THIS has been a remarkable time for the Obama administration. After a year of intense internal debate, it issued a new nuclear strategy. And after a year of intense negotiations with the Russians, President Obama signed the New Start treaty with President Dmitri Medvedev in Prague. On Monday, the president will host the leaders of more than 40 nations in a nuclear security summit meeting whose goal is to find ways of gaining control of the loose fissile material around the globe.

New Start is the first tangible product of the administration's promise to "press the reset button" on United States-Russian relations. The new treaty is welcome. But as a disarmament measure, it is a modest step, entailing a reduction of only 30 percent from the former limit - and some of that reduction is accomplished by the way the warheads are counted, not by their destruction. Perhaps the treaty's greatest accomplishment is that the negotiations leading up to its signing re-engaged Americans and Russians in a serious discussion of how to reduce nuclear dangers.

So what should come next? We look forward to a follow-on treaty that builds on the success of the previous Start treaties and leads to significantly greater arms reductions - including reductions in tactical nuclear weapons and reductions that require weapons be dismantled and not simply put in reserve.

But our discussions with Russian colleagues, including senior government officials, suggest that such a next step would be very difficult for them. Part of the reason for their reluctance to accept further reductions is that Russia considers itself to be encircled by hostile forces in Europe and in Asia. Another part results from the significant asymmetry between United States and Russian conventional military forces. For these reasons, we believe that the next round of negotiations with Russia should not focus solely on nuclear disarmament issues. These talks should encompass missile defense, Russia's relations with NATO, the Conventional Armed Forces in Europe Treaty, the Intermediate-Range Nuclear Forces Treaty, North Korea, Iran and Asian security issues.

Let's begin with missile defense. Future arms talks should make a serious exploration of a joint United States-Russia program that would provide a bulwark against Iranian missiles. We should also consider situating parts of the joint system in Russia, which in many ways offers an ideal strategic location for these defenses. Such an effort would not only improve our security, it would also further cooperation in dealing with the Iranian nuclear threat, including the imposition of consequential sanctions when appropriate.

NATO is a similarly complicated issue. After the cold war ended, Russia was invited to NATO meetings with the idea that the country would eventually become an integral part of European security discussions. The idea was good, but the execution failed. NATO has acted as if Russia's role is that of an observer with no say in decisions; Russia has acted as if it should have veto power.

Neither outlook is viable. But if NATO moves from consensus decisions to super-majority decisions in its governing structure, as has been considered, it would be possible to include Russia's vote as an effective way of resolving European security issues of common interest.

The Russians are also eager to revisit the two landmark cold war treaties. The Conventional Armed Forces in Europe Treaty enabled NATO and Warsaw Pact nations to make significant reductions in conventional armaments and to limit conventional deployments. Today, there is still a need for limiting conventional arms, but the features of that treaty pertaining to the old Warsaw Pact are clearly outdated. Making those provisions relevant to today's world should be a goal of new talks

Similarly, the 1987 treaty that eliminated American and Soviet intermediate-range ballistic missiles was a crucially important pact that helped to defuse cold war tensions. But today Russia has neighbors that have such missiles directed at its borders; for understandable reasons, it wants to renegotiate aspects of this treaty.

Future arms reductions with Russia are eminently possible. But they are unlikely to be achieved unless the United States is willing to address points of Russian concern. Given all that is at stake, we believe comprehensive discussions are a necessity as we work our way toward ever more significant nuclear disarmament.

William J. Perry, a senior fellow at the Freeman Spogli Institute for International Studies, was the secretary of defense from 1994 to 1997. George P. Shultz, the secretary of state from 1982 to 1989, is a distinguished fellow at the Hoover Institution.

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.

With an April 8 date set for the United States and Russia to sign a new nuclear arms reduction treaty, each country is preparing to cut their deployed weapons by about 30 percent. That caps each side at 1,550 nuclear warheads and bombs and 700 deployed strategic missiles and bombers.

The pact, which needs approval by the U.S. Senate and Russian Duma, is the culmination of a year's worth of often tumultuous negotiations. It's also an important step in President Obama's push for a nuclear-free world, an idea that was given a roadmap during a 2006 conference at Stanford's Hoover Institution. The conference, which was convened by former Secretary of State George Shultz and Stanford physicist Sidney Drell, resulted in a Wall Street Journal op-ed in January 2007 calling for a world without nuclear weapons.

The piece was written by Shultz, a professor emeritus at Stanford's Graduate School of Business and a distinguished Hoover fellow; William Perry, President Clinton's defense secretary and an emeritus senior fellow at Stanford's Freeman Spogli Institute for International Studies; Henry Kissinger, who served as secretary of state in the Nixon and Ford administrations; and Sam Nunn, a former chairman of the Senate Armed Services Committee and CEO of the Nuclear Threat Initiative.

President Obama mentioned the four men in a March 26 statement announcing the new treaty, noting their support for more assertive action in reducing nuclear weapons.

David Holloway, a professor of international history and faculty member at FSI's Center for International Security and Cooperation, participated in the Hoover conference and has analyzed the steps taken to shrink the world's nuclear stockpile.

Holloway, author of Stalin and the Bomb: The Soviet Union and Atomic Energy, 1939-1956, spoke with the Stanford News Service about the latest pact between the United States and Russia, and what the prospects are for further reduction of nuclear weapons.

Put the treaty in context. How significant is it?

You could say it's a small step in an important process. In the 1980s, there were about 70,000 nuclear weapons in the world. Most were owned by the U.S. and the Soviet Union. Now there are about 22,000 nuclear weapons, 90 percent of them owned by the U.S. and Russia. A number of those weapons are slated for dismantling, but it takes time to do that. Meanwhile, the feeling is that it's better to regulate the US-Russian nuclear relationship by treaty, so that it does not develop in an unpredictable way or a way that causes instability in the relationship.

This treaty reduces only the number of deployed warheads and nuclear delivery systems. What will happen to those weapons?

Some missile sites will be closed down and the warheads will be put into storage. The treaty apparently won't commit either side to dismantling the warheads. It only moves them from deployment. But cutting the number of delivery systems is important because if you don't have the missiles or bombers to launch the warheads, then the warheads aren't much use.

Is there a system in place to keep each country in compliance with the treaty?

Each country has the capacity to monitor the other side's compliance with the treaty. There are satellites that can see what the other side is doing; there are arrangements for the electronic monitoring of test flights and so on; and there are exchanges of inspectors. The two countries have considerable experience of cooperation in this area.

The treaty does not restrict America's plans to build a missile defense shield in Europe. But explain the tensions between Russia and U.S. over that issue.

This was probably the most difficult part of the negotiations. The Russians were eager to get limits on American defenses against ballistic missiles, and the U.S. was very reluctant to include them in this treaty. The Russians are worried what the effect of defense systems would be on their ability to retaliate in the event of an American first strike - as improbable as that is.

Despite that tension, the Obama administration has said it wants to "reset" U.S.-Russian relations. Does this treaty help?

The treaty makes great sense in terms of that agenda. It's an affirmation of Russia's position as a nuclear superpower, and it gives the Russians some assurance that they will maintain the status of an American partner in this area.

What the United States wants is help on issues like Iran and Afghanistan: making sure we can get supplies across Russia to Afghanistan and persuading Russia to continue putting pressure on Iran to back away from making nuclear weapons.

The treaty will have to be ratified by the U.S. Senate. How do you expect that to play out?

The mood in Washington isn't very bipartisan at present, of course. And there are many people who think: why should we have an agreement with the Russians? We're stronger; they're weaker. We shouldn't limit our own flexibility by negotiating agreements. That was a strong view in the Bush administration - that arms control is a bad thing and it only limits our freedom of action. And the issue of missile defense systems will be a contentious issue. There are people who want to see absolutely no restrictions on our defenses against ballistic missiles, whereas that is one of the goals of Russian policy.

How does this treaty fit in with concerns that unstable countries and terrorist groups might get their hands on nuclear weapons?

The Russians aren't about to blow us up, and we're not about to blow them up. The real fear is that other people will get hold of nuclear weapons. In the Obama administration's view, this treaty is part of a single effort to create a tough nuclear regime where states that have nuclear weapons are taking steps toward getting rid of them. And at the same time, the mechanisms for preventing new states - and in particular terrorist groups - from getting hold of nuclear weapons or the materials to make them are being strengthened.

Under the nuclear nonproliferation treaty, which entered into force in 1970, states that have nuclear weapons are obliged to pursue nuclear disarmament, while the states without them have promised not to acquire them. So if you want to strengthen this nuclear regime and make it harder for other states and terrorist groups to get nuclear weapons, then those with the nuclear weapons need to be moving toward zero. That's a key element in the administration's policy. The judgment is that a discriminatory regime is not viable in the long run.

What's the likelihood that we'll get to world free of nuclear weapons?

The president laid that out as a goal, and he said it probably wouldn't happen in his lifetime. Nobody can say that we can get to zero in say 20 years, but we do know what the first steps should be on such a path, and this treaty is one of them.

Before the world could get to zero nuclear weapons, there would have to be certainty that nobody could break out and say, "I've got lots of nuclear weapons, so you better listen to me."

The goal of zero is a vision, but I think it's an essential one because it gives you a sense of the direction you should go in.

What are the next steps Russia and the U.S. will take to reduce their nuclear stockpiles?

It's not clear. There is no agreement to have a further round of talks, but I very much hope there is one. There could be further negotiations on the reduction of strategic forces, but it seems more likely that talks might focus on the possibilities of cooperation in ballistic missile defense and/or on tactical nuclear weapons - the shorter-range systems that are not covered by the new treaty.