Why Can’t India Feed Its People?
















It was 1958, my father was still a child, and India was running out of food. That year’s wheat crop had slumped by 15 percent, the rice harvest by 12 percent, and prices in the markets were soaring. Far from his village in eastern India, ships loaded with wheat were steaming toward the country, part of Dwight Eisenhower’s plan to sell surplus grains, tobacco, and dairy products to friendly countries. All India Radio gave daily updates on the convoys, and the army barricaded ports in Mumbai and Kolkata against the hungry crowds.


“It was this very coarse, red wheat,” says Narsingh Deo Mishra, a childhood friend of my father’s and now a local politician in Auar, their home village. “We were told it was meant for American pigs,” says Mishra. “Back then, we weren’t any better than American pigs. So we ate it. We ate it all, and we begged for more.”













My father, Dinesh, grew up during the toughest years in modern India’s history, a time of droughts and floods. At 18 he weighed about 40 kilograms (90 pounds). In a photograph taken at the time, his cheeks are sunken, his Adam’s apple is prominent, and his eyes bulge from a gaunt skull. As he grew into his teens and early adulthood, however, the Green Revolution took hold: The fields were sown with hybrid seeds and enriched with chemical fertilizers, enabling the country first to feed itself and later to sell its grain on the global markets. India is a generation removed from those “ship-to-mouth” days; fewer than 2 percent of Indians now go without two square meals a day, and far fewer still die of starvation.


And yet, in places like Auar, malnutrition persists. The vast majority of Indians, especially villagers, are suspended in nutritional purgatory—they eat enough to fill their stomachs but not enough to stay healthy. In the early 1970s the number of calories the average Indian ate began rolling backward. In 1973 villagers ate just under 2,300 calories a day, according to the National Sample Survey Office, a branch of the Ministry of Statistics and Programme Implementation. By 2010 that number had dropped to about 2,020, compared with the government floor of 2,400 a day to qualify for food aid. The mismatch manifests itself in some of the world’s worst health score cards: Half of all children younger than three years old in India weigh too little for their age; 8 in 10 are anemic.


During months of reporting on malnutrition in India, I spoke almost daily to my father, who had long since escaped Auar and now runs a national scientific research center in Kolkata, where I grew up. This June I returned by myself to the dusty, hot village of my father’s childhood, hoping to understand more. I drove about 800 kilometers (500 miles) southeast from New Delhi to Auar, deep in the heart of Uttar Pradesh state. The local district of Pratapgarh is in the poorest third of the country’s 640 districts, according to the government. I’d been to the village before—first as a child and again in 2000, when I was getting ready to leave for college in Virginia. My father, who wanted me to remember my family’s origins, stood out then from cousins and old friends in his starched white shirt and tailored trousers, no longer comfortable sitting cross-legged in the dust.


On that visit he pointed out the few reminders from his childhood. There was the elementary school built, according to family legend, with the proceeds from a single gold coin saved by a great-granduncle during years of toil in Burma in the 1920s; and there were the brick additions made to the mud house that belonged to my grandfather. By then the house was falling apart and emptied of family, who were now scattered in cities across India.


When I returned this year, I set up camp outside, sleeping on a borrowed cot under the mango trees my father climbed as a child. Although I hired a snake charmer to clear the ruins of the hut of its newest inhabitants, I worried that he may have done a less than perfect job. For the next two weeks I walked the dry, barren fields of the village, waiting like the locals for the rains that this year, at least, never fully came. I carried out a rudimentary survey, weighing children on a bathroom scale I’d brought, and spoke to the oldest people I could find, asking them to contrast their memories of long-ago meals to those they ate today. And for those two weeks I ate what the average poor and landless Indian villager could afford.
 
 
In some ways, Auar has kept pace with modern India. I counted about 60 motorbikes parked outside houses. And 400 or so of the village’s roughly 2,000 residents carry mobile phones, according to the local merchant who offered a recharging service for the equivalent of about 20¢, using car batteries he carried on the back of his bicycle. Auar has power now—sometimes. Every other day the electricity poles hum and spark for a couple of hours, bringing life to the television in the small village store and the handful of wells irrigating the fields of wealthier farmers. It’s a luxury, nonetheless: About 400 million Indians have no access to electricity at all.


In other ways, Auar is unchanged from my father’s time. There’s still no running water in most homes, and it takes dozens of cranks of a hand pump to fill each bucket of water. Every act of nature requires a 15-minute walk to a field where pigs root around in the remains of yesterday’s visit. In 38 of the 40 households I visited, I noted the teenagers’ ribs and the distended bellies and loose, stretchy skin of the toddlers, the first and most obvious symptoms of a diet sufficient in calories but lacking in protein. When it was first reported in 1935 in Ghana, doctors called this form of malnutrition kwashiorkor, taking the local word for the illness a child gets when it’s weaned too early because a new baby has arrived. In Auar the villagers had no name for it.


I tracked down Ghanshyam, the son of a laborer who had worked about two acres of land my grandfather owned. (Like many Indians, Ghanshyam goes by only his first name.) My father remembers the laborer’s wife picking up scraps from our family’s dinner and taking them home to her sons. “She would whisper to me to take larger servings and leave something for her children,” says my father. “Even now, I feel guilty—I never left enough.” Rakesh, his oldest brother, would leave as much as he could, my father says. “But I was young, I didn’t really think.”


Ghanshyam took me to his one-room mud-and-straw hut in the center of the village. Dressed in a torn shirt and lungi—a cloth wrapped around his waist—and barefoot, it was unclear whether he was one of the same children who grew up with my father. He couldn’t tell me his age. He was too young to recall, as my father did, the school holiday to commemorate a visit by Chinese Premier Zhou Enlai in 1956. But he did remember the short-lived friendship of India and China turning into a border dispute six years later. That might make him somewhere around 50 or 52.


Ghanshyam, to me, embodies India’s poor and malnourished. He owns no land, except for the plot on which his hut stood. He has tuberculosis, which infects about 2 million Indians every year, but he still scrabbles for work in the fields of landowners, making between $ 2.50 and $ 3.50 a day. When strong enough, he hitches a ride to the city of Pratapgarh, 45 minutes away, in search of construction work paying as much as $ 3.75 a day. On other days, Ghanshyam waits for villagers to come find him for odd jobs. A neighbor once paid him $ 1.50 to build a small roof. Another time, he spent four or five hours helping to clear a field of weeds and stones. He made 80¢ that day.


In recent weeks, Ghanshyam found only a few days’ work. The monsoon was late, so there was little to be done in the fields; construction had slowed in anticipation of those same rains, the life force of rural India. With that meager income, Ghanshyam supported his wife, Urmila Devi, two teenage sons, and the wife of an older son whom I never saw. When I asked what happened to his eldest, Ghanshyam looked away. Urmila, a quiet woman who rarely spoke to me unless her husband was nearby, later told me the son had gone to a city to look for work and never returned. He’d left behind two young boys—more mouths to feed on the days the boys didn’t spend at their maternal grandparents’ house.


Every evening, I gave Ghanshyam about 50¢, the amount the government set last year as the daily poverty line above which Indians no longer qualify for the most subsidized form of food aid. In exchange, his wife included me in their meals. Thus, I would eat as many Indians do. In the morning we drank small cups of watery tea with milk, sweetened with a nugget of jaggery, a hard candy made from unrefined cane sugar. In the afternoon we each ate three rotis, a heavy, unleavened bread, dipping them into a thin gruel of lentils and spice called dal. The rotis were thick, dry, and almost tasteless, made with the cheapest, coarsest grain available. The dal was watery, with the pulses settling to the bottom, far different from my mother’s dal, which was thick, rich with butter and ghee, and spiced carefully.


At night, before walking to the family’s home, I used a stick to shake a few sour mangoes from the trees. Urmila boiled them in the dal to add flavor, pouring the mixture over some boiled rice.


It had been a year, at least, since Ghanshyam last ate meat, eight months since he was able to catch fish in the nearby river, and six months since he’d had an egg, he told me. Later I showed photos of the meals to Rachita Singh, a nutritionist at the Saket Max Hospital in New Delhi. She estimated they would provide about 1,700 to 1,800 calories a day. Such a diet, heavy in cereals and other carbohydrates, is what most rural Indians eat. In 2010, according to India’s statistics ministry, 64 percent of the calories consumed by rural Indians came from cereals, about 9 percent from oils and fats, and less than 5 percent each from sugar and pulses such as the lentils we ate. Fruit, vegetables, meat, eggs, and fish together made up about 2.5 percent. By all counts—overall calories or nutrients—it’s a poor diet.
 
 
Auar, like most Indian villages I’ve visited, is actually a collection of hamlets scattered around a central body of water, usually a deep well or two. In Auar life centered on what the villagers generously called the river. More of a rivulet, it was too small to show up on my maps. Sluggish and dirty when I visited at the end of the dry season, it served a multitude of purposes along the narrow stretch that ran past the village. Upriver, where the water was thought to be cleaner, children would do back flips into it, and women brought their laundry, the gentle slapping of wet cloth on stones filling the air. Early in the morning, the few households that owned a buffalo or cow would bring them for a bath. Downriver from the village, around a quick bend, the bank was a squelching, stinking open toilet.


The hamlets, called bastis, are segregated mostly by caste or religion. Others are settlements of five or six huts belonging to members of the same family. Sixty-two years after India’s first constitution declared caste discrimination illegal, the system still dictates daily life and constrains opportunities for hundreds of millions of people.


My first day in the village, I was taken to the upper-caste basti to meet the village headman, a tall, broad-chested Brahmin named Vinod Upadhyay. I wanted him to know I’d be living in the village and asking questions. He offered me a plastic chair outside his two-story brick house, where a shiny motorcycle stood next to an electric water pump. A servant brought out tea and biscuits. After my first sip, I asked Upadhyay why he wasn’t joining me.


“When I eat with lower castes, it disagrees with my stomach,” he answered nonchalantly.


My father’s family was of a middling caste called the Kayastha—we had neither the land nor privileges of the Brahmin but were spared the humiliating poverty of the lowest castes. Our hamlet reflected that: In old photographs my father took during trips back to Auar, the mud hut had started to take the shape of a house—a small brick addition in the early 1970s, another expansion in the early 1980s. Our neighbor was a distant cousin, his neighbor another cousin. Our hamlet was a 10-minute walk from Ghanshyam’s, where the huts were smaller, packed closer together, sharing a single hand-pumped well.


My life in the village quickly fell into a pattern that in many ways has remained unchanged for centuries. Rising with the sun, my stomach already growling with hunger, I’d seek a secluded spot to empty my slowly cramping bowels. With little running water, and almost no indoor toilets, entire fields were open latrines. Women rose earlier still, defecating in the dark in the hope of some privacy. Open defecation is a national crisis for some 665 million Indians; soiled water and food supplies are a major contributor to the spread of pathogens that kill about 1,000 children a day from diarrhea, hepatitis, and other diseases.


I’d bathe under a hand-pumped well, pumping with one hand while trying to rub myself clean. At Ghanshyam’s home, Urmila would already be burning some dry twigs to boil our morning tea. Before the sun rose too high, I’d accompany Ghanshyam on his search for work.


One morning we hitched a ride to Pratapgarh, joining a group of day laborers waiting at a traffic intersection to be picked for work. Those with obvious skills—painters with their brushes and cans of turpentine; carpenters with their tools—were chosen first. Last were people like Ghanshyam, who had little to offer but their strength. I followed him to where about 20 men were working on the foundation for a family home. My offer of labor was refused—my city clothes, tinted glasses, and well-fed frame betrayed me as an outsider.


I watched Ghanshyam carry bricks for an hour, his pace slacking as the sun climbed. By 10 a.m. the temperature was 102F. When the foreman yelled at Ghanshyam for being too slow, I took his place, an unpaid substitute. We dug ditches and broke bricks to mix in the mortar. It had been a week since I’d migrated to the village diet, and by noon I was exhausted. The men around me had withered, too, their movements slower, their ribs glistening in the sun. Ghanshyam opened a lunch box, and we ate onions and rotis. We had drunk the dal while waiting to be picked for work.


The temperature climbed to 118F, and the workers talked the foreman into letting them rest in the shade a half-hour longer. For two more hours, Ghanshyam and I took turns laboring. Finally, at 4 p.m., the foreman handed out the wages: Ghanshyam pocketed $ 1.75 for both of us; the other men each earned $ 2.20. Ghanshyam’s tuberculosis had slowed him down too much; I had done little to help. In Auar, the cereal-laden meals sat heavily in my stomach, and I felt less hungry than I’d imagined I would. The most obvious impact was a constant sense of lethargy. I moved more slowly and took longer to recover from short bursts of labor like that at the construction site. My weight dropped about five pounds in the two weeks I lived in the village.


In the evening, my phone would light up around 7 p.m. with a text message from the Papa John’s (PZZA) in Delhi. For $ 11—or 22 times the government’s poverty line—I could order a medium pepperoni and cheese pizza, except it would be delivered to my air-conditioned apartment in a posh Delhi suburb, not to this sweaty, hungry corner of India. I dreamed often of that pizza.
 
 
Experts have argued about the reasons for India’s worsening nutrition without reaching a conclusion. Abhijit Banerjee, an economist at Massachusetts Institute of Technology’s Poverty Action Lab, once described it to me as the “million-dollar question.” In 2009 two economists, Angus Deaton, at Princeton University, and Jean Drèze, at the G.B. Pant Social Science Institute in Allahabad, just two hours from Auar, wrote a paper arguing that Indians were consuming fewer calories today than in the 1980s because they needed fewer calories. Poor Indians now had bicycles and got sick less often, they said, and that might solve the puzzle that has confounded economists studying Indian nutrition—falling calorie counts at a time of rising real incomes.


According to Deaton and Drèze, economists have seen this trend twice before, in post-Mao China in the 1980s and 1990s, and in Britain during the Industrial Revolution, from 1775 to 1850. Before I left for the village, I called Deaton. He was irritated that my questions focused only on calories; he believes the environment in which those calories are consumed and burned, and the manual labor the person has to endure, are equally important, if not more so. “I am not saying, for instance, that Indians are well-nourished,” he said. “What I am saying is that the fact that they are eating fewer calories doesn’t mean anything unless you know more about the rest of their lives.”


Following Ghanshyam around, I was less convinced by Deaton’s explanation. Deepankar Basu and Amit Basole, two University of Massachusetts economists, are also skeptical. In a draft paper published in July, they found that while Indian incomes have gone up, a rise in spending on other essential items, such as health care and transportation, means the amount of money left over for food has remained stagnant at a time of high inflation.


There’s little data to show that Indians have moved into less physically strenuous jobs. India has yet to experience the kind of industrial revolution seen in large parts of China that has freed an entire generation from the fields. Sixty-nine percent of the nation’s 1.2 billion people still live in the countryside, vs. 49 percent of China’s 1.3 billion. The lives of Ghanshyam and other villagers in Auar certainly seemed to need more than what 1,700 calories or even the government-recommended minimum intake of 2,400 calories could sustain. India’s state medical research council says workers doing moderate or heavy labor need 2,730 to 3,490 calories a day.


Some of the causes for the caloric mismatch are clear. Corruption, incompetence, and official indifference mean record stockpiles of grain rot in warehouses, and supplies meant for the poor are often stolen. As much as $ 14.5 billion worth of food in one conspiracy was looted by corrupt politicians over 10 years from my father’s state of Uttar Pradesh alone, according to court documents. India spends $ 14 billion a year to help feed those who can’t afford to buy rice or wheat in the market. Every year, the World Bank estimates, almost 40 percent of that aid simply falls through the cracks of a system of paper-and-thumbprint accounting, starving the poorest, most isolated Indians. Nor has an Indian politician embraced the problem of hunger the way Brazil’s Luiz Inácio Lula da Silva did in 2003 with his Zero Hunger program, or Ghana’s John Kufuor did when he was president in the first decade of the 2000s. Both managed to halve the number of hungry people in their countries in only a few years of focused governmental effort.


To be fair, while India has struggled to improve nutrition for the entire country, it has largely managed to end death by starvation. But to cure India of hunger would require the nation to be cured of all else that ails it—corruption, bureaucracy, poverty, caste differences, the Malthusian nightmare of having more people than it can employ. In essence, it may be that Indians are still hungry because India is not yet a fully functional country. My father takes a darker view. “Nobody cares,” he says.
 
 
Most days during my stay, Ghanshyam didn’t find work. We would lie in the shade, stoned in the heat, stirring only to swat away flies and move our cots with the shadows. Soon after sundown, the darkness was complete, and almost everybody would head to sleep.


I’d walk back to the ruins of my father’s old house and imagine his childhood. In short stories he’s published, my father recreates a bucolic life interrupted by misfortune—disease, the curses of slighted gypsy women, ghosts, and poachers. The stories echo his own childhood. He survived smallpox; his body is still scarred from the near-death experience. A sister, born underweight and listless, died of malnutrition at six months. She had been named Munni, Hindi for “our little girl.”


In 1964 my grandfather landed a job as a conductor for the state-owned Indian Railways and moved the entire family—my grandmother, three sons (two more came later), and three daughters—to the city of Allahabad in eastern Uttar Pradesh. In socialist India, a government job was perhaps the only way out of poverty. My grandfather leveraged his accomplishment with a relentless focus on educating his sons.


That urge was a relic of our caste beginnings. Without large tracts of land to cultivate, Kayasthas in Uttar Pradesh and the neighboring state of Bengal became a caste of peons—clerks, bookkeepers, minor functionaries for the local maharajahs. That emphasis on being able to read and write has left an imprint throughout my family’s known history, starting with the great-granduncle who spent his life’s savings to build the primary school my father studied in and which still educates the village’s children.


Hardship for my father didn’t end with the move to the city or with the ballooning shipments of American grain. New to the city, my father and his brothers stood in lines outside ration shops to get rice and wheat. Often, he remembers, the shops would run out of supplies before their turn.


At 14, my father won a National Merit Scholarship, an Indian government program designed to help poor, talented students in villages pay for their high school and early college educations. At 19, he read an ad in a newspaper for a job in Mumbai with the government’s science and research programs. He clipped the ad and stowed away on a train, in much the same way that millions of migrants seek a better life in Mumbai, Delhi, and Bangalore today. The interview went well, and he landed a job that allowed him to earn a Ph.D. in nuclear physics at what is now the University of Mumbai.


For my father, the years of lining up for food rations were over. His older brother, who studied engineering, had gotten a job with the government of Uttar Pradesh, and their combined incomes paid for the education of their younger brothers and the weddings of their sisters. That final leap, from poverty to the lower-middle class, was repeated by each of my uncles—the three remaining brothers also became engineers. My cousins and I were born into families that could easily afford food, and the deprivation of Auar became a memory, rarely discussed.


And yet, at family reunions, it’s clear that childhood hunger stalked our parents and their siblings into adulthood. My cousins and I tower over our uncles; I am 4 inches (10 centimeters) taller than my father. One cousin was an amateur boxer in the Indian Navy; another passed the rigorous physical training required to join the Indian intelligence service and is posted in the Himalayas. A single generation of good nutrition catapulted us into the top 10 percent of Indians for height and health.


In Auar, I felt like a giant, stooping through doorways, my feet dangling over the edge of my borrowed cot. At dusk I’d walk with Ghanshyam along the borders of the village. With me at least, Ghanshyam was a quiet man, miserly with his words. He mostly resisted my attempts to get him to share more than his most basic thoughts. One night, however, I asked him about his favorite meal, and he opened up. He told me he’d been happiest when planning his eldest son’s wedding. As the groom’s father, he was the most important guest, and he described at length the dinner thrown by the girl’s family. “Mutton korma, chicken curry, fish curry, naan, saag paneer (spinach cooked in cottage cheese), pulao (rice pilaf),” he listed, along with the desserts—a sweetened rice pudding called kheer; jalebis, or sweet, fried dough; and ice cream.


On my last day in the village, I drove to Pratapgarh and had a restaurant pack up that exact meal. That night under the mango trees, I threw a small banquet for Ghanshyam’s family and his neighbors. Thirteen of us sat under the biggest tree, and in the light of my car’s headlights, Ghanshyam and I shared a small bottle of local liquor made from a flower called mahua that he’d brought for the occasion. He laughed when I spat out my first sip, and I noticed for the first time that he had no teeth except for the front row.


About an hour after dinner, as I packed my gear for the trip back to Delhi, I heard a rustling behind me. I thought it was a stray dog going through the empty plates and Styrofoam boxes, and I turned on my flashlight to scare it away.


Instead, the beam lit up Urmila. She’d come back, she said, for the chicken bones I’d thrown away. For a family too poor to buy meat, even boiled-up bones make a valuable addition to the diet. “With some spices, it will taste just like chicken curry,” she said.


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Greek PM presses for deal on loan
















ATHENS, Greece (AP) — Greece has reacted with dismay to the European Union‘s failure to agree to release vital rescue loan funds for the debt-ridden country, with the prime minister warning it was not just Greece’s future that hangs in the balance.


The delay prolongs uncertainty over the future of Greece, which faces a messy default that would threaten the entire euro currency used by 17 EU nations.













Prime Minister Antonis Samaras stressed that Greece has done what its creditors from the EU and International Monetary Fund required. “Our partners, along with the IMF, also must do what they have committed to doing,” he said.


He said that “it is not just the future of our country, but the stability of the entire eurozone” that depend on the success of negotiations in coming days.


Europe News Headlines – Yahoo! News



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One Direction’s 2nd CD hits No. 1, sells 540,000
















NEW YORK (AP) — One Direction‘s “Take Me Home” is the taking the boys to the top of the charts — and to new heights.


The group’s sophomore album has sold 540,000 in its first week, according to Nielsen SoundScan. It’s the year’s third-highest debut behind Taylor Swift‘s “Red,” which sold 1.2 million units its first week earlier this month, and Mumford & Sons’ “Babel,” which sold more than 600,000 albums in September in its debut week.













“We just want to say a massive thanks to all the fans who have supported us,” band member Harry Styles, 18, said in an interview Tuesday from London. “We can send tweets and thank them, but 140 characters is never going be enough to say how much it means.”


The album also debuted at No. 1 in the United Kingdom this week and is No. 1 in more than 30 countries, Columbia Records said Wednesday. The fivesome’s debut, “Up All Night,” came in at No. 2 in the United Kingdom last year; it was just released in March in America, where it hit No. 1 and has achieved platinum status.


“We were a little bit nervous about how people were going to take it,” 19-year-old Niall Horan said of the new album during tour rehearsals. “Everyone gets that second album syndrome.”


They say though they’re excited, they won’t be celebrating too much: “We’re finishing rehearsing soon and we’re going home to bed.”


One Direction, who placed third on the U.K. version of “The X Factor” in 2010, is signed to Simon Cowell’s Syco label imprint. In just a year, the band has become worldwide sensations, thanks to its feverish fans. They released a book and have a 3D movie planned. They also made the cut for Barbara Walters’ most fascinating people of 2012 list, which includes New Jersey Gov. Chris Christie and U.S. gold medalist Gabby Douglas.


One Direction says those experiences have helped the group mature.


“We’ve been working hard. We’re starting to grow up,” Horan said. “We’re still young, but we’ve passed the initial teenage years. …We’ve grown up quite quick in the job we have to do and we became a lot more independent.”


The group — which includes Zayn Malik, Liam Payne and Louis Tomlinson — will launch a worldwide tour in February. They hope to work with Katy Perry and are still trying to adjust to the celebrity and fame that has taken over their lives.


“I can see how it gets to people. I guess it’s quite easy to get wrapped up in it all,” Styles said. “We do the same things every other lad our age does. We go out, we have fun, we meet girls and stuff like that. Sometimes it gets written about, which, yeah, we think about it and it’s absolutely crazy. It’s still a bit weird thinking that that’s the way it is.”


___


Online:


http://www.onedirectionmusic.com/us/home/


___


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U.S. releases new health insurance reform rules
















WASHINGTON (Reuters) – The U.S. administration on Tuesday proposed new health insurance rules aimed at ending discrimination against the sick and guaranteeing minimum benefits for millions of Americans who are expected to obtain coverage under President Barack Obama‘s healthcare reform law.


The rules, unveiled by Health and Human Services Secretary Kathleen Sebelius, provide states and insurers with details about how the Obama administration intends to achieve its long-stated goals of guaranteeing access to those with preexisting conditions and making affordable coverage available to families through new online health insurance exchanges.













The administration also proposed rules laying out new consumer protections for wellness and other preventive healthcare coverage. The public has 30-60 days to comment on the proposals before the government finalizes them.


The proposed measures were likely to come under fire from healthcare reform opponents including a growing number of Republican governors who have rejected the provisions calling on states to operate their own healthcare exchanges beginning January 1, 2014.


States have until December 14, under a newly extended deadline, to tell the Department of Health and Human Services whether they intend to pursue their own healthcare exchanges, which are designed to offer consumers private insurance at subsidized rates beginning in October with open enrollment.


About 17 states have told the administration they plan to move ahead on exchanges, while at least eight Republican governors in recent days have rejected the plan outright or opted to cooperate with Washington in setting up a hybrid federal partnership exchange.


Still more states, which delayed implementation in hopes that Republican Mitt Romney would win the presidential election earlier this month and repeal the law, are only now deciding what to do and had called on the administration for more time and information.


Meanwhile, the administration is moving ahead to complete rule making to ensure timely implementation.


“The information we’re putting out today will answer many of the states’ remaining questions, as will additional guidance to be issued in the days and weeks ahead,” Sebelius said in a conference call with reporters.


“I’m confident states will have what they need to move forward with creating these critical new health insurance markets,” she said.


Sebelius said she would “sit down” with governors to discuss their concerns in the coming weeks, but provided no details.


State-level opposition and lethargy have raised concerns about whether the administration can establish functioning exchanges in states that need them. But administration officials insisted on Tuesday that the system will be up and running in all 50 states and the District of Columbia when the healthcare law comes fully into force in 2014.


“FOOD FIGHT”


The Patient Protection and Affordable Care Act, the most sweeping healthcare legislation since the 1960s, would extend coverage to more than 30 million uninsured people with about half that number obtaining insurance through the healthcare exchanges. The remainder would receive benefits from an expanded Medicaid program for low-income people.


To address regional inequities in the healthcare system, the law requires insurers to provide benefits across 10 categories in the individual and small-group markets, whether or not the plans are part of an exchange.


The categories are: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative and habilitative services; laboratory services; preventive and wellness care and chronic disease management; and pediatric services.


The proposed benefits rule largely codifies the contents of an administration bulletin last December that allowed each state to select a private or public insurance plan already operating in its market as a benchmark for benefits.


Dr. Arthur Kellermann of RAND Health, a think tank, said the approach leaves in place state variations in insurance quality the law was meant to eliminate. But he said the proposed rule still represented a significant improvement.


“It is a major step forward for consumers in trying to bring consistency to the insurance market in terms of covered services and the value of policies,” Kellermann said.


The only major benefits change from last December, according to officials, is a richer prescription drug benefit. Instead of requiring insurers to offer one drug per class, the rule calls for either one drug or the same number as the benchmark plan, whichever is greater.


However, critics said the new rules lack important details and definitions about relatively new coverage for the disabled, the mentally ill and substance dependent, which are subject to a mandate that eliminates lifetime spending limits in health insurance plans.


“They’re going out of their way to avoid doing what the law envisioned, which is spelling out the details, because it’s such an ugly interest-group food fight,” said Edmund Haislmaier of the conservative think thank, Heritage Foundation.


Health insurance companies would be prohibited from denying coverage because of a pre-existing condition, or from charging higher premiums because of current or past health problems, gender or occupation. The rules also would ensure access to catastrophic coverage plans for young adults and others who could not afford coverage otherwise.


The administration also proposed rules for expanding employment-based wellness programs to help control healthcare spending and to protect individuals from unfair underwriting practices that could otherwise reduce benefits based on their health status.


Gary Cohen, an administration official helping to oversee implementation, said the wellness rules seek to protect consumers from practices that could be used to reduce benefits based on a participant’s health status.


(Editing by David Gregorio and Carol Bishopric)


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Asian shares, euro fall on uncertainty over Greek bailout
















TOKYO (Reuters) – The euro skidded on Wednesday and Asian shares fell after European officials failed to reach a deal on another bailout for Greece, a day after Federal Reserve Chairman Ben Bernanke highlighted the dangers of a U.S. fiscal crisis.


U.S. stock futures eased 0.4 percent, pointing to a weak Wall Street open.













Financial spreadbetters predict London’s FTSE 100 <.FTSE>, Paris’s CAC-40 <.FCHI> and Frankfurt’s DAX <.GDAXI> would open down as much as 0.2 percent, following weakness in Asia. <.L> <.EU> <.N>


The euro slumped 0.5 percent to $ 1.2752, extending losses and retreating from Tuesday’s two-week high of $ 1.28295.


The euro’s decline lifted the dollar up 0.3 percent against a basket of key currencies <.DXY> and weighed on commodities such as gold, which eased 0.3 percent to $ 1,722.70 an ounce.


Euro zone finance ministers and Greece’s international lenders will gather again on Monday. Their meeting in Brussels ended on Wednesday without an agreement on the next tranche of loans to Greece, as they haggled over myriad options on how to bring the country’s debt down to a sustainable level, without which emergency aid cannot be disbursed to Athens.


“The euro is being sold because markets had believed the ministers would agree on aid for Greece at today’s meeting,” said Yuji Saito, director of foreign exchange at Credit Agricole in Tokyo.


“Instead, a settlement is postponed, highlighting the difficulty of getting consensus on the debt crisis. But I feel this is a typical European political show and an agreement will be reached.”


The bearish news from Europe dragged down Asian shares, whose two-day rise had already been stalled after Bernanke on Tuesday repeated a warning that failure to avoid the $ 600 billion “fiscal cliff” in expiring tax cuts and government spending reductions could lead to recession in the United States.


The Fed chief said worries over how budget negotiations will be resolved were already damaging growth.


Concerns about the United States failing to raise its debt ceiling rattled financial markets in August 2011 and prompted Standard & Poor’s to cut the top-notch U.S. government bond rating for the first time ever.


“The price action suggests market participants are unclear of what to make of recent developments and therefore this warrants some caution,” said Stan Shamu, strategist at IG Markets.


But Hirokazu Yuihama, a senior strategist at Daiwa Securities, said that for all the concerns over the fiscal cliff, most of the market expected the U.S. Congress and White House to reach a compromise to avert the crisis.


MSCI’s broadest index of Asia-Pacific shares outside Japan <.MIAPJ0000PUS> slipped 0.2 percent. Hong Kong <.HSI> shares bucked the falling trend but pared earlier gains to rise 0.5 percent while Shanghai shares <.SSEC> inched up 0.3 percent.


Japan’s Nikkei stock average <.N225> closed up 0.9 percent at a two month-high as exporters were buoyed by a weaker yen.


The yen has come under pressure on expectations that a general election on December 16 will result in victory for an opposition leader who wants the Bank of Japan to aggressively ease monetary policy to stem the economy from further deterioration. <.T>


MACRO DATA EYED


Daiwa’s Yuihama said concerns over third-quarter earnings have subsided as most Asian companies had already reported results.


“This has prompted investors to turn to economic fundamentals. Signs of recovery in the U.S. and China are offering some assurances that the global economic slump may not be as severe as previously feared, even if growth remains fragile,” Yuihama said.


Investors will now focus on HSBC China flash PMI for November due on Thursday to see whether a low point for China, the world’s second largest economy, is over. U.S. manufacturing figures are due later on Wednesday while those from Europe are due on Thursday.


Trading activity was slowing ahead of the U.S. Thanksgiving long weekend.


Going into the holiday, the dollar has been underpinned broadly by data indicating a moderate U.S. recovery taking root, while the yen remained under pressure, with more data showing Japan‘s economy struggling.


Japan’s exports fell 6.5 percent in October from a year ago, dropping for a fifth consecutive month, weighed down by weakening global demand and a territorial row with China, its main customer.


In the U.S. on Tuesday, a report showed housing starts rose to the highest rate in more than four years in October.


The dollar rose to a 7-1/2-month high against the yen of 81.975 yen while the euro briefly touched a peak of 105.05 yen, its highest point since May 4.


A retreat in shares dragged oil lower, although prices remained supported by a lack of ceasefire between Israelis and Palestinians, which raised concerns about supply disruptions from the Middle East.


U.S. crude futures pared earlier gains and were up 0.1 percent to $ 86.85 a barrel by midafternoon, and Brent crude also trimmed earlier rises and was up 0.2 percent at $ 110.03.


Weak appetite for riskier assets also interest in Asian credit markets subdued, with the spreads on the iTraxx Asia ex-Japan investment-grade index tightening by 1 basis point.


(Additional reporting by Miranda Maxwell in Melbourne; Editing by Simon Cameron-Moore & Kim Coghill)


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U.S. fiscal impact of great concern to Canada: Canada’s Harper
















TORONTO (Reuters) – Any fiscal problems that would significantly slow the U.S. economy would be of great concern to Canada, Canadian Prime Minister Stephen Harper said on Monday.


The United States needed a credible medium-term fiscal plan, Harper said at a business forum in Ottawa, adding that he was following the U.S. fiscal debate with “great interest.”













(Reporting by Solarina Ho)


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People turn to Twitter for CPR information: study
















(Reuters) – Amid snarky comments and links to cat videos, some Twitter users turn to the social network to find and post information on health issues like cardiac arrest and CPR, according to a U.S. study.


Over a month, researchers found 15,234 messages on Twitter that included specific information about resuscitation and cardiac arrest, said the study published in the journal Resuscitation.













“From a science standpoint, we wanted to know if we can reliably find information on a public health topic, or is (Twitter) just a place where people describe what they ate that day,” said Raina Merchant, the study’s lead author and a professor at the Department of Emergency Medicine at the University of Pennsylvania.


According to the researchers, they found people using Twitter to send and receive a wide variety of information on CPR and cardiac arrest, including their personal experiences, questions and current events.


Some researchers and organizations already use Twitter for public health matters, including tracking the 2009 H1N1 “swine flu” pandemic and finding the source of the Haitian cholera outbreak, the researchers said.


For the study, the researchers created a Twitter search for key terms, such as CPR, AED (automatic external defibrillators), resuscitation and sudden death.


Between April and May 2011, their search returned 62,163 tweets, which were whittled down to 15,324 messages that contained specific information about cardiac arrest and resuscitation.


Only 7 percent of the tweets were about specific cardiac arrest events, such as a user saying they just saw a man being resuscitated, or a user asking for prayers for a sick family member.


About 44 percent of the tweets were about performing CPR and using an AED. Those types of tweets included information on rules about keeping AEDs in businesses and questions about how to resuscitate a person.


The rest of the tweets were about education, research and news events, such as links to articles about celebrities going into cardiac arrest.


The vast majority of the Twitter users send fewer than three tweets about cardiac arrest or CPR throughout the month. Users that sent more tweets typically had more followers – people who subscribe to their messages – and often worked in a health-care related field.


About 13 percent of the tweets were re-sent, or retweeted, by other users. The most popular retweeted messages were about celebrity-related cardiac arrest news, such as an AED being used to revive a fan at a Lady Gaga concert.


“I think the pilot (study) illustrated for us that there is an opportunity to potentially provide research and information for people in real time about cardiac arrest and resuscitation,” Marchant said.


“I can imagine in the future we will see systems that would automatically respond to tweets of individual users. Twitter is a really powerful tool, and we’re just beginning to understand its abilities.”


SOURCE: http://bit.ly/T2bj7u


(Reporting from New York by Andrew Seaman at Reuters Health; editing by Elaine)


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Jackie Chan: upcoming film will be last big action movie
















BEIJING (Reuters) – Kung Fu superstar Jackie Chan said that while the upcoming film “Chinese Zodiac 2012″ will be his last major action movie, citing his increasing age, he will still be packing punches in the world of philanthropy.


Chan wrote, directed and produced his latest film, set to premiere in cinemas in China next month. He also plays the lead role and said that he regarded it the “best film for myself” in the last ten years.













“I’m the director, I’m the writer, I’m the producer, I’m the action director, almost everything,” the 58-year-old Hong Kong actor told Reuters while in Beijing to film a documentary.


“This really, really is my baby. You know, I’ve been writing the script for seven years,” and the film took a year and half to make, he added.


In the film, Chan is a treasure hunter seeking to repatriate sculpture heads of the 12 animals of the Chinese zodiac, which were taken from Beijing‘s Summer Palace by French and British forces during the Opium Wars.


He said it was an important movie for him because it will be his last major action feature, although he insisted it is not the end of his action career.


“I’m not young any more, honestly,” he said, noting that with special effects technology and doubles a lot can be done without physical risk.


“Why (do) I have to use my own life to still do these kind of things?” he said. “I will still do as much as I can. But I just don’t want to risk my life to sit in a wheelchair, that’s all.”


Chan was recently awarded the Social Philanthropist of the Year award by Harpers Bazaar magazine. He said he wanted to increase time devoted to charitable work and hoped China’s leagues of newly wealthy will follow his example – which he underlined by auctioning a Bentley 666 for around 6 million yuan ($ 961,837).


China now has more billionaires than any other Asian country, but very few philanthropic organizations, and giving to charity remains a relatively new phenomenon in the world’s most populous country.


Chan said while Chinese philanthropists have made some encouraging strides, much more still needs to be done – a task made harder by the Internet, with netizens willing to leap on every perceived wrong move.


“Right now people (must) very, very be careful, but that doesn’t stop them to want to do the charity. I think it’s a good sign,” Chan said. (Reporting by Reuters Television, editing by Elaine Lies and Christine Kearney)


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Thanksgiving Day shopping: retailer sales trump tradition
















(Reuters) – Whether U.S. shoppers and workers like or loathe the encroachment of the holiday shopping season into Thanksgiving Day, one thing is for certain – the trend is not going away.


Even as stores fight charges of spreading holiday creep instead of cheer, retailers are making money out of moving the start of the holiday shopping season from “Black Friday” — the day after Thanksgiving — into Thanksgiving night, or even the Day itself.













“Not everybody’s going to watch 12 hours of football on Thanksgiving Day. Most people, after 20 minutes of sitting at the dinner table, are ready to get out and do something. Why not cater to the people who are into the sport of shopping?” said Marshal Cohen, chief industry analyst for market research firm NPD.


Retailers like Target Corp , Sears Holdings Corp and Toys R Us Inc have joined Wal-Mart and Gap Inc in staying open on what is a national holiday. Traditionally, stores had waited until Black Friday to make their big push.


There is mounting pressure from Wall Street as well.


“From an investor’s standpoint if a retailer is not putting (in) extra hours while competitors are extending them, it would make me wonder how much they can participate in the race for the consumer dollar,” said Ken Hemauer, a senior portfolio manager at Robert W. Baird & Co based in Milwaukee.


Between sales, profits and Wall Street expectations, not many think petitions like the one on change.org, asking Target to “save Thanksgiving” by staying shut that day will succeed. The petition had 355,570 supporters at last count.


And not everyone is complaining. A recent survey by the consulting firm Deloitte showed 23 percent plan to shop in stores on Thanksgiving Day – up from 17 percent in last year’s survey.


Data on the impact of stores being open on Thanksgiving Day is hard to come by, but Alison Paul, vice chairman and U.S. Retail & Distribution lead Deloitte, said it was likely that sales made that day cut into demand later in the holiday season.


“It shifts spending,” she said. “It doesn’t create any more spending.”


Still, retailers remaining closed on Thanksgiving risk losing out to competitors in the a battle for consumer dollars as the overall spending pie is expected to grow less than last year.


“The upside is not huge, but the downside could be,” Paul said.


Industry watchdog National Retail Federation expects holiday sales this year to rise 4.1 percent to $ 586.1 billion, lower than the 5.6 percent rise in 2011.


A handful of chains like Best Buy Co , Macy’s and Kohl’s plan to wait to open at midnight on Black Friday, but they are notable for waiting.


“Most retailers have customers lining up in front of their stores for hours anyway (early on Black Friday or even very late in the night on Thanksgiving),” said Dan Butler, vice president, Merchandising and Retail Operations at the National Retail Federation. “If they are going to be there, they might as well be inside. It is silly to have your customers outside in cold, snowy weather.”


DOORBUSTERS AND DOLLARS


In an economy that is blowing hot and cold, “doorbuster” deals and other discounts are the best bet stores have to hook customers.


“You’re essentially increasing traffic. If you have some merchandise significantly marked down and can get people in through the door, there is a whole range of other products that they’ll buy at your location,” said Nick Jones, executive vice president, Retail Practice Lead at advertising agency Leo Burnett.


Jim Brownell, vice president Retail Industry Solutions for sourcing company GT Nexus said retailers were using the extra hours of sales to keep up the frenzy as the chase the dollars.


“The retailers are generating it (demand), the consumers aren’t demanding it,” said Brownell, who had worked with retailers like Williams-Sonoma Inc , Restoration Hardware and Gap.


“Retail is not growing very much, so we’re not seeing much more money coming in the season. It is really who’s getting a bigger portion of the sales pie.”


The trouble is, items on sale are low margin, so they do not bring in a lot of money unless volumes are high.


“Everybody’s worried that the price sensitive customers will go to whoever’s open first. They are worried about being late to the game,” Eric Anderson, Hartmarx Professor of Marketing at Kellogg School of Management.


NRF’s Butler said the number of shoppers ensures that retailers make a profit on that day.


“It is a profitable time for retailers. When they price their goods, even when they are on sales, they price them for profitability,” he said.


(Reporting by Nivedita Bhattacharjee in Chicago; additional reporting by Brad Dorfman in Chicago; Editing by Leslie Gevirtz)


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Maybe Diamonds Aren’t Forever
















Ian Harebottle is looking for the next Marilyn Monroe. The chief executive officer of London-based Gemfields (GEM), the world’s largest producer of emeralds, says he’s seeking “an A-lister” who can do for the green gems what Monroe did for diamonds when she sang Diamonds Are a Girl’s Best Friend in Gentlemen Prefer Blondes. Monroe’s performance in the 1953 flick added extra sparkle to diamond sales.


Diamonds still dominate the $ 21 billion precious stone market, accounting for 90 percent of all sales, according to BMO Capital Markets (BMO). But for the first time in decades they have a little competition from the colored also-rans in the gem trade. Rarer than diamonds yet cheaper, emeralds, rubies, and sapphires are gaining favor just as sales for diamonds are beginning to show weakness. Polished diamond prices have fallen for five straight quarters as jewelry buyers in Asia and Europe become more cautious about luxury shopping, according to PolishedPrices.com. Uncut diamond prices are heading for their first annual decline since 2008, according to WWW International Diamond Consultants.













Colored gems’ rising popularity is starting to worry the diamond industry. “During the past three years these other gemstone categories have taken away yet another half percent from our market share,” Moti Ganz, president of the International Diamond Manufacturers Association, said in a speech at the World Diamond Congress on Oct. 15. As a result, colored stones are becoming more valuable. Prices for high-quality emeralds have soared more than tenfold in the past three years, according to Gemfields company filings. Cut rubies have risen in value 63 percent since 2005 and sapphires by 45 percent, according to Gemval, an online gem appraisal site.


cf2a4  comp gemspixcollage47 405 Maybe Diamonds Arent Forever


The reason for the shift in tastes is multifaceted. Colored stones are still less expensive, a plus for star-struck lovers on a budget during hard times. A 0.9-carat round diamond that’s internally flawless and of rare white color costs about $ 7,000, according to online retailer Blue Nile (NILE). A round emerald with “excellent clarity” of the same size costs about half as much, according to online vendor AfricaGems.


Some of the interest in colored stones is “celebrity driven,” says Caitlin Mociun, a Brooklyn-based jewelry designer. “One reason might be Kate Middleton having a sapphire engagement ring, or even Beyoncé having a black diamond engagement ring. Those things, especially for a mass market, can definitely drive a trend.” Hollywood personality Jessica Simpson’s engagement ring sported two diamonds, but the ruby in its center got all the press and sparked numerous knockoffs. Halle Berry’s ring featured a 4-carat emerald that several celebrity magazines breathlessly announced came from “closed-down mines in Muzo, Colombia.” At a gem trade show in Hong Kong last year, Russell Shor, an analyst with the Gem Institute of America, immediately noticed the new interest in colored stones. “People were all of a sudden really hot to buy emeralds,” he says.


That may not be an accident. Harebottle, whose company produces about 20 percent of the world’s emeralds, is increasing Gemfields’ marketing budget, trying to exploit fissures in the diamond industry that until recent years was controlled by De Beers. Until the 1940s, the colored-stone market was about equal in size to the diamond industry. Then, in 1947, De Beers coined the slogan “A Diamond Is Forever,” later voted the best of the 20th century by Advertising Age. De Beers funded most of the marketing for the diamond industry through its generic marketing, similar to the dairy industry’s “Got Milk?” campaign. That changed in 2004 when De Beers’s monopoly ended after it pleaded guilty to price fixing in the U.S., concluding a 10-year legal battle. The diamond industry became chaotic and the amount spent on marketing plummeted, with De Beers cutting its ad budget in half, according to Stephen Lussier, the company’s executive director in London. The industry tried to reorganize in 2008 at a meeting in St. Petersburg, Russia, that led to the creation of the International Diamond Board. But members, including Russian state monopoly OAO Alrosa and mining giant Rio Tinto (RIO), failed to come to an agreement over how to fill the advertising void left by De Beers. “Not all people were willing to do their part,” says Lussier. “De Beers can do its part, but it alone is not enough.”


Anish Aggarwal, a partner at consulting firm Gemdax, says the diamond industry has had “four to five years without any real category marketing, and there are some markets that are suffering, such as Japan.” He adds that there’s “a danger of losing some of the cultural imperative.”


Even if Gemfields does find a modern Marilyn Monroe, it’s doubtful the company will ever be able to match De Beers’s old business model, in which a single firm mines, markets, and largely controls wholesale prices. Still, Harebottle has learned from the former monopoly’s experience. The colored-stone industry has traditionally been highly fragmented, divided up among many small, family-owned outfits. By bringing corporate heft to it, Harebottle hopes to boost supplies and raise prices at the same time. He aims to increase Gemfields’ share of the global emerald market to about 30 percent by expanding production at its African emerald and ruby mines. The company already owns 75 percent of the Kagem emerald mine in Zambia, the world’s largest, and controls 75 percent of the Montepuez ruby field in Mozambique.


De Beers still spends hundreds of millions of dollars a year on advertising, according to Lussier. But if Gemfields can demonstrate “clear industry leadership, they will have a chance” to capitalize on the diminished marketing power of diamonds, says Aggarwal of Gemdax.


Harebottle plans to boost his marketing budget to at least $ 4 million next year, up from just $ 150,000 in 2009. Next year’s budget will likely contain money for a celebrity endorser. Gemfields currently pays for about 70 percent of global emerald advertising, says Harebottle, but he doesn’t mind bearing the marketing cost for the entire colored- gems industry: “The fact that people free carry, I don’t mind—so long as it benefits us.”


The bottom line: Gemfields, the No. 1 emerald producer, is adding corporate heft to the colored-stone market, boosting its ad budget to $ 4 million.


With Caroline Winter


Businessweek.com — Top News



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