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The Economist cites the Dartmouth Atlas Project which shows differences in cost across the country for health outcomes and spending involving Medicare. It cost $5000 per person in Salem, Oregon in 2006, $8000 in San Francisco, and more than $16,000 in Miami, with outcomes for health tending to be better in places where the costs were lower. This is one of the statistics that Peter Orszag of the Congressional Budget Office uses to come up with his estimate of 30% waste in health care spending in the United States. Prof. Skinner at Dartmouth and Prof. Garber at Stanford point out that of most health systems around the world the American system is "uniquely inefficient" and wasteful. The Economist cites information that the American system is twice as costly per person for healthcare than the Swedish system, and that it costs twice as much in Minnesota as in Miami. A poll done for the Economist shows 52% of the people in the UA are dissatified with the quality of care, 40% think the system needs fundamental change, and 29% think that it should be fundamentally rebuilt. The lack of uniform coverage is also causing turmoil in the system. About 49 million are uninsured, and a quarter or more are able to buy insurance and do not buy it because it is so costly, has exclusions and coverage is inadequate. But these people also end up in the emergency rooms along with the indigent costing the whole system tens of billion of dollars for costly late interventions that could have been avoided with preventive care early on. With the economic crisis and rise in joblessness, the dire condition of state and local budgets, the situation has probably drastically worsened, and the system near breakdown. ...

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Reeves says Reagan ever the imaginative politician seized on the idea of "supply side " economics of a not so well known economist Arthur Laffer. Ideas that were simple and appealing- you reduce marginal tax rates and generate higher revenues. This worked for some time with higher economic growth for a number of years, but the arithmetic of higher spending and borrowing and lower taxes would eventually lead to large deficits at the end of Reagan's term, just as price controls worked for awhile and then led to a surge in prices at the end of Nixon's term. When Reagan became President the deficit was 2.5%, when he left office eight years later the deficit was 5% of the economy. Interest payments on debt jumped to $169 billion in 1988, from $69 billion in 1981. Reeves says American politicians know so little about economics, to which it could be added, winning presidential and congressional elections is always a big part of the picture when it comes to economic policy. Which is why Nixon even with Milton Friedman as an advisor shifted to Keynesian policies of higher fiscal spending in 1971, and why Reagan turns to intuitively appealing and effective in the short term policies of having it all- higher spending, growth, and lower taxes. During the years of the two Bush presidencies and the Clinton administration the success of Reagan policies leads to a general sense as Vice President Cheney put it referring to Reagan and Treasury Secretary Baker's belief, that "deficits don't matter." Which leads us to the current situation where 2012 presidential election politics again frame the terms of the debate on deficits and budgets, only now the deficit is much higher and on a unsustainable path. ...

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After the financial crisis of 2008-2009, commercial real estate defaults posed a serious threat to the US economy. Now this threat is receding with low interest rates making it easier to get cheap financing, which raises the returns. For banks the rising earnings give a cushion to absorb losses, letting them sell distressed properties and not have to hold onto them. From office towers in Manhattan to Florida apartment buildings and retail properties in Washington, commercial real estate values are going up. Prices of commercial real estate properties sold by institutional investors went up by 19% in 2010, according to an index developed by the MIT Center for Real Estate. Investors have boosted the prices of bonds backed by commerical real estate to the highest level in two years. The managing director at Real Capital Analytics says, that with values going up, both the owners and lenders have more room to work out difficult situations. Real Capital Analytics January 2011 report shows that of the $52 billion in retail properties to fall into default, a little over half have completed workouts. In Feb 2010, the Congressional Oversight Panel of the Troubled Asset Relief Program said that the commercial real estate market had the potential to pose a serious threat to the US economy. The panel estimated that about half of the $1.4 trillion in commercial property real estate loans set to be paid off by 2014 were under water, where the borrower owes more than the property is worth. Market segments for hotel, apartment buildings and retail are going up. Hotel occupancy rates in the top 25 markets went up from 60% to 64%, according to Smith Travel Research. Sales of apartment buildings in the US went up as home ownership hit new lows, and lease rates went up to the highest levels in 4 years, according to Axiometrics....

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In comparison to industrial companies digital companies such as Google and Apple have more room to find gaps in the U.S. tax system which was designed for the industrial period. Apple paid a tax rate of 9.8% in 2011 on its global profits in 2011 of $34.2 billion, a total of $3.3 billion. Wal-Mart for instance paid a tax rate of 24%, on its booked profits of $24.4 billion, a total of $5.9 billion. The issue is significant because of the large U.S. deficit and spending cuts by local and state governments for essential services, especially in California, where Apple is located. Apple is able to avoid state taxes on some of its profits by locating an office in Reno, Nevada. Nevada has zero corporate taxes, California's corporate tax rate is 8.84%. In the current fiscal year Apple is expected to earn $45.6 billion which if taxed at the rates companies paid in the 1950's - 30% in the 1950's compared to 6.6% in 2009 for corporate tax receipts according to a New York Times report- would enable the state of California to avoids some of the sharp cuts in funding to community colleges such as De Anza College only minutes away from Apple, Google and H-P. De Anza College's president says he simply cannot understand this, how the whole psychology of corporations and the public itself has changed over the years, to where a college where one of the Apple co-founders Steve Wozniak got his education in 1969-74, is now struggling to survive with funding cuts. The California college system of the 1950's and 1960's was funded by other companies tax dollars creating the educational resources which helped create todays companies- one generations responsibilities transferred to another generation that has failed to understand what this is about....

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Lally Weymouth of the Washington Post interviews Israeli defense minister Ehud Barak on June 20, 2012. On the negotiations of the P5+1 countries with Iran in Baghdad, Istanbul and Moscow, Barak says the Iranians are simply buying time, hoping that by being a little forthcoming they can delay giving up nuclear weapons programs capabilities and see if the situation changes with a new President in office in the U.S.. The Iranians are trying to reach a "zone of immunity," the way Pakistan and N. Korea did, and it will take a resolute determination on the part of the U.S. the Europeans, the Russians and the Chinese to prevent a nuclear Iran and nuclear proliferation. By the third meeting in Moscow it should be clear whether the Iranians are willing to give up capabilities that lead to nuclear weapons. Ayatollah Khamanei is the person in charge in Iran, but decisions are made collectively with the moderate Ayatollahs still ayatollahs, says Barak. The addition of the Khadima party to the coalition government of prime minister Netanyahu increases Israel's desire for dialogue and seeking progress on a peace with the Palestinian Authority- if not a peace arrangement then even unilateral steps towards peace by both sides. The way forward in Syria is for the U.S. to talk with the Russians about a new government. The important thing is for the removal of the Assad family, the entire Syrian state does not need to be dismantled as happened with the Baath party in Iraq. Israel continues to build a fence in the Sinai facing Egypt, as it fears infiltration during the period of civil strife in Egypt. Israel views Egypt from the standpoint of any future Egyptian government honoring its treaty committments with Israel, otherwise says Barak it is upto Egypt to decide its future government....

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Adly Mansour, a judge with the Supreme Constitutional Court in Egypt, is appointed by the military as president of Egypt. He was to take office as Chief Justice before the June 2013 protests in Egypt intervened to delay this. On July 3, 2013 he was sworn in as president before the Supreme Court. Mansour is one of two judges selected by president Morsi. He is a graduate of Cairo University, and studied public affairs and management in Paris before joining the judicial sytem in 1977. His decisions as judge went against both Mubarak and Morsi, showing his independent position as a judge on the Supreme Court. The judiciary is now taking an important role in Egypt similar to the role it has played in Pakistan, another Muslim country adopting democratic forms of governance after decades of coups and military rule since the 1950's. The larger Muslim countries in the Middle East, Turkey, Pakistan, Iran, and Egypt are faced with the challenge of balancing the demands of modernization with tradition, the demands of educated urban population with the more devout Islamist rural population, and creating stable transitions in democratically elected government. Islamists such as president Erdogan in Turkey who described western democratic forms of government as a train to get to a destination have still to take in to account the need to incorporate opposing secular views in governance. In this sense Turkey is not the model for governance as it once appeared for Egypt, Pakistan Iran and other Muslim countries. A new consensus in society needs to develop that respects all aspects of democratic governance including respect for the role of the opposition in a democracy, the role of an independent impartial judiciary, and the role of independent media. This will take time to develop just as it took time to develop in Europe and North America....

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New York Appeals Court Judge Sonia Sotomayor, is President Obama's pick for the Supreme Court. Saying that Stomayor had arigorous intellect and a mastery of the law, President Obama went on to say at an announcement ceremony, that the judge's inspiring story was crucial in his decision. One that was made with deep reflection and careful deliberation. Obama quoted Justice Oliver Wendell Homes- "the life of the law has not beenlogic, it has been experience." And added his own words to those of Holmes- its vital that ajustice know "how the world works, and how ordinary people live." Sotomayor is from the Bronx part of New York City. Her parents immigrated from Puerto Rico and lived in a poor neighborhood. Her mother worked six day weeks to earn enough money to send her and a brother to Catholic school. From there she got into Princeton University, where she once felt like "a vistor landing in an alien country," but graduated summa cum laude. She went on to Yale law school, where she was editor of the Yale Law Journal, workwed for Robert Morgenthau in the district attorney's office in New York and later went into private practice. She was nominated by the first President Bush in 1991 to the federal appeals court on the advice of Senator Patrick Moynihan, and then by Bill Clinton to the appeals court in 1997. Judge Sotomayor takes pride in her ethnicity, gender and growing up in the poor part of the Bronx, and said in a2002 lecture- " I would hope that a wise Latina woman with the richness of her experiences would more often than not reach a better conclusion than a white male who has'nt lived that life."...

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The figures are staggering. $380 billion of $400 billion in Nigerian oil revenues estimated lost to corruption and waste from 1960 to 1999. This is the estimate given by Nigeria's top anticorruption official and quoted in the NYT. Meanwhile life expectancy in Nigeria is about 47 years and little of the oil revenues goes to infrastructure, health, education and investment to improve the lives of Nigeria's people. The oil companies after years of bad publicity, Shell and Exxon, appear to be shrugging their shoulders that there is little they can do beyond their own small investments, $100 million by Shell and $22 million by Exxon each year on roads and other related infrastructure. The western oil companies typically get 7% of the profits from oil sales, with the government keeping 93%, according to the NYT. Mouwad describes life inside a 50 acre area in Port Harcourt which houses Italians working for oil company Eni. A militant movement MEND is fighting in the Delta region to have more resources devoted to this neglected region of Nigeria. The result is that life is becoming difficult for foreign oil workers in the area. About 13% of oil revenues go to the states but corruption and waste eat up the money at the state level too. The River States budget is an example, of about $1.3 billion budget only $22 million goes to health services, helicopter services and catering for the governor's office alone cost $38 million and $10 million. MEND the delta region organization wants more money for the delta states and is organizing disruption of oil production as a method to make itself heard. This has increased the need for security consultants to protect oil company property and personnel. Already a quarter of Nigerian oil production has been shut down....

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The two men, the couple one a Professor and the other a hard charging investment banker who kind of fit in together, their background, personalities, and preparation for this crisis. Throughout this crisis both had little sleep paulson some 4 hour and Bernanke leaving at midnight to catch some sleep and how the crisis kept going on and on, with one fire put out another remaining to be put out and finally after day after day on Diet coke or diet Dr. Pepper and little sleep Paulson agreed with Bernanke's opinion that "we've got to go to Congress." In fact based on his studies and research on the Great Depression and of the crisis in Japan in the nineties in the banking system there, Bernanke had given his conclusion early on about a year earlier that if there were significant decline in housing prices the government would have to step in with a large intervention. But in the end it happened all so suddenly with Paulson agreeing and both Paulson and Bernanke going upto the President and the President saying lets do it. So the meeting with Congressmen was arranged a few hours later after the inital meeting in Speaker Pelosi's office. Any reluctance to meet Congressmen who had considered any steps in this session unlikely having disappeared, and the stark nature of the crisis in the words of Senator Dodd, Chairman of the Banking Committee, became clear in the opening remarks of Paulson and Bernanke. Dodd told a news reporter that for a long time there was complete silence in the room and he does not recall a moment like this in 25 years in Congress and it being a scary story. By now it had become overwhelmingly obvious that something needed to be done in hours and days....

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This story in the WSJ on the Biden White House says it always operated with a tight inner circle. During the Covid pandemic it limited contacts for the president, yet after the pandemic eased this protective layer was not taken down says WSJ. As the president's age advanced the tight inner circe remained sheltering the president form the outside. The debate with DJT was one point that this became evident. Biden in his last year in office is 82 years- the oldest president. He had accomplished much in passing the series of bills that funded infrastructure, chips, science and protecting workers using his skills with Congress acquired over span of 50 years. Limiting Biden's one on one's and to certain parts of the day had an unexpected result. The head of Armed Services Democrat Rep. Adam Smith says this happened during the 2021 withdrawal from Afghanistan. He could not reach Biden so he could caution him about an overly optimistic view of the withdrawal. As the withdrawal led to loss of 13 armed forces men the disarray was a topic for Republicans. Only after the withdrawal issues Biden called Smith. In 4 years Smith says he had this one call with the president when he had spoken to Obama several times. Simtih's view is that Biden White House was "more insulated than most." Senator Manchin says he had less contact with Biden than his closest advisers.  This WSJ report also says the contacts of cabinet members with Biden were limited and tightly controlled. This report says Yellen at Treasury had few one one's with the president and dealt with adviers. Austin at Defense in the last 2 years during the Ukraine and Gaza crisis had only rare direct contact with Biden. During the campaign this story says close adviser Donilon kept access limited for polling experts to the president to the point where Senator Schumer and others felt Biden was falling behind but the president was not aware of this. ...

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Arvind Subramanium, outgoing Chief Economic Adviser to the prime minister in an interview with the Hindu newspaper, shares some of the knowledge he gained from failures and successes. The key lesson he gained is that it is important to have independent advisers in government who can speak their mind. Finance minister Jaitley has embraced this point, that such an adviser is not just one more part in the technocratic machinery of government. The success in getting GST he says shows that cooperative federalism is needed going forward as a kind of technology for many changes, including agriculture, DBT.  Subramanium calls the Economic Survey a success with 350,000 unique visitors. He likes the independence and distance of the CEA job to propagate the big ideas combined with closeness to decisionmakers. He counts as a failure not being able to create an office of CEA to the states, a request from 7 chief ministers and state finance ministers. Subramanium sees the need for more people in government with specific expertise in different areas as opposed to generalists as the work of government is becoming much more sophisticated. There is much need for talent and the flow of lateral talent into government.  Responding to economic issues such as the impact of oil prices on the economy Subramanium sees CAD at 2%, inflation at 4.5% much better compared to 2013 levels of double digits and not in unhealthy territory and very manageable. He sees risks in the impact of a combination of oil prices, dollar appreciation, and currency trade wars that are happening. On Iranian oil imports and strict U.S. sanctions on importers Subramanium sees the cost of not complying as stiff once you are in the dollar trading system. On demonetisation he sees there are short term costs and potential long term gains that requires an assessment every 2-3 years provisionally, what happened to tax and formalization, and the costs. Including costs in inconvenience and hardship for informal cash intensive sectors noted in the Economic Survey. For GST he says the revenue growth rate is 16-17% in aggregate for next year, growing 12% in the first year after a difficult implementation. The poorer states have seen an expansion of tax base and revenue performance is unprecedented.    ...

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Pakistan's economic delegation meets Christine Lagarde, head of the IMF, at the IMF and World Bank Annual meeting in Bali, Indonesia. Lagarde calls for transparency in accounting and complete understanding of Pakistan's debt. IMF delegation will visit Islamabad to discuss terms for a loan. The previous government of Mr. Sharif came under criticism for not providing transparency on Pakistan's total debt. There is concern about debt trap diplomacy in loans from China, as loans may exceed the country's ability to repay and the interest rate terms are not seen as favorable to Pakistan. The Sharif government is criticized for not negotiating better terms for loans from China. Pakistan faces $8 billion debt load in 2018, with first payments to China under Belt and Road Initiative of $1 billion due in 2019. Pakistan's total foreign exchange reserves fell to a low of $8.4 billion, according to the central bank. Pakistan is seeking $12 billion in IMF assistance, but experts say more will be needed to bridge the financial gap. The Pakistan rupee dropped by 10% during this week in October 2018, down to 137 rupees for a U.S. dollar. The new government of prime minister Imran Khan took office in August 2018 after election promises to bring transparency to Pakistan's debt situation. Promises were also made to improve low income housing and meet needs of poor and low income public. Imran Khan opened a public housing project to build 5 million new homes. IMF terms could restrict the money available for badly needed housing and other social projects.  Pakistan's small tax base with a small percentage of the population paying taxes, also restricts the ability of the government to fund social welfare projects and infrastructure. It makes the country more dependent on outside assistance and loans. India has moved to expand its tax base, and is implementing GST tax reforms to increase the tax revenues available to fund infrastructure, health, education and housing. The war in Yemen has complicated other sources of funding traditionally accessed by Pakistan from Saudi Arabia and the UAE. The financing gap is estimated by experts to be $20 billion, with the IMF assistance sought of $12 billion falling short of the financial needs. ...

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This WSJ report sees Angela Merkel as leaving an international legacy of cooling relations with America. It says Angela Merkel turned down US president Biden's first call after his election as president because she was going to her cottage in the country that weekend. This report says after 4 terms Merkel is to be seen as dramatically increasing her country's economic dependence on China, pushing through a energy deal with Russia, joining France in challenging US political influence in Europe, rejecting American requests on economic policy and setting Berlin's openness to Chinese technology.  What happened with her youthful fascination with America during the years growing up in East Germany asks the WSJ? It also says of the Bush years of unregulated banking leading to the 2009 US banking crisis- that left her with a distaste for Anglo-Saxon banks and Wall Street lobbying. Of the Obama years it says Merkel found Obama unsteady, verbose, and sometimes meddling, with the spying on Merkel's phone also giving her a sense of disrespect to Germany. The result was that Merkel increasingly was fascinated by the Chinese experiment in development, visiting China 13 times while in office, studying Chinese history, politics and economics.  Merkel over this period met with the Dalai Lama and had questions about one party rule by CCP. Yet she became more and more resigned to Germany as a country of 80 million, not the EU and Europe as one group united in vision with a population of about 500 million, larger than America that could be a force for good in its own right. She said "we can be as hardworking, awesome,  as super as we like, but as a country of 80 million we won't be able to prevail if China ever decided that it no longer wants to have good relations with Germany." She ignored the experience of Sweden and Scandinavian countries in their relations with China. In saying this she ignored the potential of India and its neighbors in south-east Asia that make up about 2 billion people or about twice the population of China. She also seemed unaware of the role Woodrow Wilson, FDR, have played in realizing the democratic vision of the German revolutionaries of 1948 who failed to bring democratic government to Germany. And she had forgotten of the role Harry Truman, the commoner president of the US, who played a major role in establishing German democracy and its dignity during the Berlin Crisis after the blockade of Berlin by the Soviets in 1948. The mediocrity of presidents from Bush to Trump has bothered Merkel. Yet it may very well be that there is nothing mediocre about Mr. Biden and America's vision about its future as it grapples with the social and economic problems of the last three decades, as it has done before in its history and come through. ...

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Yuka Hayashi gives an exceptional account of the rise of nationalism in Japan. This is especially true of the younger generation. As examples of the changing mood, he gives the popularity of Will magazine with circulation of 100,000 among younger readers, including large numbers of women. Other examples are the movie "Eternal Zero" remaining on the top of box office charts for 2 months, neto uyo or right wingers on the internet are popular, and bookstores display titles responding to China and S. Korea's criticism of Japan. Fringe candidates such as Toshio Tamogami have won 24% of the vote in Tokyo's gubernatorial race, with large proportion of younger voters. The younger generation is not accepting quietly the criticism of Japan's prewar record in the same way as the older generation with memories of the war. It sees itself free to respond to what it sees as China and S. Korea's constant criticism of Japan, even when Japan has apologized repeatedly for its aggressor role in Asia. Weekly magazines such as Bunshun and Shincho carry Japanese criticism of China and S. Korea with sensational headlines about lies. Abe's recent visit to the Yasukuni war shrine- the main object of S. Korean and Chinese criticism and America's concern expressed to Japan- is shown in an Asahi Shimbun poll recently to get favorable support from 60% of people in their 30's. Many of the 119 freshmen members of the Liberal Democratic Party of Mr. Abe also provide support, and some even see Japan needing to defend itself with or without the U.S. Is this level of nationalist sentiment similiar to the twenties and thirties, or to periods of tension in the 1990's and other post war periods? Only recently in 2010 the Democratic Party of Japan under a young prime minister Hatoyama and premier Naoto Kan, a civil rights activist, presented another side of Japan seeking closer ties with China- even distancing itself somewhat from the U.S. on the issue of bases in Okinawa. Naoto Kan also enjoyed a 60% level of popularity as premier Abe has in 2014. Which is the real Japan, or is it a reflection of fatigue among younger Japanese with always having to say you are sorry, as has happened to the younger generation in Germany. Hatoyama resembled Obama as a younger politician bringing a new optimism in Japan after years of LDP rule. Unfortunately president Obama distanced himself from Hatoyama on the base issue and failed to support Hatoyama at a time of tensions with N. Korea, leading to his fall in ratings and resignation. This may turn out to be a lost opportunity for the U.S. for building peaceful neighborly relations in Asia. In 2007 Chinese premier Wen Biao a speech to the Japanese parliament, the Diet, saying: "With history as a mirror it does not lead to long-lasting hate, it points to a better future." Japan's premier at the time? Shinzo Abe. What has changed? China's economy has doubled in size, and so have global Japanese corporations such as Toyota with advanced technologies, economic insecurity is unfounded in a globally linked interdependent economic system. ...

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The view that the war in Afghanistan should move forward as acounter insurgency effort like this one, does not see the partner in the Karzai government or the Afghan dislike of foreign troops on their soil as factors to be addressed seriously. It also does not address the difficult mountainous terrain in the country. It also does not look for alternative solutions that could be worked out with Pakistan for addressing the presence of AlQuaeda terrorist group in the border regions.

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Gates gives his perspective on the US role in foreign affairs and how the new policy of the US should be shaped.

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Thomas Fuller of the NYT cites Thai historian Nidhi Eoseewong about the social transformation taking place in Thailand and the emergence of farmers in the northeast as part of the middle class. This change is a result of Asia's rapid economic growth and brings with it new tensions in the social and political fabric of the country. Suthep Thangsuban, a leader of the Democrat Party, is leading protests in Nov. 2013. Because the northeast Thailand voters form about one third of the vote, the older established Democratic Party- allied to the middle class in Bangkok- has failed to win elections since 1992. The established older middle class wants to see less electoral participation that diminishes its role and is pushing for a Senate with half of the members appointed by civil servants and judges. The party of Thaksin Shinawatra and his sister, the current prime minister, appeals to the northeastern voters who want greater representation. These issues are behind the protests in Bangkok and are not likely to be resolved anytime soon as it will take time to integrate the northeast....

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U.S. budget deficit reached 10% of GDP with the 2008-2009 recession and the need for federal spending when tax revenues dropped. Partisan budget fights took place in Congress in 2010 and 2011, with a downgrade of the U.S. credit rating in 2011. By December 2014 the budget deficit declined to $488 billion for calendar year 2014, or $483 billion for fiscal year, as the unemployment situation improved. The deficit in 2014 was a liitle below 3% of GDP.