North Korean leader Kim Jong-il’s apparent stroke in mid-August raises the possibility of near-term political succession in the Democratic People’s Republic of Korea (DPRK, or North Korea). This has prompted U.S. and Republic of Korea (ROK, or South Korea) planners—concerned with command and control of North Korea’s fissile material under conditions of regime disarray, internecine conflict, or collapse—to examine afresh the alliance’s assumptions, contingency plans, and political strategies.

The Korean Peninsula occupies a central place in the Chinese national security calculus. Chinese policy above all aims to avert military conflict on the Peninsula and regime collapse in the North. Conflict and collapse scenarios could embroil China in unwanted military action, imperil its long-term economic development program, jeopardize its crucial ties with the United States and South Korea, open the floodgates to North Korean refugees, and alter the Northeast Asian strategic landscape to China’s disadvantage.

For these and other reasons, China has emphasized the need for a peaceful, negotiated resolution of the problem posed by North Korea’s nuclear ambitions. It has encouraged North Korea to emulate, to the extent feasible, China’s own post-1978 economic reforms. At the same time, China has deepened political and commercial ties with South Korea, and sustained the North Korean regime through generous economic and military assistance.

China’s core interests—plus its special ties with North Korea’s military, party, security, and economic elite—have persuaded many outside observers that Beijing possesses not only unique insights into the Pyongyang regime’s internal dynamics but also potential leverage. Further, many assume that China, having both the need and ability to influence North Korea’s political succession, will do precisely that—shape, or if necessary impose, a North Korean succession that accords with China’s policy interests.
China has consistently denied having superior knowledge and usable leverage, and has adamantly rebuffed speculation regarding its national ambitions and potential actions.

Such disclaimers notwithstanding, some in the ROK and the United States postulate that national and alliance interests might best be served by “coordinating” with China on North Korean regime change/collapse scenarios. A few even argue that the alliance should “subcontract” this issue to China, thereby tacitly acquiescing in its intervention to ensure a peaceful, stable transition.

Despite the high stakes, crucial U.S.-ROK contingency planning seemingly has been approached in an environment that is rich in conjecture and hope, and poor in hard intelligence and agreed assessments.
Yet it is possible—indeed imperative—to do better than this. With respect to one small part of the complex whole—China’s interests, potential leverage, and likely actions—a starting point for rigorous
analysis might include the following issues and questions:

Knowledge : Does China in fact enjoy superior knowledge of internal DPRK decision-making? What are the sources of and limits upon such knowledge? How have the North Koreans approachedspecial bilateral ties with the Chinese in the realms of party-to-party affairs and military cooperation?
Are there reasons to believe that China contributed to North Korea’s nuclear program? If not, are there reasons to believe that North Korea shared any knowledge whatsoever of its activities with China? Has China sought to cultivate North Korean officials and, if so, when, and how successfully?  How has North Korea reacted to any such Chinese activities?

Leverage: How much leverage does China enjoy over North Korean political, military, and economic decisions? What are the sources of such leverage? What are the constraints? How should one assess North Korea’s likely response to Chinese pressure? What options does North Korea enjoy in deflecting such pressure?

A Proactive Approach by China to North Korean Political Succession : What posture is China likely to adopt toward political succession in North Korea? What are its policy options? What assets does it hold? How does the issue of North Korean succession—including the possibility of regime chaos or collapse—fit into China’s broad strategic posture? What external considerations (especially those involving the ROK, the United States, Japan, and Russia) must China take into account?

ROK and U.S. Policy Considerations Regarding China’s Potential Involvement in a North Korean • Political Succession: What essential posture should the ROK and the United States adopt? On the one hand, should they enlist China’s cooperation in “managing” political succession in North Korea, or endeavor to minimize that involvement, instead addressing North Korean succession scenarios as primarily a task for the U.S.-ROK alliance? On the other hand, should they accept (and even tacitly encourage) China’s superior ability to effect a stable succession that preserves peace and stability? Should they broaden the scope of the current six-party talks to include formal discussion among “the five” (excepting North Korea)? Or should some other approach be adopted?

On one level, U.S. and ROK planners must urgently address these issues in order to have confidence that the two allies can deal smoothly with any North Korean political succession scenario. On a deeper level, a rigorous bilateral analysis of this type can serve to strengthen the U.S.-ROK alliance itself by fully illuminating a broader set of underlying national attitudes, interests, and priorities.

Over more than six decades, the partnership between the United States and the Republic of Korea has been subject to many stresses and strains, from the Korean War to coping with the challenge of North Korea’s nuclear ambitions. More recently, the democratization of South Korea has opened the alliance to much greater public scrutiny and pressures from an active and mobilized Korean public. Managing this strategic alliance in an era of democracy has been a focus of the research work on Korea conducted by FSI’s Walter H. Shorenstein Asia-Pacific Research Center.

With the election in December of Lee Myung-bak as South Korea’s president, ending two terms of progressive rule, Shorenstein APARC decided to launch a nonpartisan group of former senior U.S. government officials, scholars, and other American experts on Korea to explore how to revitalize the U.S. alliance with the Republic of Korea (ROK) after a decade of tensions. In partnership with the New York-based Korea Society, Shorenstein APARC assembled this policy study group at Stanford in early February for in-depth discussion of the challenges facing the alliance and then took the group to Korea for meetings with key figures, from President-elect Lee and his advisors to leaders of the opposition, Korean businessmen, and American diplomats and security officials.

Based on these intensive meetings, the members of this “New Beginnings” policy study group concluded that the United States now has a major opportunity to bolster and broaden its relationship with the ROK. Lee, Korea’s first businessman to be elected president and a self-proclaimed “pragmatist,” has stressed that he gives top priority to the United States in his foreign policy. His fixed five-year tenure will coincide with the entire first term of the next U.S. president, allowing the two new leaders an extended period of cooperation.

Immediately before Lee’s first visit to the United States as president in mid-April, New Beginnings members led by Shorenstein APARC Director Gi-Wook Shin, APARC Distinguished Fellow Michael H. Armacost, and Korea Society President Evans J.R. Revere visited Washington, D.C., and New York City to release their report, New Beginnings in the U.S.-ROK Alliance: Recommendations to U.S. Policymakers. They also addressed a forum in San Francisco co-hosted by the World Affairs Council and the Asia Society of Northern California on June 3 to discuss their recommendations and subsequent developments in U.S.-South Korean relations. The report received extensive coverage in the South Korean news media and was noted in American media as well.

Surrounded by a rising China, a more assertive Russia, a Japan seeking a greater international role, and a nuclear North Korea, the ROK can play a key role in working with the United States to maintain peace and stability in East Asia. No effort to address the nuclear and other challenges posed by North Korea is likely to succeed without the closest U.S.-South Korean cooperation. The ROK, as the world’s 13th-largest economy and one of Asia’s most democratic countries, is a model of the virtues of a market economy, of the values of freedom and human rights, and of alignment with the United States. The two countries are also bound by personal ties: 2 million people of Korean descent live in the United States, and 100,000 Koreans come to the United States each year for study and exchanges, more than from any other country.

President Lee’s election reflects four key changes in South Korea: (1) a shift from the political left back toward the center; (2) greater skepticism about North Korea; (3) increased wariness of China; and (4) enhanced support for the U.S.-ROK alliance. The protests against the United States seen in South Korea in 2002 were the result in part of transitory circumstances and no longer reflect the reality there.

President Lee seeks a global partnership with the United States while maintaining good relations with Korea’s neighbors, Japan, China, and Russia. He favors improved relations with North Korea and has stated his willingness to meet North Korean leader Kim Jong-Il. In major departures from the earlier “sunshine” policy of the South Korean government toward North Korea, however, Lee will not provide large-scale economic assistance to the North until after it abandons its nuclear weapons program. In another major departure from the previous ROK policy, he has also criticized human rights abuses in North Korea. Lee supports continued food and other humanitarian aid to the people of North Korea.

New Beginnings group members believe that the United States cannot afford to lose the opportunity presented by President Lee to build a global partnership with one of the United States’ most important allies. The group identified a number of steps that the United States, in cooperation with the ROK, could take to move the alliance into a new era (see sidebar).

The New Beginnings group has announced that it plans to continue its efforts in support of strengthened U.S.-South Korean relations. Among other projects, the group intends to present recommendations early next year to the South Korean government on how to develop a close relationship and bolster the alliance with the incoming U.S. administration.

Recommendations to United States Policymakers

• Global Partnership — Building on the cooperation between Presidents Bush and Lee, the new U.S. president next year should issue a vision statement with Lee detailing their partnership and goals for the alliance. To advise them, the two new presidents should establish a bi-national panel of distinguished Koreans and Americans. The United States and the ROK should also give increased emphasis to the foreign ministerial strategic dialogue they initiated in 2006.
• Security Alliance — We support the ongoing realignment of U.S. forces in the ROK. Congress should increase its budget for the relatively small U.S. portion of the total cost of its implementation. The decision to transfer wartime operational control of Korean forces back to the ROK in 2012 was likewise correct, but the United States should respond positively to any South Korean proposal to discuss conditions related to the transfer. We welcome the Lee administration’s apparent desire to review the main North Korea war plan and to prepare jointly for other contingencies, including that of a North Korean collapse. The United States should conduct regular, joint consultations with South Korea and other allies in East Asia to determine whether security conditions warrant changes in our respective force levels and, if so, in what direction.
• North Korea — The ROK election has brought the United States and South Korea into essential agreement, for the first time in seven years, on how to deal with North Korea and its nuclear aspirations. To avoid the danger that their North Korea policies will again diverge, they must establish stronger consultative mechanisms, including with Japan.
• Economy and Trade — Congress should ratify the U.S.-ROK Free Trade Agreement now. U.S. failure to approve the FTA would not only represent foregone business opportunities; it would damage U.S.-ROK relations and be seen by the international community as a weakening of U.S. self-confidence and engagement, in East Asia and around the globe.
• People-to-People Ties — The U.S. government should set an early target date to include the ROK in the Visa Waiver Program and encourage the Korean government to support a major expansion of the Fulbright Program’s English Teaching Assistant Program. The United States should create a new program to allow U.S. federal employees to intern in Korean ministries and increase the budget for the State Department’s International Visitor Program for young South Korean leaders. U.S. military personnel stationed in Korea should be joined by their families. The United States should, at long last, construct a new U.S. embassy in Seoul.

Clear evidence suggests the importance of health service provider payment incentives for achieving efficiency, equal access, and quality, including attention to primary, secondary, and tertiary prevention. “Pay for performance” may be on the cusp of significant expansion in Asia, and reform away from fee-for-service has been underway for several years in several economies. Yet despite the policy relevance, the evidence base for evaluating payment reforms in Asia is still very limited.

China in particular has been undertaking significant reforms to its health care system in both rural and urban areas. With the expansion of insurance coverage and need to resolve incentive problems like “supporting medical care through drug sales,” there is an urgent need for evaluating alternative ways of paying health service providers. Evidence from policy reforms in specific regions of China, as well as other economies of the Asia-Pacific, can provide valuable evidence to help inform policy decisions about how to align provider incentives with policy goals of quality care at reasonable cost.

To illuminate these questions, the Asia Health Policy Program and several collaborating institutions are planning to convene a conference on health care provider payment incentives on November 7-8, 2008 in Beijing. The conference will highlight and seek to distill “best-practice” lessons from rigorous and policy-relevant evaluations of recent reforms in China and elsewhere in the Asia Pacific.

The organizing committee – including health economists from Shorenstein APARC, Peking University, Tsinghua University, and Seoul National University – reviewed submissions in June 2008 and accepted sixteen. The conference papers cover payment issues in Korea, Japan, China, Taiwan, Thailand, Tajikistan, the Philippines, and the US, and the disciplines of economics, health services research/health policy, public health, medicine, and ethics. Topics include institutionalized informal payments; the impact of global budget policies on high-cost patients; public-private partnerships; public-sector physicians owning private pharmacies; evidence-informed case payment rates; payment and hospital quality; bonuses and physician satisfaction; physician prescription choice between brand-name and generic drugs; and differences in pharmaceutical utilization across insurance plans that pay providers differently (fee-for-service versus capitation).

Policymakers from China’s National Development and Reform Commission and Ministry of Health will also speak at the conference. Selected research papers will be published through the Shorenstein Asia-Pacific Research Center either in a special volume or in a special issue of an English-language health policy journal.