Spain’s Health Service Challenges Spur Demand for Private Care

October 19, 2025

The Spanish healthcare system is relying heavily on the private medical sector to help absorb the shock of the pandemic and address other challenges, such as acute staff shortages and long waiting lists. Last year, private hospitals made up over a third of healthcare activity, performing 41.6% of surgical procedures and treating 33.6% of emergencies.

Private healthcare providers are increasingly playing a pivotal role in supporting the overstretched Spanish public healthcare system, the SNS, as it struggles to meet patient need. But while the private healthcare sector is expanding, existing players and new entrants, must pay attention to the varying, regional nature of treatment demand, and understand the factors behind it, in order to operate effectively.

Spain’s health services are facing huge challenges, including a severe shortage of medical staff and an ageing population, particularly in rural and sparsely-populated areas, such as Asturias, Galicia and Castilla and León. The situation has been exacerbated by a substantial backlog of cases, which worsened particularly during the Covid era. Waiting lists for surgical procedures are most acute in provincial Spain. And across the country, there are big differences in delays for specific specialties.

The country is seeking to address what is essentially a severe supply and demand problem. In order to absorb the shock of the pandemic, the SNS needed to increase capacity dramatically. It was not able to do so itself because of fiscal, technical and regulatory constraints. Supply has simply not increased fast enough, which has opened the way for greater private sector involvement.

Health authorities in the country’s 17 autonomous regions and two autonomous cities (Ceuta and Melilla) – all with different surgical needs and priorities – have sought to work closely with the private sector, often in the form of public-private partnerships, as a means of boosting flagging service levels. About 58% of private hospitals have formal agreements with the SNS. At the same time, concerns about delays in – and the quality of – treatment in the public sector, have prompted many Spaniards especially the young, to purchase private health insurance. Take-up is geographically uneven but largely concentrated in urban areas.

In the wake of the pandemic, private healthcare has consolidated its role as a parallel and complementary system to the SNS. It is now an essential part of SNS’s efforts to reduce waiting lists, accounting for just over a quarter of healthcare spending in the country. More than half of Spanish hospitals are private, mainly based in Andalucía, Cataluña and Madrid, autonomous regions with the greatest demographic and economic weight.

Covid caused a sharp decline in inpatient surgical procedures in 2020, followed by a moderate recovery through 2021–2023, which was uneven across regions and surgical specialties. Overall, surgical procedure volumes are still below 2019 levels. Only urology, plastic surgery and neurosurgery were able to increase in an inpatient setting nationwide. At a regional level, just Murcia, Asturias, and Castilla and Leon have surpassed pre-pandemic inpatient volumes. Large autonomous regions such as Andalucía, Cataluña, Madrid, and the Valencian Community have yet to fully recover.

In December last year, in Spain as a whole there were still nearly 850,000 people on surgical waiting lists. Canarias, Castilla-La Mancha, Cataluña, and Madrid were able to lower average waiting times between 2019 and 2024, while the remaining autonomous regions saw them rise in the same period.

The inability to rebound from the pandemic, especially in large autonomous regions, has been attributed to factors such as doctor shortages (in 2023 the deficit reached nearly 5,900 medical specialists), an ageing workforce, and post-pandemic burnout. Studies conducted last year showed that 24% of doctors in Spain suffered from burnout, and sick leave rates jumping from 6% to 9% in the post-pandemic period. Research has shown that there are heightened regional disparities in not only waiting times, but also capacity and workforce stability.

As a consequence, we’re witnessing a major structural shift in Spain, with a significant volume of surgical procedures – especially dermatology, ophthalmology, and gynecology – transitioning from public hospital inpatient settings to private outpatient facilities. This is most prominent in regions like Andalucía (which has experienced a 700% increase in private outpatient dermatology surgeries since 2019), Aragón and Castilla-La Mancha (which since 2019 saw a 1,000% surge in outpatient gynecological procedures in private facilities). Private sector providers are increasingly vital in absorbing excess demand. They often outpace public facilities in both agility and capacity for certain specialties, likely reflecting Spanish patients’ eagerness to avoid long waiting lists.

Such is the growing reliance on private healthcare that last year the private hospital sector made up about 35% of Spain’s healthcare activity, performing 41.6% of surgical procedures (32.6% in 2023), managing 29.7% of hospital discharges (22.6% in 2023) and treating 33.6% of emergencies (25.2% in 2023). The specialties with the highest number of procedures performed by private practitioners included traumatology (37.1%), angiology and vascular surgery (35.8%), general and digestive surgery (33.1%), and urology and gynecology (30.9%).

In 2024, the turnover of the private hospital sector, which now comprises 431 medical facilities, amounted to EUR 13.9 billion, a third consecutive year of growth, spurring demand for advanced medical technologies and specialized healthcare services. Of the turnover figure for the sector, health insurers and mutual insurance companies, which are largely financing the expansion, contributed EUR 7.92 billion, while public-private collaboration agreements generated EUR 4.655 billion.

Annual investment within the private sector is now close to 1 billion EUR, of which EUR 650 million has been allocated to improvements and innovation and EUR 322 million to Medtech, presenting significant commercial opportunities for companies able to support outpatient care and operational efficiency. All the while, there has been a strong focus on the construction of new private medical facilities, particularly in regions with higher purchasing power, such as Madrid, Cataluña and the Balearic Islands.

While the Spanish healthcare is increasingly dependent on private sector providers, the complexity of demand requires the latter – whether established or new entrants – to focus on specific areas of demand in regions that invest most in private healthcare. There is quite a significant disparity in per capita public spending on healthcare across the country, with the lowest per capita spending regions, such as Madrid, seeing the greatest private sector investment. Other important factors to consider when going to market are that some surgical specialties, as we’ve seen, are more established in some regions than others while waiting lists for all specialisms vary significantly nationwide.

The private sector has been able to support the public healthcare system by being highly agile and responsive to patient needs across the country. Players have had to be alert to demographic and treatment trends to identify gaps in provision and anticipate areas of demand. They have also had to better understand regional health authority challenges and offer appropriate solutions. Such front-footedness and cooperation will be crucial in further cementing the private sector’s role in helping the state meet the country’s healthcare challenges.

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About the Authors

Irene Palomo is the Healthcare Analyst for Spain and Italy at FrontierView. Irene supports the Western Europe Healthcare Practice.

Dr. Osman Sahin is the Associate Practice Leader for Healthcare Strategic Insights at FrontierView. Osman leads the Western Europe Healthcare Practice.

Why Banks are More Resilient After a Run

October 18, 2025

Bank Collapse and Banking Crisis or global credit system falling in debt as a financial instability or insolvency concept

By Dr Kenneth Baldwin

Banks typically fail because they have too little cash on hand to meet payment demands (a liquidity problem) or asset values are too low to pay back their debts (a solvency problem). Traditionally, it’s assumed that adding liquidity risk to solvency risk can only make matters worse, but that is not necessarily the case. In fact, new research shows there are circumstances in which liquidity risk can help to mitigate solvency risk.

Introduction

Banks typically fail for at least one of two reasons: insolvency, when the total value of a bank’s assets is not enough to pay its debts, or illiquidity, when a bank is unable to turn sufficient assets into cash quickly enough to keep up with payment demands. The latter scenario can be triggered by a sharp increase in depositors rushing to withdraw their funds, called a ‘run’, or when creditors call in their loans and the bank has to sell assets quickly to pay up.

The 2008 financial crisis shows how this can play out in practice. Lax lending standards led banks to give mortgages to people who couldn’t repay them on the assumption that house prices would continue rising, so even if some borrowers defaulted on their payments, the bank could still turn a profit by selling the house.

However, as the market became flooded with houses for sale, house prices started to drop below the mortgage value. Banks started to lose money and confidence, and stopped lending, including to each other, which restricted the amount of liquid assets held by many institutions.

In the years since, regulators have taken a firmer hand, introducing additional requirements to guard against the risk of banks defaulting. For instance, the UK’s Prudential Regulation Authority (PRA) now imposes requirements on both liquidity and capital adequacy. Such oversight aims to ensure banks are able to survive runs, repay their debts, and absorb losses when they arise.

It is intuitive that adding liquidity risks to solvency risks increases the chance of a bank defaulting on its debts, but that’s not necessarily the case. While this line of thought seems to make sense at first, new research shows that there are circumstances in which liquidity risk may actually help to mitigate solvency risk.

When two risks make a right

To show how liquidity risk and solvency risk interact, I published a new financial model that derives the joint probability of bank default due to illiquidity or insolvency (the full article is freely available at https://doi.org/10.1016/j.econlet.2025.112581). The findings suggest that if a bank survives a liquidity run, the resulting contraction of its balance sheet can actually reduce its post-run insolvency risk.

Why? Because a smaller asset base suffers less damage from negative shocks to asset returns.

For instance, if a bank has £1 billion in assets and £800 million in debt, a ten percent shock would lose £100 million, leaving the bank with £900 million in assets, £800 million in debt, and a debt to assets ratio of 89%. However, if that same bank had shrunk to £600 million in assets and £400 million in debt following a liquidity crisis, a ten percent shock would only generate a loss of £60 million, leaving the bank with £540 million in assets, £400 million in debt, and a comparatively healthier debt to assets ratio of 74%. In effect, the contraction slows the bank’s possible movement towards the point where its assets are so devalued that it can no longer pay its debts. Whilst to some this result may seem obvious, its importance is that it links liquidity risk with solvency risk, showing that liquidity risk acts as a counterweight to solvency risk as long as a bank survives unexpected cash outflows.

This relationship also applies in situations where a bank faces liquidity pressure not caused by a run; for instance, when there is a non-rollover of debt and the bank has to convert assets to cash so it can pay outgoing creditors.

Rethinking risk management

A deeper understanding of how risks interact presents an opportunity for banks and regulators to fine-tune how they respond to financial stress.

Most significantly, this simple yet important result suggests that the intense pressure banks face to de-risk after a run may be overstated. Currently, it’s common practice for banks to assess the severity of each type of risk and set equity aside to guard against solvency risk accordingly. But the assumption that multiple risks are always a compounded threat, without sufficient recognition given to how sometimes one risk helps to mitigate another, may cause them to set aside more equity than they need to.

Reducing the pressure on banks to de-risk after experiencing liquidity challenges could encourage them to continue lending to the real economy in the wake of a run without compromising their stability. A revised understanding of joint liquidity-solvency risks should also be integrated into stress tests run by banks and regulators. As the financial sector continues to be impacted by geopolitical, environmental, and social uncertainties, these tests must adopt an approach to evaluating resilience that embraces the complexity of interactions between risks.

This new liquidity-solvency model offers banks a light at the end of the tunnel by reframing how risks are perceived. Rather than seeing every challenge as putting banks further on the back foot, edging closer to default and failure, it proves that surviving liquidity problems can increase resilience, proving the adage that what doesn’t kill you can indeed make you stronger.

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About the Author

Dr Kenneth Baldwin is a Senior Lecturer in the Department of Economics at Nottingham Business School, Nottingham Trent University (NTU). His research focuses on the intersection of finance and economics, including banking regulation and asset pricing. Prior to working in academia, he spent over two decades working at investment banks in senior risk management roles.

China Denounces U.S. Over Rare Earth Dispute and “Distorted” Remarks

October 17, 2025

China on Thursday accused the United States of spreading fear over its new rare earth export restrictions and sharply rebuked Treasury Secretary Scott Bessent for making “grossly distorted” comments about a top Chinese trade negotiator. The criticism came as Beijing rejected Washington’s call to lift the curbs, escalating tensions just weeks before President Donald Trump and President Xi Jinping are set to meet in South Korea.

In a strongly worded statement, the Communist Party’s official newspaper issued a detailed, seven-point rebuttal following U.S. claims that China’s rare earth measures represented a global power grab. The response came after U.S. Trade Representative Jamieson Greer and Bessent suggested Beijing could avoid Trump’s threat of a 100% tariff on Chinese imports by rolling back the export regime set to take effect on November 8.

“The U.S.’ interpretation seriously distorts and exaggerates China’s measures, deliberately stirring up unnecessary misunderstanding and panic,” Commerce Ministry spokesperson He Yongqian said at a press briefing. She emphasized that export licenses would be approved “provided the export licence applications are compliant and intended for civilian use.”

China’s latest export rules have raised concern among global manufacturers about whether any product containing even small amounts of Chinese rare earths would require government approval to ship abroad. He Yongqian clarified that this would not be the case.

Greer had earlier labeled China’s controls “a global supply-chain power grab” and urged Beijing not to enforce them. Bessent hinted that the U.S. might consider extending the current 90-day tariff truce, which is due to expire in early November.

Relations between the two economic superpowers had appeared steady following a September phone call between Trump and Xi and a Madrid summit that was hailed as a success for both sides after progress on the TikTok deal. However, tensions reignited after Washington expanded its “Entity List” in late September to target Chinese and foreign companies allegedly circumventing U.S. export restrictions on semiconductor technology.

Beijing argues that its export measures are legal and align with international standards. “The United States has long overstated national security concerns and abused controls, adopting discriminatory practices against China,” said one of seven infographics released by the state-run People’s Daily. The newspaper pointed out that the U.S. maintains a control list of over 3,000 restricted items, while China’s list includes about 900.

“Implementing such export controls is consistent with international practice,” read another section of the publication, reiterating Beijing’s defense of the new policy.

The dispute took a personal turn after Bessent described China’s chief trade negotiator Li Chenggang as “slightly unhinged” and “disrespectful,” claiming Li had threatened “global chaos” if the U.S. moved ahead with new port fees. Bessent also alleged that Li arrived in Washington uninvited in August for talks.

In response, He Yongqian said the U.S. remarks “seriously distort the facts,” stressing that China had been proactive in maintaining communication with Washington. “It is hoped the U.S. will cherish the achievements of the earlier economic and trade talks and immediately correct its wrongdoings,” she said.

Bessent maintained that trust between Trump and Xi had helped prevent further escalation, keeping diplomatic channels open despite disagreements between their trade teams. Analysts, however, warn that continued public sparring could overshadow the planned leaders’ meeting and unsettle markets already wary of new tariffs.

With both sides trading accusations and defending their policies, the world’s two largest economies appear locked in a delicate balancing act — seeking to project strength while trying to preserve enough stability to avoid another round of damaging trade escalation.

Related Readings:

China’s Rare Earth Curbs Draw U.S. Warning and Decoupling Threat

Trump Presses NATO to Sanction Russia and Tariff China

What the West is Missing About China

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China’s Rare Earth Curbs Draw U.S. Warning and Decoupling Threat

October 16, 2025

U.S. Treasury Secretary Scott Bessent has warned Beijing that its sweeping new export controls on rare earths and other critical minerals could push the United States and its allies to sever economic ties with China.

Speaking at a joint news conference with U.S. Trade Representative Jamieson Greer on Wednesday, Bessent cautioned that China’s latest policy risked isolating the world’s second-largest economy. “If China wants to be an unreliable partner to the world, then the world will have to decouple,” Bessent said. “The world does not want to decouple. We want to de-risk. But signals like this are signs of decoupling, which we don’t believe China wants.”

Beijing announced last week a new regime for rare earths and critical minerals that would require non-Chinese companies exporting products containing even trace amounts of these materials to obtain government approval. The move, scheduled to take effect in December, has drawn sharp criticism from Washington and its allies, who say it threatens global supply chains.

President Donald Trump has responded by threatening to impose an additional 100 percent tariff on Chinese imports by November 1 if Beijing proceeds with the export restrictions.

Greer said the measures represent more than just a trade response. “While China has taken a number of retaliatory trade actions against the United States, Europe, Canada, Australia and others in recent years, this move is not proportional retaliation,” he said. “It is an exercise in economic coercion on every country in the world.”

Both Bessent and Greer stressed that the United States has urged Beijing to halt implementation of the controls, warning that they could destabilize the global economy.

Sara Schuman, a former top U.S. trade negotiator for China, said the controls jeopardize progress made earlier this year in Geneva, where both countries reached an agreement aimed at easing tensions. “The ball is now in China’s court. Will it return to the Geneva agreement and rollback these [rare earth] restrictions, or choose to weaponise the global supply chains it dominates?” said Schuman, who now leads the trade and economic security practice at Beacon Global Strategies. “China’s answer to this question over the next two weeks will have broad strategic implications for years to come.”

Greer added that the restrictions would give China leverage over the global economy and technology supply chains. “This will impact artificial intelligence systems and high-tech products, but even regular consumer items like cars, smartphones and potentially even household appliances,” he warned.

Beijing has defended its decision, claiming it was a response to what it calls “punitive measures” imposed by Washington since the two sides held a fourth round of trade talks in Madrid last month. The U.S. has dismissed that argument, saying China appeared to have planned the export regime long before the Madrid meeting.

Bessent and Greer also took aim at Li Chenggang, a senior member of China’s trade delegation, accusing him of behaving unprofessionally during an unannounced visit to Washington in August. According to Bessent, Li was “very disrespectful” and threatened “global chaos” if the U.S. followed through on its plan to impose port fees on Chinese vessels docking in American harbors. The policy went into effect this week. “Perhaps he has gone rogue,” Bessent said.

Despite the growing friction, Bessent expressed hope that dialogue could prevent further escalation. He said he expected President Trump to meet Chinese President Xi Jinping during the Asia-Pacific Economic Cooperation summit in South Korea on October 29, calling it a potential “opportunity to reset the tone.”

“I’m optimistic that we can de-escalate,” Bessent said. “But if China moves ahead, we will respond.”

Analysts believe Beijing’s strategy may be aimed at pressuring Washington to relax its own export restrictions on semiconductors and chip technology. When asked if the U.S. would consider such a trade-off, Bessent declined to comment, saying, “I’m not going to pregame what the negotiations are going to look like.”

He added, however, that one key question would be whether China delays the rollout of its export controls.

The U.S. and China have repeatedly postponed tariff deadlines since agreeing to a ceasefire in their trade war earlier this year. The current 90-day window for talks is set to expire in mid-November, heightening pressure on both sides to reach a compromise before the confrontation escalates further.

Related Readings:

What the West is Missing About China

Trump Presses NATO to Sanction Russia and Tariff China

China, India, Russia, and the SCO: Multipolarity and Global Power Politics

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Time for Change in the Middle East

October 15, 2025

Flag on the map of iraq. Vintage Map and Flag of middle east, arab Countries Series

By Dan Steinbock

In the Middle East, the U.S. model has relied on oil buys, arms sales and regime change. The results have been catastrophic. What the region needs is rapid development in which China has excelled and the Global South promotes.

Accepted finally by both Hamas and Israel, the ceasefire in Gaza is the effective outcome of the US administration’s maximum pressure on Hamas and its embrace of the positions of several Arab states, particularly Qatar, Egypt and Turkey.

But the end of hostilities represents barely the first of the three phases presumably proceeding from ceasefire in Gaza to peace in the Middle East. The devil is in the details and the hardest talks loom ahead.

Here’s why: the complicated, multi-phase plan is ridden with caveats because the old U.S. approach to the Middle East is crumbling.

America’s military hegemony

Since 1945, the U.S. hegemony in the Middle East has relied on oil buys, weapons sales and regime change. In diplomacy, Washington has favored bilateral peace treaties between Israel and Egypt (1979) and Jordan (1994) and the Oslo Accords with the Palestinian Authority (1993-95).

Since his first administration, President Trump has built on the Abraham Accords (2020-21); a series of bilateral agreements to normalize relations among Israel and several Arab states, led by United Arab Emirates (UAE) and Bahrain. With massive oil buys from and arms sales to Riyadh, the U.S. goal is to have Saudi Arabia to join the Accords.

With massive oil buys from and arms sales to Riyadh, the U.S. goal is to have Saudi Arabia to join the Accords.

But arms sales are the key to America’s hegemony. In the case of its allies, the U.S. provides 60 to 80 percent of their lethal imports (Israel, Kuwait, Saudi Arabia). In the rest, it accounts for 50 to 60 percent of the total (UAE, Iraq, Qatar), followed by Egypt.

Additionally, American hegemony relies on aid dependency. Between 1946 and 2023, Washington provided a whopping $373 billion in foreign assistance to the Middle East. Before the Gaza catastrophe, the bulk of the aid was steered to just a few countries: Israel ($139 billion), Egypt ($83b), Iraq ($70b), and Jordan ($24b).

Since the Middle East is the largest regional recipient of U.S. aid, the impact should be reflected in increasing security and rising per capita income. Yet, the net effect has been precisely the reverse, as evidenced by the region’s “forever conflicts” and periods of historical economic stagnation.

Extensive periods of stagnating living standards

Worse, the military symbiosis between the U.S. and Israel has triggered huge adverse spillovers to adjacent Arab states. These severe destabilizations have been accompanied by lost years, even decades, with no increase in per capita incomes in these states.

Egypt coped with such stagnation in 1965-75 and again in the early 2010s. Jordan lost a decade after the 1967 Six-Day War, during the first Palestinian uprising in the 1980s and again in the early 2010s. Even Israel hasn’t been immune to stagnation periods, as evidenced by past economic crises, highest income polarization among OECD countries and the huge costs-of-living protests after the failure of the peace process.

In Iran and Iraq, adversities have escalated since their 1980-88 war in which the U.S. supplied arms to both sides. In Iraq, where the U.S. had backed the 1963 coup, per capita income in 2010 was where it had first been in 1978; over three decades before. In Iran, which suffered the first U.S.-UK regime change in 1953, U.S. sanctions prevented gains in per capita income for a quarter of a century after the Islamic Revolution and again in the 2010s.

Following the 1949 U.S.-led regime change, Syria’s democratic path was undermined until 2025. As a result, Syrian per capita income before October 7, 2023, is where it was last in 1981; that is, 44 years ago. In Palestine, per capita income is now where it first was in the early 1970s; half a century ago. And in Yemen, per capita income is where it first was 55 years ago.

China-led development

In the past decade, China has emerged as a credible and peaceful intermediary in the Middle East. In addition to investing significantly in countries burdened by decades of U.S. interference and regime change, Beijing has achieved several diplomatic coups.

Major regional Arab states, including Egypt, Saudi Arabia and Turkey, build on the China-led Belt and Road Initiative (BRI).

Saudi Arabia has joined the BRICS alliance, remains one of China’s largest oil suppliers and is selling oil in multiple currencies. For decades, U.S. administrations fostered divides between Saudi Arabia and Iran. Yet, in March 2023, these two countries resumed relations, after a China-brokered deal.

In July 2024, China played a vital role in fostering Palestinian national unity in the Beijing Declaration, signed by 14 different Palestinian factions.

In August 2024, Beijing established a Second Silk Road in the region. In July 2025, China and Egypt expanded their bilateral cooperation across various economic sectors.

For years, China has called and worked for de-escalation, sustained peace and development in the region.

Surely the Middle East is large enough for both great powers – as long as the presence of each is predicated on diplomacy and peacemaking rather than abject obliteration.

Catastrophic economic and human costs

Since 1945, Washington has relied on destabilization and regime change in the Middle East to maintain its hegemony in the region. The post-9/11 wars alone have cost over $8 trillion and the lives of more than 1 million people.

The region has lost decades in self-defeating wars that have benefited primarily global defense contractors in the West.

In the past, US military aid to Israel amounted to $3.8 billion per year; since October 7, 2023, it has soared to $22 billion. In Gaza and Yemen, it has made US complicit to genocidal atrocities.

In 2023-25, a quarter of a million Palestinians — mainly women and children — have been killed or wounded in Gaza, while more than 5.3 million people in the region have been displaced in Israel’s post-October 7 atrocities.

These catastrophic performances can be compared and contrasted with Chinese initiatives focusing on de-escalation and stabilization, particularly on investment, development and modernization – which are hugely attractive in the Middle East.

The region has lost decades in self-defeating wars that have benefited primarily global defense contractors in the West. The time for decisive economic development, led by China and the Global South, has arrived, also in the Middle East.

Obliteration wars are no solution to 21^st century challenges.

A version of this commentary was first published by China Daily on October 15, 2025.

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About the Author

Dr Dan Steinbock The author of The Obliteration Doctrine (2025) and The Fall of Israel (2024), Dr Dan Steinbock, a strategist of the multipolar world, is the founder of Difference Group and has served at the India, China and America Institute (US), Shanghai Institute for International Studies (China) and the EU Center (Singapore). For more, see https://www.differencegroup.net/

Remote Work is the Pro-Family Policy

October 15, 2025

By Dr. Gleb Tsipursky

Picture a young couple staring at a spreadsheet, not a sonogram. Between rent, daycare, and the commute that eats two hours a day, a second child feels out of reach. Now flip one switch: both parents work from home a day or two each week. New research from Nicholas Bloom at Stanford University and a team of colleagues shows that this single change shifts real family decisions. Evidence on flexible arrangements and fertility intentions in dual-earner couples, paired with U.S. analyses linking pandemic-era flexibility to higher births, points to a simple conclusion: if the Trump administration and cultural conservatives want more babies, they should want more remote work.

In 2023, U.S. fertility fell to 1.62 children per woman, with 3.596 million births, resuming a pre-pandemic slide. The question is which policies change day-to-day life enough to move births.

Working from home trims the commute tax and returns hours to households. A parent can handle a pediatric visit without blowing up a shift schedule, breastfeed without logistical relays, or cover school pickup without a costly nanny. One U.S. analysis documented a baby bump in 2021 and early 2022, strongest among college-educated women, aligning with the population most able to use hybrid work. Women with remote options were more likely to report plans to try for a child. New research on dual-earner couples shows how schedule control translates into realized family plans.

This gap between elite pronatalist rhetoric and household priorities is instructive. People want support that makes everyday life with kids workable.

Remote work is not going away. The Survey of Working Arrangements and Attitudes shows hybrid has stabilized since 2023, with U.S. workers performing roughly a quarter of paid days from home by 2025. That persistence matters because fertility planning responds to expected conditions, not temporary perks. A policy that institutionalizes two at-home days per week delivers hard time in a soft way. It is a structural fix to the everyday frictions that push families to stop at one child.

Many on the right propose monthly family benefits or expanded child tax credits. The conservative conversation is overdue. But cash stipends alone rarely deliver durable fertility gains.

Americans want help with practical barriers: child care affordability and better maternal health outcomes, according to an AP-NORC survey from July 2025. About three-quarters say child care costs are a major problem. This gap between elite pronatalist rhetoric and household priorities is instructive. People want support that makes everyday life with kids workable.

Hybrid work changes a binding constraint every week without a massive fiscal outlay. When one or both partners gain even one remote day, time reappears. That time lets a parent keep a job through a rough pregnancy, attend a 2:30 school concert, or start dinner at 5:30 instead of 6:45. The evidence on flexible work and fertility intentions reinforces that flexibility moves the needle because it attacks the real constraint, which is time.

The most robust data show hybrid has settled into a sustainable equilibrium. Well-run hybrid teams sustain performance while widening the pool of family-stage talent. Where remote is infeasible, targeted schedule control and paid time for essential family logistics emulate the same benefits.

Conservatives argue families, not bureaucracies, should decide how to raise children. Remote work does exactly that. It returns hours without dictating how to use them. It supports marriage, childrearing, and church engagement by making home a functional base rather than a staging area between commutes.

Remote options let a dad accept a quality job without moving away from grandparents who provide informal child care. They let a mom maintain attachment to work during early childhood, cushioning earnings and career progression. The work from home literature documents durable levels of hybrid work across dozens of countries.

Policy can amplify those gains. The federal government should model best practice where duties allow. In January 2025, the Office of Personnel Management issued guidance directing a broad return to in-person work. The federal conversation has featured blanket mandates, even as a 2025 GAO report flagged weaknesses of one-size-fits-all approaches. A smarter pro-family stance would normalize predictable hybrid schedules in eligible roles.

Second, infrastructure policy should make flexibility real outside big metros. Expanding reliable high-speed internet in rural counties enables hybrid options that keep young families near church networks, cousins, and babysitting grandparents. Public data on work from home rates helps employers and policymakers calibrate hybrid norms to different sectors and regions.

Public data on work from home rates helps employers and policymakers calibrate hybrid norms to different sectors and regions.

Skeptics ask whether flexibility distracts from reviving births. The evidence points the other way. When flexibility arrived suddenly during the pandemic, births among U.S.-born women ticked up, reversing a long decline. Newer work explains why: when couples can allocate time more sanely, they follow through on family plans. Pair that with the global stabilization of hybrid work and you get a practical lever, not a fad.

Families keep telling leaders the same thing: make everyday life with kids workable and we will respond. Work from home does exactly that. It collapses the distance between paychecks and playrooms, trims invisible costs that choke the evening routine, and preserves careers during the most fragile years of family formation. Cash bonuses make headlines. Predictable hybrid schedules change Tuesday afternoons. If the Trump administration and cultural conservatives are serious about reversing the baby bust, they should embrace the most conservative tool of all: giving families the freedom to organize their own lives.

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About the Author

Dr. Gleb Tsipursky PhD, serves as the CEO of the hybrid work consultancy Disaster Avoidance Experts and authored the best-seller Returning to the Office and Leading Hybrid and Remote Teams. He was named “Office Whisperer” by The New York Times for helping leaders overcome frustrations with Generative AI. He serves as the CEO of the future-of-work consultancy Disaster Avoidance Experts. Dr. Gleb wrote seven best-selling books, and his two most recent ones are Returning to the Office and Leading Hybrid and Remote Teams and ChatGPT for Leaders and Content Creators: Unlocking the Potential of Generative AI. His cutting-edge thought leadership was featured in over 650 articles and 550 interviews in Harvard Business Review, Inc. Magazine, USA Today, CBS News, Fox News, Time, Business Insider, Fortune, The New York Times, and elsewhere. His writing was translated into Chinese, Spanish, Russian, Polish, Korean, French, Vietnamese, German, and other languages. His expertise comes from over 20 years of consulting, coaching, and speaking and training for Fortune 500 companies from Aflac to Xerox. It also comes from over 15 years in academia as a behavioral scientist, with 8 years as a lecturer at UNC-Chapel Hill and 7 years as a professor at Ohio State. A proud Ukrainian American, Dr. Gleb lives in Columbus, Ohio.

The Cooperative Model: Financing Community, Stability, and the Future

October 14, 2025

Cooperative model and financing community

By Casey Fannon

Nearly 30 years ago, I joined the National Cooperative Bank (NCB) straight out of college.

I knew little about cooperatives then, but I quickly discovered the strength of this ownership model while working in cooperative housing finance.

Since that time, I’ve seen firsthand how co-ops create not just economic value, but community resilience, democratic participation, and long-term stability.

In 2024, NCB originated $1.1 billion in new loans, serving housing co-ops, food co-ops, purchasing co-ops, credit unions, and more. In my view, what makes co-ops so durable—especially in times of economic uncertainty—is that they are not speculative ventures. They exist to solve real needs.

Whether it’s a food co-op addressing neighborhood food scarcity, a purchasing co-op helping independent retailers compete with national chains, or a credit union providing access to the unbanked, cooperatives put people before profits.

As members both own and benefit from the enterprise, co-ops form self-sustaining ecosystems where value flows back to the community.

Take housing. Cooperative housing remains one of the most overlooked solutions to affordability and neighborhood stability.

Unlike condominiums, where decision making is less centralized, housing co-ops act collectively—whether repairing roofs, upgrading community centers, or negotiating financing.

This model works especially well in senior housing co-ops and manufactured housing communities particularly, where residents gain security and dignity by collectively owning their homes.

At NCB, we are also supporting new efforts like Frolic Communities in Seattle, which is pioneering small-scale urban cooperative developments that fight displacement, expand affordability, and build neighborhood cohesion.

And let’s be clear – Salient policy innovation can unlock even more potential.

One promising step is adapting the Low-Income Housing Tax Credit program to allow direct pay credits for co-ops—ensuring affordability and homeownership without diluting cooperative governance.

Similarly, expanding programs like Tenant Opportunity to Purchase Acts (TOPA) can give renters the first right to convert buildings into resident-owned co-ops, creating long-term community wealth.

But the cooperative difference isn’t just financial. Research shows co-op members are more likely to vote, volunteer, and engage civically.

I’ve seen this play out in real life: in one Massachusetts housing co-op, a resident who once stayed on the sidelines became active in the property committee, met her neighbors, and even met her future husband.

That may be an extraordinary case, but the point stands—cooperatives build connections. They create the conditions for belonging and purpose, which are essential to well-being and longevity.

For lenders, policymakers, and communities looking ahead, the message is clear: the cooperative model offers a double bottom line—economic returns alongside measurable social impact.

At a time when people are demanding more sustainable, community-centered ways of living and working, co-ops stand as a proven alternative.

NCB’s mission remains simple: finance cooperative enterprises that strengthen communities. But the broader call is to ensure policies, financing tools, and public understanding catch up to the model’s promise.

If we do, cooperatives can play an even greater role in addressing some of our country’s most urgent needs—from affordable housing to equitable energy, from resilient retail to inclusive finance.

The cooperative advantage isn’t just about business. It’s about building communities that endure.

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About the Author

Since joining NCB in 1996, Mr. Casey Fannon has dedicated his entire career to National Cooperative Bank and has served as its President and CEO since 2021.

Israel and Hamas Complete Historic Hostage and Prisoner Exchange

October 14, 2025

Israelis and Palestinians celebrated a rare moment of hope on Monday as a massive hostage and prisoner swap marked the first major step toward ending two years of war in Gaza. The exchange, part of a U.S.-brokered peace plan, saw Hamas release all living Israeli captives while Israel freed nearly 2,000 Palestinian prisoners and detainees.

Emotions ran high across both sides. In Israel, tearful families embraced their loved ones after years of uncertainty, their cries of relief echoing through crowds gathered outside hospitals and military bases. In Gaza and the occupied West Bank, Palestinian families celebrated the homecoming of relatives who had spent years behind bars, waving flags and chanting as buses carrying freed prisoners rolled in.

“This marks a historic dawn in a new Middle East,” U.S. President Donald Trump declared in a speech to Israel’s parliament, the Knesset, shortly after landing in Tel Aviv. He hailed the exchange as a “turning point toward lasting peace” before departing for Egypt to attend a summit in Sharm el-Sheikh with more than 20 global leaders.

At the summit, the United States, Egypt, Qatar, and Turkey signed a declaration guaranteeing the ceasefire, which began on Friday. The agreement follows months of diplomatic effort to end a war that has devastated Gaza, killing more than 67,000 people and destroying most of its infrastructure, according to the Hamas-run health ministry and the United Nations.

For many, Monday’s scenes of reunions symbolized both joy and grief. “For over two years, the hope of holding Ariel again is what sustained and drove me every single day,” said Arbel Yehoud, a former hostage reunited with her partner, Ariel Cunio. “I am overwhelmed with emotion and joy.”

However, tensions surfaced as families of Israeli hostages expressed anger that Hamas returned only four bodies of those confirmed dead. The Israeli military said it would conduct forensic tests before identifying the remains. Reports suggest up to 24 other hostages’ bodies may still be in Gaza, with Hamas claiming it cannot locate all remains within the ceasefire’s timeframe.

As part of the deal, Israel released around 1,700 Palestinians detained without charge and about 250 serving life sentences. Many of those freed into the West Bank were greeted by jubilant crowds in Ramallah, some draped in keffiyehs but visibly weak from years in detention. “There is joy, and there is pain,” said Khalil Muhammad Abdulrahman Al-Qatrous, waiting outside Nasser Hospital in Khan Younis for his son’s return.

In the Knesset, Trump received a standing ovation during his address, where he declared that “the long and painful nightmare is finally over.” His remarks were briefly interrupted by an opposition member holding up a sign reading “Recognise Palestine.” Later, Trump met with world leaders including UK Prime Minister Sir Keir Starmer, French President Emmanuel Macron, and several Arab heads of state. The stage at the summit bore the words “Peace in the Middle East,” signaling optimism for a new regional chapter.

Under Trump’s 20-point peace framework, Gaza will be temporarily governed by a committee of Palestinian technocrats overseen by a U.S.-chaired “Board of Peace.” Former UK Prime Minister Tony Blair is expected to play a key role on the board, which will guide Gaza toward eventual control by a reformed Palestinian Authority.

But experts warn that implementing the next phases of the plan will be difficult. Disputes remain over Israel’s troop withdrawal, Hamas’ disarmament, and the governance of Gaza. Hamas has rejected foreign oversight and insisted it will not surrender its weapons unless a sovereign Palestinian state is established. Israeli Prime Minister Benjamin Netanyahu has also opposed restoring the Palestinian Authority’s control over Gaza.

When asked about the next stage of talks, Trump said, “It’s started. The phases are all a little bit mixed in with each other.”

The war began after Hamas’ October 7, 2003, assault on southern Israel, which left 1,200 people dead and 251 taken hostage. Since then, Israel’s military campaign has leveled much of Gaza, leaving over 90% of its residential buildings damaged or destroyed.

Despite lingering skepticism, Monday’s exchange gave both sides a rare glimpse of peace. As one Palestinian woman said upon reuniting with her son, “Honestly, the happiness and joy is indescribable, despite the suffering… today we came to celebrate.”

Related Readings:

Israel Expands Ground Offensive in Gaza City Amid Global Outcry

The Israel/US Proxy War for Regime Change in Iran

Why Trump Bombed Iran: Preserving US and Israeli Nuclear Supremacy in the Middle East

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María Corina Machado Wins Nobel Peace Prize for Democracy Fight

October 13, 2025

Venezuelan opposition leader María Corina Machado has been awarded the 2025 Nobel Peace Prize for her unwavering commitment to democracy and human rights in her home country. The Norwegian Nobel Committee announced the honor on Friday, praising her for keeping “the flame of democracy burning amid a growing darkness” in Venezuela.

Machado, who has lived in hiding since last year’s disputed election, was recognized “for her struggle to achieve a just and peaceful transition from dictatorship to democracy.” Born in Caracas in 1967, she trained as an industrial engineer before entering politics. In 2002, she founded Súmate, a civic organization that promotes political participation and monitors elections.

Known for her belief in “ballots over bullets,” Machado has long championed nonviolent resistance to authoritarian rule. The Nobel committee described her as “one of the most extraordinary examples of civilian courage in Latin America in recent times.”

Upon receiving the call from Oslo, Machado said she was overwhelmed. “Oh my god … I have no words,” she said after being awakened in the middle of the night. In a statement, she dedicated the award to the Venezuelan people, calling it “a recognition of what we have achieved together and a reminder of what still remains.”

Although the White House criticized the Nobel Committee for overlooking President Donald Trump’s peace efforts, Trump himself congratulated Machado after speaking with her by phone. “The person who actually got the Nobel Prize called today, called me and said, ‘I’m accepting this in honor of you,’” Trump told reporters.

Machado confirmed the conversation, expressing gratitude for U.S. support. “We are deeply grateful to President Trump,” she told El País. On X, she wrote, “We are on the threshold of victory, and today more than ever we count on President Trump, the people of the United States, the people of Latin America, and the democratic nations of the world as our main allies in achieving freedom and democracy. Venezuela will be free!”

Tensions between Washington and Caracas have intensified in recent months. According to U.S. officials, Trump’s administration is pursuing a broader strategy aimed at isolating President Nicolás Maduro, including economic sanctions and naval operations targeting alleged “narco-trafficking” vessels off the Venezuelan coast.

Machado’s journey toward democratic reform has been marked by setbacks and danger. Freedom House reports that Venezuela’s institutions have deteriorated sharply since 1999, with political repression deepening under Maduro’s rule.

In 2024, Machado sought to challenge Maduro in the presidential race but was barred from running. She later backed Edmundo González Urrutia and mobilized volunteers to ensure transparent elections. Both candidates claimed victory, but the government-controlled electoral body declared Maduro the winner with 51.95% of the vote. Opposition observers reported “suspicious” data patterns, suggesting widespread irregularities.

Machado insisted that her team had proof that Maduro lost “in a landslide to Edmundo, 67% to 30%.” Writing in The Wall Street Journal, she said her group had secured “receipts obtained directly from more than 80% of the nation’s polling stations.” The Nobel Committee commended her for ensuring that “the final tallies were documented before the regime could destroy the ballots and lie about the outcome.”

The Biden administration also concurred that there was “overwhelming evidence” Maduro had lost. Following the disputed vote, the Venezuelan government cracked down on dissent, with Human Rights Watch reporting killings, torture, and disappearances of activists.

Since then, Machado has operated underground, reemerging briefly during mass protests in early 2025. Speaking from an undisclosed location, she told CNN that the regime had “lost total touch with reality and lost its social base,” but insisted that millions of Venezuelans remain committed to democratic change. “Everyone in Venezuela is afraid of losing our freedom or even our lives,” she said. “But above all, we are committed to make the truth prevail and get a transition to democracy peacefully.”

Announcing the award, Jørgen Watne Frydnes, chair of the Nobel Committee, said Machado’s courage exemplifies the values Alfred Nobel envisioned. “She has brought her country’s opposition together. She has never wavered in resisting the militarization of Venezuelan society. She has been steadfast in her support for a peaceful transition to democracy,” Frydnes said.

Her ally González celebrated the decision, saying the prize honors “peace, a fundamental element in our campaign.” He called Machado “an upright, brave and courageous political figure.”

Analysts view the award as a symbolic stand for global democracy. Karim Haggag, director of the Stockholm International Peace Research Institute, said the committee “clearly chose to highlight democracy as a priority area” amid a global decline in democratic norms. Nina Græger, director of the Peace Research Institute Oslo, added that the award is “above all, a prize for democracy,” emphasizing that “research shows democracy is an important precondition for peace.”

Last year’s Peace Prize went to Nihon Hidankyo, a Japanese organization of atomic bomb survivors, underscoring the Nobel Committee’s focus on global threats such as nuclear proliferation. This year, the emphasis has shifted toward defending democracy in the face of authoritarian resurgence.

The Nobel Peace Prize carries a cash award of 11 million Swedish kronor, or roughly $1 million, and will be presented in Oslo in December. However, Frydnes said it is uncertain whether Machado can attend due to security concerns. “It’s a question of security. It’s too early to say. We always hope to have the laureate with us in Oslo, but this is a serious security situation which needs to be handled first,” he said.

For many Venezuelans, Machado’s recognition marks both validation and motivation. As she said in her acceptance statement, “This prize is not mine alone. It belongs to all who continue to believe in ballots over bullets. Our fight is not over, but this gives us hope that the world is watching.”

Related Readings:

Trump’s Rush for Ukraine Peace Deal Sparks Global Tensions

Institutional Foundations: Nobel Laureates Uncover Key to National Prosperity

Nobel Laureate Muhammad Yunus Leads Bangladesh’s Interim Government Amid Crisis

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What Tracking Gen AI Skills Can Teach Us About the Future of Work

October 13, 2025

By Dr. Gleb Tsipursky

Generative AI (Gen AI) is reshaping the workplace, offering powerful tools for creativity, productivity, and efficiency. However, unlocking its potential hinges on more than just adoption; employees must develop a nuanced understanding of how to use this technology effectively. Organizations must go beyond traditional training approaches and embrace rigorous tracking of learning progress and outcomes specific to Gen AI skills. By measuring key performance indicators (KPIs) such as skill application rates, engagement metrics, and real-world results, leaders can ensure that their teams stay competitive in this rapidly advancing field.

Why Tracking Gen AI Skills Progress Is Crucial

Without a clear system to measure how employees are learning and applying these tools, organizations risk misaligned training efforts and underwhelming outcomes.

Gen AI tools, from text generators to image creation platforms, require a blend of technical expertise and creative application. Without a clear system to measure how employees are learning and applying these tools, organizations risk misaligned training efforts and underwhelming outcomes. Tracking provides actionable insights that guide improvements in learning programs, ensuring employees acquire not only knowledge but also the confidence to leverage Gen AI effectively.

Skill Application Rates: It’s not enough for employees to complete a training module on Gen AI; organizations must evaluate how well they apply those skills in their roles. For instance, are content teams using Gen AI-generated suggestions to improve efficiency, or are they ignoring its inputs, preferring to generate and edit their own content?
Engagement Metrics: Measuring time spent on training modules, participation in Gen AI simulations, and frequency of interaction with learning tools can reveal whether employees are actively engaged with the content or merely going through the motions.
Post-Training Results: The ultimate test of Gen AI learning is its real-world impact. Metrics such as increased productivity, error reduction, and enhanced innovation reflect how effectively employees are utilizing Gen AI to meet organizational goals.

Client Case Study: Scaling Gen AI Skills Adoption at a Regional Retailer

A regional retailer illustrates the transformative power of tracking Gen AI learning progress. Facing mounting competition, the company sought to use AI-driven tools to improve marketing personalization and streamline supply chain operations. However, initial adoption efforts fell short. Employees struggled to integrate Gen AI applications into their workflows, and training programs yielded inconsistent results.

To address these challenges, the company partnered with me as a consultant specializing in Gen AI adoption strategies. We implemented a robust tracking system with the following components:

Baseline Assessments: We tested employees on their familiarity with Gen AI tools and core AI concepts before training began.
Tailored Learning Modules: We customized training to address specific gaps, such as using Gen AI for customer segmentation or predictive analytics.
Real-Time Progress Monitoring: Dashboards provided managers with insights into module completion rates, engagement levels, and assessment scores in real time.
Outcome Tracking: We also measured post-training KPIs, such as increased marketing campaign ROI and reduced inventory mismanagement.

Within three months, 87% of employees reported confidence in using Gen AI tools, up from just 40% before training. More importantly, the retailer achieved a 15% reduction in inventory errors and a 20% increase in marketing campaign performance, demonstrating the tangible value of targeted, data-driven learning programs.

Identifying Gen AI Skills Gaps

Tracking learning progress is particularly valuable in identifying skills gaps, which are often amplified when adopting complex technologies like Gen AI. Many employees may struggle with specific aspects of Gen AI, such as prompt engineering, interpreting AI outputs, or understanding ethical considerations. By analyzing pre- and post-training assessments, organizations can pinpoint these challenges and refine their programs.

For instance, if data shows that employees consistently perform poorly on tasks related to evaluating AI-generated insights, it could indicate a need for more focused training on critical thinking and contextual judgment. Similarly, if team members excel in basic operations but struggle with advanced applications, leaders can design supplemental modules to close these gaps.

Generative AI is not a one-size-fits-all tool, and we should not approach its training in that way. Tracking learning outcomes enables organizations to personalize the learning journey for each employee, tailoring it to their specific strengths, weaknesses, and roles. Personalized learning fosters higher engagement and better retention, ensuring employees are not overwhelmed or under-challenged.

For example, a marketing analyst may need intensive training on creating compelling AI-generated copy, while a data scientist may focus more on configuring AI models for predictive analytics. Tracking data such as individual progress rates and feedback allows organizations to offer customized learning paths that adapt in real-time to employees’ needs.

Leveraging AI Tools to Track AI Learning

One of the best ways to track learning progress in Gen AI programs is by using AI itself.

Ironically, one of the best ways to track learning progress in Gen AI programs is by using AI itself. Advanced learning management systems (LMS) with built-in AI capabilities can analyze employee interactions, generate insights on performance trends, and even recommend personalized training modules. These tools simplify the process of collecting, interpreting, and acting on learning data, allowing leaders to focus on strategic improvements.

For instance, AI-powered LMS platforms can flag employees who may need additional support, such as those repeatedly scoring below average on AI ethics modules. They can also identify top performers who might be ready for leadership roles in AI adoption initiatives.

Best Practices for Tracking Gen AI Learning

To maximize the impact of tracking, organizations should follow these best practices:

Define Clear Objectives: Align training goals with strategic business priorities. For Gen AI, this could mean improving innovation rates, reducing repetitive manual tasks, or enhancing customer experiences.
Integrate Real-World Scenarios: Ensure training programs simulate practical challenges employees are likely to face when using Gen AI tools. This bridges the gap between theory and application.
Foster a Culture of Feedback: Use both quantitative data and employee feedback to refine training programs. Understanding learners’ experiences helps fine-tune content and delivery methods.
Continuously Review and Adapt: Gen AI technologies evolve rapidly, so training programs must keep pace. Regularly updating learning content and tracking mechanisms ensures long-term relevance, while managing risks.

Conclusion: Data-Driven Learning for the Gen AI Era

The rise of Gen AI presents organizations with incredible opportunities—but also challenges. Without effective tracking of learning progress and outcomes, businesses risk falling short of realizing AI’s full potential. By implementing robust systems to monitor skill acquisition, identify gaps, and personalize learning, leaders can ensure their teams are equipped to thrive in the AI-driven future. Tracking learning outcomes isn’t just about measurement; it’s about creating a culture of continuous growth and innovation where employees and AI work together to achieve extraordinary results.

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