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The health care system is designed to encourage procedure based specialist practices and discourages the patient understanding education and monitoring that occurs with a well designed preventive family physician practice. As a result a patient only spends 30 minutes ayear on average with family physician compared to one hour in other developed nations. In the USA there has been a steady decline in the level and quality and extent of family care and the close one on one rapport with well trained family physicians who enjoyed their work and understood their patients and kept up with their health conditions and provided good and regular advice on these conditions. There is no money in this care as a result first you provide an environment where a whole range of medical conditions can flourish and expand, and then you hit them with a whole series of tests to rule out specific medical conditions. It is a perfect way to expand the testing and let testing flourish, so it would appear that if someone had wanted to start with a goal of letting testing proliferate unhindered then this would be the perfect way to design it. ...

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A recent book "The Spirit Level" has become popular in Britain. It says that countries with greater disparities in income also do worse in a number of social indicators, from higher murder rates to lower life expectancy. It also affects the consensus in society which is a necessary underpinning for sustained economic development and economic growth. Inequality when it affects the middle class and reduces the size of incomes in the middle, or creates stagnation in incomes, poses large risks for society and affects economic growth. In the US the home foreclosure crisis and the lack of bargaining power of wage earners in the middle class has created this problem. This is exacerbated by the banking crisis and bad loans in the banking system. Studies show that slow growth in college graduating rates in the USA after 1970 compared to the period 1900-1970, has increased inequality, especially with today's knowledge economy. Germany is also affected by this problem as wages for workers have remained stagnant with the labor reforms. Interestingly a combination of economic growth and payments to the poor have increased the size of the middle class and its incomes in Brazil. The austerity policies in Britain will affect incomes and income growth in Britain for the middle class. In China the gap is widening quickly between the urban areas and the rural areas. And the policy of residency permits- the hukou system-which limits internal mobility from rural areas to the cities and towns, makes the inequality all the more glaring. The lack of democratic election makes the situation worse in China compared to Brazil, because free elections in Brazil enabled leaders from the working classes such as Luiz Inacio Da Silva and Ms. Rousseff to emerge as heads of government. These leaders pursued policies that would explicitly bring a more shared prosperity in Brazil compared to the leadership in China. In China policies are determined by entrenched interests in its model of development- the state-owned companies and banks and their managers, local and government officials of the Communist party, and businesses with the networks and connections with the Communist party and local governments. This is why the ginni coefficient which measures inequality has dropped significantly in China, putting it in the rank of developing countries with poor records in equality. Inflation in China, India and Africa also affects the poor and lower middle classes to a greater extent. Current trends suggest that rebuilding the middle class in the developed countries and providing fairer distribution in developing countries will be of serious importance in coming years. Especially with the likelihood of more economic crises which tend to adversely affect the middle and lower classes disproportionately....

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Michael Getler describes the missed opportunity under President Obama for using one of America's most talented diplomats to engineer a peace agreement between the warring factions in Afghanistan- the U.S., the Pakistan army, the ISI and its support in the army, the Taliban, and the other parties such as the Haqqani faction and the Afghan government of Karzai. Holbrooke had used his experience for another President, with the same force of his larger than life personality, when he helped bring about the Dayton Accords in a similiar area of stubborn ethnic strife. Could Obama have tapped Holbrooke's skills and set aside the distractions of his personality as coming from an American with unique gifts, talent and achievement, is the question Getler asks. And is this a comment on the nature of the Obama Presidency and America's poorly invested hopes.

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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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Mark Sanford, Republican Governor of South Carolina, cites Donald Trump in May 2014 on releasing tax returns. At the time Trump is quoted as saying: "If I run for office, I will release my tax returns, absolutely, I would love that." Sanford says he released his tax returns, and Mike Spence, the Republican vice presidential candidate has released his tax returns, and calls on Trump to release his returns as promised. Hillary Clinton has released her tax returns, which show she paid 34% of income in taxes. Sanford says it is important information both for transparency in the political process and in giving voters an opportunity to evaluate those who want to govern the country. He also says that this is the reason a banker asks for tax returns before making a loan, that talking is'nt enough tax returns tell the real story,  and the reason why this is a precedent too important to be broken in 2016. This has become increasingly important in this election year with the public expecting corporations and wealthy individuals to pay their fair share of taxes, so that programs to aid workers left behind during the recession, provide job retraining, finance the infrastructure that will create new jobs, provide access to college for working class and poor, require adequate government revenues. ...

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Richard Portes of the London Business School provides two good reasons why the EU's decision to adopt the French Banking Federation's proposal for rollovers with 10% interest costs is a serious mistake. It doubles the interest costs from 4-6% to 10% with 2% Greek GDP growth and makes debt servicing untenable. Portes says the real Brady Plan from the 1980's included a 35-40% bondholders haircut. Deals of this type have a precedent- in Mexico in 1988 and in Argentina in 2001 such bond exchanges were soon followed by deals that placed bondholder haricuts on creditors. The lesson from Latin America in the 1980's, says Portes, is that the burdens of servicing a debt of such proportions under onerous conditions only extinguishes the enterprise, investment and productive capabilities of the particular country trying to service that debt, making the debt even less serviceable. See the Wall Street Journal's editorial on this deal which it calls "The French Deception." The terms sound like Greek to the editors leaving a sense that French banks are only saying "gimme." The only benefit achieved may be putting off the problem and avoiding contagion to Portugal and Spain. Yet this is not that much of a benefit when one realizes that the problem has not gone away, and is likely to look much worse six or nine months from now....

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The WSJ's Alessandra Galloni speaks with Mario Monti, the Italian premier, for in-depth interviews. Here Galloni and Walker provide an account of what happened during and after the June 28, 2012 summit of European leaders. Monti described the comments of ECB president Draghi in early August- about ECB buying of bonds of Italy and Spain being within the mandate of the ECB if monetary transmission channels were not working properly to reduce yields- as a bold effort following the agreement made at the June 28 summit to support Italy and Spain. Monti expressed the idea that Draghi should feel morally and politically justified if and when he makes the bold moves to rescue the euro. The only problem he says is whether one has to wait till the night before the euro is about to disintegrate for this to happen. This is the first time Monti has publicly expressed the possibility of this happening.

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Individual investors reacted strongly to declining prospects for emerging markets with slowing growth, depreciating currencies, corruption and political uncertainty in 2013. As of the beginning of June, retail investors pulled $18.1 billion from emerging market bond funds, about one third of the amount that went in to emerging markets since the financial crisis in 2007, according to fund tracker EPFR Global. Institutional investors have pulled out less, about $9.3 billion, or 10% of their investments in emerging markets bonds since 2007. A similiar pattern is seen for investment in the stock markets of emerging market countries. The U.S. Federal Reserve's monetary expansion helped pull more money into emerging markets such as India, Indonesia, Brazil and Turkey. As the Fed shifts away from these policies in 2013 emerging market countries have large current account deficits and less money to finance imports and debt.

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There are similarities in the Republican and Democratic party platforms in 2016. One area of agreement is in the reinstatement of Glass Steagall Act. That legislation made in the Depression period to separate commercial banking from investment banking was changed  when president Clinton made changes in a deal with Senators Phil Gramm and Jim Leach in 1999. The too big to fail problems of banks and the problems of investment banks during the 2008 financial crisis are attributed to the lack of Glass Steagall protections for financial stability and safety. The result is that in the post 2016 environment banks can expect a tougher regulatory environment. Another are is in trade where both parties are expected to take tougher positions to protect U.S. interests. The Republican platform calls for "better negotiated trade agreemets that put America first."

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Daniel Yergin of consultancy firm IHS describes the geopolitical disputes in the Middle East between Russia, Saudi Arabia, and Iran that are leading to likely continued oversupply of oil in 2016, keeping prices in the $30-$40 range. Saudi Arabia is not likely to change its policy of going after market share, Venezuela is affected but lacks a voice in OPEC decisions, Russia continues its policies in Syria and Iraq under the Putin government affecting other Sunni states, and Iran following the lifting of sanctions is likely to ramp up supply to make up for its lost market share- all leading to an extended period of low prices. This situation benefits China, the European Union countries, India, Turkey and the U.S. in a period of slow economic growth in 2015-2016. Russia looks to use this period of low oil prices to shift to domestic industry after a period of rising imports when oil prices were high. The Saudis seeing their interests in the region threatened by Iran and Russia, and dissatisfied with the foreign policy of president Obama, see a policy of pushing for market share as appropriate in the current geopolitics of the region....

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The WSJ's Kimberley Strassel says a Republican winning the White House in 2016 depends on how well the party appeals to white working class voters and the struggling middle class living from paycheck to paycheck. She says Speaker Paul Ryan is taking the right step in coming up with the idea of the Kemp Forum on Expanding Opportunity event in January 2016. Presidential candidates attending the forum are Jeb Bush, Marco Rubio, Chris Christie, John Kasich. Not attending are Ted Cruz and Donald Trump who are getting support from voters who are discouraged by establishment policies. Strassel says upward mobility for the midddle and working class is emerging as the No. 1 issue in the election, especially with Hillary Clinton leading the Democrats.

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By May 2015 the Russsian ruble had recovered to 50 to the dollar from the low of 80 to the dollar in 2014. In August 2015 the ruble declined to 70 to the dollar as oil prices dropped below $40 per barrel. GDP growth showed a decline of 4.6% for the economy in the 2nd quarter of 2015. The ruble has lost close to 50% of its value in 2015 compared to the prior year.