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New Montana laws enshrine health care alternatives, for better or worse | Health



When Paul Rana’s primary care physician left the VA clinic in Kalispell to open her own practice, he followed her. But instead of picking up a new health insurance policy, Rana and his partner agreed to pay a monthly fee that came with the promise of better access.

Their provider, Dr. Lexi Tabor-Manaker, opened Glacier Direct Primary Care clinic in 2018. The model known as DPC, which can also stand for direct patient care, furnishes basic health care to patients for a set fee, often billed monthly like a subscription. The arrangement offers patients unlimited access to their doctors and allows them to communicate by phone or email. But the costs are all out-of-pocket.

“We have been pleased to be able to communicate with her instantly without going through an administrative gauntlet,” as he might with the Department of Veterans Affairs, Rana said.

Direct primary care practices have been emerging around the country, but they are often criticized for not offering the patient safeguards of traditional insurance. State legislators this year, however, sought to preserve the approach and passed two new laws that prohibit direct primary care practices or health care sharing ministries — religious or ethical groups whose members pool money to cover medical costs — from being regulated as insurance.

Such arrangements, according to supporters, afford greater flexibility and lower costs for health care compared with traditional health insurance. Without these laws, “a future commissioner of insurance may deem them to be insurance and require them to come under the health insurance regulatory scheme, thus destroying their value and defining characteristics,” said Sen. Tom McGillvray (R-Billings), sponsor of the bill on health care sharing ministries.

Lack of regulation comes with risks. Patients in direct primary care and health care sharing ministries mostly miss out on consumer protections mandated by the Affordable Care Act, such as coverage of preexisting conditions and prohibitions against charging more based on gender.

In Montana, a pastor filed a lawsuit in 2007 after Medi-Share refused to pay for expenses for a member’s heart condition. A state judge ruled the group was selling insurance without registering in the state, effectively banning health care sharing ministries. That changed in 2017 when Matthew Rosendale, then insurance commissioner, declared the programs weren’t health insurance and could operate in the state.

McGillvray’s bill cements Rosendale’s ruling into state law.

Eight direct primary care facilities operate in Montana with out-of-pocket fees that typically range from $70 to $120 per month for an adult, according to DPC Frontier.

Supporters of direct primary care said the model lets doctors spend more time with patients. Physicians told lawmakers that when working with traditional insurance plans they might spend a significant chunk of their days on administrative tasks instead of patient care, according to Sen. Cary Smith (R-Billings), sponsor of the direct primary care bill.

That bill allows for any form of health care practice — therapists, dentists, physical therapists, etc. — to operate under the direct primary care model.

Direct primary care agreements don’t cover hospital visits, prescription drugs, surgery or specialized care, such as cancer treatment. Providers and supporters recommend people sign up for health insurance to cover those costs.

Another criticism, one leveled by traditional health insurers, is that the monthly fee often doesn’t save people money. Patients would have to go to the doctor several times a year to make the direct primary care monthly payments worthwhile, and people usually don’t make that many visits, said Richard Miltenberger, CEO of Mountain Health Co-Op, a nonprofit health insurance cooperative that sells health insurance in Montana, Idaho and Wyoming.

“So, it’s actually often, for many consumers, more cost-effective to just pay for the service [that isn’t covered by insurance] when you utilize it, as you utilize it, as opposed to paying a monthly membership fee,” Miltenberger said.

Rana, a retired Army veteran who lives in Woods Bay, doesn’t fully depend on direct primary care for his health care. He still uses the VA clinic for regular checkups. He also has Medicare and Tricare — a health program for military members and their families — for larger procedures he gets outside of the VA, such as when he had knee surgery in 2020.

But his first stop when he noticed something wrong with his knee was with Tabor-Manaker, who saw him quickly and referred him to a specialist. That makes the expense worth it, he said.

“I knew going in that this was all out-of-pocket for me, and I accepted that because the quality of service is far greater in its value to me than the hundred bucks a month,” Rana said.

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KHN{span} (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at {/span}KFF{span} (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.{/span}

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COVID-19 and beyond: Health minister Horowitz’s top five challenges




Israel’s new health minister is inheriting a sick country that needs a lot of healing, despite the low number of daily COVID-19 cases.

MK Nitzan Horowitz (Meretz) will be sworn in as health minister if the government passes a confidence vote in the Knesset on Sunday. He is not a medical professional, but he has spent the last two decades engaged in social justice efforts, from fighting for foreign workers to serving as a board member of the Association for Civil Rights in Israel.

Horowitz is inheriting a ministry that suffered through a nearly year-and-a-half battle against a global pandemic that was intensely politicized by Prime Minister Benjamin Netanyahu.

He is also taking over against the backdrop of a number of fraud schemes that center around his ministry.

Last week it was reported that two top advisers of former health minister MK Ya’acov Litzman are being probed for conspiring to influence government policy in health sector issues such as food in exchange for bribes. 

Litzman is also under investigation himself for two offenses during his tenure: one that involved his meeting with Jerusalem’s district psychiatrist to pressure him into issuing a false assessment for accused sex offender Malka Leifer and the other for trying to influence inspectors to reopen a restaurant that failed a health inspection.

Horowitz’s job will be to maintain the low number of daily COVID cases while moving beyond the pandemic to other issues plaguing Israel’s healthcare system, and to gain back the trust of the Israeli public in the system.

“The things that he will need to deal with will require out-of-the-box thinking and major reforms,” Prof. Dan Ben-David, president and founder of the Shoresh Institution for Socioeconomic Research, told The Jerusalem Post. “I hope that he has the requisite sense of humility required to know that he should surround himself with some of the top people in the field.”

These should be the next health minister’s top five priorities:

1 – Mental Health

Mental illness – mainly but not only depression – is among the fastest growing health challenges for the State of Israel.

A recent survey published by Tel Aviv University researchers found that the level of personal resilience experienced by Israelis hit a two-year low during the recent Gaza escalation.

The researchers measured resilience on a scale of one (lowest) to five (strongest). In 2018, Israelis’ level of resilience was 4.68. At the height of the pandemic in October 2020, it fell to 4.28. In January 2021, during the third wave, it dropped to 3.48. And during the recent Gaza operation it plummeted to 2.47.

The data is “very concerning” and even “dangerous,” the study’s lead researcher Dr. Bruria Adini told the Post.

Israel still lacks services for and understanding of mental health issues, said Prof. Hagai Levine, former chairman of the Association of Public Health Physicians.

“We treated the COVID-19 pandemic well with the vaccines, but now we have some seriously traumatized people,” Levine told the Post.

He said there has been an increase in people coming to their family physicians for other causes that are rooted in stress and depression.

“There is a connection between mental and physical health,” he said. 

Coalition agreements have indicated that the new government plans to add psychological services for the public – an important first step if it is implemented.

At the same time, the government should specifically focus on the mental health needs of healthcare workers after coronavirus, the Meron tragedy and the latest war – all of which struck within less than two years.  

“Healthcare workers need to be mentally well to care for the population,” Levine said.

2 – COVID-19 Surveillance

While Israel was among the first countries to come out of the coronavirus crisis, vaccinating close to 5.5 million Israelis and thereby opening up its economy, health experts understand that the pandemic is not over yet.

With hundreds of thousands of new daily coronavirus cases worldwide, Israel is still vulnerable to vaccine-resistant COVID variants that could enter the country through Ben-Gurion Airport.

In general, the Health Ministry has maintained a tight and effective closure on the border since the third wave. Any unvaccinated Israelis or Israelis returning from countries with high infection must quarantine on arrival for a minimum of 10 days. And all passengers are required to take a PCR-grade coronavirus test before boarding and upon arrival.

Minimal group of vaccinated tourists have been entering Israel since last month. An announcement by the Tourism and Interior ministries last week indicated that individual vaccinated tourists will be able to enter beginning as early as July 1. It will be the new health minister’s job to test and confirm that these travelers are COVID-free during their time in Israel. 

Earlier this month, a group of 16 olim (new immigrants) from India who maintained they tested negative for COVID in their hometown were found to have had the virus on arrival. Surveillance caught the infected immigrants and they were put into state-run COVID hotels until they recovered. Strict screening protocols must be maintained.

At the same time, health officials must keep tabs on what is happening inside the country. Israel must find a way to maintain a minimum number of daily tests to catch outbreaks before they start.

Ben-David suggested that serological testing could be offered to patients undergoing routine bloodwork, for example. Or PCR testing could become part of one’s annual checkup.

3 – Healthcare Workers

The Israeli healthcare system entered the COVID-19 crisis in a starved condition, forcing Israel to enter three lockdowns for fear that the hospitals would collapse under the strain of so many seriously sick individuals.

That is because the country does not have enough doctors, nurses, technicians or even aides.

Israel has one of the worst nurse-to-population ratios, with five nurses per 1,000 people – a figure that is significantly lower than the Organization for Economic Cooperation and Development (OECD) average of 8.8 – and the number of nursing school graduates is also low, meaning there is little expectation for growth.

When it comes to physicians, Israel has only slightly less doctors per capita than the average OECD country. However, that is primarily because of the huge influx of new MDs in the 1990s from the former Soviet Union – and these doctors are aging.

While doctors over the age of 75 make up only 1% of the entire workforce in OECD countries, in Israel they make up more than 10%, Ben-David explained. And, like nursing students, Israel is at the bottom of the OECD in terms of the number of new medical school graduates.

During the coronavirus crisis, Health Minister Yuli Edelstein added around 2,000 new positions, but the financing was done via extra-budgetary payments earmarked for the virus and the positions were meant to expire on June 30.

A decision was made to extend the positions until a new government was formed and the next budget was prepared, making it the responsibility of the new health minister to fight for those roles.

Furthermore, Israel’s hospital residents work untenable 26-hour shifts – a situation that hospital heads say has to change.

4 – Infrastructure

The issue of infrastructure is vital, as the number of hospital beds per capita has been plummeting for decades, leaving Israel with the highest hospital congestion rate in the developing world. This leads to a deficient level of care, despite the high professionalism of the staff.  

“We have this dichotomy: Very good physicians and nursing staff that qualitatively speaking are the best in the world, working in a system that in some cases is not part of the developed world,” Ben-David said.

And people being treated in hospital corridors leads to unnecessary infections.

Israel went into this pandemic with the highest number by far of people dying from infectious disease per capita in the developed world – 73% more than No. 2, Greece.

A March 2020 state comptroller report highlighted Israel’s lack of a detailed program to close identified gaps in the healthcare system – including intensive care beds and equipment.

As a new state budget is set to be approved for the first time since March 2018, it is essential that the health minister works closely with the finance minister to obtain the needed money.

At the same time, Horowitz should strive to run his ministry more efficiently by providing hospitals and health funds with a greater sense of control and accountability, implementing new modes of measurement and evaluations for success.  

“The health system often takes a Band-Aid approach or is extinguishing fires all the time,” Levine said. “The system needs more long-term planning and execution.”

5 – An Aging Population

While Israel is young compared to OECD countries, its people are rapidly aging – and the Health Ministry has not prepared for this new reality.

The number of elderly in Israel is expected to reach 1.66 million by 2035, according to projections by the Central Bureau of Statistics – an increase of 77% between 2015 and 2035, which is “going to be a huge drain on the health system,” Ben-David said.

Health officials need to shift their focus to finding better solutions for elder care, both in nursing homes and through in-home care. This could include telemedicine and digital monitoring programs that could save money and keep the elderly safe.

“Health is one of the most important aspects that determines quality of life,” Ben-David said. “The COVID-19 pandemic showed the deficiencies of our country’s health system. No one can claim it isn’t broken – it is.”

The question now is whether Horowitz will take the steps needed to fix it.

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Vaccine clinic at East Bluff Heartland Health Services gives an incentive to get vaccinated




PEORIA, Ill. (WMBD) — The East Bluff Heartland Health Services administered vaccines and addressed vaccine hesitancy at their first vaccine clinic on Saturday, June 12.

Partnering with Blue Cross Blue Shield, leaders at the event provided vaccines, medical information, and food boxes from Peoria Area Foodbank and Midwest Foodbank.

Michelle Sanders, Director of Development and Marketing at Heartland Health Services, said the event is one way to educate people about COVID-19 vaccines and the virus in their community.

“We had a lot of people say you’re just trying to bribe us to get this shot,” Sanders said. “No, we just want to educate you, make you aware of what services are available, and let you know that Heartland is here.”

As an incentive to get vaccinated, every person who received a shot was entered to win a grill, grill set, and a free lunch.

Sanders said Heartland Health Services organization has vaccinated more than 1,000 people across Peoria since April.

She said they are ready to hold more events based on community needs.

To learn more about Heartland Health and vaccinations, visit their website.

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Biden and G7 News: Live Updates




President Biden with Chancellor Angela Merkel of Germany on Saturday in St. Ives, England.
Credit…Guido Bergmann/Bundesregierung, via Reuters

PLYMOUTH, England — President Biden urged Western nations and Japan on Saturday to counter China’s growing economic and security influence by offering developing nations hundreds of billions in financing as an alternative to relying on Beijing for new roads, railways, ports and communication networks.

It was the first time the world’s richest nations had discussed such a direct challenge to China’s Belt-and-Road Initiative, President Xi Jinping’s overseas lending and investment project, which has now spread across Africa, Latin America and into Europe itself.

But the White House cited no financial commitments, and there is sharp disagreement among the United States and its allies about how to respond to China’s rising power.

Mr. Biden has made challenging China the centerpiece of a foreign policy designed to build up democracies around the world as a bulwark against creeping authoritarianism. Beijing, for its part, has pointed to the poor U.S. response to the pandemic and its divisive domestic politics as signs that democracy is failing.

It is far from clear that the wealthy democracies will be able to muster a comprehensive response like the one proposed by Mr. Biden, which the White House gave a name with roots in his presidential campaign theme — “Build Back Better for the World,’’ shortened to B3W, a play on China’s BRI.

Instead, the plan appeared to stitch together existing projects in the United States, Europe and Japan, along with an encouragement of private financing, with an emphasis on the environment, anti-corruption efforts, the free flow of information and the avoidance of future debt crises.

Mr. Biden used the meeting to advance his argument that the fundamental struggle in the post-pandemic era will be democracies versus autocracies. Officials emerging from the session said there was a clear division of opinion about how to take on China.

For Mr. Biden, the first test may be whether he can persuade the allies to reject participation in any projects that rely on forced labor. It is unclear, American officials said, what kind of language about rejecting goods or investments in such projects would be included in the meeting’s final communique, to be issued on Sunday.

Commuters this month in New Delhi, which has been hit hard by the coronavirus pandemic. Leaders at the Group of 7 summit hope to blunt the impact of future outbreaks with additional resources.
Credit…Atul Loke for The New York Times

Last year, President Donald J. Trump angrily rejected global cooperation on health, pulling the United States out of the World Health Organization and asserting an “America First” approach to the pandemic and other global health concerns.

Not anymore.

At the G-7 summit on Saturday, President Biden pushed for a more unified approach to combating the pandemic, and urged his counterparts to embrace cooperation aimed at building up the world’s health care infrastructure so it will be able to respond more quickly to future emergencies.

One of Mr. Biden’s first actions as president was to rejoin the W.H.O. After more than a year of coronavirus-induced human hardship and economic woes, the leaders gathered at the Group of 7 summit are expected to sign a declaration on global health intended to ensure that the pandemic’s toll is never repeated.

The Carbis Bay declaration, named for the location of the summit, is described by the organizers as a “historic statement setting out a series of concrete commitments to prevent any repeat of the human and economic devastation wreaked by coronavirus.”

It will be one of a series of actions taken during the G7 in response to the pandemic, which has dominated the summit’s agenda much in the way it has loomed over most major events of the last year. As part of their declaration, the seven nations will not only confront the current crisis with one billion doses of vaccine for less developed nations, but they will pledge to take steps to decrease the chances of a future global health crisis.

Those include cutting the time it takes to approve vaccines to under 100 days, a period that is considered critical for containing the spread of a virus, and reinforcing the world’s ability to track and sequence diseases. In addition, Britain will create the Vaccine Manufacturing and Innovation Center to accelerate the creation of vaccines for diseases that are transferred from livestock to humans.

“We need to make sure that we learn the lessons from the pandemic,” British Prime Minister Boris Johnson told reporters on Saturday. “We need to make sure that we don’t repeat some of the errors that we doubtless made over the course over the last 18 months or so.”

Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, said his organization will welcome the move.

“Together we need to build on the significant scientific and collaborative response to the Covid-19 pandemic and find common solutions to address many of the gaps identified,” he said in a statement, noting that the world needed a stronger global surveillance system to more quickly detect the risks of pandemic

A U.S. official said that a solo press conference by President Biden would be “the appropriate format to clearly communicate with the free press” after meeting with President Vladimir V. Putin next week.
Credit…Doug Mills/The New York Times

After President Biden meets his Russian counterpart on Wednesday, the two men will not face the press at a joint news conference, United States officials said on Saturday.

Instead, Mr. Biden will face the press by himself after two private sessions with President Vladimir V. Putin of Russia, a move designed to deny the Russian leader an international platform like the one he received during a 2018 summit in Helsinki with President Donald J. Trump.

“We expect this meeting to be candid and straightforward, and a solo press conference is the appropriate format to clearly communicate with the free press the topics that were raised in the meeting,” a U.S. official said in a statement sent to reporters, “both in terms of areas where we may agree and in areas where we have significant concerns.”

Top aides to Mr. Biden said that during negotiations over the meetings, to be held at an 18th-century Swiss villa on the shores of Lake Geneva, the Russian government was eager to have Mr. Putin join Mr. Biden in a news conference. But Biden administration officials said that they were mindful of how Mr. Putin seemed to get the better of Mr. Trump in Helsinki.

At that news conference, Mr. Trump publicly accepted Mr. Putin’s assurances that his government did not interfere with the 2016 election, taking the Russian president’s word rather than the assessments of his own intelligence officials.

The spectacle in 2018 drew sharp condemnations from across the political spectrum for providing an opportunity for Mr. Putin to spread falsehoods. Senator John McCain at the time called it “one of the most disgraceful performances by an American president in memory.”

Mr. Putin has had a long and contentious relationship with United States presidents, who have sought to maintain relations with Russia even as the two nations clashed over nuclear weapons, aggression toward Ukraine and, more recently, cyberattacks and hacking.

President Barack Obama met several times with Mr. Putin, including at a joint appearance during the 2013 Group of 8 summit in Northern Ireland. Mr. Obama came under criticism at the time from rights groups for giving Mr. Putin a platform and for not challenging the Russian president more directly on human rights.

In the summer of 2001 — before the Sept. 11 terror attacks — President George W. Bush held a joint news conference with Mr. Putin at a summit in Slovenia. At the news conference, Mr. Bush famously said: “I looked the man in the eye. I found him to be very straightforward and trustworthy. We had a very good dialogue. I was able to get a sense of his soul.”

At the time, then-Senator Biden said: “I don’t trust Mr. Putin; hopefully the president was being stylistic rather than substantive.”

Biden administration officials said on Saturday that the two countries were continuing to finalize the format for the meeting on Wednesday with Mr. Putin. They said that the current plan called for a working session involving top aides in addition to the two leaders, and a smaller session.

With help from China’s Belt and Road Initiative, Egypt is building a new administrative capital.
Credit…Khaled Elfiqi/EPA, via Shutterstock

When the Group of 7 leaders gathered Saturday to discuss China’s growing global influence, they immediately agreed on one thing: They didn’t want anyone listening.

In a sign of the growing concern about pervasive Chinese surveillance, British organizers cut off all internet and Wi-Fi links around the meeting room, leaving the leaders disconnected from the outside world.

Finding common ground on how to battle China’s economic sway during the meeting isn’t as easy, however.

President Biden is urging Europe to offer hundreds of billions in loans to developing nations in a direct challenge to Beijing’s Belt and Road Initiative, which is funding projects in developing nations around the globe.

Group of 7 leaders largely agree that China is using its investment strategy both to bolster its state-owned enterprises and to build a network of commercial ports and communications systems over which it would exercise significant control. But there is sharp disagreement about how to respond.

Officials emerging from the meeting said there was a clear division of opinion about how to take on China. Germany, Italy and the European Union were clearly concerned about risking their huge trade and investment deals with Beijing or accelerating what has increasingly taken on the tones of a new Cold War.

Still, Mr. Biden senses an opening, as European nations have begun to understand the risks of dependency on Chinese supply chains, and have watched China’s reach extend into their own backyards.

Britain, which once pursued arguably the most China-friendly policy in Europe, has swung firmly behind the American hard line, particularly on Huawei, China’s telecommunications champion, which the U.S. sees as a security threat. After trying to accommodate Huawei, Britain announced, under Prime Minister Boris Johnson, that it was ripping out older Huawei equipment from its networks.

Germany, for which China has become the No. 1 market for Volkswagens and BMWs, remains committed to engagement and is deeply resistant to a new Cold War. It has kicked decisions about using Huawei and other Chinese-made networking equipment down the road, after threats from Chinese officials to retaliate with a ban on the sale of German luxury cars in China.

Italy became the first member of the G7 to sign up to Belt and Road in 2019. It then had to back away, in part, under pressure from NATO allies who feared that Italian infrastructure, including the telecommunications network, would be dependent on Chinese technology.

When China shipped face masks and ventilators to a desperate Italy during its Covid outbreak, an Italian official pointedly told his fellow Europeans that the country would remember who its friends were after the pandemic.

France did not join Belt and Road, though it has welcomed Chinese investment in the country and stopped short of banning Huawei from its wireless network. Relations with China cooled after President Emmanuel Macron criticized Beijing for its lack of transparency on the origins of the coronavirus.

“America would be well served if the European Union got its act together and defined a coherent China strategy,” said Wolfgang Ischinger, a former German ambassador to the United States. “Its interests are not well served if there is a German China strategy, a French China strategy and a British China strategy.”

Chancellor Angela Merkel of Germany, left, during the 2019 Group of 7 gathering in Canada.
Credit…Doug Mills/The New York Times

While many things have changed since the last in-person meeting of Group of 7 leaders, from a pandemic to a new United States president, one thing remains the same: Chancellor Angela Merkel of Germany is the only woman among the leaders of the Group of 7 member nations gathered to discuss the most pressing global issues.

Despite the paucity of female leadership, the G7 has made gender equality one of the five central themes of this year’s summit, as it has in years past. A new independent Gender Equality Advisory Council was formed to set out recommendations on how G7 nations should work together to ensure that women around the world are at the forefront as the group maps out a plan for pandemic recovery.

But an absence of gender diversity doesn’t end at the G7, of course. Just 22 countries currently have a female head of government or head of state — an underrepresentation that risks further marginalization of issues including gender equality.

Ms. Merkel is one of only a few women ever to have taken part in the summit as leaders of member countries — the others being Prime Ministers Margaret Thatcher and Theresa May of Britain, and (as an earlier version of this item neglected to mention) Kim Campbell, who briefly served as Canada’s prime minister. Ursula von der Leyen, the European Commission president, is also taking part in this year’s gathering as a leader of the European Union.

With Ms. Merkel due to step down after Germany holds elections in September, there might be no elected female leaders in the G7 in 2022.

Writing this week in The Independent newspaper, Jess Philips, a British lawmaker and advocate for women’s rights, urged “that the specific problems faced by women must not be forgotten when the world’s leaders gather.”

“We are a long way away from there being enough women in that particular room,” she wrote. “So all we can do is bang a drum outside and ask them not to forget us when they talk about recovery and our world’s future.”

President Biden and his wife, Jill Biden, with Queen Elizabeth II in Cornwall on Friday.
Credit…Pool photo by Jack Hill

President Biden and his wife, Jill Biden, are scheduled to meet again with Queen Elizabeth II on Sunday at Windsor Castle as part of the U.S. leader’s first foreign trip as president.

The president and first lady will visit with the queen before traveling to Brussels for meetings with NATO and European Union leaders.

The world’s longest reigning monarch, Elizabeth has met with every American president since Harry S. Truman, except Lyndon B. Johnson.

The British monarch last hosted an American president in June 2019, when Donald J. Trump visited the country on a lavish state visit. The event stirred some debate because only a handful of American presidents have received the honor of an official state visit.

On a previous visit, in 2018, Mr. Trump made headlines by walking in front of Elizabeth, 95, during an inspection of the royal guard, which was seen as a breach of protocol.

Sunday will be the second visit with the queen this weekend for Mr. Biden and the first lady. Queen Elizabeth, Prince Charles and Prince William joined Group of 7 leaders on Friday for a reception and dinner, as the royal family made an unusually robust presence around the edges of the annual summit.

The royals played hosts to the leaders at the Eden Project, an environmental and educational center in Cornwall, England, about 35 miles from Carbis Bay, where the summit is being held.

In addition to the queen, Charles, the Prince of Wales and heir to the throne; and his eldest son, Prince William, the Duke of Cambridge; Charles’s wife, Camilla, Duchess of Cornwall; and William’s wife, Kate, the Duchess of Cambridge; also attended.

Earlier Friday, the first lady, Jill Biden, visited a school in Cornwall with the Duchess of Cambridge.




First Lady and Duchess of Cambridge Tour School

The first lady, Dr. Jill Biden, and Kate, the Duchess of Cambridge, toured a primary school in England on Friday. The first lady has a particular interest in global education.

“They’re scared to death.” [laughter] “Hello.” “Thank you very much.” “Do you like it?” “At 4 years old?” “Wow, are you 5 now?” “Yes.” “Fantastic. And we know that picking up all the rubbish will —” “This is a tough word, ‘rubbish.’ That’s a hard word, very impressive.” “You’re very good at — how many do you have?” “It’s very important. It’s the foundation of everything. So I can tell you that as a teacher at the upper levels, if they don’t have a good foundation, they fall so far behind. So this is amazing to see what these children are doing and how far advanced the are at 4 and 5 years old. I met some wonderful teachers and principals and most of all, the children who were so inspiring. And so well-behaved, I know, I couldn’t get over it.”

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The first lady, Dr. Jill Biden, and Kate, the Duchess of Cambridge, toured a primary school in England on Friday. The first lady has a particular interest in global education.CreditCredit…Pool photo by Aaron Chown

The summit comes just two months after the death of Prince Philip, the queen’s husband of 73 years. But Elizabeth quickly resumed her schedule of public appearances. Friday marked her first meeting with any foreign leader since the start of the pandemic.

Protesters in Genoa, Italy, during the 2001 summit, when the diplomatic gathering was known as the Group of 8 and also included Russia.
Credit…Sean Gallup/Getty Images

Group of 7 summits like the one taking place in southwestern England this week once drew large protests.

In 1998, 70,000 people formed a human chain that ringed the city center of Birmingham, England, where President Bill Clinton and other leaders were meeting. In 2001 in Italy, more than 200,000 demonstrators massed at the Group of 7 in Genoa, setting off clashes with the police. In 2007 in Germany, protesters leapt out of the woods in black hoods and bandannas to hurl tree limbs across road to block access to the Baltic Sea resort of Heiligendamm.

Yet since then, the summit’s organizers have become much more effective at putting distance between activists and the leaders.

Mustering anger is also not easy when Covid restrictions make it difficult to mobilize large crowds, security cordons keep protesters miles away from where the leaders are staying, and one of the prime antagonists at such gatherings, President Donald J. Trump, has been replaced by the more emollient President Biden.

The airtight security presence has not deterred activists from creatively dramatizing their causes. Among the most striking examples is “Mount Recyclemore,” a tribute to the carved granite heads of Mount Rushmore composed of discarded circuit boards, laptop covers and castoff cellphone pieces, along with a floating blimp that caricatures Mr. Biden and Prime Minister Boris Johnson of Britain.

And on Saturday, Surfers Against Sewage organized a paddle out from Gyllyngvase beach in Falmouth that saw hundreds gather to highlight the effect of climate change on the world’s oceans.

But it all shows how challenging it is to be an activist at the G7 this year.

Will people in Britain soon be back in fully packed pubs, or will the Delta coronavirus variant mean an extensions of restrictions beyond June 21? 
Credit…Anthony Devlin/Getty Images

Even as the Group of 7 announced during its summit this week that its member nations would donate one billion coronavirus vaccine doses to poorer nations, the gathering’s host country, Britain, is facing a reminder that it isn’t out of the woods yet on the pandemic either.

The news media call June 21 “freedom day” — the fast approaching moment when England’s remaining coronavirus restrictions are scheduled to be cast off, allowing pubs to fill to capacity, nightclubs to open their doors and the curtain to rise in theaters around the country.

But a recent spike in cases of the highly transmissible coronavirus variant called Delta has prompted such alarm among scientists and health professionals that the country now seems destined to wait a little longer for its liberty.

For Prime Minister Boris Johnson, oft accused of doing too little, too late to combat the virus, the stakes are high. The question is not so much whether to postpone “freedom day,” but to what degree. Four weeks seems to be the maximum under consideration, with some advocating a limited version of the full opening and others favoring a two-week delay.

An announcement on the next steps is scheduled for Monday, and Mr. Johnson planned to study the data this weekend. But many health professionals have already made up their minds over the seriousness of the threat from the Delta variant, first detected in India.

The concern is that a surge of cases caused by the new variant could translate into a sharper uptick in hospitalizations and risk the virus once again overwhelming the National Health Service.

World leaders at a Group of 7 summit in Biarritz, France, in August 2019, the last time the gathering was held in person.
Credit…Erin Schaff/The New York Times

For three days, beginning Friday, some of the world’s most powerful leaders are descending on a small Cornish village for a series of meetings as part of the Group of 7 summit, which brings together the heads of Britain, Canada, France, Germany, Italy, Japan and the United States.

So what exactly is the G7, and why does it matter?

The nations belonging to the club are the world’s wealthiest large democracies, close allies and major trading partners that account for about half of the global economy.

With broadly similar views on trade, political pluralism, security and human rights, they can — when they agree — wield enormous collective influence. Their heads of government meet, along with representatives of the European Union, to discuss economic issues and major international policies.

Those attending this years’ gathering include leaders from the G7 member countries — Britain, Canada, France, Germany, Italy, Japan and the United States — plus the European Union, guests Australia, South Africa and South Korea, along with India via video link.

The group, whose origins go back to the 1973 oil crisis, grew out of an informal gathering of finance ministers from Britain, the United States, France, Japan and what was then West Germany — initially known as the Big Five — as they tried to agree on a way forward.

Since the 1970s, the group and its later additional members have met dozens of times to work on major global issues that affect the international economy, security, trade, equality and climate change. In 2015, the summit paved the way for the Paris agreement to limit global emissions, which was decided later that year.

For a time, the group had eight members — remember the G8? — but Russia, always something of an outlier, was kicked out in 2014 amid international condemnation of President Vladimir V. Putin’s annexation of Crimea. Last year, President Donald J. Trump said he believed Russia should be reinstated.

Atop the agenda this year will be the coronavirus pandemic and its effects on the global economy, with a focus on worldwide recovery and vaccination.

This summit, hosted by Britain, which currently holds the group’s presidency, is the 47th of its kind and will continue through Sunday. Last year’s summit was canceled because of the pandemic, making this gathering the first in-person G7 Leaders’ Summit in almost two years. The last was in August 2019 in Biarritz, France.

The agreement reached by Group of 7 finance ministers and other prominent officials would impose an additional tax on some of the largest multinational companies.
Credit…Pool photo by Henry Nicholls

When the top economic officials from the world’s advanced economies, in the days leading up to the Group of 7 summit, unveiled a broad agreement that aims to stop large multinational companies from seeking out tax havens and force them to pay more of their income to governments, it was a breakthrough in a yearslong efforts to overhaul international tax laws.

A new global minimum tax rate at least 15 percent, which finance leaders from the Group of 7 countries agreed to back, would apply to companies regardless of where they locate their headquarters.

The agreement would also impose an additional tax on some of the largest multinational companies, potentially forcing technology giants like Amazon, Facebook and Google as well as other big global businesses to pay taxes to countries based on where their goods or services are sold, regardless of whether they have a physical presence in that nation.

The pact could reshape global commerce and solidify public finances that have been eroded after more than a year of combating the pandemic.

And huge sums of money are at stake. A report this month from the E.U. Tax Observatory estimated that a 15 percent minimum tax would yield an additional 48 billion euros, or $58 billion, a year. The Biden administration projected in its budget last month that the new global minimum tax system could help bring in $500 billion in tax revenue over a decade to the United States.

While the agreement is a major step forward, many challenges remain. Next month, the Group of 7 countries must sell the concept to finance ministers from the broader Group of 20 nations. If that is successful, officials hope that a final deal can be signed in October.

Garnering wider support will not be easy. Ireland, which has a tax rate of 12.5 percent, argues that a global minimum tax would be disruptive to the country’s economic model. Some major countries such as China are considered unlikely to buy in.

And the biggest obstacle come from the United States. The Biden administration must win approval from a narrowly divided Congress to make changes to the tax code.

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