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Susan Jaccoby brings up a major issue facing healthcare in America from personal experience. A third of the Medicare budget, she says, goes to the last year of life, and a third of this goes to the care in the last month. At the same time public opinion polls show Americans see the problem being too much medical intervention rather than too little. Especially when there is no hope except to prolong life for the patient with an highly deteriorated qulaity of life for a few months or a year, doing no service to the patient or future generations who may see their basic services cut when they most need it as a result of the unaffordable spiralling cost of Medicare. A Pew Research Center poll in 2006, shows 22 percent say a doctor should not always make efforts to save a sick person's life, and 70 percent believe that patients should be allowed to die in some situations, when it only prolongs life for a few months for instance and patients live in pain. The problem only gets worse in future years as an estimated 8.5 million Americans are expected to be over 85 years in 2030 with these same choices facing patients, their families, Medicare and the country....

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This leader in The Economist reviews an essay in the magazine's October 8-14th, 2016 edition by U.S. president Obama. In it Obama points to the unfinished tasks of his presidency and what comes next as tasks to be done for the U.S. economy. The Economist points out the problems in the 2016 election campaign where there is a lack of discussion of economic issues as a serious problem. Obama lists as priorities efforts to improve conditions of people left out in the recovery, reducing inequality, offering more job opportunities, and increasing productivity.

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The rapidly changing demographics as the U.S. becomes more of a multicultural society. For the first time minority babies formed a majority in 2011 with 50.4% of new babies, according to the Census Bureau. The median age of the non-Hispanic White population is 42 compared to 28 for Hispanics. Hispanics are right at the child bearing age. This also raises the issue of how the U.S. will educate the minority population. Today 13% of Hispanics have college degrees, 18% of Blacks and 31% of Whites. High school graduation rates in places like New York City for Hispanics are lagging far behind other groups. The economic downturn after the 2008 financial crisis has worsened the educational prospects for Hispanics and other minorities. The education of minority children is essential to improve the competitiveness of the U.S. in a global economy, as the educational levels in emerging markets accelerates with more opportunities.

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John Hills, a law professor at Indiana University and author of "The Political Centrist," says tough political exchanges are endemic to the American political system. Others say putting crosshairs on representatives in Congress like Giffords on websites or its equivalent wasn't the practice since the times of Jefferson and Adams. We looked at the letters of George Washington during the long struggle with the British and it showed composure and civility even in dire circumstances and difficulties. Criticism by Washington of the lack of help and risks he was exposed to throughout the war was worded carefully, with civility and yet conveys the great urgency. What about the letters of Jefferson and Adams who were on opposite sides of the debates of that time, a time more infused with momentous issues because of the French revolutionary tide in those years? A letter to Abigail Adams, from Washington, June 13, 1804, gives a glimpse of that relationship: "The friendship with which you honored me has ever been valued, and fully reciprocated, and altho' events have been passing which may be trying to some minds, I never believed yours to be of that kind, nor felt that my own was. Neither my estimate of your character, nor the esteem founded on that, have ever been lessened for a single moment, although doubts whether it would be acceptable may have forbidden manifestations of it. Mr Adams friendship and mine began at an earlier date. It accompanied us thro' long and important scenes. The different conclusions that we had drawn from our political reading and reflections were not permitted to lessen mutual esteem, each party being conscious they were the result of an honest conviction in the other. Like differences of opinion existing among our fellow citizens attached them to the one or the other of us, and produced a rivalship in their minds which did not exist in ours." Jefferson in this letter says that one act of Adam's gave him a moment of personal displeasure, the last appointments by Adams as President "from among my most ardent political enemies." This says Jefferson "laid me under the embarrassment of acting thro' men whose views were to defeat mine, or to encounter the odium of putting others in their places...If my respect for him did not permit me to ascribe the whole blame on the influence of others, it left something for friendship to forgive, and after brooding over it for some little time, and not alwasys resisting the expression of it, I forgave it cordially, and returned to the same state of esteem and respect for him which had long subsisted...I maintain for him and shall carry into private life an unform and high measure of respect and goodwill, and for yourself a sincere attachment."...

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Questions about the true cost of the Obama health care legislation and the assumption that the legislation cuts the deficit by billions of dollars. This WSJ editorial says one has to look at this closely, and not merely look at CBO projections, which may be based in a certain context and not reflect the true costs, especially because many accounting gimmicks and use of numbers to present a particular picture is taking place. The information this editorial cites is that: it uses 10 years of taxes to fund six years of subsidies, Social Security and Medicare revenues are double-counted to the tune of $398 billion, a new program funding long-tem care frontloads taxes but backloads spending, and the assumption of an automatic 25% cut to physician payments that Congress is unwilling to authorize. Rep. Rand Paul has tried to present an alternative view which needs to be studied just as closely, because of the enormous impact of a jump in spending at a time when the public finances are fragile. WSJ also cites the work of Richard Foster, the chief Medicare actuary, as an alternate perspective of how things could turn out, Doug Holtz-Eakin, and Eugene Steuerle. It calls for common sense in evaluating programs, entitlements, defense or other government spending. They not only cost money, but costs escalate over time as history has shown over decades, till they eventually are discovered to be not affordable unless the middle class is willing to dig deeper into its finances to pay for them. Alternate perspectives from a range of informed opinion, Howard Dean, Martin Feldstein, and the head of Harvard's Medical School show that the issue needs to be looked at closely and carefully and cannot be something in which CBO numbers can be trusted to tell the whole story. Especially when common sense, history, and informed opinion across a spectrum of thought advises caution, and fragile public finances also suggest caution. Howard Dean, former Governor of Vermont, says the health care bill is not real reform, and may do more harm than good. He says in a Washington Post article, December 17, 2009, the Obama health care bill does not insert competition into insurance markets, does not significantly reduce costs, and does not improve the delivery and use of health services. It was he says done with a political calculus and crafted for votes not real reform. Jeffrey S. Flier, Dean of the Harvard Medical School, gave the Obama health reform bill an "F" grade, saying in a Nov 18, 2009, WSJ article, that it was disingenuous to call this reform, Congress and the White House were simply deceiving the public. He said the bill will accelerate US health care spending, postpone most of the major health care problems, expecially the ones that drive cost, including the "fee for service" system and delivery of health care. He says in his discussions with economists and other health care leaders the opinion was unanimous that the bill will accelerate health care spending. He cites Massachusetts as an example, where access to care was expanded under the same dysfunctional system, and spending went up, and it doesn't work. Feldstein, who in early 2008 suggested proactive solutions to the mortgage debt crisis which were never adopted, says that the Obama health care law means higher taxes in the long run to pay for the $1 trillion cost of health care for the uninsured group over 10 years. Feldstein says that the Obama plan is to cut Medicare to cut spending, and will reduce the amount of medical services, as reduced spending comes from fewer services, not reducing payments to providers. And he asks if the cost reductions are weighted too heavily towards reduced services and not reduced payments to providers ,would this result in large cuts to services to affect the quality of healthcare for the 85% of the American people who are accustomed to a different pattern of healthcare. ...

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E.J. Dionne, of Gerogetown University and the Brookings Institution, says the current situation in U.S. politics resembles the 1912 presidential election when a Princeton professor Democrat Woodrow Wilson called for stronger curbs on big financial institutions, and Republican Teddy Roosevelt, a former president, called for tighter regulation. During his presidency Roosevelt had helped pass legislation to curb monopolies, and represented the Progressive wing of the Republican party. Taft who was president was Teddy Roosevelt's protege and vice president before becoming president, and alienated Roosevelt by moving away from progressive actions taken during Roosevelt's administration. Dionne says Hillary Clinton's views are similiar to Teddy Roosevelt's views, and Bernie Sanders' views to Wilson's views. Wilson won 435 electoral votes to Roosevelt's 88, and Tafts 8. The big difference now is that on the Republican side the progressive wing that Teddy Roosevelt established is non existent, with Cruz's positions similiar to Reagan's, Kasich and Cruz at best close to Jack Kemp's views on broadening the Republican base with concern for working class issues, and Trump's views not clear because of lack of clear policy or programs beyond the personality based campaign. Dionne points to the problems facing the "progressives" of Sander's young supporters staying away from the polling booths with Hillary Clinton as the nominee, putting a Republican nominee into the White House. Overlooked here is the idea that much of the election campaign even in an advanced country like the U.S. is fought on slogans, leaving out some critical facts. The problems progressives face emerged during a period when a Democrat was president, and the influence of lobbyists had not diminished. Outsiders on the Republican side are focussed on diminishing the power of lobbyists, the political calculus of elections, and other interests that have affected policy in the last 8 years hurting the middle class and working class. ...

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Krauthammer tells U.S. presidential candidates stop saying that Social Security is a Ponzi scheme, because by its very definition it is a Ponzi scheme. Instead exercize common sense and take the simple steps to update Social Security for today's longer life expectancy, aging population and way fewer workers to support a retired person. In a Ponzi scheme payments by people joining currently are paid to those who joined earlier, with not enough to pay future entrants- which is what is happening to Social Security. In 1940, after Roosevelt signed Social Security into law, there were 160 workers for each retired person. That dropped to 16.5 in 1950, today there are 3 workers. In 1940 the life expectancy was 62, today it is closer to 80. Krauthammer says the writing is on the wall- simply have the courage to make the changes by raising the retirement age, means testing the rich for benefits, and adjust the cost of living measure.

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Krugman says voters in France, Greece, the UK and other countries are protesting against austerity measures imposed in the EU countries. The policies were based on the assumption made by the Chrisitian Democrats in Germany that the German model if applied in other countries would generate the kind of recovery Germany made in the last decade from the high unemployment under chancellor Gerhard Schroeder. German wage restraint agreement between unions, industry and government made this possible under the Hartz reforms, and France is already embarking on wage restraint, with the two major parties, unions and industry backing the plan. But for this to work France and other countries such as Spain and Italy have to be able to export to Germany or other countries. German workers are suffering from stagnant wages for many years, stemming from concessions made to reduce unemployment. Allowing wages to rise in Germany when there is a shortage of workers in industry, would benefit workers in Germany and help France and other EU countries increase exports. German industry is failing to make this normal adjustment in markets by insisting on smaller concessions, even though there is support within the government for higher wages. German growth was possible because of demand outside for its exporters. The "austerity measures" Germany supports would depress demand inside the domestic economies of France, Spain, Italy and other EU countries, and without the wage and inflation adjustments with Germany leave demand weak outside. Without needed demand output falls, unemployment rises and tax revenues decline, leaving deficits worse than before, and a dangerous downward spiral. Better management of finances as Germany has insisted has ceased to become the issue, as both Hollande in France and Rajoy in Spain, and Monti in Italy, are keen on getting control of finances, especially regional spending in Spain....

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Brooks points out that the best way to arrive at workable solutions is to take the best ideas from all sides of the political spectrum. The Republicans and the Democrats are too ideologically and politically driven and lack the imagination to come up with good solutions.

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Congressional Budget Office figures show the share of government benefits going to the bottom fifth of American households in income declined from 54% in 1979 to 36% in 2007.

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This Washington Post editorial says vice president Biden's comments that "I guarantee you, flat guarantee you, there will be no changes to Social Security. I flat guarantee you," made to a voter in Southern Virginia, is downright disheartening. It points out that this is not the conclusion of the trustees of the Social Security Fund, which includes the secretaries of Treasury, labor and health and human services of the Obama administration. The April annual report of the trustees says that the disability portion of the trust fund "becomes exhausted in 2016," and the overall fund "becomes exhausted and unable to pay scheduled benefits in full on a timely basis in 2033." Actions suggested by the trustees include: raising the payroll tax, tweaking the inflation calculator, reducing benefits, or some combination of this. It is clear from polls that the U.S. voter does not want either party to touch Social Security, but the reality is something different. The idea of a flat guarantee in the light of facts that all can see is seen by the Post as going too far, trying to win votes at the cost of postponing necessary decisions which will become harder and costlier if not addressed early....

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Lawrence Katz, Harvard labor economist, talks to Friedman about the jobs crisis in the U.S.. Katz identifies three jobs crises occurring at the same time today. One is the drop in the demand for goods and services that resulted from the longer term effects of the financial crisis of 2008, with rising foreclosures, weak housing markets, bad debt on the balance sheets of banks, and interest rates at close to zero reducing the scope of action by the Federal Reserve bank. The second, is the widespread long term unemployment with workers dropping out of the labor market. The third, is the nature of new factories and hiring. Work in new factories is done through increased automation, information technology and fewer workers. As a result job creation is a fraction of what it was in the past. Not mentioned here is the shrinking of the public sector under the strain of budget deficits for local, state and federal government. This leads to the question of how America will create jobs in the future. Katz believes the answer is creating more "hubs," networked urban areas like Austin, Silicon Valley, and Raleigh-Durham, by bringing together universities, high-tech manufacturers, software providers, and startup companies, to cooperate in creating new products that enhance people's lives worldwide. This has to be done by the private sector and government working together to build the infrastructure and make the investments in education, training of workers, and equipment for new job creation....

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Christina Romer, Prof. of Economics at the University of California, Berkeley, was chairwoman of the Council of Economic Advisors under U.S. president Obama. Here she discusses the different aspects of the debate on raising the minimum wage. Romer says the negative effects on unemployment are small. The impact on consumer spending is also limited. The anti-poverty effects are real for raising the minimum wage from the current $7.25 an hour, says Romer, as over half the families earning a minimum wage make less than $40,000 an hour. President Obama called for raising the minimum wage to $9 an hour in 2013. Studies show 13 million U.S. workers earning less than $9 an hour. Raising the incomes of these families by about $3500 an year under the president's proposal gives workers badly needed income to cope with rising cost of gas, food and other basic necessities. The effects on consumer spending are small, estimated at between $10 to $20 billion. Its main virtue is keeping the principle of fairness and maintaining social cohesion at a time of increaing inequality. Romer says there is competition for workers which makes it possible for workers at the lower end to get a fair wage, but does not account for the effect of high unemployment which takes pressure off raising the minimum wage in the market economy. Another benefit for countries of keeping a fair minimum wage is that other actions can be taken to improve competitiveness for business and manufacturing and reducing the deficit and be seen in a positive context of overall improvement. This is part of the case made in Europe for boosting the mnimum wage as austerity measures are taking place....

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Samuelson warns that turning seniors into a protected class making no sacrifices whatsoever, will mean shrinking all other social programs, defense and investments in education and infrastructure. This is the reality of the budget deficits facing the U.S. He cites the Congressional Budget Office projections that even with cutting defense and non defense discretionary spending by a third, the U.S. risks a deficit in 2023 of about 6.75% of the economy or gross domestic product (GDP). To cover this would require $1 trillion in higher taxes, an increase of a third above the 1970-2011 average. He says Democrats are using demagoguery and intimidation on this issue, and ironically even Paul Ryan's proposal reflects a desire not to touch seniors benefits and willingness to pass on the costs to the young to pay for these programs. Social Security and Medicare are a critical part of the American fabric, and no one wants to dismantle them, it is about modernizing them to reflect higher life expectancy and larger wealth accumulated by the elderly compared to previous generations, and to reduce the burden on the young. ...

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Charlie Rose talks to Paul Ryan, the Republican Congressman from Wisconsin on his "Roadmap for the Future" and a major overhaul of taxes, spending, Medicare and Social Security. He tells Rose, who hosts a news show on Bloomberg TV, that in 2010 he is all by himself looking at the big picture for shaping ideas on economic reform, and still hopes others will join him in this effort.

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Obama's comments during a visit to Greece about the challenges facing multiracial and multicultural societies such as the U.S. and the people left behind through globalization. He says "we are going to have to guard against a rise in a crude sort of nationalism or ethnic identity or tribalism that is built around an "us" and a "them."  Obama also referred to a global elite "that seems to live by a different set of rules, such as being able to avoid taxes," which he said "fuels a feeling that globalization only benefits those at the top," and leads to a push back from people who feel they are losing control over their future." The problem for workers is that fewer and fewer workers are needed in todays advanced automated factories and manufacturing moves across borders leading to anxiety. The president may have realized the extent of the damage only in the closing days of the campaign in 2016, because of his support for trade agreements without talking in this manner about the lives of workers.  ...