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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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Hagel did exactly what the White House expected him to do, say experts, including not coming up with any large ideas on the defense forces, tackling the budget cuts, working with the rank and file in the military, and implementing the administration's policy of reducing involvement in foreign military conflicts. Hagel's role was limited by micromanagement by NSC officials and Hagel was seen as deferential to the military chiefs and generals who had different views of the conflicts in Syria and Afghanistan- some generals seeing the administration's response as hamstrung by keeping resource committment to the minimum in Syria and others saying not enough resources were there to extend involvement to places such as Aleppo in Syria. Hagel resigned after pressure from White House officials who realized the inadequate nature of the very things that the White House expected of Hagel- following what the public sees as failures in the Middle East.

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Following the fifth North Korean nuclear test DW.com talks with Rudiger Frank about the test and what this means. Frank says the negotiations with North Korea and efforts to limit the program so far have been a colossal failure. Tests have continued and without a change in strategy more tests will be followed by the usual condemnations by world leaders and further sanctions. Frank says this change in strategy would include recognizing North Korea as a nuclear state, and getting North Korea to ensure the weapons are safe and secure in the country, getting a clear idea of what and where the weapons are. The International Atomic Agency would be asked to go in and make inspections. The next step would be to freeze the program at some level agreed to. This is a tough step to take but it only recognizes the reality of the situation, and continued development by North Korea of nuclear weapons if no steps for change are taken. 

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Ms. Annegret Kramp-Krarrenbauer, elected leader of the CDU party in 2018 with the support of Angela Merkel, will not run for chancellor in next years election and will resign from her position by the end of the year. She will continue as Germany's defense minister. After losses for the CDU in recent elections and the embarrassment of local CDU leaders in Thuringia supporting the far right AfD, AKK as she is known decided to step down. Angela Merkel has decided not to run for chancellor again. Germany is set to chair the EU in the second half of 2020, and Merkel is no longer seen as a leader of influence. The Nationalist Alternative for Germany AfD has gained votes in recent elections following the 2015-2016 migrant crisis, with large numbers of refugees from North Africa and Arab world landing in Greece and Turkey and walking to Hungary, Austria and Germany. Merkel's handling of the crisis with acceptance of a million refugees in 2015-2016 unsettled European and German politics. Why? One way of looking at it is that in the same way that the U.S. took in Chinese imported goods ending in the Trump tariffs war, at some point it just becomes too big to handle. That ended up at $1 billion a day in imports from China when president Trump called it off and accused Obama Democrats, Bush Republicans, of betraying the country. Putting it into perspective Germany with one fourth of the population of the U.S. took in about twice the number of refugees in just one year 2015-2016 that the U.S. took in 10 years 2005-2015. The U.S. took in 675,000 immigrants between 2005-2015. This is as if the U.S. took in something like 20 million immigrants in a short period of 1 year on an equivalent basis- though the cultural impact is even greater in a nation like Germany that is like Japan an historically immigrant averse nation. All this happened too quickly for Germany to handle for its fragile cultural fabric. Much of the initial outpouring of support and positive sentiment came from the sense of having gone through World War II and the refugees in that and the early post war period, the need to return in the same spirit support Germany had received. Over time it eroded support for the Christian Democratic Union and Merkel. That Merkel could have done this is itself a small miracle. Now the rebuilding has to begin. Adenauer's CDU and the socialist SPD party of Willy Brandt now have less than 50% support, only with the Greens Party do they make up 50%. The question now is can the CDU, and the SPD which has fallen to 14% in elections, make it back and what kind of future makeup political parties will have in Germany, how the social fabric can be restored. AKK's achievement is to mend relations between the liberal Merkel wing of the CDU and conservatives from Bavaria (CSU) over immigration.  Candidates for CDU leadership are Armin Laschet, Jens Spahn, and Friedrich Merz. Laschet premier of North Rhine-Westphalia has Merkel's support. Looking back too much attention was taken up by the euro crisis, and too little was done in the areas of infrastructure, inequality gaps, education, child care, under Merkel's leadership and of the preceding SPD years, much like what happened under Bush and Obama administrations in the U.S. where wars, economic crises led to neglect on issues that affect lives of ordinary working families. ...

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Two US carrier strike groups and 17 naval ships prepare for joint exercizes with Japan's Self-Defense Forces off Okinawa in the first week of October 2021. In late September a British aircraft carrier group goes through the Taiwan Straits. China has flown aircraft near Taiwan's airspace before. On October 1-5 over a period of 4 days China sends 150 fighter, bombers and other aircraft near Taiwanese airspace. This situation is reminiscent of the situation in 1950-53 during the period of the Korean War when US president Harry Truman sent the Seventh Fleet to the Straits of Taiwan. In 1954 Chinese artillery started the shelling of offshore islands Quemoy and Matsu. This happened again in 1958 under president Eisenhower. At that point the US sent a naval contingent to the Taiwan Straits. The crisis was resolved through talks with China. Eisenhower then setup a joint defense agreement with Taiwan.  Here the Taiwan Defense Minister says China is capable of an invasion of Taiwan in 2021 but "it has to calculate what it would cost and what kind of outcome it would achieve." He also says that after 2025 "it would have lowered the costs and losses to a minimum." As US companies seek expansion in China the situation is changing rapidly in 2021 in the other areas.The US under president Biden sees the wars under previous presidents and the economic policies of not investing in American industrial strength have created risks for America in its role in the world. Biden seeks to restore American industrial strength through massive investments. It has been reported that Taiwan even considers the concentration of world semiconductor industry in Taiwan a way to assure the US dependence on Taiwan for semiconductors would lead to allied economic commitment to Taiwan in addition to defense commitments already given. In a sign of awareness of the distorted situation in semiconductor manufacturing that American companies such as Intel have allowed to happen, including ceding essential technologies in manufacturing semiconductors to other nations, the Biden administration has pushed to reverse these policies giving $52 billion in state aid. President Biden talked to president Xi of China in early September in a 90 minute call. This was aimed at easing hostility between the two countries. During that call the two leaders had agreed to abide by the Taiwan Relations Act, that states Taiwan's status should be resolved through peaceful means. It was passed in the US Congress in 1979 during the period when the US restored diplomatic relations with China. The situation today resembles that in the period after the Korean War into the late 1950's when China under Mao continued shelling of islands under Taiwan from the mainland. This makes the existing supply chains that make the US, Europe and India overly dependent on China,Taiwan, Singapore, for manufactured goods look antiquated and out of place. American companies such as Apple, GM, Black Rock and American financial companies are caught in a bind as they operate as if nothing is happening, when a lot has changed during the coronavirus pandemic. The Biden administration is pursuing its own long term policy for restructuring the supply chain for American industry. ...

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Mead points out that the world with an effective U.S. leadership based on democracy and the values we cherish is needed now more than ever, after the failures of the Bush and Obama administrations to provide the kind of balanced leadership all Americans can stand behind. A world without an effective and enlightened leadership from the U.S, is one in which the world could fall apart in regional rivalry, one in which the hundreds of millions of people in the poorer parts of India, China, Russia, Brazil, and other developing countries of the world, will have less opportunity to meet their aspirations for a better life. This is because a focus on development requires less regional rivalry and because serious missteps can reverse in a few years decades of economic progress as shown in the 2008 global financial crisis. More so because we live in an increasingly interdependent global economy. It is also the kind of world where suppression of freedoms and suppression of the opposition as in China and Russia, provides a wrong kind of message, a world in which we or our children would not want to live in. Russia, India and China, are too driven by rivalry and lack the deep experience to go it alone, multipolar is more likely to end up being multipolar rivalry leading to a race to the bottom, which would be bad for all, especially for the poor in Asia and the developing world. The 2008 crisis showed what some serious economic mistakes could do to employment and incomes in the world with output dropping by a third in most places. Political missteps could lead to a slippery slope of this magnitude but more difficult to correct. Greater participation in the political process and more enlightened leadership is needed in all countries to allow many voices and greater interaction across boundaries, focussing on the dangers of such multipolar rivalries. The world of the G-7 is already moving to the G-20 where many voices are heard and serious discussion of differences takes place, but participatory is different from multipolar....

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John Bolton on the efforts needed to secure nuclear and biological weapons in North Korea and to reunite the two Koreas, by joint concerted action between China, the U.S. and South Korea. Prof. Cha of Georgetown University, and the Editorial Board of the Washington Post call for similiar preparation and action on Dec. 20, 2011, soon after Kim's death.