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The CEO of the New York Times and the former director general of the BBC, takes a look at the public discourse in the 2016 U.S. presidential election and in the Brexit campaign, and finds some troubling changes. The use of words that can eaily be picked up by Twitter and social media to attack opponents, the complete disregard for facts, and outright attempts to denigrate and destroy using rhetorical tactics, and a section of the public that has turned away from the facts or is disinterested in facts, is deeply troubling for Mark Thompson. When the public discourse fails, then the politics as a whole starts to collapse, says Thompson. We are children of the enlightenment, says Thompson, and were taught to look underneath statements to discern the truth. This is a crisis in public discourse. Worse it is one in which truth telling by people who say they are outsiders and tell it like it is, is not about telling the truth. Which is what makes it so dangerous. Thompson cites the statement by Michael Gove that "people in this country have had enough of experts," as another dangerous sign. He says it is time that experts make themselves understandable and talk in a way the public can understand. The media needs to explain issues in clear ways, and professional policymakers language of discourse needs to be conveyed in better ways that the public can grasp, in which the Brexit Remain campaign failed, says Thompson. Its important to acknowledge the problem, as the health of our democracies depends on finding solutions to what has happened in 2015-2016 to change the public discourse and let it deteriorate to unimaginable levels.  ...

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Peter Orszag's role in the healthcare debate and the formulation of health care policy proposals. One proposal of Orszag, who heads the Congressional Budget Office, is to set up a new agency with powers to cut spending and implement changes in Medicare. Says Orszag, "one of the reasons we have such disjointed and skewed incentives is that we have an excessively political process." At a recent meeting with House Democrats, one Congresswoman said her top priority is winning higher payments for oxygen suppliers, and Orszag was taken aback. For years officials have been trying to cut payments to oxygen and medical equipment suppliers, which are said to be inflated. When a new competitive bidding process was set to take effect last year, industry supporters in Congress were able to delay the plan, and these supporters are still fighting to block changes says the WSJ. Here is a 40 year old Orszag, with degrees from Princeton and London School of Economics, who got his early experience in the Clinton adminstration at age 24. He then followed this with a number of policy oriented jobs, ending with appointment to head CBO in 2007. And he faces the whole system of Congressmen from both parties beholden to interests in the healthcare industry, who provide the donations for them to finance their election campaigns. Dan Eggen describes this in the Washington Post, 7/21/2009. Max Baucus of Montana, and to some extent Grassley of Iowa, are senators from both parties who Eggen points out are beholden to the healthcare industry because of large donations they receive from the interests in the healthcare industry. These interests want to see their payments system protected. The further escalation in health care costs, which would make the whole healthcare system unaffordable even as it delivers poor results, can only be prevented by making cost control an exercize that is not influenced by healthcare industry donations. Jackie Calmes describes the huge hurdles in achieving a deficit neutral move to universal health care in the U.S. in the NYT 6/26/2009. See the link. The exchange between Grassley and Orszag on the issue of the $177 billion in savings needed from the payments to health insurers under the Medicare managed care plans- which allow seniors to obtain Medicare coverage outside the government run program -went as follows. These are dubbed overpayments by outside experts and efforts have been made to cut them in Congress. When Mr Grassley raised concerns about the impact of such cuts in a hearing, -and Grassley has opposed the cut for this overpayment to insurers- Orszag responded saying: "I very firmly believe that capitalism is not founded on excessively high subsidies to private firms. This is what this system delivers right now." ...

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Analysts see the likelihood of Greece exiting the eurozone at over 50%. The actions of the ECB under Mario Draghi to provide funding to weak banks through the Long Term Financing Operation have reduced the effect the effects of contagion from a Greek default spreading to banks in other EU countries. The fiscal pact signed in Jan 2012 at the EU summit with automatic penalties for countries lacking budget discipline provides Angela Merkel more room with her domestic political base to support the EFSF's capacity to help other eurozone countries. Greece with its deteriorating economic situation would then be considered a special case.

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The new Dutch Health system that went into effect on Jan1, 2006, and is based on Stanford university prof Eindhoven's idea of "managed competition." What the Dutch experience holds for the USA as states like massachusetts look at mandatory universal health coverage on a private basis and for the US as a whole as the present system appears to be coming to a close.

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The Obama administration is pushing for new U.S. fuel efficiency standards of 56.2 mpg by 2025. In May 2009 President Obama announced domestic car and light truck fuel efficiency standards of 35 mpg by 2016. Europe is expected to reach fuel efficiency of 60 mpg by 2020. This would still leave Europe considerably ahead of the U.S. in fuel efficiency for automobiles, but the gap would be much smaller. For the last several decades the U.S. has fallen sadly behind Europe and Japan in fuel efficiency. The perception of poor fuel efficiency hurt the automakers badly during periods of high fuel prices and when buyers were facing difficult economic choices. The automakers are beginning to grasp this fact. Mark Reuss, president of General Motors, commented that- "it's very challenging, but its upto us engineers to provide high value to the customer and support the environment." This is an issue that has serious national and global implications as it affects the future prices and demand for oil, emissions, and future economic growth. It would also bring the U.S. in line with Europe and Japan when it comes to fuel efficiency of automobiles. ...

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Inozemtsev of the Institute of Post-Industrial Studies in Moscow, asks the question wht if the Russian economy shows no growth in 2017, and 2015-2016 become the beginning of a serious downturn. If oil prices remain low for an extended period as now looks likely with factors such as shale oil technologies, Iranian oil, and Saudi policy, playing an increasingly long term role, Russia could face some of the problems former finance minister, Alexei Kudrin, other business leaders including head of Sberbank, warned about. A major problem that Inozemtsev points to is the change in the business climate for foreign investment in 2012-2016 as the Russian economy looks more inward, and the departure of many foreign companies. During the period 2000-2008, a major boost to the economy came from foreign investment which brought with it management and technological improvements. No emerging market country, including China, can have a bright future without access to new technologies and investments from foreign investment. The current period starting in 2009 stands in sharp contrast to the earlier period with the Russian economy lacking the boost from foreign investment, facing capital outflows, and international conflicts creating a long term effect on oil prices. Russia needed time to move its economy away from commodity dependence through technological improvements and investment, yet this does not appear to be happening, raising serious questions....

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Estimates show the 50 million Americans enrolled in Medicare today will increase to 80 million by 2030, according to the program's actuaries. Simple demographics as the baby boom generation ages is making controlling the deficit without controlling increase in health care costs as both sides in the fiscal cliff negotiations are attempting to do can only lead to defunding critical areas such as education, R&D and infrastructure, and breaching the safety net for lower income Americans. Health care spending took up 7% of GDP in 1960, increasing to 17.9% of GDP in 2010. Federal spending on healthcare has grown to about 25% in 2012 from 10% in 1960, and is projected to increase to about 33% in ten years by the Congressional Budget Office.

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EpiPen's price has jumped 550% over 8 years. Mylan Pharmaceuticals is dominant in the $1 billion market for treating serious allergic reactions. Mylan acquired reights to sell EPiPen in late 2007. A pack of two list price is now $608.61. Last Nov. Sanofi's competing product Auvi-Q was recalled giving Mylan price dominance. A problem for consumers is that EpiPen expires in one year. Mylan launched a campaign to make parents aware of the product for children with peanut and other allergies, and also lobbied the governments to make ready supply of EpiPens available in schools and other public places. Now the controversy over price increases, with Hillary Clinton citing this as an example of exorbitant pharmaceutical pricing, is likely to change the environment around EpiPen and other overpriced drugs or healthcare products.

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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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The shift of voters from the Democratic Party to the Republican Party in the South such as Georgia and South Carolina, and the Deep South such as Mississippi and Alabama, started in the sixties with the civil rights movement. Reagan tapped into it by making his first post convention trip to Alabama, where George Wallace had already worked up white southern voters on segregation in the way Trump is doing today on immigration. Strom Thurmond was one of the high profile southerners shifting from Dixiecrat Democrat to Republican in South Carolina. After Thurmond in the fifties the Republican formula was to mix cultural issues with economic conservatism, with Nixon, then Reagan, and then Bush. Reagan added religious conservatives to the cause. Now says Emory University Prof. Joseph Crespino, this is changing as the more educated college educated white collar professionals that Goldwater once appealed to shifting in 2016 to the Democratic Party in places like Georgia and South Carolina. This is a result of the rhetoric of Trump resembling that of George Wallace and Thurmond in the Deep South. With demographic changes there is also new infusion of people from the North to the South in major urban areas. The result in 2016 is that the South no longer appears the way it once was. ...

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Thomas Frank describes how things went wrong in America by drawing the contrast between Martha's Vineyard and Decatur, Illinois. In 1946 he says a typical executive's salary was only 2 times that of a worker at a Caterpillar plant in Decatur, Illinois. By 2016 this had changed to where the top executive at Caterpillar was making over 400 times the wage of a typical worker at a Caterpillar plant. Democratic politicians he said had moved away from their working class base towards places like Martha's Vineyard. For Republicans the embrace of tax cutting, the deficit, and cuts in education and healthcare, entitlements, to the exclusion of everything else in a recession environment led to the rise of Trump and the rejection of stands on these issues- including amazingly the embrace of a $5.3 trillion increase in the deficit under the Trump plan estimated by economists and a recession after a temporary boost.  Inserted into this were the culture wars, immigration, with the change to mass deportation as a solution to immigration problems. ...

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John Bolton looks at the continual dithering behaviour of the U.S. president in the Middle East- Iran, Libya, Syria, Iraq in sequence- and provides some insights into the president's behaviour. He says it comes from Obama's distrust of the U.S. role in the world as a positive factor, and a deterministic view of the "arc of history" bending towards outcomes he finds ideologically acceptable. This coincides with a different public perception of America's role in the world, not so much of mistrust and skepticism, as of indifference and focus back on domestic issues following the event of the first war in Iraq and of the 2008-2009 financial crisis. The two are different in nature as the public including women may not share the ideological frame of mind of the president that the U.S. is not overall a serious positive factor in the world through the presidencies of TR, Wilson, FDR, Truman, Ike, to Kennedy, Reagan and Clinton, from the Russo-Japanese war, through the First and Second World War, the Berlin Airlift and the Korean War, to the Balkan conflict. Bolton writes at a time when the two perceptions are about to diverge as the U.S. returns to its normal role of positive and constructive engagement with the world....

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The majority report of the Financial Crisis Inquiry Commisssion says Alan Greenspan and Ben Bernanke, regulators, and several financial institutions were responsible for what was an "avoidable disaster." The report criticizes Mr Greenspan for advocating deregulation and considers the failure to stem the flow of toxic mortgages under his leadership at the central bank as a "prime example" of negligence. The report also says that the New York Fed under Timothy Geithner, now Treasury Secretary, also missed signs of trouble at Citigroup and Lehman. There are 6 Democrats and 4 Republicans on the Commission. The fourth Republican has his dissent, calling policies to promote home ownership, the role of Fannie Mae and Freddie Mac a major cause. The panel was hobbled by internal divisions and staff turnover, which have made what should have been a report of major significance into one marred by partisan differences. The majority report itself was heavily shaped by Phil Angelides, the committee's chairman, and it has many literary phrases. Overleveraging was a critical factor in the crisis. For every $40 in assets, the US's 5 largest investment banks had only $1 in capital to cover losses. The banks hid their leveraging with derivatives, off-balance sheet entities and other devices. The banks relied heavily on short-term debt which worsened the crisis. The report also said the Clinton adminstration's decision to exempt over-the counter derivatives from regulation- made in the last year of Clinton's term- also helped set up the ground for later events leading to the crisis....

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Nawaf Obaid, a fellow of the Belfer Center for Science and International Affairs at Harvard University's Kennedy School of Government, is also senior fellow at the King Faisal Center for Research and Islamic Studies. Here he describes the events leading to the Saudi turndown of a seat on the UN Security Council. The Saudi foreign policy establishment made this decision after several weeks of debate in Jeddah considering the U.S. and Russia's effort to make only a muted criticism of the use of chemical weapons in Syria in the Security Council; and the U.S. effort to have the British, French and Saudis give up on demands for firm language in a Security Council resolution on action to be taken against the use of chemical weapons. For the Saudis, says Obaid, better not taking a temporary seat on the UN Security Council, than to be left a docile member without its own voice and the voice of others in the international community being heard. Obaid also points out that this is the beginning of Saudi effort to exercize its own influence in the Middle East, as it faces three separate developments in 2013- the Iranian rapprochement with the West under new president Rouhani, the Arab Awakening and the new consciousness in the Middle East, the U.S. policy under president Obama of not taking leadership in the Middle East. This also comes as the Saudis parted ways with the Obama administration on the role of the military in Egypt, and has differences with Turkey and Quatar on support for Islamic groups in Egypt and Syria....