The United States and the ASEAN group of nations have further strengthened political, economic and security ties, after their second full-scale summit in New York.

President Barack Obama said the Association of Southeast Asian Nations, which groups ten countries, had the potential for true world leadership. President Obama also made it clear that he saw Asia as a vital plank of US foreign policy.

DR EMMERSON: In the run-up to the summit, there was a big question. Would the partnership be declared as being strategic in nature? That was a key word in the discussion and what happened was the leaders basically finessed the issue. It's not hard to suspect that they worried that if they declared a strategic partnership with the United States, this would cause alarm in Beijing. Because let's remember in the run-up to this summit, we've had a lot of activity - the split between China and Japan over the disputed islands, one could continue with some evidence of a more muscular Chinese foreign policy, its commitment to its claim to possess basically the entire South China Sea, escalating that to the level of a core interest, presumably equivalent to their interest in recovering Taiwan. I could go on, but in many case, it was understandable that the subtext of the meeting was what will China think? So basically what the summit did was to finesse the issue. They decided to pass on the question of raising the partnership to quote - a strategic level - unquote, to the ASEAN US Eminent Persons Group, presumably expert advisors that would be convened and would make recommendations down the road.

And one of the most remarkable things about the statement was how much ground it covered. I mean, among the topics and issues that the leaders committed themselves to do something about, were 14 as I count them, 14 different subjects. Human rights, educational change, trade and investment, science, technology, climate change, interfaith dialogue, disaster management, illicit trafficking, international terrorism, I could go on. So it is clear to me that one of the tasks that ASEAN and the US will have to face in the coming months, is to try to insert some sense of priority.

LAM: On that issue of priority, the US President, Barack Obama, of course, postponed a couple of visits to Indonesia due to pressing domestic demands. Did he in anyway express American commitment to the ASEAN region?

DR EMMERSON: Yes, this was particularly kind of, I suppose you could say, evident in the fact that the meeting occurred at all, finally it was organized. It lasted two hours. He was apparently quite engaged and engaging during that period of time. And I think there is no question that the United States under his administration is committed to South East Asia as a region, indeed has agreed with the leaders of ASEAN, that ASEAN should play a central role in the process of building regional cooperation in East Asia.

LAM: And, of course, one of the topics that came up as well was the South China Sea, that entire region, given the competing maritime and territorial claims vis-à-vis the Spratley and Paracel Island groups. Do you think China is watching the US relationship with ASEAN, this growing relationship - do you think Beijing might be watching it with unease?

DR EMMERSON: Yes, absolutely. I am confident that they are watching it with considerable unease and I note that the statement that the leaders made, made no reference whatsoever to the South China Sea, presumably because of sensitivity with regard to Beijing's possible reaction. The topic was implicitly mentioned, but not explicitly.

LAM: And what about within ASEAN, the grouping itself? The UN Secretary-General, Ban Ki-moon, on the weekend said that the ASEAN nations' credibility might suffer if they did not take a tougher line with Burma and this is in view of the upcoming elections in November. This is presumably directed at specifically China and India, but it could also be referenced to ASEAN could it not, because Burma is a member of ASEAN. Do you see that changing anytime soon with ASEAN, that ASEAN countries, leading members like Indonesia, Malaysia, Singapore, that they might take a stronger stand with the military junta in Rangoon?

DR EMMERSON: The election in Myanmar, if I can call it an election, since it will be highly compromised and manipulated will take place, at least is scheduled to take place November 7th. Indonesia does not take over the chairmanship of ASEAN until the 1st January. So the question is, since Indonesia is a democratic country, arguably, the most democratic of any country in South East Asia, will it use its opportunity to try to put pressure on Burma in the year 2011? My own view is that ASEAN will probably not fulfill Ban Ki-moon's hope, will not exercise significant pressure on the junta. Instead, we could get the opposite situation in which so long as there is not major violence associated with the election, it will essentially be received by ASEAN as a kind of minimally-acceptable basis for assuring the Burmese junta that ASEAN still treats them as a full member. In other words, it's quite possible that the junta may get away with what I take to be a kind of facade effort to legitimate their rule.

Yihai Kerry Group, a Singapore-based agribusiness and food company, has drawn criticism for its presence in China’s wheat market. Among the accusations leveled at the company, Yihai Kerry has been blamed for causing price inflation. Scott Rozelle, Helen F. Farnsworth Senior Fellow in the Freeman Spogli Institute for International Studies, comments on the positive side of competition.

The Southeast Asia Forum experienced an embarrassment of riches in 2009-2010.  In no previous academic year had the Forum enjoyed the intellectual company of so many first-rate scholars working on Southeast Asia at Stanford.  They were six in all—Marshall Clark (Australia), James Hoesterey (US), Juliet Pietsch (Australia), Thitinan Pongsudhirak (Thailand), Sudarno Sumarto (Indonesia), and Christian von Luebke (Germany)—three for the full academic year and three for two months apiece.  All six visitors shared their findings and thoughts on Southeast Asia in talks hosted by SEAF.  Not least among the pleasures of having them at Stanford was a Spring 2010 seminar in which they read each other’s work in progress and shared ideas as to how it might be improved.  These conversations gave specific, heuristic, and collegial meaning to the abstract notion of “a community of scholars.”

Here are brief updates on all six as of the end of June 2010:  

Marshall Clark

A lecturer in Indonesian studies at Deakin University in Australia, Dr. Clark came to Stanford on sabbatical to spend two months at Stanford in Spring 2010 writing up and sharing his research findings with US-based colleagues.  Publications associated with his stay at APARC include two books, Maskulinitas:  Culture, Gender and Politics in Indonesia (Monash University Press, 2010) and Indonesia-Malaysia Relations:  Media Politics and Regionalism (co-authored with Juliet Pietsch and forthcoming in 2011), and two articles, “The Ramayana in Southeast Asia: Fostering Regionalism or the State?” in Ramayana in Focus, and (with Dr. Pietsch) “Generational Change:  Regional Security and Australian Engagement with Asia,” The Pacific Review  During his time with SEAF he presented papers at venues including the Association for Asian Studies convention in Philadelphia in March 2010.  In April at the University of California-Berkeley at the Islam Today Film Festival he moderated a discussion of the ins and outs of making movies in Indonesia and Malaysia. (2010).

He returns to his position on the faculty of Deakin University.

James Hoesterey

Dr. Hoesterey was awarded the Walter H. Shorenstein Fellowship to spend the academic year at APARC working on several projects, including revising his University of Wisconsin-Madison doctoral dissertation into a book.  Based on anthropological research in Indonesia on media-savvy Muslim preachers, Sufi Gurus and Celebrity Scandal:  Islamic Piety on the Public Stage should be under review in 2010 for possible publication in 2011.  Also in the pipeline are an essay, “Shaming the State: Pop Preachers and the Politics of Pornography in Indonesia,” to appear in a volume he is co-editing with political scientist Michael Buehler, and chapters in Muslim Cosmopolitanisms and Digital Subjectivities:  Anthropology in the Age of Mass Media.  During his fellowship he spoke to audiences at several US universities.  In March 2010 he was elected incoming chair of the Indonesian and East-Timor Studies Committee of the Association for Asian Studies.

In Fall 2010 the BBC-Discovery Channel series “Human Planet” will feature Dr. Hoesterey’s work as a cultural consultant with documentary-film makers in West Papua.  He will spend AY 2010-11 in Illinois as the Andrew W. Mellon Postdoctoral Fellow in Islamic Studies at Lake Forest College.  

Juliet Pietsch

Dr. Pietsch is a senior lecturer in the School of Politics and International Relations at the Australian National University.  During her two-month sabbatical at Stanford in Spring 2010 she worked on two books:  Indonesia-Malaysia Relations: Media, Politics and Regionalism (with Dr. Clark) and (with two other co-authors) Dimensions of Australian Society (3rd ed., Palgrave Macmillan, 2010).  In April, jointly with Dr. Clark, she spoke at the Berkeley APEC Study Center on “Indonesia-Malaysia Relations and Southeast Asian Regional Identity.”

Dr. Pietsch returns to her faculty position at the Australian National University.

Thitinan Pongsudhirak

Dr. Pongsudhirak is an associate professor in the Department of International Relations in the Faculty of Political Science at Chulalongkorn University, whose Institute of Security and International Studies he also heads.  He was selected to spend a month at Stanford in Spring 2010 as an FSI-Humanities Center international scholar, and was supported for a second month by FSI’s Center on Democracy, Development, and the Rule of Law.  During his time on campus he focused on the turbulent politics of Thailand—in an article drafted for the Journal of Democracy, in a number of shorter pieces, in lectures at various venues, and in interviews with media around the world.  (For a filmed interview on 4 June 2010, see http://absolutelybangkok.com/thitinan-on-continuity-change/.)

Dr. Pongsudhirak will briefly rejoin some of his Stanford colleagues at a conference on Asian regionalism to be hosted by APARC in Kyoto in September 2010.  Meanwhile he continues his scholarship and teaching at Chulalongkorn.

Sudarno Sumarto

An Indonesian economist specializing on poverty reduction, Dr. Sumarto spent AY 2009-2010 at APARC as an Asia Foundation fellow writing up research, lecturing on and off campus, and advising Indonesian officials on anti-poverty policy.  Notable among the publications resulting from his residence at Stanford is a book, Poverty and Social Protection in Indonesia (Singapore / Jakarta:  ISEAS / Smeru Institute, May 2010), which he co-edited and most of whose chapters he co-wrote.  Noteworthy, too, is a co-authored essay, “Targeting Social Protection Programs:  The Experience of Indonesia,” in Deficits and Trajectories: Rethinking Social Protection as Development Policy in the Asia Region (forthcoming, 2010).  Indonesia-related subjects of writing in progress include lessons from the cash transfer program, how such transfers have affected political participation, and the impacts of violent conflict on economic growth.  During his stay at Stanford, Dr. Sumarto was chosen to co-convene the September 2010 Indonesia Update conference in Canberra on “Employment, Living Standards, and Poverty in Contemporary Indonesia” and to co-edit the resulting book. 

Dr. Sumarto returns to Jakarta to become a senior research fellow at the Smeru Institute, which he co-founded and directed, and to continue his work on poverty alleviation in Indonesia.

Christian von Luebke

Former Shorenstein fellow Dr. von Luebke completed the first year of a two-year German Research Foundation fellowship at Stanford writing a book on democracy and governance in Southeast Asia.  Before the end of 2010, Gauging Governance:  The Mesopolitics of Democratic Change in Indonesia should be in the pipeline toward publication.  Other relevant work includes “Politics of Reform:  Political Scandals, Elite Resistance, and Presidential Leadership in Indonesia,” Journal of Current Southeast Asian Affairs (2010), and a co-authored piece on current economics and politics in the Bulletin of Indonesian Economic Studies (2010).  Pending revision and resubmission is an article on the political economy of investment climates in Indonesia.  In the course of the year he spoke on his research before audiences in North America, Europe, and Southeast Asia, and co-organized a panel on Southeast Asian politics to be held at the annual conference of Oxford Analytica in the UK in September 2010.

Dr. von Luebke’s plans for AY 2010-11 at Stanford include research and writing on Indonesia and the Philippines and teaching a course on Southeast Asian politics

How does a corrupt government stop corruption? What if that government is democratic, and must cultivate the support of political parties that are themselves corrupt? Is fostering reform in such a political economy the equivalent of trying to make snow in hell?

These questions may be overstated, but the dilemmas they convey are all too real. Witness the storm of concern triggered by the recent resignation of the highest-profile reformist in Indonesia, Sri Mulyani Indrawati, from her linchpin job as minister of finance in a country that was ranked the most corrupt and the most democratic in Southeast Asia in 2009.

Sri Mulyani waged unremitting war on graft. Under her stewardship of the finance ministry, more than 150 of its personnel were dishonorably discharged. Nearly 2,000 more were otherwise punished for infractions. She led a vigorous campaign against tax cheats. Among them were rich and influential people who had grown accustomed to absconding with funds they owed the government.

Euromoney named her ‘finance minister of the year’ in 2006—a post she had only taken up the year before. In 2008 and again in 2009 Forbes magazine admiringly listed her among ‘the 100 most powerful women in the world.’ Correspondingly, on the heels of her resignation on 5 May 2010, Indonesian stocks and rupiahs fell.

Indonesian president Susilo Bambang Yudhoyono (SBY) was directly elected to that office in 2004 and, for a second five-year term, in 2009. As president he has opposed corruption and championed reform. Fatefully, however, in 2004 he chose a wealthy businessman, Aburizal Bakrie, to join his government as coordinating minister for the economy.

In 2006 in East Java, a Bakrie-controlled company using an unprotected drill while probing for gas may have triggered a mud volcano that would swallow more than a dozen villages and render more than 15,000 people homeless. In 2010 the volcano continued to spew an estimated 100,000 tons of mud daily onto the surface. Bakrie’s reputation for probity was not enhanced when, reportedly against Mulyani’s advice, he insisted on denying responsibility for the disaster. Instead he blamed an undersea earthquake that had struck off the south coast of Java, some 250 kilometers away, two days before the mud erupted. Opinions remain divided as to what caused what.

An unambiguously man-made crisis in 2008, the global financial meltdown, shrank the Jakarta stock market, Bakrie’s holdings included. Trading on the exchange was temporarily suspended. Bakrie urged his fellow cabinet member Mulyani to extend the suspension. She refused. He was furious. Her relations with him worsened further when she slapped travel bans on certain Bakrie company executives accused of tax evasion.

In 2009 Bakrie became chair of the Golkar Party. Toward the end of that year he led a fierce campaign in the Indonesian legislature against both Mulyani and another nonpartisan technocrat, Indonesian vice-president Boediono, for malfeasance related to the government’s decision in 2008 to rescue an ailing financial institution, Bank Century. The bailout may have prevented a spiral of withdrawals, and thus helped Indonesia weather the global crisis, but the effort cost far more than expected, and some of the infusions apparently benefited key depositors more than the bank itself.

Legitimate financial questions were soon superseded, however, by a thoroughly political effort on the part of politicians and their supporters opposed to Mulyani and her reforms to oust not only her but the vice-president as well. Mulyani’s and Boediono’s opponents included, in addition to Bakrie, others whose circumstancial links to corruption she had uncovered.

An anti-Mulyani case in point is the Justice and Welfare Party (PKS). Despite priding itself on upholding Islamic ethics and opposing corruption, the PKS rejected allegations that one of its legislators, Muhammad Misbakhun, could have been implicated in a fictitious Bank Century letter of credit for US $22.5 million. When, at the end of April 2010, Misbakhun was arrested and detained on a warrant signed by the national police official in charge of economic and tax crimes, PKS leaders accused the police of having an ulterior motive. The party had by then, in effect, joined the anti-Mulyani chorus.

Subjected to intense and prolonged criticism by these politicians in the glare of the media, Mulyani had ample reason to quit the spotlight, resign, and leave Indonesia. (On 1 June 2010 she will become a managing director of the World Bank in Washington DC.) But her long record of nonpartisan tenacity in the struggle against corruption makes it hard to believe that she simply lost her will to fight. For the time being it is impossible to rule out that she was sacrificed for the sake of a restoration of political comity between SBY and his opponents.

The irony is that Golkar and the PKS had joined with SBY’s Democrat Party to form a ruling coalition, to which they continue to belong. SBY had built that coalition with the expectation that its members, having joined the government, would support it, including its campaign against corruption.

That inclusive or ‘rainbow’ strategy was a triple failure. First, cabinet posts that might have been held by competent and ethical nonpartisans motivated by a desire for public service were allocated instead to partisans whose skills and motives, shall we say, varied. Governance suffered. Second, coalition-party leaders who were given ministerial posts in return for ensuring broad legislative backing for the government in the legislature either would not or could not deliver that support. Cooptation failed. Third, some ruling-team politicians, who might have at least stood back from the fray, instead jumped in, seemingly hoping to blunt the government’s efforts to diminish corruption and improve governance while protecting themselves and furthering their own careers. Discipline frayed.

Mulyani has resigned. Has Bakrie won?

In a recent conversation, an off-the-record analyst anticipated ‘more stability, which, in Indonesia, correlates inversely with reform.’ He could be wrong. But it may not be coincidental that on 6 May 2010, one day after Mulyani announced her resignation, SBY met with ruling-coalition leaders. Or that the meeting launched a Coalition Parties Forum whose daily activities will be led by none other than the chair of the Golkar Party, Aburizal Bakrie. Or that Bakrie reported that SBY had agreed that the Forum would not try to bind the coalition to a common position. Or that, again according to Bakrie, whereas previously the coalition parties were only asked to help safeguard the government’s policies, henceforth they would be asked to help determine them as well. Much will depend on Mulyani’s replacement as minister of finance, and on whether he or she is told to stop rocking the boat.

If Mulyani’s remarkable legacy is indeed erased, illiberal circles in Singapore may think, ‘We thought so. Democracy does thwart reform.’ But my own judgment in hindsight will be less sweeping.

Indonesia’s Democrat Party is still basically an extension of the appealing personality of SBY. Over the six years since he was first elected president, more time, energy, and resources could have been invested in deepening the roots and popularity of the party itself. Had those assets been so spent, the Democrats might have been able, in the legislative elections of 2009, to enlarge their contingent of lawmakers enough to be able to rule, not by the dubious grace of Sri Mulyani’s antagonists, but in SBY’s and his party’s own right—subject to democracy’s checks and balances, yes, but freed of the need to cobble together a coalitional rainbow of colors that clash.

Donald K. Emmerson heads the Southeast Asia Forum at Stanford University and is also the editor of Hard Choices: Security, Democracy, and Regionalism in Southeast Asia. (Stanford/ISEAS, 2008/9)

A heartening number of analysts helpfully commented on an earlier draft of this essay.  While protecting their privacy by not naming them, I am grateful to them.  Complementing my focus here on the politics of Sri Mulyani’s exit is the economic context ably reviewed by Arianto A. Patunru and Christian von Luebke in their ‘Survey of Recent Developments’ in the Bulletin of Indonesian Economic Studies, 46: 1 (2010, 7-31.)

How does a corrupt government stop corruption? What if that government is democratic, and must cultivate the support of political parties that are themselves corrupt? Is fostering reform in such a political economy the equivalent of trying to make snow in hell?

These questions may be overstated, but the dilemmas they convey are all too real. Witness the storm of concern triggered by the recent resignation of the highest-profile reformist in Indonesia, Sri Mulyani Indrawati, from her linchpin job as minister of finance in a country that was ranked the most corrupt and the most democratic in Southeast Asia in 2009.

Sri Mulyani waged unremitting war on graft. Under her stewardship of the finance ministry, more than 150 of its personnel were dishonorably discharged. Nearly 2,000 more were otherwise punished for infractions. She led a vigorous campaign against tax cheats. Among them were rich and influential people who had grown accustomed to absconding with funds they owed the government.

Euromoney named her ‘finance minister of the year’ in 2006—a post she had only taken up the year before. In 2008 and again in 2009 Forbes magazine admiringly listed her among ‘the 100 most powerful women in the world.’ Correspondingly, on the heels of her resignation on 5 May 2010, Indonesian stocks and rupiahs fell.

Indonesian president Susilo Bambang Yudhoyono (SBY) was directly elected to that office in 2004 and, for a second five-year term, in 2009. As president he has opposed corruption and championed reform. Fatefully, however, in 2004 he chose a wealthy businessman, Aburizal Bakrie, to join his government as coordinating minister for the economy.

In 2006 in East Java, a Bakrie-controlled company using an unprotected drill while probing for gas may have triggered a mud volcano that would swallow more than a dozen villages and render more than 15,000 people homeless. In 2010 the volcano continued to spew an estimated 100,000 tons of mud daily onto the surface. Bakrie’s reputation for probity was not enhanced when, reportedly against Mulyani’s advice, he insisted on denying responsibility for the disaster. Instead he blamed an undersea earthquake that had struck off the south coast of Java, some 250 kilometers away, two days before the mud erupted. Opinions remain divided as to what caused what.

An unambiguously man-made crisis in 2008, the global financial meltdown, shrank the Jakarta stock market, Bakrie’s holdings included. Trading on the exchange was temporarily suspended. Bakrie urged his fellow cabinet member Mulyani to extend the suspension. She refused. He was furious. Her relations with him worsened further when she slapped travel bans on certain Bakrie company executives accused of tax evasion.

In 2009 Bakrie became chair of the Golkar Party. Toward the end of that year he led a fierce campaign in the Indonesian legislature against both Mulyani and another nonpartisan technocrat, Indonesian vice-president Boediono, for malfeasance related to the government’s decision in 2008 to rescue an ailing financial institution, Bank Century. The bailout may have prevented a spiral of withdrawals, and thus helped Indonesia weather the global crisis, but the effort cost far more than expected, and some of the infusions apparently benefited key depositors more than the bank itself.

Legitimate financial questions were soon superseded, however, by a thoroughly political effort on the part of politicians and their supporters opposed to Mulyani and her reforms to oust not only her but the vice-president as well. Mulyani’s and Boediono’s opponents included, in addition to Bakrie, others whose circumstancial links to corruption she had uncovered.

An anti-Mulyani case in point is the Justice and Welfare Party (PKS). Despite priding itself on upholding Islamic ethics and opposing corruption, the PKS rejected allegations that one of its legislators, Muhammad Misbakhun, could have been implicated in a fictitious Bank Century letter of credit for US $22.5 million. When, at the end of April 2010, Misbakhun was arrested and detained on a warrant signed by the national police official in charge of economic and tax crimes, PKS leaders accused the police of having an ulterior motive. The party had by then, in effect, joined the anti-Mulyani chorus.

Subjected to intense and prolonged criticism by these politicians in the glare of the media, Mulyani had ample reason to quit the spotlight, resign, and leave Indonesia. (On 1 June 2010 she will become a managing director of the World Bank in Washington DC.) But her long record of nonpartisan tenacity in the struggle against corruption makes it hard to believe that she simply lost her will to fight. For the time being it is impossible to rule out that she was sacrificed for the sake of a restoration of political comity between SBY and his opponents.

The irony is that Golkar and the PKS had joined with SBY’s Democrat Party to form a ruling coalition, to which they continue to belong. SBY had built that coalition with the expectation that its members, having joined the government, would support it, including its campaign against corruption.

That inclusive or ‘rainbow’ strategy was a triple failure. First, cabinet posts that might have been held by competent and ethical nonpartisans motivated by a desire for public service were allocated instead to partisans whose skills and motives, shall we say, varied. Governance suffered. Second, coalition-party leaders who were given ministerial posts in return for ensuring broad legislative backing for the government in the legislature either would not or could not deliver that support. Cooptation failed. Third, some ruling-team politicians, who might have at least stood back from the fray, instead jumped in, seemingly hoping to blunt the government’s efforts to diminish corruption and improve governance while protecting themselves and furthering their own careers. Discipline frayed.

Mulyani has resigned. Has Bakrie won?

In a recent conversation, an off-the-record analyst anticipated ‘more stability, which, in Indonesia, correlates inversely with reform.’ He could be wrong. But it may not be coincidental that on 6 May 2010, one day after Mulyani announced her resignation, SBY met with ruling-coalition leaders. Or that the meeting launched a Coalition Parties Forum whose daily activities will be led by none other than the chair of the Golkar Party, Aburizal Bakrie. Or that Bakrie reported that SBY had agreed that the Forum would not try to bind the coalition to a common position. Or that, again according to Bakrie, whereas previously the coalition parties were only asked to help safeguard the government’s policies, henceforth they would be asked to help determine them as well. Much will depend on Mulyani’s replacement as minister of finance, and on whether he or she is told to stop rocking the boat.

If Mulyani’s remarkable legacy is indeed erased, illiberal circles in Singapore may think, ‘We thought so. Democracy does thwart reform.’ But my own judgment in hindsight will be less sweeping.

Indonesia’s Democrat Party is still basically an extension of the appealing personality of SBY. Over the six years since he was first elected president, more time, energy, and resources could have been invested in deepening the roots and popularity of the party itself. Had those assets been so spent, the Democrats might have been able, in the legislative elections of 2009, to enlarge their contingent of lawmakers enough to be able to rule, not by the dubious grace of Sri Mulyani’s antagonists, but in SBY’s and his party’s own right—subject to democracy’s checks and balances, yes, but freed of the need to cobble together a coalitional rainbow of colors that clash.

Donald K. Emmerson heads the Southeast Asia Forum at Stanford University and is also the editor of Hard Choices: Security, Democracy, and Regionalism in Southeast Asia (Stanford/ISEAS, 2008/9).

A heartening number of analysts helpfully commented on an earlier draft of this essay.  While protecting their privacy by not naming them, I am grateful to them.  Complementing my focus here on the politics of Sri Mulyani’s exit is the economic context ably reviewed by Arianto A. Patunru and Christian von Luebke in their ‘Survey of Recent Developments’ in the Bulletin of Indonesian Economic Studies, 46: 1 (2010, 7-31.)

In early spring, historic health reform passes, extending insurance to millions of uninsured. Despite problems with workplace-based coverage, controversy over government subsidies for insurance premiums, and disparities across a large and diverse nation, dramatic shift to a single-payer system was seen as impractical.

Instead, reforms focus on expanding current social insurance programs as well as new initiatives to cover the uninsured, improve quality, and control spending. They provide a basic floor, subsidized for the poorest, but preserve consumer freedom to choose in health care. No government body dictates choice of doctor or hospital; investor-owned and private not-for-profits compete alongside government-run providers like community health centers and rural hospitals.

Left to be addressed in later phases are the difficult questions of how to slow the relentless pace of health care spending increases -- driven in part by technological change and population aging, but also perverse incentives embedded in fee-for-service payment and fragmented delivery. Pushed through despite multiple crises confronting the leadership, the final landmark health reform works in conjunction with measures enacted as part of the fiscal stimulus package to strengthen the healthcare system. Some provisions take effect immediately; others will take many years to unfold.

President Obama’s triumph on his top domestic priority? Actually, there were no votes along partisan lines, no controversy over abortion. I am describing health reform in China, which was announced almost exactly a year ago.

We do not hear much about the parallels in the US and Chinese social policy. But we cannot fully understand each other if we ignore these commonalities. We do not hear much about those who, in both societies, have been rendered destitute merely because they or a family member became sick or injured in a system with a social safety net full of gaping holes.

It will surprise many Americans to know that government financing as a share of total health spending was lower in socialist China over the last decade than in the United States. Now China has pledged about US$124 billion over 3 years to expand basic health insurance, strengthen public health and primary care, and reform public hospitals.

In China, the injustice of differential access to life-saving healthcare had sparked cases of social unrest. The April 2009 reform announcement was the culmination of years of post-SARS (2003) soul searching for a healthcare system befitting China’s dynamically transforming society. Special interests block change. (Sound familiar?) The CPC Central Committee and the State Council acknowledge that successful health reform will be “an arduous and long-term task”.  

If the US can pass sweeping health reform despite an unprecedented financial crisis, and China can envision universal health coverage for 1.3 billion while “getting old before getting rich,” then together we should be able to look past our many differences to focus on our common interests. Our two proud nations must work together to confront numerous challenges, such as upholding regional stability (e.g. on the Korean peninsula); redressing global economic imbalances (increasing health insurance can help spur China towards more domestic consumption); and investing in “green tech” for a warming planet and “grey tech” for an aging society.

 

* * *

When searching for insights about how other countries deal with similar challenges, Americans often look to Europe and Canada. Rarer is the comparison to counterparts across the Pacific. Yet President Obama has clearly articulated the vision of the US as a Pacific Nation, and there are developments around the Pacific Rim that merit consideration in our debates.  

Australia pioneered cost-effectiveness in health care purchasing, while the US continues to debate whether cost should be part of comparative effectiveness research and policy decisions.

Both Japan and South Korea, like Germany, have enacted long term care insurance to smooth the transition to an aging society. Their experiences might be fruitful as we implement the first national government-run long-term care insurance program, a little-heralded component of the newly passed legislation (and a fitting legacy of Senator Edward Kennedy).

Japan and Singapore provide universal coverage to older populations than ours with health systems that, although surprisingly different from each other in terms of public financing and role of market forces, both ranked among the best in the world -- and far higher than the US -- in the World Health Organization’s ranking of health systems in the year 2000. Although one may quibble with the ranking, it is indisputable that Japan spends a much smaller share of GDP on healthcare than the US does, despite being one of the oldest and longest-lived societies in the history of the world and having (like the US) a fee-for-service payment system.

Japan and South Korea are also democracies, where health policies occasionally engender heated debates. In South Korea, physicians went on nationwide strike three times to oppose the separation of prescribing from dispensing. Although Japan’s incremental reforms rarely spur such drama, the passions aroused by end-of-life care – embodied in the bizarre “death panels” controversy in the US health reform debate of 2009 – has its counterpart in the bitter nickname for Japan’s separate insurance plan for the oldest old: “hurry-up-and-die” insurance.

Yet Japan, Singapore, and Hong Kong all offer health systems that provide reasonable risk protection and quality of care for populations older than ours, with a diverse range of government and market roles in financing and delivery, while spending far less per capita than the US.

No system has all the answers. But the US and our neighbors across the vast Pacific have a common interest in sharing what we’ve found that works for health reform. Despite divergence in our political and economic systems, we all value long, healthy lives for ourselves and our children -- and we’re united in health reforms that try to further that goal.