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Donald K. Emmerson
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US President Barack Hussein Obama's speech on 4 June 2009 in Cairo, the second of three planned trips to Muslim-majority countries, was outstanding.

First, it opened daylight between the US and Israel. Israeli settlements on the West Bank are impediments to a two-state solution and a stable peace with Palestine. Obama did not split hairs. He did not distinguish between increments to existing settler populations by birth versus immigration with or without adding a room to an existing house. The United States, he said, does not accept the legitimacy of continued Israeli settlements. Period.

The American Israel Political Affairs Committee, which advertises itself as America’s pro-Israel lobby, cannot have been pleased to hear that sentence. But without some semblance of independence from Israel, the US cannot be a credible broker between the two sides. It is not necessary to treat the actions of Israeli and Palestinian protagonists as morally equivalent in order to understand that they share responsibility for decades of deadlock. New settlements and the expansion of existing ones merely feed Palestinian suspicions that Israel intends permanently to occupy the West Bank. Nor did Obama’s criticism of Israeli settlements prevent him from also stating: Palestinians must abandon violence. Period.

Second, alongside his candor, he showed respect. The most effective discourse on controversial topics involving Islam and Muslims is both sensitive to feelings and frank about facts, as I argue in a forthcoming book (Islamism: Contested Perspectives on Political Islam). Inter-faith dialogues that rely on mutual self-censorship–an agreed refusal to raise divisive topics or speak hard truths – resemble sand castles. Empathy based on denial is unlikely to survive the next incoming tide of reality. Respect without candor, in my view, is closer to fawning than to friendship.

As Obama put it in Cairo, ‘In order to move forward, we must say openly to each other the things we hold in our hearts and that too often are said only behind closed doors. As the Holy Quran tells us, ‘Be conscious of God and speak always the truth.” His listeners applauded – most of them, perhaps, because he had cited their preferred Book, but some at least because he had defended accuracy regardless of what this or that Book might avow.

In the partnership that Obama offered his audience, sources of tensions were not to be ignored. On the contrary, we must face these tensions squarely. He then followed his own advice by noting that extremists acting in the name of Islam had in fact killed more adherents of their own religion than they had Christians, Jews, or the followers of any other faith. In the same candid vein, he noted with disapproval the propensity of some Muslims to repeat vile stereotypes about Jews, the opposition of Muslim extremists to educating women, and the fact of discrimination against Christian Copts in Egypt, the very country in which he spoke.

Third, his speech was notable for what it did not contain. The word ‘terrorism’,’ a fixture of the Manichean rhetoric of George W. Bush, did not occur once. Back in Washington, in his 26 January televised interview with Al Arabiya, Obama had used the phrase Muslim world 11 times in 44 minutes – an average of once every four minutes. In the run-up to his Cairo speech, the White House had repeatedly hyped it as an address to ‘the Muslim world.’ Yet in the 55 minutes it took him to deliver the oration, the words ‘Muslim world’ were never spoken. He must have been advised to delete the reference from an earlier draft of his text.

I believe the excision strengthened the result, but not because a ‘Muslim world’ does not exist. Admittedly, one can argue that 1.4 billion Muslims have too little in common to justify speaking of such a world at all. But the already vast and implicitly varied compass of any ‘world’ diminishes the risk of homogenization. One can easily refer to ‘the Muslim world’ while stressing its diversity. Many Muslims and non-Muslims already use the phrase without stereotyping its members. No, the reasons why Obama avoided the phrase were less definitional than they were political in nature.

Had Obama explicitly addressed the Muslim world in Cairo, he would have risked implying that his host represented that Muslim world, as if Egypt were especially authentic–quintessentially Muslim–in that sphere. That would have been poorly received in many of the other Muslim-majority societies that diversely span the planet from Morocco to Mindanao.

Several years ago a professor from Cairo’s Al-Azhar University, which co-sponsored Obama’s appearance, told me in all seriousness that Indonesian Muslims, because they did not speak Arabic, were not Muslims at all. Obama did not wish to be read by the followers of ostensibly universalist Islam as endorsing such a parochially Arabo-centric conceit.

The US president could, of course, have mentioned the Muslim world and in the next breath denied that it was represented by Egypt, a country under an authoritarian regime with a reputation for corruption of near-Nigerian proportions. But it was far smarter and more effective for Obama to have shunned the phrase altogether, thereby avoiding the need to clarify it and risk implying that his hosts were somehow less than central to Islam, less than paradigmatically Muslim. Such a candid but insensitive move would have triggered nationalist and Islamist anger not only in his Egyptian audience, but in other Muslim-majority countries as well. Indonesian Muslims, for example, would have wondered with some apprehension whether to expect comparably rude behavior were he to visit their own country later this year.

Obama’s listeners at Cairo University were, instead, subjected to twin eloquences of absence and silence: Egyptian President Hosni Mubarak’s not being present, and Obama’s not mentioning him at all. Eloquent, too, was the absence of Israel from his itinerary. This omission was not a sign of hostility toward Tel Aviv, however. He termed the US-Israel bond ‘unbreakable.’ Not visiting Israel merely signaled that Washington on his watch would not limit its foreign-policy horizon to what any one country would allow.

Obama mispronounced the Arabic term for the head covering worn by some Muslim women. The word is hijab not hajib. But that small slip was trivial compared with the brilliance and timeliness of what he had to say. Rhetoric is one thing, of course; realities are quite another. The tasks of resolving the Israeli-Palestinian conundrum and improving relations with the heterogeneous Muslim world are more easily discussed than done. Illustrating that Muslim world’s extraordinary diversity are the many and marked differences between Turkey, where Obama spoke on 6 April on his first overseas trip, his Egyptian venue two months later, and Indonesia, which he is likely to visit before the end of 2009.

Before his choice of Cairo was announced, several commentators advised him to give his Muslim world speech in June in the Indonesian capital, Jakarta. Rather than risk legitimating Mubarak’s autocracy, they argued, he should celebrate Indonesia’s success in combining moderate Islam with liberal democracy.

Following their advice would have been a mistake. Not only did speaking in Cairo enable Obama boldly to address the Israeli-Palestinian conflict from a podium close to its Middle Eastern epicenter. Had he traveled to Indonesia instead, his visit would have been tainted by an appearance of American intervention in the domestic politics of that country, whose President Susilo Bambang Yudhoyono is up for re-election on 8 July.

Earlier in his career, Yudhoyono completed military training programs in the US, at Fort Benning and Fort Leavenworth, and earned a master’s in management from Webster University in St. Louis. No previous Indonesian head of state has had a closer prior association with the United States. Yudhoyono’s rivals for the presidency are already berating him and his running mate as neo-liberals who have pawned Indonesia’s economy to the capitalist West. Obama could feel comfortable keeping the autocrat Mubarak at arm’s length in Cairo, but in campaign-season Indonesia the US president would have been torn between behaving ungraciously toward his democratically chosen host and appearing to back him in his race for re-election.

Yudhoyono’s popularity ratings among Indonesians are even better than Obama’s are among Americans. The July election is Yudhoyono’s to lose. But the winner’s new government will not be in place until October. The US president was wise to postpone visiting Indonesia until after its electoral dust has cleared and the next administration in Jakarta has taken shape. A gathering of leaders of the Asia Pacific Economic Cooperation forum, which Obama is expected to attend, is conveniently scheduled for mid-November in Singapore. He could easily visit Indonesia en route to or from that event.

An Indonesian journalist in Cairo interviewed Obama shortly after his speech. The president virtually confirmed this November itinerary by saying that his next trip to Asia would include Indonesia. He said he looked forward to revisiting the neighborhood in Jakarta where he had lived as a child, and to eating again his favorite Indonesian foods – fried rice, bakso soup, and rambutan fruit among them.

A trifecta happens when a gambler correctly predicts the first three finishers of a race in the correct order. Obama appears to have bet his skills in public diplomacy on this sequence: Ankara first, then Cairo, then Jakarta.

One can ask whether his actions will match his words, and whether the US Congress will go along with his prescriptions. But with two destinations down and one to go, Obama is well on his way to completing a trifecta in the race for hearts and minds in the Muslim world.

A version of this essay appeared in AsiaTimes Online on 6 June 2009.

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A keynote speech delivered on 19 March 2009 to a conference on  “The Philippines and Japan in East Asia and the World:  Interests, Identity, and Roles” organized by the Philippines’ Asian Center with support from the Japan Foundation Manila, the Philippines, March 19-20, 2009.

Published in Aileen S. P. Baviera and Rowena R. Pangilinan, eds, The Philippines and Japan in East Asia and the World: Interests, Identity and Roles (Quezon City: University of the Philippines Asian Center / Japan Foundation, 2009).

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More than 75 people connected to CISAC's past and present gathered in Encina Hall on Friday, May 29, to reminisce and look toward the center's next quarter century. The CISAC String Quartet led by Paul Stockton, who has just left CISAC to work as an assistant defense secretary, welcomed guests with concertos by Bach and Beethoven. Meanwhile, a slide show depicting CISAC's history through the decades brought back memories of potluck meals, receptions and group clean-up parties at Galvez House.

Co-Director Siegfried Hecker's opening and closing remarks acted as bookends to speeches highlighting the center's different eras. Law School Professor John Barton, a member of the center's executive committee, was a founder of CISAC's predecessor organization, the Center for International Security and Arms Control. He spoke about how turbulence on campus in the 1970s surrounding the Vietnam War led to courses focusing on international security matters under the Stanford Arms Control Program and, eventually, the center's establishment. Gloria Duffy, president of the Commonwealth Club of California, was a CISAC fellow from 1980-82, and spoke about the 1980s as "a time of alarm in our field." Acting Co-Director Lynn Eden, who was affiliated with the center as a fellow from 1987 to 1990, spoke about the 1990s, followed by Jessica McLaughlin, a 2005 graduate from CISAC's honor's program, who explained how she continues to apply the skills she learned in the program to her job as a management consultant. Former U.S. Defense Secretary William J. Perry, a former CISAC co-director, looked to the future and what the center must do to remain as effective and relevant to international security as it has been in the past. John Lewis, Scott Sagan, Michael May and David Holloway, who have all held leadership positions at CISAC, also made remarks about the center.


CISAC 25th Anniversary

Program

 

Background Music by the CISAC Quartet:

Beethoven Opus 59 #1

Bach Brandenburg Concerto #3, first movement

 

Introductory Remarks

Siegfried Hecker

Dr. Siegfried Hecker is a professor (research) in the Department of Management Science and Engineering, a senior fellow at FSI, and co-director of CISAC. He is also an emeritus director of Los Alamos National Laboratory.

 

Guest speakers (in order of appearance)

John Barton '68: CISAC in the 1970s

Professor John Barton is one of the founders of CISAC's predecessor organization (the Center for International Security and Arms Control), a professor at the Law School, and a member of CISAC's Executive Committee.

 

Gloria Duffy: CISAC in the 1980s

Dr. Gloria Duffy was a CISAC fellow from 1980 to 1982.  She served as a deputy assistant secretary of defense during the Clinton Administration.  Dr. Duffy is currently president of the Commonwealth Club of California.

 

Lynn Eden: CISAC in the 1990s

Dr. Lynn Eden is acting co-director and a senior research scholar at the Center. She was a CISAC fellow from 1987-88 and 1989-1990.

Jessica McLaughlin '05: CISAC in the New Millennium

Ms. Jessica McLaughlin graduated from Stanford in 2005, majoring in management science and engineering, with a certificate in Honors in International Security Studies through CISAC's undergraduate honors program.  Her thesis, "A Bayesian Updating Model for Intelligence Analysis," won CISAC's William J. Perry Prize for excellence in policy-relevant research in international security studies.  She is a management consultant at Oliver Wyman.

 

William J. Perry BS'49, MS '50: The Future of CISAC

Professor William J. Perry holds several positions at Stanford and was previously a co-director of CISAC. He was the 19th secretary of defense of the United States, serving from February 1994 to January 1997.

 

Closing Remarks

Siegfried Hecker

 

Special thanks to the CISAC Quartet:

Beverly Jean Harlan, Anne Prescott, Nancy Solomon, Paul N. Stockton

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Professor Walter P. Falcon, Deputy Director of the Center on Food Security and the Environment (FSE), former director of FSI, and Helen Farnsworth Professor of International Agricultural Policy, Emeritus has been recognized with an honorary degree from McGill University for his research aimed at reducing world hunger and enhancing global food security.

Professor Falcon's expertise is in food policy, commodity markets, trade policies, and regional development. Professor Falcon's current research focuses on agricultural decision-making in Indonesia and Mexico, biotechnology, climate change, and biofuels.

From 1972 to 1991, Professor Falcon served as professor of economics and director of Stanford University's Food Research Institute, after which he directed the Freeman Spogli Institute for International Studies until 1998. From 1998 to 2007 he co-directed the Center for Environmental Science and Policy. At Stanford he has also served as senior associate dean for the social sciences, a member of the academic senate, and twice a member of the University's Advisory Board.

Professor Falcon has also consulted with numerous international organizations, been a trustee of Winrock International, and was chairman of the board of the International Rice Research Institute (IRRI). From 1978 to 1980, he was a member of the Presidential Commission on World Hunger and in 1990 was named a Fellow of the American Agricultural Economics Association. From 1996-2001 he served as chairman of the board of the International Corn and Wheat Institute (CIMMYT), and from 2001-07 served on the board of the Center for International Forestry Research (CIFOR).

Falcon was cited as the outstanding 1958 graduate of Iowa State University in 1989 and in 1992 was awarded the prestigious Bintang Jasa Utama medal of merit by the government of Indonesia for twenty-five years of assistance to that country's development effort.

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AHPP sponsors special journal issue on health service provider incentives

The Director of the Asia Health Policy Program, Karen Eggleston, served as guest editor of the International Journal of Healthcare Finance and Economics for the June 2009 issue. The eight papers of that issue evaluate different provider payment methods in comparative international perspective, with authors from Hungary, China, Thailand, the US, Switzerland, and Canada. These contributions illustrate how the array of incentives facing providers shapes their interpersonal, clinical, administrative, and investment decisions in ways that profoundly impact the performance of health care systems.

The collection leads off with a study by János Kornai, one of the most prominent scholars of socialism and post-socialist transition, and the originator of the concept of the soft budget constraint. Kornai’s paper examines the political economy of why soft budget constraints appear to be especially prevalent among health care providers, compared to other sectors of the economy.

Two other papers in the issue take up the challenge of empirically identifying the extent of soft budget constraints among hospitals and their impact on safety net services, quality of care, and efficiency, in the United States (Shen and Eggleston) and – even more preliminarily – in China (Eggleston and colleagues, AHPP working paper #8).

The impact of adopting National Health Insurance (NHI) and policies separating prescribing from dispensing are the subject of Kang-Hung Chang’s article entitled “The healer or the druggist: Effects of two health care policies in Taiwan on elderly patients’ choice between physician and pharmacist services” (AHPP working paper #5).

In “Does your health care depend on how your insurer pays providers? Variation in utilization and outcomes in Thailand” (AHPP working paper #4), Sanita Hirunrassamee of Chulalongkorn University and Sauwakon Ratanawijitrasin of Mahidol University study the impact of multiple provider payment methods in Thailand, providing striking evidence consistent with standard predictions of how payment incentives shape provider behavior. For example, patients whose insurers paid on a capitated or case basis (the 30 Baht and social security schemes) were less likely to receive new drugs than those for whom the insurer paid on a fee-for-service basis (civil servants). Patients with lung cancer were less likely to receive an MRI or a CT scan if payment involved supply-side cost sharing, compared to otherwise similar patients under fee-for-service. (This article is open access.)

The fourth paper in this special issue is entitled “Allocation of control rights and cooperation efficiency in public-private partnerships: Theory and evidence from the Chinese pharmaceutical industry” (AHPP working paper #6). Zhe Zhang and her colleagues use a survey of 140 pharmaceutical firms in China to explore the relationships between firms’ control rights within public-private partnerships and the firms’ investments.

Hai Fang, Hong Liu, and John A. Rizzo delve into another question of health service delivery design and accompanying supply-side incentives: requiring primary physician gatekeepers to monitor patient access to specialty care (AHPP working paper #2).

Direct comparisons of payment incentives in two or more countries are rare. In “An economic analysis of payment for health care services: The United States and Switzerland compared,” Peter Zweifel and Ming Tai-Seale compare the nationwide uniform fee schedule for ambulatory medical services in Switzerland with the resource-based relative value scale in the United States.

Several of the papers featured in this special issue were presented at the conference “Provider Payment Incentives in the Asia-Pacific” convened November 7-8, 2008 at the China Center for Economic Research (CCER) at Peking University in Beijing. That conference was sponsored by the Asia Health Policy Program of the Shorenstein Asia-Pacific Research Center at Stanford University and CCER, with organizing team members from Stanford University, Peking University, and Seoul National University.

As Eggleston notes in the guest editorial to the special issue, AHPP and the other scholars associated with the issue “hope that these papers will contribute to more intellectual effort on how provider payment reforms, carefully designed and rigorously evaluated, can improve ‘value for money’ in health care.”

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The Walter H. Shorenstein Asia-Pacific Research Center is pleased to announce that Jim Hoesterey has been awarded the Shorenstein Fellowship for 2009-2010. This Fellowship is made possible through the generosity of Walter H. Shorenstein. The Fellowship supports a scholar to conduct research and writing on contemporary political, economic, or social change in the Asia-Pacific region, or topics in international relations and international political economy.

Jim Hoesterey is a cultural anthropologist whose research explores the burgeoning industry of Islamic self-help in contemporary Indonesia. He is completing a Ph.D. in Anthropology at the University of Wisconsin-Madison where he also received a M.A. in Anthropology. Jim also holds an M.A. in Anthropology from the University of South Carolina and a B.A. in Psychology from Marquette University.

During two years of ethnographic fieldwork (2005-07) at the Islamic school and “Heart Management” training complex of television preacher Abdullah Gymnastiar, Jim sought to understand how a new generation of popular preachers and Muslim “trainers” has garnered novel forms of psycho-religious authority within the market niche of Islamic self-help.

As a postdoctoral fellow at the Shorenstein Asia-Pacific Research Center, Jim will work on his book manuscript, Sufis and Self-help Gurus: Postcolonial Psychology, Religious Authority, and Muslim Subjectivity in Indonesia.

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Thailand introduced a universal coverage program in 2001. This program is commonly known as a "30 Baht Health Reform," adding coverage for nearly 14 million more people. This presentation will give an overview of the 30 Baht Health Reform including its main features and evolution, as well as a preliminary evaluation of its success. The talk will mostly be based on a paper entitled "Early Results from Thailand's 30 Baht Universal Health Reform - Something to Smile About," published in Health Affairs.

Kannika Damrongplasit is currently the Agency for Healthcare Research and Quality (AHRQ) Postdoctoral Research Fellow at the University of California at Los Angeles and RAND Corporation. She received her Ph.D. in Economics from the University of Southern California. Her fields of interest are in program evaluation, applied econometrics, health economics and applied microeconomics. She has published in Journal of Business and Economic Statistics, Health Affairs, and Singapore Economic Review. In January 2010, she will assume an assistant professor position at the Department of Economics, Nanyang Technological University in Singapore.

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Kannika Damrongplasit Postdoctoral Research Fellow Speaker University of California at Los Angeles and RAND Corporation
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