Twenty years have passed since the Berlin Wall fell and Angela Merkel – then a budding politician who grew up in communist East Germany – first saw the potential and promise of a free world.

Now the chancellor of Germany, Merkel says freedom can only flourish with international cooperation aimed at making the world safer, cleaner and more economically stable.

"Freedom and solidarity and partnership belong together," Merkel told a capacity crowd at Stanford's Dinkelspiel Auditorium on Thursday after being introduced by President Emeritus Gerhard Casper. "They must be indivisible for us to be able to master the challenges ahead."

But Merkel's speech – the only one she delivered during a four-day trip to the United States – showed that those alliances often come at a cost. Speaking hours after four German troops were killed in fighting in Afghanistan, Merkel expressed her condolences while calling the war a "mission that guarantees our freedom and security."

"It is a sad experience for us in Germany," she said. "It is an experience we share with you in the United States."

With polls showing the war becoming increasingly unpopular in Germany, Merkel said she accepts and respects "doubts" about whether the conflict is necessary or right. But her commitment to fighting the war is unwavering.

She told the audience at Dinkelspiel that the fallout of the international financial crisis "will be with us for a long time to come." But strengthening global trade agreements, steering away from protectionism and bolstering innovation will put financial markets back on the right course, she said.

European financial woes are a volatile topic in Germany right now. The country has offered to pitch in about $11 billion for a Greek economic rescue package, a move that has sparked criticism of Merkel's government.
The bailout poses a serious political risk, as Merkel’s political party faces regional elections in Germany's biggest state on May 9. The party of Christian Democrats must win in order to maintain its majority in the Bundesrat, parliament's upper house.

Merkel did not directly address the Greek economic situation during her speech, but she did stress the need for countries to work together and share responsibility for strengthening the world's financial future.
"We need a new global financial architecture," she said. "We need rules that prevent a whole community of nations from being damaged because individuals have made mistakes."

She said the players behind the world's largest markets have to take an interest in emerging economies and "sit down and reflect together with them" how to establish a strong and prosperous global economy.

A scientist by training, Merkel earned a doctorate in physics and worked as a chemist at a scientific academy in East Berlin. While she was a student, Stanford "was just a far, far-away scientific paradise unreachable from behind the Iron Curtain." And when the Berlin Wall came down, she found herself pulled to a life of politics.

But first, she and her husband celebrated their newfound freedom by doing what they had long dreamed of. They visited California. The chancellor reminisced about the trip as she concluded her speech at Dinkelspiel, standing in front of a backdrop displaying Stanford's German motto: Die Luft der Freiheit weht.

The wind of freedom blows.

Jonathan Rabinovitz contributed to this report.

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.

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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.