Paragraphs

Dissatisfaction with the financing of U.S. health care is widespread. The system is inefficient, inequitable, and increasingly perceived to be unaffordable. Because only incremental reform is deemed politically feasible, inordinate attention is devoted to treating the institutional symptoms rather than diagnosing systemic problems that require major surgery. As an alternative, we propose a voucher system for universal health care, an efficient, fair, and relatively simple approach that might elicit broad support. We recognize that change is not imminent, but such a proposal can stimulate discussion and provide a readily available model when the political climate becomes hospitable for endorsing meaningful reform.

The key features of the voucher system are the following:

  • Universality
  • Free Choice of Health Plan
  • Freedom to Purchase Additional Services
  • Funding by an Earmarked Value-Added Tax
  • Reliance on a Private Delivery System
  • End of Employer-Based Insurance
  • Elimination of Medicaid and Other Means-Tested Programs
  • Phasing Out of Medicare
  • Administration by a Federal Health Board
  • Establishment of an independent Institute for Technology and Outcomes Assessment
All Publications button
1
Publication Type
Journal Articles
Publication Date
Journal Publisher
New England Journal of Medicine
Authors
-

Dr. Hilton Root, an academic and policy specialist in international political economy and development joined the Faculty of Pitzer, a member of Claremont Colleges, as Freeman Fellow from June 2003 to June 2005. Before joining, he served the current administration as US Executive Director Designate of the Asian Development Bank, and as senior advisor on development finance to the Department of the Treasury. Dr. Root was Director and Senior Fellow of Global Studies at the Milken Institute and was a Senior Research Fellow and Director of the Initiative on Economic Growth and Democracy at the Hoover Institution. His areas of expertise are international economics, economic development and policy reform, and Asian affairs.

As a policy expert, Dr. Root advises the Asian Development Bank, the IMF, the World Bank, the UNDP, the OECD, the US State Department, the US Treasury Department and USAID. He has completed projects in 23 countries. The analytical framework he contributed to the World Bank's Asian Miracle study, 1993, was part of the effort to put institutions on the development agenda. While at the ADB as chief advisor on governance, he was the principal author of the ADB's Board-approved governance policy. He presided over a committee on governance indicators at the OECD and initiated the restructuring of the Sri Lanka civil service as an advisor to President Chandrika Bandaranaike Kumaratunga. He was one of the principal contributors to the design of the Millenium Challenge Account of the Bush administration.

As an academic, he has taught at the University of Michigan, California Institute of Technology, the University of Pennsylvania and Stanford University. Dr. Root has written and lectured extensively, publishing six books and more than 100 articles. He is a frequent contributor to the Wall Street Journal Asia, the International Herald Tribune, Los Angeles Times and the Washington Post. He has published and presented in both the English and the French languages and has been translated into many languages including Chinese, Korean and Japanese.

He has been awarded honors for The Key to the East Asian Miracle: Making Shared Growth Credible (with J. Edgardo Campos), which won the 1997 Charles H. Levine Award for best book of the year by the International Political Science Association. The Social Sciences History Association awarded him the 1995 best book prize of its Economic History Section for The Fountain of Privilege: Political Foundations of Markets in Old Regime France and England. From the American Historical Association he received the Chester Higby Prize, 1986, for the best article among those published during the previous two years. He is on the board of a number of organizations and journals including the Open Society Institute, Center for Public Integrity and Review of Pacific Basin Markets and Policies. Dr. Root received his doctorate from the University of Michigan in 1983.

Encina Basement Conference Room

Hilton Root Professor or Economics Claremont Colleges, Claremont, CA
Seminars
-

CDDRL Fellow, J. Alexander Thier will discuss Afghanistan's experiences with nation building, particularly in the post-Taliban era. J Alexander Thier was legal advisor to Afghanistan's Constitutional and Judicial Reform Commissions in Kabul in 2003-2004, where he assisted in the development of a new constitution and judicial system. In 2002 Alex worked in Kabul as a Constitutional and Legal expert to the British Department for International Development, and as Senior Analyst for the International Crisis Group.

Encina Basement Conference Room

J Alexander Thier Visiting Fellow CDDRL
Seminars
Paragraphs

Background: Although the Centers for Disease Control and Prevention (CDC) recommend routine HIV counseling, testing, and referral (HIVCTR) in settings with at least a 1 percent prevalence of HIV, roughly 280,000 Americans are unaware of their human immunodeficiency virus (HIV) infection. The effect of expanded screening for HIV is unknown in the era of effective antiretroviral therapy.

Methods: We developed a computer simulation model of HIV screening and treatment to compare routine, voluntary HIVCTR with current practice in three target populations: "high-risk" (3.0 percent prevalence of undiagnosed HIV infection; 1.2 percent annual incidence); "CDC threshold" (1.0 percent and 0.12 percent, respectively); and "U.S. general" (0.1 percent and 0.01 percent). Input data were derived from clinical trials and observational cohorts. Outcomes included quality-adjusted survival, cost, and cost-effectiveness.

Results: In the high-risk population, the addition of one-time screening for HIV antibodies with an enzyme-linked immunosorbent assay (ELISA) to current practice was associated with earlier diagnosis of HIV (mean CD4 cell count at diagnosis, 210 vs. 154 per cubic millimeter). One-time screening also improved average survival time among HIV-infected patients (quality-adjusted survival, 220.7 months vs. 219.8 months). The incremental cost-effectiveness was $36,000 per quality-adjusted life-year gained. Testing every five years cost $50,000 per quality-adjusted life-year gained, and testing every three years cost $63,000 per quality-adjusted life-year gained. In the CDC threshold population, the cost-effectiveness ratio for one-time screening with ELISA was $38,000 per quality-adjusted life-year gained, whereas testing every five years cost $71,000 per quality-adjusted life-year gained, and testing every three years cost $85,000 per quality-adjusted life-year gained. In the U.S. general population, one-time screening cost $113,000 per quality-adjusted life-year gained.

Conclusions: In all but the lowest-risk populations, routine, voluntary screening for HIV once every three to five years is justified on both clinical and cost-effectiveness grounds. One-time screening in the general population may also be cost-effective.

All Publications button
1
Publication Type
Journal Articles
Publication Date
Journal Publisher
New England Journal of Medicine
Authors
Paragraphs

Background:

The costs, benefits, and cost-effectiveness of screening for human immunodeficiency virus (HIV) in health care settings during the era of highly active antiretroviral therapy (HAART) have not been determined.

Methods:

We developed a Markov model of costs, quality of life, and survival associated with an HIV-screening program as compared with current practice. In both strategies, symptomatic patients were identified through symptom-based case finding. Identified patients started treatment when their CD4 count dropped to 350 cells per cubic millimeter. Disease progression was defined on the basis of CD4 levels and viral load. The likelihood of sexual transmission was based on viral load, knowledge of HIV status, and efficacy of counseling.

Results:

Given a 1 percent prevalence of unidentified HIV infection, screening increased life expectancy by 5.48 days, or 4.70 quality-adjusted days, at an estimated cost of $194 per screened patient, for a cost-effectiveness ratio of $15,078 per quality-adjusted life-year. Screening cost less than $50,000 per quality-adjusted life-year if the prevalence of unidentified HIV infection exceeded 0.05 percent. Excluding HIV transmission, the cost-effectiveness of screening was $41,736 per quality-adjusted life-year. Screening every five years, as compared with a one-time screening program, cost $57,138 per quality-adjusted life-year, but was more attractive in settings with a high incidence of infection. Our results were sensitive to the efficacy of behavior modification, the benefit of early identification and therapy, and the prevalence and incidence of HIV infection.

Conclusions:

The cost-effectiveness of routine HIV screening in health care settings, even in relatively low-prevalence populations, is similar to that of commonly accepted interventions, and such programs should be expanded.

All Publications button
1
Publication Type
Journal Articles
Publication Date
Journal Publisher
New England Journal of Medicine
Authors
Douglas K. Owens
Authors
News Type
Commentary
Date
Paragraphs
Imagine that Israel never existed. Would the economic malaise and political repression that drive angry young men to become suicide bombers vanish? Would the Palestinians have an independent state? Would the United States, freed of its burdensome ally, suddenly find itself beloved throughout the Muslim world? Wishful thinking. Far from creating tensions, Israel actually contains more antagonisms than it causes.

Since World War II, no state has suffered so cruel a reversal of fortunes as Israel. Admired all the way into the 1970s as the state of "those plucky Jews" who survived against all odds and made democracy and the desert bloom in a climate hostile to both liberty and greenery, Israel has become the target of creeping delegitimization. The denigration comes in two guises. The first, the soft version, blames Israel first and most for whatever ails the Middle East, and for having corrupted U.S. foreign policy. It is the standard fare of editorials around the world, not to mention the sheer venom oozing from the pages of the Arab-Islamic press. The more recent hard version zeroes in on Israel's very existence. According to this dispensation, it is Israel as such, and not its behavior, that lies at the root of troubles in the Middle East. Hence the "statocidal" conclusion that Israel's birth, midwifed by both the United States and the Soviet Union in 1948, was a grievous mistake, grandiose and worthy as it may have been bat the time.

The soft version is familiar enough. One motif is the "wagging the dog" theory. Thus, in the United States, the "Jewish lobby" and a cabal of neoconservatives have bamboozled the Bush administration into a mindless pro-Israel policy inimical to the national interest. This view attributes, as has happened so often in history, too much clout to the Jews. And behind this charge lurks a more general one-that it is somehow antidemocratic for subnational groups to throw themselves into the hurly-burly of politics when it comes to foreign policy. But let us count the ways in which subnational entities battle over the national interest: unions and corporations clamor for tariffs and tax loopholes; nongovernmental organizations agitate for humanitarian intervention; and Cuban Americans keep us from smoking cheroots from the Vuelta Abajo. In previous years, Poles militated in favor of Solidarity, African Americans against Apartheid South Africa, and Latvians against the Soviet Union. In other words, the democratic melee has never stopped at the water's edge.

Another soft version is the "root-cause" theory in its many variations.

Because the "obstinate" and "recalcitrant" Israelis are the main culprits, they must be punished and pushed back for the sake of peace. "Put pressure on Israel"; "cut economic and military aid"; "serve them notice that we will not condone their brutalities"-these have been the boilerplate homilies, indeed the obsessions, of the chattering classes and the foreign-office establishment for decades. Yet, as Sigmund Freud reminded us, obsessions tend to spread. And so there are ever more creative addenda to the well-wrought root-cause theory. Anatol Lieven of the Carnegie Endowment for International Peace argues that what is happening between Israelis and Palestinians is a "tremendous obstacle to democratization because it inflames all the worst, most regressive aspects of Arab nationalism and Arab culture." In other words, the conflict drives the pathology, and not the other way around-which is like the streetfighter explaining to the police: "It all started when this guy hit back."

The problem with this root cause argument is threefold: It blurs, if not reverses, cause and effect. It ignores a myriad of conflicts unrelated to Israel. And it absolves the Arabs of culpability, shifting the blame to you know whom. If one believes former U.N. weapons inspector Scott Ritter, the Arab-Islamic quest for weapons of mass destruction, and by extension the war against Iraq, are also Made in Israel. "[A]s long as Israel has nuclear weapons," Ritter opines, "it has chosen to take a path that is inherently confrontational....Now the Arab countries, the Muslim world, is not about to sit back and let this happen, so they will seek their own deterrent. We saw this in Iraq, not only with a nuclear deterrent but also with a biological weapons deterrent...that the Iraqis were developing to offset the Israeli nuclear superiority."

This theory would be engaging if it did not collide with some inconvenient facts. Iraqis didn't use their weapons of mass destruction against the Israeli usurper but against fellow Muslims during the Iran-Iraq War, and against fellow Iraqis in the poison-gas attack against Kurds in Halabja in 1988-neither of whom were brandishing any nuclear weapons. As for the Iraqi nuclear program, we now have the "Duelfer Report," based on the debriefing of Iraqi regime loyalists, which concluded: "Iran was the preeminent motivator of this policy. All senior-level Iraqi officials considered Iran to be Iraq's principal enemy in the region. The wish to balance Israel and acquire status and influence in the Arab world were also considerations, but secondary."

Now to the hard version. Ever so subtly, a more baleful tone slips into this narrative: Israel is not merely an unruly neighbor but an unwelcome intruder. Still timidly uttered outside the Arab world, this version's proponents in the West bestride the stage as truth sayers who dare to defy taboo. Thus, the British writer A.N. Wilson declares that he has reluctantly come to the conclusion that Israel, through its own actions, has proven it does not have the right to exist. And, following Sept. 11, 2001, Brazilian scholar Jose Arthur Giannotti said: "Let us agree that the history of the Middle East would be entirely different without the State of Israel, which opened a wound between Islam and the West. Can you get rid of Muslim terrorism without getting rid of this wound which is the source of the frustration of potential terrorists?"

The very idea of a Jewish state is an "anachronism," argues Tony Judt, a professor and director of the Remarque Institute at New York University. It resembles a "late-nineteenth-century separatist project" that has "no place" in this wondrous new world moving toward the teleological perfection of multiethnic and multicultural togetherness bound together by international law. The time has come to "think the unthinkable," hence, to ditch this Jewish state for a binational one, guaranteed, of course, by international force.

So let us assume that Israel is an anachronism and a historical mistake without which the Arab-Islamic world stretching from Algeria to Egypt, from Syria to Pakistan, would be a far happier place, above all because the original sin, the establishment of Israel, never would have been committed. Then let's move from the past to the present, pretending that we could wave a mighty magic wand, and "poof," Israel disappears from the map.

Civilization of Clashes

Let us start the what-if procession in 1948, when Israel was born in war.

Would stillbirth have nipped the Palestinian problem in the bud? Not quite. Egypt, Transjordan (now Jordan), Syria, Iraq, and Lebanon marched on Haifa and Tel Aviv not to liberate Palestine, but to grab it. The invasion was a textbook competitive power play by neighboring states intent on acquiring territory for themselves. If they had been victorious, a Palestinian state would not have emerged, and there still would have been plenty of refugees. (Recall that half the population of Kuwait fled Iraqi dictator Saddam Hussein's "liberation" of that country in 1990.) Indeed, assuming that Palestinian nationalism had awakened when it did in the late 1960s and 1970s, the Palestinians might now be dispatching suicide bombers to Egypt, Syria, and elsewhere.

Let us imagine Israel had disappeared in 1967, instead of occupying the West Bank and the Gaza Strip, which were held, respectively, by Jordan's King Hussein and Egypt's President Gamal Abdel Nasser. Would they have relinquished their possessions to Palestinian leader Yasir Arafat and thrown in Haifa and Tel Aviv for good measure? Not likely. The two potentates, enemies in all but name, were united only by their common hatred and fear of Arafat, the founder of Fatah (the Palestine National Liberation Movement) and rightly suspected of plotting against Arab regimes. In short, the "root cause" of Palestinian statelessness would have persisted, even in Israel's absence.

Let us finally assume, through a thought experiment, that Israel goes "poof" today. How would this development affect the political pathologies of the Middle East? Only those who think the Palestinian issue is at the core of the Middle East conflict would lightly predict a happy career for this most dysfunctional region once Israel vanishes. For there is no such thing as "the" conflict. A quick count reveals five ways in which the region's fortunes would remain stunted-or worse:

States vs. States Israel's elimination from the regional balance would hardly bolster intra-Arab amity. The retraction of the colonial powers, Britain and France, in the mid-20th century left behind a bunch of young Arab states seeking to redraw the map of the region. From the very beginning, Syria laid claim to Lebanon. In 1970, only the Israeli military deterred Damascus from invading Jordan under the pretext of supporting a Palestinian uprising. Throughout the 1950s and 1960s, Nasser's Egypt proclaimed itself the avatar of pan-Arabism, intervening in Yemen during the 1960s. Nasser's successor, President Anwar Sadat, was embroiled in on-and-off clashes with Libya throughout the late 1970s. Syria marched into Lebanon in 1976 and then effectively annexed the country 15 years later, and Iraq launched two wars against fellow Muslim states: Iran in 1980, Kuwait in 1990. The war against Iran was the longest conventional war of the 20th century. None of these conflicts is related to the Israeli-Palestinian one. Indeed, Israel's disappearance would only liberate military assets for use in such internal rivalries.

Believers vs. Believers: Those who think that the Middle East conflict is a "Muslim-Jewish thing" had better take a closer look at the score card: 14 years of sectarian bloodshed in Lebanon; Saddam's campaign of extinction against the Shia in the aftermath of the first Gulf War; Syria's massacre of 20,000 people in the Muslim Brotherhood stronghold of Hama in 1982; and terrorist violence against Egyptian Christians in the 1990s. Add to this tally intraconfessional oppression, such as in Saudi Arabia, where the fundamentalist Wahhabi sect wields the truncheon of state power to inflict its dour lifestyle on the less devout.

Ideologies vs. Ideologies: Zionism is not the only "ism" in the region, which is rife with competing ideologies. Even though the Baathist parties in Syria and Iraq sprang from the same fascist European roots, both have vied for precedence in the Middle East. Nasser wielded pan-Arabism-cumsocialism against the Arab nation-state. And both Baathists and Nasserites have opposed the monarchies, such as in Jordan. Khomeinist Iran and Wahhabite Saudi Arabia remain mortal enemies. What is the connection to the Arab-Israeli conflict? Nil, with the exception of Hamas, a terror army of the faithful once supported by Israel as a rival to the Palestine Liberation Organization and now responsible for many suicide bombings in Israel. But will Hamas disband once Israel is gone? Hardly Hamas has bigger ambitions than eliminating the "Zionist entity." The organization seeks nothing less than a unified Arab state under a regime of God.

Reactionary Utopia vs. Modernity: A common enmity toward Israel is the only thing that prevents Arab modernizers and traditionalists from tearing their societies apart. Fundamentalists vie against secularists and reformist Muslims for the fusion of mosque and state under the green flag of the Prophet. And a barely concealed class struggle pits a minuscule bourgeoisie and millions of unemployed young men against the power structure, usually a form of statist cronyism that controls the means of production. Far from creating tensions, Israel actually contains the antagonisms in the world around it.

Regimes vs. Peoples: The existence of Israel cannot explain the breadth and depth of the Mukhabarat states (secret police states) throughout the Middle East. With the exceptions of Jordan, Morocco, and the Gulf sheikdoms, which gingerly practice an enlightened monarchism, all Arab countries (plus Iran and Pakistan) are but variations of despotism-from the dynastic dictatorship of Syria to the authoritarianism of Egypt. Intranational strife in Algeria has killed nearly 100,000, with no letup in sight. Saddam's victims are said to number 300,000. After the Khomeinists took power in 1979, Iran was embroiled not only in the Iran-Iraq War but also in barely contained civil unrest into the 1980s. Pakistan is an explosion waiting to happen. Ruthless suppression is the price of stability in this region.

Again, it would take a florid imagination to surmise that factoring Israel out of the Middle East equation would produce liberal democracy in the region. It might be plausible to argue that the dialectic of enmity somehow favors dictatorship in "frontline states" such as Egypt and Syria-governments that invoke the proximity of the "Zionist threat" as a pretext to suppress dissent. But how then to explain the mayhem in faraway Algeria, the bizarre cult-of-personality regime in Libya, the pious kleptocracy of Saudi Arabia, the clerical despotism of Iran, or democracy's enduring failure to take root in Pakistan? Did Israel somehow cause the various putsches that produced the republic of fear in Iraq? If Jordan, the state sharing the longest border with Israel, can experiment with constitutional monarchy, why not Syria?

It won't do to lay the democracy and development deficits of the Arab world on the doorstep of the Jewish state. Israel is a pretext, not a cause, and therefore its dispatch will not heal the self-inflicted wounds of the Arab-Islamic world. Nor will the mild version of "statocide," a binational state, do the trick-not in view of the "civilization of clashes" (to borrow a term from British historian Niall Ferguson) that is the hallmark of Arab political culture. The mortal struggle between Israelis and Palestinians would simply shift from the outside to the inside.

My Enemy, Myself

Can anybody proclaim in good conscience that these dysfunctionalities of the Arab world would vanish along with Israel? Two U.N. "Arab Human Development Reports," written by Arab authors, say no. The calamities are homemade. Stagnation and hopelessness have three root causes. The first is lack of freedom. The United Nations cites the persistence of absolute autocracies, bogus elections, judiciaries beholden to executives, and constraints on civil society. Freedom of expression and association are also sharply limited. The second root cause is lack of knowledge: Sixty-five million adults are illiterate, and some 10 million children have no schooling at all. As such, the Arab world is dropping ever further behind in scientific research and the development of information technology. Third, female participation in political and economic life is the lowest in the world. Economic growth will continue to lag as long as the potential of half the population remains largely untapped.

Will all of this right itself when that Judeo-Western insult to Arab pride finally vanishes? Will the millions of unemployed and bored young men, cannon fodder for the terrorists, vanish as well-along with one-party rule, corruption, and closed economies? This notion makes sense only if one cherishes single-cause explanations or, worse, harbors a particular animus against the Jewish state and its refusal to behave like Sweden.(Come to think of it, Sweden would not be Sweden either if it lived in the Hobbesian world of the Middle East.)

Finally, the most popular what-if issue of them all: Would the Islamic world hate the United States less if Israel vanished? Like all what-if queries, this one, too, admits only suggestive evidence. To begin, the notion that 5 million Jews are solely responsible for the rage of 1 billion or so Muslims cannot carry the weight assigned to it. Second, Arab-Islamic hatreds of the United States preceded the conquest of the West Bank and Gaza. Recall the loathing left behind by the U.S.-managed coup that restored the shah's rule in Tehran in 1953, or the U.S. intervention in Lebanon in 1958. As soon as Britain and France left the Middle East, the United States became the dominant power and the No. 1 target. Another bit of suggestive evidence is that the fiercest (unofficial) anti-Americanism emanates from Washington's self-styled allies in the Arab Middle East, Egypt and Saudi Arabia. Is this situation because of Israel-or because it is so convenient for these regimes to "busy giddy minds with foreign quarrels" (as Shakespeare's Henry IV put it) to distract their populations from their dependence on the "Great Satan"?

Take the Cairo Declaration against "U.S. hegemony," endorsed by 400 delegates from across the Middle East and the West in December 2002. The lengthy indictment mentions Palestine only peripherally. The central condemnation, uttered in profuse variation, targets the United States for monopolizing power "within the framework of capitalist globalization," for reinstating "colonialism," and for blocking the "emergence of forces that would shift the balance of power toward multi-polarity." In short, Global America is responsible for all the afflictions of the Arab world, with Israel coming in a distant second.

This familiar tale has an ironic twist: One of the key signers is Nader Fergany, lead author of the 2002 U.N. Arab Human Development Report. So even those who confess to the internal failures of the Arab world end up blaming "the Other." Given the enormity of the indictment, ditching Israel will not absolve the United States. Iran's Khomeinists have it right, so to speak, when they denounce America as the "Great Satan" and Israel only as the "Little Satan," a handmaiden of U.S. power. What really riles America-haters in the Middle East is Washington's intrusion into their affairs, be it for reasons of oil, terrorism, or weapons of mass destruction. This fact is why Osama bin Laden, having attached himself to the Palestinian cause only as an afterthought, calls the Americans the new crusaders, and the Jews their imperialist stand-ins.

None of this is to argue in favor of Israel's continued occupation of the West Bank and Gaza, nor to excuse the cruel hardship it imposes on the Palestinians, which is pernicious, even for Israel's own soul. But as this analysis suggests, the real source of Arab angst is the West as a palpable symbol of misery and an irresistible target of what noted Middle East scholar Fouad Ajami has called "Arab rage." The puzzle is why so many Westerners, like those who signed the Cairo Declaration, believe otherwise. Is this anti-Semitism, as so many Jews are quick to suspect? No, but denying Israel's legitimacy bears an uncanny resemblance to some central features of this darkest of creeds. Accordingly, the Jews are omnipotent, ubiquitous, and thus responsible for the evils of the world.

Today, Israel finds itself in an analogous position, either as handmaiden or manipulator of U.S. might. The soft version sighs: "If only Israel were more reasonable..." The semihard version demands that "the United States pull the rug out from under Israel" to impose the pliancy that comes from impotence. And the hard-hard version dreams about salvation springing from Israel's disappearance.

Why, sure-if it weren't for that old joke from Israel's War of Independence: While the bullets were whistling overhead and the two Jews in their foxhole were running out of rounds, one griped, "If the Brits had to give us a country not their own, why couldn't they have given us Switzerland?" Alas, Israel is just a strip of land in the world's most noxious neighborhood, and the cleanup hasn't even begun.

All News button
1
Authors
News Type
Commentary
Date
Paragraphs
What might we expect of the Bush administration in its second term? APARC's Michael Armacost considers the road ahead.

President Bush has claimed a renewed mandate, and has begun to reshuffle his national security team. Condi Rice will move to State; Steve Hadley will move up at the NSC. Rich Armitage and Jim Kelly, who have borne much of the day-to-day responsibility for U.S. policy in Asia, are leaving along with Colin Powell. What might we expect of the Bush administration in its second term?

Generally speaking, continuity rather than change is likely to be the watchword in foreign policy. Above all, the Middle East and South Asia are likely to remain the principal preoccupations of American concerns. In Iraq, Washington will seek to acquit its commitments - to hold elections, train Iraqi security forces, and accelerate reconstruction projects - with whatever measure of dignity and honor it can muster in the face of excruciatingly difficult choices. With Yassar Arafat's death, American engagement in Israeli-Palestinian issues is destined to increase. And Iran's bid for nuclear weapons will continue to challenge the United States and Europe.

Thus Asia will not have pride of place on the Bush agenda. Yet it will continue to command Washington's attention. Why? Because it is in Asia that the interests of the great powers intersect most directly. Asia is the world's most dynamic economic area, and it is becoming more tightly integrated. Washington cannot afford to neglect South and Southeast Asia, for in these areas Islam presents a relatively moderate face. And North Korea, of course, poses a direct and growing challenge to the administration's nonproliferation policy.

Fortuitously, the United States is better positioned in Asia than in most other regions. Our military presence remains sizable and retains mobility and flexibility. Our economy continues to generate solid demand for Asian exports and is a robust source of direct investment. While criticism of American policy is widespread in the region, it is not expressed with the virulence that is seen in Europe and the Middle East. Above all, Washington has cultivated the Asian great powers assiduously, and has managed to improve relations with Tokyo, Beijing, Moscow, and New Delhi - a substantial accomplishment. It remains to be seen whether it can work in concert with others to ameliorate the sources of discord on the Korean Peninsula and over the Taiwan Straits.

The United States, to be sure, confronts some daunting challenges in Asia. If the U.S.-Japan alliance is in excellent condition, defense cooperation with Seoul remains troubled by the sharp divergence in U.S. and Korean perspectives on North Korean aims and strategy. Nor have we found a solid basis for pursuing with Pyeongyang's neighbors a coordinated approach to the six-nation talks. Regional economic cooperation is taking shape along pan-Asian rather than trans-Pacific lines. Developments in the Middle East threaten to "Arabize Islam" in Southeast Asia. And the "Johnny One Note" quality of American diplomacy - i.e. its preoccupation with international terrorism - often plays poorly against Beijing's more broadly based effort to provide regional leadership.

Nor is America unconstrained in its policy efforts in the region. Our military forces are stretched thin globally, impelling some downsizing of deployments in Asia. Huge fiscal deficits loom, and with growing bills falling due in both Iraq and Afghanistan, resources available for policy initiatives elsewhere are likely to be tight. The president has succeeded in pushing negotiations with North Korea into a multilateral framework, yet Washington is being pressed by its negotiating partners to adopt a more conciliatory posture. The democratization of Asian nations, while welcome, does not automatically facilitate U.S. diplomatic objectives. Recent elections in South Korea and Taiwan were decisively shaped by a new generation of voters. Governments in Seoul and Taipei are increasingly accountable, yet viewed from the United States, they are not extraordinarily sensitive to Washington's views, let alone deferential to its lead.

With these considerations in mind, one should expect President Bush and his foreign policy team to continue cultivating close ties with the Asian powers. Whether Washington can effectively utilize those relationships to roll back North Korea's nuclear program and avert crises in the Taiwan Straits will depend heavily on its relationships with the governments in Seoul and Taipei. And at the moment South Korea appears determined to expand economic ties with the North virtually without reference to Pyeongyang's nuclear activities. Taipei remains preoccupied with efforts to assert its own identity while counting on American protection.

In the end, of course, foreign policy rarely sees carefully laid plans bear fruit. Someone once asked a new British prime minister, Harold MacMillan, what would drive foreign policy in his government. He answered without hesitation, "Events, dear boy, events." I expect the same may be true for Mr. Bush.

All News button
1
Authors
News Type
News
Date
Paragraphs

Three of CISAC's undergraduate honors students are among Stanford's handful of winners of prestigious scholarships for 2005-2006. Senior Sheena Chestnut and 2002 graduate Tarun Chhabra, both Phi Beta Kappa members, are among five Stanford students selected for 2005 Marshall Scholarships. Alex Greninger, a 2003 graduate of CISAC's honors program, is one of two Stanford graduates named as George J. Mitchell Scholars.

Marshall Scholarships go to about 40 scholars each year, in recognition of academic excellence, leadership, and commitment to public service. The awards cover all costs for students to attend the British university of their choice for two to three years.

A total of 12 Mitchell Scholars selected nationwide will receive tuition, housing, and a stipend to pursue post-graduate studies at universities in Ireland or Northern Ireland.

Chhabra served in 2003-2004 on the research staff for the United Nations High-Level Panel on Threats, Challenges, and Change, a group convened by the U.N. secretary-general to study global threats and recommend collective security measures, including potential changes to the U.N. A double-major in Slavic languages and literatures and international relations, Chhabra wrote his honors thesis at CISAC on "The Generals' Intervention: U.S. Humanitarian Intervention in Somalia, 1992-1993." He plans to study international relations at Oxford University next year.

Greninger graduated Stanford in 2004 with co-terminal bachelor's and master's degrees in biological sciences and a bachelor's degree in international relations. His CISAC honors thesis, "Beyond the Last Move--Developing Biodefenses against Engineered Anthrax and Smallpox," for which he won the Firestone Medal for Excellence in Undergraduate Research, is one of three honors theses he wrote at Stanford. His undergraduate research served as the basis for "Biotechnology and Bioterrorism: An Unprecedented World," which he co-wrote with CISAC Co-Director Christopher Chyba and published in Survival. Greninger is now at Cambridge University on a Churchill Scholarship.

Chestnut, a political science major and creative writing minor, is researching nuclear smuggling in the Democratic People's Republic of Korea (North Korea) for her honors thesis. After studying at Oxford during her junior year and interning at the International Institute for Strategic Studies in London, she is interested in using her Marshall scholarship to study international relations at Oxford.

All News button
1
Authors
Donald Kennedy
News Type
Commentary
Date
Paragraphs
Speaking at a June 24 joint conference sponsored by the Brookings Institution and the Pew Center on Global Climate Change, CESP senior fellow Donald Kennedy warned of the pressing need to address global warming now. The conference, titled, "Toward a Sensible Center," brought together senators, CEOs, top federal and state officials, and other prominent leaders to debate the future of U.S. policy on climate change. Speakers included senators Joseph Lieberman and John McCain, U.S. Secretary of Energy Spencer Abraham, World Bank president James Wolfensohn, Larry Schweiger, president of the National Wildlife Federation, and Michael Morris, president and CEO of American Electric Power.

I begin with a proposition. There are a great many pressing problems in the world. There is population growth and economic development, with attending pressures on resources - including food and that other essential, water. There is a continuing global security crisis, augmented by the rise in terrorism. There is the chronically inequitable distribution in resources between the rich nations of the North and the poor nations of the South. And there is the steadily growing body of evidence for a major reorganization of the global climate regime.

My proposition is that the last of these is the most serious threat - not only because it will profoundly affect the lives of our children and our grandchildren in a direct way, but also because it will interact powerfully with every single one of the other problems I have listed.

Let me begin with the science underlying climate change. Last week I helped organize a symposium and briefing session on climate science for press, policy-makers, and the public, supported by the Hewlett Foundation and with co-sponsorship from the Conference Board. We had ten of the most distinguished climate scientists in the United States, led off by Sherry Rowland, the Nobel Laureate in Chemistry. The purpose was to make a careful assessment of the science - what we know for sure, what we think likely, and what are interesting but unproven possibilities.

So here is a short summary of what we know. General Circulation Models - climate models that take into account variations in the sun's energy, volcanic activity, and other natural phenomena - explained fluctuations in average global temperature very well over most of the past thousand years. But for the past hundred years, these same models faithfully reproduce global temperature history ONLY if they include the greenhouse gases - carbon dioxide, methane, and chlorofluorocarbons - that are by-products of human economic activity. That is why the average temperature of the globe has risen by about one degree F, and the sea level has risen by between 10 and 20 cm., in the last century. The primary causative agent is carbon dioxide, which in preindustrial times was about 280 ppm/v and has now reached 380ppm/v. It is rising continually as the activities that produce it are proceeding on a business as usual basis. That is because the failure of the Kyoto protocol - a failure both because its targets were inadequate, and also because they were unattainable by many of the participating nations - has left us without any basis for meeting the goals of the 1992 Framework Convention on Climate Change. Just to remind us, the US is a signatory and a party to that agreement, under which we are committed to limit atmospheric concentrations of greenhouse gases to avoid "dangerous anthropogenic interference with the climate system."

Why, a dozen years later, is there some doubt about the dangers of this interference? The C02 we add to the atmosphere will stay there; its average residence time is a century. There is no disagreement about whether average global temperature will rise; it will. The scientific debate is about how much. For the future we depend again on the General Circulation Models. It's reassuring that when applied to past climates in "back-casting" efforts, like the example I gave a moment ago, these actually predict climate history so accurately. Perhaps more interesting, they regularly somewhat underestimate the magnitude of the real climate changes - that is, Nature regularly turns out to be harsher than the models suggest. Projecting the models into the future, the Intergovernmental Panel on Climate Change, and an evaluation by the National Academies prepared at President Bush's request, estimate that by the end of this century, the increase in average global temperature will be between 1.4 and 5.8 degrees Centigrade.

Why such a range? These models, like most, contain some uncertainties. Some of these are scientific: how increased cloud cover might affect the outcome, since clouds can either cool the climate by reflecting sunlight from above, or warm it by trapping heat that is leaving from below; how changes in the earth's albedo due to melting ice might accelerate heating, and so on. Aerosols produced by volcanic eruptions have a cooling effect, as the eruption of Mt. Pinatubo did in giving us two unusually cool years in the early 90's. Other uncertainties are economic and social: we don't know how national policies and international agreements will serve to restrain the amount of greenhouse gases we are adding.

These uncertainties - about half due to the models themselves, and the rest to social and economic unknowns -- have provided arguments for those who prefer to postpone economically difficult approaches for controlling greenhouse gas emissions. But it is important that even at the very lowest estimates, there will be substantial changes in the nature of human life on the only planet we currently occupy. The rather modest impacts of the past century have already produced profound changes in regional climate dynamics. Substantial ice-sheet melting and retreat is taking place both in the Arctic and in the West Antarctic ice sheet. In the Arctic, where climate warming has been extreme, sea ice is sharply diminished and rivers become ice-free much earlier. Low latitude mountain glaciers are shrinking; the famous snow-capped summit of Kilimanjaro will be bare within fifteen years, converting hundreds of old African safari shots into historic treasures.

Biological cycles are experiencing the effects of warming, with upward extensions of the range of Alpine flora and advances in the time of flowering or breeding by an average of 5 days per decade. The models have all also predicted more frequent and severe weather events, and we have had heat waves in the upper Midwest and Paris, accelerated beach erosion on coasts all over the world, and disastrous floods and landslides in Central America.

That is now, but of course we are more interested in the future. What the models tell us unambiguously is that the climate system is headed for further disruption. The standard scenario foresees a steady, ramp-like increase in average global temperature, with a concomitant rise in sea level, but records of past climate tell us that it is riddled with abrupt changes - something that the models fail to predict well. A possible alternative involves a change in major ocean circulation patterns - especially in the North Atlantic, where a clockwise gyre brings warm equatorial water up via the Gulf Stream. As it flows Northward and then crosses Eastward, it is cooled by the atmosphere, becomes more saline through evaporation, and then sinks to return as a cold deep current. If large discharges of fresh meltwater or rain made this water less dense, it could fail to sink and thus disrupt the entire cycle.

A fictionalized version of such a scenario appears in the disaster film "The Day After Tomorrow," which you should see only for amusement. Beyond that silliness lies a real prospect that a gradual change in average global temperature could intercept the threshold for some non-linear, dynamic process, triggering abrupt changes in either direction. Of course there is uncertainty: we are engaged in a large-scale, uncontrolled experiment on the only planet we have.

Let's consider some collateral impacts. A group of us at Stanford was asked by the Carnegie Commission on Preventing Deadly Conflict to look - among other things -- at ways in which environmental change might alter the circumstances under which human populations might be placed. Climate change was an important variable. One example we looked at was the impact of sea level rise, along with storm surges from extreme weather events, on the Ganges-Brahmaputra delta. Flood disasters already occur there regularly. 15 million people live within 2 meter above sea level, and are vulnerable to abrupt displacement. We know they will have to go somewhere; in the past they have fled in much smaller numbers to Bengal. The security problems arising from a massive influx of a traditionally hostile population, combined with an almost certain high level of cholera infection, are not difficult to imagine.

Water is a desperately important resource in most parts of the world, and drought is often followed by famine or emigration. Here in the US, warmer winters threaten mountain snowpacks and will soon demand the revision of interstate and international water allocation agreements. Maritime rivers are already undertaking management steps to deal with saline intrusions due to sea level rise or storm surges. In Great Britain, the barrier that protects London from occasional flooding of the Thames estuary is now being used six times a year compared to less than once a year in the 1980's.

Agriculture, of course, is the most essential of human activities. The regional distribution of global warming impacts may be at least temporarily kind to temperate-zone food production. But the models all predict an increased incidence of mid-continent droughts as climate change progresses, and we know that the American Midwest has in the past experienced droughts both deeper and longer than the one in the 30's that led to the Dust Bowl migrations. Irrigation is an answer to drought, but in the six High Plains states, dryland wheat production depends upon the Ogallala Aquifer, a buried ice-age storage well that is being so rapidly depleted that it is already unusable in its southern portion. And in the tropics, where people are poorest and capacity to adapt is minimal, the consequences of even modest warming will be far more serious.

Infectious diseases are spread by vectors, like the Anopheles malaria mosquito, that have their own patterns of reproduction, movement, and climate sensitivity. In parts of Africa where vertical topography dominates, warmer and rainier seasons cause malaria incidence to rise in higher-altitude locations. In a warmer and wetter world, more of the same can be expected.

So climate change is not an isolated problem. Instead, it is likely to interact with most of the other problems humans face all over the world. Thus I hope that this meeting will help encourage us to prepare a sound portfolio of risk-reducing measures. These will not, I must tell you, bring us out of the woods. Our destiny is partly built in -- to the heat that is already locked into our oceans, to the greenhouse gases that are already in our atmosphere and will increase by another 50% or more no matter what we do, and to the justified economic appetites of the developing world. What we will be talking about, it should be clear, are ways of limiting the damage to manageable levels, NOT preserving the status quo. We lost that years ago.

So the contemporary policy challenge amounts to a bet about risk: are the consequences of business as usual likely to entail costs greater than those of beginning to mitigate those consequences now? Other nations - the UK, several EU countries, and Japan - are making substantial commitments. Some industries - British Petroleum, Royal Dutch Shell, and Swiss Re, for example - have undertaken steps of their own. The insurance burden from the exploding rates of coastal erosion and storm damage has pushed the insurance industry to lead. If companies fail to participate in emissions reduction and join with others to resist such measures, questions are already being raised. If you believe so strongly that climate change is a myth, Swiss Re might say, then surely you won't mind a climate-related events exclusion from your Directors and Officers insurance policy.

 

But we can't count on voluntary actions, and the United States so far has only announced a long-range research program that, although it looks reasonable, makes NO current commitments to mitigate our contribution, about a quarter of the world's, to the global warming problem. We must have a more aggressive national policy to purchase insurance against this risk.

It will not be cheap. We have old, coal-fired power plants in this country; it may take subsidies to replace them with modern, less carbon-intensive facilities that run on natural gas. States like mine are already driving the transportation sector to ultra-low emission, and that may move the domestic industry in a positive direction. Some of us will have to give up our reflex opposition to nuclear power and begin comparing its risks realistically against those of global climate change. Although the room for alternative energy sources (photovoltaic, wind, geothermal) is limited, these options need encouragement. Energy conservation measures have, at several times in the past, turned economic predictions on their head by their success, and the right incentives could yield real benefits there.

The portfolio I have just described is needed, but will not be enough. We know that market-based mechanisms for emissions control can work, because they did in the 1990 Clean Air Act Amendments that limited SO2 emissions. The bill proposed by Senators McCain and Lieberman would mandate a cap-and-trade program for controlling carbon dioxide emissions. Similar systems are being considered by regional assemblages of states in the Northwest and the Northeast, and that may encourage the development of a national system - which could then build trading relationships with other nations that are moving toward similar regimes. A case for this approach is elegantly made in the Council on Foreign Relations Policy Initiative on Climate Change, by my colleague David Victor.

The United States is in a position of natural leadership here. It is the most powerful nation - and the world's leading producer of greenhouse gases. Plainly it is in its own national interest, in multiple ways, to reduce its consumption of fossil fuels. To see it failing in this most vital, globally sensitive matter is a national embarrassment.

All News button
1
Subscribe to United Kingdom