The G20 leaders gathering on November 30 in Buenos are meeting at a time of rising global challenges to the global economic and financial system: slowing global growth, rising trade tensions, attacks by the Trump administration on the global financial architecture, financial markets meltdown,  regional disputes among key G20 members.

I know some people abhor social media.  The sector has certainly taken a beating lately in the markets, but I really love Twitter. It gives me the ability to hear the (curated) voices of people I know, don’t know, and in some cases hope I never know, but who make me think.  I follow the newspapers and journals I used to have to login to separately, read other media from all around the world I didn’t even know existed, and get into impromptu conversations with real experts. 

Since World War Two and the Bretton Woods agreements that established the post-war dollar-centric global financial system, the dollar has been the pre-eminent vehicle (reserve/international) currency. The dollar accounts for over 60% of global foreign exchange reserves and 80% of world trade is dollar-denominated, as are 100% of the global transactions in oil and other commodities. Moreover, the chronic U.S. external deficits have provided global markets with abundant dollar liquidity.

FMI’s commentary on the use of state & local incentives in the Amazon headquarters deals.

Amazon HQ Flawed But Still Good Deals for Winning States

When Socialist flavor-of-the-month Representative-elect Alexandra Ocasio-Cortez and conservative Fox host Sean Hannity both denounce a policy as an outrage, it must be truly outrageous. Or they must both be very confused. In the case of the incentives given Amazon for its new headquarters, it is the latter.

For health systems, the day of reckoning is near. A recent Morgan Stanley report states that over 1,000 of the nation’s 5,000+ hospitals are currently weak or at risk of closing. (1) This is the beginning of a larger wave.

The pressure is top down and bottom up. Payers are unwilling to continue unadulterated fee-for-service (FFS) payment formularies. Consumers increasingly expect convenience, lower costs, better outcomes and improved customer experience.

The expansion of Chinese commercial activities in Latin America and the Caribbean raises questions.

The U.S. healthcare system will not change the way it delivers care until it changes the way it pays for care. Perverse incentives riddle fee-for-service payment (FFS) and lead to overtreatment, fragmented delivery and runaway medical inflation. Incremental attempts to reform care delivery through value-based payment reform and provider education (e.g. the “Choosing Wisely” initiative) have not changed practice patterns in meaningful ways.

As everyone knows, October has been a terrible month for equity markets. Some market participants feel that this did not just coincide with higher interest rates, but was caused by flawed Fed monetary policy and comments on overshooting. Like the humming chorus in Madama Butterfly, there has been a steady rise in the number of voices supporting a Fed pause in December. These include members of the Federal Reserve Open Market Committee itself, such as Neel Kashkari, and leading economists such as Jason Furman. 

For several months, I’ve written about growing signals of a possible recession perhaps 10 to 15 months from now. The yield curve has flattened dramatically, because global investors are nervous about our near-term prospects. Investment growth after depreciation has slowed, even with Trump’s costly tax cuts. Inflation has picked up some steam, and interest rates have risen accordingly. Most important, productivity has been virtually flat for three years, and the inflation-adjusted earnings of a typical household have fallen now for more than a year.

Healthcare data wants to be free, but it is oppressed. Entrenched oligarchs trap information within closed, centralized systems that prioritize revenue collection, misuse resources and tolerate medical error. Data gasps for breath as it fights to break into curated systems that produce insight.