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Elizabeth Rosenthal looks at Obamacare's contribution to cost containment in 2013-2014. Rosenthal says its is a kind of delicate maneuvring at the edges, because serious work needs to be done. The fee-for-service and many of the drivers for increases in medical costs, the old system of pricing, are still in place. In 20 years at the current rate and after Obamacare health care will still take 25% of the U.S. budget if nothing is done. Healthcare costs are about half that of the U.S. in some of the advanced European countries. She calls Obamacare a trickle down theory of cost containment becaue it leaves most of the drivers for cost increase in place and works at the margins. Princeton economist Uwe Reinhardt calls it an ugly patch on a somewhat ugly system. Rosenthal cites the armies of consultants anticipating every move to reduce prices, and working on "strategic billing'' to increase revenues for hospitals and doctors. For those who say the prices are now up more slowly than in the past, Michael Chernew of the Harvard Medical School, has this to say- its like a diet, reminding us that that we haven't even lost weight, just gaining weight slower than before. ...

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J.P. Morgan Chase announces $2 billion in trading losses in May 2012. The Chief Investment Office unit made a bet with a trading strategy that CEO Jamie Dimon said had grown very complex. These losses could grow or shrink during the rest of the year.

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The IMF's managing director, Christine Lagarde, pointed to the urgent need to recapitalize European banks in September 2011. European banks face potential losses of 120 billion euros for Belgium, Spain and Italy, 60 billion euros for Greece, 20 billion euros for Ireland and Portugal, and 100 billion euros for other banking exposure, for a total of 300 billion euros, according to the International Monetary Fund. In the absence of recapitalization there could be further damage to EU economies from restricted lending by banks. IMF estimates show that deteriorating credit conditions could damage growth in the eurozone countries by 3.5 percentage points, and in the U.S. by 2.2 percentage points, creating another recession.

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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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A report released by the Organization for Economic Cooperation and Development (OECD) shows growing income inequality in 34 OECD countries. OECD Secretary General, Angel Gurria says: "The social contract is starting to unravel in many countries. This study dispels the assumptions that the benefits of economic growth will automatically trickle down to the disadvantaged and that the greater inequality fosters greater social mobility. Without a comprehensive strategy for inclusive growth, income inequality will continue to rise." Countries with the largest ratios between incomes at the top and the bottom, are the United States, Turkey and Israel, roughly 14 to 1. Germany, Denmark and Sweden have ratios of 6 to 1, with their ratios up from the 1980's. Gaps in Chile and Mexico are at 25 to 1. The study covers the period from 1980 to 2008. Overall inequality went up by 25% in the U.S. from 1980. In 2008 the top ten percent in the U.S. earned $114,000, 15 times than incomes for the bottom 10%. The top 1% of Americans saw incomes go up from 1980 to 2008, increasing from 8 percent to 18 percent. The richest 1% having $1.3 million in after tax income, and the lowest 20% making $17,700. The trends have accentuated an increase at the highest end- the top 1% and top 10% of the people- and a sharp decrease for the bottom 20%, which can be grasped from the $17,700 and the $1.3 million, both at extreme ends. The study attributes the rise in inequality to a growing gap in wages for highly skilled workers as technology advances, a surge in foreign direct investment and a looser regulatory regime that reduces employee protections leading to wage premiums for financial jobs and smaller incomes for workers at the bottom. Income groups and professions and sectors that had the greatest influence in government were able during this period to get the greatest protection for incomes, and able also to maximize their incomes. Incomes in the financial sector increased dramatically in the last decade, as a result of deregulation leading to higher risk and speculative activities in the financial sector, leading to the financial crisis of 2008-2009. Financial crises further depress incomes at the lower end. Similiar income inequality trends can be seen for India and China. China has a Ginni coefficient of 0.5 according to researchers at Beijing Normal University, up from 0.3 three decades ago- a Ginni Coefficient above 0.4 is considered destabilizing. Another factor that played a part in these countries is corruption and lobbying by special interests for favored treatment of sectors or groups. Austerity measures taken in Europe and in the U.S. are likely to widen income gaps by depressing the lower end income groups, creating social unrest, especially in the absence of efforts to stimulate growth....

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This Journal editorial on Oct 5, 2012, says that by not offering leadership in the Syrian conflict beause it would lead to a wider conflict the U.S. and the European Union face a wider conflict. The current crossborder shelling between Syria and Turkey is the latest evidence of this. Turkey and the Saudis cannot handle this on their own. Without U.S. leadership the costs of this conflict will be even greater, and even poses risks for the Turkish economy if handled badly.

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Five rules the editors of the WSJ say should be followed when working on cleaning up the banking system. A clear no, as Krugman and other experts point out is for the government to make the rather imprudent move to take on all the debts of the banks as in Ireland. A second rule is not to underestimate the size of the problem and delay action till the problem gets much worse, when its harder to deal with. ECB president, Mario Draghi, pointed out the problem at Spain's handling of Bankia bank as a clear example, telling the European parliament recently: "There is a first assessment, then a second, a third, a fourth. This is the worst possible wayof doing things. Everyone ends up doing the right thing, but at the highest cost." A third rule is to set clear rules about banks, who gets rescued and who gets closed and why- so that its not left upto the discretion of officials. On this rule Spain's outgoing Zapatero administration gets good marks from WSJ for settting clear rules to the cajas svings banks. A fourth rule applicable to Europe is to first setup the expertise and conditions for a European banking regulator before setting up a banking union and direct injection of funds by the EFSF into banks of individual countries. A fifth rule is to avoid creating even larger mega banks by consolidating failing banks with large banks, and continuing the government's implicit guarantee of the bank because it is "too big to fail" and creates systemic risk- this is the situation after action by the U.S. Federal Reserve, regulators and the U.S. Treasury....

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Kessler in the WP corrects Obama's claim that he created 800,000 jobs. He says this is clever arithmetic as it takes a low point in Feb. 2010 following the financial crisis. Kessler points out that according to the Bureau of Labor Statistics, U.S. manufacturing jobs were 12.56 million in Jan. 2009 when Obama became president. In Nov. 2016, early estimates show there were 12.26 million manufacturing jobs, a loss of 300,000. This loss does not reflect the problems in the U.S. auto industry and older industries in the midwestern states as a result of trade and globalization that speeded up with the rapid industrialization of China. And led as Greg Ip pointed out in a recent WSJ report to a rapid acceleration of job losses in a decade that did not happen in the same scale during Japan's industrialization and urbanization in the sixties. This aggravated the situation in Michigan, Ohio, Wisconsin, Indiana, and Pennsylvania, and was met with a feeble response from Democrats. Even a economist like Krugman favoring the Obama administration's efforts came to the conclusion that TPP did not add much to gains from trade as most of the gains had already been realized. More of the gains went to tech and IT in California, at the expense of the auto industry based in the midwest. A report in WP show a president too close to IT in California and failing to grasp the situation in the midwest. Voters punish whoever is in power, regardless of being Conservative or Liberal, in Canada the hollowing out of manufacturing under Harper in Ontario and Quebec led to the win by Trudeau's Liberals.  ...

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Former Defense Secretary in the second term of the Obama administration, Chuck Hagel, says U.S. president Obama hurt his credibility when he failed to act on his own comments of a "red line" being crossed following the chemical attacks in Syria by the Assad government. Hagel was critical in an article in Foreign Policy magazine of the way the national security advisor, Susan E. Rice, ran discussions on foreign policy issues, with too many meetings and discussion followed up with deferring difficult decisions.

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U.S. Speaker Paul Ryan and Senator Tim Scott describe the event on poverty organized by the Jack Kemp Foundation in Jan. 2016, in which both Congressmen are moderators. Ryan and Scott point out the importance of upward educational and economic mobility for working class and middle class people. The 2 Republican leaders say education, work, opportunity and accountability for federal spending in anti-poverty programs are critical parts of their program for addressing the problem. They suggest trying different solutions by giving states more opportunity to try different solutions.

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This WSJ editorial points out that the lack of action from the Obama administration has led to the current situation in the Middle East with Russian intervention, the wave of refugees from Syria, and the increasing sectarian conflict. It cites from president Obama's address to the UN General Assembly that "the nations of the world cannot return to the old ways of conflict and coercion," yet failing to take action in the Middle East to prevent this from happening.

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Helene Cooper and Worth point to the vacillating response to the Arab Spring and movement for democracy and freedom in the Middle East of the Obama administration and President Obama. The dangerous overtones of this lack of U.S. leadership in the region as the U.S. completes a withdrawal from Iraq without an agreement for a residual presence, sees diplomacy reaching an impasse with Iran's development of nuclear weapons, and the Syrian civil war drawing in Turkey with its long border with Syria, and drawing in Saudi Arabia as a defendor of Sunnis in Syria. The stakes for Russia in Syria were minimal compared to that of people in the Middle East and the U.S., yet it had an outsized influence with its early military assistance to the Assad regime and the lack of U.S. leadership to resolve the situation in Syria in favor of the democracy movement.

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Reflecting the volatile nature of the global economy with systemic risks remaining, impact of sharp cuts in spending, and the danger of oil prices exceeding $150 with a mideast crisis, the IMF provided a wide range of possibilities around its basic forecast. The IMF says it expects the global economy to grow 3.5% in 2012, up 0.2% from a Jan. forecast, and a forecast of 4.1% for 2013. But the IMF says this depends on the eurozone crisis, which could take off 2% from global output and 3.5% from output in the eurozone if things went wrong in Europe. Higher oil prices above $165 with supply disruptions after Iranian sanctions are another danger. Its forecast for Europe is 0.3% contraction in 2012 and 0.9% growth in 2013. Because of the risks in the outlook the IMF cautions countries from cutting spending too quickly, and says the best approach is to reduce deficits gradually over the long term and not to move too fast in the short term. This word of caution applies to Spain, the UK, France and Germany. To maintain enough funding in a crisis the IMF plans to increase its lending capacity from $380 billion by an additional $280 billion, with pledges of $60 billion from Japan, $26 billion from the Nordic countries, and $200 from other eurozone countries. ...

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The strong showing by National Front leader Marie Le Pen and her focus on the economy in France, and the lack of growth with austerity measures, is likely to change the way the eurozone countries respond to the deficits and German insistence on austerity cuts. Marie Le Pen's economic positions for more government spending to reduce unemployment and provide additional benefits is closer to Socialist candidate Hollande's position. The right wing party in Holland also voiced the same concern recently- that it did not want to hurt Dutch pensioners with austerity cuts- when it refused to support the Dutch government leading to its collapse and new elections.

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Fomer Defense Secretary Leon Panetta says America needs to take up a vigorous foreign policy in his book "Worthy Fights." Both Panetta and Hillary Clinton, and Gen. Dempsey of the Joint Chiefs, Gen. Petraeus of the CIA, supported U.S. taking a strong stand in Syria by supporting Syrian opposition forces in the summer of 2011 and were overruled by president Obama and his election advisers because of the approaching 2012 election. Here Mark Landler provides more insights into Hillary Clinton's deeply held belief shared with Panetta that the U.S. had to take strong action where necessary to deter foes, to get into the ring to use Panetta's expression. The U.S. support for action in Libya to support Britain and France comes from the efforts of Clinton, and any lack of followup one of president Obama's errors in foreign policy. In April 2016 president Obama said that he considered his failure to followup in Libya to help the new Libyan government his biggest mistake in his presidency. Here Mark Landler looks at Hillary Clinton's entire career as showing a conviction and belief on the need for action where necessary in the U.S. global engagement. Compared to the bluster of the candidates Trump, Cruz and Sanders, with little experience to back this up in their careers in real estate, law or the Senate , Landler says Clinton is the last remaining hawk. Here he describes Hillary Clinton's contact and empathy for the troops from her trip to the American base in Tuzla, Bosnia, in March 1996. In fact many have forgotten that Yugoslavia is what it is today after the Milosevic years and the ethnic wars with Slovenia, Croatia, Montenegro, members of the EU and Serbia negotiating to enter EU, because of the bombing campaign taken by Bill Clinton through NATO in 1999 to prevent ethnic cleansing in Kosovo, and peacemaking following the Bosnian War using diplomat Holbrooke to negotiate the 1995 Dayton Accords. Here Landler describes the meetings with Gen. Keane who pushed for the troop surge that worked in Iraq under president George W. Bush. Clinton supported Keane's proposal made in April 2015, for a no-fly-zone in Syria that would help opposition forces till a settlement could be negotiated. Keane pointed out to Clinton that there was a flaw in Obama's policies- that negotiation would work only if the no-fly-zone was used to support opposition forces. By the end of 2015 Hillary Clinton publicly adopted this position. During a period when Americans are weary of foreign entanglements but understand the need to provide leadership where needed, Hillary Clinton, provides a balance between the pendulum swinging too sharply in one direction in the Bush years and in another direction in the Obama years, says Landler. A view also articulated by Leon Panetta, who was chief of staff for President Clinton during the Bosnian conflict and the Dayton Accords, where the U.S. showed strength of purpose in war and also in negotiating the peace without major entanglements....

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Kristof says social ills- the lack of stable marraiges, drug use, poor day care resources- compound the problems of lack of education beyond high school in America's white underclass. The lack of good manufacturing jobs and lower wages have hit people with only a high school education the hardest. Two decades of decline in good manufacturing jobs with globalization have hit this part of the population in the U.S. hard creating increasing inequality in America. He sounds a Moynihan type call to the plight of America's poorest white communities.

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Mark Landler's interview with Hussain Haqqani in Oct. 2013 provides insights into the misperceptions on both sides of the U.S.-Pakistan relationship since 1947. Particularly the way Pakistan cannot shake free from seeing everything through the prism of India. He points out that Ambassador Holbrooke had a forward looking approach to the South Asian region, but failed to get the support of president Obama and the weak leadership of president Zardari, resulting in a squandered opportunity for the region to look beyond the twentieth century's conflicts towards a brighter future.

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U.S. President Obama's 2013 State of the Union address focussed on the problems facing the U.S. middle class, calling it "our generation's task" to tackle this problem. Economic changes have changed the patterns of economic growth and jobs, growth, income growth, that prevailed from the end of the Second World War to about 1989. But he offered few solutions beyond increasing the minimum wage to $9.00 from $7.25 to reduce poverty.

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Krugman points out the gains on three fronts evident from the Census Bureau report of 5.2% gain in median income of households in the U.S. He says the first is the growth in incomes of ordinary working class and middle class families, second the large decline in the poverty rate, and third the further rise in insurance coverage in 2015 for people without health insurance. He points to the steady efforts of the Obama administration to improve lives of ordinary families as working based on the Census report though results have taken time, and could have been better. The Stimulus, says Krugman could have been larger following the blow of the 2009 financial crisis and increased unemployment at the time. Janet Yellen at the inequality conference of the Boston Fed in 2014 pointed out the problems of 62 million households having net worth of about $10,000, and why this was running against the American idea of a better life for all Americans. In that sense the Census report is a movement in the right direction but a lot remains to be done.   ...

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U.S. President Obama's speech at the General Assembly of the United Nations, Sept. 25, 2012, in which he praised the work of Ambassador Stevens in Libya. He defended First Amendment rights in the U.S. of free speech to an audience that was not fully convinced that the "anti-Muslim video" designed from the start as a provocation, produced as a violation of probation rulings by the individual, and being given the distribution channel of a vast internet audience by Google owned YouTube, falls neatly into free speech. The German government is reported to be looking into banning the video from distribution in Germany, and Germany also protects free speech under its constitution. He cited the "voices that rally against bigotry and blasphemy," as the way a First Amendment democracy protects against this type of abuse; which would suggest that Google as one of these voices has the responsibility to treat such content similiar to other extreme content of a pornographic nature or other such provocative material inducing violence, which it routinely excludes from distribution. The ultimate protection of First Amendment rights comes not from the U.S. constitution itself, but from the responsible exericize of wisdom, vigilance and common sense. During the long years of drafting of the Constitution when Madison, Jefferson and others who drafted the document took pains to include every protection so that basic rights would be preserved, George Washington pointed out that one could do this only upto a point, because it was upto the wisdom of future generations to preserve these rights, and this could never be done completely....

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This editorial in the Journal provides reflections on U.S. foreign policy in the Obama years and advice for U.S. presidential candidate Mitt Romney before the third presidential debate on foreign policy on Oct. 22, 2012. It says the U.S. has always done better from a position of economic strength and defense preparedness in addressing foreign policy issues. It also points to the failure of president Obama to support the freedom struggle of the peoples of the Middle East, and a withdrawal from Iraq without securing an agreement that failed to consolidate the gains of the long conflict and resources spent in that region.