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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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U.S consumer spending declines by 0.9% in Dec. 2014 over the prior month, according to the Commerce Department. Consumer spending was up in Nov. 2014 by 0.4%. Excluding auto sales and falling gas prices the Dec. 2014 decline in consumer spending was 0.3%. This shows that consumers are saving most of the money saved as a result of gasoline at about $2 a gallon, or using it to pay off debt. Analysts had estimated a significant increase in retail spending which turned out not to be happening.

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The 2016 primaries with Sanders and Trump have brought to the forefront voter dissatisfaction with the agenda of both parties, especially so for Republicans with the lack of specifics and personality driven campaign of frontrunner Trump. On a whole host of issues from poverty, wages and inequality, regulatory reform, to trade, borders, security, ISIS, both parties are facing questions from voters. Particularly the Republicans who have lacked specifics during the two terms of the Democratic Obama administration with a divided Republican Congress, and the risks for Republicans running for Congress under frontrunners Trump or Cruz who have provided few details on their agenda. The Agenda project of Ryan will have about 25 meetings and prepared specific agenda, including white papers and legislation, that would give Republicans hope to run on positive proposals that are placed before the Republican Convention in Cleveland. Chairmen of House standing committees were assigned 6 areas- health care, taxes, national security, regulatory reform, poverty, and Congress reasserting constitutional authority. Ryan told the Ethics and Public Policy Center on April 19, 2016- "A lot of people don't like conservatism as they know it. For too many people Republicans seem to be caught in a time warp. They're thinking, 'We don't control our borders. Wages are going nowhere. College and healthcare keep getting expensive. ISIS continues to spread. And what are Republicans going to do about it?' So we need to adapt our policies to meet the challenges of the 21st century."...

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According to a report from China's Environment Ministry for the first half of 2013, only 4 cities met the acceptable air quality standards. The national grade 2 standard in China is for 35 micrograms per cubic meter for levels of airborne particulate matter smaller than 2.5 micrograms in diameter. WHO standard is for 25 micrograms per cubic meter in a 24 hour period. The 4 cities with acceptable air qualty out of 74 cities monitored by the Environment Ministry are Lhasa in Tibet, island city Haikou, coastal town Zhoushan, and Pearl River Delta city of Huizhou.

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Ip's point about the actions of previous president's in promoting a recovery long after they are in office has to be qualified by the uncertain economic outlook for 2013, with a slowdown in the eurozone, China and India, and the efforts to control the deficit in the U.S. also affecting the economic outlook. The process of deleveraging has still to work itself out and the economy is still being supported by the Fed's continual easing of monetary policy.

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Several experts point to a dangerous change in the nature of unemployment in this downturn. Heidi Shierholz of the Economic Policy Institute, says people are more likely to get stuck with unemployment now than at any time in the post war period. Andrew Stettner, deputy Director of the National Employment Law Project, says a larger share of the unemployed are not going to be able to go to the same line of work. They will need new skills, just like an auto worker in a permanently downsized industry would have to find new skills to make a product in the renewable energy field or health care. And the law as it currently stands does not help either. Because if an unmeployed worker looks for training or goes back to school he loses his unemployment benefits, something the Obama administration proposes to change. What this means is that many of the unemployed will end up as permanent job losers. Rob Valetta, an economist at the San Francisco Federal Reserve Bank says that throughout the the last 3 decades including good times, the unemployment pool is shifting towards permanent job losers. Lawrence Katz, a Harvard University economist, points out that once workers exhaust their unemployment benefits and don't get new training, they become disconnected to the labor market, and bascially end up on disability or become permanently unemployed. The statistics bear this out. In April 2009, 47.1% of the people collecting state unemployment insurance exhausted the usual 26 weeks of benefits without finding work, according to the Bureau of Laor Statistics, that is the highest rate on record. In December 2007, there were about 2 unemployed workers for every job opening, according to Labor Department data. In March 2009 there were five unemployed workers for every opening. Mark Beaupre, 49, of Providence, R.I. lost his $8 an hour manufacturing job an year ago, one of many manufacturing jobs he has held since the 1980's. His wife Cathy lost her customer service job a year ago. This couple who together made $50,000 a year, are now behind on their mortgage payments and have applied for food assistance. At a recent job fair in Providence he says three thousand people turned up and he could not even get into the parking lot. ...

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The New York Times reminds readers that Newt Gingrich- who criticized Romney's record at Bain Capital- was himself on the advisory board of private equity firm Forstmann Little. This editorial describes Santorum, Romney and Gingrich as corporate candidates who had close ties to private equity or lobbying firms.

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A 15% minimum corporate tax on large, profitable corporations is part of the global minimum corporate tax proposed by US central bank chairwoman Janet Yellen, and the tax proposed by US president Biden. The tax would not apply to companies making $100 million as earlier proposed. The threshold has been raised to $2 billion and affects the companies that have avoided taxes the most. This report says there are 45 such companies in the US.  A US Treasury report on the tax says "the 15% minimum tax is a targeted approach to ensure that the most aggressive tax avoiders are forced to pay meaningful tax liabilities." The Biden agenda on corporate taxes would raise more than $2 trillion over 15 years to pay for essential infrastructure renovation to replace decaying infrastructure in the US. This means roads, bridges, airports, ports, transit systems, electricity grid, broadband systems, school systems, health systems, would all be targets for investment for the first time in 50 years in a concerted drive. The tax drive would partly reverse the Republican Congress's 2017 reduction in corporate tax rate to 21% from 35%, boosting it to 28%. European Union countries such as Britain are also following similar policies after decades in which a race to the bottom led to the lack of funds to finance essential infrastructure rebuilding. As a result China which was a nation of bicycles back in the 1980's now has some of the newest infrastructure, while the US and the EU countries have what might be considered crumbling infrastructure badly in need for renovation. As the shift in mood to a competitive world not only in technologies but in infrastructure and ease of living happens there is more and more awareness of what has been lost in the last 40 years.  ...

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Declining U.S. birthrate with 63.2 births per 1000 women of childbearing age in 2011, according to the Pew Research Center. The rate declines by 23% for Mexican immigrants to the U.S. from 2007-2010 as a result of the severe economic effects of the financial crisis of 2008 on Hispanic immigrants.

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The Fiscal Survey of States, a report put out by the National Governor's Association, says that Medicaid will become an increasing burden on state budgets as help from the federal government declines. The report points out that state general fund revenue remains $21 billion below 2008 levels, just as the states prepare for less federal help.

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Mortimer Zuckerman, publisher of U.S. News and World Report, looks behind the unemployment numbers and points to U-6 the real measure of under utilized labor and of workers working part time because of a lack of full time work, and says this is at about 15%. Add the eight million who quit looking and it is 19%, says Zuckerman The unemployment rate of 8.1% does not reflect the eight million workers who have quit looking. The long term unemployed, workers unemployed for more than 27 weeks is at 40.7%, or 5.2 million workers. Fewer Americans work today than in 2000, even though the population has increased by 31 million. Only 96,000 jobs were generated in August 2012. Something is seriously wrong and the right steps have not been taken.

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Friedman's sense of Minnesotans desire for parties working together, business and elected officials working together to build a better America. He visits his public school in Minnesota.

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William Cohan describes the "bait and switch" techniques used by Bain Capital that he experienced in his personal dealings as a deal maker for 17 years on Wall Street. By this he means that Bain would make attractive offers in the early rounds of an auction for firms as the only way to get selected as a prospective buyer for a final bid. This was necessary for Bain to visit the company facilities and examine its books on-site. At that point Bain would finds all sorts of problems with the company and lowball its bid. Cohan says of all the private equity companies Bain Capital was the one most noted for using these methods during the period Romney headed the firm, and questions the credibility of Bain's word and Romney's word.