our surprise, things have only gotten worse. In some middle-class parts of Lagos, people are lucky if they now get 30 minutes of power a day.”
South Africa’s recent history of electrification is more complicated, and it has been the subject of fierce debate as the current blackout crisis has dragged on for several months.
In the last years of apartheid, before a democratic government was elected in 1994, electricity reached only a third of South African households, few of them black.
Under the African National Congress — whose leaders have governed ever since, often promising free electricity and other services as part of the nation’s new democracy — 85 percent of households now have electricity, a remarkable accomplishment by any standard.
President Jacob Zuma has forcefully rejected any blame for the energy crisis. The strain on the grid, he said, resulted from the burden of bringing light to millions of black households without power under white-minority rule.
“It is a problem of apartheid, which we are resolving,” he said this year.
But energy experts say that these households, many of them low-income, consume little electricity. Instead, they said, the shortages result from frequent breakdowns at aging plants and, most critically, the delayed construction of two new facilities.
As far back as 1998, a government report warned that without new capacity, the country would face serious power shortages by 2007. A year later, in 2008, South Africa suffered its first rolling blackouts.
South Africa, which has the continent’s only nuclear power plant, has around half of sub-Saharan Africa’s power generating capacity, roughly 44 gigawatts. Still, the power cuts contributed to a recent drop in economic growth and a spike in unemployment to 26.4 percent, the worst level in a dozen years.
The rolling blackouts have affected everyone from giant gold mining companies and manufacturers to small businesses and individuals.
South Africans are now buying up generators, rechargeable lights and gas burners. They plan their days and evenings around scheduled blackouts by the utility. Dominating South Africa’s list of popular app downloads are ones that alert smartphone users to the impending start of a cutoff in their neighborhood or the risk of one as load shedding across the nation increases from Stage 1 to Stage 2 or Stage 3.
To Ms. Ngwenya, who was sharing meat pies with her family in the parking lot, load shedding was not only about electricity. She blamed the African National Congress, the party that liberated South Africa and has steered its course ever since.
“I always supported the A.N.C.,” said Ms. Ngwenya, who grew up in Soweto, a black township outside Johannesburg, but now lives in a wealthy suburb. “However, when it comes to load shedding, I don’t know. It’s not normal coming to a mall and carrying a torch like this man here,” she said, pointing to another consumer shrouded in darkness.
“For me, this is the biggest failure of the A.N.C.,” she added. “We even have a name for it, load shedding. Why don’t they say blackout once and for all?”
In Sandton, a Johannesburg suburb with gated communities and sumptuous malls, Junior Nji, 38, walked out of a well-lit Woolworth’s in an otherwise dark mall. His wife had just sent him a text message with the news that their neighborhood had gone dark and not to bother getting groceries.
“Load shedding boo,” she had written him, using a term of endearment. “This can’t be life.”
That morning, Mr. Nji said, he had finally decided to buy a diesel generator for his house, and workers had come to prepare for the installation. But Mr. Nji, an architect, was holding off on plans to move to a bigger office because of the extra costs of equipping it with a generator. He had been planning, he said, to hire an additional architect and a draftsman.
He texted his wife: “Then let’s go out somewhere. That Chinese restaurant might just be O.K.”

Greece made simple

So Greece owes $310 billion euros to a range of lenders – but note $107 billion were written off by private lenders in 2012, so this brings Greek total debt to almost a half trillion dollars:

Greek lenders and amounts lent

Note that the IMF is a relatively small lender and the “Greek Public Sector” and the EU are large.

The story is a really sad one. Maybe it traces back to 1981, when Greece joined the EU. But arguably the real beginning is 2001, when they joined the Eurozone. As the newest member of the Eurozone, they were fortunate (???) to join as the economy was picking up steam. The go-go years were 2001-2007, when lenders poured money into this promising new member – almost a half trillion dollars!

Thus is it that they were the hardest hit when the recession hit in late 2007. They have been paying a steep price for this massive credit splurge in 2001-2007.

So – – – in summary:

As with so many stories, this one has two sides:

1) a poor country fighting to get resources – to get out of poverty and build a better life for its citizens (don’t believe anyone who starts their story here with “those Greek corrupt politicians”)
2) rich countries who love being bankers – to extend their reach and influence and income while feeling good about trying to help their poor neighbors (don’t believe anyone who starts their story with “those greedy German bankers…”.

Ok, OK, so Greek pride got the best of them when they borrowed almost a half trillion dollars!!!!! 12 million people ….. borrow a half trillion dollars?????!!!!!!

OK, OK, so us rich people got a little carried away when those nice Greeks kept wanting to borrow more ….. so what’s another 100 million when everyone is feeling so fine??????

A few sources explain in ways I trust:

NYT explains
Financial Times Coverage

http://www.nytimes.com/interactive/2015/business/international/greece-debt-crisis-euro.html?_r=0

Fortune Magazine Q&A

Everything to Know About Greece’s Economic Crisis
Geoffrey Smith / Fortune June 29, 2015

How Greece and the eurozone ended up in this mess, and where they go from here

Q. How did we get here?

A. Long story. Greece’s economy was never strong enough to share a currency with Germany’s, but both sides pretended it was, as it satisfied Greek pride and Germany’s ambitions (suffused with war guilt) of building an ‘Ever Closer Union’ in a new, democratic Europe. Reckless lending by French and German banks allowed the Greeks to finance widening budget and current account deficits for six years, but private capital flows dried up sharply after the 2008 crisis, forcing Greece to seek help from Eurozone governments and the International Monetary Fund in 2010.

Q. But all that was 5 years ago. How has Greece not managed to turn the corner since then, when every other Eurozone country that took a bailout has?

A. Greece was the first country to ask for help, and the Eurozone was totally unprepared for it on all levels–political, technological, emotional, whatever. The IMF, too, had no experience of dealing with a country in a monetary union. Consequently, the bailout was badly conceived (a point admitted at the weekend by Dominique Strauss-Kahn, who was head of the IMF at the time), focusing too much on the budget balance and not enough on fixing Greece’s uniquely dysfunctional state apparatus. In a normal recession, government spending can offset the negative effects of private demand contracting, but in this case, the budgetary austerity drove Greece into a vicious spiral. The economy contracted by 25% between 2010 and 2014, fatally weakening Greece’s ability ever to repay its debts.

Q. But didn’t Greece already get a load of debt relief?

A. Yes, €107 billion of it in a 2012 debt restructuring, the biggest in history. But it was only private creditors–i.e., bondholders–who took the hit. The Eurozone and IMF refused to write down their claims (although they did soften the repayment terms), and the new bailout agreement was based on more assumptions (since exposed as too rose-tinted) that Greece could grow itself out of its troubles. The economy continued to shrink in absolute terms and unemployment shot over 25%, forcing an ever bigger burden of taxation onto fewer and fewer shoulders. That created the political environment for this year’s crisis.

Q. You make it sound like this year is different from the previous four…

A. Victory for the radical left-wing Syriza party at elections in January completely changed the political dynamic. Previous governments had come from the political mainstream, and reluctantly played along with rules dictated in Brussels and, indirectly, Berlin. Syriza didn’t have any truck with that. It has campaigned for a 50% write-off of its debts and a relaxation of its budget targets. It has been openly confrontational and reversed key reforms made by the previous governments, despite promising the creditors in February that it wouldn’t. Syriza’s tactics–embodied by Finance Minister Yanis Varoufakis, an economics professor specializing in Game Theory–have been a gamble that the Eurozone would rather make concessions than risk the economic havoc caused by a Greek exit.

5. That gamble has failed, hasn’t it?

As of today, yes. It’s Greece, yet again, which is bearing the burden of everything: the economy had shown signs of bottoming out before Syriza came to power, with business sentiment at its highest in seven years after a very good tourist season in 2014. But the brinkmanship has destroyed confidence, and caused a sharp rise in government arrears and deposit flight, capped now by capital controls and a week-long closure of the banking system. Eurozone financial markets aren’t taking it well, but the prospect of a ‘shock and awe’ intervention by the ECB is keeping the sell-off within limits Monday morning. A real “Grexit” may yet wreak havoc on the Eurozone too, but it’s unlikely that Prime Minister Alexis Tsipras will be around that long to reap the political rewards.

Q. Aren’t the creditors to blame too?

A. For sure, there’s plenty of blame to go round. Most people now recognize that the banks that had lent to Greece pre-crisis should have been forced to take more losses in 2009/2010. Now the Eurozone has effectively swapped the private loans for public ones, any debt write-offs have enormous political costs at home. But governments in Germany and elsewhere have made a rod for their own back by being so stubborn. When Greece defaults, they’re going to lose billions anyway, and the cost of their posturing will become clear to taxpayers who have only been told half the story. They have squandered a host of opportunities to manage that loss in a more orderly way. By failing to accommodate more willing (if still inadequate) Greek governments with debt relief earlier, they prepared the ground for Syriza’s rise.

Q. What happens next?

A. Greece will miss a payment to the IMF Tuesday, and its bailout will expire the same day. The ECB seems likely to ignore the default at least until the planned referendum on Sunday, anxious to avoid responsibility for precipitating the total collapse of the financial system. The creditors are hoping the Greek government will capitulate under the pressure, and be replaced by a new ‘government of national unity’. There’s no sign of that happening yet.

Q. But how long can the current situation go on?

A. The banks are closed until July 7, after the referendum. As long as they still have the lifeline of the ECB’s emergency credit facility (over €85 billion), the banks and the government can continue to operate, albeit in a very restricted fashion. But the government is due to repay €3.5 billion in debts to the ECB on July 20, and if it can’t do that, then the ECB will have to accept that the Greek state is bankrupt, and cancel that credit line. At that point, the banks will be insolvent, and it will only be possible to restore their solvency by re-denominating the rest of their liabilities (i.e. deposits) in a new Greek currency.

Q. How, legally, does Greece leave the Eurozone?

A. Nobody knows. Like Cortes burning his boats after arriving in Mexico, the E.U. deliberately chose not to draft rules for that eventuality when it formed its currency union. There are rules for leaving the E.U., but even Syriza doesn’t want to do that. We will be, as Irish Finance Minister Michael Noonan said at the weekend, “in completely uncharted waters.”

They’ll be damned choppy waterss, too.

Q. How did we get here?

A. Long story. Greece’s economy was never strong enough to share a currency with Germany’s, but both sides pretended it was, as it satisfied Greek pride and Germany’s ambitions (suffused with war guilt) of building an ‘Ever Closer Union’ in a new, democratic Europe. Reckless lending by French and German banks allowed the Greeks to finance widening budget and current account deficits for six years, but private capital flows dried up sharply after the 2008 crisis, forcing Greece to seek help from Eurozone governments and the International Monetary Fund in 2010.

Q. But all that was 5 years ago. How has Greece not managed to turn the corner since then, when every other Eurozone country that took a bailout has?

A. Greece was the first country to ask for help, and the Eurozone was totally unprepared for it on all levels–political, technological, emotional, whatever. The IMF, too, had no experience of dealing with a country in a monetary union. Consequently, the bailout was badly conceived (a point admitted at the weekend by Dominique Strauss-Kahn, who was head of the IMF at the time), focusing too much on the budget balance and not enough on fixing Greece’s uniquely dysfunctional state apparatus. In a normal recession, government spending can offset the negative effects of private demand contracting, but in this case, the budgetary austerity drove Greece into a vicious spiral. The economy contracted by 25% between 2010 and 2014, fatally weakening Greece’s ability ever to repay its debts.

Q. But didn’t Greece already get a load of debt relief?

A. Yes, €107 billion of it in a 2012 debt restructuring, the biggest in history. But it was only private creditors–i.e., bondholders–who took the hit. The Eurozone and IMF refused to write down their claims (although they did soften the repayment terms), and the new bailout agreement was based on more assumptions (since exposed as too rose-tinted) that Greece could grow itself out of its troubles. The economy continued to shrink in absolute terms and unemployment shot over 25%, forcing an ever bigger burden of taxation onto fewer and fewer shoulders. That created the political environment for this year’s crisis.

Q. You make it sound like this year is different from the previous four…

A. Victory for the radical left-wing Syriza party at elections in January completely changed the political dynamic. Previous governments had come from the political mainstream, and reluctantly played along with rules dictated in Brussels and, indirectly, Berlin. Syriza didn’t have any truck with that. It has campaigned for a 50% write-off of its debts and a relaxation of its budget targets. It has been openly confrontational and reversed key reforms made by the previous governments, despite promising the creditors in February that it wouldn’t. Syriza’s tactics–embodied by Finance Minister Yanis Varoufakis, an economics professor specializing in Game Theory–have been a gamble that the Eurozone would rather make concessions than risk the economic havoc caused by a Greek exit.

5. That gamble has failed, hasn’t it?

As of today, yes. It’s Greece, yet again, which is bearing the burden of everything: the economy had shown signs of bottoming out before Syriza came to power, with business sentiment at its highest in seven years after a very good tourist season in 2014. But the brinkmanship has destroyed confidence, and caused a sharp rise in government arrears and deposit flight, capped now by capital controls and a week-long closure of the banking system. Eurozone financial markets aren’t taking it well, but the prospect of a ‘shock and awe’ intervention by the ECB is keeping the sell-off within limits Monday morning. A real “Grexit” may yet wreak havoc on the Eurozone too, but it’s unlikely that Prime Minister Alexis Tsipras will be around that long to reap the political rewards.

Q. Aren’t the creditors to blame too?

A. For sure, there’s plenty of blame to go round. Most people now recognize that the banks that had lent to Greece pre-crisis should have been forced to take more losses in 2009/2010. Now the Eurozone has effectively swapped the private loans for public ones, any debt write-offs have enormous political costs at home. But governments in Germany and elsewhere have made a rod for their own back by being so stubborn. When Greece defaults, they’re going to lose billions anyway, and the cost of their posturing will become clear to taxpayers who have only been told half the story. They have squandered a host of opportunities to manage that loss in a more orderly way. By failing to accommodate more willing (if still inadequate) Greek governments with debt relief earlier, they prepared the ground for Syriza’s rise.

Q. What happens next?

A. Greece will miss a payment to the IMF Tuesday, and its bailout will expire the same day. The ECB seems likely to ignore the default at least until the planned referendum on Sunday, anxious to avoid responsibility for precipitating the total collapse of the financial system. The creditors are hoping the Greek government will capitulate under the pressure, and be replaced by a new ‘government of national unity’. There’s no sign of that happening yet.

Q. But how long can the current situation go on?

A. The banks are closed until July 7, after the referendum. As long as they still have the lifeline of the ECB’s emergency credit facility (over €85 billion), the banks and the government can continue to operate, albeit in a very restricted fashion. But the government is due to repay €3.5 billion in debts to the ECB on July 20, and if it can’t do that, then the ECB will have to accept that the Greek state is bankrupt, and cancel that credit line. At that point, the banks will be insolvent, and it will only be possible to restore their solvency by re-denominating the rest of their liabilities (i.e. deposits) in a new Greek currency.

Q. How, legally, does Greece leave the Eurozone?

A. Nobody knows. Like Cortes burning his boats after arriving in Mexico, the E.U. deliberately chose not to draft rules for that eventuality when it formed its currency union. There are rules for leaving the E.U., but even Syriza doesn’t want to do that. We will be, as Irish Finance Minister Michael Noonan said at the weekend, “in completely uncharted waters.”

They’ll be damned choppy waters, too.

References:

Harvard analysis of Vacation Days

How Tesla will Change Your Life

This is an extraordinary article: in length (it is very long) and in breadth (it covers the universe, beginning with first principles), and in quality (it is lay person readable).

How Tesla Will Change Your Life

The article is actually one article of four. Here is the first, all about Elon Musk:

The Reality Project

Here is an amazing compilation of a certain category of world events, by Leon Newton. Newton obviously has a POV, which can be independently understood. But what I find amazing is the diligence of the compilation.

Thanks to my friend Usman Mirza for letting me know about this.

Leon explains his work below:

“The Messengers” which is a compilation of the works of many critical thinkers over the years who have tried to explain existing conditions or to warn us of future conditions if we continued to do what we are doing.

The Reality Project File
Messages in History

“2015 Headlines” contains articles, videos and audio presentations from around the world. It is different from most other news sources in that it includes Energy as a separate category. At the bottom of the “Headlines” sheet are four videos (selected from “The Messengers”) which, I believe describe our present economic predicament.

Headlines in history

“The Reality Project Power Flow Chart”. This is my interpretation of how C. Wright Mills described the roles of the Power Elite, Corporations and governmental entities it also includes many of the entities that were created by the Powell Memo, including the propaganda machine that has so divided this country.

The Realty Project Flow Chart