For decades, leftist policies first espoused by Juan Perón have dominated the country’s politics. But as electioneering begins it is clear that rampant inflation is driving voters away from Peronism and toward the populist right. We examine why big American retailers see opportunity in providing primary health care (9:33). And our annual list of the world’s most liveable cities (15:38).
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Hello, and welcome to the Intelligence from the Economist.

Every weekday we provide a fresh perspective on the events shaping your world.

Where did you go the last time you had a blood test?

Or if you're American, it may have been the local supermarket.

Could this convenience finally drive down patients' healthcare costs?

And deciding what makes a city livable is a subjective thing, partly.

Our annual Livability Index puts some numbers to it.

We run through the top and the bottom of the latest list.

Argentina's election season is in full swing.

Candidates are vying to win their party's primaries, which will be held in August.

The winners will then move on to the first round of the presidential election in October.

But whoever gets through faces big challenges, including a floundering economy.

the third highest in the world, and 2 5ths of the people say they can't afford necessities.

Shoppers describe skyrocketing prices for everything from cheese to

15% In the case of cheese, it would be meat.

An especially grave problem for the world's biggest steak eaters.

And yet worries about the economy are giving an unexpected boost to some of those presidential hopefuls.

Argentina has mostly been run by a populist movement called Peronism since

Ana Lankes writes about Latin America for The Economist.

Right now, a left-wing Peronist administration is in power.

But since the country's economy is really struggling, that's hurting the Peronists' chances of keeping power.

So what we're seeing right now is a surge in popularity for center-right and right-wing candidates.

This weekend, the Peronist coalition announced that they would line up behind a centrist candidate Sergio Massa, the current Minister of Economy, instead of someone considered more left-wing.

You've had very high public spending that has increased a lot in the last 20 years.

So it has grown from 26% of GDP in 2000 to almost 40% today.

But tax revenues haven't caught up because Argentina's tax base is really small because lots of Argentines work in the informal sector.

So the government can't raise taxes really in order to increase revenues.

And it doesn't have lots of other options to raise financing either.

Because it has defaulted on its sovereign debt, which is the debt that the government issues, so many times, it's effectively shunned by the markets.

So it can only really get funds from multilateral lenders like the IMF.

What it could do is export more to bring in cash, but successive Peronist administrations have shut off the country from global trade.

So instead, what many governments have become accustomed to is the central bank printing money to basically finance their policies.

the amount of money in circulation has quadrupled to almost 4 trillion pesos.

Ah, so it's all this printing of cash that's causing the inflation problem.

So yes, the central bank printing money is 1 of the main reasons that inflation is so high.

But there's also other signs of economic distress in Argentina that have been worsening.

So because the peso devalues so quickly, Argentines rush out as soon as they get paid to buy dollars, which is the currency they save in.

And the government doesn't want that to happen because it doesn't have enough dollars to pay for things like imports.

So the government over the past few years has made it harder for Argentines to buy dollars and a huge black market for dollars has emerged.

And over the past few months, the price of the dollar on the black market has really gone up.

So it's become very expensive for Argentines to buy dollars and be able to save.

So the election is coming at a time of real economic turmoil.

Who do voters think can best solve the problem?

Initially, the traditional centre-right opposition, known as Juntos por el Cambio, Together for Change, was in the lead.

And 1 of the main candidates is called Horacio Rodríguez Larreta, who's the mayor of Buenos Aires.

He's kind of similar to Emmanuel Macron, France's president.

And he wants to enshrine central bank independence, to reduce the fiscal deficit, to get rid of controls on the dollar.

But he says this needs to happen gradually.

And he also wants to build consensus, including with moderate Peronists.

This emphasis on gradualism has led to him losing some appeal as the economic situation spirals.

Mainly because the reforms that I've mentioned, last time his party was in charge, they tried some of these reforms, but it ended in crisis in 2018.

So now a lot of Argentines want way more radical solutions, which is opening up the door for extreme candidates.

Tell me more about these more extreme candidates and these radical solutions.

She comes from the same coalition as Lareta.

She wants to basically do the same things but a lot faster.

Then there is a way more radical candidate and he's a proper right-wing populist and he's called Javier Millet.

And what is this proper right-wing populist promising?

The policy of his that has grabbed the most attention is an idea to replace the Argentine peso with the American dollar as the country's currency.

Some economists think this is not feasible because the central bank doesn't have enough reserves of dollars.

But young men in particular like his radical style.

So he raffles his congressman's salary on social media.

He lives with 5 Mastiffs, 4 of which are named after famous economists.

And in interviews, he says that other politicians are part of a political caste.

But in recent local elections, Millet's allies have done very badly.

However, at the moment when polled, around a fifth of voters say they would vote for him.

And Patricia Bullrich has said that if she wins, she would make an alliance with his party.

And Ana, do you think any of them are up to the task of fixing Argentina's broken economy?

Whoever wins is going to have a very hard time doing this.

So I spoke earlier about how Argentina doesn't have a lot of options for new revenue.

And if the government wants to cut back the fiscal deficit, it'll need to reduce public spending and subsidies.

But it's really tricky to solve this because all the problems are intertwined.

So for example, if you reduce subsidies on energy, you're going to push up inflation even more.

And Argentina has 24 provinces, and these provinces account for quite a lot of the increase in public spending over the past 2 decades.

So any incoming president would have to negotiate reforms with the governors of these provinces.

Are you saying that these economic problems are so bad that effectively

No it does matter because the next president has to start taking steps in the right direction.

There are a few things playing in the next president's favour.

This year 1 of Argentina's worst droughts in history wiped out around 3.2% of GDP in exports of soy, corn and wheat.

But the harvest is expected to recover somewhat next year.

Second, global demand for lithium is increasing as more people buy electric vehicles And Argentina has a lot of lithium, so investments are pouring in.

And third, there is this gigantic field of shale gas and oil in Argentina's west.

And recently investments have started coming in.

But quick fixes like dollarization, which Millet is offering, are not going to be enough.

Winning back the trust of foreign investors and Argentine savers is going to take a lot of time.

And given Argentina's volatile politics, that's a tall order.

Enjoy a 1.70-euro cheeseburger, part of the McDonald's EuroSaver menu.

Serve from 11 a.m., subject to availability.

So we're walking now through the lobby now into the store.

A few weeks ago, I visited a Walmart in Northwest Arkansas.

John Fasman covers American business and society for The Economist.

Instead, I was visiting 1 of the retailers' new medical centers.

1 of the senior VPs at Walmart Health, a primary care doctor named David Karmush, showed me around.

There were exam rooms, doctors in white coats, a lab for blood tests,

and we do both point of care testing here.

the country aren't co-located with dental.

There's a huge unmet dental access challenge in rural America and

Since 2019 Walmart has opened up 32 such medical centers that provide primary care mostly in rural America.

By the end of next year It plans to more than double that number and expand into 2 more states.

And it isn't the only retailer entering primary care.

Which other retailers are we talking about?

There's Dollar General, which is a chain of discount stores.

They recently partnered with a company that runs mobile health clinics.

So there's a pilot program at 3 of their stores in Tennessee.

Amazon recently acquired 1 medical, which is a concierge practice, which means clients pay an annual membership fee.

Then you have retail pharmacies like Walgreens and CVS.

Now CVS is a retail pharmacy, but it also is part of a larger insurance company, and they're also expanding the number of clinics they have that give primary care at their pharmacies.

And why are all these retailers deciding to do this?

Well, as with anything involving American health care, right, there's a simple and a complex answer.

Americans spend an unbelievable amount of it on health care, around 17.8% of GDP.

Last year, That spending is forecast to rise by about 5.5% year over year over the next 8 years.

By 2031, it'll account for about 1 5th of GDP.

A lot of that spending comes from 2 federal programs.

You have Medicaid, which covers health care costs for poor people, and Medicare, which pays for health care for people over the age of

And tell me more about this more complex part.

The more complex answer has to do with payment, with how Medicare and Medicaid pay for service.

And because they are such big payers, they tend to set standards that private insurers follow.

So the traditional payment model is fee for service, meaning the doctor sees me for a checkup, performs a surgery, and the insurance company pays that doctor back.

And the advantage of that is simplicity, right?

The disadvantage is that it can encourage over-consumption of medical services, there's not much coordination, and there's not much attention paid to outcomes.

The changing model is something called value-based care, which means essentially that Medicare and Medicaid will pay a set amount for a patient's forecasted health care costs for a set period of time.

Now, if the doctor can keep that patient healthy, that is, spends less on health care.

This is especially true for people with chronic conditions.

If that doctor can keep someone with chronic conditions healthy, so keep a diabetic from going to the hospital, that doctor can then share in any cost savings that Medicare pays up front.

So this is really a bet by all of these retailers that they will be able to manage patients' health care, keep patients healthier, better than traditional doctors' practices, and that in so doing, they'll be able to share in those cost savings.

But John, do people really want to go to Walmart for their medical care?

There is a survey recently taken by Accenture, which is a consultancy, and it found that almost a third of consumers, and more than a third of younger consumers, are open to getting medical care at a grocery store or big box retailer.

More than 90% would trust that retailer with their medical data.

And the other advantage is really that these locations, Walmart and Dollar General, are just extremely convenient.

About 75% of Americans live within 5 miles of a Dollar General.

A lot of people do their shopping at both of these places, so it's easy to get to, it's easy to combine a medical visit with sort of the week's shopping visit.

And so this is an example of doctors figuring out a way to meet patients where they are.

Will it work for Walmart and more importantly will it work for the patients?

Well we'll see, that's the big experiment right?

I think 1 of the ways that these new practices are operating is with better use of technology.

So you have better patient data, which means that doctors can track outcomes, can track a patient's health, can make sure that they're staying on top of their medications, that they're coming to the appointments that they need to come to.

You also have for Walmart and Amazon 1 Medical, especially you have apps on your phone, so patients can stay on top of their own health.

So they know when their medication is running low, they know when their appointments are coming up.

Providers still have to invest in technology upfront.

They may ultimately need to do the sorts of things that apps can't.

That means going to patients' homes, calling patients, sort of making sure that patients get into the habit of taking care of their own health care.

But that's a lot cheaper for the system than chronic conditions going untreated, right?

That's how people with heart conditions end up with very serious medical conditions rather than sort of the routine management that could help keep it in check.

And so I think if these companies get it right, and not all will, But the companies that do get it right will manage to share in these cost savings, and they may also keep people healthier.

Like just about everybody else, I've been guilty of daydreaming about where I might live, if I could just pick up and move wherever I wanted.

Helpfully, analysts over at the Economist Intelligence Unit, a sister company of the Economist, have been tackling that question quantitatively.

So if you're daydreaming too, you'll get some decision-making help from the latest iteration of their annual list of most livable cities.

Well, the Livability Index examines 173 cities around the world.

This has actually been just increased last year from

Matthew Oxenford is Senior Analyst for Europe with the Economist Intelligence Unit.

By analyzing it, we quantify the challenges presented to an individual's lifestyle that have taken place over the last 12 months.

We divide this into 5 categories, stability, healthcare, culture and environment, education, and infrastructure, and provide scores for each of these, which are combined into an aggregate score.

The index takes into account all of the global and regional disruption that may have taken place over the last 12 months, and that most significantly includes impacts from COVID-19, which has been a significant driver of scores as the last of the COVID restrictions have been removed in most countries over the last 12 months.

With that, each city is assigned a livability score between 0 and 100 that we can use to track across cities, across regions, and across time.

Okay, and so let's look at the top of the list for this year.

Well, Vienna is the top scorer in our rankings for 2023.

out of 100 compared to an average of 76.2 for all cities across our survey.

Vienna has been the top scorer in our index for most of the last several years with the exception of 2021 when pandemic restrictions caused it to temporarily lose the top spot.

Vienna has a very strong combination of stability, good culture, good quality entertainment, reliable infrastructure and very high quality education and health services.

Okay, and who else is in the in the top 10 let's say?

The runner-up is Copenhagen which has scored 98 which similarly has very high scores across the 5 metrics and then following that we have Australia moving back into the third and fourth spot with Sydney and Melbourne bouncing up the ratings.

Largely that's due to the end of COVID restrictions in Australia.

is then rounded out with 3 Canadian cities, Calgary, Toronto and Vancouver, 2 Swiss cities, Zurich and Geneva, and 1 city from Japan, that's Osaka.

Okay, and we're sitting here in London thinking selfishly, where does London fit in?

London has actually not done particularly well this year.

UK cities in general have done rather poorly.

London's fallen 12 places and is now in 46th place with a score of 90.5.

Similarly, Manchester is down by 16 places to 44th, and Edinburgh, which entered our ratings last year for the first time in 35th, has now moved down to 58th.

Most European cities have seen their rankings fall, as well as some of the US cities such as San Diego and Los Angeles, which are both in our list of top 10 greatest fallers.

However, none of this is really due to any sort of decline in the quality of life in the actual score.

It's largely that cities in Asia have increased in their livability over the last year as COVID restrictions have just been removed in the last few months in that region.

And looking at the other end of the list, which places are on

The 2 worst scorers are Damascus in Syria and Tripoli in Libya, which remained at the bottom of the list.

This is largely due to the ongoing regional conflicts in those regions, as long with the accompanying social unrest and terrorism.

While Damascus has seen no improvement though, we have seen a lot of cities at the bottom of the list, including Tripoli, have their scores improved slightly, largely again due to the removal of pandemic restrictions.

There's 1 city that was not included at all in the 2022 list, that's Kiev, which is now returning to the list at a 165th place out of

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Juan way, or another? Argentina’s election