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Samuelson points to the risks to the American economic growth from excessive health care costs. This is hurting take home pay and shows up in consumer spending. It is hurting government spending in other areas such as needed infrastructure spending and efforts to reduce the deficit. This hurts private capital investment to create jobs because of lower demand from constricted consumer spending. The U.S. budget has as its largest single expense 27% on health care compared to 20% on defense the next largest expense, with growth in health care spending taking this to one third of the budget in coming years. Without addressing health care, says Samuelson, the Supercommitte in Congress even if successful at deficit reduction will basically have failed to do its job, and it did not have the time, resources or conviction to do this. According to a new study from the Organization for Economic Cooperation and Development (OECD), U.S. healthcare spending per person is $7,960 per person in 2009. This compares with Norway $5,352, Britain $3,487, France $3, 978, an OECD average of $3,233. Life expectancy in the U.S. is 78.2 years, compared to Japan 83 years, OECD average of 79.5 years. Chile and the Czech Republic have life expectancy equal to the U.S. Except for cancer care where the five year survival rate is 89.3% in the U.S. and the OECD average is 83.5%, the U.S. lags far behind in much needed critical areas such as diabetes and asthma. Rates of emergency hospitalization for asthma are 3 times that in France and 6 times that in Germany and Italy. The U.S. has fewer doctors per thousand population and higher cost per medical procedure- with more frequent use of the costliest procedures- creating a supply shortage that induces higher prices, and less preventive and early action care through physician visits. The number of practicing U.S. doctors is 2.4 per thousand population in the U.S. compared to 3.1 per thousand for the OECD average; and number of annual doctor consultations 3.9 per capita in the U.S. versus 6.5 for the OECD average. Appendectomy cost $7,962 in the U.S., $5,004 in Canada and $2,943 in Germany. Coronary angioplasty cost $14,378 in the U.S., compared to $9,296 in Sweden, and $7,027 in France. Knee replacement cost $14,946 in the U.S., $12,424 in France, and $9,910 in Canada. Knee replacements, angioplasties and MRI exams are twice as common in the U.S. compared to the OECD countries. ...

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Congressional Budget Office projections show the difficult choices facing the U.S. - tackling the deficit by letting the Bush tax cuts and the payroll tax cuts expire will lead to low growth. The alternative is growth with much higher deficits. GDP growth would be at about 2.3% in this fiscal year if the payroll tax cut is kept till December 2012. In fiscal 2013 if a number of tax cuts are permitted to expire and across the board spending cuts take effect as scheduled GDP growth would decline to 1.1%. Taxes would increase by $465 billion in 2013 over 2012 if tax cuts expire - individuals and companies would pay $2.99 trillion in taxes in fiscal year 2013 in that scenario. Spending cuts would take effect in Jan 2013 for $1.2 trillion over 10 years. The result- " a sharp fiscal contraction" in the words of CBO director Elmendorf. Unemployment would go up to 8.9% in 2012 year end and 9.2% in 2013 yearend from 8.5% today, if no agreement is made to extend tax cuts and block spending cuts. The risk of not taking the debt reduction actions is to let the debt grow to $11 trillion over 10 years, an unsustainable path, compared to about $3.1 trillion over 10 years if tax cuts are permitted to expire and spending cuts take place. This is the tough choice facing America in 2012, and comes when Europe is facing similar tough choices....

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 Mayor Reiter of Munich, Christian Kern, head of Austrian railway OBB, say here that the actions of Viktor Orban of Hungary gave the German government very little time, only a few hours, to act. The first motivation was to act in a humanitarian way, which is what happened. The German government had asked Orban to register and handle immigrants in an orderly way. In the end with the failure of Orban to do this, the immigrants who would have come north anyway, streamed into Germany and Austria in buses and trains. Clearly Hungary and Germany could have handled this better. The German public provided support with a large number of volunteers helping. One German minister is cited here as saying that if Orban wanted to build a fence he should have done it in a quiet way, as there are fences between Bulgaria and Turkey, and Turkey and Greece and it has not bothered anyone.

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A report by pharmacy benefits managing company Express Scripts shows a 13% increase in the price of branded drugs in the U.S. from Sept 2011 to Sept 2012. Generic drug prices declined by 22% in this period. The report also shows that growing spending on specialty drugs for cancer, MS and other diseases is a big reason for the increase in prices of branded drugs. This report is from a random sample of six millon Express Scripts members using prescription drug coverage. Prof. Schondelmeyer of the University of Minnesota, who manages the drug benefits program at the university and conducts a similiar price report for AARP, says the potential benefits for these specialty drugs are not that good to justify the high prices.

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The new labor law of prime minister Mario Monti's administration was passed in the Italian parliament by a vote of 393-74 on June 27, 2012. Passage of the major labor law reform was an important piece of legislation for Italy to regain cometitiveness in the eurozone and increase growth. It was seen as a confidence vote in the Monti administration.

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This editorial in the New York Times is strongly critical of former president Barack Obama for accepting $400,000 in speaking fees from Wall Street for a single speech. It says the news is causing people to question the ideas and words presented by Obama in his books about the dangers of losing sight of the interests of ordinary people. It gives the impression says the NYT, that Obama is cashing in like everybody else, and that his talk was empty. The editorial says the millions raised by Hillary Clinton led to her defeat in the election. Obama is reported to plan a foundation with the work of training a new generation of political leaders. This NYT editorial says it would be better to stay true to vision and purpose, to walk the talk for president Obama, especially now that a recent poll shows two thirds of voters, including about half of Democrats say that the Democratic Party is out of touch with the interests of the American People. By associating this closely with wealthy donors leading Democrats contributed to this. During a period when some of the remarkable achievements of the last fifty years such as the European Union are being called into question, when ordinary working people, young people and older people are struggling, this is all the more a tone deaf approach by politicians. The idea of helping train a new generation of political leaders through a foundation sounds bizarre in this context, and seems to suggest politicians believe there is always a solution through marketing their audacity and money.   ...

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President Obama's proposed legislation for the fight against Islamic State proposes a three year effort with use of Special Commandos, but no major ground combat effort. It also rescinds a broad Bush era 2002 legislation for the Iraq war, but leaves in place 2001 legislation for the war against al-Qaeda and affiliates.

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David Brooks on the candidacy for U.S. President of Senator Rick Santorum. He says Santorum genuinely represents the working class- a grandson of a coal miner and the son of Italian immigrants who has represented workers of the steel manufacturing region of western Pennsylvania. Santorum has pushed hard in this campaign largely ignored by the media. He has visited 370 towns riding in a pickup truck trying to cover as much ground as possible and talking with great conviction about his positions distant from the corporate and financial wings of the Republican party, about family, and communities. Bring someone like Sherrod Brown of Ohio together with someone like Rick Santorum and you have good representation of the working class across the political spectrum to win this election for the working class of America, says Brooks, who sees this as a lot better alternative today than Harvard Law.

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Krugman points out that about 13 million Americans without insurance gained health insurance under the Obama plan. He says if it is turned back 8 million whites without a college degree in that 13 million will lose health insurance. Of these eight million about two out of three voted for Trump, so that 5 million Trump supporters could now lose health insurance even though they are older and have more health conditions. Krugman says this aspect of the election campaign was not covered well in the misinformation and social media information of the 2016 campaign, and the lack of media focus on the important issues in the election. On manufacturing jobs he says most of the jobs lost are not returning, and only token jobs such as at a Carrier plant in the news will take their place.

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Peter Coy of Bloomberg Business Week points out that the debt ceiling and proposed deficit reductions in the range of $4 trillion really obscure the real size of the problem which is much larger. The real problems hit when the U.S. faces a larger graying population by 2020 with sharply higher per capita health care spending; and at the same time workers from this generation retire and become beneficiaries of Social Security and Medicare with fewer younger workers to support the system with tax revenues. Another problem is that older Americans are likely as a voting bloc to vote themselves benefits that will cost the younger generation, benefits that the younger generation will not be able to enjoy. Even the Paul Ryan plan with its cuts to Medicare insulated todays seniors from the sharp cuts, as it becomes political necessity for both Republicans and Democrats to shy away from touching the current beneficiaries.

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The WSJ's Christopher Emsden and Alessandra Galloni's interview with Italy's Labor Minister, Elsa Fornero, after major changes to Italy's labor laws including Article 18. This is a major change for Italy. She describes the problems she faced and how she has tackled them to get the new labor law passed. Fornero will set up a monitoring system to ensure that the law's imprementation takes place smoothly. To make the change Fornero took apart Article 18 to its constituent elements, preserving the anti discrimination aspect and the right to appeal, but allowing employees to be terminated for economic reasons. This puts Italy on an even footing with its europartners Germany and France, and addresses one of the main reasons Italian businesses are loath to hiring new employees. It also addresses the main reason why foreign investment in the Italian economy is so scarce. In achieving this Fornero faced the lack of support from Confindustria, the business association (which does not cease to amaze her), CGIL, the labor unions, and the political class in Italy, with each side wanting to tweak the system to make gains or get special exemptions. Fornero is a pensions expert and economics professor at the University of Turin. Her ministry covers pensions, labor, welfare and equal opportunity policies....

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A study by AARP of 514 brand name and generic drugs between 2005 and 2009, shows that generic drug prices went down an average of 31% during this period, and brand name drug prices went up by 41%. One of the authors of the report says that it is important to look at individual drug prices and not studies showing total spending on drugs, because this is a significant cost for people paying out-of-pocket, It drives up insurance premiums, and pushes retirees into coverage gaps in Medicare Part D drug program. Analysts indicate pharmaceutical companies are increasing prices on drugs before patent expiration to get as much profit before the patents expire.

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One military expert says even if half of the Iraqi army can be put in shape it could turn the tide against the ISIS. Advice from U.S. military experts is for the Iraqi army to focus only on the ISIS and avoid hurting relations with the Sunni population. Advisers are seen as making a difference and needed also for the tribal forces. A major difficulty is that Shiite militias and advisors from Iran play a role in the forces loyal to prime minister Maliki. Following the U.S. training of the Iraqi Army at a cost of over $25 billion there was a period under prime minister Maliki when he appointed officers more for loyalty than for military skills and training. With the U.S. withdrawal the Iraqi Army languished in this situation. Reporters from NYT and WSJ have documented extensively the weakness of the Iraqi Army in commanding officers, in training and in equipment.

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This report in the Economist magazine says views in the Trump base of support in rural areas and among white working class voters are likely to persist for some time. One reason given is that many of these people live in isolation and little contact with the more educated urban voters in America. Another factor cited here is that only a fifth of voters follow politics closely, and of these voters only a small fraction have a good grasp of the positions of the two major parties. Most people follow the instincts and thinking of the groups they are with. As a result many of the issues covered in the media such as climate change and U.S. withdrawal from the Paris agreement, the Comey firing and the Mueller investigation into Russian meddling in the election, president Trump's Twitter comments, are not having much impact on the president's ratings among his support base at this early stage of the Trump presidency. Yet it is too early to tell only 6 months into the Trump term in office. After 8 years of president Obama's two terms in office voters who feel left out are not likely to change their views in so short a time. Republican voters as distinct from the core Trump base voter are also unlikely to change their views after 8 years of Democratic party administration. By staying close to traditional Republican party positions president Trump is likely to continue to have the support of the lifelong Republican party voters unless things change. Can a centrist position emerge after voter fatigue with excessive partisan opinion, as voters seek to make America a more quieter place and a consensus on working together to lift all boats emerges. This could be expected as time passes.   ...

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Friedman says Obama's 2012 presidential campaign lacks bold vision, a failure to articulate tangible achievements, and owes too much to campaign consultants. He describes it as being developed in test tube fashion. The failure to embrace and strongly advocate his own presidential commission's Simpson-Bowles deficit reduction plan, which could be coupled with long term investment in the productive potential of the U.S. economy, shows the lack of courage to prepare a plan going forward. It is likely to cost support of independent, center and center-right voters in the 2012 U.S. presidential election.